Validity of the Supramaximal Test to Verify Maximal Oxygen Uptake in Children and Adolescents

Validation and Calibration for Embedding Rating of Perceived Exertion Into High-Intensity Interval Exercise in Adolescents: A Lab-Based Study

PURPOSE

Rating of perceived exertion (RPE) is a convenient and cost-effective tool that can be used to monitor high-intensity interval exercise (HIIE). However, no methodological study has demonstrated the validity of RPE in this context. Therefore, the aim of this study was to validate and calibrate RPE for monitoring HIIE in adolescents.

METHODS

RPE, heart rate (HR), and oxygen uptake (V˙O2) data were retrospectively extracted from 3 lab-based crossover studies, with a pooled sample size of 45 adolescents, performing either cycling-based or running-based HIIE sessions. Within-participant correlations were calculated for RPE-HR and RPE-V˙O2, and receiver operator characteristic curve analysis was used to establish RPE cut points.

RESULTS

The results showed that RPE-HR demonstrated acceptable criterion validity (r = .53-.74, P < .01), while RPE-V˙O2 had poor validity (r = .40-.48, P < .01), except for HIIE at 100% peak power (r = .59, P < .01). RPE cut points of 4 and 5 were established in corresponding to HR/V˙O2 based thresholds.

CONCLUSION

RPE has some utility in evaluating intensity during lab-based running or cycling HIIE in adolescents. Future studies should expand the validation and calibration of RPE for prescribing and monitoring HIIE in children and adolescents in field-based contexts.

Middle cerebral artery blood velocity and end-tidal carbon dioxide responses to moderate intensity cycling in children, adolescents, and adults

This study investigated the middle cerebral artery blood velocity (MCAv) response to constant work-rate moderate-intensity cycling exercise in 21 children (9.3 ± 0.8 yr), 17 adolescents (12.3 ± 0.4 yr), and 20 young adults (23.6 ± 2.4 yr). Participants completed an incremental ramp test to exhaustion on a cycle ergometer to determine maximal oxygen uptake and gas exchange threshold (GET) before completing three 6-min transitions at a moderate intensity (90% GET) on separate visits. On each visit, bilateral MCAv was measured by transcranial Doppler ultrasonography and breath-by-breath end-tidal carbon dioxide ([Formula: see text]) via a metabolic cart. Data were ensemble-averaged for each participant and analyzed using a monoexponential model. Absolute MCAv was significantly higher throughout exercise in children and adolescents compared with adults (P < 0.001). Children had a significantly lower relative increase in MCAv from baseline (∼12%) compared with adolescents (∼20%) and adults (∼18%, P < 0.040). All adolescents and adults had a monoexponential rise in MCAv and [Formula: see text], but this was observed in only eight children. Children and adolescents had a significantly faster MCAv time constant (τ, 12 ± 6 and 14 ± 8 s, respectively) compared with adults (27 ± 9 s, P < 0.001). MCAv τ was positively associated with faster [Formula: see text] τ in adolescents (r = 0.70, P = 0.002) but not in children (r = -0.20, P = 0.640). Time- and amplitude-based response parameters of MCAv kinetics were significantly associated with [Formula: see text] kinetics in adults (r = 0.50-0.74, P ≤ 0.025), but not in children (r = -0.19 to -0.48, P > 0.227). These findings suggest that the transition from childhood to adulthood impacts the MCAv response to exercise and the relationships between [Formula: see text] and MCAv kinetics during exercise.NEW & NOTEWORTHY This is the first study to find that children have smaller increases in Δ%MCAv (∼12%) during moderate-intensity exercise compared with adolescents and adults (∼18%-20%). Furthermore, MCAv kinetics were significantly faster in children and adolescents, compared with adults. MCAv kinetic responses were significantly and positively associated with [Formula: see text] kinetics in adults, but not in children. These novel data also suggest that the regulatory role of [Formula: see text] on MCAv during exercise begins to strengthen during adolescence.

The Influence of Acute Hypoxia on Oxygen Uptake and Muscle Oxygenation Kinetics During Cycling Exercise in Prepubertal Boys

PURPOSE

To examine the effect of normobaric hypoxia on pulmonary oxygen uptake (V˙O2) and muscle oxygenation kinetics during incremental and moderate-intensity exercise in children.

