Enhancing specificity in proxy-design for the assessment of bioenergetics

Adequacy of an Altitude Fitness Program (Living and Training) plus Intermittent Exposure to Hypoxia for Improving Hematological Biomarkers and Sports Performance of Elite Athletes: A Single-Blind Randomized Clinical Trial

Athletes incorporate altitude training programs into their conventional training to improve their performance. The purpose of this study was to determine the effects of an 8-week altitude training program that was supplemented with intermittent hypoxic training (IHE) on the blood biomarkers, sports performance, and safety profiles of elite athletes. In a single-blind randomized clinical trial that followed the CONSORT recommendations, 24 male athletes were randomized to an IHE group (HA, n = 12) or an intermittent normoxia group (NA, n = 12). The IHE consisted of 5-min cycles of hypoxia−normoxia with an FIO2 of between 10−13% for 90 min every day for 8 weeks. Hematological (red blood cells, hemoglobin, hematocrit, hematocrit, reticulated hemoglobin, reticulocytes, and erythropoietin), immunological (leukocytes, monocytes, and lymphocytes), and renal (urea, creatinine, glomerular filtrate, and total protein) biomarkers were assessed at the baseline (T1), day 28 (T2), and day 56 (T3). Sports performance was evaluated at T1 and T3 by measuring quadriceps strength and using three-time trials over the distances of 60, 400, and 1000 m on an athletics track. Statistically significant increases (p < 0.05) in erythropoietin, reticulocytes, hemoglobin, and reticulocyte hemoglobin were observed in the HA group at T3 with respect to T1 and the NA group. In addition, statistically significant improvements (p < 0.05) were achieved in all performance tests. No variations were observed in the immunological or renal biomarkers. The athletes who were living and training at 1065 m and were supplemented with IHE produced significant improvements in their hematological behavior and sports performance with optimal safety profiles.

Impact of Warm-Up on Muscle Temperature and Athletic Performance

Purpose: We performed two studies to investigate: the minute-by-minute changes in muscle temperature following a 20-min warm-up routine (Study-1) and the impact of the typical post-warm-up period of inactivity on the performance of basketball athletes (Study-2). Method: In Study-1, 26 males (age: 23.6 ± 6.2 yr; BMI: 24.1 ± 3.1 kg/m²) performed a 20-min cycling warm-up and then rested for 20 min. Tibialis anterior muscle temperature was assessed throughout. In Study-2, six male professional basketball players (age: 24.9 ± 4.6 yr; BMI: 25.5 ± 1.8 kg/m²) performed a series of basketball performance tests after a 20-min warm-up, as well as 9-min and 23-min into a post-warm-up period of inactivity. Results: On average, muscle temperature increased by 0.1°C every minute during warm-up and dropped by the same amount every minute during inactivity. The increase during warm-up and the decrease during inactivity were higher at the start of each period. A 9-min inactivity period is accompanied by 3.8 ± 0.6% reduction in countermovement jump (p = .046). A 23-min inactivity period is accompanied by 7.3 ± 0.7% reduction in lay-up points (p = .027). Conclusion: These two studies show that a 20-min warm-up routine increases muscle temperature but this benefit is lost after a typical post-warm-up inactivity period in high-level basketball, leading to reductions in certain aspects of athletic performance.

Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review

We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.

Does the Multistage 20-m Shuttle Run Test Accurately Predict VO2max in NCAA Division I Women Collegiate Field Hockey Athletes?

Laboratory assessments of maximal oxygen uptake (VO_2max) are considered the "gold standard" for ascertaining cardiovascular fitness, but they are not always practical for use in team sport settings. Therefore, the purpose of the current study was to compare the criterion assessment of VO_2max on a treadmill to the progressive, multistage 20-m shuttle run test (i.e., Beep test), and to determine the predictability of 6 previously established Beep test predictive equations (i.e., Chatterjee, Flouris, Leger, Leger and Gadoury, Ramsbottom, St. Clair-Gibson). Collegiate women field hockey athletes (n = 65, mean±SD: age 19.6 ± 1.2 years; weight 64.7 ± 6.1 kg) completed criterion VO_2max (mean ± SD: 46.4 ± 4.6 mL·kg^-1·min^-1) and Beep tests to volitional fatigue. According to Bland-Altman and Ordinary Least Products Regressions, the Ramsbottom (46.5 ± 4.2 mL·kg^-1·min^-1) and Flouris (46.3 ± 3.8 mL·kg^-1·min^-1) equations were considered valid predictions of criterion measured VO_2max (46.4 ± 4.6). The Chatterjee, Leger, Leger and Gadoury, and St. Clair-Gibson equations overestimated VO_2max, and are not recommended for use with women collegiate field hockey athletes. The Ramsbottom and Flouris estimates of VO_2max from 20-m shuttle performances may be used in this population. For accurate estimates of VO_2max, the clientele's age, fitness level, and training history should be considered when selecting equations.

