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Franssen RFW, Berkel AEM, Ten Cate DWG, van der Palen J, van Meeteren NLU, Vogelaar FJ, Slooter G, Klaase JM, Janssen-Heijnen MLG, Bongers BC. A retrospective analysis of the association of effort-independent cardiopulmonary exercise test variables with postoperative complications in patients who underwent elective colorectal surgery. Langenbecks Arch Surg 2023; 409:7. [PMID: 38093118 DOI: 10.1007/s00423-023-03197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE This study aimed to investigate the association of effort-independent variables derived from the preoperative cardiopulmonary exercise test (CPET) with 30-day postoperative complications after elective colorectal surgery. METHODS A multicenter (n=4) retrospective explorative study was performed using data of patients who completed a preoperative CPET and underwent elective colorectal surgery. The preoperative slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2-slope) and the oxygen uptake efficiency slope (OUES), as well as 30-day postoperative complications, were assessed. Multivariable logistic regression analyses and receiver operating characteristic (ROC) curves were used to investigate the prognostic value of the relationship between these preoperative CPET-derived effort-independent variables and postoperative complications. RESULTS Data from 102 patients (60.1% males) with a median age of 72.0 (interquartile range 67.8-77.4) years were analyzed. Forty-four patients (43.1%) had one or more postoperative complications (of which 52.3% general and 77.3% surgical complications). Merely 10 (9.8%) patients had a general complication only. In multivariate analysis adjusted for surgical approach (open versus minimally invasive surgery), the VE/VCO2-slope (odds ratio (OR) 1.08, confidence interval (CI) 1.02-1.16) and OUES (OR 0.94, CI 0.89-1.00) were statistically significant associated with the occurrence of 30-day postoperative complications. CONCLUSION The effort-independent VE/VCO2-slope and OUES might be used to assist in future preoperative risk assessment and could especially be of added value in patients who are unable or unwilling to deliver a maximal cardiorespiratory effort. Future research should reveal the predictive value of these variables individually and/or in combination with other prognostic (CPET-derived) variables for postoperative complications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05331196.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210, 5912, BL, Venlo, The Netherlands.
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Annefleur E M Berkel
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- General Practice, Rijk-Berkel, Hengelo, The Netherlands
| | - David W G Ten Cate
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Nico L U van Meeteren
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Top Sector Life Sciences & Health, The Hague, The Netherlands
| | - F Jeroen Vogelaar
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gerrit Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Joost M Klaase
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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2
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Van Hooren B, Mennen B, Gronwald T, Bongers BC, Rogers B. Correlation properties of heart rate variability to assess the first ventilatory threshold and fatigue in runners. J Sports Sci 2023:1-10. [PMID: 37916488 DOI: 10.1080/02640414.2023.2277034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE The short-term scaling exponent alpha1 of detrended fluctuation analysis (DFA-a1) of heart rate variability (HRV) has shown potential to delineate the first ventilatory threshold (VT1). The aims of this study were to investigate the accuracy of this method for VT1 determination in runners using a consumer grade chest belt and to explore the effects of acute fatigue. METHODS We compared oxygen uptake (V̇O2) and heart rate (HR) at gas exchange VT1 to V̇O2 and HR at a DFA-a1 value of 0.75. Gas exchange and HRV data were obtained from 14 individuals during a treadmill run involving two incremental ramps. Agreement was assessed using Bland-Altman analysis and linear regression. RESULTS Bland-Altman analysis between gas exchange and HRV V̇O2 and HR at VT1 during the first ramp showed a mean (95% limits of agreement) bias of -0.5 (-6.8 to 5.8) ml∙kg-1∙min-1, and -0.9 (-12.2 to 10.5) beats∙min-1, with R2 of 0.83 and 0.56, respectively. During the second ramp, the differences were -7.3 (-18.1 to 3.5) ml∙kg-1∙min-1 and -12.3 (-30.4 to 5.9) beats∙min-1, with R2 of 0.62 and 0.43, respectively. CONCLUSION A chest-belt derived DFA-a1 of 0.75 is closely related to gas exchange VT1, with the variability in accuracy at an individual level being similar to gas exchange methods. This suggests this to be a useful method for exercise intensity demarcation. The altered relationship during the second ramp indicates that DFA-a1 is only able to accurately demarcate exercise intensity thresholds in a non-fatigued state, but also opens opportunities for fatigue-based training prescription.
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Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Bram Mennen
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Thomas Gronwald
- MSH Medical School Hamburg, Institute of Interdisciplinary Exercise Science and Sports Medicine, Hamburg, Germany
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Bruce Rogers
- College of Medicine, University of Central Florida, Orlando, Florida, USA
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Bar S, Moussa MD, Descamps R, El Amine Y, Bouhemad B, Fischer MO, Lorne E, Dupont H, Diouf M, Guinot PG. Respiratory Exchange Ratio guided management in high-risk noncardiac surgery: The OPHIQUE multicentre randomised controlled trial. Anaesth Crit Care Pain Med 2023; 42:101221. [PMID: 36958473 DOI: 10.1016/j.accpm.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND There is a need to develop non-invasive markers to identify the occurrence of anaerobic metabolism in high-risk surgery. Our objective was to demonstrate that a goal-directed therapy algorithm incorporating the respiratory exchange ratio (ratio between CO2 production and O2 consumption) can reduce postoperative complications. METHODS We conducted a randomized, multicenter, controlled clinical trial in four university medical centers and one non-university hospital from December 26, 2018, to September 9, 2021. 350 patients with a high risk of postoperative complications undergoing high-risk noncardiac surgery lasting 2 h or longer under general anesthesia were enrolled. The control group was treated according to current hemodynamic guidelines. The interventional group was treated according to an algorithm based on the measurement of the respiratory exchange ratio. The primary outcome was a composite of major complications or death within seven days of surgery. The secondary outcomes were the length of hospital stay, 30-day mortality, and the total intraoperative volume of fluids administered. RESULTS The primary outcome occurred for 78 patients (45.6%) in the interventional group and 83 patients (48.8%) in the control group (relative risk: 0.93, 95% confidence interval [CI]: 0.75-1.17; p = 0.55). There were no clinically relevant differences between the two groups for secondary outcomes. CONCLUSIONS In high-risk surgery, a goal-directed therapy algorithm integrating the measurement of the respiratory-exchange ratio did not reduce a composite outcome of major postoperative complications or death within seven days after surgery compared to routine care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03852147.
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Affiliation(s)
- Stéphane Bar
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France; SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes - Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, Amiens, France.
