Validity of the relative percent concept for equating training intensity

Evidence that the talk test can be used to regulate exercise intensity

The Talk Test (TT) has been shown to be a surrogate of the ventilatory threshold and to be a viable alternative to standard methods of prescribing exercise training intensity. The TT has also been shown to be responsive to manipulations known to change physiologic function including blood donation and training. Whether the TT can be used independently to regulated training intensity is not known. Physically active volunteers (N = 16) performed an incremental exercise test to identify stages of the TT (Last Positive [LP], Equivocal [EQ], and Negative [NEG]). In subsequent, randomly ordered, 30-minute steady-state runs, the running velocity was regulated solely by "clamping" the TT response desired and then monitoring the response of conventional markers of exercise intensity (heart rate, blood lactate, rating of perceived exertion). All subjects were able to complete the LP stage, but only 13 of 16 and 2 of 16 subjects were able to complete the EQ and NEG stages, respectively. Physiologic responses were broadly within those predicted from the incremental exercise test and within the appropriate range of physiologic responses for exercise training. Thus, in addition to correlating with convenient physiological markers, the TT can be used proactively to guide exercise training intensity. The LP stage produced training intensities compatible with appropriate training intensity in healthy adults and with recovery sessions or long duration training sessions in athletes. The EQ and NEG stages produced intensities compatible with higher intensity training in athletes. The results demonstrate that the TT can be used as a primary method to control exercise training intensity.

Is a threshold-based model a superior method to the relative percent concept for establishing individual exercise intensity? a randomized controlled trial

BACKGROUND

Exercise intensity is arguably the most critical component of the exercise prescription model. It has been suggested that a threshold based model for establishing exercise intensity might better identify the lowest effective training stimulus for all individuals with varying fitness levels; however, experimental evidence is lacking. The purpose of this study was to compare the effectiveness of two exercise training programs for improving cardiorespiratory fitness: threshold based model vs. relative percent concept (i.e., % heart rate reserve - HRR).

METHODS

Apparently healthy, but sedentary men and women (n = 42) were randomized to a non-exercise control group or one of two exercise training groups. Exercise training was performed 30 min/day on 5 days/week for 12weeks according to one of two exercise intensity regimens: 1) a relative percent method was used in which intensity was prescribed according to percentages of heart rate reserve (HRR group), or 2) a threshold based method (ACE-3ZM) was used in which intensity was prescribed according to the first ventilatory threshold (VT1) and second ventilatory threshold (VT2).

RESULTS

Thirty-six men and women completed the study. After 12weeks, VO2max increased significantly (p < 0.05 vs. controls) in both HRR (1.76 ± 1.93 mL/kg/min) and ACE-3ZM (3.93 ± 0.96 mL/kg/min) groups. Repeated measures ANOVA identified a significant interaction between exercise intensity method and change in VO2max values (F = 9.06, p < 0.05) indicating that VO2max responded differently to the method of exercise intensity prescription. In the HRR group 41.7 % (5/12) of individuals experienced a favorable change in relative VO2max (Δ > 5.9 %) and were categorized as responders. Alternatively, exercise training in the ACE-3ZM group elicited a positive improvement in relative VO2max (Δ > 5.9 %) in 100 % (12/12) of the individuals.

CONCLUSIONS

A threshold based exercise intensity prescription: 1). elicited significantly (p < 0.05) greater improvements in VO2max, and 2). attenuated the individual variation in VO2max training responses when compared to relative percent exercise training. These novel findings are encouraging and provide important preliminary data for the design of individualized exercise prescriptions that will enhance training efficacy and limit training unresponsiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: ID NCT02351713 Registered 30 January 2015.

High responders and low responders: factors associated with individual variation in response to standardized training

The response to an exercise intervention is often described in general terms, with the assumption that the group average represents a typical response for most individuals. In reality, however, it is more common for individuals to show a wide range of responses to an intervention rather than a similar response. This phenomenon of 'high responders' and 'low responders' following a standardized training intervention may provide helpful insights into mechanisms of training adaptation and methods of training prescription. Therefore, the aim of this review was to discuss factors associated with inter-individual variation in response to standardized, endurance-type training. It is well-known that genetic influences make an important contribution to individual variation in certain training responses. The association between genotype and training response has often been supported using heritability estimates; however, recent studies have been able to link variation in some training responses to specific single nucleotide polymorphisms. It would appear that hereditary influences are often expressed through hereditary influences on the pre-training phenotype, with some parameters showing a hereditary influence in the pre-training phenotype but not in the subsequent training response. In most cases, the pre-training phenotype appears to predict only a small amount of variation in the subsequent training response of that phenotype. However, the relationship between pre-training autonomic activity and subsequent maximal oxygen uptake response appears to show relatively stronger predictive potential. Individual variation in response to standardized training that cannot be explained by genetic influences may be related to the characteristics of the training program or lifestyle factors. Although standardized programs usually involve training prescribed by relative intensity and duration, some methods of relative exercise intensity prescription may be more successful in creating an equivalent homeostatic stress between individuals than other methods. Individual variation in the homeostatic stress associated with each training session would result in individuals experiencing a different exercise 'stimulus' and contribute to individual variation in the adaptive responses incurred over the course of the training program. Furthermore, recovery between the sessions of a standardized training program may vary amongst individuals due to factors such as training status, sleep, psychological stress, and habitual physical activity. If there is an imbalance between overall stress and recovery, some individuals may develop fatigue and even maladaptation, contributing to variation in pre-post training responses. There is some evidence that training response can be modulated by the timing and composition of dietary intake, and hence nutritional factors could also potentially contribute to individual variation in training responses. Finally, a certain amount of individual variation in responses may also be attributed to measurement error, a factor that should be accounted for wherever possible in future studies. In conclusion, there are several factors that could contribute to individual variation in response to standardized training. However, more studies are required to help clarify and quantify the role of these factors. Future studies addressing such topics may aid in the early prediction of high or low training responses and provide further insight into the mechanisms of training adaptation.

