Beta1-adrenoceptor mediated origin of the heart rate performance curve deflection

Attenuation of the increase of heart rate and oxygen consumption during progressive exercise in professional rugby players

BACKGROUND

The response of oxygen uptake (VO2) and heart rate (HR) to continuous progressive large muscle mass exercise is not always linear. This study aimed to compare the patterns of the Speed/VO2 (S/VO2) and speed/HR (S/HR) relationships during an incremental treadmill-running test in professional rugby players.

METHODS

Fourteen professional rugby athletes performed a maximal incremental treadmill-running test, following the Conconi test protocol. Speed, heart rate, and gas exchange parameters were recorded. The slope of the S/VO2 and S/HR relationships were mathematically determined.

RESULTS

The S/VO2 and S/HR relationships were linear up to a submaximal speed and curvilinear thereafter. The speed of locomotion at which the slope of the S/VO2 and S/HR relationships start to attenuate (VO2att and HRatt) were coincident (12.3±1.0 and 12.4±0.9 km/h), strongly correlated and in good agreement. VO2 values at VO2att (44.9±8.7 mL/kg/min) were significantly correlated with VO2 values at the ventilatory threshold (43.3±6.0 mL/kg/min) (R2=0.83, P=0.001) and in good agreement. The running speed/VO2 ratio (ΔS/ΔVO2) up to VO2att was significantly lower than that beyond VO2att (2.98±1.1 vs. 5.16±2.31); P<0,001).

CONCLUSIONS

The speed/oxygen uptake and S/HR relationships during progressive exercise start to attenuate at a coincident exercise intensity, and at oxygen uptake values strongly correlated with the ventilatory threshold. These findings further support the usefulness of the attenuation of the S/HR relationship as a practical tool for exercise testing and training purposes in professional rugby players.

Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18-65 Years old men and women: the 4HAIE study

Introduction: The heart rate performance curve (HRPC) in maximal incremental cycle ergometer exercise demonstrated three different patterns such as downward, linear or inverse versions. The downward pattern was found to be the most common and therefore termed regular. These patterns were shown to differently influence exercise prescription, but no data are available for running. This study investigated the deflection of the HRPC in maximal graded treadmill tests (GXT) of the 4HAIE study. Methods: Additional to maximal values, the first and second ventilatory thresholds as well as the degree and the direction of the HRPC deflection (k_HR) were determined from 1,100 individuals (489 women) GXTs. HRPC deflection was categorized as downward (k_HR < -0.1), linear (-0.1 ≤ k_HR ≤ 0.1) or inverse (k_HR > 0.1) curves. Four (even split) age- and two (median split) performance-groups were used to investigate the effects of age and performance on the distribution of regular (= downward deflection) and non-regular (= linear or inverse course) HR curves for male and female subjects. Results: Men (age: 36.8 ± 11.9 years, BMI: 25.0 ± 3.3 kg m^-2, VO_2max: 46.4 ± 9.4 mL min^-1. kg^-1) and women (age: 36.2 ± 11.9 years, BMI: 23.3 ± 3.7 kg m^-2, VO_2max: 37.4 ± 7.8 mL min^-1. kg^-1) presented 556/449 (91/92%) downward deflecting, 10/8 (2/2%) linear and 45/32 (7/6%) inverse HRPC´s. Chi-squared analysis revealed a significantly higher number of non-regular HRPC´s in the low-performance group and with increasing age. Binary logistic regression revealed that the odds ratio (OR) to show a non-regular HRPC is significantly affected by maximum performance (OR = 0.840, 95% CI = 0.754-0.936, p = 0.002) and age (OR = 1.042, 95% CI = 1.020-1.064, p < 0.001) but not sex. Discussion: As in cycle ergometer exercise, three different patterns for the HRPC were identified from the maximal graded treadmill exercise with the highest frequency of regular downward deflecting curves. Older subjects and subjects with a lower performance level had a higher probability to show a non-regular linear or inverted curve which needs to be considered for exercise prescription.

