Ramp-incremented and RPE-clamped test protocols elicit similar VO2max values in trained cyclists

Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries

INTRODUCTION

Pulmonary function is lower after a severe burn injury, which could influence ventilatory responses during exercise. It is unclear whether exercise training improves pulmonary function or ventilatory responses during exercise in adults with well-healed burn injuries. Therefore, we tested the hypothesis that exercise training improves pulmonary function and ventilatory responses during exercise in adults with well-healed burn injuries.

METHODS

Thirty-nine adults (28 with well-healed burn injuries and 11 non-burn-injured controls) completed 6 months of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we performed comprehensive pulmonary function testing and measured ventilatory responses during cycling exercise. We compared variables using two-way ANOVA (group-time; i.e., preexercise/postexercise training (repeated factor)).

RESULTS

Exercise training did not increase percent predicted spirometry, lung diffusing capacity, or airway resistance measures (time: P ≥ 0.14 for all variables). However, exercise training reduced minute ventilation ( V̇E ; time: P ≤ 0.05 for 50 and 75 W) and the ventilatory equivalent for oxygen ( V̇E /V̇O 2 ; time: P < 0.001 for 75 W) during fixed-load exercise for both groups. The ventilatory equivalent for carbon dioxide ( V̇E /V̇CO 2 ) during exercise at 75 W was reduced after exercise training (time: P = 0.04). The percentage of age-predicted maximum heart rate at the ventilatory threshold was lower in adults with well-healed burn injuries before ( P = 0.002), but not after ( P = 0.22), exercise training. Lastly, exercise training increased V̇E and reduced V̇E /V̇O 2 during maximal exercise (time: P = 0.005 for both variables).

CONCLUSIONS

These novel findings demonstrate that exercise training can improve ventilatory responses during exercise in adults with well-healed burn injuries.

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 [Formula: see text]O2max in young trained adults

OBJECTIVE

This study compared the robustness of a [Formula: see text]-plateau definition and a verification-phase protocol to day-to-day and diurnal variations in determining the true [Formula: see text]. 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 mean [Formula: see text] 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) for [Formula: see text]-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 of [Formula: see text].

CONCLUSION

Compared to [Formula: see text]-plateau the verification-phase shows lower reliability, increases costs and only adds certain value in 2% of cases.

Determination of Submaximal and Maximal Training Zones From a 3-Stage, Variable-Duration, Perceptually Regulated Track Test

PURPOSE

To validate a new perceptually regulated, self-paced maximal oxygen consumption field test (the Running Advisor Billat Training [RABIT] test) that can be used by recreational runners to define personalized training zones.

DESIGN

In a cross-sectional study, male and female recreational runners (N = 12; mean [SD] age = 43 [8] y) completed 3 maximal exercise tests (2 RABIT tests and a University of Montreal Track Test), with a 48-hour interval between tests.

METHODS

The University of Montreal Track Test was a continuous, incremental track test with a 0.5-km·h-1 increment every minute until exhaustion. The RABIT tests were conducted at intensities of 11, 14, and 17 on the rating of perceived exertion (RPE) scale for 10, 5, and 3 minutes, respectively, with a 1-minute rest between efforts.

RESULTS

The 2 RABIT tests and the University of Montreal Track Test gave similar mean (SD) maximal oxygen consumption values (53.9 [6.4], 56.4 [9.1], and 55.4 [7.6] mL·kg-1·min-1, respectively, P = .722). The cardiorespiratory and speed responses were reliable as a function of the running intensity (RPE: 11, 14, and 17) and the relative time point for each RPE stage. Indeed, the oxygen consumption, heart rate, ventilation, and speed values did not differ significantly when the running time was expressed as a relative duration of 30%, 60%, or 90% (ie, at 3, 6, and 9 min of a 10-min effort at RPE 11; P = .997).

CONCLUSIONS

The results demonstrate that the RABIT test is a valid method for defining submaximal and maximal training zones in recreational runners.

