A call to action towards an evidence-based approach to using verbal encouragement during maximal exercise testing

Self-Paced Field Running Test in Monitoring Fatigue and Training Adaptations in Recreational Runners

PURPOSE

To examine the reproducibility and sensitivity of a self-paced field running test (SFT) in monitoring positive and negative changes in endurance performance.

METHODS

A total of 27 (11 women) recreational runners participated in a 6-week training intervention. The intervention was divided into a 3-week baseline period, a 2-week overload period, and a 1-week recovery period. An incremental treadmill test was performed before the baseline period and a 3000-m running test before and after all periods (T1-T4). In addition, the participants performed once a week an SFT (SFT1-6), which consisted of submaximal (6 + 6 + 3-min test at perceived exertion of 9/20, 13/20, and 17/20) and maximal sections (6 × 3-min intervals at maximum sustainable effort). The associations between the incremental treadmill test and the SFT1 performance were examined with the Pearson correlation, and the intraclass correlation was analyzed for the parameters of SFT1 to SFT3 sessions during the baseline period. The repeated-measures correlation was calculated for the 3000-m speed at T1 to T4 and the corresponding speeds at SFT.

RESULTS

Significant associations (r = .68-.93; P < .001) were found between the speeds of the SFT and the peak and lactate threshold speeds of the incremental treadmill test. Intraclass correlations varied between .77 and .96, being the highest for the average speed of 6 × 3-minute intervals. Repeated-measures correlation was significant (P < .05) for the 9/20 (r = .24), 13/20 (r = .24), and 6 × 3-minute intervals (r = .29).

CONCLUSIONS

The SFT seemed a reproducible method to estimate endurance performance in recreational runners. The sensitivity to track short-term and small-magnitude changes in performance seems more limited and might require more standardized conditions.

Role of Thigh Muscle Strength and Joint Kinematics in Dynamic Stability: Implications for Y-Balance Test Performance

CONTEXT

The Y-Balance Test Lower Quarter (YBT-LQ) is a widely utilized tool for evaluating dynamic postural control, requiring a combination of mobility and strength. This study aimed to investigate the combined relationship between isometric thigh muscle strength and joint kinematics on YBT-LQ performance.

DESIGN

Cross-sectional laboratory study.

METHODS

Isometric quadriceps and hamstrings strength were measured before the YBT-LQ in 39 healthy participants (27 females and 12 males). The test was performed under 3-dimensional markerless motion capture, where joint kinematics were extracted from the maximum reach position from each direction. Three multivariable linear regression models were then used to determine the strongest combination of predictors for YBT-LQ performance.

RESULTS

Greater hamstrings strength and increased knee flexion, ankle dorsiflexion, and trunk ipsilateral-flexion joint angles explained 56.8% (P < .001) of the variance in anterior reach. Hip flexion, knee flexion, and ankle dorsiflexion angles were the strongest predictors for posteromedial reach distance, explaining 73.0% of the variance (P < .001). Last, 43.3% (P < .001) of the variance in posterolateral reach distance was predicted by hamstring strength and knee-flexion angle.

CONCLUSIONS

These results emphasize the importance of hamstring strength in YBT-LQ performance across different reach directions. Additionally, the kinematics illustrate a potential movement strategy for maximizing reach distance on the YBT-LQ in healthy individuals. Clinicians can utilize this information to guide interventions aimed at improving dynamic postural control, particularly by focusing on increasing hamstring strength and testing for impairments in specific movement patterns.

The influence of real-time quantitative feedback and verbal encouragement on adults' performance in maximal and explosive strength and power in bench press exercise

Background

In sports practice, a wide array of verbal and non-verbal stimuli can elicit diverse motivations and performance changes. Therefore, the primary objective of this study was to compare the impact of various stimuli on maximal strength and power in bench press exercises.

Methods

This study involved 48 university students (average age 20.5 ± 2.8 years; body mass 80.1 ± 20 kg; height 174.6 ± 6.7 cm; BMI 26.2 ± 6 kg/m2) who engaged in an 8-week resistance training program. The students were randomly divided into three experimental groups and one control group. The first group received real-time quantitative feedback (RF) on their power output during the bench press exercise, the second group received verbal encouragement (VE) from an instructor, and the third group exercised without any external stimulus (WS). The control group (CG) underwent only pre- and post-measurements. To compare differences in strength parameters among groups a Two-Way Repeated Measures ANOVA was applied.