| | - Mouhamed Djahoum Moussa
- Department of Anaesthesiology and Critical Care Medicine, Lille University Medical Centre, Lille, France
| | - Richard Descamps
- Department of Anaesthesiology and Critical Care Medicine, Caen University Medical Center, Caen, France
| | - Younes El Amine
- Department of Anaesthesiology and Critical Care Medicine, Valenciennes Medical Center, Valenciennes, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France
| | - Marc-Olivier Fischer
- Department of Anaesthesiology and Critical Care Medicine, Caen University Medical Center, Caen, France; Saint Augustin Clinic, Bordeaux, France
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Millénaire Clinic, Montpellier, France
| | - Hervé Dupont
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France; SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes - Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, Amiens, France
| | - Momar Diouf
- Biostatistical Unit, Direction de la Recherche Clinique, University Hospital of Amiens Picardy, Amiens, France
| | - Pierre Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France
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4
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Franssen RFW, Eversdijk AJJ, Kuikhoven M, Klaase JM, Vogelaar FJ, Janssen-Heijnen MLG, Bongers BC. Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery. BMC Anesthesiol 2022; 22:131. [PMID: 35490221 PMCID: PMC9055752 DOI: 10.1186/s12871-022-01680-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate determination of cardiopulmonary exercise test (CPET) derived parameters is essential to allow for uniform preoperative risk assessment. The objective of this prospective observational study was to evaluate the inter-observer agreement of preoperative CPET-derived variables by comparing a self-preferred approach with a systematic guideline-based approach. METHODS Twenty-six professionals from multiple centers across the Netherlands interpreted 12 preoperative CPETs of patients scheduled for hepatopancreatobiliary surgery. Outcome parameters of interest were oxygen uptake at the ventilatory anaerobic threshold (V̇O2VAT) and at peak exercise (V̇O2peak), the slope of the relationship between the minute ventilation and carbon dioxide production (V̇E/V̇CO2-slope), and the oxygen uptake efficiency slope (OUES). Inter-observer agreement of the self-preferred approach and the guideline-based approach was quantified by means of the intra-class correlation coefficient. RESULTS Across the complete cohort, inter-observer agreement intraclass correlation coefficient (ICC) was 0.76 (95% confidence interval (CI) 0.57-0.93) for V̇O2VAT, 0.98 (95% CI 0.95-0.99) for V̇O2peak, and 0.86 (95% CI 0.75-0.95) for the V̇E/V̇CO2-slope when using the self-preferred approach. By using a systematic guideline-based approach, ICCs were 0.88 (95% CI 0.74-0.97) for V̇O2VAT, 0.99 (95% CI 0.99-1.00) for V̇O2peak, 0.97 (95% CI 0.94-0.99) for the V̇E/V̇CO2-slope, and 0.98 (95% CI 0.96-0.99) for the OUES. CONCLUSIONS Inter-observer agreement of numerical values of CPET-derived parameters can be improved by using a systematic guideline-based approach. Effort-independent variables such as the V̇E/V̇CO2-slope and the OUES might be useful to further improve uniformity in preoperative risk assessment in addition to, or in case V̇O2VAT and V̇O2peak are not determinable.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210, 5912, BL, Venlo, the Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Anne J J Eversdijk
- Department of Sports Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Mayella Kuikhoven
- Fanaticus Sports Medicine, Sports Medical Center, Groningen and Arnhem, the Netherlands
| | - Joost M Klaase
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Bart C Bongers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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5
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Hammer TM, Pedersen S, Pettersen SA, Rognmo K, Sagelv EH. Affective Valence and Enjoyment in High- and Moderate-High Intensity Interval Exercise. The Tromsø Exercise Enjoyment Study. Front Psychol 2022; 13:825738. [PMID: 35391958 PMCID: PMC8982257 DOI: 10.3389/fpsyg.2022.825738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/11/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Exercise at high intensity may cause lower affective responses toward exercise compared with moderate intensity exercise. We aimed to elucidate affective valence and enjoyment in high- and moderate-high interval exercise. Methods Twenty recreationally active participants (9 females, 11 males, age range: 20-51 years) underwent three different treadmill running exercise sessions per week over a 3-week period, in randomized order; (1) CE70: 45 min continuous exercise at 70% of heart rate maximum (HRmax), (2) INT80: 4 × 4 min intervals at 80% of HRmax, (3) INT90: 4 × 4 min intervals at 90% of HRmax. Pre-tests included graded submaximal steady state intensities and a test to exhaustion for determining peak oxygen uptake and HRmax. Affective valence (pleasure/displeasure) was measured before, during and after the sessions using the Feeling Scale (FS). Enjoyment was assessed before and after the sessions applying the Physical Activity Enjoyment Scale (PACES) and during the sessions using the Exercise Enjoyment Scale (EES). Results The participants felt lower pleasure (between-sessions effect: p = 0.02, p η2: 0.13) during INT90 sessions (FS: 1.08, 95% CI: 0.35-1.92) compared with INT80 (FS: 2.35, 95% CI: 1.62-3.08, p = 0.052) and CE70 sessions (FS: 2.45, 95% CI: 1.72-3.18, p = 0.03), with no differences between INT80 and CE70 sessions (p = 1.00). There were higher enjoyment after INT80 sessions (PACES: 101.5, 95% CI: 95.7-107.3) versus CE70 sessions (PACES: 91.3 95% CI: 85.5-97.1, p = 0.046), and no differences between INT90 (PACES: 98.2, 95% CI: 92.4-103.4) and CE70 (p = 0.29) or INT80 (p = 1.00). For enjoyment during exercise, CE70 were perceived more enjoyable, and INT80 and INT90 less enjoyable in week 2 (EES: week x session: p = 0.01, p η2: 0.11; CE70: 4.3, 95% CI: 3.6-4.9, INT80: 4.6, 95% CI: 3.9-5.2, INT90: 4.0, 95% CI: 3.4-4.7) and 3 (EES: CE70: 4.2, 95% CI: 3.7-4.8, INT80: 4.8, 95% CI: 4.2-5.3, INT90: 4.3, 95% CI: 3.8-4.9) than in week 1 (EES: CE70: 3.5, 95% CI: 3.0-4.0, INT80: 5.0, 95% CI: 4.5-5.5, INT90: 4.5, 95% CI: 4.0-5.0). Conclusion The negative affective consequences associated with high intensity interval exercise can be alleviated by keeping the intensity at or around 80% of HRmax while preserving the beneficial enjoyment responses associated with interval exercise.
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Affiliation(s)
- Tord Markussen Hammer
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sigurd Pedersen
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Svein Arne Pettersen
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kamilla Rognmo
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Edvard H Sagelv
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Morishita S, Tsubaki A, Hotta K, Inoue T, Kojima S, Qin W, Sato D, Shirayama A, Ito Y, Onishi H. Perceived Exertion Correlates with Multiple Physiological Parameters During Cardiopulmonary Exercise Testing. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:423-427. [PMID: 36527673 DOI: 10.1007/978-3-031-14190-4_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate the relationship of the Borg scale score with leg-muscle oxygenated haemoglobin (O2Hb) and deoxygenated haemoglobin (HHb) levels on near infrared spectroscopy (NIRS) and the work rate, heart rate (HR), oxygen uptake (VO2) and minute ventilation (VE) during supine cardiopulmonary exercise testing (CPET) in healthy adult men. We also investigated the relationships between the leg-muscle O2Hb and HHb levels and the work rate during supine CPET. Fifteen healthy male volunteers (mean age, 20.7 ± 0.6 years; mean height, 172.1 ± 5.7 cm; mean body weight, 61.7 ± 6.6 kg) participated in this study. The cardiopulmonary and NIRS parameters were assessed during each minute of supine CPET and at the end of the test. The Borg scale score significantly correlated with the work rate, HR, VO2, and VE during supine CPET (Rs = 0.86-0.94, p < 0.05). Furthermore, the Borg scale score significantly correlated with the leg-muscle O2Hb and HHb levels during supine CPET (Rs = -0.6, and 0.8, respectively; p < 0.05). The leg-muscle O2Hb and HHb levels had significant correlations with the work rate (R = -0.62 and 0.8, respectively; p < 0.05). The Borg scale score may be used to determine the rating of perceived exertion, whole-body fatigue and local-muscle fatigue during supine exercise. Moreover, leg-muscle oxygenation is associated with the work rate in supine exercise, similar to that observed in upright exercise.
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Affiliation(s)
- Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University, Fukushima, Japan. .,Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan. .,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan.
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Kazuki Hotta
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Tatsuro Inoue
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Weixiang Qin
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Daichi Sato
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Akihito Shirayama
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Ito
- Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Science, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
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Baumgart JK, Ettema G, Griggs KE, Goosey-Tolfrey VL, Leicht CA. A Reappraisal of Ventilatory Thresholds in Wheelchair Athletes With a Spinal Cord Injury: Do They Really Exist? Front Physiol 2021; 12:719341. [PMID: 34899368 PMCID: PMC8664409 DOI: 10.3389/fphys.2021.719341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
The ventilatory threshold (VT) separates low- from moderate-intensity exercise, the respiratory compensation point (RCP) moderate- from high-intensity exercise. Both concepts assume breakpoints in respiratory data. However, the objective determination of the VT and RCP using breakpoint models during upper-body modality exercise in wheelchair athletes with spinal cord injury (SCI) has received little attention. Therefore, the aim of this study was to compare the fit of breakpoint models (i.e., two linear regression lines) with continuous no-breakpoint models (i.e., exponential curve/second-order polynomial) to respiratory data obtained during a graded wheelchair exercise test to exhaustion. These fits were compared employing adjusted R2, and blocked bootstrapping was used to derive estimates of a median and 95% confidence intervals (CI). V̇O2-V̇CO2 and V̇E/V̇O2-time data were assessed for the determination of the VT, and V̇CO2-V̇E and V̇E/V̇CO2-time data for the determination of the RCP. Data of 9 wheelchair athletes with tetraplegia and 8 with paraplegia were evaluated. On an overall group-level, there was an overlap in the adjusted R2 median ± 95% CI between the breakpoint and the no-breakpoint models for determining the VT (V̇O2-V̇CO2: 0.991 ± 0.003 vs. 0.990 ± 0.003; V̇E/V̇O2-time: 0.792 ± 0.101 vs. 0.782 ± 0.104, respectively) and RCP (V̇E-V̇CO2: 0.984 ± 0.004 vs. 0.984 ± 0.004; V̇E/V̇CO2-time: 0.729 ± 0.064 vs. 0.691 ± 0.063, respectively), indicating similar model fit. We offer two lines of reasoning: (1) breakpoints in these respiratory data exist but are too subtle to result in a significant difference in adjusted R2 between the investigated breakpoint and no-breakpoint models; (2) breakpoints do not exist, as has been argued previously.