Are There Sex-Specific Neuromuscular or Force Responses to Fatiguing Isometric Muscle Actions Anchored to a High Perceptual Intensity?

Keller, JL, Housh, TJ, Hill, EC, Smith, CM, Schmidt, RJ, and Johnson, GO. Are there sex-specific neuromuscular or force responses to fatiguing isometric muscle actions anchored to a high perceptual intensity? J Strength Cond Res XX(X): 000-000, 2019-The purpose of this study was to use the ratings of perceived exertion (RPE) clamp model to examine sex-specific changes in neuromuscular responses and force after a sustained isometric leg extension muscle action anchored to RPE = 8. Twenty adults (10 men and 10 women) performed sustained, isometric leg extension muscle actions at RPE = 8. Electromyographic (EMG) and mechanomyographic signals were recorded from the dominant leg. Neuromuscular and force values resulting from the sustained muscle action were normalized to pretest maximal voluntary isometric contractions (MVICs). The level of significance set for the study was p ≤ 0.05. The pretest MVIC was significantly (p < 0.001) greater (averaged across sex) than posttest MVIC force (55.5 ± 10.0 vs. 47.6 ± 11.1 kg). There was a significant (p < 0.01) decrease from pretest (95.4 ± 7.7 Hz) to posttest (76.2 ± 5.9 Hz) in EMG mean power frequency (MPF) for the men. The normalized force (averaged across sex) decreased significantly (p < 0.001) from the initial timepoint (57.1 ± 16.4%) to the final timepoint (44.3 ± 15.7%) of the sustained muscle action. Normalized EMG MPF (averaged across sex) decreased significantly (p = 0.001) from the initial timepoint (96.4 ± 17.5%) to final timepoint (87.8 ± 18.1%). The men and women exhibited similar fatigue-induced changes in force and neuromuscular parameters; therefore, these findings did not indicate different sex-specific responses after the fatiguing task anchored to a high perception of exertion. The force corresponding to RPE = 8 did not match the anticipated value; so, RPE and percentages of MVIC cannot be used interchangeably, and sustained isometric muscle actions anchored to RPE may elicit unique neuromuscular adaptations.

Which Cutoffs for Secondary V˙O2max Criteria Are Robust to Diurnal Variations?

PURPOSE

The aim was to determine the minimum maximum oxygen uptake (V˙O2max) criteria cut-offs in highly trained athletes (i.e., maximum RER [RERmax], maximum HR [HRmax], maximum RPE [RPEmax], and maximum blood lactate concentration [BLmax]) necessary to determine maximum oxygen uptake (V˙O2max) during cardiopulmonary exercise tests (CPET), by balancing type I and type II errors. A further aim was to investigate if the defined cutoffs would be robust to diurnal and to day-to-day variations.

METHODS

Data from two CPET studies involving young athletes were analyzed. In the first study, 70 male participants performed one CPET until exhaustion to define cutoffs. In the second study, eight males and five females performed one CPET on seven consecutive days at six different times of day (i.e., diurnal variation). The time of the CPET was identical on the sixth and seventh days (i.e., day-to-day variation). To ensure comparability both studies were carried out under the same conditions.

RESULTS

Participants' mean V˙O2max was 63.0 ± 5.3 mL·kg·min. RERmax ≥1.10 was reached by 100%, HRmax ≥95% of age-predicted HRmax by 99%, RPEmax ≥19 by 100%, and BLmax ≥8 mmol·L by 100% of participants, respectively. Regarding the intraday variations, latter cutoffs were not reached in two cases for RERmax and in one case for HRmax and BLmax. Intraclass correlations for the day-to-day variability were r = 0.823 for RERmax, r = 0.828 for HRmax, and r = 0.380 for BLmax, respectively.

CONCLUSIONS

The proposed high cut-off values for secondary criteria provide some assurance that V˙O2max may have been achieved in athletes without increasing type II errors. However, type I errors may still occur indicating that further methods such as V˙O2-plateau or V˙O2-validation may be required.