Results

The results revealed significant improvements in the mean weight for one repetition maximum in the real-time quantitative feedback group (5 kg, 9.76%, p = 0.001, d = 0.529) and the verbal encouragement group (5.42 kg, 11.51%, p = 0.001, d = 1.201). Positive changes were also observed in the mean power at 20 and 30 kg for the RF, VE, and WS groups, but at 40 kg, significant improvement was only seen in the real-time quantitative feedback group (247 W, 31.30%, p = 0.001, d = 1.199).

Conclusion

These findings underscore the effectiveness of selected stimuli in enhancing maximum strength and power during bench press exercises, with real-time quantitative feedback proving to be the most effective stimulus for improving both maximal strength and power.

Improvement of Motor Task Performance: Effects of Verbal Encouragement and Music-Key Results from a Randomized Crossover Study with Electromyographic Data

External motivational stimuli have been shown to improve athletic performance. However, the neurophysiological mechanisms underlying this improvement remain poorly understood. This randomized crossover study investigated the effects of music and verbal encouragement on measures of muscle excitation and myoelectric manifestations of fatigue in the biceps brachii and brachioradialis muscles during an endurance task. Fifteen untrained (mean age 29.57 ± 2.77 years) and 13 trained individuals (mean age 32.92 ± 2.90 years) were included. The endurance task, performed to exhaustion, consisted of keeping the dominant arm flexed to 90 degrees while holding a dumbbell loaded to 80% of 1RM with a supine grip in three randomized conditions: standard, with self-selected music, and with verbal encouragement. The untrained subjects showed an increase in task duration of 15.26% (p < 0.003) with music and 15.85% (p < 0.002) with verbal encouragement compared to the condition without external stimuli. There were no significant differences in the myoelectric manifestations of fatigue between the different conditions. Regarding the muscle excitation metrics, although the mean amplitude, peak value, and area under the curve remained unchanged across conditions, a significant reduction in the trend coefficient, indicating motor unit recruitment over time, was observed with both music (biceps brachii: -10.39%, p < 0.001; brachioradialis: -9.40%, p < 0.001) and verbal encouragement (biceps brachii: -7.61%, p < 0.001; brachioradialis: -6.51%, p < 0.001) compared to the standard condition. For the trained participants, no significant differences were observed between conditions in terms of task duration and outcome measures related to muscle excitation and myoelectric manifestations of fatigue, suggesting the possible presence of a ceiling effect on motivation. These results highlight the important role of external motivational stimuli, such as music and verbal encouragement, in improving task performance in untrained subjects, probably through more effective and efficient recruitment of motor units.

Exploring the impact of verbal encouragement on strength, endurance, and psychophysiological responses: enhancing teaching strategies in sports science education

Introduction

This study investigates the effects of teacher verbal encouragement (VE) on strength, endurance, and psychophysiological responses, aiming to enhance teaching strategies in sports science education.

Methods

Forty-eight sports science students, aged 21.3 ± 0.5 years, participated in this study. The sample was randomly divided into two groups, and a counterbalancing procedure was implemented. Participants completed strength and endurance testing sessions under normal conditions in the first week and repeated similar sessions in the second week with teacher VE. Strength was assessed using the 1RM bench press, squat, and deadlift tests, while endurance was evaluated through 8-minute time trials (8MTT: burpees, box jumps, hand-release push-ups, and sit-ups). Perceived exertion and physical activity enjoyment were investigated using self-reporting instruments.

Results

The key findings showed that participants lifted greater weights in the 1RM bench press (p < 0.01; r   = 0.45, medium to large effect), squat (p < 0.001; Hedges' g = 1.36, large effect), and deadlift tests (p < 0.001; r = 0.79, large effect) and completed a greater number of repetitions in the 8MTT (p < 0.001; r = 0.87, large effect) under VE. Perceived exertion was found to be lower under normal conditions (p < 0.05; r = 0.29, small effect), yet physical activity enjoyment significantly increased under VE (p < 0.05; r = 0.81, large effect).

Discussion

In conclusion, implementing teacher VE in sports science education can contribute to improved strength and endurance training outcomes and student psychophysiological response.

Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols

Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.

