Time Course Changes in Confirmed 'True' VO 2 max After Individualized and Standardized Training

Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols

BACKGROUND AND AIM

A plateau in oxygen uptake ([Formula: see text]) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake ([Formula: see text]) criteria have been shown to commonly underestimate the actual [Formula: see text]. The verification phase protocol might determine the occurrence of 'true' [Formula: see text] in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming 'true' [Formula: see text] in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest [Formula: see text] values attained in the CPET and verification phase.

METHODS

Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak [Formula: see text] from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in [Formula: see text] according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level [Formula: see text] data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots.

RESULTS

Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean [Formula: see text] values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1, p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar [Formula: see text] between the CPET and verification phase (p > 0.05, LoE: limited to strong). Across all 30 studies, [Formula: see text] was not affected by differences in test protocols (p > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher [Formula: see text] value in the verification phase versus the CPET or reported or supplied participant-level [Formula: see text] data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher [Formula: see text] value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher [Formula: see text] in the verification phase ranged from 0% to 88.9%).

CONCLUSION

Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited [Formula: see text], or a reproducible [Formula: see text], for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited [Formula: see text], or a reproducible [Formula: see text], however, more research reporting participant-level data is required before evidence-based guidelines can be given.

TRIAL REGISTRATION

PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.

The Minimal Difference as an Individual Threshold to Examine the Utility of a Verification Bout in Determining V̇O 2max

PURPOSE

A square-wave verification bout to confirm maximal oxygen uptake (V̇O 2max ) from a graded exercise test (GXT) has been recommended based on mean responses. This study used the test-retest reliability, mean, and individual differences between the highest V̇O 2 from the GXT (V̇O 2GXT ) and verification bout (V̇O 2verification ) to examine the efficacy of a verification bout in the determination of O 2max in healthy, recreationally trained, well-motivated men.

METHODS

Ten men (24 ± 4 yr) completed a GXT on a cycle ergometer followed by a submaximal verification bout to determine V̇O 2GXT and V̇O 2verification . After completion of the initial GXT, subjects rested for 5 min then performed the verification bout at 90% of the peak power output from the initial GXT. Analyses included a two-way repeated-measures ANOVA, intraclass correlation coefficients (ICC 2,1 ), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (COV).

RESULTS

There was no test (test 1 vs test 2)-method (GXT vs verification) interaction ( P = 0.300) and no main effect for test ( P = 0.690), but there was a main effect for method ( P = 0.003). The V̇O 2GXT (46.0 mL⋅kg -1 ⋅min -1 ) was significantly greater than V̇O 2verification (43.9 mL⋅kg -1 ⋅min -1 ), collapsed across test. The V̇O 2GXT (ICC = 0.970, SEM = 1.63 mL⋅kg -1 ⋅min -1 , MD = 4.51 mL⋅kg -1 ⋅min -1 , COV = 3.54%) and the V̇O 2verification (ICC = 0.953, SEM = 1.87 mL⋅kg -1 ⋅min -1 , MD = 5.17 mL⋅kg -1 ⋅min -1 , COV = 4.25%) demonstrated "excellent" reliability. No subject exceeded the MD test-retest for V̇O 2GXT or V̇O 2verification . No subject had a V̇O 2verification that exceeded V̇O 2GXT by more than the MD, but two subjects had a V̇O 2GXT , which exceeded V̇O 2verification by more than the MD.

CONCLUSIONS

The excellent reliability of V̇O 2GXT in addition to the examination of the individual differences between V̇O 2GXT and V̇O 2verification using the MD indicated that a standalone GXT was sufficient to determine V̇O 2max .