Developing and testing an instrument to assess aquaticity in humans

We developed and validated an aquaticity assessment test (AAT) for the evaluation of human physical adequacy in the water. Forty-six volunteers (25M/21F; 20 ± 8 years) participated and performed 10 easy-to-administer and practical aquatic tasks. Group A was formed by 36 elite athletes (M/F 20/16, 24.7 ± 10yrs) from two sports categories depending on their affinity to the water environment: terrestrial (wrestling, cycling, dancing) and aquatic (swimming, synchronized swimming, free diving) sports. Group B was formed by 10 non-athlete participants (5M/5F, 14.4 ± 1.4yrs) and was assessed by two independent evaluators. Participants in Group A performed the aquatic tasks once to develop the final AAT items and cutoffs. Participants in Group B performed the aquatic tasks twice on different days to assess repeatability. Factor analysis recommended all 10 aquatic tasks to be included in the final AAT, resulting in scores ranging from 9.5 to 49.5. The AAT scores were statistically different between the terrestrial and the aquatic sports' participants (p < 0.001). The duration of the test was 25 min from the time of water entry. Receiver operating characteristics curve analyses demonstrated that the cutoffs for low and high aquaticity levels in this sample were ≤23.7 and ≥43.3, respectively. Reliability analyses demonstrated that the aquaticity scores obtained on different days and by different examiners highly correlated (p < 0.001) and were not significantly different (p > 0.05). The AAT appears to be a valid and reliable tool for the evaluation of human physical adequacy in the water. It is an easy and user-friendly test which can be performed in any swimming pool without a need for highly trained staff and specialized equipment, however more research needs to be done in order to be applied in other population group.

Non-invasive measurement of tibialis anterior muscle temperature during rest, cycling exercise and post-exercise recovery

We introduce a non-invasive and accurate method to assess tibialis anterior muscle temperature (Tm) during rest, cycling exercise, and post-exercise recovery using the insulation disk (INDISK) technique. Twenty-six healthy males (23.6  ±  6.2 years; 24.1  ±  3.1 body mass index) were randomly allocated into the 'model' (n = 16) and the 'validation' (n = 10) groups. Participants underwent 20 min supine rest, 20 min cycling exercise at 60% of age-predicted maximum heart rate, and 20 min supine post-exercise recovery. In the model group, Tm (34.55  ±  1.02 °C) was greater than INDISK temperature (Tid; 32.44  ±  1.23 °C; p < 0.001) and skin surface temperature (Tsk; 29.84  ±  1.47 °C; p < 0.001) throughout the experimental protocol. The strongest prediction model (R(2) = 0.646) incorporated Tid and the difference between the current Tid temperature and that recorded four minutes before. No mean difference (p > 0.05) and a strong correlation (r = 0.804; p < 0.001) were observed between Tm and predicted Tm (predTm) in the model group. Cross-validation analyses in the validation group demonstrated no mean difference (p > 0.05), a strong correlation (r = 0.644; p < 0.001), narrow 95% limits of agreement (-0.06  ±  1.51), and low percent coefficient of variation (2.24%) between Tm (34.39  ±  1.00 °C) and predTm (34.45  ±  0.73 °C). We conclude that the novel technique accurately predicts Tm during rest, cycling exercise, and post-exercise recovery, providing a valid and cost-efficient alternative when direct Tm measurement is not feasible.