Effect of Verbal Encouragement on Performance and Affective Responses in Male Sport Science Students during Sprint Modalities

This investigation aimed to examine the effect of verbal encouragement teacher to student (VETS) versus verbal encouragement student to student (VESS) on physical performance and affective responses during different modalities of sprint tests in active male students. In a randomized crossover design, twenty-two male sport science students (age: 21 ± 1.2 years, body height: 1.77 ± 0.3 m, body mass: 76.6 ± 2.1 kg, BMI: 22.9 ± 1.3 kg·m-2) performed linear and change-of-direction sprint tests under one of three conditions: (1) VETS; (2) VETS; (3) no verbal encouragement. In each condition, participants performed the 20 m sprint test, the 10 × 2 sprint test, and the L sprint test. The assessed parameters comprised physical performance, rating of perceived exertion (RPE), and a feeling scale. Post hoc test analysis indicates a significant increase in physical performance during VETS and VESS conditions compared to the control condition due to a decrease in sprint in line 20 m (VETS: p < 0.001, d = 0.55; VESS: p = 0.016, d = 0.41), sprint 10*2 (VETS: p < 0.001, d = 0.64; VESS: p = 0.05, d = 0.36), and sprint L (VETS: p = 0.001, d = 1.19) times compared to the control condition. Moreover, the feeling score was greater after VETS compared to other conditions (p = [<0.001-0.001], d = [0.77-1.18]). In addition, the RPE had no effect on sprint performance between the different conditions. It is indicated that VETS, rather than VESS, is a more significant and effective way to increase effort intensity and positive feelings during sprinting modalities.

When Studying Affective Responses to Exercise, the Definition of "Intensity" Must Reference Homeostatic Perturbations: A Retort to Vollaard et al

In articles on the methodology of studies investigating affective and enjoyment responses to high-intensity interval training, we noted that, occasionally, exercise conditions described as involving "high" intensity exhibited heart rates that were only as high as, or even lower than, heart rates recorded during comparator conditions described as being of "moderate" intensity. Drs. Vollaard, Metcalfe, Kinghorn, Jung, and Little suggest instead that exercise intensity in high-intensity interval-training studies can be defined in terms of percentages of peak workload. Although we maintain that defining exercise intensity in terms of percentages of maximal heart rate is a suboptimal way to quantify the degree of homeostatic perturbations in response to exercise, we are unconvinced that definitions of intensity relying solely on workload are appropriate for studies investigating affective and enjoyment responses to exercise. The reason is that affect is theorized to have evolved to relay information about homeostatic perturbations to consciousness.

Feasibility of predicting maximal oxygen uptake by using the efficiency factor in healthy men

Conventionally, efficiency is indirectly estimated through a respiratory gas analyser (oxygen, carbon dioxide), which is a complex and rather costly calculation method that is difficult to perform in many situations. Therefore, the present study proposed a modified definition of efficiency, called the efficiency factor (EF) (i.e., the ratio of work to the corresponding exercise intensity), and evaluated the relation between the EF and maximal oxygen uptake ([Formula: see text]), as well as compared the prediction models established based on the EF. The heart rate (maximal heart rate: 186 ± 6 beats min-1), rating of perceived exertion (19 ± 1), and [Formula: see text] (39.0 ± 7.1 mL kg-1 min-1) of 150 healthy men (age: 20 ± 2 years; height: 175.0 ± 6.0 cm; weight: 73.6 ± 10.7 kg; body mass index [BMI]: 24.0 ± 3.0 kg m-2; percent body fat [PBF]: 17.0 ± 5.7%) were measured during the cardiopulmonary exercise test (CPET). Through multiple linear regression analysis, we established the BMI model using age and BMI as parameters. Additionally, we created the PBF modelHRR utilizing weight, PBF, and heart rate reserve (HRR) and developed PBF modelEF6 and PBF modelEF7 by incorporating EF6 from the exercise stage 6 and EF7 from the exercise stage 7 during the CPET, respectively. EF6 (r = 0.32, p = 0.001) and EF7 (r = 0.31, p = 0.002) were significantly related to [Formula: see text]. Among the models, the PBF modelEF6 showed the highest accuracy, which could explain 62.6% of the variance in the [Formula: see text] at with a standard error of estimate (SEE) of 4.39 mL kg-1 min-1 (%SEE = 11.25%, p < 0.001). These results indicated that the EF is a significant predictor of [Formula: see text], and compared to the other models, the PBF modelEF6 is the best model for estimating [Formula: see text].

Extraordinary Claims in the Literature on High-Intensity Interval Training (HIIT): I. Bonafide Scientific Revolution or a Looming Crisis of Replication and Credibility?

