The influence of crank rate on peak oxygen consumption during arm crank ergometry

Exploring the effects of a combined exercise programme on pain and fatigue outcomes in people with systemic sclerosis: study protocol for a large European multi-centre randomised controlled trial

Background

Pain, related to Raynaud’s phenomenon or digital ulceration, has been identified as very prevalent and debilitating symptoms of systemic sclerosis (SSc), both significantly affecting patients’ quality of life (QoL). Pharmacological therapeutic strategies were found not to be sufficiently effective in the management of SSc-induced pain and fatigue, and evidence for exercise is scarce. As yet, the effects of a long-term, tailored exercise programme on pain and fatigue in patients with SSc have not been explored. In addition to pain and fatigue, this study aims to evaluate the effects of exercise on QoL, physical fitness, functional capacity, and vascular structure in people with SSc (PwSSc).

Methods

This will be a multicentre (n = 6) randomised controlled clinical trial to assess the effect of a previously established, supervised 12-week combined exercise programme on pain and fatigue as compared to no exercise in PwSSc. The study will recruit 180 patients with SSc that will be allocated randomly to two groups. Group A will perform the exercise programme parallel to standard usual care and group B will receive usual care alone. Patients in the exercise group will undertake two, 45-min sessions each week consisting of 30-min high-intensity interval training (HIIT) (30-s 100% peak power output/30-s passive recovery) on an arm crank ergometer and 15 min of upper body circuit resistance training. Patients will be assessed before as well as at 3 and 6 months following randomisation. Primary outcomes of the study will be pain and fatigue assessed via questionnaires. Secondary outcomes include quality of life, structure of digital microvasculature, body composition, physical fitness, and functional capacity.

Discussion

Data from this multi-centre research clinical trial will primarily be used to establish the effectiveness of a combined exercise protocol to improve pain and fatigue in SSc. In parallel, this study will be the first to explore the effects of long-term exercise on potential microvascular alterations assessed via NVC. Overall, this study will provide sufficient data to inform current clinical practice guidelines and may lead to an improvement of QoL for patients with SSc.

Trial registration

ClinicalTrials.gov NCT05234671. Registered on 14 January 2022

Prediction of upper extremity peak oxygen consumption from heart rate during submaximal arm cycling in young and middle-aged adults

Based on the strong linear relationship between heart rate (HR) and oxygen consumption, the Åstrand-Ryhming cycle ergometer test (Astrand and Ryhming in J Appl Physiol 7:218-221, 1954) is a widely used submaximal test to predict whole body maximal oxygen consumption ([Formula: see text]). However, a similar test predicting peak oxygen consumption ([Formula: see text]) in the upper extremities is not established, and may be very useful for individuals unable to use their lower extremities or/and if separation of upper extremity aerobic capacity is sought after. Thus, the aim of the current study was to develop a submaximal test predicting [Formula: see text] in arm-cycling. Forty-nine healthy volunteers (25 women: 38 ± 13 years; 24 men: 39 ± 12 years) tested arm-cycle [Formula: see text] on a protocol with 4-min, 21-W increments to exhaustion. The data were contrasted to treadmill [Formula: see text] values. Arm-cycle [Formula: see text] was 66 ± 8% of [Formula: see text] (r = 0.92, p < 0.001; women: 1.9 ± 0.4 L min^-1; men: 3.0 ± 0.7 L min^-1). Arm-cycle HR and [Formula: see text] exhibited correlations of r = 0.79 and r = 0.78 for women and men, respectively, while corresponding correlations between work rate and [Formula: see text] were r = 0.95 (women) and r = 0.89 (men) (all p < 0.001). Arm-cycle [Formula: see text] prediction revealed a standard error of estimate (SEE) of 11.2% (women) and 10.2% (men), and was primarily due to individual arm-cycle maximal HR (women: 173 ± 13 beats min^-1; men: 174 ± 10 beats min^-1; correction factor: 5-7%). In conclusion, from a single 4-min stage of submaximal arm cycling, [Formula: see text] can be predicted with a SEE of 10-11%. The arm-cycle test may have important value for individuals who rely on arms in sports and occupations, and for patients with lower extremity disabilities.

Effects of different increments in workload and duration on peak physiological responses during seated upper-body poling

PURPOSE

To compare the effects of test protocols with different increments in workload and duration on peak oxygen uptake ([Formula: see text]O_2peak), and related physiological parameters during seated upper-body poling (UBP).