Sex differences in cardiovascular function during submaximal exercise in humans

Differences in cardiovascular function between sexes have been documented at rest and maximal exercise. The purpose of this study was to examine the sex differences in cardiovascular function during submaximal constant-load exercise, which is not well understood.

Thirty-one male and 33 female subjects completed nine minutes moderate and nine minutes vigorous intensity submaximal exercise (40 and 75% of peak watts determined by maximal exercise test). Measurements included: intra-arterial blood pressure (SBP and DBP), cardiac index (Q_I), heart rate (HR), oxygen consumption (VO₂) and arterial catecholamines (epinephrine = EPI and norepinephrine = NE), and blood gases. Mean arterial pressure (MAP), stroke volume index (SV_I), systemic vascular resistance index (SVR_I), arterial oxygen content (CaO₂), arterial to venous O₂ difference (AVO₂) and systemic oxygen transport (SOT) were calculated.

At rest and during submaximal exercise Q_I, SV_I, SBP, MAP, NE, CaO₂, and SOT were lower in females compared to males. VO₂, AVO₂, EPI were lower in females throughout exercise. When corrected for wattage, females had a higher Q, HR, SV, VO₂ and AVO₂ despite lower energy expenditure and higher mechanical efficiency.

This study demonstrates sex differences in the cardiovascular response to constant-load submaximal exercise. Specifically, females presented limitations in cardiac performance in which they are unable to compensate for reductions in stroke volume through increases in HR, potentially a consequence of a female’s blunted sympathetic response and higher vasodilatory state. Females demonstrated greater cardiac work needed to meet the same external work demand, and relied on increased peripheral oxygen extraction, lower energy expenditure and improvements in mechanical efficiency as compensatory mechanisms.

Intensity control in swim training by means of the individual anaerobic threshold

This study aimed at evaluating the homogeneity of physiological responses during swim training bouts with intensities prescribed by reference to the individual anaerobic threshold (IAT). Eighteen competitive front crawl swimmers (female 5, male 13, 10 long-distance, and 8 short-distance swimmers [LDSs, SDSs], age: 17 ± 1.7 years, training history: 7.0 ± 2.8 years, training volume per week: 35 ± 5.7 km) performed an incremental swimming test to determine the IAT. Within a maximum of 3 weeks, 4 training programs were conducted: 20 × 100-m low-intensity endurance training (EN(low), 97% IAT), 5 × 400-m high-intensity endurance training (EN(high), 101% IAT), 5 × 200 m (IT1, 105% IAT), and 10 × 100 m (IT2, 108% IAT) intensive interval training. Blood lactate concentrations (bLa) were determined during each training session. The results are given as median (25th and 75th percentiles). During EN(low) and EN(high), the mean bLas were 1.8 mmol·L(-1) (1.3/3.0 mmol·L(-1)) and 4.4 mmol·L(-1) (3.9/6.4 mmol·L(-1)). The bLas were higher during both IT programs: IT1, 6.3 mmol·L(-1) (5.6/7.2 mmol·L(-1)); IT2, 5.8 mmol·L(-1) (5.0/6.5 mmol·L(-1)). The bLas of most individuals were close to the median values (±2.4 mmol·L(-1)). However, in each of the training programs, some subjects showed bLa values that were clearly above (3-7 mmol·L(-1) higher). In particular, SDSs reached higher bLas at the same intensity compared with LDSs. It is concluded that intensity prescriptions by means of IAT seem to elicit an expected metabolic response in approximately 85% of swim training sessions. The observed average bLa is in the range of those recommended in the scientific literature.

Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

The pleasure and displeasure people feel when they exercise at different intensities: decennial update and progress towards a tripartite rationale for exercise intensity prescription

The public health problem of physical inactivity has proven resistant to research efforts aimed at elucidating its causes and interventions designed to alter its course. Thus, in most industrialized countries, the majority of the population is physically inactive or inadequately active. Most theoretical models of exercise behaviour assume that the decision to engage in exercise is based on cognitive factors (e.g. weighing pros and cons, appraising personal capabilities, evaluating sources of support). Another, still-under-appreciated, possibility is that these decisions are influenced by affective variables, such as whether previous exercise experiences were associated with pleasure or displeasure. This review examines 33 articles published from 1999 to 2009 on the relationship between exercise intensity and affective responses. Unlike 31 studies that were published until 1998 and were examined in a 1999 review, these more recent studies have provided evidence of a relation between the intensity of exercise and affective responses. Pleasure is reduced mainly above the ventilatory or lactate threshold or the onset of blood lactate accumulation. There are pleasant changes at sub-threshold intensities for most individuals, large inter-individual variability close to the ventilatory or lactate threshold and homogeneously negative changes at supra-threshold intensities. When the intensity is self-selected, rather than imposed, it appears to foster greater tolerance to higher intensity levels. The evidence of a dose-response relation between exercise intensity and affect sets the stage for a reconsideration of the rationale behind current guidelines for exercise intensity prescription. Besides effectiveness and safety, it is becoming increasingly clear that the guidelines should take into account whether a certain level of exercise intensity would be likely to cause increases or decreases in pleasure.