The 3-Minute Burpee Test: A Minimalistic Alternative to the Conventional Estimated Oxygen Uptake Test

Background Maximal oxygen uptake and muscle strength are fundamental components of physical fitness. Improving these capacities is highly beneficial to health. The validity of maximal oxygen uptake and muscle strength has been widely emphasized in clinical, sports, and research-related settings. However, many of the previous tests required special equipment and space. Aim This study examined the effectiveness of field tests that do not require special equipment or space. Materials and methods The relationship between the 3-minute burpee test (3MBT) and estimated maximal oxygen uptake (Yo-Yo intermittent recovery test (Yo-Yo IRT)) using whole-body muscle groups was examined. The subjects were young men (n=127) with a history of exercising at least once a week. Results A strong relationship between 3MBT and Yo-YoIRT was shown (p<0.001). Conclusions The 3MBT is a field test that can be performed anytime and anywhere there is space for plank and standing postures. Because it is very brief, efficient, and uses muscle groups throughout the body, it is effective and potentially quite useful as a new field test.

Changes in the Second Ventilatory Threshold Following Individualised versus Standardised Exercise Prescription among Physically Inactive Adults: A Randomised Trial

The second ventilatory threshold (VT2) is established as an important indicator of exercise intensity tolerance. A higher VT2 allows for greater duration of higher intensity exercise participation and subsequently greater reductions in cardiovascular disease (CVD) risk. This study aimed to compare the efficacy of standardised and individualised exercise prescription on VT2 among physically inactive adults. Forty-nine physically inactive male and female participants (48.6 ± 11.5 years) were recruited and randomised into a 12-week standardised (n = 25) or individualised (n = 24) exercise prescription intervention. The exercise intensity for the standardised and individualised groups was prescribed as a percentage of heart rate reserve (HRR) or relative to the first ventilatory threshold (VT1) and VT2, respectively. Participants were required to complete a maximal graded exercise test at pre-and post-intervention to determine VT1 and VT2. Participants were categorised as responders to the intervention if an absolute VT2 change of at least 1.9% was attained. Thirty-eight participants were included in the analysis. A significant difference in VT2 change was found between individualised (pre vs. post: 70.6% vs. 78.7% maximum oxygen uptake (VO2max)) and standardised (pre vs. post: 72.5% vs. 72.3% VO2max) exercise groups. Individualised exercise prescription was significantly more efficacious (p = 0.04) in eliciting a positive response in VT2 (15/19, 79%) when compared to the standardised exercise group (9/19, 47%). Individualised exercise prescription appears to be more efficacious than standardised exercise prescription in eliciting a positive VT2 change among physically inactive adults. Increasing VT2 allows for greater tolerance to higher exercise intensities and therefore greater cardiovascular health outcomes.

Time course of changes in V̇o2peak and O2 extraction during ramp cycle exercise following HIIT versus moderate-intensity continuous training in type 2 diabetes

In the present study, we assessed the time course of adaptations in peak oxygen uptake (V̇o2peak) and muscle fractional oxygen (O2) extraction (using near-infrared spectroscopy) following 12 wk of low-volume high-intensity interval training (HIIT) versus moderate-intensity continuous endurance training (MICT) in adults with uncomplicated type 2 diabetes (T2D). Participants with T2D were randomly assigned to MICT ( n = 12, 50 min of moderate-intensity cycling) or HIIT ( n = 9, 10 × 1 min at ∼90% maximal heart rate) or to a nonexercising control group ( n = 9). Exercising groups trained three times per week and measurements were taken every 3 wk. The rate of muscle deoxygenation (i.e., deoxygenated hemoglobin and myoglobin concentration, Δ[HHb + Mb]) profiles of the vastus lateralis muscle were normalized to 100% of the response, plotted against % power output (PO), and fitted with a double linear regression model. V̇o2peak increased ( P < 0.05) by week 3 of MICT (+17%) and HIIT (+8%), with no further significant changes thereafter. Total increases in V̇o2peak posttraining ( P < 0.05) were 27% and 14%, respectively. The %Δ[HHb + Mb] versus %PO slope of the first linear segment ( slope1) was reduced ( P < 0.05) beyond 3 wk of HIIT and MICT, with no further significant changes thereafter. No changes in V̇o2peak or slope1 were observed in the control group. Low-volume HIIT and MICT induced improvements in V̇o2peak following a similar time course, and these improvements were likely, at least in part, due to an improved microvascular O2 delivery.