METHODS

Thirteen upper-body trained, male individuals completed four UBP test protocols with increments in workload until volitional exhaustion in a counterbalanced order: 20 W increase/every 30 s, 20 W/60 s, 10 W/30 s and 10 W/60 s. Cardio-respiratory parameters and power output were measured throughout the duration of each test. Peak blood lactate concentration (bLa_peak) was measured after each test.

RESULTS

The mixed model analysis revealed no overall effect of test protocol on [Formula: see text]O_2peak, peak minute ventilation (VE_peak), peak heart rate (HR_peak), bLa_peak (all p ≥ 0.350), whereas an overall effect of test protocol was found on peak power output (PO_peak) (p = 0.0001), respiratory exchange ratio (RER) (p = 0.024) and test duration (p < 0.001). There was no difference in PO_peak between the 20 W/60 s (175 ± 25 W) and 10 W/30 s test (169 ± 27 W; p = 0.092), whereas PO_peak was lower in the 10 W/60 s test (152 ± 21 W) and higher in the 20 W/30 s test (189 ± 30 W) compared to the other tests (all p = 0.001). In addition, RER was 9.9% higher in the 20 W/30 s compared to the 10 W/60 s test protocol (p = 0.003).

CONCLUSIONS

The UBP test protocols with different increments in workload and duration did not influence [Formula: see text]O_2peak, and can therefore be used interchangeably when [Formula: see text]O_2peak is the primary outcome. However, PO_peak and RER depend upon the test protocol applied and the UBP test protocols can, therefore, not be used interchangeably when the latter is the primary outcome parameter.

Investigating the effectiveness and feasibility of exercise on microvascular reactivity and quality of life in systemic sclerosis patients: study protocol for a feasibility study

Background

Raynaud’s phenomenon is one of the first clinical manifestations observed in systemic sclerosis (SSc). This microvasculature disorder affects mostly the digits in over 95% of SSc patients, significantly affecting their health-related quality of life (HRQoL) and incurring higher hospital admissions and other healthcare costs. Exercise is known to improve both micro- and macrovascular function – aerobic exercise and resistance training, separately or combined, have been demonstrated to lead to significant vasculo-physiological improvements in conditions that present vasculopathy. However, the effects of a combined exercise programme on microcirculation in SSc patients has yet to be investigated. Therefore, the purpose of this study is to assess the effects of high-intensity interval training (HIIT) combined with circuit resistance training on the microvascular function in the digital area of SSc patients.

Methods

This will be a randomised controlled, feasibility trial with two arms, wherein 30 patients with SSc in receipt of medical treatment will be randomly assigned to usual care (medical treatment) or to a 12-week supervised exercise programme. Patients in the exercise group will undertake two, 45-min sessions each week consisting of 30 min HIIT (30 s 100% peak power output/30 s passive recovery) on the arm crank ergometer and 15 min of upper body circuit resistance training. Patients will be assessed before as well as at 3 and 6 months following randomisation. Primary outcomes of the study will be recruitment and retention rate, intervention acceptability and adherence to the exercise programme. Secondary outcomes include the digital area cutaneous microvascular function (laser Doppler fluximetry combined with iontophoresis), physical fitness, functional ability, upper back transcutaneous oxygen tension, body composition and quality of life (EQ-5D-5L). Selected interviews with a subsample of patients will be undertaken to explore their experiences of having Raynaud’s phenomenon and the acceptability of the exercise intervention and study procedures.

Discussion

Data from this study will be used to identify the feasibility of a combined exercise programme to be implemented in SSc patients, the acceptability of the intervention and the study design, and to determine the effects of exercise on the microvasculature. Overall, this study will provide sufficient data to inform and support a full multicentre clinical trial.

Trial registration

ClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2980-1) contains supplementary material, which is available to authorized users.

Metabolic Responses to a Battling Rope Protocol Performed in the Seated or Stance Positions