Glucose and Fructose Supplementation and Their Acute Effects on Electrocardiographic Time Intervals during Anaerobic Cycling Exercise in Healthy Individuals: A Secondary Outcome Analysis of a Double-Blind Randomized Crossover-Controlled Trial

The impact of glucose and fructose supplementation on acute cardiac effects during cardiopulmonary exercise testing (CPET) is a topic that is rarely investigated. The aim of the presented secondary outcome analysis of a double-blind, randomized crossover-controlled trial was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru), and sucralose on electrocardiogram (ECG), heart rate variability (HRV), premature ventricular complexes (PVCs), and heart rate turn points (HRTP) during CPET. Fourteen healthy individuals (age 25.4 ± 2.5 years, body mass index (BMI) 23.7 ± 1.7 kg/m2, body mass (BM) of 76.3 ± 12.3 kg) participated in this study, of which 12 were included for analysis. Participants received 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose dissolved in 300 mL 30 min prior to each exercise session. No relevant clinical pathology or significant inter-individual differences between our participants could be revealed for baseline ECG parameters, such as heart rate (HR) (mean HR 70 ± 16 bpm), PQ interval (146 ± 20 ms), QRS interval (87 ± 16 ms) and the QT (405 ± 39 ms), and QTc interval (431 ± 15 ms). We found preserved cardiac autonomic function by analyzing the acute effects of different Glu, Fru, GluFru, or sucralose supplementation on cardiac autonomic function by Schellong-1 testing. SDNN and RMSSD revealed normal sympathetic and parasympathetic activities displaying a balanced system of cardiac autonomic regulation across our participating subjects with no impact on the metabolism. During CPET performance analyses, HRV values did not indicate significant changes between the ingested drinks within the different time points. Comparing the HRTP of the CPET with endurance testing by variable metabolic conditions, no significant differences were found between the HRTP of the CPET data (170 ± 12 bpm), Glu (171 ± 10 bpm), Fru (171 ± 9 bpm), GluFru (172 ± 9 bpm), and sucralose (170 ± 8 bpm) (p = 0.83). Additionally, the obtained time to reach HRTP did not significantly differ between Glu (202 ± 75 s), Fru (190 ± 88 s), GluFru (210 ± 89 s), and sucralose (190 ± 34 s) (p = 0.59). The significance of this study lies in evaluating the varying metabolic conditions on cardiac autonomic modulation in young healthy individuals. In contrast, our participants showed comparable cardiac autonomic responses determined by ECG and CPET.

Pattern of the Heart Rate Performance Curve in Subjects with Beta-Blocker Treatment and Healthy Controls

(1): Heart rate performance curve (HRPC) in incremental exercise was shown to be not uniform, causing false intensity estimation applying percentages of maximal heart rate (HR_max). HRPC variations are mediated by β-adrenergic receptor sensitivity. The aim was to study age and sex dependent differences in HRPC patterns in adults with β-blocker treatment (BB) and healthy controls (C). (2): A total of 535 (102 female) BB individuals were matched 1:1 for age and sex (male 59 ± 11 yrs, female 61 ± 11 yrs) in C. From the maximum incremental cycle ergometer exercise a first and second heart rate (HR) threshold (Th1 and Th2) was determined. Based on the degree of the deflection (kHR), HRPCs were categorized as regular (downward deflection (kHR > 0.1)) and non-regular (upward deflection (kHR < 0.1), linear time course). (3): Logistic regression analysis revealed a higher odds ratio to present a non-regular curve in BB compared to C (females showed three times higher odds). The odds for non-regular HRPC in BB versus C decreased with older age (OR interaction = 0.97, CI = 0.94-0.99). Maximal and submaximal performance and HR variables were significantly lower in BB (p < 0.05). %HR_max was significantly lower in BB versus C at Th2 (male: 77.2 ± 7.3% vs. 80.8 ± 5.0%; female: 79.2 ± 5.1% vs. 84.0 ± 4.3%). %P_max at Th2 was similar in BB and C. (4): The HRPC pattern in incremental cycle ergometer exercise is different in individuals receiving β-blocker treatment compared to healthy individuals. The effects were also dependent on age and sex. Relative HR values at Th2 varied substantially depending on treatment. Thus, the percentage of Pmax seems to be a stable and independent indicator for exercise intensity prescription.