Similar maximal oxygen uptake assessment from a step cycling incremental test and verification tests on the same or different day

The present study aimed to compare maximal oxygen uptake of a step incremental test with time to exhaustion verification tests (T_LIM) performed on the same or different day. Nineteen recreationally trained cyclists (age: 23 ± 2.7 years; maximal oxygen uptake: 48.0 ± 5.8 mL·kg^-1·min^-1) performed 3 maximal tests as follows: (i) same day: an incremental test with 3-min stages followed by a T_LIM at 100% of peak power output of the incremental test (T_LIM-SAME) interspaced by 15 min; and (ii) different day: a T_LIM at 100% of peak power output of the incremental test (T_LIM-DIFF). The maximal oxygen uptake was determined for the 3 tests. The maximal oxygen uptake was not different among the tests (incremental: 3.83 ± 0.41; T_LIM-SAME: 3.72 ± 0.42; T_LIM-DIFF: 3.75 ± 0.41 L·min^-1; P = 0.951). Seven subjects presented a variability greater than ±3% in both verification tests compared with the incremental test. The same-day verification test decreased the exercise tolerance (240 ± 38 vs. 310 ± 36 s) compared with T_LIM-DIFF (P < 0.05). In conclusion, the incremental protocol is capable of measuring maximal oxygen uptake because similar values were observed in comparison with verification tests. Although the need for the verification phase is questionable, the additional tests are useful to evaluate individual variability. Novelty Step incremental test is capable of measuring maximal oxygen uptake with similar values during T_LIM on the same or different day. Although the necessity of the verification phase is questionable, it can allow the determination of variability in maximal oxygen uptake.

Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users

This study compares test-retest reliability and peak exercise responses from ramp-incremented (RAMP) and maximal perceptually-regulated (PRET_max) exercise tests during arm crank exercise in individuals reliant on manual wheelchair propulsion (MWP). Ten untrained participants completed four trials over 2-weeks (two RAMP (0-40 W + 5-10 W · min^-1) trials and two PRET_max. PRET_max consisted of five, 2-min stages performed at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20). Participants freely changed the power output to match the required RPE. Gas exchange variables, heart rate, power output, RPE and affect were determined throughout trials. The V̇O_2peak from RAMP (14.8 ± 5.5 ml · kg^-1 · min^-1) and PRET_max (13.9 ± 5.2 ml · kg^-1 · min^-1) trials were not different (P = 0.08). Measurement error was 1.7 and 2.2 ml · kg^-1 · min^-1 and coefficient of variation 5.9% and 8.1% for measuring V̇O_2peak from RAMP and PRET_max, respectively. Affect was more positive at RPE 13 (P = 0.02), 15 (P = 0.01) and 17 (P = 0.01) during PRET_max. Findings suggest that PRET_max can be used to measure V̇O_2peak in participants reliant on MWP and leads to a more positive affective response compared to RAMP.

Prescribing 6-weeks of running training using parameters from a self-paced maximal oxygen uptake protocol

Purpose

The self-paced maximal oxygen uptake test (SPV) may offer effective training prescription metrics for athletes. This study aimed to examine whether SPV-derived data could be used for training prescription.

Methods

Twenty-four recreationally active male and female runners were randomly assigned between two training groups: (1) Standardised (STND) and (2) Self-Paced (S-P). Participants completed 4 running sessions a week using a global positioning system-enabled (GPS) watch: 2 × interval sessions; 1 × recovery run; and 1 × tempo run. STND had training prescribed via graded exercise test (GXT) data, whereas S-P had training prescribed via SPV data. In STND, intervals were prescribed as 6 × 60% of the time that velocity at \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}V˙O2max (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_{{\text{v}}}\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}vV˙O2max) could be maintained (T_max). In S-P, intervals were prescribed as 7 × 120 s at the mean velocity of rating of perceived exertion 20 (_vRPE20). Both groups used 1:2 work:recovery ratio. 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}$$\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}V˙O2max), \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_{{\text{v}}}\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}vV˙O2max, T_{max, v}RPE20, critical speed (CS), and lactate threshold (LT) were determined before and after the 6-week training.