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Affiliation(s)
- Julia Kathrin Baumgart
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gertjan Ettema
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katy E Griggs
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Victoria Louise Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Christof Andreas Leicht
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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8
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Features of electromyography threshold of the respiratory muscles during incremental exercise test. Respir Physiol Neurobiol 2021; 295:103785. [PMID: 34508868 DOI: 10.1016/j.resp.2021.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
In this study, we aimed to examine the electromyography threshold (EMGT) of the respiratory muscle and accessory respiratory muscles. Sixteen healthy men underwent an incremental exercise test at 15 W/minute to the end point. Expired gases and electromyograms of the respiratory and lower limb muscles were measured. The breakpoints for the EMG and expired gas data were analyzed using a segmented regression model. EMGT of the sternocleidomastoid and diaphragm was significantly more delayed than the ventilation threshold (VT) (287.94 s, 288.15 s vs. 185.5 s, p = 0.028 and 0.044, respectively). The EMGT of respiratory muscles and VT were not related, though EMGT of rectus femoris and vastus lateralis correlated with VT (r = 0.854, p < 0.001; r = 0.657, p = 0.011, respectively). EMGT of respiratory muscles may be influenced by multiple factors, such as central command and afferent input of mechanical stimulation from muscles, in addition to VT-induced changes in metabolic dynamics.
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9
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Inagaki Y, Sato R, Uchiyama T, Kojima S, Morishita S, Qin W, Tsubaki A. Sex Differences in the Oxygenation of the Left and Right Prefrontal Cortex during Moderate-Intensity Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105212. [PMID: 34068936 PMCID: PMC8157032 DOI: 10.3390/ijerph18105212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Differences in cognitive performance with exercise between men and women have previously been reported. In this study, we evaluated between-sex differences in oxygenation of the prefrontal cortex (PFC) with moderate-intensity aerobic exercise (AE), which could contribute to noted differences in cognitive function. METHOD The subjects were ten men (age, 21.5 ± 0.5 years; height, 171.7 ± 4.8 cm; weight, 65.6 ± 5.6 kg) and ten women (age, 21.4 ± 0.5 years; height, 157.6 ± 4.9 cm; weight, 51.3 ± 6.5 kg). They completed our AE protocol, consisting of a 30-min leg-ergometer cycling at an intensity of 50% peak oxygen uptake, with an initial 4-min rest period for baseline measurement. Measures of the dynamics of cerebral oxygenation included: oxygenated hemoglobin (O2Hb) in the left and right PFC (LR-PFC) and deoxygenated hemoglobin (HHb). The 30-min exercise period was subdivided into six 5-min phases, with the average and peak values determined in each phase. RESULTS A significant interaction was found between LR-PFC HHb and sex (p < 0.001), with significantly higher values in men than in women in phases 3-6 (p < 0.05). CONCLUSION We report a significant sex effect of HHb in the LR-PFC.
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Affiliation(s)
- Yuta Inagaki
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe-city 650-0047, Japan
- Correspondence:
| | - Reo Sato
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
| | - Takashi Uchiyama
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
| | - Sho Kojima
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
| | - Shinichiro Morishita
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan;
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Weixiang Qin
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan;
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Atsuhiro Tsubaki
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan; (R.S.); (T.U.); (S.K.); (S.M.); (A.T.)
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan;
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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10
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Zignoli A, Fornasiero A, Rota P, Muollo V, Peyré-Tartaruga LA, Low DA, Fontana FY, Besson D, Pühringer M, Ring-Dimitriou S, Mourot L. Oxynet: A collective intelligence that detects ventilatory thresholds in cardiopulmonary exercise tests. Eur J Sport Sci 2021; 22:425-435. [PMID: 33331795 DOI: 10.1080/17461391.2020.1866081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The problem of the automatic determination of the first and second ventilatory thresholds (VT1 and VT2) from cardiopulmonary exercise test (CPET) still leads to controversy. The reliability of the gold standard methodology (i.e. expert visual inspection) feeds into the debate and several authors call for more objective automatic methods to be used in the clinical practice. In this study, we present a framework based on a collaborative approach, where a web-application was used to crowd-source a large number (1245) of CPET data of individuals with different aerobic fitness. The resulting database was used to train and test an artificial intelligence (i.e. a convolutional neural network) algorithm. This automatic classifier is currently implemented in another web-application and was used to detect the ventilatory thresholds in the available CPET. A total of 206 CPET were used to evaluate the accuracy of the estimations against the expert opinions. The neural network was able to detect the ventilatory thresholds with an average mean absolute error of 178 (198) mlO2/min (11.1%, r = 0.97) and 144 (149) mlO2/min (6.1%, r = 0.99), for VT1 and VT2 respectively. The performance of the neural network in detecting VT1 deteriorated in case of individuals with poor aerobic fitness. Our results suggest the potential for a collective intelligence system to outperform isolated experts in ventilatory thresholds detection. However, the inclusion of a larger number of VT1 examples certified by a community of experts will be likely needed before the abilities of this collective intelligence can be translated into the clinical use of CPET.
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Affiliation(s)
- A Zignoli
- Department of Industrial Engineering, University of Trento, Trento, Italy.,CeRiSM Research Centre, University of Verona, Trento, Italy.,ProM Facility, Trentino Sviluppo, Trento, Italy
| | - A Fornasiero
- CeRiSM Research Centre, University of Verona, Trento, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - P Rota
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - V Muollo
- Department of Medicine, Clinical and Experimental Biomedical Sciences, University of Verona, Verona, Italy
| | - L A Peyré-Tartaruga
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - D A Low
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - F Y Fontana
- Team Novo Nordisk professional cycling team, Atlanta, USA
| | - D Besson
- INSERM, CIC 1432, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France
| | - M Pühringer
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - S Ring-Dimitriou
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - L Mourot
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) platform, University of Bourgogne Franche-Comté, Besançon, France.,National Research Tomsk Polytechnic University, Tomsk, Russia
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11
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Relationship Between the Borg Scale Rating of Perceived Exertion and Leg-Muscle Deoxygenation During Incremental Exercise in Healthy Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1269:95-99. [PMID: 33966201 DOI: 10.1007/978-3-030-48238-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The Borg scale rating of perceived exertion is a reliable indicator and widely used to monitor and guide exercise intensity. We aimed to evaluate the relationships between the Borg scale score and oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) concentrations in the leg muscle as measured by near-infrared spectroscopy (NIRS) during cardiopulmonary exercise testing (CPET) in healthy adult men. We also investigated the relationships between the Borg scale score and the work rate (WR), heart rate (HR), oxygen uptake (VO2), and minute ventilation (VE). METHODS Participants comprised 12 healthy men. Cardiopulmonary and NIRS parameters were assessed during each minute of CPET and at the end of the test. RESULTS The Borg scale score was significantly correlated with cardiopulmonary parameters including WR, HR, VO2, and VE during CPET (Rs = 0.87-0.95; p < 0.05). Furthermore, the Borg scale score was significantly correlated with NIRS parameters including O2Hb and HHb levels during CPET (Rs = -0.48 and 0.45, respectively; p < 0.05). DISCUSSION The Borg scale score is significantly correlated with cardiopulmonary parameters (WR, HR, VO2, and VE), as well as with leg-muscle oxygenation parameters as assessed by NIRS, during CPET in healthy adults. The correlation coefficients obtained from NIRS parameters were lower than those of cardiopulmonary parameters. CONCLUSIONS The Borg scale score might better reflect cardiopulmonary responses than muscle deoxygenation during exercise. These results can aid in the planning of rehabilitation programs for healthy adults.
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12
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Morishita S, Tsubaki A, Hotta K, Inoue T, Qin W, Kojima S, Fu JB, Onishi H. Face Pain Scale and Borg Scale compared to physiological parameters during cardiopulmonary exercise testing. J Sports Med Phys Fitness 2020; 61:1464-1468. [PMID: 33269889 DOI: 10.23736/s0022-4707.20.11815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the differences between the Face Pain and Borg Scales for rating of perceived exertion (RPE) during cardiopulmonary exercise testing (CPET) in healthy adults, and their relationships with work rate (watts), heart rate (HR), oxygen uptake (VO<inf>2</inf>), and minute ventilation (VE). METHODS In this prospective observational study, two experiments were conducted. In Experiment 1, 77 healthy adults were randomly assigned to either the group using the Face Pain Scale (19 men, 18 women) or using the Borg Scale (21 men, 19 women) for the RPE during CPET. In Experiment 2, 40 healthy adults (20 men, 20 women) used both the Face Pain and Borg Scales for the RPE during CPET. In both experiments, CPET was performed on ramp protocols with incremental increases in the work rate by 20 watts/minute. Their responses in terms of watts, HR, VO<inf>2</inf>, VE, and RPE (assessed using the Face Pain Scale or Borg Scale) were recorded each minute. RESULTS There were significant relationships between the two scales and all physiological variables during CPET in 74 out of the 77 participants in Experiment 1 and in all subjects in Experiment 2 (P<0.05). The correlation coefficient of the Face Pain Scale with respect to the physiological parameters was slightly lower than that of Borg Scale in both experiments (P<0.05). The Face Pain Scale had a significant correlation with the Borg Scale during CPET in Experiment 2 (P<0.05). CONCLUSIONS The Face Pain Scale may be useful for determining the intensity of exercise in healthy adults, similar to the Borg Scale.