METHODS

Eight prepubertal boys (9-11 y) performed incremental cycle tests to exhaustion in both normoxia and hypoxia (fraction of inspired O2 of 15%) followed by repeat 6-minute transitions of moderate-intensity exercise in each condition over subsequent visits.

RESULTS

Maximal oxygen uptake (V˙O2max) was reduced in hypoxia compared with normoxia (1.69 [0.20] vs 1.87 [0.26] L·min-1, P = .028), although the gas exchange threshold was not altered in absolute terms (P = .33) or relative to V˙O2max (P = .78). During moderate-intensity exercise, the phase II V˙O2 time constant (τ) was increased in hypoxia (18 [9] vs 24 [8] s, P = .025), with deoxyhemoglobin τ unchanged (17 [8] vs 16 [6], P ≥ .28).

CONCLUSIONS

In prepubertal boys, hypoxia reduced V˙O2max and slowed V˙O2 phase II kinetics during moderate-intensity exercise, despite unchanged deoxyhemoglobin kinetics. These data suggest an oxygen delivery dependence of V˙O2max and moderate-intensity V˙O2 kinetics under conditions of reduced oxygen availability in prepubertal boys.

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.

Validation of the maximal cardiopulmonary exercise test in adolescents with major depressive disorder and comparison of cardiorespiratory fitness with sex- and age-related control values

Endurance training has been shown to be effective in treating adolescents with major depressive disorder (MDD). To integrate endurance training into the therapeutic setting and the adolescents' daily lives, the current performance status of the adolescents should be accurately assessed. This study aims to examine adolescents with MDD concerning exhaustion criteria during a cardiopulmonary exercise test (CPET), as well as to compare the values obtained thereon with sex- and age-related control values. The study included a retrospective examination of exhaustion criteria ((i) oxygen consumption (V̇O2) plateau, (ii) peak respiratory exchange ratio (RERpeak) > 1.0, (iii) peak heart rate (HRpeak) ≥ 95% of the age-predicted maximal HR, and (iv) peak blood lactate concentration (BLCpeak) > 8.0 mmol⋅L-1) during a graded CPET on a cycle ergometer in adolescents with MDD (n = 57). Subsequently, maximal V̇O2, peak minute ventilation, V̇O2 at the first ventilatory threshold, and peak work rate of participants who met at least two of four criteria were compared with published control values using an independent-sample t-test. Thirty-three percent of the total population achieved a V̇O2 plateau and 75% a RERpeak > 1.0. The HR and BLC criteria were met by 19% and 22%, respectively. T-test results revealed significant differences between adolescents with MDD and control values for all outcomes. Adolescents with MDD achieved between 56% and 83% of control values.   Conclusions: The study shows that compared with control values, fewer adolescents with MDD achieve the exhaustion criteria on a CPET and adolescents with MDD have significantly lower cardiorespiratory fitness.   Clinical trial registration: No. U1111-1145-1854. What is Known: • It is already known that endurance training has a positive effect on depressive symptoms. What is New: • A relevant proportion of adolescents with major depressive disorder do not achieve their V̇O2max during a graded cardiopulmonary exercise test. • Adolescents with major depressive disorder have significantly lower cardiorespiratory fitness compared to sex- and age-related control values.

Which indices of cardiorespiratory fitness are more strongly associated with brain health in children with overweight/obesity?

PURPOSE

To compare the strength of associations between different indices of cardiorespiratory fitness (CRF) and brain health outcomes in children with overweight/obesity.

METHODS

Participants were 100 children aged 8-11 years. CRF was assessed using treadmill exercise test (peak oxygen uptake [V̇O2peak ], treadmill time, and V̇O2 at ventilatory threshold) and 20-metre shuttle run test (20mSRT, laps, running speed, estimated V̇O2peak using the equations by Léger et al., Mahar et al., and Matsuzaka et al.). Intelligence, executive functions, and academic performance were assessed using validated methods. Total gray matter and hippocampal volumes were assessed using structural MRI.

