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Inglis EC, Iannetta D, Rasica L, Mackie MZ, Keir DA, Macinnis MJ, Murias JM. Heavy-, Severe-, and Extreme-, but Not Moderate-Intensity Exercise Increase V̇o 2max and Thresholds after 6 wk of Training. Med Sci Sports Exerc 2024; 56:1307-1316. [PMID: 38376995 DOI: 10.1249/mss.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This study assessed the effect of individualized, domain-based exercise intensity prescription on changes in maximal oxygen uptake (V̇O 2max ) and submaximal thresholds. METHODS Eighty-four young healthy participants (42 females, 42 males) were randomly assigned to six age, sex, and V̇O 2max -matched groups (14 participants each). Groups performed continuous cycling in the 1) moderate (MOD), 2) lower heavy (HVY1), and 3) upper heavy-intensity (HVY2) domain; interval cycling in the form of 4) high-intensity interval training (HIIT) in the severe-intensity domain, or 5) sprint-interval training (SIT) in the extreme-intensity domain; or no exercise for 6) control (CON). All training groups, except SIT, were work-matched. Training participants completed three sessions per week for 6 wk with physiological evaluations performed at PRE, MID, and POST intervention. RESULTS Compared with the change in V̇O 2max (∆V̇O 2max ) in CON (0.1 ± 1.2 mL·kg -1 ·min -1 ), all training groups, except MOD (1.8 ± 2.7 mL·kg -1 ·min -1 ), demonstrated a significant increase ( P < 0.05). HIIT produced the highest increase (6.2 ± 2.8 mL·kg -1 ·min -1 ) followed by HVY2 (5.4 ± 2.3 mL·kg -1 ·min -1 ), SIT (4.7 ± 2.3 mL·kg -1 ·min -1 ), and HVY1 (3.3 ± 2.4 mL·kg -1 ·min -1 ), respectively. The ΔPO at the estimated lactate threshold ( θLT ) was similar across HVY1, HVY2, HIIT, and SIT, which were all greater than CON ( P < 0.05). The ΔV̇O 2 and ΔPO at θLT for MOD was not different from CON ( P > 0.05). HIIT produced the highest ΔPO at maximal metabolic steady state, which was greater than CON, MOD, and SIT ( P < 0.05). CONCLUSIONS This study demonstrated that i) exercise intensity is a key component determining changes in V̇O 2max and submaximal thresholds and ii) exercise intensity domain-based prescription allows for a homogenous metabolic stimulus across individuals.
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Affiliation(s)
| | - Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Letizia Rasica
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Mary Z Mackie
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Daniel A Keir
- School of Kinesiology, Western University, London, ON, CANADA
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Ferri Marini C, Micheli L, Grossi T, Federici A, Piccoli G, Zoffoli L, Correale L, Dell’Anna S, Naldini CA, Lucertini F, Vandoni M. Are incremental exercise relationships between rating of perceived exertion and oxygen uptake or heart rate reserve valid during steady-state exercises? PeerJ 2024; 12:e17158. [PMID: 38711624 PMCID: PMC11073009 DOI: 10.7717/peerj.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/04/2024] [Indexed: 05/08/2024] Open
Abstract
Background Rating of perceived exertion (RPE) is considered a valid method for prescribing prolonged aerobic steady-state exercise (SSE) intensity due to its association with physiological indicators of exercise intensity, such as oxygen uptake (V̇O2) or heart rate (HR). However, these associations between psychological and physiological indicators of exercise intensity were found during graded exercise tests (GXT) but are currently used to prescribe SSE intensity even though the transferability and validity of the relationships found during GXT to SSE were not investigated. The present study aims to verify whether (a) RPE-HR or RPE-V̇O2 relations found during GXTs are valid during SSEs, and (b) the duration and intensity of SSE affect these relations. Methods Eight healthy and physically active males (age 22.6 ± 1.2 years) were enrolled. On the first visit, pre-exercise (during 20 min standing) and maximal (during a GXT) HR and V̇O2 values were measured. Then, on separate days, participants performed 4 SSEs on the treadmill by running at 60% and 80% of the HR reserve (HRR) for 15 and 45 min (random order). Individual linear regressions between GXTs' RPE (dependent variable) and HRR and V̇O2 reserve (V̇O2R) values (computed as the difference between maximal and pre-exercise values) were used to predict the RPE associated with %HRR (RPEHRR) and %V̇O2R (RPEV̇O2R) during the SSEs. For each relation (RPE-%HRR and RPE-%V̇O2R), a three-way factorial repeated measures ANOVA (α = 0.05) was used to assess if RPE (dependent variable) was affected by exercise modality (i.e., RPE recorded during SSE [RPESSE] or GXT-predicted), duration (i.e., 15 or 45 min), and intensity (i.e., 60% or 80% of HRR). Results The differences between RPESSE and GXT-predicted RPE, which were assessed by evaluating the effect of modality and its interactions with SSE intensity and duration, showed no significant differences between RPESSE and RPEHRR. However, when RPESSE was compared with RPEV̇O2R, although modality or its interactions with intensity were not significant, there was a significant (p = 0.020) interaction effect of modality and duration yielding a dissociation between changes of RPESSE and RPEV̇O2R over time. Indeed, RPESSE did not change significantly (p = 0.054) from SSE of 15 min (12.1 ± 2.0) to SSE of 45 min (13.5 ± 2.1), with a mean change of 1.4 ± 1.8, whereas RPEV̇O2R decreased significantly (p = 0.022) from SSE of 15 min (13.7 ± 3.2) to SSE of 45 min (12.4 ± 2.8), with a mean change of -1.3 ± 1.5. Conclusion The transferability of the individual relationships between RPE and physiological parameters found during GXT to SSE should not be assumed as shown by the results of this study. Therefore, future studies modelling how the exercise prescription method used (e.g., RPE, HR, or V̇O2) and SSE characteristics (e.g., exercise intensity, duration, or modality) affect the relationships between RPE and physiological parameters are warranted.