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Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan -
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kazuki Hotta
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tatsuro Inoue
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Weixiang Qin
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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13
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Gronwald T, Rogers B, Hoos O. Fractal Correlation Properties of Heart Rate Variability: A New Biomarker for Intensity Distribution in Endurance Exercise and Training Prescription? Front Physiol 2020; 11:550572. [PMID: 33071812 PMCID: PMC7531235 DOI: 10.3389/fphys.2020.550572] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
Exercise and training prescription in endurance-type sports has a strong theoretical background with various practical applications based on threshold concepts. Given the challenges and pitfalls of determining individual training zones on the basis of subsystem indicators (e.g., blood lactate concentration, respiratory parameters), the question arises whether there are alternatives for intensity distribution demarcation. Considering that training in a low intensity zone substantially contributes to the performance outcome of endurance athletes and exceeding intensity targets based on a misleading aerobic threshold can lead to negative performance and recovery effects, it would be desirable to find a parameter that could be derived via non-invasive, low cost and commonly available wearable devices. In this regard, analytics conducted from non-linear dynamics of heart rate variability (HRV) have been adapted to gain further insights into the complex cardiovascular regulation during endurance-type exercise. Considering the reciprocal antagonistic behavior and the interaction of the sympathetic and parasympathetic branch of the autonomic nervous system from low to high exercise intensities, it may be promising to use an approach that utilizes information about the regulation quality of the organismic system to determine training-intensity distribution. Detrended fluctuation analysis of HRV and its short-term scaling exponent alpha1 (DFA-alpha1) seems suitable for applied sport-specific settings including exercise from low to high intensities. DFA-alpha1 may be taken as an indicator for exercise prescription and intensity distribution monitoring in endurance-type sports. The present perspective illustrates the potential of DFA-alpha1 for diagnostic and monitoring purposes as a “global” system parameter and proxy for organismic demands.
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Affiliation(s)
- Thomas Gronwald
- Department of Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Bruce Rogers
- Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Olaf Hoos
- Center for Sports and Physical Education, Julius Maximilians University of Würzburg, Würzburg, Germany
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14
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Vainshelboim B, Arena R, Kaminsky LA, Myers J. Reference Standards for Ventilatory Threshold Measured With Cardiopulmonary Exercise Testing. Chest 2020; 157:1531-1537. [DOI: 10.1016/j.chest.2019.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
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15
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El-Ghazali SK, Pandit JJ. Pre-incision hypotension and the association with postoperative acute kidney injury - an opportunity to improve peri-operative outcomes? Anaesthesia 2019; 74:1611-1614. [PMID: 31486532 DOI: 10.1111/anae.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
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16
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Ntima N, Lumb A. Physiology and conduct of pulmonary function tests. BJA Educ 2019; 19:198-204. [PMID: 33456891 PMCID: PMC7808018 DOI: 10.1016/j.bjae.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- N.O. Ntima
- St James's University Hospital, Leeds, UK
| | - A.B. Lumb
- St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
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17
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Dearlove DJ, Faull OK, Rolls E, Clarke K, Cox PJ. Nutritional Ketoacidosis During Incremental Exercise in Healthy Athletes. Front Physiol 2019; 10:290. [PMID: 30984015 PMCID: PMC6450328 DOI: 10.3389/fphys.2019.00290] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 03/05/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose: Ketosis, achieved through ingestion of ketone esters, may influence endurance exercise capacity by altering substrate metabolism. However, the effects of ketone consumption on acid-base status and subsequent metabolic and respiratory compensations are poorly described. Methods: Twelve athletically trained individuals completed an incremental bicycle ergometer exercise test to exhaustion following the consumption of either a ketone ester [(R)-3-hydroxybutyrate-(R)-1,3-butanediol] or a taste-matched control drink (bitter flavoured water) in a blinded, cross-over study. Respiratory gases and arterialised blood gas samples were taken at rest and at regular intervals during exercise. Results: Ketone ester consumption increased blood D-β-hydroxybutyrate concentration from 0.2 to 3.7 mM/L (p < 0.01), causing significant falls versus control in blood pH to 7.37 and bicarbonate to 18.5 mM/L before exercise. To compensate for ketoacidosis, minute ventilation was modestly increased (p < 0.05) with non-linearity in the ventilatory response to exercise (ventilatory threshold) occurring at a 22 W lower workload (p < 0.05). Blood pH and bicarbonate concentrations were the same at maximal exercise intensities. There was no difference in exercise performance having consumed the ketone ester or control drink. Conclusion: Athletes compensated for the greater acid load caused by ketone ester ingestion by elevating minute ventilation and earlier hyperventilation during incremental exercise.
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Affiliation(s)
- David J Dearlove
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Olivia K Faull
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Edward Rolls
- Mathematical Institute, University of Oxford, Oxford, United Kingdom
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Pete J Cox
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
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18
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Morishita S, Tsubaki A, Nashimoto S, Fu JB, Onishi H. Face scale rating of perceived exertion during cardiopulmonary exercise test. BMJ Open Sport Exerc Med 2018; 4:e000474. [PMID: 30622732 PMCID: PMC6307607 DOI: 10.1136/bmjsem-2018-000474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to investigate the correlation between the face scale and heart rate (HR), exercise load and oxygen uptake (V̇O2) during cardiopulmonary exercise testing. Methods This was a prospective, observational study of face scale rating of perceived exertion (RPE) and HR, exercise load and V̇O2 during cardiopulmonary exercise testing. A total of 30 healthy college men and 21 healthy college women were included. Subjects performed a cardiopulmonary exercise test with ramps and an increment increase in workload of 20 W/min. We recorded the responses of subjects using a face scale for RPE, HR, exercise load and V̇O2 every minute during the cardiopulmonary exercise test. Results In men, there was a significant positive correlation between the face scale RPE and HR (ρ=0.856, p<0.01), exercise load (ρ=0.888, p<0.01) and V̇O2 (ρ=0.878, p<0.01) during the cardiopulmonary exercise test. Similarly, in women, there was a significant positive correlation between the face scale RPE and HR (ρ=0.885, p<0.01), exercise load (ρ=0.908, p<0.01) and V̇O2 (ρ=0.895, p<0.01) during the cardiopulmonary exercise tests. Conclusion The face scale proposed in this study was related to physiological parameters, which suggests that it may be used to determine the intensity of exercise in healthy adults.
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Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Satoshi Nashimoto
- Department of Rehabilitation, Niigata Medical Centre, Niigata, Japan
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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19
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Baumgart JK, Moes M, Skovereng K, Ettema G, Sandbakk Ø. Examination of gas exchange and blood lactate thresholds in Paralympic athletes during upper-body poling. PLoS One 2018; 13:e0205588. [PMID: 30379853 PMCID: PMC6209185 DOI: 10.1371/journal.pone.0205588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives The primary aim was to compare physiological and perceptual outcome parameters identified at common gas exchange and blood lactate (BLa) thresholds in Paralympic athletes while upper-body poling. The secondary aim was to compare the fit of the breakpoint models used to identify thresholds in the gas exchange thresholds data versus continuous linear and curvilinear (no-breakpoint) models. Methods Fifteen elite Para ice hockey players performed seven to eight 5-min stages at increasing workload until exhaustion during upper-body poling. Two regression lines were fitted to the oxygen uptake (VO2)-carbon dioxide (VCO2) and minute ventilation (VE)/VO2 data to determine the ventilatory threshold (VT), and to the VCO2-VE and VE/VCO2 data to determine the respiratory compensation threshold (RCT). The first lactate threshold (LT1) was determined by the first rise in BLa (+0.4mmol·L-1 and +1.0mmol·L-1) and a breakpoint in the log-log transformed VO2-BLa data, and the second lactate threshold (LT2) by a fixed rise in BLa above 4mmol·L-1 and by employing the modified Dmax method. Paired-samples t-tests were used to compare the outcome parameters within and between the different threshold methods. The fit of the two regression lines (breakpoint model) used to identify thresholds in the gas exchange data was compared to that of a single regression line, an exponential and a 3rd order polynomial curve (no-breakpoint models) by Akaike weights. Results All outcome parameters identified with the VT (i.e., breakpoints in the VO2-VCO2 or VE/VO2 data) were significantly higher than the ones identified with a fixed rise in BLa (+0.4 or +1.0mmol·L-1) at the LT1 (e.g. BLa: 5.1±2.2 or 4.9±1.8 vs 1.9±0.6 or 2.3±0.5mmol·L-1,p<0.001), but were not significantly different from the log-log transformed VO2-BLa data (4.3±1.6mmol·L-1,p>0.06). The outcome parameters identified with breakpoints in the VCO2-VE data to determine the RCT (e.g. BLa: 5.5±1.4mmol·L-1) were not different from the ones identified with the modified Dmax method at the LT2 (5.5±1.1mmol·L-1) (all p>0.53), but were higher compared to parameters identified with VE/VCO2 method (4.9±1.5mmol·L-1) and a fixed BLa value of 4mmol·L-1 (all p<0.03). Although we were able to determine the VT and RCT via different gas exchange threshold methods with good fit in all 15 participants (mean R2>0.931), the continuous no-breakpoint models had the highest probability (>68%) of being the best models for the VO2-VCO2 and the VCO2-VE data. Conclusions In Paralympic athletes who exercise in the upper-body poling mode, the outcome parameters identified at the VT and the ones identified with fixed methods at the LT1 showed large differences, demonstrating that these cannot be used interchangeably to estimate the aerobic threshold. In addition, the close location of the VT, RCT and LT2 does not allow us to distinguish the aerobic and anaerobic threshold, indicating the presence of only one threshold in athletes with a disability exercising in an upper-body mode. Furthermore, the better fit of continuous no-breakpoint models indicates no presence of clear breakpoints in the gas exchange data for most participants. This makes us question if breakpoints in the gas exchange data really exist in an upper-body exercise mode in athletes with disabilities.
