The Maximal Oxygen Uptake Verification Phase: a Light at the End of the Tunnel?

Fourteen weeks of β-alanine supplementation and HIIT did not improve serum BDNF concentrations and Stroop test performance

This study aimed to investigate whether 14 weeks of β-alanine supplementation and high-intensity intermittent training improves brain-derived neurotrophic factor concentrations and cognitive aspects related to executive functions assessed by the Stroop test. Thirteen healthy and active men underwent a 4-week supplementation period (β-alanine: 6.4 g/d or a placebo) followed by 10-week supplementation combined with high-intensity intermittent training, totaling 14 weeks of intervention. Participants underwent a graded exercise test, while the blood samples for brain-derived neurotrophic factor analysis and the Stroop test (cognitive task) were assessed before and after a high-intensity intermittent exercise (10 runs of 1:1 min effort and a pause ratio at 130% of respiratory compensation point). These measurements were performed three times across the study being at baseline, after 4 weeks of supplementation (POST4weeks) and at the end of the 14 weeks of study (POST14weeks). Compared to baseline values, there were no improvements in brain-derived neurotrophic factor concentrations or Stroop test performance with either β-alanine or high-intensity intermittent training. Lactate peak concentrations in a high-intensity intermittent exercise session also did not differ between groups. However, high-intensity intermittent training did improve some cardiorespiratory parameters (i.e., intensity associated with V̇O2max p=0.01 and respiratory compensation point, p=0.01). In conclusion, β-alanine supplementation alone or associated with high-intensity intermittent training did not improve the brain-derived neurotrophic factor concentrations and Stroop test performance in healthy men.

Validation of the metabolic power model during three intermittent running-based exercises with emphasis on aerobic and anaerobic energy supply

Introduction

In intermittent sports, available internal load measurements like capillary blood techniques and portable respiratory gas analyzers are considered as gold standards in controlled laboratory environments, but are impractical for daily use in training and matches. A newer approach, the metabolic power model, allows to extrapolate from speed and acceleration data to the metabolic power, simulated oxygen uptake, and aerobic and anaerobic energy supply. The aim of this study was to validate the metabolic power model against the established 3-component model to allow direct comparison of variables including energy expenditure and supplies during intermittent running-based exercises.

Methods

Twelve male athletes (24 ± 3 years) performed three different running-based exercises consisting of continuous shuttle runs and repeated accelerations and sprints with change of direction. Each exercise condition intended to primarily stress the aerobic, anaerobic alactic, and lactic energy supply. One-way repeated measures ANOVA or Friedman test and corresponding effect sizes were applied for statistical analyses. Additionally, absolute and relative biases and Bland-Altman plots were generated.

Results

For total energy expenditure, there were statistically significant differences (p ≤ .002, d ≥ .882, large) and biases of -13.5 ± 11.8% for the continuous shuttle runs and up to 352.2 ± 115.9% for repeated accelerations and sprints. Concerning aerobic energy supply, there were statistically significant differences (p < .001, d ≥ 1.937, large effect sizes) and biases of up to -38.1 ± 11.7%. For anaerobic energy supply, there were statistically significant differences (p < .001, d ≥ 5.465, large) and biases of up to 1,849.9 ± 831.8%.

Discussion

In conclusion, the metabolic power model significantly under- or overestimates total energy expenditure and supplies with large effect sizes during intermittent running-based exercises. Future studies should optimize the model before it can be used on a daily basis for scientific and practical purposes.

Submaximal Verification Test to Exhaustion Confirms Maximal Oxygen Uptake: Roles of Anaerobic Performance and Respiratory Muscle Strength

Background: The incremental exercise test is commonly used to measure maximal oxygen uptake (VO2max), but an additional verification test is often recommended as the "gold standard" to confirm the true VO2max. Therefore, the aim of this study was to compare the peak oxygen uptake (VO2peak) obtained in the ramp incremental exercise test and that in the verification test performed on different days at submaximal intensity. Additionally, we examined the roles of anaerobic performance and respiratory muscle strength. Methods: Sixteen physically active men participated in the study, with an average age of 22.7 ± 2.4 (years), height of 178.0 ± 7.4 (cm), and weight of 77.4 ± 7.3 (kg). They performed the three following tests on a cycle ergometer: the Wingate Anaerobic Test (WAnT), the ramp incremental exercise test (IETRAMP), and the verification test performed at an intensity of 85% (VER85) maximal power, which was obtained during the IETRAMP. Results: No significant difference was observed in the peak oxygen uptake between the IETRAMP and VER85 (p = 0.51). The coefficient of variation was 3.1% and the Bland-Altman analysis showed a high agreement. We found significant correlations between the total work performed in the IETRAMP, the anaerobic peak power (r = 0.52, p ≤ 0.05), and the total work obtained in the WAnT (r = 0.67, p ≤ 0.01). There were no significant differences in post-exercise changes in the strength of the inspiratory and expiratory muscles after the IETRAMP and the VER85. Conclusions: The submaximal intensity verification test performed on different days provided reliable values that confirmed the real VO2max, which was not limited by respiratory muscle fatigue. This verification test may be suggested for participants with a lower anaerobic mechanical performance.

Test-Retest Reliability of Running Economy and Metabolic and Cardiorespiratory Parameters During a Multistage Incremental Treadmill Test in Male Middle- and Long-Distance Runners

This study investigated the test-retest reliability of running economy (RE) and metabolic and cardiorespiratory parameters related to endurance running performance using a multistage incremental treadmill test. On two occasions separated by 21-28 days, 12 male middle- and long-distance runners ran at 10, 11, 12, 13, and 14 km/hr for 8 min each stage, immediately followed by a ramp test to volitional exhaustion. Carbohydrate (10% maltodextrin solution) was consumed before and during the test to provide ∼1 g/min of exercise. RE, minute ventilation (V˙E), oxygen consumption (V˙O2), carbon dioxide production (V˙CO2), respiratory exchange ratio (RER), heart rate (HR), ratings of perceived exertion (RPE), and blood glucose and lactate concentrations were recorded for each stage and at volitional exhaustion. Time-to-exhaustion (TTE) and peak oxygen consumption (V˙O2peak) during the ramp test were also recorded. Absolute reliability, calculated as the coefficient of variation (CV) between repeated measures, ranged from 2.3% to 3.1% for RE, whereas relative reliability, calculated as the intraclass correlation coefficient (ICC), ranged from .42 to .79. V˙E, V˙O2, V˙O2peak, V˙CO2, RER, and HR had a CV of 1.1%-4.3% across all stages. TTE and RPE had a CV of 7.2% and 2.3%-10.8%, respectively, while glucose and lactate had a CV of 4.0%-17.8%. All other parameters, except for blood glucose, were demonstrated to have good-to-excellent relative reliability assessed by ICC. Measures of RE, V˙O2peak, and TTE were reliable during this two-phase multistage incremental treadmill test in a cohort of trained and highly trained male middle- and long-distance runners.

Effects of Aerobic Exercise on Brain Age and Health in Middle-Aged and Older Adults: A Single-Arm Pilot Clinical Trial

BACKGROUNDS

Sleep disturbances are prevalent among elderly individuals. While polysomnography (PSG) serves as the gold standard for sleep monitoring, its extensive setup and data analysis procedures impose significant costs and time constraints, thereby restricting the long-term application within the general public. Our laboratory introduced an innovative biomarker, utilizing artificial intelligence algorithms applied to PSG data to estimate brain age (BA), a metric validated in cohorts with cognitive impairments. Nevertheless, the potential of exercise, which has been a recognized means of enhancing sleep quality in middle-aged and older adults to reduce BA, remains undetermined.

METHODS

We conducted an exploratory study to evaluate whether 12 weeks of moderate-intensity exercise can improve cognitive function, sleep quality, and the brain age index (BAI), a biomarker computed from overnight sleep electroencephalogram (EEG), in physically inactive middle-aged and older adults. Home wearable devices were used to monitor heart rate and overnight sleep EEG over this period. The NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing, and a multiplex cytokines assay were employed to compare pre- and post-exercise brain health, exercise capacity, and plasma proteins.

RESULTS

In total, 26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Data are presented as mean [lower 95% CI of mean, upper 95% CI of mean]. Participants significantly increased maximal oxygen consumption (Pre: 21.11 [18.98, 23.23], Post 22.39 [20.09, 24.68], mL/kg/min; effect size: -0.33) and decreased resting heart rate (Pre: 66.66 [63.62, 67.38], Post: 65.13 [64.25, 66.93], bpm; effect size: -0.02) and sleeping heart rate (Pre: 64.55 [61.87, 667.23], Post: 62.93 [60.78, 65.09], bpm; effect size: -0.15). Total cognitive performance (Pre: 111.1 [107.6, 114.6], Post: 115.2 [111.9, 118.5]; effect size: 0.49) was significantly improved. No significant differences were seen in BAI or measures of sleep macro- and micro-architecture. Plasma IL-4 (Pre: 0.24 [0.18, 0.3], Post: 0.33 [0.24, 0.42], pg/mL; effect size: 0.49) was elevated, while IL-8 (Pre: 5.5 [4.45, 6.55], Post: 4.3 [3.66, 5], pg/mL; effect size: -0.57) was reduced.

CONCLUSIONS

Cognitive function was improved by a 12-week moderate-intensity exercise program in physically inactive middle-aged and older adults, as were aerobic fitness (VO2max) and plasma cytokine profiles. However, we found no measurable effects on sleep architecture or BAI. It remains to be seen whether a study with a larger sample size and more intensive or more prolonged exercise exposure can demonstrate a beneficial effect on sleep quality and brain age.