Effects of high-intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES

The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training. Traditional pulmonary rehabilitation programmes (PRPs) do not consistently achieve high-intensity training and have variable training effects. This study examined the effects of high-intensity exercise training on cardiac and pulmonary function in COPD patients.

METHODS

Patients with COPD participated in a 6-week, cardiopulmonary exercise test-based PRP. Spirometry, 6-min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function, respiratory muscle strength and endurance at rest, during exercise and before and after the programme. Patients were encouraged to complete high-intensity exercise with a targeted training intensity of at least 75% maximum oxygen uptake (VO(2)).

RESULTS

Thirty-four COPD patients were enrolled into the study; 16 completed the high-intensity training, 18 did not. At the end of the 12-session PRP, submaximal exercise capacity (6-min walking distance, 461.8 +/- 77.2-502.7 +/- 66.9 m, P < 0.001) improved in both the patients who completed high-intensity training and those who did not. Only the patients who completed high-intensity training had significant improvements in FVC (2.47 +/- 0.70-2.70 +/- 0.62 L, P = 0.024) at rest, maximal exercise capacity (peak VO(2), 1001.6 +/- 286.4-1116.1 +/- 320.4 mL/min, P = 0.020) and work efficiency (7.3 +/- 1.4-8.4 +/- 1.8 mL/min/watt, P = 0.026). There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise.

CONCLUSIONS

Exercise training in a PRP improved submaximal exercise capacity. Only patients who completed high-intensity exercise training showed improvements in maximal exercise capacity, FVC and work efficiency.

Determination of "Fatmax"with 1 h cycling protocols of constant load

Several earlier studies were aimed at determining an exercise intensity that elicits maximal fat oxidation (Fatmax). However, these studies employed few different intensities or used exercise periods of too short a duration. All investigators described intensity with reference to maximal ergometric values, which might lead to metabolically inhomogeneous workloads between individuals. The aim of this study was to determine Fatmax by overcoming these methodological shortcomings of earlier investigations. Ten healthy recreational athletes (29 +/- 5 y; 75 +/- 6 kg; 1.81 +/- 0.04 m) conducted an initial incremental cycling test to determine VO2 peak (59.2 +/- 6.1 mL.min-1.kg-1) and individual anaerobic threshold (IAT; 221 +/- 476 W). Within 4 weeks, 5 constant-load tests of 1 h duration were carried out at 55%, 65%, 75%, 85%, and 95% IAT. During all tests indirect calorimetry (MetaMax I, Cortex, Leipzig, Germany) served to quantify fat oxidation. Capillary blood sampling for lactate measurements was conducted every 15 min. All subjects remained in a lactate steady state during the constant load tests, which minimized influences from excess CO2. There was no difference between the 5 intensities for the percentage of energy from fat metabolism (p = 0.12). Additionally, the intensities led to similar absolute amounts of oxidized fat (p = 0.34). However, there was a significant increase in fat metabolism with increasing exercise duration (p = 0.04). It is impossible to define one theoretical optimal intensity for fat oxidation that is true in all individuals. It is thus mandatory to perform an individual assessment with indirect calorimetry. Intra-individual day-to-day variation might render the use of several tests of long duration less applicable than incremental testing with stages of sufficient duration.

A modified TRIMP to quantify the in-season training load of team sport players

The aims of the study were to modify the training impulse (TRIMP) method of quantifying training load for use with intermittent team sports, and to examine the relationship between this modified TRIMP (TRIMP(MOD)) and changes in the physiological profile of team sport players during a competitive season. Eight male field hockey players, participating in the English Premier Division, took part in the study (mean+/-s: age 26+/-4 years, body mass 80.8+/-5.2 kg, stature 1.82+/-0.04 m). Participants performed three treadmill exercise tests at the start of the competitive season and mid-season: a submaximal test to establish the treadmill speed at a blood lactate concentration of 4 mmol . l(-1); a maximal incremental test to determine maximal oxygen uptake ([V]O(2max)) and peak running speed; and an all-out constant-load test to determine time to exhaustion. Heart rate was recorded during all training sessions and match-play, from which TRIMP(MOD) was calculated. Mean weekly TRIMP(MOD) was correlated with the change in [V]O(2max) and treadmill speed at a blood lactate concentration of 4 mmol x l(-1) from the start of to mid-season (P<0.05). The results suggest that TRIMP(MOD) is a means of quantifying training load in team sports and can be used to prescribe training for the maintenance or improvement of aerobic fitness during the competitive season.

Variation and homogeneity in affective responses to physical activity of varying intensities: an alternative perspective on dose-response based on evolutionary considerations

A model for systematic changes in patterns of inter-individual variation in affective responses to physical activity of varying intensities is presented, as a conceptual alternative to the search for a global dose-response curve. It is theorized that trends towards universality will emerge in response to activities that are either generally adaptive, such as moderate walking, or generally maladaptive, such as strenuous running that requires anaerobic metabolism and precludes the maintenance of a physiological steady state. At the former intensity the dominant response will be pleasure, whereas at the latter intensity the dominant response will be displeasure. In contrast, affective responses will be highly variable, involving pleasure or displeasure, when the intensity of physical activity approximates the transition from aerobic to anaerobic metabolism, since activity performed at this intensity entails a trade-off between benefits and risks. Preliminary evidence in support of this model is presented, based on a reanalysis of data from a series of studies.