Agreement between heart rate deflection point and maximal lactate steady state in young adults with different body masses

We examined the agreement between heart rate deflection point (HRDP) variables with maximal lactate steady state (MLSS) in a sample of young males categorized to different body mass statuses using body mass index (BMI) cut-off points. One hundred and eighteen young males (19.9 ± 4.4 years) underwent a standard running incremental protocol with individualized speed increment between 0.3 and 1.0 km/h for HRDP determination. HRDP was determined using the modified Dmax method called S.Dmax. MLSS was determined using 2-5 series of constant-speed treadmill runs. Heart rate (HR) and blood lactate concentration (La) were measured in all tests. MLSS was defined as the maximal running speed yielding a La increase of less than 1 mmol/L during the last 20 min. Good agreement was observed between HRDP and MLSS for HR for all participants (±1.96; 95% CI = -11.5 to +9.2 b/min, ICC = 0.88; P < 0.001). Good agreement was observed between HRDP and MLSS for speed for all participants (±1.96; 95% CI = -0.40 to +0.42 km/h, ICC = 0.98; P < 0.001). The same findings were observed when participants were categorized in different body mass groups. In conclusion, HRDP can be used as a simple, non-invasive and time-efficient method to objectively determine submaximal aerobic performance in nonathletic young adult men with varying body mass status, according to the chosen standards for HRDP determination.

Intensity Thresholds and Maximal Lactate Steady State in Small Muscle Group Exercise

The aim of our study is to determine the first (LTP₁) and the second (LTP₂) lactate turn points during an incremental bicep curl test and to verify these turn points by ventilatory turn points (VT₁ and VT₂) and constant-load exercise tests. Twelve subjects performed a one-arm incremental bicep curl exercise (IET) after a one repetition maximum (1RM) test to calculate the step rate for the incremental exercise (1RM/45). Workload was increased every min at a rate of 30 reps/min until maximum. To verify LTPs, VT₁ and VT₂ were determined from spirometric data, and 30 min constant-load tests (CL) were performed at 5% P_max below and above turn points. Peak load in IET was 5.3 ± 0.9 kg (La_max: 2.20 ± 0.40 mmol·L⁻¹; HR_max: 135 ± 15 b·min⁻¹; VO_2max: 1.15 ± 0.30 L·min⁻¹). LTP₁ was detected at 1.9 ± 0.6 kg (La: 0.86 ± 0.36 mmol·L⁻¹; HR 90 ± 13 b·min⁻¹; VO₂: 0.50 ± 0.05 L·min⁻¹) and LTP₂ at 3.8 ± 0.7 kg (La: 1.38 ± 0.37 mmol·L⁻¹; 106 ± 10 b·min⁻¹; VO₂: 0.62 ± 0.11 L·min⁻¹). Constant-load tests showed a lactate steady-state in all tests except above LTP₂, with early termination after 16.5 ± 9.1 min. LTP₁ and LTP₂ could be determined in IET, which were not significantly different from VT₁/VT₂. Constant-load exercise validated the three-phase concept, and a steady-state was found at resting values below VT₁ and in all other tests except above LTP₂. It is suggested that the three-phase model is also applicable to small muscle group exercise.

Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Introduction: The Heart Rate Performance Curve (HRPC) is neither linear nor uniform and related to ß1-adrenoceptor sensitivity. As aging and exercise influence ß1-adrenoceptors we suggested age, sex and performance effects on the HRPC. Aim of the study was to examine the effects of aging on the deflection of the HRPC in maximal incremental cycle ergometer exercise (CE) in a large cohort of healthy subjects.

Methods: Heart rate (HR) data of 2,980 men (51 ± 15 years) and 1,944 women (52 ± 14 years) were classified into age groups (≤20 up to >80 years). We analyzed age and performance (P_low 25%-quartile and P_high 75%-quartile of age predicted power) effects on HR_max and on the degree (k) and the type (regular downward deflection k > 0.1, linear −0.1 ≤ k ≤ 0.1 and atypical upward deflection k < −0.1) of the HRPC.

Results:k-values decreased significantly with age in men and women and were significantly higher in women. Atypical HRPC's increased by a linear trend from ≤20 to 70 years (m) respectively 80 years (w) from 10 to 43% (m) and 9 to 30% (w). HR_max of all age groups was lower in P_low and overall number of atypical HRPC's was 21% (m) and 16% (w) higher compared to P_high.

Conclusion: Aging increased the number of atypical HRPC's with upward deflection in CE tests, which influences exercise intensity prescription especially when using fixed percentages of HR_max. Changes in HRPC's were affected by sex and performance, where women generally and subjects with higher performance presented less atypical HRPC's even at older age.