The literature on high-intensity interval training (HIIT) contains claims that, if true, could revolutionize the science and practice of exercise. This critical analysis examines two varieties of claims: (i) HIIT is effective in improving various indices of fitness and health, and (ii) HIIT is as effective as more time-consuming moderate-intensity continuous exercise. Using data from two recent systematic reviews as working examples, we show that studies in both categories exhibit considerable weaknesses when judged through the prism of fundamental statistical principles. Predominantly, small-to-medium effects are investigated in severely underpowered studies, thus greatly increasing the risk of both type I and type II errors of statistical inference. Studies in the first category combine the volatility of estimates associated with small samples with numerous dependent variables analyzed without consideration of the inflation of the type I error rate. Studies in the second category inappropriately use the p > 0.05 criterion from small studies to support claims of 'similar' or 'comparable' effects. It is concluded that the situation in the HIIT literature is reminiscent of the research climate that led to the replication crisis in psychology. As in psychology, this could be an opportunity to reform statistical practices in exercise science.

The relevance of body composition assessment for the rating of perceived exertion in trained and untrained women and men

Introduction: Mechanic power output (MPO) and oxygen consumption (VO2) reflect endurance capacity and are often stated relative to body mass (BM) but less often per skeletal muscle mass (SMM). Rating of perceived exertion (RPE) has previously shown conflicting results between sexes at submaximal intensities. Individual body composition, however, largely differs due to sex and training status. It was the aim of this study to evaluate RPE of untrained and trained individuals of both sexes considering body composition and to estimate whether RPE could be improved as a tool to determine endurance capacity. Methods: The study included 34 untrained adults (age 26.18 ± 6.34 years, 18 women) and 29 endurance trained (age 27.86 ± 5.19, 14 women) who were measured for body composition (InBody 770, InBody Europe B.V., Germany) and tested on a treadmill (Pulsar, H/P/Cosmos, Germany) for aerobic capacity (Metalyzer 3B, Cortex Biophysik GmbH, Germany) in an all-out exercise test applying the Bruce-protocol. VO2, MPO, heart rate (HR), and RPE were obtained at each exercise stage. VO2 and MPO were calculated per BM and SMM. RPE values were correlated with absolute VO2 and MPO, as well as relative to BM, and SMM. HR values and the parameters' standardized values served for comparison to standard procedures. Results: VO2 and MPO were higher in men compared to women and in trained compared to untrained participants. No differences between groups and sexes exist when VO2 and MPO were calculated per BM. When calculated per SMM, VO2 and MPO indicate opposite results already at low intensity stages of exercise test. RPE values had highest correlation with MPO per SMM (R2 = 0.8345) compared to absolute MPO (R2 = 0.7609), or MPO per BM (R2 = 0.8176). Agreement between RPE and MPO per SMM was greater than between RPE and HR (p = 0.008). Conclusion: Although RPE represents a subjective value at first glance, it was shown that RPE constitutes a valuable tool to estimate endurance capacity, which can be further enhanced if individual body composition is considered. Furthermore, MPO and VO2 should be considered relative to SMM. These findings might help to avoid over-exertion, especially among untrained people, by adjusting the training intensity for each subject according to the individual strain evaluated in an exercise test based on individual body composition.

Reliability and Validity of a Portable Traction Dynamometer in Knee-Strength Extension Tests: An Isometric Strength Assessment in Recreationally Active Men

BACKGROUND

the study determined the validity and reliability of measurements obtained using the portable traction dynamometer (PTD) (E-Lastic, E-Sports Solutions, Brazil) and the reproducibility between evaluators (precision) in the evaluation of the isometric muscle strength of the knee extensors of healthy male adults, compared to measurements obtained with the "gold standard" computerized dynamometer (CD) (Biodex System 3, Nova York, NY, USA).

METHODS

we evaluated sixteen recreationally active men (29.50 ± 7.26 years). The test-retest reliability of both equipment to determine quadriceps strength, agreement analysis, and the minimal important difference were verified.

RESULTS

excellent test-retest interrater reliability was observed for absolute and relative measurements, with a low absolute error for both sets of equipment and excellent validity of the PTD against the CD, as verified by linear regression and Pearson's correlation coefficient.

CONCLUSIONS

PTD is a valid and reliable instrument for assessing the isometric strength of knee extensors, with results similar to the isometric CD "gold standard".