RESULTS

V̇O2peak /body mass (β = 0.18, 95% CI = 0.01-0.35) and treadmill time (β = 0.18-0.21, 95% CI = 0.01-0.39) were positively associated with gray matter volume. 20mSRT laps were positively associated with executive functions (β = 0.255, 95% CI = 0.089-0.421) and academic performance (β = 0.199-0.255, 95% CI = 0.006-0.421), and the running speed was positively associated with executive functions (β = 0.203, 95% CI = 0.039-0.367). Estimated V̇O2peak/Léger et al. was positively associated with intelligence, executive functions, academic performance, and gray matter volume (β = 0.205-0.282, 95% CI = 0.013-0.500). Estimated V̇O2peak/Mahar et al. and V̇O2peak/Matsuzaka et al. (speed) were positively associated with executive functions (β = 0.204-0.256, 95% CI = 0.031-0.436).

CONCLUSION

Although V̇O2peak is considered the gold standard indicator of CRF in children, peak performance (laps or running speed) and estimated V̇O2peak/Léger et al. derived from 20mSRT had stronger and more consistent associations with brain health outcomes than other indices of CRF in children with overweight/obesity.

Verification Phase Confirms V̇O 2max in a Hot Environment in Sedentary Untrained Males

PURPOSE

This study aimed to assess the V̇O 2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment.

METHODS

Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline.

RESULTS

Mean verification phase V̇O 2max (37.8 ± 4.3 mL·kg -1 ·min -1 ) was lower than GXT (39.8 ± 4.1 mL·kg -1 ·min -1 ; P = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a V̇O 2 plateau during the GXT. Verification phase confirmed GXT V̇O 2max in 100% of participants, whereas the traditional and the new age-dependent secondary V̇O 2max criteria indicated GXT V̇O 2max achievement at much lower rates (8/12 [67%] vs 7/12 [58%], respectively). Correlational indices between GXT and verification phase V̇O 2max were strong (intraclass correlation coefficient = 0.95, r = 0.86), and Bland-Altman analysis revealed a low mean bias of -2.1 ± 1.9 mL·kg -1 ·min -1 and 95% limits of agreement (-5.8 to 1.7 mL·kg -1 ·min -1 ).

CONCLUSIONS

Very few untrained males achieved a V̇O 2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm V̇O 2max in untrained males.

Validity and repeatability of cardiopulmonary exercise testing in interstitial lung disease

BACKGROUND

Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO_2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap.

METHODS

Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. Of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error.

RESULTS

Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO₂, the primary criteria for establishing a maximal effort. The majority of participants otherwise presented with secondary criteria of respiratory exchange ratios in excess of 1.05, and maximal heart rates in excess of their predicted values. Repeatability analyses identified that the typical error (expressed as percent of coefficient of variation) was 20% over 3-months in those reaching volitional exhaustion.

CONCLUSION

This work has, for the first time, fully characterised how patients with ILD respond to CPET in terms of primary and secondary verification criteria, and generated novel repeatability data that will prove useful in the assessment of disease progression, and future evaluation of therapeutic regimens where VO_2peak is used as an outcome measure.

Normal reference values for aerobic fitness in cystic fibrosis: a scoping review

Objective

The importance of aerobic fitness (VO2peak) in cystic fibrosis (CF) is well established, and regular exercise testing is recommended. To standardise VO2peak, a 'percentage of predicted' (%pred) derived from normative reference values (NRV), as promoted by the 2015 European Cystic Fibrosis Society Exercise Working Group (ECFS EWG), can be reported. However, the NRVs used in CF and their relative frequency is unknown.

Method

A scoping review was performed via systematic database searches (PubMed, Embase, Web of Science, SciELO, EBSCO) and forward citation searches for studies that include people with CF and report VO2peak as %pred. Studies were screened using Covidence, and data related to patient demographics, testing modality and reference equations were extracted. Additional analyses were performed on studies published in 2016-2021, following the ECFS EWG statement in 2015.

Results

A total of 170 studies were identified, dating from 1984 to 2022, representing 6831 patients with CF, citing 34 NRV. Most studies (154/170) used cycle ergometry, 15/170 used treadmills, and the remainder used alternative, combination or undeclared modalities. In total, 61/170 failed to declare the NRV used. There were 61 studies published since the ECFS EWG statement, whereby 18/61 used the suggested NRV.