A verification phase adds little value to the determination of maximum oxygen uptake in well-trained adults

PURPOSE

The objective was to investigate if performing a sub-peak or supra-peak verification phase following a ramp test provides additional value for determining 'true' maximum oxygen uptake ( V ˙ O2).

METHODS

17 and 14 well-trained males and females, respectively, performed two ramp tests each followed by a verification phase. While the ramp tests were identical, the verification phase differed in power output, wherein the power output was either 95% or 105% of the peak power output from the ramp test. The recovery phase before the verification phase lasted until capillary blood lactate concentration was ≤ 4 mmol·L-1. If a V ˙ O2 plateau occurred during ramp test, the following verification phase was considered to provide no added value. If no V ˙ O2 plateau occurred and the highest V ˙ O2 ( V ˙ O2peak) during verification phase was < 97%, between 97 and 103%, or > 103% of V ˙ O2peak achieved during the ramp test, no value, potential value, and certain value were attributed to the verification phase, respectively.

RESULTS

Mean (standard deviation) V ˙ O2peak during both ramp tests was 64.5 (6.0) mL·kg-1·min-1 for males and 54.8 (6.2) mL·kg-1·min-1 for females. For the 95% verification phase, 20 tests showed either a V ˙ O2 plateau during ramp test or a verification V ˙ O2peak < 97%, indicating no value, 11 showed potential value, and 0 certain value. For the 105% verification phase, the values were 26, 5, and 0 tests, respectively.

CONCLUSION

In well-trained adults, a sub-peak verification phase might add little value in determining 'true' maximum V ˙ O2, while a supra-peak verification phase adds no value.

Acute oral antioxidant consumption does not alter brachial artery flow mediated dilation in young adults independent of exercise training status

Endothelium-dependent vasodilation can be tested using a variety of shear stress paradigms, some of which may involve the production of reactive oxygen species. The purpose of this study was to compare different methods for assessing endothelial function and their specific involvement of reactive oxygen species and influence of aerobic training status. Twenty-nine (10 F) young and healthy participants (VO2max: 34-74 mL·kg-1·min-1) consumed either an antioxidant cocktail (AOC; vitamin C, vitamin E, α-lipoic acid) or placebo (PLA) on each of two randomized visits. Endothelial function was measured via three different brachial artery flow-mediated dilation (FMD) tests: reactive hyperemia (RH-FMD: 5 min cuff occlusion and release), sustained shear (SS-FMD: 6 min rhythmic handgrip), and progressive sustained shear (P-SS-FMD: three intensities of 3 min of rhythmic handgrip). Baseline artery diameter decreased (all tests: 3.8 ± 0.5 to 3.7 ± 0.6 mm, p = 0.004), and shear rate stimulus increased (during RH-FMD test, p = 0.021; during SS-FMD test, p = 0.36; during P-SS-FMD test, p = 0.046) following antioxidant consumption. However, there was no difference in FMD following AOC consumption (RH-FMD, PLA: 8.1 ± 2.6%, AOC: 8.2 ± 3.5%, p = 0.92; SS-FMD, PLA: 6.9 ± 3.9%, AOC: 7.8 ± 5.2%, p = 0.15) or FMD per shear rate slope (P-SS-FMD: PLA: 0.0039 ± 0.0035 mm·s-1, AOC: 0.0032 ± 0.0017 mm·s-1, p = 0.28) and this was not influenced by training status/fitness (all p > 0.60). Allometric scaling did not alter these outcomes (all p > 0.40). Reactive oxygen species may not be integral to endothelium-dependent vasodilation tested using reactive, sustained, or progressive shear protocols in young males and females, regardless of fitness level.

Guidance and standard operating procedures for functional exercise testing in cystic fibrosis

Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.

Repeated cold-water immersion improves autonomic cardiac modulation following five sessions of high-intensity interval exercise

PURPOSE

The study aimed to investigate the effect of repeated cold-water immersion (CWI) after high-intensity interval exercise sessions on cardiac-autonomic modulation, neuromuscular performance, muscle damage markers, and session internal load.

METHODS

Twenty-one participants underwent five sessions of high-intensity interval exercise (6-7 bouts of 2 min; pause of 2 min) over a two-week period. Participants were allocated randomly into either a group that underwent CWI (11-min; 11 °C) or a group that performed passive recovery after each exercise session. Before the exercise sessions were performed, countermovement jump (CMJ) and heart rate variability were recorded (i.e., rMSSD, low and high frequency power and its ratio, SD1 and SD2). Exercise heart rate was calculated by recording the area under the curve (AUC) response. Internal session load was evaluated 30 min after each session. Blood concentrations of creatine kinase and lactate dehydrogenase were analyzed before the first visit and 24 h after the last sessions.

RESULTS

The CWI group presented higher rMSSD than the control group at each time point (group-effect P = 0.037). The SD1 was higher in CWI group when compared to the control group following the last exercise session (interaction P = 0.038). SD2 was higher in CWI group compared to the control group at each time point (group-effect P = 0.030). Both groups presented equal CMJ performance (P > 0.05), internal load (group-effect P = 0.702; interaction P = 0.062), heart rate AUC (group-effect P = 0.169; interaction P = 0.663), and creatine kinase and lactate dehydrogenase blood concentrations (P > 0.05).

CONCLUSION

Repeated post-exercise CWI improves cardiac-autonomic modulation. However, no differences in neuromuscular performance, muscle damage markers, or session internal load were demonstrated between the groups.

The efficacy of a verification stage for determining V˙O2max and the impact of sampling intervals

It is unknown whether oxygen uptake (V̇O₂) sampling intervals influence the efficacy of a verification stage following a graded exercise test (GXT). Fifteen females and 14 males (18-25 years) completed a maximal treadmill GXT. After a 5 ​min recovery, the verification stage began at the speed and grade corresponding with the penultimate stage from the GXT. Maximal oxygen consumption (V̇O_2max) from the incremental GXT (iV̇O_2max) and V̇O_2max from the verification stage (verV̇O_2max) were determined using 10 seconds (s), 30 ​s, and 60 ​s from breath ​× ​breath averages. There was no main effect for V̇O_2max measure (iV̇O_2maxvs. verV̇O_2max) 10 ​s ([47.9 ​± ​8.31] ml∙kg^-1∙min^-1 vs [48.85 ​± ​7.97] ml∙kg^-1∙min^-1), 30 ​s ([46.94 ​± ​8.62] ml∙kg^-1∙min^-1 vs [47.28 ​± ​7.97] ml∙kg^-1∙min^-1), and 60 ​s ([46.17 ​± ​8.62] ml∙kg^-1∙min^-1 vs [46.00 ​± ​8.00] ml∙kg^-1∙min^-1]. There was a stage ​× ​sampling interval interaction as the difference between (verV̇O_2max-iV̇O_2max) was greater for 10-s than 60-s sampling intervals. The verV̇O_2max was > 4% higher than iV̇O_2maxin 31%, 31%, and 17% of the tests for the 10-s, 30-s, and 60-s sampling intervals respectively. Sensitivity for the plateau was < 30% for 10-s, 30-s, and 60-s sampling intervals. Specificity ranged from 44% to 60% for all sampling intervals. Sensitivity for heart rate ​+ ​respiratory exchange ratio was > 90% for all sampling intervals; while specificity was < 25%. Findings from the present study suggest that the efficacy of verification stages for eliciting a higher V̇O_2max may be influenced by the sampling interval utilized.

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.

Electrically assisted cycling for individuals with type 2 diabetes mellitus: a pilot randomized controlled trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) and its associated complications puts considerable strain on healthcare systems. With the global incidence of T2DM increasing, effective disease management is essential. Physical activity (PA) is a key component of T2DM management; however, rates of PA engagement are low in this population. Developing effective and sustainable interventions that encourage PA is a high priority. Electrically assisted bicycles are becoming increasingly popular and may increase PA in healthy adults. This study aimed to provide evidence of the feasibility of conducting a randomized controlled trial to evaluate the efficacy of an e-cycling intervention to increase PA and improve health in individuals with T2DM.

METHODS

A parallel-group two-arm randomized, waitlist-controlled pilot study was conducted. Individuals were randomized to either an e-bike intervention or standard care. The intervention incorporated two one-to-one e-bike skills training and behavioural counselling sessions delivered by a community-based cycling charity, followed by a 12-week e-bike loan with two further sessions with the instructors. Feasibility was assessed via measures related to recruitment, retention and intervention implementation. Post-intervention interviews with instructors and participants explored the acceptability of the study procedures and intervention. Clinical, physiological and behavioural outcomes were collected at baseline and post-intervention to evaluate the intervention's potential.

RESULTS

Forty participants (M_age = 57) were randomized, of which 34 were recruited from primary care practices. Thirty-five participants were retained in the trial. The intervention was conducted with high fidelity (> 80% content delivered). E-bike training provided participants with the skills, knowledge and confidence needed to e-bike independently. Instructors reported being more confident delivering the skills training than behavioural counselling, despite acknowledging its importance. The study procedures were found to be acceptable to participants. Between-group differences in change during the intervention were indicative of the interventions potential for improving glucose control, health-related quality of life and cardiorespiratory fitness. Increases in overall device measured moderate-to-vigorous PA behaviour following the intervention were found, and there was evidence that this population self-selected to e-cycle at a moderate intensity.