Verbal Encouragement Improves Game Intensity, Technical Aspects, and Psychological Responses During Soccer-Specific Training

BACKGROUND

Soccer match outcomes rely on technical accuracy, intensity of play, and athlete motivation, and these parameters can be developed during sport-specific practice such as during small-sided games (SSGs). Verbal encouragement as a coaching technique improves exercise intensity and athlete enjoyment (indicative of motivation), but the impact on technical performance alongside these critical parameters remains unknown.

PURPOSE

To examine the effects of verbal encouragement on technical performance, exercise intensity, and enjoyment during SSGs.

METHODS

Sixteen male youth soccer players (mean [SD]; age: 17.2 [0.4] y; height: 176.3 [7.0] cm; body mass: 68.0 [4.1] kg; body fat: 11.9% [2.2%]) completed 4 sessions of 4-per-side SSG without a goalkeeper. Two sessions were conducted as SSGs with verbal encouragement and 2 without verbal encouragement. Each SSG lasted 25 minutes (4 × 4-min work, 3-min passive recovery between bouts) on a 25 × 35-m pitch. Heart rate (HR) was continuously recorded, and rating of perceived exertion was collected after each SSG. Video analysis was used to quantify technical actions during SSG. Enjoyment was assessed after each SSG using the Physical Activity Enjoyment Scale.

RESULTS

Paired t tests revealed that SSGs with verbal encouragement induced higher HR (% maximum HR and mean HR), rating of perceived exertion, and Physical Activity Enjoyment Scale score than SSGs without verbal encouragement (all P < .001, all d ≥ 0.92, large). Compared with SSGs without verbal encouragement, SSGs with verbal encouragement resulted in an increased percentage of successful passes (P < .001, d = 0.73, medium) and number of interceptions (P < .001, d = 0.89, large) and fewer lost balls (P < .001, d = 0.68, medium).

CONCLUSIONS

Coaches should use verbal encouragement during SSGs to improve physical effort, technical performance, and psychological status in soccer players.

The Effect of Verbal Encouragement on Performance and Muscle Fatigue in Swimming

Background and Objectives: Verbal encouragement (VE) can be used to enhance performance in several sports, even though no studies have been conducted among swimmers and only a few effects have been reported in elite athletes. Besides influencing motor performance, VE is also known to enhance the physical load, thus potentially increasing the probability of developing fatigue. With this in mind, this study aimed to explore the effects of VE in swimmers in order to fill in the knowledge gap concerning the aquatic environment. Materials and Methods: Each athlete swam a maximal 200 m freestyle trial under two different conditions: one trial with VE and the other without VE. The two main outcome measures were: (1) performance velocity (m/s); and (2) muscle fatigue, investigated by means of surface electromyography. Sixty swimmers were recruited, aged 18.63 ± 3.46 years (median 18 years), 28 men (47%), and 32 women (53%), with 7.03 ± 3.9 years of experience. Results: With VE, performance significantly improved in the swim trial (p < 0.001, effect size (ES) −0.95, large). When breaking the results down into the first half (first (0−100 m) vs. the second half (100−200 m)), the ES was large in the first part (−1.11), indicating an improvement in performance. This worsened, however, in the second part of the trial (ES 0.63). In the multivariate analysis, years of experience were found to be a significant predictor of the change in overall performance (p = 0.011). There was a significant increase in muscle fatigue induced by VE, overall, and during the second half, but not during the first half of the trial. Conclusions: The present study indicates that VE during a middle-distance event (200 m) increases performance most in swimmers with little experience. However, it has a negative impact on fatigue.

Pediatric Cardiopulmonary Exercise Testing: Interoperability Through Domain Analysis Modeling and a National Survey

PURPOSE

The electronic health record, data science advances, and dynamic environmental and infectious threats to child health highlight the need for harmonized and interoperable approaches to pediatric cardiopulmonary exercise testing (CPET). Accordingly, we developed a terminology harmonization in exercise medicine and exercise science domain analysis model (THEMES DAM) to structure CPET data elements.

METHODS

THEMES DAM identified 114 data elements, including participant information, calibration, equipment, protocols, laboratory personnel, encouragement strategies, and analysis procedures. We used the THEMES DAM, vetted by the international data standards organization HL7, to construct a current-state survey of pediatric CPET centers in the United States. Forty-eight of 101 centers responded to a questionnaire covering seven major topic areas (38 items).