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Affiliation(s)
- Carlo Ferri Marini
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Lorenzo Micheli
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Tommaso Grossi
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Ario Federici
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Giovanni Piccoli
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Luca Zoffoli
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
- Scientific Research & Innovation Department, Technogym S.p.A, Cesena, FC, Italy
| | - Luca Correale
- Sports Science Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
| | - Stefano Dell’Anna
- Sports Science Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy
| | - Carlo Alberto Naldini
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
| | - Francesco Lucertini
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
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Kuerschner B, Kirton M, Dalleck LC, Beleigoli A, Gebremichael L, Weatherwax R, Ramos JS. The impact of individualised versus standardised endurance and resistance training on the fitness-fatness index in inactive adults. J Sci Med Sport 2024; 27:326-332. [PMID: 38388327 DOI: 10.1016/j.jsams.2024.01.011] [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: 10/07/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES The aim of the current study was to investigate the impact of individualised versus standardised combined endurance and resistance training on the fitness-fatness index in physically inactive adults. DESIGN Randomised controlled trial. METHODS Fifty-four participants aged 21-55 years were randomised into three groups; 1) non-exercise control (n = 18), 2) standardised moderate-intensity continuous training (n = 18), or 3) individualised moderate-intensity continuous training + high-intensity interval training (n = 18). The fitness-fatness index was calculated by dividing cardiorespiratory fitness (expressed as metabolic equivalents) by the waist-to-height ratio. Participants were classified as likely responders to the intervention if a change of ≥1 fitness-fatness index unit was achieved. RESULTS The individualised group showed the greatest fitness-fatness index improvement (between group difference p < 0.001), with 100 % of this group classified as likely responders, compared to the standardised (68 %) and non-exercise control (0 %) groups. CONCLUSIONS An individualised, threshold-based exercise programme may produce more favourable changes in the fitness-fatness index than a standardised exercise programme.
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Affiliation(s)
- Bridget Kuerschner
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia; Flinders University, SHAPE Research Centre, Australia
| | - Michael Kirton
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia; Flinders University, SHAPE Research Centre, Australia
| | - Lance C Dalleck
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia; Flinders University, SHAPE Research Centre, Australia; Western Colorad University, Recreation, Exercise & Sports Science Department, USA
| | - Alline Beleigoli
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia
| | - Lemlem Gebremichael
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia
| | - Ryan Weatherwax
- Southern Oregon University, Department of Health and Exercise Science, Ashland, USA
| | - Joyce S Ramos
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Australia; Flinders University, SHAPE Research Centre, Australia; Flinders University, Medical Device Research Institute, College of Science and Engineering, Australia.