Brewer, W, Kovacs, R, Hogan, K, Felder, D, and Mitchell, H. Metabolic responses to a battling rope protocol performed in the seated or stance positions. J Strength Cond Res 32(12): 3319-3325, 2018-The purpose of this study is to compare the levels of oxygen consumption and heart rate responses elicited by a treadmill or cycle V[Combining Dot Above]O2max test with a standing or sitting battling rope protocol (BRP) (treadmill vs. standing BRP) (cycle vs. seated BRP). Forty healthy subjects performed either a ramped V[Combining Dot Above]O2max treadmill or cycle test. At least 3 days later, the subjects who performed the ramped treadmill test did the standing BRP, and the subjects who performed the ramped cycle test did the sitting BRP. Each BRP consisted of 10 sets of 15/45 seconds of work/rest for 10 sets. V[Combining Dot Above]O2peak and HRpeak were recorded. Metabolic responses were significantly lower for the sitting BRP and standing as compared to the HRmax and V[Combining Dot Above]O2max values derived from the bicycle and treadmill tests. The BRP produced a V[Combining Dot Above]O2peak that was 71.87% (sitting) and 68.37% (standing) of the subjects' V[Combining Dot Above]O2max assessed u the bicycle and treadmill protocol. Moderate correlations were found between the V[Combining Dot Above]O2 during the seated (r = 0.61; p = 0.003) and standing (r = 0.43; p = 0.03) BRP and the bicycle and treadmill V[Combining Dot Above]O2max tests, respectively. The HRpeak elicited by the BRP performed in sitting (r = 0.52; p = 0.009) and standing (r = 0.67; p = 0.001) had a moderate correlation with the HRmax derived from the bicycle and treadmill tests. Battling ropes may be a low cost, accessible option to improve cardiovascular endurance for individuals who cannot stand or move their lower extremities in a rhythmic manner to conduct aerobic exercise.

Comparison of peak oxygen uptake and exercise efficiency between upper-body poling and arm crank ergometry in trained paraplegic and able-bodied participants

Purpose

To compare peak oxygen uptake (VO_2peak) and exercise efficiency between upper-body poling (UBP) and arm crank ergometry (ACE) in able-bodied (AB) and paraplegic participants (PARA).

Methods

Seven PARA and eleven AB upper-body trained participants performed four 5-min submaximal stages, and an incremental test to exhaustion in UBP and ACE. VO_2peak was the highest 30-s average during the incremental test. Metabolic rate (joule/second = watt) at fixed power outputs of 40, 60, and 80 W was estimated using linear regression analysis on the original power-output-metabolic-rate data and used to compare exercise efficiency between exercise modes and groups.

Results

VO_2peak did not significantly differ between UBP and ACE (p = 0.101), although peak power output was 19% lower in UBP (p < 0.001). Metabolic rate at fixed power outputs was 24% higher in UBP compared to ACE (p < 0.001), i.e., exercise efficiency was lower in UBP. PARA had 24% lower VO_2peak compared to AB (p = 0.010), although there were no significant differences in peak power output between PARA and AB (p = 0.209).

Conclusions

In upper-body-trained PARA and AB participants, VO_2peak did not differ between UBP and ACE, indicating that these two test modes tax the cardiovascular system similarly when the upper body is restricted. As such, the 19% lower peak power output in UBP compared to ACE may be explained by the coinciding lower efficiency.

Electronic supplementary material

The online version of this article (10.1007/s00421-018-3912-1) contains supplementary material, which is available to authorized users.

The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients

BACKGROUND

Aerobic exercise in general and high-intensity interval training (HIIT) specifically is known to improve vascular function in a range of clinical conditions. HIIT in particular has demonstrated improvements in clinical outcomes, in conditions that have a strong macroangiopathic component. Nevertheless, the effect of HIIT on microcirculation in systemic sclerosis (SSc) patients is yet to be investigated. Therefore, the purpose of the study was to compare the effects of two HIIT protocols (cycle and arm cranking) on the microcirculation of the digital area in SSc patients.

METHODS

Thirty-four limited cutaneous SSc patients (65.3 ± 11.6 years old) were randomly allocated in three groups (cycling, arm cranking and control group). The exercise groups underwent a 12- week exercise program twice per week. All patients performed the baseline and post-exercise intervention measurements where physical fitness, functional ability, transcutaneous oxygen tension (ΔTcpO2), body composition and quality of life were assessed. Endothelial-dependent as well as -independent vasodilation were assessed in the middle and index fingers using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous flux data were expressed as cutaneous vascular conductance (CVC).

RESULTS

Peak oxygen uptake increased in both exercise groups (p < 0.01, d = 1.36). ΔTcpO2 demonstrated an increase in the arm-cranking group only, with a large effect, but not found statistically significant,(p = 0.59, d = 0.93). Endothelial-dependent vasodilation improvement was greater in the arm-cranking (p < 0.05, d = 1.07) in comparison to other groups. Both exercise groups improved life satisfaction (p < 0.001) as well as reduced discomfort and pain due to Raynaud's phenomenon (p < 0.05). Arm cranking seems to be the preferred mode of exercise for study participants as compared to cycling (p < 0.05). No changes were observed in the body composition or the functional ability in both exercise groups.