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Affiliation(s)
- Julia Kathrin Baumgart
- Centre for Elite Sports Research, Department of Neuroscience and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Maaike Moes
- Department of Human Movement Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Knut Skovereng
- Centre for Elite Sports Research, Department of Neuroscience and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gertjan Ettema
- Centre for Elite Sports Research, Department of Neuroscience and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuroscience and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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20
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Palumbo MC, Morettini M, Tieri P, Diele F, Sacchetti M, Castiglione F. Personalizing physical exercise in a computational model of fuel homeostasis. PLoS Comput Biol 2018; 14:e1006073. [PMID: 29698395 PMCID: PMC5919631 DOI: 10.1371/journal.pcbi.1006073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
The beneficial effects of physical activity for the prevention and management of several chronic diseases are widely recognized. Mathematical modeling of the effects of physical exercise in body metabolism and in particular its influence on the control of glucose homeostasis is of primary importance in the development of eHealth monitoring devices for a personalized medicine. Nonetheless, to date only a few mathematical models have been aiming at this specific purpose. We have developed a whole-body computational model of the effects on metabolic homeostasis of a bout of physical exercise. Built upon an existing model, it allows to detail better both subjects' characteristics and physical exercise, thus determining to a greater extent the dynamics of the hormones and the metabolites considered.
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Affiliation(s)
- Maria Concetta Palumbo
- Institute for Applied Computing (IAC) “Mauro Picone”, National Research Council of Italy, Rome, Italy
| | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Tieri
- Institute for Applied Computing (IAC) “Mauro Picone”, National Research Council of Italy, Rome, Italy
| | - Fasma Diele
- Institute for Applied Computing (IAC) “Mauro Picone”, National Research Council of Italy, Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Filippo Castiglione
- Institute for Applied Computing (IAC) “Mauro Picone”, National Research Council of Italy, Rome, Italy
- * E-mail:
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21
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Abbott TEF, Gooneratne M, McNeill J, Lee A, Levett DZH, Grocott MPW, Swart M, MacDonald N. Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study. Br J Anaesth 2017; 120:475-483. [PMID: 29452804 DOI: 10.1016/j.bja.2017.11.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET. METHODS We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO2 peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement. RESULTS Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO2 peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO2 peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO2 peak was moderate [0.73 (0.64-0.80)]. CONCLUSIONS Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
| | | | | | - A Lee
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D Z H Levett
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M P W Grocott
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M Swart
- South Devon Healthcare NHS Trust, Torbay, UK
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A comparison of methods for determining the ventilatory threshold: implications for surgical risk stratification. Can J Anaesth 2017; 64:634-642. [DOI: 10.1007/s12630-017-0862-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/16/2017] [Accepted: 03/13/2017] [Indexed: 12/22/2022] Open
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23
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Jenkins LA, Mauger AR, Hopker JG. Age differences in physiological responses to self-paced and incremental [Formula: see text] testing. Eur J Appl Physiol 2016; 117:159-170. [PMID: 27942980 PMCID: PMC5306335 DOI: 10.1007/s00421-016-3508-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/25/2016] [Indexed: 11/26/2022]
Abstract
Purpose A self-paced maximal exercise protocol has demonstrated higher \documentclass[12pt]{minimal}
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\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}
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\begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max protocol (SPV) in comparison to a traditional ramp \documentclass[12pt]{minimal}
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\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}
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\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}
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\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}
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\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.
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Affiliation(s)
- Lauren A Jenkins
- STRAPH Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, Kent, UK
| | - Alexis R Mauger
- STRAPH Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, Kent, UK
| | - James G Hopker
- STRAPH Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, Kent, UK.
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Arratibel-Imaz I, Calleja-González J, Emparanza JI, Terrados N, Mjaanes JM, Ostojic SM. Lack of concordance amongst measurements of individual anaerobic threshold and maximal lactate steady state on a cycle ergometer. PHYSICIAN SPORTSMED 2016; 44:34-45. [PMID: 26578151 DOI: 10.1080/00913847.2016.1122501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The calculation of exertion intensity, in which a change is produced in the metabolic processes which provide the energy to maintain physical work, has been defined as the anaerobic threshold (AT). The direct calculation of maximal lactate steady state (MLSS) would require exertion intensities over a long period of time and with sufficient rest periods which would prove significantly difficult for daily practice. Many protocols have been used for the indirect calculation of MLSS. OBJECTIVES The aim of this study is to determine if the results of measurements with 12 different AT calculation methods and calculation software [Keul, Simon, Stegmann, Bunc, Dickhuth (TKM and WLa), Dmax, Freiburg, Geiger-Hille, Log-Log, Lactate Minimum] can be used interchangeably, including the method of the fixed threshold of Mader/OBLA's 4 mmol/l and then to compare them with the direct measurement of MLSS. METHODS There were two parts to this research. Phase 1: results from 162 exertion tests chosen at random from the 1560 tests. Phase 2: sixteen athletes (n = 16) carried out different tests on five consecutive days. RESULTS There was very high concordance among all the methods [intraclass correlation coefficient (ICC) > 0.90], except Log-Log in relation to the Stegamnn, Dmax, Dickhuth-WLa and Geiger-Hille. The Dickhuth-TKM showed a high tendency towards concordance, with Dmax (2.2 W) and Dickhuth-WLa (0.1 W). The Dickhuth-TKM method presented a high tendency to concordance with Dickhuth-WLa (0.5 W), Freiburg (7.4 W), MLSS (2.0 W), Bunc (8.9 W), Dmax (0.1 W). The calculation of MLSS power showed a high tendency to concordance, with Dickhuth-TKM (2 W), Dmax (2.1 W), Dickhuth-WLa (1.5 W). CONCLUSION The fixed threshold of 4 mmol/l or OBLA produces slightly different and higher results than those obtained with all the methods analyzed, including MLSS, meaning an overestimation of power in the individual anaerobic threshold. The Dickhuth-TKM, Dmax and Dickhuth-WLa methods defined a high concordance on a cycle ergometer. Dickhuth-TKM, Dmax, Dickhuth-WLa described a high concordance with the power calculated to know the MLSS.