RESULTS

Centers predominantly performed between 100 and 500 tests annually. Cardiac disease represented 55% of referrals. Almost all centers calibrated gas concentrations and flow daily, but 42% never calibrated their treadmill or cycle ergometers. All centers measured V̇O2peakbut calculated differently. Centers used a variety of protocols (e.g., for treadmill: 61%, Bruce; 43%, modified Bruce; 59%, other); 44% calculated CPET slopes from submaximal portions of CPET (e.g., V̇O2-HR). All centers verbally encouraged participants, but only 40% used a standardized approach. The interpretation of CPET was done by physicians (60%), exercise physiologists (25%), exercise technicians (10%), nurses (1%), or others (4%). Ninety-one percent would agree to collaborate in multicenter research, 89% to establish dynamic reference values, and 83% to better interpret CPET.

CONCLUSIONS

The survey data and the implementation of THEMES DAM could accelerate interoperability across multiple centers. This would facilitate a nimble approach to create pediatric reference values responsive to the constantly changing health environment and stimulate novel approaches to CPET research and clinical application.

The Effects of Verbal Encouragement and Compliments on Physical Performance and Psychophysiological Responses During the Repeated Change of Direction Sprint Test

The general and sports psychology research is limited regarding the difference between the effects of verbal encouragement (VE) or compliment methods during high-intensity functional exercise testing. The purpose of this study was to explore the effects of VE and compliments on the performance of the repeated change-of-direction (RCOD) sprint test. A total of 36 male students in secondary school participated voluntarily in the study. They were divided equally into three homogeneous groups [VE group, compliment group (CG), and control group) and performed a standardized one repetition RCOD. The RCOD (6 × 20 m with 25-s active recovery) test consisted of a 100°change in the direction at every 4 m. Outcomes included performance indices (fast time, average time, and total time), rating of perceived exertion (RPE), and feeling scale scores. VE and the compliment increased the performance indices and RPE compared with the control group. In conclusion, VE during the exercise testing would be more beneficial for optimal performance and RPE compared with the compliment and control groups. However, the moods, during RCOD, reproduce more positively during compliment conditions than the VE and control groups.

Effects of Verbal Encouragement and Performance Feedback on Physical Fitness in Young Adults

This study evaluates the effects on the performance of young adults undergoing physical fitness tests with external stimuli (verbal encouragement (VE), performance feedback (PF), goal-oriented (GO) and a combination of external stimuli (CS)) and without external stimuli (WS). A group of 432 male students (age 19.1 ± 2.1 y, BMI 24.72 ± 5.97) was randomly selected for this study. They underwent a battery of fitness tests (bench press, 10 and 30 m sprints, and vertical jump) with and without external stimuli. The results showed greater improvements in mean power in bench press after PF compared to attempts WS (14.93 W, 3.43%, p = 0.005), and after CS compared to WS (13.84 W, 3.18%, p = 0.015). The time in the 10 and 30 m sprints decreased more profoundly after a combination of VE and GO compared to WS (0.021 s, 1.07%, p = 0.000 and 0.06 s, 1.23%, p = 0.001, respectively) and after CS compared to VE (0.015 s, 0.76%, p = 0.004 and 0.074 s, 1.52%, p = 0.000, respectively). Furthermore, the height of the jump improved more after VE than WS (1.36 cm, 5.46%, p = 0.000), after CS than WS (1.94 cm, 7.79%, p = 0.000), and after CS than VE stimulus (0.58 cm, 2.21%, p = 0.000). These findings indicate that external stimuli and their combination are more effective for achieving better results in physical fitness tests than without external stimuli. Therefore, practitioners should use verbal encouragement, performance feedback, goal-oriented stimuli, and their combinations during physical fitness testing in physical education classes in order to enable their students to achieve a better performance.

The Association of Fatigue With Decreasing Regularity of Locomotion During an Incremental Test in Trained and Untrained Healthy Adults