CONCLUSIONS

Our results suggest that arm cranking has the potential to improve the microvascular endothelial function in SSc patients. Also notably, our recommended training dose (e.g., a 12-week HIIT program, twice per week), appeared to be sufficient and tolerable for this population. Future research should focus on exploring the feasibility of a combined exercise such as aerobic and resistance training by assessing individual's experience and the quality of life in SSc patients.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT number): NCT03058887 , February 23, 2017.

Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis

Background

Peak oxygen uptake (VO_2peak) in Paralympic sitting sports athletes represents their maximal ability to deliver energy aerobically in an upper-body mode, with values being influenced by sex, disability-related physiological limitations, sport-specific demands, training status and how they are tested.

Objectives

To identify VO_2peak values in Paralympic sitting sports, examine between-sports differences and within-sports variations in VO_2peak and determine the influence of sex, age, body-mass, disability and test-mode on VO_2peak.

Design

Systematic literature review and meta-analysis.

Data sources

PubMed, CINAHL, SPORTDiscus^TM and EMBASE were systematically searched in October 2016 using relevant medical subject headings, keywords and a Boolean.

Eligibility criteria

Studies that assessed VO_2peak values in sitting sports athletes with a disability in a laboratory setting were included.

Data synthesis

Data was extracted and pooled in the different sports disciplines, weighted by the Dersimonian and Laird random effects approach. Quality of the included studies was assessed with a modified version of the Downs and Black checklist by two independent reviewers. Meta-regression and pooled-data multiple regression analyses were performed to assess the influence of sex, age, body-mass, disability, test mode and study quality on VO_2peak.

Results

Of 6542 retrieved articles, 57 studies reporting VO_2peak values in 14 different sitting sports were included in this review. VO_2peak values from 771 athletes were used in the data analysis, of which 30% participated in wheelchair basketball, 27% in wheelchair racing, 15% in wheelchair rugby and the remaining 28% in the 11 other disciplines. Fifty-six percent of the athletes had a spinal cord injury and 87% were men. Sports-discipline-averaged VO_2peak values ranged from 2.9 L∙min^-1 and 45.6 mL∙kg^-1∙min^-1 in Nordic sit skiing to 1.4 L∙min^-1 and 17.3 mL∙kg^-1∙min^-1 in shooting and 1.3 L∙min^-1 and 18.9 mL∙kg^-1∙min^-1 in wheelchair rugby. Large within-sports variation was found in sports with few included studies and corresponding low sample sizes. The meta-regression and pooled-data multiple regression analyses showed that being a man, having an amputation, not being tetraplegic, testing in a wheelchair ergometer and treadmill mode, were found to be favorable for high absolute and body-mass normalized VO_2peak values. Furthermore, high body mass was favourable for high absolute VO_2peak values and low body mass for high body-mass normalized VO_2peak values.

Conclusion

The highest VO_2peak values were found in Nordic sit skiing, an endurance sport with continuously high physical efforts, and the lowest values in shooting, a sport with low levels of displacement, and in wheelchair rugby where mainly athletes with tetraplegia compete. However, VO_2peak values need to be interpreted carefully in sports-disciplines with few included studies and large within-sports variation. Future studies should include detailed information on training status, sex, age, test mode, as well as the type and extent of disability in order to more precisely evaluate the effect of these factors on VO_2peak.

Effect of cadence on locomotor-respiratory coupling during upper-body exercise

Introduction

Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor–respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise.

Methods

Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min⁻¹) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter.

Results

The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min⁻¹ (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min⁻¹ (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p < 0.05) at higher cadences. During moderate exercise, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \dot{V}{\text{O}}_{ 2} $$\end{document}V˙O2 and f_C were higher at 90 rev min⁻¹ (p < 0.05) relative to 70 and 50 rev min⁻¹ (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \dot{V}{\text{O}}_{ 2} $$\end{document}V˙O2 1.19 ± 0.25 vs. 1.05 ± 0.21 vs. 0.97 ± 0.24 L min⁻¹; f_C 116 ± 11 vs. 101 ± 13 vs. 101 ± 12 b min⁻¹), with concomitantly elevated dyspnoea. There were no discernible cadence-mediated effects on diaphragm EMG.

Conclusion

Participants engage in LRC to a greater extent at moderate-high cadences which, in turn, increase respiratory airflow. Cadence rate should be carefully considered when designing aerobic training programmes involving the upper-limbs.

Did the crew of the submarine H.L. Hunley suffocate?