Exercise Intensity Prescription After Myocardial Infarction in Patients Treated With Beta-blockers

PURPOSE

The aim of our study was to answer the following questions: (1) Is it possible to estimate the exercise training intensity according to heart rate in patients treated with beta-blockers after myocardial infarction? and (2) Are there any other appropriate alternate possibilities to estimate the training intensity?

METHODS

This study involved 112 men (60.2 +/- 8.6 years) with a previous myocardial infarction treated with beta-blockers. Patients underwent exercise echocardiography and also completed a symptom-limited cardiopulmonary ramp test to determine peak exercise capacity, maximal heart rate, heart rate (HR) at the anaerobic threshold (AT), peak oxygen uptake (VO2peak) VO2 consumption at AT, and exercise capacity at AT.

RESULTS

The mean value of HR at AT was 104.7 +/- 13.3 bpm, corresponding to 81.0% +/- 8% of VO2peak and 87.9% +/- 5.6% of HRpeak. The mean HR at 80% HRpeak was 96 +/- 13.7 bpm, at 70% heart rate reserve (HRR) 103.3 +/- 13.1 bpm and at 80% HRR 108 +/- 14.4 bpm. A close correlation was observed between HR at AT and values at 80% HRpeak (r = 0.86, P < .01). A similar correlation was found also for 70% and 80% HRR (r = 0.87 and 0.88, respectively, P < .01). Exercise intensity at AT occurred close to the value of 1 W/kg(bodyweight).

CONCLUSIONS

As an upper limit in determining training intensities, the assessment of AT is the gold standard. However, findings suggest that %HRpeak, %HRR, and %VO2peak can be used alternatively. The use of workload expressed as in W/kg also appears useful.

Aerobic training improves insulin sensitivity 72–120 h after the last exercise session in younger but not in older women

The regular practice of aerobic training (AT) induces an improvement in insulin sensitivity (IS) in healthy younger women that persists until 96-120 h after the last exercise bout. Due to the dearth of research data, it still remains unclear whether a regular AT program can improve IS for such a period of time after the last training bout in healthy older women. To address this issue, we trained 14 younger and 8 older women 3 days per week during 6 months, and measured IS 3-5 days after the last training bout. AT consisted of 25-60 min sessions of running at 60-95% of maximal heart rate. Fat mass decreased (8%) in older women only. VO(2max) and fat-free mass increased in both groups. Only older women decreased bodyweight (4%) and subcutaneous adipose tissue (19%). Visceral adipose tissue decreased in none of the groups. The IS improved only in younger women (relative: 22%; absolute: 24%). The present findings suggest that in older women the improvement in IS following AT is short-lived and results mainly from the acute effect of the last training bout, whereas in younger women the chronic adaptations induced by AT are implicated, as the improvement in IS is maintained beyond the residual effect of the last training bout. From a clinical standpoint, our findings suggest that in older women AT should be performed every day to improve glucose metabolism, whereas in younger women an AT frequency (three times per week) allowing to induce and maintain chronic minimal physiological adaptations would be required.

Peak oxygen uptake. Myth and truth about an internationally accepted reference value

This article critically examines the execution of VO(2)-peak testing in cardiac patients and questions their appropriate interpretation. In the first part, the most common clinical implications of VO(2)peak measurements are discussed: assessment of (changes in) functional capacity, evaluation of the necessity of invasive diagnostic/therapeutic measures, reference for exercise prescriptions, determination of prognosis. In the second part, important methodological problems and constraints are addressed and illustrated by references to scientific studies. Finally, recommendations are given for meaningful VO(2)peak testing. It is evident that failure to strictly follow such recommendations might result in misleading ergometric findings and, thus, in over- or underestimation of endurance capacity and/ or training effects.

Ventilatory threshold characterizations during incremental rowing and cycling exercises in older subjects

In order to individualize the intensity of an aerobic training program on different ergometers in healthy elderly subjects using a single test of muscular exercise, we analysed cardiorespiratory responses in 8 men (65.7 +/- 4.5 yrs) and 10 women (63.3 +/- 4.8 yrs). The heart rate corresponding to the ventilatory threshold was defined as individualised exercise intensity. All subjects carried out two incremental exercise tests on the cycle and rowing ergometers. For men, the results on the cycle ergometer and rowing ergometer demonstrated that, at ventilatory threshold, heart rates were not significantly different (114.6 +/- 13.7 and 115.6 +/- 14.2 beats x min (-1), respectively), but ventilation was significantly higher in rowing (p < 0.05). At ventilatory threshold, heart rates for women were not significantly different between the cycle ergometer and rowing ergometer (121.3 +/- 12.4 and 125.1 +/- 15.2 beats x min (-1 ), respectively), but ventilation was significantly higher in rowing (p< 0.01). At maximal exercise, maximal tidal volume for men (p < 0.01) and women (p < 0.05) was significantly higher in rowing. In spite of alterations of breathing patterns on the rowing ergometer, it is possible to design an individualized training program for healthy elderly subjects based on a single muscle evaluation exercise in order to diversify and optimize the cardiorespiratory benefits following an aerobic training program.

Practical markers of the transition from aerobic to anaerobic metabolism during exercise: rationale and a case for affect-based exercise prescription

BACKGROUND

The high rates of dropout from exercise programs may be attributed in part to the poor ability of most individuals to accurately self-monitor and self-regulate their exercise intensity. The point of transition from aerobic to anaerobic metabolism may be an appropriate level of exercise training intensity as it appears to be effective and safe for a variety of populations. Possible practical markers of this event were compared.