CONCLUSIONS

The study's recruitment, retention, acceptability and potential efficacy support the development of a definitive trial subject to identified refinements.

TRIAL REGISTRATION

ISRCTN, ISRCTN67421464 . Registered 17/12/2018.

Is the Verification Phase a Suitable Criterion for the Determination of Maximum Oxygen Uptake in Patients with Heart Failure and Reduced Ejection Fraction? A Validation Study

The verification phase (VP) has been proposed as an alternative to the traditional criteria used for the determination of the maximum oxygen uptake (VO2 max) in several populations. Nonetheless, its validity in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. Therefore, the aim of this study was to analyse whether the VP is a safe and suitable method to determine the VO2 max in patients with HFrEF. Adult male and female patients with HFrEF performed a ramp-incremental phase (IP), followed by a submaximal constant VP (i.e., 95% of the maximal workload during the IP) on a cycle ergometer. A 5-min active recovery period (i.e., 10 W) was performed between the two exercise phases. Group (i.e., median values) and individual comparisons were performed. VO2 max was confirmed when there was a difference of ≤ 3% in peak oxygen uptake (VO2 peak) values between the two exercise phases. Twenty-one patients (13 males) were finally included. There were no adverse events during the VP. Group comparisons showed no differences in the absolute and relative VO2 peak values between both exercise phases (p = 0.557 and p = 0.400, respectively). The results did not change when only male or female patients were included. In contrast, individual comparisons showed that the VO2 max was confirmed in 11 patients (52.4%) and not confirmed in 10 (47.6%). The submaximal VP is a safe and suitable method for the determination of the VO2 max in patients with HFrEF. In addition, an individual approach should be used because group comparisons could mask individual differences.

The Energetic Costs of Uphill Locomotion in Trail Running: Physiological Consequences Due to Uphill Locomotion Pattern-A Feasibility Study

The primary aim of our feasibility reporting was to define physiological differences in trail running (TR) athletes due to different uphill locomotion patterns, uphill running versus uphill walking. In this context, a feasibility analysis of TR athletes' cardiopulmonary exercise testing (CPET) data, which were obtained in summer 2020 at the accompanying sports medicine performance center, was performed. Fourteen TR athletes (n = 14, male = 10, female = 4, age: 36.8 ± 8.0 years) were evaluated for specific physiological demands by outdoor CPET during a short uphill TR performance. The obtained data of the participating TR athletes were compared for anthropometric data, CPET parameters, such as V˙Emaximum, V˙O2maximum, maximal breath frequency (BF_max) and peak oxygen pulse as well as energetic demands, i.e., the energy cost of running (C_r). All participating TR athletes showed excellent performance data, whereby across both different uphill locomotion strategies, significant differences were solely revealed for V˙Emaximum (p = 0.033) and time to reach mountain peak (p = 0.008). These results provide new insights and might contribute to a comprehensive understanding of cardiorespiratory consequences to short uphill locomotion strategy in TR athletes and might strengthen further scientific research in this field.

Specific Incremental Test for Aerobic Fitness in Trail Running: IncremenTrail

Trail running (TR) is performed in a natural environment, including various ranges of slopes where maximal oxygen consumption is a major contributor to performance. The aim of this study is to investigate the validity of tests performed in uphill conditions named the "IncremenTrail" (IncT), based on the incremental ascending speed (AS) to evaluate trail runners' cardiorespiratory parameters. IncT protocol included a constant gradient slope set at 25% during the whole test; the starting speed was 500 m·h-1 (25% slope and 2.06 km·h-1) and increased by 100 m·h-1 every minute (0.41 km·h-1). Twenty trail runner specialists performed the IncT and a supramaximal exercise bout to exhaustion with intensity set at 105% of maximal AS (Tlim). Oxygen consumption, breathing frequency, ventilation, respiratory exchange ratio (RER), and heart rate were continuously recorded during the exercises. The blood lactate concentration and rate of perceived exertion were collected at the end of the exercises. During the IncT test, 16 athletes (80%) reached a plateau of maximal oxygen uptake (65.5 ± 7.6 mL·kg-1·min-1), 19 athletes (95%) reached RER values over 1.10 (1.12 ± 0.02) and all the athletes achieved blood lactate concentration over 8.0 mmol·L-1 (17.1 ± 3.5 mmol·L-1) and a maximal heart rate ≥90% of the theoretical maximum (185 ± 11 bpm). Maximal values were not significantly different between IncT and Tlim. In addition, ventilatory thresholds could be determined for all runners with an associated AS. IncT provided a suitable protocol to evaluate trail runners' cardiorespiratory limitations and allowed us to obtain specific intensities based on the ascending speed useful for training purposes in specific conditions.

Hierarchical framework to improve individualised exercise prescription in adults: a critical review

Physical activity (PA) guidelines for the general population are designed to mitigate the rise of chronic and debilitating diseases brought by inactivity and sedentariness. Although essential, they are insufficient as rates of cardiovascular, pulmonary, renal, metabolic and other devastating and life-long diseases remain on the rise. This systemic failure supports the need for an improved exercise prescription approach that targets the individual. Significant interindividual variability of cardiorespiratory fitness (CRF) responses to exercise are partly explained by biological and methodological factors, and the modulation of exercise volume and intensity seem to be key in improving prescription guidelines. The use of physiological thresholds, such as lactate, ventilation, as well as critical power, have demonstrated excellent results to improve CRF in those struggling to respond to the current homogenous prescription of exercise. However, assessing physiological thresholds requires laboratory resources and expertise and is incompatible for a general population approach. A case must be made that balances the effectiveness of an exercise programme to improve CRF and accessibility of resources. A population-wide approach of exercise prescription guidelines should include free and accessible self-assessed threshold tools, such as rate of perceived exertion, where the homeostatic perturbation induced by exercise reflects physiological thresholds. The present critical review outlines factors for individuals exercise prescription and proposes a new theoretical hierarchal framework to help shape PA guidelines based on accessibility and effectiveness as part of a personalised exercise prescription that targets the individual.

Exercise intervention does not reduce the likelihood of VO2max underestimation in older adults with hypertension

The present study aimed to investigate whether training status would influence the capacity of a verification phase (VER) to confirm maximal oxygen uptake (VO₂max) of a previous graded exercise test (GXT) in individuals with hypertension. Twelve older adults with hypertension (8 women) were recruited. Using a within-subject design, participants performed a treadmill GXT to exhaustion followed by a multistage VER both before and after a 12-wkcombined exercise training programme. Individual VO₂max, respiratory exchange ratio (RER), maximal heart rate (HR_max), and rating of perceived exertion (RPE) were measured during both GXT and VER tests. Absolute and relative VO₂max values were higher in VER than in GXT at baseline, but only absolute VO₂max differed between bouts post-intervention (all p < 0.05). Individual VO₂max comparisons revealed that 75% of the participants (9/12) achieved a VO_2max value that was ≥3% during VER both before (range: +4.9% to +21%) and after the intervention (range: +3.4% to +18.8%), whereas 91.7% (11/12) of the tests would have been validated as a maximal effort if the classic criteria were employed. A 12-wk combined training intervention could not improve the capacity of older adults with hypertension to achieve VO₂max during a GXT, as assessed by VER.

Assessing Physical Fitness of Athletes in a Confined Environment during Prolonged Self-Isolation: Potential Usefulness of the Test of Maximal Number of Burpees Performed in 3 Minutes

Due to a prolonged period of quarantine during the COVID-19 pandemic, it is essential to monitor the physical condition of athletes isolated at home with a fitness tool that measures various aspects of physical fitness, which does not require any special equipment, and can be performed within a small space. This study assessed the reliability and validity of the test of performing the maximal number of burpees in 3 min (or 3-MBT) to monitor strength, power, and aerobic endurance in trained athletes. For Part I (reliability of the 3-MBT), 20 (10 male, 10 female) national athletes from various sports performed the 3-MBT on two separate test sessions. Athletes performed as many burpees as possible within 3 min and the primary performance criteria was the number of burpees completed (where a higher number reflected a better performance). The 3-MBT displayed excellent relative reliability in the athletes, with an intraclass correlation coefficient (ICC) and coefficient of variation (CV %) of >0.92, and <3.0%, respectively. For Part II (validity of the 3-MBT), 40 (20 M, 20 F) athletes performed the 3-MBT, and the countermovement jump (CMJ), isometric mid-thigh pull (IMTP), seated medicine ball throw (SMBT), isometric bench (IBP) and maximal aerobic power (VO2max) tests on separate sessions. When data of male and female athletes were pooled, there were significant correlations between relative 3-MBT and relative CMJ height (r = 0.65, large; p < 0.001), relative IMPT peak force (r = 0.50, large; p < 0.001), relative IBP peak force (r = 0.36, moderate, p = 0.02), and relative VO2max (r = 0.50, large; p < 0.001). In conclusion, the 3-MBT is a reliable and reasonably useful test and is a valid assessment of lower body power and strength, upper body strength and aerobic fitness in trained male and female athletes.