On the evening of February 17th, 1864, the Confederate submarine H.L. Hunley attacked the Union ship USS Housatonic outside Charleston, South Carolina and became the first submarine in history to successfully sink an enemy ship in combat. One hypothesis for the sinking of the Confederate submarine H.L. Hunley is that the crew, in the enclosed vessel, suffered a lack of oxygen and suffocated. This study estimates the effects of hypoxia and hypercapnia on the crew based on submarine gas volume and crew breathing dynamics. The calculations show the crew of the Hunley had a minimum of 10 min between the onset of uncomfortable hypercapnia symptoms and danger of loss of consciousness from hypoxia. Based on this result and the location of the crew when discovered, hypoxia and hypercapnia do not explain the sinking of the world's first successful combat submarine.

The effects of an increasing versus constant crank rate on peak physiological responses during incremental arm crank ergometry

We examined the effects of concomitant increases in crank rate and power output on incremental arm crank ergometry. Ten healthy males undertook three incremental upper body exercise tests to volitional exhaustion. The first test determined peak minute power. The subsequent tests involved arm cranking at an initial workload of 40% peak minute power with further increases of 10% peak minute power every 2 min. One involved a constant crank rate of 70 rev · min(-1), the other an initial crank rate of 50 rev · min(-1) increasing by 10 rev · min(-1) every 2 min. Fingertip capillary blood samples were analysed for blood lactate at rest and exhaustion. Local (working muscles) and cardiorespiratory ratings of perceived exertion (RPE) were recorded at the end of each exercise stage. Heart rate and expired gas were monitored continuously. No differences were observed in peak physiological responses or peak minute power achieved during either protocol. Blood lactate concentration tended to be greater for the constant crank rate protocol (P = 0.06). Test duration was shorter for the increasing than for the constant crank rate protocol. The relationship between local RPE and heart rate differed between tests. The results of this study show that increasing cadence during incremental arm crank ergometry provides a valid assessment of peak responses over a shorter duration but alters the heart rate-local RPE relationship.

Energy expenditure and metabolism during exercise in persons with a spinal cord injury

Resting energy expenditure of persons with a spinal cord injury (SCI) is generally lower than that seen in able-bodied (AB) individuals due to the reduced amounts of muscle mass and sympathetic nervous system available. However, outside of clinical studies, much less data is available regarding athletes with an SCI. In order to predict the energy expenditure of persons with SCI, the generation and validation of prediction equations in relation to specific levels of SCI and training status are required. Specific prediction equations for the SCI would enable a quick and accurate estimate of energy requirements. When compared with the equivalent AB individuals, sports energy expenditure is generally reduced in SCI with values representing 30-75% of AB values. The lowest energy expenditure values are observed for sports involving athletes with tetraplegia and where the sport is a static version of that undertaken by the AB, such as fencing. As with AB sports there is a lack of SCI data for true competition situations due to methodological constraints. However, where energy expenditure during field tests are predicted from laboratory-based protocols, wheelchair ergometry is likely to be the most appropriate exercise mode. The physiological and metabolic responses of persons with SCI are similar to those for AB athletes, but at lower absolute levels. However, the underlying mechanisms pertaining to substrate utilization appear to differ between the AB and SCI. Carbohydrate feeding has been shown to improve endurance performance in athletes with generally low levels of SCI, but no data have been reported for mid to high levels of SCI or for sport-specific tests of an intermittent nature. Further research within the areas reviewed may help to bridge the gap between what is known regarding AB athletes and athletes with SCI (and other disabilities) during exercise and also the gap between clinical practice and performance.

The influence of a fast ramp rate on peak cardiopulmonary parameters during arm crank ergometry

The influence of a very fast ramp rate on cardiopulmonary variables at ventilatory threshold and peak exercise during a maximal arm crank exercise test has not been extensively studied. Considering that short arm crank tests could be sufficient to achieve maximal oxygen consumption (VO₂), it would be of practical interest to explore this possibility. Thus, this study aimed to analyse the influence of a fast ramp rate (20 W min⁻¹) on the cardiopulmonary responses of healthy individuals during a maximal arm crank ergometry test. Seventeen healthy individuals performed maximal cardiopulmonary exercise tests (Ultima CardiO2; Medical Graphics Corporation, St Louis, USA) in arm ergometer (Angio, LODE, Groningen, The Netherlands) following two protocols in random order: fast protocol (increment: 2 w/6 s) and slow protocol (increment: 1 w/6 s). The fast protocol was repeated 60-90 days after the 1st test to evaluate protocol reproducibility. Both protocols elicited the same peak VO₂ (fast: 23.51 ± 6.00 versus slow: 23.28 ± 7.77 ml kg⁻¹ min⁻¹; P = 0.12) but peak power load in the fast ramp protocol was higher than the one in the slow ramp protocol (119 ± 43 versus. 102 ± 39 W, P < 0.001). There was no other difference in ventilatory threshold and peak exercise variables when 1st and 2nd fast protocols were compared. Fast protocol seems to be useful when healthy young individuals perform arm cardiopulmonary exercise test. The usefulness of this protocol in other populations remains to be evaluated.