METHODS

Two samples of 30 young and healthy volunteers each participated in incremental treadmill tests until volitional exhaustion. The ventilatory threshold, a noninvasive estimate of the aerobic-anaerobic transition, was identified from gas exchange data. Heart rate, self-ratings of affective valence (pleasure-displeasure), perceived activation, and perceived exertion were recorded every minute.

RESULTS

In both samples, heart rate, perceived activation, and perceived exertion rose continuously, whereas the ratings of affective valence showed a pattern of quadratic decline, initiated once the ventilatory threshold was exceeded.

CONCLUSIONS

Exercise intensity that exceeds the point of transition from aerobic to anaerobic metabolism is accompanied by a quadratic decline in affective valence. This marker may be useful in aiding exercisers to recognize the transition to anaerobic metabolism and, thus, more effectively self-monitor and self-regulate the intensity of their efforts.

Pulmonary disorders and exercise

The respiratory system rarely limits exercise in the normal subject. In patients with chronic pulmonary processes or in the elite athlete, however, the respiratory system may indeed be the limiting factor. Common respiratory disorders include chest pain syndromes, cough, exercise-induced asthma, and vocal cord dysfunction. Chronic lung diseases such as asthma, COPD, and interstitial lung disease impact exercise capacity and endurance. Exercise testing can be useful to distinguish acute and chronic pulmonary causes of dyspnea during exercise, as well as to differentiate between cardiac and pulmonary causes.

Relationships between HR and (.)VO(2) in the obese

PURPOSE

To enable more targeted exercise prescription for the obese, the purpose of this study was to consider relationships between relative indices of (.)VO(2peak), (.)VO(2)R, HR(peak), and HRR in a sample of obese adults. In particular, the study aimed to determine whether %HRR was equivalent to %(.)VO(2peak) or %(.)VO(2)R. A further aim was to evaluate whether the %(.)VO(2peak)-%HR(peak) relationship defined by the ACSM holds in the obese population, or whether there is a deviation in this relationship as is noted in individuals with low functional capacity. Finally, the study aimed to determine the degree of variability in relative workload relating to lactate threshold (LT).

METHODS

Thirty-two sedentary obese adults, 17 women and 15 men (42.1 +/- 9.6 yr; 37.4 +/- 5.7 kg.m) attended a testing session each week for 3 wk. The three sessions involved 1) familiarization with testing protocols; 2) graded treadmill tests to evaluate submaximal and peak cardiorespiratory capacity; and 3) assessment of body composition via deuterium dilution, and resting HR (HR(rest)) and oxygen consumption ((.)VO(2rest)) collected during assessment of resting metabolic rate (RMR) via a ventilated hood system.

RESULTS

The primary findings were that in the obese: 1) the %HR(peak)-%(.)VO(2peak) relationship was significantly greater than the ACSM recommendations, 2) the %HRR was equivalent with (.)VO(2)R not %(.)VO(2peak), and 3) exercise prescription at fixed percentages of (.)VO(2peak) or HR(peak) corresponded with wide ranges of exercise intensities in relation to LT.

CONCLUSIONS

The relationships between cardiorespiratory parameters defined in normal weight populations differ to some degree in the obese, and this has implications both for optimizing exercise intensity for weight loss and exercise adherence in obese adults.

Heart rate prescriptions from performance and anthropometrical characteristics

PURPOSE

Heart rate (HR) is widely used to adjust exercise intensity in aerobic training. Training HR recommendations are calculated often from simple equations. Because at lactate steady state (LASS) may be an intensity of exercise eliciting similar objective measures of intensity and similar subjective measures of metabolism, it is an appropriate intensity upon which to base aerobic-training prescription. The purpose of this research was to develop regression equations using age and other easily accessible characteristics to estimate the HR associated with LASS (HRLASS).

METHODS

The data of 7397 healthy subjects (age >or= 10 yr; 5044 male, 2353 female) with different training habits were analyzed. All participants were tested in an incremental exercise test on the treadmill until subjective exhaustion. The LASS was determined by the concept of blood lactate at the "lactate threshold" plus a net increase of 1.5 mmol.L-1. The interdependence of further characteristics was tested by stepwise multiple regression.

RESULTS

Age alone did not allow a precise prediction of lass=hText>HRLASS (r = 0.645 for all participants), regardless of adjustment by sex, training state, body mass, or performance characteristics using ANCOVA. Resting HR (HRrest) decreased steeply within the second life decade but not with further advancing age. The best discrete lactate-independent predictor for HRLASS was HRmax (r = 0.798). Inclusion of age and weight in the model resulted in only a small improvement of the prediction (r = 0.826). Other anthropometrical characteristics could not improve the model further.

CONCLUSIONS

The use of age alone seems too imprecise for exactly driven aerobic training prescriptions. A minor improvement can be achieved in this objective by use of HRmax supplemented by age using a multiple regression model.

Accuracy of estimating exercise prescription intensity in patients with left ventricular systolic dysfunction

PURPOSE

Exercise prescription in patients with left ventricular systolic dysfunction (LVSD) is difficult. Exercising beyond ventilatory threshold (VT) can have negative physiologic effects; therefore, exercise prescribed above VT may be detrimental. A majority of cardiac rehabilitation programs use the Karvonen/heart rate reserve (HRR) method, rating of perceived exertion (RPE), and/or a percentage of oxygen consumption to prescribe exercise intensity. The purpose of this study was to determine if these methods correlate with an exercise intensity below VT in LVSD patients.

METHODS

The authors studied 52 patients (37 males, 15 females; age 52 +/- 13 years; left ventricular ejection fraction 27% +/- 8%) who underwent a symptom-limited cardiopulmonary exercise test and reached VT to determine functional capacity and exercise prescription.