Physiological and Perceived Exertion Responses during Exercise: Effect of β-blockade

PURPOSE

This study investigated the effect of β-blockade on physiological and perceived exertion (RPE) responses during incremental treadmill exercise.

METHODS

Sixteen healthy participants (n = 8 men; age, 25.3 ± 4.6 yr) performed a maximal treadmill exercise test after ingestion of 100 mg metoprolol or placebo, with a double-blind, randomized, and counterbalanced design. Heart rate (HR), ventilatory, and gas exchange variables were measured continuously, and participants reported RPE at the end of each minute. Physiological and RPE responses during each condition were compared at the ventilatory threshold (VT), respiratory compensation point, and at maximal exercise using repeated-measures ANOVA. Linear regression modeled relationships between perceived exertion and physiological variables.

RESULTS

The HR and V˙O2 at the VT, respiratory compensation point, and maximal exercise were all significantly lower after β-blockade (P < 0.05). However, when standardized to within condition peak values, differences were no longer significant. The RPE associated with VT was higher after β-blockade (12.9 ± 1.0 vs 12.3 ± 1.2, P < 0.05) but lower at maximal exercise (19.1 ± 0.6 vs 19.4 ± 0.5, P < 0.05). Increases in RPE relative to HR were greater after β-blockade and remained significant when expressed relative to peak HR. There was no difference in the growth of the relationship between RPE and V˙O2 across conditions, although the origin of the relationship was higher with β-blockade.

CONCLUSIONS

Although β-blockade resulted in a significant reduction in exercising HR and V˙O2, the RPE for a given relative intensity remained unchanged. The relationship between RPE and V˙O2 was not affected by β-blockade. The results provide evidence that RPE is a useful and reliable measure for exercise testing and prescription in patients prescribed β-blockade therapy.

Exercise-based cardiac rehabilitation is associated with a normalization of the heart rate performance curve deflection

The heart rate (HR) rises with increased power output, whereby in most healthy individuals, the slope of HR levels off with higher intensity. This corresponds to a downward deflection of the heart rate performance curve (HRPC). Conversely, in patients after myocardial infarction, an upward HRPC deflection is frequently observed that is especially pronounced in patients with compromised left ventricular ejection fraction. To investigate whether regular endurance training during cardiac rehabilitation might normalize HRPC, data of 128 male patients were analyzed. All patients performed three exercise tests: at baseline, after 6 weeks, and after 1 year. Ninety‐six patients exercised regularly according to guidelines for 1 year (training group, TG), and 32 stopped after 6 weeks (control group, CG). Similarly, upward‐deflected HRPCs were observed at baseline and after 6 weeks in both groups. After 1 year, TG patients had less upward‐deflected HRPCs compared with CG ones, corresponding to a partial normalization. Greater changes in HRPC deflection were associated with larger improvements in cardiorespiratory fitness. Our results might indicate improved myocardial function due to long‐term rehabilitation. Further, HRPC alterations over time should be considered when prescribing exercise intensities using a target HR, as deflection flattening might render the intensity of corresponding exercise insufficient.

Heart rate dynamics during cardio-pulmonary exercise testing are associated with glycemic control in individuals with type 1 diabetes

INTRODUCTION

This study investigated the degree and direction (kHR) of the heart rate to performance curve (HRPC) during cardio-pulmonary exercise (CPX) testing and explored the relationship with diabetes markers, anthropometry and exercise physiological markers in type 1 diabetes (T1DM).

MATERIAL AND METHODS

Sixty-four people with T1DM (13 females; age: 34 ± 8 years; HbA1c: 7.8 ± 1% (62 ± 13 mmol.mol-1) performed a CPX test until maximum exhaustion. kHR was calculated by a second-degree polynomial representation between post-warm up and maximum power output. Adjusted stepwise linear regression analysis was performed to investigate kHR and its associations. Receiver operating characteristic (ROC) curve was performed based on kHR for groups kHR < 0.20 vs. > 0.20 in relation to HbA1c.

RESULTS

We found significant relationships between kHR and HbA1c (β = -0.70, P < 0.0001), age (β = -0.23, P = 0.03) and duration of diabetes (β = 0.20, P = 0.04). Stepwise linear regression resulted in an overall adjusted R2 of 0.57 (R = 0.79, P < 0.0001). Our data revealed also significant associations between kHR and percentage of heart rate at heart rate turn point from maximum heart rate (β = 0.43, P < 0.0001) and maximum power output relativized to bodyweight (β = 0.44, P = 0.001) (overall adjusted R2 of 0.44 (R = 0.53, P < 0.0001)). ROC curve analysis based on kHR resulted in a HbA1c threshold of 7.9% (62 mmol.mol-1).