Noninvasive assessment of muscle temperature during rest, exercise, and postexercise recovery in different environments

We introduced noninvasive and accurate techniques to estimate muscle temperature (Tm) of vastus lateralis (VL), triceps brachii (TB), and trapezius (TRAP) during rest, exercise, and postexercise recovery using the insulation disk (iDISK) technique. Thirty-six volunteers (24 men, 12 women; 73.0 ± 12.2 kg; 1.75 ± 0.07 m; 24.4 ± 5.5 yr; 49.2 ± 6.8 ml·kg(-1)·min(-1) peak oxygen uptake) underwent periods of rest, cycling exercise at 40% of peak oxygen uptake, and postexercise recovery in three environments: Normal (24°C, 56% relative humidity), Hot-Humid (30°C, 60% relative humidity), and Hot-Dry (40°C, 24% relative humidity). Participants were randomly allocated into the "model" and the "validation" groups. Results in the model group demonstrated that Tm (VL: 36.65 ± 1.27°C; TB: 35.76 ± 1.73°C; TRAP: 36.53 ± 0.96°C) was increased compared with iDISK (VL: 35.67 ± 1.71°C; TB: 34.77 ± 2.27°C; TRAP: 35.98 ± 1.34°C) across all environments (P < 0.001). Stepwise regression analysis generated models that accurately predicted Tm (predTm) of VL (R(2) = 0.73-0.91), TB (R(2) = 0.85-0.93), and TRAP (R(2) = 0.84-0.86) using iDISK and the difference between the current iDISK temperature and that recorded between 1 and 4 min before. Cross-validation analyses in the validation group demonstrated small differences (P < 0.05) of no physiological significance, small effect size of the differences, and strong associations (r = 0.85-0.97; P < 0.001) between Tm and predTm. Moreover, narrow 95% limits of agreement and low percent coefficient of variation were observed between Tm and predTm. It is concluded that the developed noninvasive, practical, and inexpensive techniques provide accurate estimations of VL, TB, and TRAP Tm during rest, cycling exercise, and postexercise recovery.

Validity of the Yo-Yo Intermittent Recovery Test Level 1 for Direct Measurement or Indirect Estimation of Maximal Oxygen Uptake in Female Soccer Players

Purpose:

To evaluate the validity of the Yo-Yo Intermittent Recovery Test Level 1 (YYIR1) for the direct assessment and the indirect estimation of maximal oxygen consumption (VO2max) in female soccer players compared with a maximal laboratory treadmill test (LTT).

Methods:

Eighteen female soccer players (21.5 ± 3.4 y, 165.6 ± 7.5 cm, 63.3 ± 7.4 kg; mean ± SD) completed an LTT and a YYIR1 in random order (1 wk apart). Their VO2max was directly measured via portable spirometry during both tests and indirectly estimated from a published non-gender-specific formula (YYIR1-F1).

Results:

The measured VO2max values in LTT and YYIR1 were 55.0 ± 5.3 and 49.9 ± 4.9 mL · kg−1 · min−1, respectively, while the estimated VO2max values from YYIR1-F1 corresponded to 45.2 ± 3.4 mL · kg−1 · min−1. Large positive correlations between the VO2max values from YYIR1 and LTT (r = .83, P < .001, 90% confidence interval = .64–.92) and YYIR1-F1 and LTT (r = .67, P = .002, .37–.84) were found. However, the YYIR1 significantly underestimated players’ VO2max by 9.4% compared with LTT (P < .001) with Bland-Altman 95% limits of agreement ranging from –20.0% to 1.4%. A significant underestimation from the YYIR1-F1 (P < .001) was also identified (17.8% with Bland-Altman 95% limits of agreement ranging from –31.8% to –3.8%).

Conclusions:

The YYIR1 and YYIR1-F1 are not accurate methods for the direct assessment or indirect estimation of VO2max in female soccer players. The YYIR1-F1 lacks gender specificity, which might have been the reason for its larger error.

Instruments to assess secondhand smoke exposure in large cohorts of never smokers: the smoke scales

The objectives of this study were to: (i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7–18 years) and 95 adult (23 males; 72 females; 18–62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30% answered the questions again after 20–30 days. Prevalence of SHS+ in children and adults was 0.52±0.07 and 0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at >16.5 and >16, respectively. Significant Kappa agreement (p<0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p<0.001) and not significantly different (p>0.05). Area under the curve and McNemar's Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p>0.05). We conclude that the SS-C and the SS-A represent valid, reliable, practical, and inexpensive instruments to identify children and adult never-smokers exposed to increased SHS. Future research should aim to further increase the validity of the two questionnaires.