RESULTS

Peak heart rate (HR) as well as HRR derived minimum (60%), midpoint (70%), and maximum (80%) HR were highly correlated (P < 0.001) with HR at VT. Using these three different HR cutoff formulas from HRR, 15% to 62% of patients were prescribed exercise outside the range of VT-HR +/- 10%. The midpoint (70% HRR) best predicted exercise HR in the VT-HR +/- 10% range (73% of patients). Mean oxygen consumption at VT was 83 +/- 9% of peak oxygen consumption. There was no correlation (P < 0.16) between RPE and VT.

CONCLUSIONS

The Karvonen/HRR method failed to estimate HR-VT +/- 10% in a large percentage of patients with LVSD. There was no correlation between RPE and VT. Based on these data, exercise training intensity should ideally be prescribed based on the HR identified at VT using cardiopulmonary exercise testing in patients with LVSD.

Exercise training in chronic obstructive pulmonary disease

Exercise limitation is a common and disturbing manifestation of COPD. The exercise intolerance is often caused by multiple interrelated anatomic and physiologic disturbances. Importantly, exercise tolerance can be improved despite the presence of fixed structural abnormalities in the lung. Exercise training, undertaken alone or in the context of comprehensive PR, improves exercise endurance and, to a lesser degree, the maximal tolerated workload of patients with COPD. Pulmonary rehabilitation also improves dyspnea and QOL. Exercise training and PR should be considered for all patients lacking contraindications who experience exercise intolerance despite optimal medical therapy. Lower-extremity training should be included routinely in the exercise prescription. The choice of type and intensity of training should be based primarily on the patient's individual baseline functional status, symptoms, needs, and long-term goals. When tolerated, high-intensity (continuous or interval) training may lead to greater improvements in aerobic fitness than low-intensity training but is not absolutely necessary to achieve gains in exercise endurance. Upper-extremity training should be undertaken when possible. Ventilatory muscle training should be considered for patients who continue to experience exercise limitation and breathlessness despite medical therapy and general exercise reconditioning. Exercise tolerance may improve following exercise training because of gains in aerobic fitness or peripheral muscle strength; enhanced mechanical skill and efficiency of exercise; improvements in respiratory muscle function, breathing pattern, or lung hyperinflation; as well as reduction in anxiety, fear, and dyspnea associated with exercise. Gains made in exercise tolerance can last up to 2 years following a limited duration (6-12 week) rehabilitation program.

The relationship between heart rate and oxygen uptake during non-steady state exercise

In this study the validity of using heart rate (HR) responses to estimate oxygen uptake (VO2) during varying non-steady state activities was investigated. Dynamic and static exercise engaging large and small muscle masses were studied in four different experiments. In the first experiment, 16 subjects performed an interval test on a cycle ergometer, and 12 subjects performed a field test consisting of various dynamic leg exercises. Simultaneous HR and VO2 measurements were made. Linear regression analyses revealed high correlations between HR and VO2 during both the interval test (r = 0.90 +/- 0.07) and the field test (r = 0.94 +/- 0.04). In the second experiment, 14 non-wheelchair-bound subjects performed both an interval wheelchair test on a motor driven treadmill, and a wheelchair field test consisting of dynamic and static arm exercise. Significant relationships were found for all subjects during both the interval test (r = 0.91 +/- 0.06) and the field test (r = 0.86 +/- 0.09). During non-steady state exercise using both arms and legs in a third experiment, contradictory results were found. For 11 of the 15 subjects who performed a field test consisting of various nursing tasks no significant relationship between HR and VO2 was found (r = 0.42 +/- 0.16). All tasks required almost the same physiological strain, which induced a small range in data points. In a fourth experiment, the influence of a small data range on the HR-VO2 relationship was investigated: five subjects performed a field test that involved both low and high physiological strain, non-steady state arm and leg exercise. Significant relationships were found for all subjects (r = 0.86 +/- 0.04). Although the r-values found in this study were less than under steady state conditions, it can be concluded that VO2 may be estimated from individual HR-VO2 regression lines during non-steady state exercise.

Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription

Aerobic exercise seems to be effective in improving general mood and symptoms of depression and anxiety in healthy individuals and psychiatric patients. This effect is not limited to aerobic forms of exercise. There are almost no contraindications for psychiatric patients to participate in exercise programmes, provided they are free from cardiovascular and acute infectious diseases. However, very little is known about the effects of exercise in psychiatric disease other than those in depression and anxiety disorders. A few reports indicate the need for controlled investigations in psychotic and personality disorders. Unfortunately, no general concept for a therapeutic application of physical activity has been developed so far. Reliance on submaximal measures is highly recommended for fitness assessment. Monitoring of exercise intensity during training sessions is most easily done by measuring the heart rate using portable devices (whereas controlling the exact workload may be preferable for scientific purposes). Appropriate pre- and post-training testing is emphasised to enable adequate determinations of fitness gains and to eventually allow positive feedback to be given to patients in clinical settings.