Verification of Maximal Oxygen Uptake in Active Military Personnel During Treadmill Running

ABSTRACT

Figueiredo, PS, Looney, DP, Pryor, JL, Doughty, EM, McClung, HL, Vangala, SV, Santee, WR, Beidleman, BA, and Potter, AW. Verification of maximal oxygen uptake in active military personnel during treadmill running. J Strength Cond Res 36(4): 1053-1058, 2022-It is unclear whether verification tests are required to confirm "true" maximal oxygen uptake (V̇o2max) in modern warfighter populations. Our study investigated the prevalence of V̇o2max attainment in U.S. Army soldiers performing a traditional incremental running test. In addition, we examined the utility of supramaximal verification testing as well as repeated trials for familiarization for accurate V̇o2max assessment. Sixteen U.S. Army soldiers (1 woman, 15 men; age, 21 ± 2 years; height, 1.73 ± 0.06 m; body mass, 71.6 ± 10.1 kg) completed 2 laboratory visits, each with an incremental running test (modified Astrand protocol) and a verification test (110% maximal incremental test speed) on a motorized treadmill. We evaluated V̇o2max attainment during incremental testing by testing for the definitive V̇O2 plateau using a linear least-squares regression approach. Peak oxygen uptake (V̇o2peak) was considered statistically equivalent between tests if the 90% confidence interval around the mean difference was within ±2.1 ml·kg-1·min-1. Oxygen uptake plateaus were identified in 14 of 16 volunteers for visit 1 (87.5%) and all 16 volunteers for visit 2 (100%). Peak oxygen uptake was not statistically equivalent, apparent from the mean difference in V̇o2peak measures between the incremental test and verification test on visit 1 (2.3 ml·kg-1·min-1, [1.3-3.2]) or visit 2 (1.1 ml·kg-1·min-1 [0.2-2.1]). Interestingly, V̇o2peak was equivalent, apparent from the mean difference in V̇o2peak measures between visits for the incremental tests (0.0 ml·kg-1·min-1 [-0.8 to 0.9]) but not the verification tests (-1.2 ml·kg-1·min-1 [-2.2 to -0.2]). Modern U.S. Army soldiers can attain V̇o2max by performing a modified Astrand treadmill running test. Additional familiarization and verification tests for confirming V̇o2max in healthy active military personnel may be unnecessary.

Assessment of Peak Oxygen Uptake with a Smartwatch and its Usefulness for Training of Runners

Peak oxygen uptake (˙VO _2peak ) is an important factor contributing to running performance. Wearable technology may allow the assessment of ˙VO _2peak more frequently and on a larger scale. We aim to i) validate the ˙VO _2peak assessed by a smartwatch (Garmin Forerunner 245), and ii) discuss how this parameter may assist to evaluate and guide training procedures. A total of 23 runners (12 female, 11 male; ˙VO _2peak : 48.6±6.8 ml∙min ⁻¹ ∙kg ⁻¹ ) visited the laboratory twice to determine their ˙VO _2peak during a treadmill ramp test. Between laboratory visits, participants wore a smartwatch and performed three outdoor runs to obtain ˙VO _2peak values provided by the smartwatch. The ˙VO _2peak obtained by the criterion measure ranged from 38 to 61 ml∙min ⁻¹ ∙kg ⁻¹ . The mean absolute percentage error (MAPE) between the smartwatch and the criterion ˙VO _2peak was 5.7%. The criterion measure revealed a coefficient of variation of 4.0% over the VO2peak range from 38–61 ml∙min ⁻¹ ∙kg ⁻¹ . MAPE between the smartwatch and criterion measure was 7.1, 4.1 and −6.2% when analyzing ˙VO _2peak ranging from 39–45 ml∙min ⁻¹ ∙kg ⁻¹ , 45–55 ml∙min ⁻¹ ∙kg ⁻¹ or 55–61 ml∙min ⁻¹ ∙kg ⁻¹ , respectively.

Validity of Estimating the Maximal Oxygen Consumption by Consumer Wearables: A Systematic Review with Meta-analysis and Expert Statement of the INTERLIVE Network

Background

Technological advances have recently made possible the estimation of maximal oxygen consumption (VO_2max) by consumer wearables. However, the validity of such estimations has not been systematically summarized using meta-analytic methods and there are no standards guiding the validation protocols.

Objective

The aim was to (1) quantitatively summarize previous studies investigating the validity of the VO_2max estimated by consumer wearables and (2) provide best-practice recommendations for future validation studies.

Methods

First, we conducted a systematic review and meta-analysis of studies validating the estimation of VO_2max by wearables. Second, based on the state of knowledge (derived from the systematic review) combined with the expert discussion between the members of the Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) consortium, we provided a set of best-practice recommendations for validation protocols.

Results

Fourteen validation studies were included in the systematic review and meta-analysis. Meta-analysis results revealed that wearables using resting condition information in their algorithms significantly overestimated VO_2max (bias 2.17 ml·kg⁻¹·min⁻¹; limits of agreement − 13.07 to 17.41 ml·kg⁻¹·min⁻¹), while devices using exercise-based information in their algorithms showed a lower systematic and random error (bias − 0.09 ml·kg⁻¹·min⁻¹; limits of agreement − 9.92 to 9.74 ml·kg⁻¹·min⁻¹). The INTERLIVE consortium proposed six key domains to be considered for validating wearable devices estimating VO_2max, concerning the following: the target population, reference standard, index measure, testing conditions, data processing, and statistical analysis.

Conclusions

Our meta-analysis suggests that the estimations of VO_2max by wearables that use exercise-based algorithms provide higher accuracy than those based on resting conditions. The exercise-based estimation seems to be optimal for measuring VO_2max at the population level, yet the estimation error at the individual level is large, and, therefore, for sport/clinical purposes these methods still need improvement. The INTERLIVE network hereby provides best-practice recommendations to be used in future protocols to move towards a more accurate, transparent and comparable validation of VO_2max derived from wearables.

PROSPERO ID

CRD42021246192.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01639-y.

High-intensity resistance exercise is not as effective as traditional high-intensity interval exercise for increasing the cardiorespiratory response and energy expenditure in recreationally active subjects

PURPOSE

Traditional high-intensity interval exercise (HIIE) highly stimulates the cardiorespiratory system and increases energy expenditure (EE) during exercise. High-intensity resistance exercise (HIRE) has become more popular in recreationally active subjects. The physiological responses to HIRE performed with light or moderate load is currently largely unknown. Here, we examined the effect of the type of interval exercise [HIRE at 40% (HIRE40) and 60% (HIRE60) 1-RM vs. traditional HIIE] on the cardiorespiratory response and EE during and after exercise.

METHODS

Fifteen recreationally active adults randomly completed traditional HIIE on an ergocyle, HIRE40 and HIRE60. The sessions consisted of two sets of ten 30-s intervals (power at 100% VO_2max during HIIE; maximal number of repetitions for 10 different free-weight exercises during HIRE40 and HIRE60) separated by 30-s active recovery periods. Gas exchange, heart rate (HR) and EE were assessed during and after exercise.

RESULTS

VO_2mean, VO_2peak, HR_mean, the time spent above 90% VO_2max and HR_max, and aerobic EE were lower in both HIRE sessions compared with HIIE (P < 0.05). Anaerobic glycolytic contribution to total exercise EE was higher in HIRE40 and HIRE60 compared with HIIE (P < 0.001). EE from excess post-exercise oxygen consumption (EPOC) was similar after the three sessions. Overall, similar cardiorespiratory responses and EE were found in HIRE40 and HIRE60.

CONCLUSIONS

HIRE is not as effective as HIIE for increasing the cardiorespiratory response and EE during exercise, while EPOC remains similar in HIRE and HIIE. These parameters are not substantially different between HIRE40 and HIRE60.

Real Assessment of Maximum Oxygen Uptake as a Verification After an Incremental Test Versus Without a Test

The study was conducted to compare peak oxygen uptake (VO_2peak) measured with the incremental graded test (GXT) (VO_2peak) and two tests to verify maximum oxygen uptake, performed 15 min after the incremental test (VO_2peak1) and on a separate day (VO_2peak2). The aim was to determine which of the verification tests is more accurate and, more generally, to validate the VO_2max obtained in the incremental graded test on cycle ergometer. The study involved 23 participants with varying levels of physical activity. Analysis of variance showed no statistically significant differences for repeated measurements (F = 2.28, p = 0.118, η² = 0.12). Bland–Altman analysis revealed a small bias of the VO_2peak1 results compared to the VO_2peak (0.4 ml⋅min^–1⋅kg^–1) and VO_2peak2 results compared to the VO_2peak (−0.76 ml⋅min^–1⋅kg^–1). In isolated cases, it was observed that VO_2peak1 and VO_2peak2 differed by more than 5% from VO_2peak. Considering the above, it can be stated that among young people, there are no statistically significant differences between the values of VO_2peak measured in the following tests. However, in individual cases, the need to verify the maximum oxygen uptake is stated, but performing a second verification test on a separate day has no additional benefit.

Comparison and Performance Validation of Calculated and Established Anaerobic Lactate Thresholds in Running

Background and Objectives: This study aimed to compare the calculated running velocity at the anaerobic lactate threshold (cLT_An), determined by a mathematical model for metabolic simulation, with two established threshold concepts (onset of blood lactate accumulation (OBLA; 4 mmol∙L⁻¹) and modified maximal deviation method (mDmax)). Additionally, all threshold concepts were correlated with performance in different endurance running events. Materials and Methods: Ten sub-elite runners performed a 30 s sprint test on a cycle ergometer adjusted to an isokinetic mode set to a cadence of 120 rpm to determine maximal lactate production rate (VLa_max), and a graded exercise test on a treadmill to determine maximal oxygen uptake (VO_2max). Running velocities at OBLA, mDmax, and cLT_An were then compared with each other, and further correlated with running performance over various distances (3000 m, 5000 m, and 10,000 m). Results: The mean difference in cLT_An was −0.13 ± 0.43 m∙s⁻¹ and −0.32 ± 0.39 m∙s⁻¹ compared to mDmax (p = 0.49) and OBLA (p < 0.01), respectively. cLT_An indicated moderate to good concordance with the established threshold concepts (mDmax: ICC = 0.87, OBLA: ICC = 0.74). In comparison with other threshold concepts, cLT_An exhibited comparable correlations with the assessed running performances (cLT_An: r = 0.61–0.76, mDmax: r = 0.69–0.79, OBLA: r = 0.56–0.69). Conclusion: Our data show that cLT_An can be applied for determining endurance performance during running. Due to the consideration of individual physiological profiles, cLT_An offers a physiologically justified approach to assess an athlete’s endurance performance.