Power output and metabolic cost of synchronous and asynchronous submaximal and peak level hand cycling on a motor driven treadmill in able-bodied male subjects

PURPOSE

To evaluate external power output and physiological responses of synchronous (SYNC) and asynchronous hand cycling (ASYNC) at submaximal and peak levels of exercise.

METHODS

n=9 able-bodied male subjects (age: 20.1+/-2.1 years) performed two (sub)maximal continuous hand cycle exercise tests, using the SYNC and ASYNC mode in a standardized commercial add-on hand cycle unit (counter-balanced order). Treadmill speed (1.89 and 2.17 m s(-1)) and slope (steps of +1%) were changed in a fixed sequence of 3-min exercise steps. Gears were adjusted to 65 rpm. External power output (PO) was continuously monitored with a strain-gauge instrumented chain ring ((SRM) Schoberer Rad Messtechnik). A conventional wheelchair drag test was performed to validate mean external power for each speed-slope combination. Heart rate (HR; bpm) and oxygen uptake (VO2; ml kg(-1) min(-1), SMTP) were continuously monitored. Paired T-tests and ANOVA for repeated measures evaluated effects of mode and exercise level (p<0.05).

RESULTS

Subjects reached peak levels of performance (RER: 1.05+/-0.07 versus 1.10+/-0.1 for SYNC and ASYNC). Peak PO and V(o2) were significantly higher for SYNC (81.6+/-11.8 W versus 68.5+/-10.6 W; 26.4+/-4.5 ml kg(-1) min(-1) versus 21.2+/-3.0 ml kg(-1) min(-1)). At submaximal exercise levels, gross mechanical efficiency (ME) was significantly higher for SYNC (12.1+/-0.9% versus 9.7+/-1.4% at 41 W). No significant differences were found for PO (at equal velocity and slope), as derived from the SRM (SYNC and ASYNC), and from the drag test.

DISCUSSION

The absence of any differences in PO between SYNC and ASYNC, and with respect to the drag test, rules out 'additional external work due to maintain the desired heading' in the ASYNC as an explanation for the lower performance in this mode. Lower peak performance and ME in ASYNC may be explained by the increased stabilizing muscle effort in the upper extremities and trunk in order to combine power production with stable steering. ASYNC is less efficient compared to SYNC. Similarly, peak performance capacity was higher for SYNC.

CONCLUSION

External work does not differ between SYNC and ASYNC hand cycling. SRM readings appear valid for PO monitoring in hand cycling within the studied range of PO. SYNC is more efficient than ASYNC and leads to higher peak performance.

The effects of cadence and power output upon physiological and biomechanical responses to incremental arm-crank ergometry

The aim of this study was to examine the effects of cadence and power output on physiological and biomechanical responses to incremental arm-crank ergometry (ACE). Ten male subjects (mean ± SD age, 30.4 ±5.4 y; height, 1.78 ±0.07 m; mass, 86.1 ±14.2 kg) undertook 3 incremental ACE protocols to determine peak oxygen uptake (VO2 peak; mean of 3 tests: 3.07 ± 0.17 L·min–1) at randomly assigned cadences of 50, 70, or 90 r·min–1. Heart rate and expired air were continually monitored. Central (RPE-C) and local (RPE-L) ratings of perceived exertion were recorded at volitional exhaustion. Joint angles and trunk rotation were analysed during each exercise stage. During submaximal power outputs of 50, 70, and 90 W, oxygen consumption (VO2) was lowest for 50 r·min–1 and highest for 90 r·min–1 (p < 0.01). VO2 peak was lowest during 50 r·min–1 (2.79 ±0.45 L·min–1; p < 0.05) when compared with both 70 r·min–1 and 90 r·min–1 (3.16 ±0.58, 3.24 ±0.49 L·min–1, respectively; p > 0.05). The difference between RPE-L and RPE-C at volitional exhaustion was greatest during 50 r·min–1 (2.9 ± 1.6) when compared with 90 r·min–1 (0.9 ± 1.9, p < 0.05). At VO2 peak, shoulder range of motion (ROM) and trunk rotation were greater for 50  and 70 r·min–1 when compared with 90 r·min–1 (p < 0.05). During submaximal power outputs, shoulder angle and trunk rotation were greatest at 50 r·min–1 when compared with 90 r·min–1 (p < 0.05). VO2 was inversely related to both trunk rotation and shoulder ROM during submaximal power outputs. The results of this study suggest that the greater forces required at lower cadences to produce a given power output resulted in greater joint angles and range of shoulder and trunk movement. Greater isometric contractions for torso stabilization and increased cost of breathing possibly from respiratory–locomotor coupling may have contributed increased oxygen consumption at higher cadences.