Oxygen uptake kinetics in treadmill running and cycle ergometry: a comparison

The purpose of the present study was to comprehensively examine oxygen consumption (VO(2)) kinetics during running and cycling through mathematical modeling of the breath-by-breath gas exchange responses to moderate and heavy exercise. After determination of the lactate threshold (LT) and maximal oxygen consumption (VO(2 max)) in both cycling and running exercise, seven subjects (age 26.6 +/- 5.1 yr) completed a series of "square-wave" rest-to-exercise transitions at running speeds and cycling power outputs that corresponded to 80% LT and 25, 50, and 75%Delta (Delta being the difference between LT and VO(2 max)). VO(2) responses were fit with either a two- (<LT) or three-phase ( >LT) exponential model. The parameters of the VO(2) kinetic response were similar between exercise modes, except for the VO(2) slow component, which was significantly (P < 0.05) greater for cycling than for running at 50 and 75%Delta (334 +/- 183 and 430 +/- 159 ml/min vs. 205 +/- 84 and 302 +/- 154 ml/min, respectively). We speculate that the differences between the modes are related to the higher intramuscular tension development in heavy cycle exercise and the higher eccentric exercise component in running. This may cause a relatively greater recruitment of the less efficient type II muscle fibers in cycling.

The effect of endurance training on parameters of aerobic fitness

Endurance exercise training results in profound adaptations of the cardiorespiratory and neuromuscular systems that enhance the delivery of oxygen from the atmosphere to the mitochondria and enable a tighter regulation of muscle metabolism. These adaptations effect an improvement in endurance performance that is manifest as a rightward shift in the 'velocity-time curve'. This shift enables athletes to exercise for longer at a given absolute exercise intensity, or to exercise at a higher exercise intensity for a given duration. There are 4 key parameters of aerobic fitness that affect the nature of the velocity-time curve that can be measured in the human athlete. These are the maximal oxygen uptake (VO2max), exercise economy, the lactate/ventilatory threshold and oxygen uptake kinetics. Other parameters that may help determine endurance performance, and that are related to the other 4 parameters, are the velocity at VO2max (V-VO2max) and the maximal lactate steady state or critical power. This review considers the effect of endurance training on the key parameters of aerobic (endurance) fitness and attempts to relate these changes to the adaptations seen in the body's physiological systems with training. The importance of improvements in the aerobic fitness parameters to the enhancement of endurance performance is highlighted, as are the training methods that may be considered optimal for facilitating such improvements.

A importância do limiar anaeróbio e do consumo máximo de oxigênio (VO2 máx.) em jogadores de futebol

O objetivo deste estudo foi fazer uma abordagem sobre a importância do limiar anaeróbio (LA) e o consumo máximo de oxigênio (VO2máx.) em jogadores de futebol e comparar os resultados encontrados em nossos futebolistas com os da literatura especializada. Foram avaliados 18 jogadores de futebol profissional, com média de idade de 24 ± 4 anos, peso de 72,5 ± 5,9kg; estatura de 176,5 ± 7,0cm e superfície corpórea de 1,91 ± 0,15m². Todos os atletas foram avaliados após um período de dois meses de treinamentos. Os futebolistas foram submetidos a teste máximo em esteira ergométrica, utilizando-se protocolo escalonado e contínuo. A resposta de freqüência cardíaca (FC) foi registrada por meio de um eletrocardiógrafo (HeartWare) de 12 derivações simultâneas e, a pressão arterial (PA), por meio de método auscultatório. A ventilação pulmonar (V E), o consumo de oxigênio (VO2), a produção de dióxido de carbono (VCO2) e a razão de troca respiratória (RER) foram avaliados por método espirométrico computadorizado respiração-a-respiração (MedGraphics Corporation [MGC]). Os seguintes resultados foram verificados: no (LA): [FC = 173,6 ± 8,6bpm; VO2 = 55,78 ± 5,93ml.kg.-1.min-1; velocidade = 14,6 ± 1,0km.h-1]; no exercício máximo [FC = 189,5 ± 11,4bpm; V E = 134,1 ± 15,9L.min-1; VO2máx. = 63,75 ± 4,93ml.kg.-1.min-1; velocidade = 17,8 ± 1,0km.h-1; Borg = 18,3 ± 1,3 pontos]. Concluindo: Os resultados, comparados com os da literatura especializada na modalidade futebol, demonstraram que os índices de LA e VO2máx. foram semelhantes e, até mesmo, superiores a vários de estudos publicados sobre essas duas variáveis em jogadores de futebol profissional. Entretanto, considerando as posições dos jogadores, não há um consenso definido sobre os índices mais adequados de LA e VO2máx. em futebolistas, mas, sim, sugestões.

Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma

BACKGROUND

A study was undertaken to determine whether swimming training improved aerobic capacity, exercise induced bronchoconstriction (EIB), and bronchial responsiveness to inhaled histamine in children with asthma.

METHODS

Eight children with mild or moderate asthma participated in swimming training every day for six weeks. The intensity of training was individually determined and set at 125% of the child's lactate threshold (LT), measured using a swimming ergometer. Another group of eight asthmatic children served as control subjects. Aerobic capacity and the degree of EIB were assessed by both cycle ergometer and swimming ergometer before and after swimming training.

RESULTS

The mean (SD) aerobic capacity at LT increased by 0.26 (0.11) kp after training when assessed with the swimming ergometer and by 10.6 (4.5) W when assessed with the cycle ergometer, and these changes were significantly different from the control group. The mean (SD) maximum % fall in forced expiratory volume in one second (FEV1) to an exercise challenge (cycle ergometer) set at 175% of LT decreased from 38.7 (15.4)% before training to 17.9 (17.6)% after training, but with no significant difference from the control group. There was, however, no difference in histamine responsiveness when compared before and after the training period.

CONCLUSION

A six week swimming training programme has a beneficial effect on aerobic capacity but not on histamine responsiveness in children with asthma.

The validity of the lactate minimum test for determination of the maximal lactate steady state

PURPOSE

The purpose of this study was to investigate the validity of the lactate minimum test ([Lac-]BMIN) in the determination of the velocity at the maximal lactate steady state (V-MLSS), and to identify those physiological factors most closely associated with 8-km running performance.