Results

STND and S-P training significantly improved \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}V˙O2max by 4 ± 8 and 6 ± 6%, CS by 7 ± 7 and 3 ± 3%; LT by 5 ± 4% and 7 ± 8%, respectively (all P < .05), with no differences observed between groups.

Conclusions

Novel metrics obtained from the SPV can offer similar training prescription and improvement in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot {V}{{\text{O}}_{{\text{2max}}}}$$\end{document}V˙O2max, CS and LT compared to training derived from a traditional GXT.

Hemodynamic and metabolic responses to self-paced and ramp-graded exercise testing protocols

Recent examinations have shown lower maximal oxygen consumption during traditional ramp (RAMP) compared with self-paced (SPV) graded exercise testing (GXT) attributed to differences in cardiac output. The current study examined the differences in hemodynamic and metabolic responses between RAMP and SPV during treadmill exercise. Sixteen recreationally trained men (aged23.7 ± 3.0 years) completed 2 separate treadmill GXT protocols. SPV consisted of five 2-min stages (10 min total) of increasing speed clamped by the Borg RPE6-20 scale. RAMP increased speed by 0.16 km/h every 15 s until volitional exhaustion. All testing was performed at 3% incline. Oxygen consumption was measured via indirect calorimetry; hemodynamic function was measured via thoracic impedance and blood lactate (BLa^-) was measured via portable lactate analyzer. Differences between SPV and RAMP protocols were analyzed as group means by using paired-samples t tests (R Core Team 2017). Maximal values for SPV and RAMP were similar (p > 0.05) for oxygen uptake (47.1 ± 3.4 vs. 47.4 ± 3.4 mL·kg^-1·min^-1), heart rate (198 ± 5 vs. 200 ± 6 beats·min^-1), ventilation (158.8 ± 20.7 vs. 159.3 ± 19.0 L·min^-1), cardiac output (26.9 ± 5.5 vs. 27.9 ± 4.2 L·min^-1), stroke volume (SV) (145.9 ± 29.2 vs. 149.8 ± 25.3 mL·beat^-1), arteriovenous oxygen difference (18.5 ± 3.1 vs. 19.7 ± 3.1 mL·dL^-1), ventilatory threshold (VT) (78.2 ± 7.2 vs. 79.0% ± 7.6%), and peak BLa^- (11.7 ± 2.3 vs. 11.5 ± 2.4 mmol·L^-1), respectively. In conclusion, SPV elicits similar maximal hemodynamic responses in comparison to RAMP; however, SV kinetics exhibited unique characteristics based on protocol. These results support SPV as a feasible GXT protocol to identify useful fitness parameters (maximal oxygen uptake, oxygen uptake kinetics, and VT).

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

Commonly performed during an incremental test to exhaustion, maximal oxygen uptake (V̇O_2max) assessment has become a recurring practice in clinical and experimental settings. To validate the test, several criteria were proposed. In this context, the plateau in oxygen uptake (V̇O₂) is inconsistent in its frequency, reducing its usefulness as a robust method to determine “true” V̇O_2max. Moreover, secondary criteria previously suggested, such as expiratory exchange ratios or percentages of maximal heart rate, are highly dependent on protocol design and often are achieved at V̇O₂ percentages well below V̇O_2max. Thus, an alternative method termed verification phase was proposed. Currently, it is clear that the verification phase can be a practical and sensitive method to confirm V̇O_2max; however, procedures to conduct it are not standardized across the literature and no previous research tried to summarize how it has been employed. Therefore, in this review the knowledge on the verification phase was updated, while suggestions on how it can be performed (e.g. intensity, duration, recovery) were provided according to population and protocol design. Future studies should focus to identify a verification protocol feasible for different populations and to compare square-wave and multistage verification phases. Additionally, studies assessing verification phases in different patient populations are still warranted.