Menstrual cycle impacts adipokine and lipoprotein responses to acute high-intensity intermittent exercise bout

Due to hormonal fluctuation, the menstrual cycle impacts inflammatory response and lipid metabolism; moreover, the anti-atherogenic and anti-inflammatory effects of exercise in this cycle, mainly high-intensity intermittent exercise (HIIE), need to be examined. Therefore, the aim of the current study was to investigate the influence of menstrual cycle phases on adipokine and lipoprotein responses after acute HIIE sessions in healthy women. Fourteen women (age: 24 ± 2 years; BMI: 22.79 ± 1.89 kg·m²) were recruited to perform two HIIE sessions (10 × 1 min running at 90% of maximum aerobic velocity, with 1 min recovery); one during the follicular phase (FP) and other during the luteal phase (LP), randomly. Blood samples were collected at rest, immediately, and 60 min after HIIE sessions. Macrophage inflammatory protein-1α (MIP-1α), leptin, adiponectin, total cholesterol, triacylglycerol (TAG), HDL-c, and glucose concentrations were analyzed. At rest, higher MIP-1α concentrations were observed during the LP compared to FP (p = 0.017). Likewise, leptin (p = 0.050), LDL-c (p = 0.015), and non-HDL (p = 0.016) were statistically higher in the LP. In contrast, the adiponectin/leptin ratio was lower in the LP compared to the ratio found in the FP (p = 0.032). Immediately post-HIIE sessions, in both menstrual phases, higher TAG (p = 0.001) and HDL-c (p = 0.001) concentrations were found, which returned to resting levels after 60 min. In conclusion, adipokine and lipoprotein responses after a single HIIE session are regulated by the phase of the menstrual cycle, contributing to inflammatory conditions, and demonstrating the importance of considering the phases of the menstrual cycle for the periodization of physical training.

Utility of Verification Testing to Confirm Attainment of Maximal Oxygen Uptake in Unhealthy Participants: A Perspective Review

Maximal oxygen uptake (VO₂max) is strongly associated with endurance performance as well as health risk. Despite the fact that VO₂max has been measured in exercise physiology for over a century, robust procedures to ensure that VO₂max is attained at the end of graded exercise testing (GXT) do not exist. This shortcoming led to development of an additional bout referred to as a verification test (VER) completed after incremental exercise or on the following day. Workloads used during VER can be either submaximal or supramaximal depending on the population tested. Identifying a true VO₂max value in unhealthy individuals at risk for or having chronic disease seems to be more paramount than in healthy and active persons, who face much lower risk of premature morbidity and mortality. This review summarized existing findings from 19 studies including 783 individuals regarding efficacy of VER in unhealthy individuals to determine its efficacy and feasibility in eliciting a 'true' VO₂max in this sample. Results demonstrated that VER is a safe and suitable approach to confirm attainment of VO₂max in unhealthy adults and children, as in most studies VER-derived VO₂max is similar of that obtained in GXT. However, many individuals reveal higher VO₂max in response to VER and protocols used across studies vary, which merits additional work identifying if an optimal VER protocol exists to elicit 'true' VO₂max in this particular population.

Five-Minute Power-Based Test to Predict Maximal Oxygen Consumption in Road Cycling

PURPOSE

To examine the ability of a multivariate model to predict maximal oxygen consumption (VO2max) using performance data from a 5-minute maximal test (5MT).

METHODS

Forty-six road cyclists (age 38 [9] y, height 177 [9] cm, weight 71.4 [8.6] kg, VO2max 61.13 [9.05] mL/kg/min) completed a graded exercise test to assess VO2max and power output. After a 72-hour rest, they performed a test that included a 5-minute maximal bout. Performance variables in each test were modeled in 2 independent equations, using Bayesian general linear regressions to predict VO2max. Stepwise selection was then used to identify the minimal subset of parameters with the best predictive power for each model.

RESULTS

Five-minute relative power output was the best explanatory variable to predict VO2max in the model from the graded exercise test (R2 95% credibility interval, .81-.88) and when using data from the 5MT (R2 95% credibility interval, .61-.77). Accordingly, VO2max could be predicted with a 5MT using the equation VO2max = 16.6 + (8.87 × 5-min relative power output).

CONCLUSIONS

Road cycling VO2max can be predicted in cyclists through a single-variable equation that includes relative power obtained during a 5MT. Coaches, cyclists, and scientists may benefit from the reduction of laboratory assessments performed on athletes due to this finding.

Effects of modern military backpack loads on walking speed and cardiometabolic responses of US Army Soldiers

INTRODUCTION

Military leaders must understand how modern military equipment loads affect trade-offs between movement speed and physiological strain to optimize pacing strategies.

PURPOSE

To evaluate the effects of load carried in a recently developed military backpack on the walking speed and cardiometabolic responses of dismounted warfighters.

METHODS

Fifteen soldiers (1 woman, 14 men; age, 22 ± 2 years; height, 173 ± 7 cm; body mass (BM), 73 ± 10 kg) completed incremental walking tests with four external load conditions (0, 22, 44, or 66% BM) using the US Army's newest backpack: the Modular Lightweight Load-Carrying Equipment 4000 (MOLLE 4000). Oxygen uptake (V̇O₂) and heart rate (HR) were evaluated relative to maximal values (V̇O_2max and HR_max respectively). Testing ceased when participants completed the highest tested speed (1.97 m s^-1), exceeded a respiratory exchange ratio (RER) of 1.00, or reached volitional exhaustion.

RESULTS

Peak speed significantly decreased (p < 0.03) with successively heavier loads (0% BM, 1.95 ± 0.06 m s^-1; 22% BM, 1.87 ± 0.10 m s^-1; 44% BM, 1.69 ± 0.13 m s^-1; 66% BM, 1.48 ± 0.13 m s^-1). Peak V̇O₂ was significantly lower (p < 0.01) with 0% BM (47 ± 5% V̇O_2max) than each load (22% BM, 58 ± 8% V̇O_2max; 44% BM, 63 ± 10% V̇O_2max; 66% BM, 61 ± 11% V̇O_2max). Peak HR was significantly lower (p < 0.01) with 0% BM (71 ± 5% HR_max) versus each load (22% BM, 83 ± 6% HR_max; 44% BM, 87 ± 6% HR_max; 66% BM, 88 ± 6% HR_max).

CONCLUSION

Overburdened warfighters suffer severe impairments in walking speed even when carrying recently developed military load carriage equipment. Our results suggest that the relative work intensity of heavy load carriage may be better described when expressed relative to HR_max versus V̇O_2max.

Incremental and decremental cardiopulmonary exercise testing protocols produce similar maximum oxygen uptake in athletes

The aim of the study was to evaluate and compare the maximal oxygen uptake (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max) achieved during incremental and decremental protocols in highly trained athletes. Nineteen moderate trained runners and rowers completed, on separate days, (i) an initial incremental \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max test (INC) on a treadmill, followed by a verification phase (VER); (ii) a familiarization of a decremental test (DEC); (iii) a tailored DEC; (iv) a test with decremental and incremental phases (DEC-INC); (v) and a repeated incremental test (INC_F). During each test \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O₂, carbon dioxide production, ventilation, heart and breath rates and ratings of perceived exertion were measured. No differences were observed in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max between INC (61.3 ± 5.2 ml kg⁻¹ min⁻¹) and DEC (61.1 ± 5.1 ml kg⁻¹ min⁻¹; average difference of ~ 11.58 ml min⁻¹; p = 0.831), between INC and DEC-INC (60.9 ± 5.3 ml kg⁻¹ min⁻¹; average difference of ~ 4.8 ml min⁻¹; p = 0.942) or between INC and INC_F (60.7 ± 4.4 ml kg⁻¹ min⁻¹; p = 0.394). \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max during VER (59.8 ± 5.1 ml kg⁻¹ min⁻¹) was 1.50 ± 2.20 ml kg⁻¹ min⁻¹ lower (~ 2.45%; p = 0.008) compared with values measured during INC. The typical error in the test-to-test changes for evaluating \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max over the five tests was 2.4 ml kg⁻¹ min⁻¹ (95% CI 1.4–3.4 ml kg⁻¹ min⁻¹). Decremental tests do not elicit higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O_2max than incremental tests in trained runners and rowers, suggesting that a plateau in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O₂ during the classic incremental and verification tests represents the maximum ceiling of aerobic power.

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.