CONCLUSION

Our data demonstrate atypical HRPC during CPX testing that were mainly related to glycemic control in people with T1DM.

Different Heart Rate Patterns During Cardio-Pulmonary Exercise (CPX) Testing in Individuals With Type 1 Diabetes

To investigate the heart rate during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes (T1D) compared to healthy (CON) individuals. Fourteen people (seven individuals with T1D and seven CON individuals) performed a CPX test until volitional exhaustion to determine the first and second lactate turn points (LTP₁ and LTP₂), ventilatory thresholds (VT₁ and VT₂), and the heart rate turn point. For these thresholds cardio-respiratory variables and percentages of maximum heart rate, heart rate reserve, maximum oxygen uptake and oxygen uptake reserve, and maximum power output were compared between groups. Additionally, the degree and direction of the deflection of the heart rate to performance curve (k_HR) were compared between groups. Individuals with T1D had similar heart rate at LTP₁ (mean difference) -11, [(95% confidence interval) -27 to 4 b.min^-1], at VT₁ (-12, -8 to 33 b.min^-1) and at LTP₂ (-7, -13 to 26 b.min^-1), at VT₂ (-7, -13 to 28 b.min^-1), and at the heart rate turn point (-5, -14 to 24 b.min^-1) (p = 0.22). Heart rate expressed as percentage of maximum heart rate at LTP₁, VT₁, LTP₂, VT₂ and the heart rate turn point as well as expressed as percentages of heart rate reserve at LTP₂, VT₂ and the heart rate turn point was lower in individuals with T1D (p < 0.05). k_HR was lower in T1D compared to CON individuals (0.11 ± 0.25 vs. 0.51 ± 0.32, p = 0.02). Our findings demonstrate that there are clear differences in the heart rate response during CPX testing in individuals with T1D compared to CON individuals. We suggest using submaximal markers to prescribe exercise intensity in people with T1D, as the heart rate at thresholds is influenced by k_HR. Clinical Trial Identifier: NCT02075567 (https://clinicaltrials.gov/ct2/show/NCT02075567).

PONTOS DE TRANSIÇÃO DA FREQUÊNCIA CARDÍACA NA MARCHA ATLÉTICA

RESUMO Introdução: A frequência cardíaca fornece informações úteis para os treinamentos de marcha atlética. Objetivo: O objetivo do estudo foi analisar o comportamento da frequência cardíaca (FC) e seus pontos de inflexão (PIFC) e deflexão (PDFC) em teste progressivo de marcha atlética (TPMA) antes e depois de 20 sessões de treinamento. Métodos: Participaram 13 jovens atletas (12,46 ± 1,61 anos, 44,29 ± 10,25 kg, 157,93 ± 12,03 cm, 24,39 ± 7,60 %G). O TPMA foi realizado em uma pista oficial de atletismo, antes e depois do treinamento. Os dados de FC e carga foram plotados a cada minuto para identificação dos PIFC e PDFC. Resultados: A FC apresentou comportamento sigmoide, com identificação dos pontos de transição (PT), sendo no pré-treinamento: a) oito sujeitos PIFC (5,31 km·h-1; 125 bpm) e PDFC (7,63 km·h-1; 169 bpm); b) um sujeito somente PIFC (7,00 km·h-1; 149 bpm); c) um sujeito somente PDFC (8,00 km·h-1; 170 bpm); d) três sujeitos sem detecção de PT e no pós-treinamento: a) em 12 sujeitos PIFC (5,46 km·h-1; 125 bpm) e PDFC (7,75 km·h-1; 168 bpm); b) um sujeito somente PDFC (7,50 km·h-1; 184 bpm). O PIFC foi encontrado em carga significativamente inferior ao PDFC no pré (p < 0,001) e no pós-treinamento (p < 0,001). Quando comparamos o PIFC e o PDFC pré e pós, não encontramos diferença significativa, seja em relação à carga (p = 0,87 e p = 0,61) ou FC (p = 0,60 e p = 0,99). Conclusão: Conclui-se que a FC tem relação curvilínea com a carga, sendo possível detectar os seus pontos de transição em TPMA.