Assessment of peak oxygen uptake during handcycling: Test-retest reliability and comparison of a ramp-incremented and perceptually-regulated exercise test

Purpose

To examine the reliability of a perceptually-regulated maximal exercise test (PRET_max) to measure peak oxygen uptake (V˙O2peak) during handcycle exercise and to compare peak responses to those derived from a ramp-incremented protocol (RAMP).

Methods

Twenty recreationally active individuals (14 male, 6 female) completed four trials across a 2-week period, using a randomised, counterbalanced design. Participants completed two RAMP protocols (20 W·min^-1) in week 1, followed by two PRET_max in week 2, or vice versa. The PRET_max comprised five, 2-min stages clamped at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20. Participants changed power output (PO) as often as required to maintain target RPE. Gas exchange variables (oxygen uptake, carbon dioxide production, minute ventilation), heart rate (HR) and PO were collected throughout. Differentiated RPE were collected at the end of each stage throughout trials.

Results

For relative V˙O2peak, coefficient of variation (CV) was equal to 4.1% and 4.8%, with ICC_(3,1) of 0.92 and 0.85 for repeated measures from PRET_max and RAMP, respectively. Measurement error was 0.15 L·min^-1 and 2.11 ml·kg^-1·min^-1 in PRET_max and 0.16 L·min^-1 and 2.29 ml·kg^-1·min^-1 during RAMP for determining absolute and relative V˙O2peak, respectively. The difference in V˙O2peak between PRET_max and RAMP was tending towards statistical significance (26.2 ± 5.1 versus 24.3 ± 4.0 ml·kg^-1·min^-1, P = 0.055). The 95% LoA were -1.9 ± 4.1 (-9.9 to 6.2) ml·kg^-1·min^-1.

Conclusion

The PRET_max can be used as a reliable test to measure V˙O2peak during handcycle exercise in recreationally active participants. Whilst PRET_max tended towards significantly greater V˙O2peak values than RAMP, the difference is smaller than measurement error of determining V˙O2peak from PRET_max and RAMP.

Pacing strategy during the final stage of a self-paced V̇O₂max (SPV) test does not affect maximal oxygen uptake

PURPOSE

Self-paced [Formula: see text] tests (SPVs) have shown to produce maximal oxygen consumption values similar to those from traditional protocols. These tests involve perceptually regulated stages in which subjects are asked to maintain rating of perceived exertion values of 11, 13, 15, 17 and 20 for 2 min each. What is not clear is how the last stage should be paced. The purpose of this study was to compare two different pacing strategies during the final stage.

METHODS

Fourteen healthy, recreationally active individuals (11 men, 3 women) participated in a familiarization and two experimental laboratory visits. For both lab visits, a treadmill-based SPV was performed. In one of these SPVs, an aggressive pacing strategy was used; in the other, a conservative strategy was implemented. [Formula: see text], HR, [Formula: see text], [Formula: see text] and RER were recorded and compared between conditions.

RESULTS

There were no differences in [Formula: see text] between the conditions [aggressive 58.8 ± 8.8 ml kg^-1 min^-1 (mean ± SD), conservative 58.3 ± 7.9 ml kg^-1 min^-1; p = 0.548]. There were also no differences in HR, [Formula: see text], or [Formula: see text] between the pacing strategies. There was a significantly higher RER found in the aggressive (1.25 ± 0.09) compared to the conservative (1.18 ± 0.07) strategy (p = 0.040).

CONCLUSIONS

The pacing strategy that is implemented in the last 2 min of an SPV on a treadmill does not affect the maximal oxygen consumption that is elicited during that test. Either pacing strategy can be used for this protocol without compromising the results, when [Formula: see text] is the variable of interest.