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Bossi AH, Naumann U, Passfield L, Hopker J. Modelling inter-individual variability in acute and adaptive responses to interval training: insights into exercise intensity normalisation. Eur J Appl Physiol 2024; 124:1201-1216. [PMID: 37966510 PMCID: PMC10954971 DOI: 10.1007/s00421-023-05340-y] [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: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To investigate the influence of exercise intensity normalisation on intra- and inter-individual acute and adaptive responses to an interval training programme. METHODS Nineteen cyclists were split in two groups differing (only) in how exercise intensity was normalised: 80% of the maximal work rate achieved in an incremental test (% W ˙ max) vs. maximal sustainable work rate in a self-paced interval training session (% W ˙ max-SP). Testing duplicates were conducted before and after an initial control phase, during the training intervention, and at the end, enabling the estimation of inter-individual variability in adaptive responses devoid of intra-individual variability. RESULTS Due to premature exhaustion, the median training completion rate was 88.8% for the % W ˙ max group, but 100% for the % W ˙ max-SP the group. Ratings of perceived exertion and heart rates were not sensitive to how intensity was normalised, manifesting similar inter-individual variability, although intra-individual variability was minimised for the % W ˙ max-SP group. Amongst six adaptive response variables, there was evidence of individual response for only maximal oxygen uptake (standard deviation: 0.027 L·min-1·week-1) and self-paced interval training performance (standard deviation: 1.451 W·week-1). However, inter-individual variability magnitudes were similar between groups. Average adaptive responses were also similar between groups across all variables. CONCLUSIONS To normalise completion rates of interval training, % W ˙ max-SP should be used to prescribe relative intensity. However, the variability in adaptive responses to training may not reflect how exercise intensity is normalised, underlining the complexity of the exercise dose-adaptation relationship. True inter-individual variability in adaptive responses cannot always be identified when intra-individual variability is accounted for.
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Affiliation(s)
- Arthur Henrique Bossi
- School of Sport and Exercise Sciences, University of Kent, Canterbury, Kent, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
- The Mountain Bike Centre of Scotland, Peel Tower, Glentress, Peebles, UK.
| | | | - Louis Passfield
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - James Hopker
- School of Sport and Exercise Sciences, University of Kent, Canterbury, Kent, UK
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Weatherwax RM, Nelson MC, Dalleck LC. The Impact of Personalized versus Standardized Cardiorespiratory and Muscular Training on Health-Related Outcomes and Rate of Responders. J Sports Sci Med 2024; 23:209-218. [PMID: 38455427 PMCID: PMC10915607 DOI: 10.52082/jssm.2024.209] [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: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
Recent research has shown more favorable training adaptations for inactive adults when cardiorespiratory fitness (CRF) exercise is prescribed with the use of ventilatory thresholds compared to percentages of heart rate reserve (HRR). However, there is limited research on changes in health-related outcomes with the use of these CRF methods in combination with muscular fitness exercises. The objective of this study was to compare the effectiveness of two training programs for improving CRF, muscular fitness, and cardiometabolic risk factors. Inactive men and women (n=109, aged 49.3±15.5 years) were randomized to a non-exercise control group or one of two exercise training groups. The exercise training groups consisted of 13 weeks of structured exercise with progression using either CRF exercise prescribed with the use of ventilatory thresholds and functional training for muscular fitness (THRESH group) or HRR and traditional muscular fitness training (STND group). After the 13-week protocol, there were significant differences in body weight, body composition, systolic blood pressure, high-density lipoprotein cholesterol (HDL-c), VO2max, 5-repetition maximum (RM) bench press, and 5-RM leg press for both treatment groups compared to the control group after controlling for baseline values. However, the THRESH group had significantly more desirable outcomes for VO2max, 5-RM bench press, 5-RM leg press, body composition, and HDL-c when compared to both the STND and control group. Additionally, the proportion of individuals estimated as likely to respond above 3.5 mL·kg-1·min-1 in VO2max (i.e., the minimal clinically important difference) was 76.4%, 20.8%, and 0.13% for the THRESH, STND, and control groups, respectively. While both exercise programs elicited favorable health-related adaptations after 13 weeks, these results suggest that a personalized program with exercise prescribed based on ventilatory threshold and with the use of functional muscular fitness training may yield greater training adaptations.