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Affiliation(s)
- Iñaki Arratibel-Imaz
- a Department of Physical Education and Sport , Faculty of Sport Sciences, University of Basque Country , Vitoria-Gasteiz , Spain
| | - Julio Calleja-González
- a Department of Physical Education and Sport , Faculty of Sport Sciences, University of Basque Country , Vitoria-Gasteiz , Spain
| | - Jose Ignacio Emparanza
- b Epidemiology and Public Health, CIBER-ESP, IIS BioDonostia , University Hospital Donostia , Donostia , Spain
| | - Nicolas Terrados
- c Sports Medicine Regional Unit of Asturias-FDM Aviles and Department of Functional Biology , University of Oviedo , Oviedo , Spain
| | - Jeffrey M Mjaanes
- d Regional Department of Orthopedic Surgery and Pediatrics, Midwest Orthopedics at Rush , Rush University Medical Center , Chicago , IL , USA
| | - Sergej M Ostojic
- e Faculty of Sport and Physical Education , University of Novi Sad , Novi Sad , Serbia
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25
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Cochrane-Snyman KC, Housh TJ, Smith CM, Hill EC, Jenkins NDM, Schmidt RJ, Johnson GO. Inter-individual variability in the patterns of responses for electromyography and mechanomyography during cycle ergometry using an RPE-clamp model. Eur J Appl Physiol 2016; 116:1639-49. [PMID: 27325528 DOI: 10.1007/s00421-016-3394-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/06/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine inter-individual variability versus composite models for the patterns of responses for electromyography (EMG) and mechanomyography (MMG) versus time relationships during moderate and heavy cycle ergometry using a rating of perceived exertion (RPE) clamp model. METHODS EMG amplitude (amplitude root-mean-square, RMS), EMG mean power frequency (MPF), MMG-RMS, and MMG-MPF were collected during two, 60-min rides at a moderate (RPE at the gas exchange threshold; RPEGET) and heavy (RPE at 15 % above the GET; RPEGET+15 %) intensity when RPE was held constant (clamped). Composite (mean) and individual responses for EMG and MMG parameters were compared during each 60-min ride. RESULTS There was great inter-individual variability for each EMG and MMG parameters at RPEGET and RPEGET+15 %. Composite models showed decreases in EMG-RMS (r (2) = -0.92 and R (2) = 0.96), increases in EMG-MPF (R (2) = 0.90), increases in MMG-RMS (r (2) = 0.81 and 0.55), and either no change or a decrease (r (2) = 0.34) in MMG-MPF at RPEGET and RPEGET+15 %, respectively. CONCLUSIONS The results of the present study indicated that there were differences between composite and individual patterns of responses for EMG and MMG parameters during moderate and heavy cycle ergometry at a constant RPE. Thus, composite models did not represent the unique muscle activation strategies exhibited by individual responses when cycling in the moderate and heavy intensity domains when using an RPE-clamp model.
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Affiliation(s)
- Kristen C Cochrane-Snyman
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA.
| | - Terry J Housh
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Cory M Smith
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Ethan C Hill
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Nathaniel D M Jenkins
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Richard J Schmidt
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Glen O Johnson
- Department of Nutrition and Health Sciences, 110 Ruth Leverton Hall, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
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26
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Loe H, Steinshamn S, Wisløff U. Cardio-respiratory reference data in 4631 healthy men and women 20-90 years: the HUNT 3 fitness study. PLoS One 2014; 9:e113884. [PMID: 25426954 PMCID: PMC4245230 DOI: 10.1371/journal.pone.0113884] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/31/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To provide a large reference material on key cardio-respiratory variables in a healthy population of Norwegian men and women aged 20-90 years. METHODS Sub maximal and peak levels of cardio-respiratory variables were measured using cardiopulmonary exercise testing during treadmill running. RESULTS The highest peak ventilation among men (141.9±24.5 L·min-1) and women (92.0±16.5 L·min-1) was observed in the youngest age group (20-29 years, sex differences p<0.001) with an average 7% reduction per decade. The highest tidal volumes were observed in the 30-39 and 40-49 year age groups among men (2.94±0.46 L) and women (2.06±0.32 L) (sex differences p<0.001), with a subsequent average 6% reduction per decade. Ventilatory threshold and respiratory compensation point were observed at approximately 77% and 87% of peak oxygen uptake (VO2peak) among men and women, respectively. The best ventilatory efficiency (EqVCO2Than) was observed in the youngest age group (20-29 years) in both men (26.2±2.8) and woman (27.5±2.7) (sex differences p<0.001) with an average 3% deterioration in ventilatory efficiency per decade. CONCLUSION This is the largest European reference material of cardio-respiratory variables in healthy men and women aged 20-90 years, establishing normal values for, and associations between key cardio-respiratory parameters. This will be useful in clinical decision making when evaluating cardiopulmonary health in similar populations.
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Affiliation(s)
- Henrik Loe
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Valnesfjord Rehabilitation Center, Valnesfjord, Norway
| | - Sigurd Steinshamn
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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27
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Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, McPhail MJ, Willars C, Auzinger G, Sizer E, Heneghan M, Cottam S, Heaton N, Wendon J. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease. Liver Transpl 2014; 20:54-62. [PMID: 24136710 DOI: 10.1002/lt.23766] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
Chronic liver disease (CLD) is associated with muscle wasting, reduced exercise tolerance and aerobic capacity (AC). Measures of AC determined with cardiopulmonary exercise testing (CPET) may predict survival after liver transplantation (LT), but the relationship with nontransplant outcomes is uncertain. In patients assessed for LT, we examined the relationship of CPET AC parameters with the severity of liver disease, nutritional state, and survival with and without LT. Patients assessed for elective first LT who underwent CPET and an anthropometric assessment at a single center were studied. CPET-derived measures of AC that were evaluated included the peak oxygen consumption (VO2 peak) and the anaerobic threshold (AT). Three hundred ninety-nine patients underwent CPET, and 223 underwent LT; 45% of the patients had a VO2 peak < 50% of the predicted value, and 31% had an AT < 9 mL/kg/minute. The VO2 peak and AT values correlated with the Model for End-Stage Liver Disease score, but they more closely correlated with serum sodium and albumin levels. The handgrip strength correlated strongly with the VO2 peak. Patients with impaired AC had prolonged hospitalization after LT, and nonsurvivors had lower AT values than survivors 1 year after transplantation (P < 0.05); this was significant in a multivariate analysis. One hundred seventy-six patients did not undergo LT; the 1-year mortality rate was 34.6%. The AT (P < 0.05) and VO2 peak values (P < 0.001) were lower for nonsurvivors. In a multivariate analysis, AT was independently associated with nonsurvival. In conclusion, AC was markedly impaired in many patients with CLD. In patients who did not undergo transplantation, impaired AT was predictive of mortality, and in patients undergoing LT, it was related to postoperative hospitalization and survival. AC should be evaluated as a modifiable factor for improving patient survival whether or not LT is anticipated.
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, King's College London, London, United Kingdom
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Otto JM, Montgomery HE, Richards T. Haemoglobin concentration and mass as determinants of exercise performance and of surgical outcome. EXTREME PHYSIOLOGY & MEDICINE 2013; 2:33. [PMID: 24280034 PMCID: PMC3874847 DOI: 10.1186/2046-7648-2-33] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/28/2013] [Indexed: 06/02/2023]
Abstract
The ability of the cardiorespiratory system (heart, lungs, blood) to deliver oxygen to exercising skeletal muscle constrains maximum oxygen consumption V˙O2max, with cardiac output and the concentration of oxygen-carrying haemoglobin ([Hb]) being key limiting parameters. Total blood volume (BV) is the sum of the plasma volume (PV) and the total red cell volume. The measured [Hb] is dependent upon the total circulating mass of haemoglobin (tHb-mass) and plasma volume (PV). While the proportion of oxygen carried in plasma is trivial (0.3 mL of oxygen per 100 mL of plasma), each gram of Hb, contained in red blood cells, binds 1.39 mL of oxygen. As a result, the relationship between V˙O2max and tHb-mass is stronger than that observed between V˙O2max and [Hb] or BV. The glycoprotein hormone erythropoietin drives red cell synthesis and, like simple transfusion of packed red blood cells, can increase tHb-mass. An iron-containing haem group lies at the centre of the Hb molecule and, in situations of actual or functional iron deficiency, tHb-mass will also rise following iron administration. However achieved, an increase in tHb-mass also increases circulating oxygen-carrying capacity, and thus the capacity for aerobic phosphorylation. It is for such reasons that alterations in V˙O2max and exercise performance are proportional to those in arterial oxygen content and systemic oxygen transport, a change in tHb-mass of 1 g being associated with a 4 mL · min-1 change in V˙O2max. Similarly, V˙O2max increases by approximately 1% for each 3 g · L-1 increase in [Hb] over the [Hb] range (120 to 170 g · L-1). Surgery, like exercise, places substantial metabolic demands on the patient. Whilst subject to debate, oxygen supply at a rate inadequate to prevent muscle anaerobiosis may underpin the occurrence of the anaerobic threshold (AT), an important submaximal marker of cardiorespiratory fitness. Preoperatively, cardiopulmonary exercise testing (CPET) can be used to determine AT and peak exertional oxygen uptake (V˙O2 peak) as measures of ability to meet increasing oxygen demands. The degree of surgical insult and the ability to meet the resulting additional postoperative oxygen demand appear to be fundamental determinants of surgical outcome: individuals in whom such ability is impaired (and thus those with reduced V˙O2 peak and AT) are at greater risk of adverse surgical outcome. This review provides an overview of the relationships between [Hb], tHb-mass, exercise capacity, and surgical outcome and discusses the potential value of assessing tHb-mass over [Hb].