Submaximal, Perceptually Regulated Exercise Testing Predicts Maximal Oxygen Uptake: A Meta-Analysis Study

BACKGROUND

Recently, several authors have proposed the use of a submaximal 'perceptually regulated exercise test' (PRET) to predict maximal oxygen uptake ([Formula: see text]). The PRET involves asking the individual to self-regulate a series of short bouts of exercise corresponding to pre-set ratings of perceived exertion (RPE). The individual linear relationship between RPE and oxygen uptake (RPE:[Formula: see text]) is then extrapolated to the [Formula: see text], which corresponds to the theoretical maximal RPE (RPE20). Studies suggest that prediction accuracy from this method may be better improved during a second PRET. Similarly, some authors have recommended an extrapolation to RPE19 rather than RPE20.

OBJECTIVES

The purpose of the meta-analysis was to examine the validity of the method of predicting [Formula: see text] from the RPE:[Formula: see text] during a PRET, and to determine the level of agreement and accuracy of predicting [Formula: see text] from an initial PRET and retest using RPE19 and RPE20.

DATA SOURCES

From a systematic search of the literature, 512 research articles were identified.

STUDY ELIGIBILITY CRITERIA

The eligible manuscripts were those which used the relationship between the RPE≤15 and [Formula: see text], and used only the Borg's RPE scale.

PARTICIPANTS AND INTERVENTIONS

Ten studies (n = 274 individuals) were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

For each study, actual and predicted [Formula: see text] from four subgroup outcomes (RPE19 in the initial test, RPE19 in the retest, RPE20 in the initial test, RPE20 in the retest) were identified, and then compared. The magnitude of the difference regardless of subgroup outcomes was examined to determine if it is better to predict [Formula: see text] from extrapolation to RPE19 or RPE20. The magnitude of differences was examined for the best PRET (test vs retest).

RESULTS

The results revealed that [Formula: see text] may be predicted from RPE:[Formula: see text] during PRET in different populations and in various PRET modalities, regardless of the subgroup outcomes. To obtain greater accuracy of predictions, extrapolation to RPE20 during a retest may be recommended.

LIMITATIONS

The included studies reported poor selection bias and data collection methods.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The [Formula: see text] may be predicted from RPE:[Formula: see text] during PRET, especially when [Formula: see text] is extrapolated to RPE20 during a second PRET.

Graded Exercise Testing Protocols for the Determination of VO2max: Historical Perspectives, Progress, and Future Considerations

Graded exercise testing (GXT) is the most widely used assessment to examine the dynamic relationship between exercise and integrated physiological systems. The information from GXT can be applied across the spectrum of sport performance, occupational safety screening, research, and clinical diagnostics. The suitability of GXT to determine a valid maximal oxygen consumption (VO₂max) has been under investigation for decades. Although a set of recommended criteria exists to verify attainment of VO₂max, the methods that originally established these criteria have been scrutinized. Many studies do not apply identical criteria or fail to consider individual variability in physiological responses. As an alternative to using traditional criteria, recent research efforts have been directed toward using a supramaximal verification protocol performed after a GXT to confirm attainment of VO₂max. Furthermore, the emergence of self-paced protocols has provided a simple, yet reliable approach to designing and administering GXT. In order to develop a standardized GXT protocol, additional research should further examine the utility of self-paced protocols used in conjunction with verification protocols to elicit and confirm attainment of VO₂max.

Age differences in physiological responses to self-paced and incremental [Formula: see text] testing

Purpose

A self-paced maximal exercise protocol has demonstrated higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max values when compared against traditional tests. The aim was to compare physiological responses to this self-paced \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max protocol (SPV) in comparison to a traditional ramp \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max (RAMP) protocol in young (18–30 years) and old (50–75 years) participants.