Is a verification phase useful for confirming maximal oxygen uptake in apparently healthy adults? A systematic review and meta-analysis

BACKGROUND

The 'verification phase' has emerged as a supplementary procedure to traditional maximal oxygen uptake (VO2max) criteria to confirm that the highest possible VO2 has been attained during a cardiopulmonary exercise test (CPET).

OBJECTIVE

To compare the highest VO2 responses observed in different verification phase procedures with their preceding CPET for confirmation that VO2max was likely attained.

METHODS

MEDLINE (accessed through PubMed), Web of Science, SPORTDiscus, and Cochrane (accessed through Wiley) were searched for relevant studies that involved apparently healthy adults, VO2max determination by indirect calorimetry, and a CPET on a cycle ergometer or treadmill that incorporated an appended verification phase. RevMan 5.3 software was used to analyze the pooled effect of the CPET and verification phase on the highest mean VO2. Meta-analysis effect size calculations incorporated random-effects assumptions due to the diversity of experimental protocols employed. I2 was calculated to determine the heterogeneity of VO2 responses, and a funnel plot was used to check the risk of bias, within the mean VO2 responses from the primary studies. Subgroup analyses were used to test the moderator effects of sex, cardiorespiratory fitness, exercise modality, CPET protocol, and verification phase protocol.

RESULTS

Eighty studies were included in the systematic review (total sample of 1,680 participants; 473 women; age 19-68 yr.; VO2max 3.3 ± 1.4 L/min or 46.9 ± 12.1 mL·kg-1·min-1). The highest mean VO2 values attained in the CPET and verification phase were similar in the 54 studies that were meta-analyzed (mean difference = 0.03 [95% CI = -0.01 to 0.06] L/min, P = 0.15). Furthermore, the difference between the CPET and verification phase was not affected by any of the potential moderators such as verification phase intensity (P = 0.11), type of recovery utilized (P = 0.36), VO2max verification criterion adoption (P = 0.29), same or alternate day verification procedure (P = 0.21), verification-phase duration (P = 0.35), or even according to sex, cardiorespiratory fitness level, exercise modality, and CPET protocol (P = 0.18 to P = 0.71). The funnel plot indicated that there was no significant publication bias.

CONCLUSIONS

The verification phase seems a robust procedure to confirm that the highest possible VO2 has been attained during a ramp or continuous step-incremented CPET. However, given the high concordance between the highest mean VO2 achieved in the CPET and verification phase, findings from the current study would question its necessity in all testing circumstances.

PROSPERO REGISTRATION ID

CRD42019123540.

Does heart rate response confirm the attainment of maximal oxygen uptake in adults 45 years and older?

PURPOSE

To test the efficacy of a plateau in heart rate (HR_plat) as an effective indicator for confirming [Formula: see text]max attainment in a middle-aged to older sample.

METHODS

Nine men and eleven women (age 60 ± 8.5 years, [Formula: see text]max 35.9 ± 9.4 ml/kg/min, N = 20) completed a single [Formula: see text]max test on both the treadmill and cycle ergometer.[Formula: see text]max was confirmed using a plateau in [Formula: see text] ([Formula: see text]_plat) of ≤ 150 ml/min, a verification bout, and HR_plat (≤ 4 bpm).

RESULTS

[Formula: see text]_plat occurred in 100% and 95% of participants on the treadmill and cycle ergometer, respectively. Verification criteria ([Formula: see text]max during verification ≤ 2% of [Formula: see text]max during incremental test) were met by 80% of participants on both modalities. HR_plat was achieved by 90% and 70% of participants on the treadmill and cycle ergometer, respectively.

CONCLUSION

These results suggest that a verification bout is reliable for confirming [Formula: see text]max in older adults on both modalities. In our sample of middle-aged and older adults, [Formula: see text]_plat was the most robust method to assess [Formula: see text]max when indirect calorimetry is available. Although more research is warranted, when indirect calorimetry is not available, a HR_plat of ≤ 4 bpm may be a useful alternative to get an accurate representation of maximal effort in middle-aged and older adults.