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Affiliation(s)
- James M Otto
- Division of Surgery and Interventional Science, c/o 4th Floor, Rockefeller Building, 21 University Street, London WC1E 6DE, UK
| | - Hugh E Montgomery
- UCL Institute for Sport, c/o 4th Floor, Rockefeller Building, 21 University Street, London WC1E 6DE, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, c/o 4th Floor, Rockefeller Building, 21 University Street, London WC1E 6DE, UK
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The effect of adding CO2 to hypoxic inspired gas on cerebral blood flow velocity and breathing during incremental exercise. PLoS One 2013; 8:e81130. [PMID: 24278389 PMCID: PMC3836745 DOI: 10.1371/journal.pone.0081130] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
Hypoxia increases the ventilatory response to exercise, which leads to hyperventilation-induced hypocapnia and subsequent reduction in cerebral blood flow (CBF). We studied the effects of adding CO2 to a hypoxic inspired gas on CBF during heavy exercise in an altitude naïve population. We hypothesized that augmented inspired CO2 and hypoxia would exert synergistic effects on increasing CBF during exercise, which would improve exercise capacity compared to hypocapnic hypoxia. We also examined the responsiveness of CO2 and O2 chemoreception on the regulation ventilation (E) during incremental exercise. We measured middle cerebral artery velocity (MCAv; index of CBF), E, end-tidal PCO2, respiratory compensation threshold (RC) and ventilatory response to exercise (E slope) in ten healthy men during incremental cycling to exhaustion in normoxia and hypoxia (FIO2 = 0.10) with and without augmenting the fraction of inspired CO2 (FICO2). During exercise in normoxia, augmenting FICO2 elevated MCAv throughout exercise and lowered both RC onset andE slope below RC (P<0.05). In hypoxia, MCAv and E slope below RC during exercise were elevated, while the onset of RC occurred at lower exercise intensity (P<0.05). Augmenting FICO2 in hypoxia increased E at RC (P<0.05) but no difference was observed in RC onset, MCAv, or E slope below RC (P>0.05). The E slope above RC was unchanged with either hypoxia or augmented FICO2 (P>0.05). We found augmenting FICO2 increased CBF during sub-maximal exercise in normoxia, but not in hypoxia, indicating that the ‘normal’ cerebrovascular response to hypercapnia is blunted during exercise in hypoxia, possibly due to an exhaustion of cerebral vasodilatory reserve. This finding may explain the lack of improvement of exercise capacity in hypoxia with augmented CO2. Our data further indicate that, during exercise below RC, chemoreception is responsive, while above RC the ventilatory response to CO2 is blunted.
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Zamunér AR, Catai AM, Martins LEB, Sakabe DI, Da Silva E. Identification and agreement of first turn point by mathematical analysis applied to heart rate, carbon dioxide output and electromyography. Braz J Phys Ther 2013; 17:614-22. [PMID: 24346296 PMCID: PMC4207143 DOI: 10.1590/s1413-35552012005000129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/06/2013] [Indexed: 11/22/2022] Open
Abstract
Background The second heart rate (HR) turn point has been extensively studied, however
there are few studies determining the first HR turn point. Also, the use of
mathematical and statistical models for determining changes in dynamic
characteristics of physiological variables during an incremental
cardiopulmonary test has been suggested. Objectives To determine the first turn point by analysis of HR, surface electromyography
(sEMG), and carbon dioxide output () using two mathematical models and
to compare the results to those of the visual method. Method Ten sedentary middle-aged men (53.9±3.2 years old) were submitted to
cardiopulmonary exercise testing on an electromagnetic cycle ergometer until
exhaustion. Ventilatory variables, HR, and sEMG of the vastus lateralis were
obtained in real time. Three methods were used to determine the first turn
point: 1) visual analysis based on loss of parallelism between
and oxygen uptake
(); 2) the
linear-linear model, based on fitting the curves to the set of
data (Lin-Lin
); 3) a bi-segmental
linear regression of Hinkley' s algorithm applied to HR (HMM-HR),
(HMM-
), and sEMG data
(HMM-RMS). Results There were no differences between workload, HR, and ventilatory variable
values at the first ventilatory turn point as determined by the five studied
parameters (p>0.05). The Bland-Altman plot showed an even distribution of
the visual analysis method with Lin-Lin , HMM-HR, HMM-CO2, and HMM-RMS. Conclusion The proposed mathematical models were effective in determining the first turn
point since they detected the linear pattern change and the deflection point
of , HR responses, and
sEMG.
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Affiliation(s)
- Antonio R Zamunér
- Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil
| | - Aparecida M Catai
- Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil
| | - Luiz E B Martins
- Universidade Estadual de Campinas, Physical Education College, CampinasSP, Brazil
| | - Daniel I Sakabe
- Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil
| | - Ester Da Silva
- Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil
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Second ventilatory threshold from heart-rate variability: valid when the upper body is involved? Int J Sports Physiol Perform 2013; 9:695-701. [PMID: 24231307 DOI: 10.1123/ijspp.2013-0286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To determine the most accurate method based on spectral analysis of heart-rate variability (SA-HRV) during an incremental and continuous maximal test involving the upper body, the authors tested 4 different methods to obtain the heart rate (HR) at the second ventilatory threshold (VT(2)). Sixteen ski mountaineers (mean ± SD; age 25 ± 3 y, height 177 ± 8 cm, mass 69 ± 10 kg) performed a roller-ski test on a treadmill. Respiratory variables and HR were continuously recorded, and the 4 SA-HRV methods were compared with the gas-exchange method through Bland and Altman analyses. The best method was the one based on a time-varying spectral analysis with high frequency ranging from 0.15 Hz to a cutoff point relative to the individual's respiratory sinus arrhythmia. The HR values were significantly correlated (r(2) = .903), with a mean HR difference with the respiratory method of 0.1 ± 3.0 beats/min and low limits of agreements (around -6 /+6 beats/min). The 3 other methods led to larger errors and lower agreements (up to 5 beats/min and around -23/+20 beats/min). It is possible to accurately determine VT(2) with an HR monitor during an incremental test involving the upper body if the appropriate HRV method is used.
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Otto JM, O'Doherty AF, Hennis PJ, Cooper JA, Grocott MP, Snowdon C, Carlisle JB, Swart M, Richards T, Montgomery HE. Association between preoperative haemoglobin concentration and cardiopulmonary exercise variables: a multicentre study. Perioper Med (Lond) 2013; 2:18. [PMID: 24472426 PMCID: PMC3964342 DOI: 10.1186/2047-0525-2-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background Preoperative anaemia and low exertional oxygen uptake are both associated with greater postoperative morbidity and mortality. This study reports the association among haemoglobin concentration ([Hb]), peak oxygen uptake (V˙O2 peak) and anaerobic threshold (AT) in elective surgical patients. Methods Between 1999 and 2011, preoperative [Hb] and cardiopulmonary exercise tests were recorded in 1,777 preoperative patients in four hospitals. The associations between [Hb], V˙O2 peak and AT were analysed by linear regression and covariance. Results In 436 (24.5%) patients, [Hb] was <12 g dl-1 and, in 83 of these, <10 g dl-1. Both AT and V˙O2 peak rose modestly with increasing [Hb] (r2 = 0.24, P <0.0001 and r2 = 0.30, P <0.0001, respectively). After covariate adjustment, an increase in [Hb] of one standard deviation was associated with a 6.7 to 9.7% increase in V˙O2 peak, and a rise of 4.4 to 6.0% in AT. Haemoglobin concentration accounted for 9% and 6% of the variation in V˙O2 peak and AT respectively. Conclusions To a modest extent, lower haemoglobin concentrations are independently associated with lower oxygen uptake during preoperative cardiopulmonary exercise testing. It is unknown whether this association is causative.
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Affiliation(s)
- James M Otto
- Division of Surgery and Interventional Science, University College London, 21 University Street, London WC1E 6DE, UK.
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Bergstrom HC, Housh TJ, Cochrane KC, Jenkins NDM, Lewis RW, Traylor DA, Zuniga JM, Schmidt RJ, Johnson GO, Cramer JT. An examination of neuromuscular and metabolic fatigue thresholds. Physiol Meas 2013; 34:1253-67. [PMID: 24021781 DOI: 10.1088/0967-3334/34/10/1253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examined the relationships among the physical working capacity at the fatigue threshold (PWCFT), the power outputs associated with the gas exchange threshold (PGET) and the respiratory compensation point (PRCP), and critical power (CP) to identify possible physiological mechanisms underlying the onset of neuromuscular fatigue. Ten participants (mean ± SD age: 20 ± 1 years) performed a maximal incremental cycle ergometer test to determine the PWCFT, PGET, and PRCP. CP was determined from the 3 min all-out test. The PWCFT (197 ± 55 W), PRCP (212 ± 50 W), and CP (208 ± 63 W) were significantly greater than the PGET (168 ± 40 W), but there were no significant differences among the PWCFT, PRCP, and CP. All thresholds were significantly inter-4 (r = 0.794-0.958). The 17% greater estimates for the PWCFT than PGET were likely related to differences in the physiological mechanisms that underlie these fatigue thresholds, while the non-significant difference and high correlation between the PWCFT and the PRCP suggested that hyperkalemia may underlie both thresholds. Furthermore, it is possible that the 5% lower estimate of the PWCFT than CP could more accurately reflect the demarcation of the heavy from severe exercise intensity domains.