Methods

Forty-four participants (22 young; 22 old) completed both protocols in a randomised, counter-balanced, crossover design. The SPV included 5 × 2 min stages, participants were able to self-regulate their power output (PO) by using incremental ‘clamps’ in ratings of perceived exertion. The RAMP consisted of either 15 or 20 W min⁻¹.

Results

Expired gases, cardiac output (Q), stroke volume (SV), muscular deoxyhaemoglobin (deoxyHb) and electromyography (EMG) at the vastus lateralis were recorded throughout. Results demonstrated significantly higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max in the SPV (49.68 ± 10.26 ml kg⁻¹ min⁻¹) vs. the RAMP (47.70 ± 9.98 ml kg⁻¹ min⁻¹) in the young, but not in the old group (>0.05). Q and SV were significantly higher in the SPV vs. the RAMP in the young (<0.05) but not in the old group (>0.05). No differences seen in deoxyHb and EMG for either age groups (>0.05). Peak PO was significantly higher in the SPV vs. the RAMP in both age groups (<0.05).

Conclusion

Findings demonstrate that the SPV produces higher \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max, peak Q and SV values in the young group. However, older participants achieved similar \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max values in both protocols, mostly likely due to age-related differences in cardiovascular responses to incremental exercise, despite them achieving a higher physiological workload in the SPV.

Validity of a perceptually-regulated step test protocol for assessing cardiorespiratory fitness in healthy adults

PURPOSE

To determine whether maximal oxygen uptake (VO₂max) could be predicted accurately and reliably from a 2-step, perceptually-regulated exercise test (PRET) in healthy adults.

METHODS

Sixteen participants (31.7 ± 11.3 years, 3 females) completed three PRETs (separated by 24-72 h) and one maximal, perceptually-regulated, graded exercise test (PRETmax) on a motorized treadmill. Oxygen uptake (VO₂) and heart rate (HR) were recorded during each test. VO₂ values for RPE range 9-15 were extrapolated to RPE 20 and age-predicted maximal HR (HRmax) using individual linear regression analysis to predict VO₂max values compared to measured VO₂max.

RESULTS

VO₂ and HR values were consistent between each of four RPE levels of the PRET. ICC values ranged between 0.76 and 0.85. Predicted VO₂max from both methods were lower than measured VO₂max (p < 0.01). Limits of agreement (LoA) for measured (41.4 ± 5.3 ml kg^-1 min^-1) versus predicted VO₂max from each of the three PRETs using RPE20 were -1.2 ± 15.6, -1.0 ± 7.2 and -2.1 ± 5.5 and for HRmax were -1.8 ± 4.2; -2.6 ± 4.2 and -2.4 ± 4.4 ml kg^-1 min^-1 for PRET 1, 2 and 3, respectively.

CONCLUSIONS

The step PRET elicited significant and reliable increases in VO₂ across the four RPE levels, but under-estimated treadmill VO₂max. However, there was better agreement between measured and predicted VO₂max when extrapolated to HRmax. As evidence indicates the underestimation of VO₂max is explained by the difference in the mode of exercise, the step PRET provides a simple and convenient test of cardiorespiratory fitness.

The effect of trial familiarisation on the validity and reproducibility of a field-based self-paced VO2max test

The self-paced maximal oxygen uptake (VO2max) test (SPV), which is based on the Borg 6-20 Ratings of Perceived Exertion (RPE) scale, allows participants to self-regulate their exercise intensity during a closed-loop incremental maximal exercise test. As previous research has assessed the utility of the SPV test within laboratory conditions, the purpose to this study was to assess the effect of trial familiarisation on the validity and reproducibility of a field-based, SPV test. In a cross-sectional study, fifteen men completed one laboratory-based graded exercise test (GXT) and three field-based SPV tests. The GXT was continuous and incremental until the attainment of VO2max. The SPV, which was completed on an outdoor 400m athletic track, consisted of five x 2 min perceptually-regulated (RPE11, 13, 15, 17 and 20) stages of incremental exercise. There were no differences in the VO2max reported between the GXT (63.5±10.1 ml·kg(-1)·min(-1)) and each SPV test (65.5±8.7, 65.4±7.0 and 66.7±7.7 ml·kg(-1)·min(-1) for SPV1, SPV2 and SPV3, respectively; P>.05). Similar findings were observed when comparing VO2max between SPV tests (P>.05). High intraclass correlation coefficients were reported between the GXT and the SPV, and between each SPV test (≥.80). Although participants ran faster and further during SPV3, a similar pacing strategy was implemented during all tests. This study demonstrated that a field-based SPV is a valid and reliable VO2max test. As trial familiarisation did not moderate VO2max values from the SPV, the application of a single SPV test is an appropriate stand-alone protocol for gauging VO2max.