Maximal and Submaximal Cardiorespiratory Responses to a Novel Graded Karate Test

The present study aimed to propose and assess the physiological responses of a novel graded karate test. Ten male national-level karate athletes (age 26 ± 5 yrs; body mass 69.5 ± 11.6 kg; height 1.70 ± 0.09 m) performed two exercise tests (separated by 2-7 days): 1) a running-based cardiopulmonary exercise test; 2) a graded karate test. The cardiopulmonary exercise test was comprised of an individualized ramp protocol for treadmill running, and the graded karate test was comprised of a sequence of 'kisami-gyaku-zuki" punching at a fixed frequency of a stationary target that becomes progressively distant. Cardiorespiratory responses, blood lactate concentration, and perceived exertion were measured. A verification phase was also performed in both tests to confirm the maximal physiological outcomes. The graded karate test evoked similar maximal responses to the running protocol: V̇O₂ (57.4 ± 5.1 vs 58.3 ± 3.5 mL·kg^-1·min^-1; p = 0.53), heart rate (192 ± 6 vs 193 ± 10]beats.min^-1; p = 0.62) and blood lactate (14.6 ± 3.4 vs 13.1 ± 3.0 mmol·L^-1; p = 0.14) with a shorter duration (351 ± 71 vs 640 ± 9 s; p < 0.001). Additionally, the graded karate test evoked higher V̇O₂ (72.6 ± 6.5 vs 64.4 ± 4.3 %V̇O_2MAX; p = 0.005) and heart rate (89.4 ± 4.6 vs 77.3 ± 7.2 %HR_MAX p < 0.001) at the ventilatory threshold and a higher heart rate (97.0 ± 2.4 vs 92.9 ± 2.2 %HR_MAX; p = 0.02) at the respiratory compensation point. Incremental and verification phases evoked similar responses in V̇O₂ and minute-ventilation during both tests. This novel displacement-based sport-specific test evoked similar maximal and higher submaximal responses, indicating a superior pathway to assess karate athletes.

Is a verification phase needed to determine V ˙ O2max across fitness levels?

INTRODUCTION

Current methods (plateau/secondary criteria) to determine maximal oxygen consumption (V ˙ O2max) are inconsistently achieved leading some to suggest the use of a verification phase (VP) to confirmV ˙ O2max.

PURPOSE

To provide further evidence for the inclusion of a VP to confirmV ˙ O2max in different fitness levels.

METHODS

Forty-nine participants (22 females; 21.9 ± 2.6 years, 24.3 ± 2.8 kg m-2, 45.27 ± 7.68 mL kg-1 min-1) had theirV ˙ O2 and heart rate measured during three graded exercise tests (GXT) on separate days each followed by a VP of differing intensity (85%, 95%, 105% final workload). Participants were divided into groups using norms adapted from American College of Sports MedicineV ˙ O2max guidelines (30.47-61.47 mL kg-1 min-1).V ˙ O2max was confirmed if theV ˙ O2peak on the VP or an additional GXT was within ± 2 × typical error of theV ˙ O2peak attained on the first GXT. There was no effect of test number so the third GXT was not included in comparison with VP.

RESULTS

TheV ˙ O2peak from the first GXT was not different than either value attained following the VP at 95 or 105% workload or a second GXT (p > 0.999). The 85% VPV ˙ O2peak was lower than the first GXTV ˙ O2peak (p = 0.002). The VP confirmed the GXTV ˙ O2peak on 73% of VP (no differences among fitness levels). Submaximal VP (85 and 95%) was less effective as 65% and 51% of participants achieved a higherV ˙ O2peak on one of the GXT.

CONCLUSION

The use of a VP at 105% or a second GXT was able to confirm theV ˙ O2max value attained across a range of fitness levels.

Peripheral BDNF and psycho-behavioral aspects are positively modulated by high-intensity intermittent exercise and fitness in healthy women

Acute high-intensity intermittent exercise (HIIE) induces the myokine secretion associated with neurogenesis, as well brain-derived neurotrophic factor (BDNF); however, it remains unknown how the menstrual phase influences this secretion after an acute exercise session. The current study aimed to investigate the effects of HIIE performed in luteal and follicular menstrual phases on BDNF, cognitive function, mood, and exercise enjoyment. Fourteen healthy women completed four experimental sessions, randomly. One graded exercise test (GXT) and one HIIE session (10 × 1-min runs 90% peak GXT velocity [1-min recovery]) were performed for each menstrual phase. Blood samples were collected at rest and immediately after efforts, and the profile of mood states questionnaire (POMS) and Stroop-task test were applied. During the HIIE, subjective scales were applied (feeling, felt arousal, rate of perceived exertion, and physical activity enjoyment). The main results showed that the serum BDNF presented no difference between menstrual phases (p = 0.870); however, HIIE increased BDNF concentration in both menstrual phases (p = 0.030). In addition, the magnitude of circulating BDNF variation (Δ%BDNF) and [Formula: see text] demonstrated an inverse relationship in the follicular phase (r =  - 0.539, p = 0.046), whereas in the luteal phase, Δ%BDNF was negatively correlated with time test (r =  - 0.684, p = 0.007) and RPE (r =  - 0.726, p = 0.004) in GXT. No differences between menstrual phases were observed for POMS (p ≥ 0.05); however, HIIE attenuated tension (p < 0.01), depression (p < 0.01), and anger moods (p < 0.01), independently of menstrual phases. The subjective scales and Stroop-task test did not show differences. In conclusion, menstrual cycle phase does not affect serum BDNF levels, cognitive function, mood, and exercise enjoyment. Contrary, HIIE increases peripheral BDNF and attenuates tension, depression, and anger independently of menstrual phase. In addition, Δ%BDNF was correlated with physical fitness in the follicular phase, exhibiting higher changes in women with lower physical fitness status.

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.

Verification-phase tests show low reliability and add little value in determining V ˙ ⁢ O 2 ⁢ max in young trained adults

OBJECTIVE

This study compared the robustness of aV ˙ ⁢ O 2 -plateau definition and a verification-phase protocol to day-to-day and diurnal variations in determining the trueV ˙ ⁢ O 2 ⁢ max . Further, the additional value of a verification-phase was investigated.

METHODS

Eighteen adults performed six cardiorespiratory fitness tests at six different times of the day (diurnal variation) as well as a seventh test at the same time the sixth test took place (day-to-day variation). A verification-phase was performed immediately after each test, with a stepwise increase in intensity to 50%, 70%, and 105% of the peak power output.

RESULTS

Participants meanV ˙ ⁢ O 2 ⁢ p ⁢ e ⁢ a ⁢ k was 56 ± 8 mL/kg/min. Gwet's AC1 values (95% confidence intervals) for the day-to-day and diurnal variations were 0.64 (0.22, 1.00) and 0.71 (0.42, 0.99) forV ˙ ⁢ O 2 -plateau and for the verification-phase 0.69 (0.31, 1.00) and 0.07 (-0.38, 0.52), respectively. In 66% of the tests, performing the verification-phase added no value, while, in 32% and 2%, it added uncertain value and certain value, respectively, in the determination ofV ˙ ⁢ O 2 ⁢ max .

CONCLUSION

Compared toV ˙ ⁢ O 2 -plateau the verification-phase shows lower reliability, increases costs and only adds certain value in 2% of cases.

Supra-Versus Submaximal Cycle Ergometer Verification of VO2max in Males and Females

This study was designed to determine the optimal intensity for verification phase testing (VP) in healthy, young adults. Thirty one young, active participants (16 females) completed a cycle ergometer graded exercise test (GXT) VO_2max test and 4 VP tests at 80, 90, 100, and 105% of the maximum wattage achieved during the GXT. GXT and VP VO_2max values showed a significant test x sex interaction (p = 0.02). The males elicited significantly higher VO_2max values during the GXT, 80%, and 90% when compared to the 105%, (105 vs. GXT: p = 0.05; 105% vs. 80%: p < 0.01; 105% vs. 90%: p = 0.02). There were no significant differences in VO_2max across the tests in the females (p > 0.05); 80% of the males achieved their highest VP VO_2max during a submaximal VP test compared to only 37.5% of the females. A secondary study conducted showed excellent reliability (ICCs > 0.90) and low variation (CVs < 3%) for the 90% VP. Our findings show that a submaximal verification phase intensity is ideal for young healthy males to elicit the highest VO_2max during cycle ergometer testing. For females, a range of intensities (80-105%) produce similar VO_2max values. However, the 80% VP yields an unnecessarily high time to exhaustion.

Predicting Maximal Oxygen Uptake Using the 3-Minute All-Out Test in High-Intensity Functional Training Athletes

Maximal oxygen uptake (VO2max) and critical speed (CS) are key fatigue-related measurements that demonstrate a relationship to one another and are indicative of athletic endurance performance. This is especially true for those that participate in competitive fitness events. However, the accessibility to a metabolic analyzer to accurately measure VO2max is expensive and time intensive, whereas CS may be measured in the field using a 3 min all-out test (3MT). Therefore, the purpose of this study was to examine the relationship between VO2max and CS in high-intensity functional training (HIFT) athletes. Twenty-five male and female (age: 27.6 ± 4.5 years; height: 174.5 ± 18.3 cm; weight: 77.4 ± 14.8 kg; body fat: 15.7 ± 6.5%) HIFT athletes performed a 3MT as well as a graded exercise test with 48 h between measurements. True VO2max was determined using a square-wave supramaximal verification phase and CS was measured as the average speed of the last 30 s of the 3MT. A statistically significant and positive correlation was observed between relative VO2max and CS values (r = 0.819, p < 0.001). Based on the significant correlation, a linear regression analysis was completed, including sex, in order to develop a VO2max prediction equation (VO2max (mL/kg/min) = 8.449(CS) + 4.387(F = 0, M = 1) + 14.683; standard error of the estimate = 3.34 mL/kg/min). Observed (47.71 ± 6.54 mL/kg/min) and predicted (47.71 ± 5.7 mL/kg/min) VO2max values were compared using a dependent t-test and no significant difference was displayed between the observed and predicted values (p = 1.000). The typical error, coefficient of variation, and intraclass correlation coefficient were 2.26 mL/kg/min, 4.90%, and 0.864, respectively. The positive and significant relationship between VO2max and CS suggests that the 3MT may be a practical alternative to predicting maximal oxygen uptake when time and access to a metabolic analyzer is limited.