The effect of crank rate strategy on peak aerobic power and peak physiological responses during arm crank ergometry

The main aim of this study was to determine whether the use of an imposed or freely chosen crank rate would influence submaximal and peak physiological responses during arm crank ergometry. Fifteen physically active men participated in the study. Their mean age, height, and body mass were 25.9 (s = 6.2) years, 1.80 (s = 0.10) m, and 78.4 (s = 6.1) kg, respectively. The participants performed two incremental peak oxygen consumption (VO(2peak)) tests using an electronically braked ergometer. One test was performed using an imposed crank rate of 80 rev x min(-1), whereas in the other the participants used spontaneously chosen crank rates. The order in which the tests were performed was randomized, and they were separated by at least 2 days. Respiratory data were collected using an on-line gas analysis system, and fingertip capillary blood samples ( approximately 20 microl) were collected for the determination of blood lactate concentration. Heart rate was also recorded throughout the tests. Time to exhaustion was measured and peak aerobic power calculated. Submaximal data were analysed using separate two-way repeated-measures analyses of variance, while differences in peak values were analysed using separate paired t-tests. Variations in spontaneously chosen crank rate were assessed using a one-way analysis of variance with repeated measures. Agreement between the crank rate strategies for the assessment of peak values was examined by calculating intra-class correlation coefficients (ICC) and 95% limits of agreement (95% LoA). While considerable between-participant variations in spontaneously chosen crank rate were observed, the mean value was not different (P > 0.05) from the imposed crank rate of 80 rev x min(-1) at any point. No differences (P > 0.05) were observed for submaximal data between crank strategies. Furthermore, mean peak minute power [158 (s = 20) vs. 158 (s = 18) W], time to exhaustion [739 (s = 118) vs. 727 (s = 111) s], and VO(2peak)[3.09 (s = 0.38) vs. 3.04 (s = 0.34) l x min(-1)] were similar for the imposed and spontaneously chosen crank rates, respectively. However, the agreement for the assessment of VO(2peak) (ICC = 0.78; 95% LoA = 0.04 +/- 0.50 l x min(-1)) between the cranking strategies was considered unacceptable. Our results suggest that either an imposed or spontaneously chosen crank rate strategy can be used to examine physiological responses during arm crank ergometry, although it is recommended that the two crank strategies should not be used interchangeably.

Effect of shoulder angle on physiological responses during incremental peak arm crank ergometry

This study examined the effect of shoulder angle and gender on physiological and perceptual responses during incremental peak arm ergometry. Healthy adults (nine males, seven females) volunteered for the study and completed an incremental arm ergometry test on two separate occasions at two different shoulder angles (90 degrees and 45 degrees). Initial work rate was set at 16 W x min-1 and was increased progressively until exhaustion. Cardiorespiratory and perceptual responses were recorded at the end of each minute and compared using separate three-way (position x work rate x gender) repeated-measures analyses of variance. The systematic bias of peak responses was examined using separate two-way (position x gender) analyses of variance, while reproducibility of these parameters was explored using intraclass correlation coefficients, measurement bias/ratio, and 95% ratio limits of agreement. Despite a significantly greater peak heart rate for the 45 degrees position, cardiorespiratory and perceptual responses were similar at peak exercise for both positions. Peak values for all variables, although similar, demonstrated similar and large inter-test variability for men and women. Reduction of the shoulder joint angle to 45 degrees did not enhance peak work rate and peak oxygen consumption during seated upper body exercise. Due to the large inter-test variability, arm ergometry should be conducted using the same seated position.