Determination of Anaerobic Threshold by Monitoring the O2 Pulse Changes in Endurance Cyclists

The purpose of this study was to determine the validity of anaerobic threshold (AnT)-equivalent to the second turn point for lactate (LTP2)-estimation using the O2 pulse changes in highly trained endurance cyclists who do not show heart rate deflection point (HRDP) during incremental testing. Sixteen endurance cyclists (age, 24.8 ± 4.7 years) and fifteen active men (age, 24.8 ± 3.7 years) performed an incremental cycling test to exhaustion. Pulmonary oxygen uptake (V[Combining Dot Above]O2) and other hemodynamic variables, heart rate, and blood lactate concentration were measured continuously throughout the test. O2 pulse anaerobic threshold (O2 pulse-AnT) was defined as the second turn point in O2 pulse-workload curve. LTP2 was considered as gold standard assessment of AnT and was applied to confirm the validity of O2 pulse-AnT. Intraclass correlation coefficients and the Bland-Altman method were used to determine the relationship and agreement between the O2 corresponding to LTP2 and O2 pulse-AnT, respectively. The active men and 68.7% of the endurance cyclists showed HRDP, whereas all subjects showed O2 pulse-AnT during incremental testing. In both groups, the values for V[Combining Dot Above]O2 corresponding to LTP2 were not significantly different from the V[Combining Dot Above]O2 at O2 pulse-AnT. The V[Combining Dot Above]O2 at LTP2 and O2 pulse-AnT were highly correlated (endurance cyclists: R = 0.68; standard error of estimate [SEE] = 3.74 ml·kg·min and active men: R = 0.58; SEE = 2.91 ml·kg·min) and Bland-Altman plot revealed the limit of agreement of O2 at LTP2 and O2 pulse-AnT differences between 5.1 and 8.6 ml·kg·min (95% CI). In summary, results of this study showed that the second turn point in the O2 pulse-workload curve occurs around LTP2. Therefore, using O2 pulse-AnT is recommended for the noninvasive determination of AnT in highly trained endurance cyclists who do not show HRDP during incremental exercise.

Identification and agreement of first turn point by mathematical analysis applied to heart rate, carbon dioxide output and electromyography

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-CO_2, 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.

Programming exercise intensity in patients on beta-blocker treatment: the importance of choosing an appropriate method

AIM

To verify the usefulness of current recommended level of target exercise heart rate (HR) and of different HR-based methods for calculating target HR in patients with and without beta-blocker treatment.

METHODS

We studied 53 patients not treated with beta-blocker and 159 patients on beta-blocker treatment. All patients underwent a maximal exercise test with gas analysis, and first ventilatory threshold (VT1 or aerobic threshold), second ventilatory threshold (VT2 or anaerobic threshold), time of exercise, maximum load, metabolic parameters, HR at rest (HRrest), HRpeak, HR at VT1 (HRVT1) and at VT2 (HRVT2), and 75, 80, and 85% of HRmax (HR75%, HR80%, HR85%) were calculated. Exercise HR was also determined using the Karvonen formula, applying 60, 70, and 80% of the heart rate reserve (HRR) (HRKarv0.6, HRKarv0.7, and HRKarv0.8).

RESULTS

This study included 102 patients on a beta-blocker and 39 not treated with negative cronotropic effect drugs. Maximum load, metabolic parameters, HRrest, HRpeak, HRVT1, and HRVT2 were significantly lower in patients on beta-blocker treatment. The proportion of patients with a HR75%, HR80%, HR85%, ​​HRKarv0.6, HRKarv0.7, and HRKarv0.8 <VT1 and >VT2 was very high and depended on whether patients were on beta-blocker treatment.

CONCLUSIONS

Prescribed exercise intensity should be within VT1 and VT2, so that the efficacy and safety is guaranteed. If determining VT1 and VT2 is not possible, HR-based methods can be used, but with caution. In fact, there will be always a proportion of patients training below VT1 or above VT2. On the other hand, recommendations for patients on a beta-blocker should be different from patients not receiving a beta-blocker. Patients not treated with a beta-blocker should exercise at HRKarv0.7 or at HR85%. In patients on a beta-blocker, we recommend preferentially a target HR of HRKarv0.6 or HR80%.