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Affiliation(s)
- Ryan M Weatherwax
- Department of Health and Exercise Science, Southern Oregon University, Ashland, OR, USA
| | - Megan C Nelson
- School of Health and Human Performance, Northern Michigan University, Marquette, MI, USA
| | - Lance C Dalleck
- Recreation, Exercise, and Sport Science Department, Western Colorado University, Gunnison, CO, USA
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Fleitas-Paniagua PR, de Almeida Azevedo R, Trpcic M, Murias JM, Rogers B. Combining Near-Infrared Spectroscopy and Heart Rate Variability Derived Thresholds to Estimate the Critical Intensity of Exercise. J Strength Cond Res 2024; 38:e16-e24. [PMID: 37815285 DOI: 10.1519/jsc.0000000000004597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT Fleitas-Paniagua, PR, de Almeida Azevedo, R, Trpcic, M, Murias, JM, and Rogers, B. Combining near-infrared spectroscopy and heart rate variability derived thresholds to estimate the critical intensity of exercise. J Strength Cond Res 38(1): e16-e24, 2024-Critical intensity determination often requires costly tools and several testing sessions. Alternative approaches display relatively large individual variation. Therefore, simpler estimations with improved precision are needed. This study evaluated whether averaging the heart rate (HR) and oxygen uptake (V̇O 2 ) responses associated with the muscle deoxyhemoglobin concentration breakpoint ([HHb] BP ) and the heart rate variability (HRV) given by the detrended fluctuation analysis second threshold (HRVT2) during ramp incremental (RI) test improved the accuracy of identifying the HR and V̇O 2 at the respiratory compensation point (RCP). Ten female and 11 male recreationally trained subjects performed a 15 W·minute -1 RI test. Gas exchange, near-infrared spectroscopy (NIRS), and RR interval were recorded to assess the RCP, [HHb] BP , and HRVT2. Heart rate (mean ± SD : 158 ± 14, 156 ± 13, 160 ± 14 and, 158 ± 12 bpm) and V̇O 2 (3.08 ± 0.69, 2.98 ± 0.58, 3.06 ± 0.65, and 3.02 ± 0.60 L·minute -1 ) at the RCP, [HHb] BP , HRVT2, and HRVT2&[HHb] BP average (H&H Av ), respectively, were not significantly different ( p > 0.05). The linear relationship between H&H Av and RCP was higher compared with the relationship between [HHb] BP vs RCP and HRVT2 vs RCP for both HR ( r = 0.85; r = 0.73; r = 0.79, p > 0.05) and V̇O 2 ( r = 0.94; r = 0.93; r = 0.91, p > 0.05). Intraclass correlation between RCP, [HHb] BP , HRVT2, and H&H AV was 0.93 for V̇O 2 and 0.79 for HR. The [HHb] BP and the HRVT2 independently provided V̇O 2 and HR responses that strongly agreed with those at the RCP. Combining [HHb] BP and the HRVT2 resulted in estimations of the V̇O 2 and HR at the RCP that displayed smaller variability compared with each modality alone.
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Affiliation(s)
| | | | | | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar; and
| | - Bruce Rogers
- College of Medicine, University of Central Florida, Orlando, Florida
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Bell LR, McNicol AJ, McNeil E, Van Nguyen H, Hunter JR, O'Brien BJ. The impact of progressive overload on the proportion and frequency of positive cardio-respiratory fitness responders. J Sci Med Sport 2023; 26:561-563. [PMID: 37643931 DOI: 10.1016/j.jsams.2023.08.175] [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: 04/04/2023] [Revised: 07/10/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
The proportion of individuals whose cardio-respiratory fitness change after endurance training does not exceed the test's measurement error can be 40 %. We determined if progressively increasing treadmill run intensity compared to maintaining the same run intensity, improved the responder proportion to a 6-week 20-minute treadmill training regimen. The intervention response standard deviation method estimated the proportion of responders attributable to progressively increasing run intensity. The mixed-effects model demonstrated V̇O2 peak improved significantly more in the progressive versus constant run intensity group. The proportion of V̇O2 peak responses above the smallest worthwhile change attributable to progressively increasing run intensity was 63.6 %.
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Affiliation(s)
- Leo R Bell
- Institute of Health and Wellbeing, Health Innovation and Transformation Centre, Federation University Australia, Australia.