Two different fatigue protocols and lower extremity motion patterns during a stop-jump task

CONTEXT

Altered neuromuscular control strategies during fatigue probably contribute to the increased incidence of noncontact anterior cruciate ligament injuries in female athletes.

OBJECTIVE

To determine biomechanical differences between 2 fatigue protocols (slow linear oxidative fatigue protocol [SLO-FP] and functional agility short-term fatigue protocol [FAST-FP]) when performing a running-stop-jump task.

DESIGN

Controlled laboratory study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A convenience sample of 15 female soccer players (age = 19.2 ± 0.8 years, height = 1.67 ± 0.05 m, mass = 61.7 ± 8.1 kg) without injury participated.

INTERVENTION(S)

Five successful trials of a running-stop-jump task were obtained prefatigue and postfatigue during the 2 protocols. For the SLO-FP, a peak oxygen consumption (Vo(2)peak) test was conducted before the fatigue protocol. Five minutes after the conclusion of the Vo(2)peak test, participants started the fatigue protocol by performing a 30-minute interval run. The FAST-FP consisted of 4 sets of a functional circuit. Repeated 2 (fatigue protocol) × 2 (time) analyses of variance were conducted to assess differences between the 2 protocols and time (prefatigue, postfatigue).

MAIN OUTCOME MEASURE(S)

Kinematic and kinetic measures of the hip and knee were obtained at different times while participants performed both protocols during prefatigue and postfatigue.

RESULTS

Internal adduction moment at initial contact (IC) was greater during FAST-FP (0.064 ± 0.09 Nm/kgm) than SLO-FP (0.024 ± 0.06 Nm/kgm) (F(1,14) = 5.610, P = .03). At IC, participants had less hip flexion postfatigue (44.7° ± 8.1°) than prefatigue (50.1° ± 9.5°) (F(1,14) = 16.229, P = .001). At peak vertical ground reaction force, participants had less hip flexion postfatigue (44.7° ± 8.4°) than prefatigue (50.4° ± 10.3°) (F(1,14) = 17.026, P = .001). At peak vertical ground reaction force, participants had less knee flexion postfatigue (-35.9° ± 6.5°) than prefatigue (-38.8° ± 5.03°) (F(1,14) = 11.537, P = .001).

CONCLUSIONS

Our results demonstrated a more erect landing posture due to a decrease in hip and knee flexion angles in the postfatigue condition. The changes were similar between protocols; however, the FAST-FP was a clinically applicable 5-minute protocol, whereas the SLO-FP lasted approximately 45 minutes.

Prediction of VO2max from a new field test based on portable indirect calorimetry

We assessed the validity and reliability of the new 15m square shuttle run test (SST) for predicting laboratory treadmill test (TT) maximal oxygen uptake (VO(2 max)) compared to the 20 m multistage shuttle run test (MST) in 45 adult males. Thirty participants performed a TT and a SST once to develop a VO( 2max) prediction model. The remaining 15 participants performed the TT and MST once and the SST twice for cross-validation purposes. Throughout testing V O(2max) was determined via portable indirect calorimetry while blood lactate concentration was assessed at the fifth recovery minute. Comparisons of TT V O(2 max) (51.3+/-3.1 ml kg(-1)min(-1)) with SST measured (51.2+/-3.2 ml kg(-1)min(-1)) and predicted (50.9+/-3.3 ml kg(-1)min(-1)) V O(2 max) showed no differences while TT blood lactate was higher compared to SST (10.3+/-1.7 mmol vs. 9.7+/-1.7 mmol, respectively). In contrast, MST measured (53.4+/-3.5 ml kg(-1)min(-1)) and predicted (57.0+/-4.5 ml kg(-1)min(-1)) V O(2 max) and blood lactate (11.2+/-2.0 mmol) were significantly higher compared to TT. No test-retest differences were detected for SST measured and predicted V O(2 max) and blood lactate. It is concluded that the SST is a highly valid and reliable predictive test for V O(2 max).