Pontos de transição da frequência cardíaca em teste progressivo máximo

Foi realizada análise do comportamento da frequência cardíaca (FC) e identificação dos pontos de inflexão (PIFC) e de deflexão da FC (PDFC) em teste progressivo máximo, em sujeitos do sexo feminino e masculino. Vinte universitários foram submetidos ao teste em cicloergômetro. A FC foi monitorada para posterior análise e identificação dos pontos de transição (PT). A FC apresentou comportamento sigmóide, com identificação de PT em todos os sujeitos, sendo: a) em 65% PIFC (64 ± 27W; 29 ± 9%Pmáx e 126 ± 12bpm; 66 ± 5%FCmáx) e PDFC (177 ± 45W; 81 ± 10%Pmáx e 178 ± 8bpm; 93 ± 4%FCmáx); b) em 30% apenas PIFC (80 ± 32W; 36 ± 14%Pmáx e 125 ± 13bpm; 66 ± 5%FCmáx) e c) em 5% o PDFC isolado (103W; 57%Pmáx e 150bpm; 82%FCmáx). O PIFC foi encontrado em carga significativamente inferior ao PDFC, sem diferenças na carga e FC relativas entre os sexos.

The mathematical analysis of the heart rate and blood lactate curves during incremental exercise testing

This paper describes a new mathematical approach for the analysis of HR (heart rate) and BL (blood lactate) curves during incremental exercise testing using a HR/BL curve and its derivatives, taking into account the native shape of all curves, without any linear approximation. Using this approach the results indicate the appearance of three characteristic points (A, B and C) on the HR/BL curve. The point A on the HR/BL curve which is the value that corresponds to the load (12.73 ± 0.46 km h-1) at which BL starts to increase above the resting levels (0.9 ± 0.06 mM), and is analogous to Lactate Turn Point 1 (LTP1). The point C on the HR/BL curve which corresponds to a BL of approximately 4mM, and is analogous to LTP2. The point B on the HR/BL curve, which corresponds to the load (16.32 ± 0.49 km h-1) at which the moderate increase turns into a more pronounced increase in BL. This point has not been previously recognized in literature. We speculate this point represents attenuation of left ventricular ejection fraction (LVEF) increase, accompanied by the decrease in diastolic time duration during incremental exercise testing. Proposed mathematical approach allows precise determination of lactate turnpoints during incremental exercise testing.

Special needs to prescribe exercise intensity for scientific studies

There is clear evidence regarding the health benefits of physical activity. These benefits follow a dose-response relationship with a particular respect to exercise intensity. Guidelines for exercise testing and prescription have been established to provide optimal standards for exercise training. A wide range of intensities is used to prescribe exercise, but this approach is limited. Usually percentages of maximal oxygen uptake (VO₂) or heart rate (HR) are applied to set exercise training intensity but this approach yields substantially variable metabolic and cardiocirculatory responses. Heterogeneous acute responses and training effects are explained by the nonuniform heart rate performance curve during incremental exercise which significantly alters the calculations of %HR_max and %HRR target HR data. Similar limitations hold true for using %VO_2max and %VO₂R. The solution of these shortcomings is to strictly apply objective submaximal markers such as thresholds or turn points and to tailor exercise training within defined regions.

Value of the Application of the Heart Rate Performance Curve in Sports

The heart rate performance curve (HRPC) has been shown to be nonlinearly related to work load. This phenomenon has been used to determine a defection point and to be related to the lactate anaerobic threshold. The original method was heavily criticized, and the method was challenged by several authors. However, some authors also demonstrated a high value for this method’s application in various sports conditions. Unfortunately, the HRPC was shown to be not uniform and three different patterns were found. Basic investigations have shown a dependence of the HR-defection on beta1-receptor sensitivity, which gave a plausible explanation of the phenomenon. Important details regarding the testing protocol and the method of turn point determination are given in this review. As a conclusion, we may state that based on numerous studies the method is plausible and valid to determine aerobic exercise performance in various laboratory ergometer and specific sports-related field conditions. Standard protocol conditions adjusted to the exercise performance level of subjects and a computer-supported determination of turn points are necessary to obtain reliable results. Large-scale investigations to validate the heart rate turn point with maximal lactate steady state are still needed. However, from the available literature, the application of this noninvasive method can be recommended to determine aerobic exercise performance in various sports. This noninvasive test is easy to perform repeatedly, which gives interesting possibilities for the monitoring of training adaptation in the short term, such as altitude training or specifc taper forms.