The effects of arm crank strategy on physiological responses and mechanical efficiency during submaximal exercise

The purpose of this study was to compare submaximal physiological responses and indices of mechanical efficiency between asynchronous and synchronous arm ergometry. Thirteen wheelchair-dependent trained athletes performed eight steady-state incremental bouts of exercise (0 to 140 W), each lasting 4 min, using synchronous and asynchronous arm-cranking strategies. Physiological measures included oxygen uptake (VO2), heart rate, and blood lactate concentration. The power outputs corresponding to fixed whole blood lactate concentrations of 2.0 to 4.0 mmol x l(-1) were calculated using linear interpolation. Mechanical efficiency indices - gross efficiency, net efficiency, and work efficiency - were also calculated. An analysis of variance with repeated measures was applied to determine the effect of crank mode on the physiological parameters. Oxygen uptake was on average 10% lower (P < 0.01), and both net efficiency (P < 0.01) and gross efficiency (P < 0.01) were higher, during the asynchronous strategy at both 60 and 80 W (gross efficiency: 16.9 +/- 2.0% vs. 14.7 +/- 2.4% and 17.5 +/- 1.8% vs. 15.9 +/- 2.6% at 60 and 80 W respectively). There were no differences in heart rate, blood lactate concentration or power output at either of the blood lactate reference points between the asynchronous and synchronous strategies (P > 0.05). In conclusion, test specificity is an important consideration. If a synchronous strategy is to be adopted, it is likely to result in lower efficiency than an asynchronous strategy. The exercise testing scenario may help dictate which method is ultimately chosen.

Influence of crank rate on the slow component of pulmonary O2 uptake during heavy arm-crank exercise

The principal aim of this study was to examine the influence of variations in crank rate on the slow component of the pulmonary oxygen uptake ([Formula: see text]O2) response to heavy-intensity arm-crank ergometry (ACE). We hypothesized that, for the same external work rate, a higher crank rate would elicit a greater amplitude of the [Formula: see text]O2 "slow component". Eleven healthy males (mean (± SD) age, 25 (±6) y; body mass, 89.1 (±10.7) kg; ACE [Formula: see text]O2 peak, 3.36 (±0.47) L·min-1) volunteered to participate. The subjects initially completed an incremental exercise test for the determination of [Formula: see text]O2 peak and peak power on an electrically braked arm ergometer. Subsequently, they completed "step" transitions from an unloaded baseline to a work rate requiring 70% of peak power: 2 at a crank rate of 50 r·min-1 (LO) and 2 at a crank rate of 90 r·min-1 (HI). Pulmonary gas exchange was measured on a breath-by-breath basis and [Formula: see text]O2 kinetics were evaluated from the mean response to each condition using non-linear regression techniques. In contradiction to our hypothesis, the [Formula: see text]O2 slow component was significantly greater at 50 r·min-1 than at 90 r·min-1 (LO: 0.60 ± 0.30 vs. HI: 0.47 ± 0.21 L·min-1; p < 0.05). The mean value for the localized rating of perceived exertion was also higher at 50 r·min-1 than at 90 r·min-1 (LO: 16.7 ± 1.4 vs. HI: 15.2 ± 1.3; p < 0.05), but there was no significant difference in end-exercise blood lactate concentration. It is possible that differences in muscle tension development and blood flow resulted in a greater contribution of "low-efficiency" type II muscle fibres to force production at the lower crank rate in ACE, and that this was linked to the greater [Formula: see text]O2 slow component. However, other factors such as greater isometric contraction of the muscles of the trunk and legs at the lower crank rate might also be implicated.Key words: O2 kinetics, [Formula: see text]O2 slow component, fibre recruitment, oxygen uptake.

Influence of Crank Rate in Hand Cycling

PURPOSE

The purpose of this study was to determine gross mechanical efficiency (ME) at different power output (PO) levels of synchronous hand cycling and to evaluate the influence of increasing PO by changing crank rate or resistance in wheelchair users with experience in hand cycling.

METHODS

Nine male participants with spinal cord injury randomly performed three maximal incremental hand cycling tests using a computer controlled cycle ergometer. Each test started at a PO level of 50 W with increments of 10 W. In the velocity protocol, PO was increased via crank rate while resistance was constant (VEL). In the resistance protocol PO was increased via resistance while crank rate was constant (RES). In the freely chosen frequency protocol, the participants could freely select their crank rate while resistance was automatically adjusted to obtain the desired PO (FCF).

RESULTS

Peak physiological responses were similar in all three tests, whereas PO max was lower in VEL compared with RES and FCF. Similar values for gross ME were found in both RES and FCF protocols, although systematically higher and increasing crank rates were adopted throughout FCF. Nevertheless, differences in gross ME at comparable relative (RES > VEL at 60 and 80% of PO range: 14.09 and 14.40% vs 13.02 and 13.11%, respectively) and absolute (RES, FCF > VEL at 90 W: 14.47, 14.47, and 13.43%, respectively) PO levels were demonstrated.

CONCLUSION

These results suggest that during synchronous hand cycling the freely chosen crank rate is not necessarily the most economical, that high crank rates result in a lower ME at a given PO and that freely chosen crank rates increase with increasing PO levels.