Criterion-related validity and test-retest reliability of the 20m square shuttle test

We assessed validity and reliability of the new 20m square shuttle run test (SST) for predicting maximal oxygen uptake (V O(2max)) and compared it with its predecessor, the 20m Multistage Shuttle Run Test (MST). In a repeated-measures randomised-block design, 74 healthy adult males performed the SST, the MST and a treadmill test (TT). To assess reliability, 40 of the total 74 volunteers were randomly-selected to perform the SST and MST twice. Unlike the SST (p>0.05), mean predicted V O(2max)(V predO(2max)) from the MST was significantly increased from that measured during the TT (p<0.05). The V predO(2max) from SST and MST correlated with TT V O(2max) at r=0.95 (p<0.001) and r=0.63 (p<0.001), respectively. Prediction error of SST was -0.3+/-3.3mlkg(-1)min(-1) with a coefficient of variation of +/-3.5%, while the equivalent values for MST were 4.2+/-7.3mlkg(-1)min(-1) and +/-7.4%. Mean test-retest V predO(2max) did not differ for both SST and MST (p>0.05), while the corresponding test-retest correlation coefficients were r=0.85 (p<0.001) and r=0.72 (p<0.001). Reliability errors in 95% limits of agreement were 0.3+/-4.8 and 0.6+/-6.8mlkg(-1)min(-1) while coefficients of variation were +/-5.2% and +/-6.8% for the SST and MST, respectively. It is concluded that SST is a more valid proxy than MST for predicting laboratory V O(2max) based on the current procedures, while both tests are sufficiently reliable in healthy male adults.

The effect of performance feedback on cardiorespiratory fitness field tests

We investigated the effects of performance feedback (PF) on predicting maximal oxygen uptake (VO2 max) using the 20 m Multistage Shuttle Run Test (MST) and 20 m Square Shuttle Test (SST). The agreement between these two field tests in relation to laboratory VO2 max was also examined. Forty healthy males (age: 21.5+/-2.3; BMI: 23.7+/-2.0) randomly performed four indirect VO2 max tests; that is the MST and SST, as well as a modified version of MST (MSTMD) and SST (SSTMD). During MST and SST subjects received PF with respect to both test stage and running pace. In contrast, MSTMD and SSTMD incorporated auditory feedback which solely emitted signals regulating the running pace. Participants also performed a laboratory VO2 max treadmill test (TT). ANOVA demonstrated significant mean predicted VO2 max decrements in both MSTMD (p<0.001) and SSTMD (p<0.05) compared to MST and SST, respectively. In predicting TTVO2 max, the '95% limits of agreement' analysis indicated errors equal to 3.6+/-9.6 and 1.4+/-10.3 ml kg-1 min-1 with coefficients of variation of +/-10.0% and +/-10.9%, for MST and MSTMD, respectively. The corresponding '95% limits of agreement' values for SST and SSTMD were 0.1+/-5.0 and -1.1+/-6.1 ml kg-1 min-1 with coefficients of variation of +/-5.4% and +/-6.7%, respectively. It is concluded that the application of PF leads to superior field testing performances.

The need for energy equilibrium

Human bioenergetics has been extensively assessed by means of field proxies (ie, cardiorespiratory fitness field tests) during the last two decades. A systematic review of the germane literature, however, suggests considerable controversy as to whether the present tests lead to valid measurements of energy expenditure/utilisation. The present paper suggests that current modalities of field testing being used as predictive models for bioenergetics may suffer from methodological limitations, stemming primarily from inappropriate design. A major weakness in the theoretical basis of proxies is that, although based on field measurements, it seeks to predict laboratory bioenergetics which, in turn, are used to provide information on field performance. Hence, it seems reasonable that the number of transformations increases the potential for error and may have significant impact on the prediction of bioenergetics. Recent studies asserted the importance of achieving 'energy equilibrium' between the reference standard and each proxy. The suggested approach involves designing proxies that closely simulate each laboratory protocol used as reference standard. The theoretical bases of previous and contemporary approaches are discussed in an attempt to increase the validity of current proxy assessments.