METHODS

Thirteen trained male runners (VO2max range 53-67 mL.kg-1.min-1) took part in an 8-km simulated race on flat roads and completed a comprehensive battery of laboratory tests.

RESULTS

Performance velocity was most strongly correlated with the estimated running velocity at VO2max (r = 0.93) and with V-MLSS (r = 0.92) and velocity at lactate threshold (V-Tlac) (r= 0.93). The running velocity at the ventilatory threshold (V-Tvent) (r = 0.81) and the [Lac-]BMIN (r = 0.83) also produced good correlations with performance velocity. Performance running velocity (mean +/- SEM 16.0 +/- 0.3 km.h-1) was not significantly different from V-MLSS (15.7 +/- 0.3 km.h-1). The running velocity at [Lac-]BMIN (14.9 +/- 0.2 km.h-1) was not significantly different from the V-Tlac (15.1 +/- 0.3 km.h-1) or V-Tvent (14.9 +/- 0.2 km.h-1) was not significantly different from the V-Tlac (15.1 +/- 0.3 km.h-1) or V-Tvent (14.9 +/- 0.3 km.h-1) but was significantly lower than the V-MLSS (P < 0.05). The [Lac-]BMIN provided the lowest correlation with V-MLSS (r = 0.61) and the worst estimate of V-MLSS (SEE = 0.75 km.h-1) compared with the other measures of lactate accumulation. The V-Tlac was not significantly different from V-MLSS and provided the highest correlation (r = 0.94) and a close estimate (SEE = 0.33 km.h-1) of the V-MLSS.

CONCLUSIONS

It is concluded that of the measures studied relating to blood lactate accumulation during submaximal exercise, V-Tlac provides the best estimate of the V-MLSS and the V-Tlac had equal predictive power for 8-km race performance.

Tolerable exercise intensity in the early rehabilitation of paraplegic patients. A preliminary study

Accessible indicators for setting exertion levels in newly injured paraplegias could be useful to improve their daily and occupational performances in less time than is presently required. Eight male newly injured paraplegic subjects performed progressive resisted and endurance exercise tests on an arm cranking ergometer. Cardiorespiratory parameters during exercise were monitored with an oxygen uptake analyzer and perceived exertion was rated on Borg's 10-point scale. Four subjects (Group A) underwent an 'enhanced' rehabilitation protocol which included aerobic arm training sessions. The prescription of exercise intensity was tailored to each subject's tolerable power output for prolonged exertion. The remaining four (Group B) followed a 'conventional' rehabilitation program. Tests were repeated in both groups after 6 weeks. We observed a greater improvement in endurance capacity in Group A than in Group B after completion of the rehabilitation program. A 6-week 'enhanced' rehabilitation program based on a 'moderate' intensity of exercise was well tolerated and effective in improving the fitness levels of newly injured paraplegic subjects. Subjective perception has been shown to be a simple and accessible indicator for setting exertion levels.

Use of the relationship between blood lactate and running speed to determine the exercise intensity of horses

Eight thoroughbred horses, trained for racing competition, were subjected to a standardised incremental speed test to determine the relationship between their blood lactate concentrations and running speed. Between 14 days before and 14 days after completing the standardised exercise test, the horses were timed for runs of 2000 to 6000 m. The blood lactate concentration after each run was measured and compared with the blood lactate concentration predicted from the individual horse's blood lactate-running speed relationship curve determined from the standardised exercise test. The relationship between the predicted and measured lactate concentrations was evaluated by linear regression. For 42 exercise runs there was a significant positive correlation between the measured and the predicted lactate concentrations and a significant regression: measured lactate (mmol/litre) = 1.01 predicted lactate (mmol/litre) -0.36 (r2 = 0.79, standard error of estimate 0-63 mmol/litre, P < 0.001). It was concluded that the standardised exercise test was a useful technique for predicting the blood lactate concentrations of horses after field exercise.

Physiologic responses of cardiac patients to supine, recumbent, and upright cycle ergometry

Physiological responses were compared in nine stable male cardiac patients (mean +/- standard error (SE): age, 68.3 +/- 8.1 years; height, 172.7 +/- 3.9cm; weight, 72.8 +/- 14.5kg) during stationary cycling in the supine, recumbent, and upright positions. A discontinuous exercise protocol was performed in which each stage included 3 minutes of exercise and 1 minute of recovery. Each subject's workload started at 150kgm.min-1 and increased by 150kgm.min-1 per stage until volitional fatigue. Testing sessions were randomized and performed 1 week apart. Subjects continued their normal medication regimen. All subjects were participants in a community-based cardiac rehabilitation program. Dependent variables were assessed at two different intensities; submaximal (300kgm.min +/- 1) and maximal. A two-way repeated measures ANOVA found no significant differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), minute ventilation (VE), respiratory exchange ratio (R), rate pressure product (RPP), and rating of perceived exertion (RPE) at submaximal (300kgm.min +/- 1) and maximal exercise efforts. Heart rate (HR) was significantly lower (p < or = .05) in the supine position compared with either the upright or recumbent positions during the submaximal workload. In addition, oxygen uptake (VO2) was significantly lower in the supine position at the submaximal workload (p < or = .05) compared with both upright and recumbent. No difference in HR or VO2 was observed at maximal exercise. Regressions of HR on VO2 showed similar slopes and intercepts for supine, recumbent, and upright ergometry.(ABSTRACT TRUNCATED AT 250 WORDS)