Conclusion

There is a wide discrepancy in NRV used in the CF literature base to describe VO2peak as %pred, with few studies using NRV from the ECFS EWG statement. This high variance compromises the interpretation and comparison of studies while leaving them susceptible to misinterpretation and limiting replication. Standardisation and alignment of reporting of VO2peak values are urgently needed.

Skin Blood Flow Responses to Acetylcholine, Local Heating, and to 60% VO2max exercise with and without Nitric Oxide inhibition, in Boys vs. Girls

PURPOSE

To determine sex-related differences in the skin blood flow (SkBF) response to exercise, local heating, and acetylcholine (ACh) in children, and to assess nitric oxide contribution to the SkBF response.

METHODS

Forearm SkBF during local heating (44°C), ACh iontophoresis, and exercise (30-min cycling and 60% of maximum oxygen consumption) was assessed, using laser Doppler fluxmetry, in 12 boys and 12 girls (7-13 y old), with and without nitric oxide synthase inhibition, using Nω-nitro-L-arginine methyl ester iontophoresis.

RESULTS

Local-heating-induced and ACh-induced SkBF increase were not different between boys and girls (local heating: 1445% [900%] and 1432% [582%] of baseline, P = .57; ACh: 673% [434%] and 558% [405%] of baseline, respectively, P = .18). Exercise-induced increase in SkBF was greater in boys than girls (528% [290%] and 374% [192%] of baseline, respectively, P = .03). Nω-nitro-L-arginine methyl ester blunted the SkBF response to ACh and during exercise (P < .001), with no difference between sexes.

CONCLUSION

SkBF responses to ACh and local heat stimuli were similar in boys and girls, while the increase in SkBF during exercise was greater in boys. The apparent role of nitric oxide was not different between boys and girls. It is suggested that the greater SkBF response in boys during exercise was related to greater relative heat production and dissipation needs at this exercise intensity. The response to body size-related workload should be further examined.

Comparison of two methods of cardiopulmonary exercise testing for assessing physical fitness in children and adolescents with extreme obesity

It is well-known that children and adolescents with obesity have increased over recent decades which in turn carries greater risk of co-morbidities and poses a preventive as well as a therapeutic challenge. Currently, there are limited recommendations available on proven methods for recording physical fitness in children and adolescents presenting with extreme obesity. In this study, twenty participants, aged 12-17 years, with a body mass index (BMI) above the 99.5th percentile, were comparatively assessed, using a correlation between their physical fitness on a bicycle (BC) and treadmill (TM) cardiopulmonary exercise testing (CPET) with a lactate diagnostic. The results of the BC and the TM were as follows: maximum heart rate (HR_max) 186.4 ± 8.6 beats per minute (bpm) vs. 190.8 ± 8.8 bpm, peak oxygen consumption (VO₂peak/kg) 23.5 ± 2.9 ml/min/kg vs. 25.4 ± 3.1 ml/min/kg, and maximum lactate (La_max) 6.4 ± 1.6 mmol/l vs. 5.6 ± 1.4 mmol/l. The values of HR_max and VO₂peak/kg were significantly higher for adolescents tested on the TM. However, no significant difference was observed in either La_max values or between the genders.    Conclusions: The higher values of HR_max and VO₂peak/kg could be attributed to the activation of a higher percentage of muscle mass on the TM. Lower La_max values on the TM suggest maximum physical exertion was not achieved. This could be due to the extreme body weight carried by the participants. Both the BC and the TM CPET could be used for assessing physical fitness in children and adolescents with extreme obesity but should not be used interchangeably. What is Known: • Currently, there are only limited recommendations available on proven methods for recording physical fitness in children and adolescents with extreme obesity available. What is New: • Cardiopulmonary exercise testing with maximum physical exertion has been shown to be feasible in children and adolescents with extreme obesity. The results obtained from this study demonstrated that both a bicycle and a treadmill can be effectively used for assessing the physical fitness levels in children and adolescents with extreme obesity.