Comparison of the Ekblom-Bak Submaximal Test to a Maximal Test in a Cohort of Healthy Younger and Older Adults in the United States

Cardiorespiratory fitness (CRF) is routinely investigated in diverse populations, including in older adults of varying physical activity levels. Commonly performed maximal exercise testing protocols might be contraindicated and/or inadequate for older individuals who have physical or cognitive impairment. Moreover, early termination of an attempted maximal exercise test could result in underestimation of CRF in this population. The goal of the current study was to compare CRF estimates using the Ekblom-Bak (EB) submaximal exercise test - previously validated in a cohort of Scandinavian adults - versus a subsequent maximal exercise test in a diverse, Midwestern United States cohort. Fifteen generally healthy individuals were included in this study who were either "Young" (25-34 years old) or "Older" (55-75 years old) as well as either sedentary or highly active. Participants completed the EB submaximal exercise test, followed immediately by a maximal exercise test. We found that all 15 individuals were able to successfully perform the EB submaximal testing method. Across the wide range of volumes of maximal oxygen consumption (VO2max; 12-52 ml/kg/min), the EB submaximal estimates of VO2max correlated highly with the maximal test based values (Pearson's r = 0.98), but with a small bias (6 ml/kg/min, 95% limits of agreement -1.06 and -11.29). Our results suggest that the EB submaximal testing method may be useful in identifying wide differences in CRF among a diverse cohort of older adults in the United States, but larger studies will be needed to determine the degree of its accuracy and precision in identifying smaller differences.

Exercise intensity prescription in cancer survivors: ventilatory and lactate thresholds are useful submaximal alternatives to VO2peak

PURPOSE

Most studies with cancer survivors use percentages of peak oxygen uptake (VO2peak) for intensity prescription. Lactate or ventilatory thresholds might be useful submaximal alternatives, but this has never been investigated. Therefore, we aimed at comparing three training sessions prescribed using %VO2peak (reference), lactate thresholds, and ventilatory thresholds in terms of meeting the vigorous-intensity zone, physiological, and psychological responses.

METHODS

Twenty breast (58 ± 10 years) and 20 prostate cancer survivors (68 ± 6 years), 3.6 ± 2.4 months after primary therapy, completed a maximal cardiopulmonary exercise test and three vigorous training sessions in randomized order: 38 min of cycling at 70% VO2peak (M-VO2peak), 97% of individual anaerobic lactate threshold (M-IAT), and 67% between ventilatory thresholds 1 and 2 (M-VT). Heart rate (HR), blood lactate concentration (bLa), perceived exertion, and enjoyment were assessed.

RESULTS

Cancer survivors exercised at 75 ± 23, 85 ± 18, and 79 ± 19 W during M-VO2peak, M-IAT, and M-VT (p > .05). Sessions could not be completed in 3, 8, and 6 cases. Session completers showed HR of 82 ± 7, 83 ± 9, and 84 ± 8 %HRpeak and bLa of 3.7 ± 1.9, 3.9 ± 0.9, and 3.9 ± 1.5 mmol·l-1, which was not different between sessions (p > .05). However, variance in bLa was lower in M-IAT compared to M-VO2peak (p = .001) and to M-VT (p = .022).

CONCLUSION

All intensity prescription methods on average met the targeted intensity zone. Metabolic response was most homogeneous when using lactate thresholds.

IMPLICATIONS FOR CANCER SURVIVORS

Submaximal thresholds are at least as useful as VO2peak for intensity prescription in cancer survivors. Overall, slightly lower percentages should be chosen to improve durability of the training sessions.

Backward extrapolation technique: analysis of different criteria after supramaximal exercise in cycling

BACKGROUND

Backward extrapolation technique (BE) was used to estimate V̇O<inf>2</inf> from postexercise measuring, eliminating oronasal mask (OM) during the efforts. Despite its advantage, literature presents discrepancy in applied methods. Thus, the first aim of this study was to compare different mathematical criteria to estimate values of V̇O<inf>2</inf> during a supramaximal effort (V̇O<inf>2PEAK</inf>), while the second aim was to verify the effects of OM on cycling performance.

METHODS

Twenty-four male cyclists (35±6 years, 81.3±8.9 kg, 180±6 cm) performed three days of tests, with at least 24 h of interval between each test. Firstly, a graded exercise test was applied to determine V̇O<inf>2max</inf> and your correspondent intensity (MAP). The second and the third day were destined to supramaximal efforts at 120% of MAP, performed with (Supra<inf>mask</inf>) and without (Supra<inf>be</inf>) oronasal mask (OM) in a randomized order. After Supra<inf>be</inf>, OM was coupled, and BE was applied. Sixty-six values of V̇O<inf>2</inf> were obtained based on a linear regression fitting.

RESULTS

V̇O<inf>2peak</inf> can be estimated using different curve lengths. However, only curves between 20 and 60 s with extrapolation to 3 s or lesser shows at least one consistent criterion. The 60 s curve extrapoled to -3 s was the most accurate criteria (P=0.723; ES=-0.055; r=0.824; Bias=-0.36 and LoA=7.72 mL.kg.min^-1). Performance was not impaired with OM and was similar in both condition (P=0.84, ES=0.04).

CONCLUSIONS

We conclude that it was possible to accurately estimate V̇O<inf>2</inf> values of a supramaximal effort without any respiratory apparatus with a time-efficient analysis. Therefore, we recommended the use of a 60 seconds V̇O<inf>2</inf> curve analysis with a negative extrapolation for 3 seconds.

Measuring maximum oxygen uptake with an incremental swimming test and by chasing rainbow trout to exhaustion inside a respirometry chamber yields the same results

This study hypothesized that oxygen uptake (ṀO₂ ) measured with a novel protocol of chasing rainbow trout Oncorhynchus mykiss to exhaustion inside a static respirometer while simultaneously monitoring ṀO₂ (ṀO_2chase ) would generate the same and repeatable peak value as when peak active ṀO₂ (ṀO_2active ) is measured in a critical swimming speed protocol. To reliably determine peak ṀO_2chase , and compare to the peak during recovery of ṀO₂ after a conventional chase protocol outside the respirometer (ṀO_2rec ), this study applied an iterative algorithm and a minimum sampling window duration (i.e., 1 min based on an analysis of the variance in background and exercise ṀO₂ ) to account for ṀO₂ dynamics. In support of this hypothesis, peak ṀO_2active (707 ± 33 mg O₂ h^-1 kg^-1 ) and peak ṀO_2chase (663 ± 43 mg O₂ h^-1 kg^-1 ) were similar (P = 0.49) and repeatable (Pearson's and Spearman's correlation test; r ≥ 0.77; P < 0.05) when measured in the same fish. Therefore, estimates of ṀO_2max can be independent of whether a fish is exhaustively chased inside a respirometer or swum to fatigue in a swim tunnel, provided ṀO₂ is analysed with an iterative algorithm and a minimum but reliable sampling window. The importance of using this analytical approach was illustrated by peak ṀO_2chase being 23% higher (P < 0.05) when compared with a conventional sequential interval regression analysis, whereas using the conventional chase protocol (1-min window) outside the respirometer increased this difference to 31% (P < 0.01). Moreover, because peak ṀO_2chase was 18% higher (P < 0.05) than peak ṀO_2rec , chasing a fish inside a static respirometer may be a better protocol for obtaining maximum ṀO₂ .

Criteria for the determination of maximal oxygen uptake in patients newly diagnosed with cancer: Baseline data from the randomized controlled trial of physical training and cancer (Phys-Can)

Introduction

Maximal oxygen uptake (V˙O2max) is a measure of cardiorespiratory fitness often used to monitor changes in fitness during and after treatment in cancer patients. There is, however, limited knowledge in how criteria verifying V˙O2max work for patients newly diagnosed with cancer. Therefore, the aim of this study was to describe the prevalence of fulfillment of typical criteria verifying V˙O2max and to investigate the associations between the criteria and the test leader’s evaluation whether a test was performed “to exhaustion”. An additional aim was to establish new cut-points within the associated criteria.

Methods

From the Phys-Can randomized controlled trial, 535 patients (59 ±12 years) newly diagnosed with breast (79%), prostate (17%) or colorectal cancer (4%) performed an incremental V˙O2max test on a treadmill. The test was performed before starting (neo-)adjuvant treatment and an exercise intervention. Fulfillment of different cut-points within typical criteria verifying V˙O2max was described. The dependent key variables included in the initial bivariate analysis were achievement of a V˙O2 plateau, peak values for maximal heart rate, respiratory exchange ratio (RER), the patients’ rating of perceived exertion on Borg’s scale_6-20 and peak breathing frequency (f_R). A receiver operating characteristic analysis was performed to establish cut-points for variables associated with the test leader’s evaluation. Last, a cross-validation of the cut-points found in the receiver operating characteristic analysis was performed on a comparable sample of cancer patients (n = 80).