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Affiliation(s)
- Haley C Bergstrom
- Human Performance Laboratory, Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
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Lee L, Schwartzman K, Carli F, Zavorsky GS, Li C, Charlebois P, Stein B, Liberman AS, Fried GM, Feldman LS. The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection. Anaesthesia 2013; 68:811-6. [DOI: 10.1111/anae.12329] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- L. Lee
- Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation; Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - K. Schwartzman
- Respiratory Epidemiology and Clinical Research Unit, and Respiratory Division; McGill University; Montreal; Quebec; Canada
| | - F. Carli
- Department of Anaesthesia; McGill University Health Centre; Montreal; Quebec; Canada
| | - G. S. Zavorsky
- Human Physiology Laboratory; Marywood University; Scranton; Pennsylvania; USA
| | - C. Li
- Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation; Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - P. Charlebois
- Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - B. Stein
- Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - A. S. Liberman
- Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - G. M. Fried
- Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
| | - L. S. Feldman
- Department of Surgery; McGill University Health Centre; Montreal; Quebec; Canada
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Ramos RP, Alencar MCN, Treptow E, Arbex F, Ferreira EMV, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med 2013; 2013:359021. [PMID: 23766901 PMCID: PMC3666297 DOI: 10.1155/2013/359021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023] Open
Abstract
The advent of microprocessed "metabolic carts" and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses' reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.
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Affiliation(s)
- Roberta P. Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Maria Clara N. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Erika Treptow
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Flávio Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Eloara M. V. Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Richardson House, 102 Stuart Street, Kingston, ON, Canada K7L 2V6
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36
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Methods of Prescribing Relative Exercise Intensity: Physiological and Practical Considerations. Sports Med 2013; 43:613-25. [DOI: 10.1007/s40279-013-0045-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Older P. Anaerobic threshold, is it a magic number to determine fitness for surgery? Perioper Med (Lond) 2013; 2:2. [PMID: 24472514 PMCID: PMC3964343 DOI: 10.1186/2047-0525-2-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 01/24/2013] [Indexed: 10/28/2022] Open
Abstract
The use of cardiopulmonary exercise testing (CPET) to evaluate cardiac and respiratory function was pioneered as part of preoperative assessment in the mid 1990s. Surgical procedures have changed since then. The patient population may have aged; however, the physiology has remained the same. The use of an accurate physiological evaluation remains as germane today as it was then. Certainly no 'magic' is involved. The author recognizes that not everyone accepts the classical theories of the anaerobic threshold (AT) and that there is some discussion around lactate and exercise. The article looks at aerobic capacity as an important predictor of perioperative mortality and also looks at some aspects of CPET relative to surgical risk evaluation.
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Affiliation(s)
- Paul Older
- Department of Anaesthetics, Western Hospital, Melbourne, Australia.
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Validity of reporting oxygen uptake efficiency slope from submaximal exercise using respiratory exchange ratio as secondary criterion. Pulm Med 2012; 2012:874020. [PMID: 22666584 PMCID: PMC3361344 DOI: 10.1155/2012/874020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 12/15/2022] Open
Abstract
Background. Oxygen uptake efficiency slope (OUES) is a reproducible, objective marker of cardiopulmonary function. OUES is reported as being relatively independent of exercise intensity. Practical guidance and criteria for reporting OUES from submaximal tests has not been established. Objective. Evaluate the use of respiratory exchange ratio (RER) as a secondary criterion for reporting OUES. Design. 100 healthy volunteers (53 women) completed a ramped treadmill protocol to exhaustive exercise. OUES was calculated from data truncated to RER levels from 0.85 to 1.2 and compared to values generated from full test data. Results. Mean (sd) OUES from full test data and data truncated to RER 1.0 and RER 0.9 was 2814 (718), 2895 (730), and 2810 (789) mL/min per 10-fold increase in VE, respectively. Full test OUES was highly correlated with OUES from RER 1.0 (r = 0.9) and moderately correlated with OUES from RER 0.9 (r = 0.79). Conclusion. OUES values peaked in association with an RER level of 1.0. Sub-maximal OUES values are not independent of exercise intensity. There is a significant increase in OUES value as exercise moves from low to moderate intensity. RER can be used as a secondary criterion to define this transition.
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Whipp BJ, Ward SA. The physiological basis of the 'anaerobic threshold' and implications for clinical cardiopulmonary exercise testing. Anaesthesia 2011; 66:1048-9; author reply 1049-50. [PMID: 22004202 DOI: 10.1111/j.1365-2044.2011.06909_1.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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West M, Jack S, Grocott MPW. Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol 2011; 25:427-37. [PMID: 21925407 DOI: 10.1016/j.bpa.2011.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
The elderly constitute an increasingly large segment of the population and of the patients requiring medical attention. Major surgery is associated with a substantial burden of postoperative morbidity and mortality. Advancing age is a particular risk factor for these outcomes. This article reviews the current literature on the value and practical applications of cardiopulmonary exercise testing (CPET) as a tool to evaluate risk and thereby improve the management of the elderly patient undergoing major surgery. There is a consistent association between CPET-derived variables and outcome following major surgery. Furthermore, CPET-derived variables have utility in perioperative risk prediction and identification of patients at high risk of adverse outcome following major surgery. This optimal predictor appears to differ between various surgery types and the incremental benefit of combining CPET with alternative methods of perioperative risk prediction remains poorly defined.
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Affiliation(s)
- M West
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
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41
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Hopker JG, Jobson SA, Pandit JJ. A reply. Anaesthesia 2011. [DOI: 10.1111/j.1365-2044.2011.06909_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Belli T, Ribeiro LFP, Ackermann MA, Baldissera V, Gobatto CA, Galdino da Silva R. Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women. Diabetes Res Clin Pract 2011; 93:337-43. [PMID: 21636159 DOI: 10.1016/j.diabres.2011.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/20/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
This study analyzed the effects of overground walking training at ventilatory threshold (VT) velocity on glycaemic control, body composition, physical fitness and lipid profile in DM2 women. Nineteen sedentary patients were randomly assigned to a control group (CG; n=10, 55.9±2.2 years) or a trained group (TG; n=9, 53.4±2.3 years). Both groups were subjected to anthropometric measures, a 12-h fasting blood sampling and a graded treadmill exercise test at baseline and after a 12-week period, during which TG followed a training program involving overground walking at VT velocity for 20-60min/session three times/week. Significant group×time interactions (P<0.05) in glycated hemoglobin (HbA1c), body mass, body mass index (BMI), peak oxygen uptake (VO(2peak)) and exercise duration were observed as effects of training exercise, whereas intervention did not induced significant changes (P>0.05) in fasting blood glucose, submaximal fitness parameters and lipid profile. Our results suggest that overground walking training at VT velocity improves long term glycaemic control, body composition and exercise capacity, attesting for the relevance of this parameter as an effective strategy for the exercise intensity prescription in DM2 population.
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Affiliation(s)
- Taisa Belli
- Laboratory of Sports Applied Physiology, FCA, UNICAMP, Limeira, SP, Brazil.
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Phypers BJ, Robiony-Rogers D, Pickering RM, Garden AL. Test-retest reliability of the oxygen uptake efficiency slope in surgical patients. Anaesthesia 2011; 66:659-66. [PMID: 21707558 DOI: 10.1111/j.1365-2044.2011.06714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The oxygen uptake efficiency slope is a measure of cardiopulmonary fitness, that can be obtained from a sub-maximal cardiopulmonary exercise test. It has been evaluated in medical patients but its reliability in surgical populations remains uncertain. We conducted a test-retest study with the aim of establishing the reliability of the oxygen uptake efficiency slope in relation to that of the anaerobic threshold and peak oxygen uptake, in general surgical patients. Twenty-six patients over 60 years old completed two symptom-limited, incremental cycle ergometry tests within 7 days. The mean (SD) anaerobic threshold was 13.0 (3.0) mlO(2) .kg(-1) .min(-1) . There were no significant differences between mean test and retest values of anaerobic threshold (p = 0.50), peak oxygen uptake (p = 0.76) or oxygen uptake efficiency slope (p = 0.42). Reliability coefficients (95% CI) for the anaerobic threshold, oxygen uptake efficiency slope and peak oxygen uptake were 66.7% (45.3-87.9%), 89.0% (81.0-96.9%) and 91.7% (85.7-97.8%), respectively. The oxygen uptake efficiency slope was determined easily in all patients and found to have excellent reliability. Its clinical utility in determining pre-operative fitness warrants further evaluation.
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Affiliation(s)
- B J Phypers
- Southampton University Hospitals NHS Trust, Southampton, UK.
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