VO2max Measured with a Self-selected Work Rate Protocol on an Automated Treadmill

PURPOSE

The use of graded maximal exercise tests for measuring maximal oxygen consumption (VO2max) is common practice in both cardiopulmonary rehabilitation settings and in sports medicine research. Recent alterations of common testing protocols to allow for self-selected work rates (SPV) have elicited V˙O2max values similar to or higher than more traditional style protocols (TP). Research is lacking in the delivery of the SPV protocol using a treadmill modality. The purpose of the study was to examine the validity of an SPV using an automated treadmill for measuring cardiorespiratory fitness.

METHODS

Thirteen experienced endurance runners completed three maximal exercise tests on a treadmill. Oxygen consumption was measured using a computerized system and averaged more than 30-s time periods. SPV was completed using an automated treadmill that consisted of a sonar range finder, microcontroller, and customized computer software. Subject deviations from the middle of the treadmill belt resulted in rapid, graded increases or decreases in speed. TP was completed on the same treadmill without the use of the automated software. A verification phase protocol (VP) was used to verify if VO2 was maximal.

RESULTS

Peak work rate achieved during SPV was significantly greater than that achieved during TP by 1.2 METs; P < 0.05, d = 0.564. Oxygen consumption was significantly greater in TP (64.9 ± 8.2 mL·kg·min) than SPV (63.4 ± 7.8 mL·kg·min); P < 0.005, d = 0.195.

CONCLUSION

An automated treadmill allowed for the completion of SPV similar to what has been reported for cycling. SPV with an automated treadmill did not provide a higher VO2max than TP despite higher work rates.

Increased cardiac output elicits higher V̇O2max in response to self-paced exercise

Recently, a self-paced protocol demonstrated higher maximal oxygen uptake versus the traditional ramp protocol. The primary aim of the current study was to further explore potential differences in maximal oxygen uptake between the ramp and self-paced protocols using simultaneous measurement of cardiac output. Active men and women of various fitness levels (N = 30, mean age = 26.0 ± 5.0 years) completed 3 graded exercise tests separated by a minimum of 48 h. Participants initially completed progressive ramp exercise to exhaustion to determine maximal oxygen uptake followed by a verification test to confirm maximal oxygen uptake attainment. Over the next 2 sessions, they performed a self-paced and an additional ramp protocol. During exercise, gas exchange data were obtained using indirect calorimetry, and thoracic impedance was utilized to estimate hemodynamic function (stroke volume and cardiac output). One-way ANOVA with repeated measures was used to determine differences in maximal oxygen uptake and cardiac output between ramp and self-paced testing. Results demonstrated lower (p < 0.001) maximal oxygen uptake via the ramp (47.2 ± 10.2 mL·kg(-1)·min(-1)) versus the self-paced (50.2 ± 9.6 mL·kg(-1)·min(-1)) protocol, with no interaction (p = 0.06) seen for fitness level. Maximal heart rate and cardiac output (p = 0.02) were higher in the self-paced protocol versus ramp exercise. In conclusion, data show that the traditional ramp protocol may underestimate maximal oxygen uptake compared with a newly developed self-paced protocol, with a greater cardiac output potentially responsible for this outcome.