Fatigue is a key factor that affects human motion and modulates physiology, biochemistry, and performance. Prolonged cyclic human movements (locomotion primarily) are characterized by a regular pattern, and this extended activity can induce fatigue. However, the relationship between fatigue and regularity has not yet been extensively studied. Wearable sensor methodologies can be used to monitor regularity during standardized treadmill tests (e.g., the widely used Bruce test) and to verify the effects of fatigue on locomotion regularity. Our study on 50 healthy adults [27 males and 23 females; <40 years; five dropouts; and 22 trained (T) and 23 untrained (U) subjects] showed how locomotion regularity follows a parabolic profile during the incremental test, without exception. At the beginning of the trial, increased walking speed in the absence of fatigue is associated with increased regularity (regularity index, RI, a. u., null/unity value for aperiodic/periodic patterns) up until a peak value (RI = 0.909 after 13.8 min for T and RI = 0.915 after 13.4 min for U subjects; median values, n. s.) and which is then generally followed (after 2.8 and 2.5 min, respectively, for T/U, n. s.) by the walk-to-run transition (at 12.1 min for both T and U, n. s.). Regularity then decreases with increased speed/slope/fatigue. The effect of being trained was associated with significantly higher initial regularity [0.845 (T) vs 0.810 (U), p < 0.05 corrected], longer test endurance [23.0 min (T) vs 18.6 min (U)], and prolonged decay of locomotor regularity [8.6 min (T) vs 6.5 min (U)]. In conclusion, the monitoring of locomotion regularity can be applied to the Bruce test, resulting in a consistent time profile. There is evidence of a progressive decrease in regularity following the walk-to-run transition, and these features unveil significant differences among healthy trained and untrained adult subjects.

Does verbal encouragement change dynamic balance? The effect of verbal encouragement on Star Excursion Balance Test performance in chronic ankle Instability

BACKGROUND

The Star Excursion Balance Test (SEBT) is commonly used for testing dynamic balance in chronic ankle instability (CAI) in both clinical and research settings. However, the effect of verbal encouragement (VE) on the SEBT performance is not known.

OBJECTIVE

To investigate the effects of VE on maximum reach distance performance between CAI and healthy participants on the SEBT.

METHOD

Thirty-four college-aged adults, 17 with CAI and 17 healthy controls, performed the SEBT in the anterior, posteromedial, and posterolateral reach directions. Independent variables (VE versus No-VE) and group (CAI versus healthy) were analyzed using Analysis of Variance (ANOVA) to determine whether VE and group affected reach performance.

RESULTS

There was a significant group-by-condition interaction (p = 0.02) for the anterior as well as for the posteromedial reach (p = 0.04). There was no statistically significant interaction (p = 0.48) for the posterolateral reach. There were moderate to large effect sizes in the reach distances found in the No-VE condition between the CAI and healthy controls, but with VE, the range of effect sizes from No-VE to VE were diminished.

CONCLUSION

There was a significant group by condition interaction for anterior and posteromedial reaches which shows that providing VE resulted in a greater increase in performance for participants with CAI compared to healthy controls. Psychological constraints need to be considered while performing and interpreting the results of the SEBT.

Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis

OBJECTIVES

To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors.

METHODS

A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7-14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients.

RESULTS

Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors.

CONCLUSION

The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Key Points • The adapted core strength endurance test battery measures the isometric strength of the ventral, lateral and dorsal core muscle chains. • The adapted core strength endurance test battery showed a moderate to substantial intra-rater reliability for all three muscle chains tested in axSpA patients. • No correlations were found between the adapted core strength endurance test battery and the disease-specific factors of self-reported pain, functional status and perceived strength performance.

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.

Effect of the Verbal Encouragement on Psychophysiological and Affective Responses during Small-Sided Games

Verbal encouragement (VE) is considered as external motivation provided by physical education teacher. For this reason, this study aimed to examine the effects of VE on psychophysiological and affective responses during small-sided games (SSG). Sixteen male school students (age: 17.37 ± 0.48 years) completed four sessions of a 4-a-side SSG. Two sessions occurred with VE (SSGE), and two sessions did not include VE (SSGNE). Heart rate was continuously recorded, and rating of perceived exertion (RPE) and blood lactate concentration ([La]b) were measured after each training session. Physical enjoyment was assessed after each protocol. Mood state was recorded before and after each training session using the profile of mood-state. HR max, [La]b, RPE, Physical enjoyment, and vigor were higher in SSGE compared to SSGNE (all, p < 0.001). The SSGE and SSGNE resulted in a decreased total mood disturbance (TMD) (p = 0.001, ES = 0.60; p = 0.04, ES = 0.33, respectively) and tension (p < 0.001, ES = 0.91; p = 0.004, ES = 0.47, respectively), and the vigor was increased after the SSGE (p < 0.001, ES = 0.76). SSGE and SSGNE induce similar improvement in TMD and tension. However, SSGE induced higher physiological responses, RPE, enjoyment, and positive mood than SSGNE. Physical education teachers could use VE during specific soccer sessions to improve physical aspects, enjoyment, and mood in participants.