The Oxygen Uptake Plateau-A Critical Review of the Frequently Misunderstood Phenomenon

A flattening of the oxygen uptake–work rate relationship at severe exercise indicates the achievement of maximum oxygen uptake \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\left({\text{VO}}_{2\max } \right)$$\end{document}VO2max. Unfortunately, a distinct plateau \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\left( {{{\text{VO}}}_{2} {\text{pl}}} \right)$$\end{document}VO2pl at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2\max }$$\end{document}VO2maxis not found in all participants. The aim of this investigation was to critically review the influence of research methods and physiological factors on the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl incidence. It is shown that many studies used inappropriate definitions or methodical approaches to check for the occurrence of a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl. In contrast to the widespread assumptions it is unclear whether there is higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl incidence in (uphill) running compared to cycling exercise or in discontinuous compared to continuous incremental exercise tests. Furthermore, most studies that evaluated the validity of supramaximal verification phases, reported verification bout durations, which are too short to ensure that \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2\max }$$\end{document}VO2max have been achieved by all participants. As a result, there is little evidence for a higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl incidence and a corresponding advantage for the diagnoses of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2\max }$$\end{document}VO2max when incremental tests are supplemented by supramaximal verification bouts. Preliminary evidence suggests that the occurrence of a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl in continuous incremental tests is determined by physiological factors like anaerobic capacity, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2}$$\end{document}VO2-kinetics and accumulation of metabolites in the submaximal intensity domain. Subsequent studies should take more attention to the use of valid \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2} {\text{pl}}$$\end{document}VO2pl definitions, which require a cut-off at ~ 50% of the submaximal \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2}$$\end{document}VO2 increase and rather large sampling intervals. Furthermore, if verification bouts are used to verify the achievement of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{{2{\text{peak}}}}$$\end{document}VO2peak/\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\text{VO}}}_{2\max }$$\end{document}VO2max, it should be ensured that they can be sustained for sufficient durations.

Verification Testing to Confirm V˙O2max in a Hot Environment

PURPOSE

This study aimed to evaluate the validity and reliability of a verification test to confirm GXT V˙O2max in a hot environment.

METHODS

Twelve recreationally trained cyclists completed a two-test protocol that included a GXT progressing 20 W·min-1 followed by a biphasic supramaximal-load verification test (1 min at 60% increasing to 110% maximal GXT wattage until failure) in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a thermoneutral room and was anchored to the duration required for gastrointestinal temperature to return to baseline.

RESULTS

Mean verification test V˙O2max (51.3 ± 8.8 mL·kg-1·min-1) was lower than GXT (55.9 ± 7.6 mL·kg-1·min-1, P = 0.02). Verification tests confirmed GXT V˙O2max in 92% of participants using individual analysis thresholds. Bland-Altman analysis revealed a sizable mean bias (-4.6 ± 4.9 mL·kg-1·min-1) with wide 95% limits of agreement (-14.0 to 5.0 mL·kg-1·min-1) across a range of V˙O2max values. The high coefficient of variation (9.6%) and typical error (±3.48 mL·kg-1·min-1) indicate potential issues of test-retest reliability in the heat.

CONCLUSIONS

Verification testing in a hot condition confirmed GXT V˙O2max in virtually all participants, indicating robust utility. To enhance test-retest reliability in this environment, protocol recommendations for work rate and recovery between tests are provided.

Influence of grade of obesity on the achievement of VO2max using an incremental treadmill test in youths

The purpose of this study was to analyze the influence of grade of obesity on the probability of achieving a VO2 plateau and threshold secondary criteria for verifying VO2max during a treadmill walk test in youths with obesity. Therefore, 72 youths with obesity (aged 8-16) performed an incremental treadmill walk test to exhaustion during which oxygen uptake (VO2), minute ventilation (VE), heart rate (HR) and rating of perceived exertion were continuously measured. HR corresponding to a "hard" level of perceived exertion was reported and expressed as a percentage of the predicted HRmax. The rate of achievement of criteria for validation VO2max (VO2 plateau; HR>95% theoretical HRmax; RER>1.0; rating of perceived exertion ≥ "hard") was compared between participants with grade I and grade II obesity. 37% of the participants achieved a VO2 plateau and 23% achieved both an HR>95% and RER >1.0. Youths with grade II obesity had lower minute ventilation (p<0.01) tended to be more likely to reach an HR>95% (OR = 0.33; P=0.06) and a "hard" rating of perceived exertion than grade I (OR = 4.5; P=0.07). However, there was no influence of grade of obesity on the achievement of VO2 plateau, and RER>1.0.