Results

The criteria RERpeak (<0.001), Borg’s RPE (<0.001) and f_R peak (p = 0.018) were associated with the test leader’s evaluation of whether a test was defined as “to exhaustion”. The cut-points that best predicted the test leader’s evaluation were RER ≥ 1.14, RPE ≥ 18 and f_R ≥ 40. Maximal heart rate and V˙O2 plateau was not associated with the test leader’s evaluation.

Conclusion

We recommend a focus on RER (in the range between ≥1.1 and ≥1.15) and RPE (≥17 or ≥18) in addition to the test leader’s evaluation. Additionally, a f_R peak of ≥40 breaths/min may be a cut-point to help the test leader evaluate the degree of exhaustion. However, more research is needed to verify our findings, and to investigate how these criteria will work within a population that are undergoing or finished with cancer treatment.

Cycling Performance Enhancement After Drop Jumps May Be Attributed to Postactivation Potentiation and Increased Anaerobic Capacity

de Poli, RAB, Boullosa, DA, Malta, ES, Behm, D, Lopes, VHF, Barbieri, FA, and Zagatto, AM. Cycling performance enhancement after drop jumps may be attributed to postactivation potentiation and increased anaerobic capacity. J Strength Cond Res 34(9): 2465-2475, 2020-The study aimed to investigate the effects of drop jumps (DJs) on supramaximal cycling performance, anaerobic capacity (AC), electromyography, and fatigue. Thirty-eight recreational cyclists participated into 3 independent studies. In study 1 (n = 14), neuromuscular fatigue was assessed with the twitch interpolation technique. In study 2 (n = 16), the AC and metabolic contributions were measured with the maximal accumulated oxygen deficit method and the sum of the glycolytic and phosphagen pathways. In study 3 (n = 8), postactivation potentiation (PAP) induced by repeated DJs was evaluated. The DJ protocol was effective for significantly improving cycling performance by +9.8 and +7.4% in studies 1 and 2, respectively (p ≤ 0.05). No differences were observed in electromyography between conditions (p = 0.70); however, the force evoked by a doublet at low (10 Hz) and high frequencies (100 Hz) declined for control (-16.4 and -23.9%) and DJ protocols (-18.6 and -26.9%) (p < 0.01). Force decline was greater in the DJ condition (p < 0.03). Anaerobic capacity and glycolytic pathway contributions were +7.7 and +9.1% higher after DJ protocol (p = 0.01). Peak force during maximal voluntary contraction (+5.6%) and doublet evoked force at 100 Hz (+5.0%) were higher after DJs. The DJ protocol induced PAP, improved supramaximal cycling performance, and increased AC despite higher peripheral fatigue.

Water-based continuous and interval training in older women: Cardiorespiratory and neuromuscular outcomes (WATER study)

The purpose of this study was to investigate the effects of two water-based aerobic programs on cardiorespiratory and neuromuscular outcomes in older women. Forty-one women (60 to 75 years old) volunteered to participate in the study. Participants were randomized into a water-based continuous (CTG; n = 21; 63.9 ± 2.5 years) or an interval (ITG; n = 20; 64.8 ± 3.6 years) aerobic training group. Both training programs were performed for 12 weeks (45-min sessions twice a week), with exercise intensity based on rating of perceived exertion (Borg's RPE 6-20 Scale). Pre and post training assessments of cardiorespiratory and neuromuscular outcomes were performed. Data analyses were conducted using Generalized Estimating Equations and Bonferroni post-hoc test (α = 0.05). After the intervention, the CTG and the ITG displayed similar improvements in time to exhaustion (8% vs. 11%), peak oxygen uptake (9% vs. 7%), maximal dynamic knee extension strength (5% vs. 6%), dynamic muscular endurance of knee extensors (10% vs. 11%), maximal vastus lateralis electromyographic signal amplitude (13% vs. 35%), as well as an increase in muscle thickness (5% vs. 6%) and decrease in muscle echo intensity (-2% vs. -3%) of the quadriceps femoris. In conclusion, older women benefited from water-based exercise training prescribed based on participants' RPE, with both the interval and the continuous training programs resulting in similar increases in the cardiorespiratory and neuromuscular parameters.

Índice de masa corporal y capacidad cardiorrespiratoria en docentes de colegios públicos de Barranquilla, Colombia

Introducción. La capacidad cardiorrespiratoria (CCR) es un excelente indicador para medir la salud, pues su disminución puede ser un marcador temprano de alteraciones en el sistema cardiovascular.Objetivo. Determinar la relación entre el índice de masa corporal (IMC) y la CCR en docentes de colegios públicos de Barranquilla, Colombia.Materiales y métodos. Estudio descriptivo con diseño transversal y correlacional realizado entre octubre de 2015 y mayo de 2016 en una muestra de 363 docentes de colegios públicos de Barranquilla. Se recolectaron los datos sociodemográficos de los participantes, y se utilizó el test de Rockport o test de la milla para medir su IMC y CCR.Resultados. La media de edad fue 48.1±9.4 años, el 72.1% de los participantes fueron mujeres y el 65.55% de la población tuvo un IMC>25 kg/m2. Por otra parte, la CCR obtuvo una media de 26.4 mL/kg/min y mostró una correlación inversa con el IMC (p<0.05).Conclusión. Teniendo en cuenta la alta prevalencia de sobrepeso y obesidad y la baja CCR observadas en la población estudiada, es necesario implementar programas de promoción y prevención de la salud que estén mediados por la actividad física y el componente nutricional, y que ayuden a la adquisición de estilos de vida saludables.

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.

The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy.http://bit.ly/31SXeB5

Incidence of V˙O2max Responders to Personalized versus Standardized Exercise Prescription

INTRODUCTION

Despite knowledge of cardiorespiratory fitness (CRF) training responders and nonresponders, it is not well understood how the exercise intensity prescription affects the incidence of response. The purpose of this study was to determine CRF training responsiveness based on cohort-specific technical error after 12 wk of standardized or individually prescribed exercise and the use of a verification protocol to confirm maximal oxygen uptake (V˙O2max).

METHODS

Sedentary adult participants (9 men, 30 women; 48.2 ± 12.2 yr) completed exercise training on 3 d·wk for 12 wk, with exercise intensity prescribed based on standardized methods using heart rate reserve or an individualized approach using ventilatory thresholds. A verification protocol was used at baseline and 12 wk to confirm the identification of a true V˙O2max and subsequent relative percent changes to quantify CRF training responsiveness. A cohort-specific technical error (4.7%) was used as a threshold to identify incidence of response.

RESULTS

Relative V˙O2max significantly increased (P < 0.05) from 24.3 ± 4.6 to 26.0 ± 4.2 and 29.2 ± 7.5 to 32.8 ± 8.6 mL·kg·min for the standardized and individualized groups, respectively. Absolute V˙O2max significantly increased (P < 0.05) from 2.0 ± 0.6 to 2.2 ± 0.6 and 2.4 ± 0.8 to 2.6 ± 0.9 L·min for the standardized and individualized groups, respectively. A significant difference in responsiveness was found between the individualized and standardized groups with 100% and 60% of participants categorized as responders, respectively.

CONCLUSIONS

A threshold model for exercise intensity prescription had a greater effect on the incidence of CRF training response compared with a standardized approach using heart rate reserve. The use of thresholds for intensity markers accounts for individual metabolic characteristics and should be considered as a viable and practical method to prescribe exercise intensity.

Electrically assisted cycling for individuals with type 2 diabetes mellitus: protocol for a pilot randomized controlled trial

Background

The global incidence of type 2 diabetes mellitus (T2DM) is increasing. Given the many complications associated with T2DM, effective management of the disease is crucial. Physical activity is considered to be a key component of T2DM management. However, people with T2DM are generally less physically active than individuals without T2DM and adherence to physical activity is often poor following completion of lifestyle interventions. As such, developing interventions that foster sustainable physical activity is of high priority. Electrically assisted bicycles (e-bikes) have been highlighted as a potential strategy for promoting physical activity in this population. E-bikes provide electrical assistance to the rider only when pedalling and could overcome commonly reported barriers to regular cycling. This paper describes the protocol of the PEDAL-2 pilot randomized controlled trial, an e-cycling intervention aimed at increasing physical activity in individuals with T2DM.

Methods

A parallel-group two-arm randomized waitlist-controlled pilot trial will be conducted. Forty individuals with T2DM will be randomly assigned, in a 1:1 allocation ratio, to an e-cycling intervention or waitlist control. Recruitment and screening will close once 20 participants have been randomized to each study arm. The intervention will involve e-bike training with a certified cycle instructor and provision of an e-bike for 12 weeks. Data will be collected at baseline, during the intervention and immediately post-intervention using both quantitative and qualitative methods. In this trial, the primary interests are determination of effective recruitment strategies, recruitment and consent rates, adherence and retention and delivery and receipt of the intervention. The potential impact of the intervention on a range of clinical, physiological and behaviour outcomes will be assessed to examine intervention promise. Data analyses will be descriptive.

Discussion

This paper describes the protocol for the PEDAL-2 pilot randomized controlled trial. Results from this trial will provide information on trial feasibility and identify the promise of e-cycling as a strategy to positively impact the health and behaviour of individuals with T2DM. If appropriate, this information can be used to design and deliver a fully powered definitive trial.

Trial registration

ISRCTN, ISRCTN67421464. Registered 03/01/2019.