A broad diversity in oxygen affinity to haemoglobin

Oxygen affinity to haemoglobin is indicated by the p50 value (pO₂ at 50% O₂Hb) and critically determines cellular oxygen availability. Although high Hb-O₂ affinity can cause tissue hypoxia under conditions of well O₂ saturated blood, individual differences in p50 are commonly not considered in clinical routine. Here, we investigated the diversity in Hb-O₂ affinity in the context of physiological relevance. Oxyhaemoglobin dissociation curves (ODCs) of 60 volunteers (18–40 years, both sexes, either endurance trained or untrained) were measured at rest and after maximum exercise (VO₂max) test. At rest, p50 values of all participants ranged over 7 mmHg. For comparison, right shift of ODC after VO₂max test, representing the maximal physiological range to release oxygen to the tissue, indicated a p50 difference of up to 10 mmHg. P50 at rest differs significantly between women and men, with women showing lower Hb-O₂ affinity that is determined by higher 2,3-BPG and BPGM levels. Regular endurance exercise did not alter baseline Hb-O₂ affinity. Thus, p50 diversity is already high at baseline level and needs to be considered under conditions of impaired tissue oxygenation. For fast prediction of Hb-O₂ affinity by blood gas analysis, only venous but not capillary blood samples can be recommended.

Exercise testing for children with cystic fibrosis: A systematic review

BACKGROUND

Exercise testing is routinely used to measure exercise capacity in children with cystic fibrosis (CF). Various tests are available, however the psychometric properties of these measures have not been systematically reviewed for this population.

METHOD

A systematic search of electronic databases (PubMed, Web of Science, Medline, CINHAL, Cochrane, and PEDro) was performed to identify papers that: (a) reported original psychometric data, (b) examined a measure of exercise capacity, (c) examined children with CF aged eight to 18 years; and (d) were published in English after 1950. The level of psychometric evidence was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULTS

Searches identified 1025 papers. Forty-six papers were included, covering 15 tests: incremental cardiopulmonary exercise test using a cycle ergometer (CPET(cycle)) or treadmill (CPET(treadmill)), 6 minute walk test (6MWT), modified shuttle test (MST), 3-minute step test (3MST), 2 minute walk test (2MWT), Bratteby walk test, intermittent sprint test, speed ramp test, incremental step test, forward-backwards jump test (FBJT), astride jump test (AJT), motor quotient test, Munich fitness test, and Glittre ADL test.

CONCLUSION

There is a plethora of exercise tests available with varying psychometric robustness. The CPET, 6MWT, and MST have fair to good psychometric properties, but each with their clinical advantages and limitations. Thus, a Selection Guide was developed to assist clinicians and researchers in selecting the most appropriate exercise test for various situations.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Verbal Encouragement and Between-Day Reliability During High-Intensity Functional Strength and Endurance Performance Testing

As verbal encouragement (VE) is used in high intensity functional exercise testing, this randomized controlled crossover study aimed at investigating whether VE affects high intensity functional strength and endurance performance testing. We further examined between-day variability of high intensity functional strength and endurance performance testing with and without VE. Nineteen experienced athletes (seven females and 12 males, age: 23.7 ± 4.3 years) performed a standardized one repetition maximum (1 RM) squat test and a 12-min high-intensity functional training (HIFT) workout [as many repetitions as possible (AMRAP)] on four different days over a 2-week period. Athletes randomly performed each test twice, either with VE or without (CON), with a minimum of 72 h rest between tests. Very good to excellent relative between-day reliability with slightly better values for strength testing (ICC: 0.99; CV: 3.5–4.1%) compared to endurance testing (ICC 0.87–0.95; CV: 3.9–7.3%) were observed. Interestingly, VE led to higher reliability during endurance testing. Mean squat strength depicted higher strength values with VE (107 ± 33 kg) compared to CON (105 ± 33 kg; p = 0.009, Cohen’s d: 0.06). AMRAP in the endurance test showed negligible differences between VE (182 ± 33 AMRAP) and CON (181 ± 35 AMRAP; p = 0.71, Cohen’s d: 0.03). In conclusion, the effects of VE do not notably exceed day-to-day variability during high intensity functional strength (CV: 3.5–4.1%) and endurance (CV: 3.9–7.3%) testing. However, high intensity functional strength and endurance testing with VE seems to be slightly more reliable, particularly during endurance testing.