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.

Associations of cardiorespiratory fitness, adiposity, and arterial stiffness with cognition in youth

Purpose

To investigate the associations of cardiorespiratory fitness, adiposity, and arterial stiffness with cognition in 16‐ to 19‐year‐old adolescents.

Methods

Fifty four adolescents (35 girls; 19 boys) participated in the study. Peak oxygen uptake (V̇O_2peak) and peak power output (W_max) were measured by the maximal ramp test on a cycle ergometer and ventilatory threshold (VT) was determined with ventilation equivalents. Lean mass (LM) and body fat percentage (BF%) were measured using a bioelectrical impedance analysis. Aortic pulse wave velocity (PWVao) and augmentation index (AIx%) were measured by a non‐invasive oscillometric device. Working memory, short term memory, visual learning and memory, paired‐associate learning, attention, reaction time, and executive function were assessed by CogState tests.

Results

V̇O_2peak/LM (β = 0.36 p = .011) and W_max/LM (β = 0.30 p = .020) were positively associated with working memory. W_max/LM was also positively associated with visual learning (β = 0.37, p = .009). V̇O₂ at VT/LM was positively associated with working memory (β = 0.30 p = .016), visual learning (β = 0.31 p = .026), and associated learning (β = −0.27 p = .040). V̇O₂ at VT as % of V̇O_2peak, BF%, PWVao, and AIx% were not associated with cognition.

Conclusion

Cardiorespiratory fitness was related to better cognitive function, while BF% and arterial stiffness were not associated with cognition in adolescents.

Relationship between (non)linear phase II pulmonary oxygen uptake kinetics with skeletal muscle oxygenation and age in 11-15 year olds

NEW FINDINGS

What is the central question of this study? Do the phase II parameters of pulmonary oxygen uptake ( V ̇ O 2 ) kinetics display linear, first-order behaviour in association with alterations in skeletal muscle oxygenation during step cycling of different intensities or when exercise is initiated from an elevated work rate in youths. What is the main finding and its importance? Both linear and non-linear features of phase II V ̇ O 2 kinetics may be determined by alterations in the dynamic balance between microvascular O₂ delivery and utilization in 11-15 year olds. The recruitment of higher-order (i.e. type II) muscle fibres during 'work-to-work' cycling might be responsible for modulating V ̇ O 2 kinetics with chronological age.

ABSTRACT

This study investigated in 19 male youths (mean age: 13.6 ± 1.1 years, range: 11.7-15.7 years) the relationship between pulmonary oxygen uptake ( V ̇ O 2 ) and muscle deoxygenation kinetics during moderate- and very heavy-intensity 'step' cycling initiated from unloaded pedalling (i.e. U → M and U → VH) and moderate to very heavy-intensity step cycling (i.e. M → VH). Pulmonary V ̇ O 2 was measured breath-by-breath along with the tissue oxygenation index (TOI) of the vastus lateralis using near-infrared spectroscopy. There were no significant differences in the phase II time constant ( τ V ̇ O 2 p ) between U → M and U → VH (23 ± 6 vs. 25 ± 7 s; P = 0.36); however, the τ V ̇ O 2 p was slower during M → VH (42 ± 16 s) compared to other conditions (P < 0.001). Quadriceps TOI decreased with a faster (P < 0.01) mean response time (MRT; i.e. time delay + τ) during U → VH (14 ± 2 s) compared to U → M (22 ± 4 s) and M → VH (20 ± 6 s). The difference (Δ) between the τ V ̇ O 2 p and MRT-TOI was greater during U → VH compared to U → M (12 ± 7 vs. 2 ± 7 s, P < 0.001) and during M → VH (23 ± 15 s) compared to other conditions (P < 0.02), suggesting an increased proportional speeding of fractional O₂ extraction. The slowing of the τ V ̇ O 2 p during M → VH relative to U → M and U → VH correlated positively with chronological age (r = 0.68 and 0.57, respectively, P < 0.01). In youths, 'work-to-work' transitions slowed microvascular O₂ delivery-to-O₂ utilization with alterations in phase II V ̇ O 2 dynamics accentuated between the ages of 11 and 15 years.