| | - Ashleigh J McNicol
- Institute of Health and Wellbeing, Health Innovation and Transformation Centre, Federation University Australia, Australia
| | - Elizabeth McNeil
- Institute of Health and Wellbeing, Health Innovation and Transformation Centre, Federation University Australia, Australia
| | - Huy Van Nguyen
- Institute of Health and Wellbeing, Health Innovation and Transformation Centre, Federation University Australia, Australia
| | - Jayden R Hunter
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Australia
| | - Brendan J O'Brien
- Institute of Health and Wellbeing, Health Innovation and Transformation Centre, Federation University Australia, Australia
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Succi PJ, Benitez B, Kwak M, Bergstrom HC. Analysis of Individual V˙O 2max Responses during a Cardiopulmonary Exercise Test and the Verification Phase in Physically Active Women. J Funct Morphol Kinesiol 2023; 8:124. [PMID: 37754957 PMCID: PMC10532016 DOI: 10.3390/jfmk8030124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
This study aimed to investigate the test-retest reliability, mean, and individual responses in the measurement of maximal oxygen consumption (V˙O2max) during a cardiopulmonary exercise test (CPET) and the verification phase during cycle ergometry in women. Nine women (22 ± 2 yrs, 166.0 ± 4.5 cm, 58.6 ± 7.7 kg) completed a CPET, passively rested for 5 min, and then completed a verification phase at 90% of peak power output to determine the highest V˙O2 from the CPET (V˙O2CPET) and verification phase (V˙O2verification) on 2 separate days. Analyses included a two-way repeated measures ANOVA, intraclass correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). There was no test (test 1 versus test 2) × method (CPET vs. verification phase) interaction (p = 0.896) and no main effect for method (p = 0.459). However, test 1 (39.2 mL·kg-1·min-1) was significantly higher than test 2 (38.3 mL·kg-1·min-1) (p = 0.043). The V˙O2CPET (ICC = 0.984; CoV = 1.98%; SEM = 0.77 mL·kg-1·min-1; MD = 2.14 mL·kg-1·min-1) and V˙O2verification (ICC = 0.964; CoV = 3.30%; SEM = 1.27 mL·kg-1·min-1; MD = 3.52 mL·kg-1·min-1) demonstrated "excellent" reliability. Two subjects demonstrated a test 1 V˙O2CPET that exceeded the test 2 V˙O2CPET, and one subject demonstrated a test 1 V˙O2verification that exceeded the test 2 V˙O2verification by more than the respective CPET and verification phase MD. One subject demonstrated a V˙O2CPET that exceeded the V˙O2verification, and one subject demonstrated a V˙O2verification that exceeded the V˙O2CPET by more than the MD. These results demonstrate the importance of examining the individual responses in the measurement of the V˙O2max and suggest that the MD may be a useful threshold to quantify real individual changes in V˙O2.
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Affiliation(s)
| | | | | | - Haley C. Bergstrom
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY 40536, USA; (P.J.S.); (B.B.); (M.K.)
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Kaufmann S, Gronwald T, Herold F, Hoos O. Heart Rate Variability-Derived Thresholds for Exercise Intensity Prescription in Endurance Sports: A Systematic Review of Interrelations and Agreement with Different Ventilatory and Blood Lactate Thresholds. SPORTS MEDICINE - OPEN 2023; 9:59. [PMID: 37462761 DOI: 10.1186/s40798-023-00607-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Exercise intensities are prescribed using specific intensity zones (moderate, heavy, and severe) determined by a 'lower' and a 'higher' threshold. Typically, ventilatory (VT) or blood lactate thresholds (LT), and critical power/speed concepts (CP/CS) are used. Various heart rate variability-derived thresholds (HRVTs) using different HRV indices may constitute applicable alternatives, but a systematic review of the proximity of HRVTs to established threshold concepts is lacking. OBJECTIVE This systematic review aims to provide an overview of studies that determined HRVTs during endurance exercise in healthy adults in comparison with a reference VT and/or LT concept. METHODS A systematic literature search for studies determining HRVTs in healthy individuals during endurance exercise and comparing them with VTs or LTs was conducted in Scopus, PubMed and Web of Science (until January 2022). Studies claiming to describe similar physiological boundaries to delineate moderate from heavy (HRVTlow vs. VTlow and/or LTlow), and heavy from severe intensity zone (HRVThigh vs. VThigh and/or LThigh) were grouped and their results synthesized. RESULTS Twenty-seven included studies (461 participants) showed a mean difference in relative HR between HRVTlow and VTlow of - 0.6%bpm in weighted means and 0.02%bpm between HRVTlow and LTlow. Bias between HR at HRVTlow and VTlow was 1 bpm (limits of agreement (LoA): - 10.9 to 12.8 bpm) and 2.7 bpm (LoA: - 20.4 to 25.8 bpm) between HRVTlow and LTlow. Mean difference in HR between HRVThigh and VThigh was 0.3%bpm in weighted means and 2.9%bpm between HRVThigh and LThigh while bias between HR at HRVThigh and VThigh was - 4 bpm (LoA: - 17.9 to 9.9 bpm) and 2.5 bpm (LoA: - 12.1 to 17.1 bpm) between HRVThigh and LThigh. CONCLUSION HRVTlow seems to be a promising approach for the determination of a 'lower' threshold comparable to VTlow and potentially for HRVThigh compared to VThigh, although the latter needs further empirical evaluation. LoA for both intensity zone boundaries indicates bias of HRVTs on an individual level. Taken together, HRVTs can be a promising alternative for prescribing exercise intensity in healthy, male athletes undertaking endurance activities but due to the heterogeneity of study design, threshold concepts, standardization, and lack of female participants, further research is necessary to draw more robust and nuanced conclusions.
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Affiliation(s)
- Sebastian Kaufmann
- Center for Sports and Physical Education, Faculty of Human Sciences, Julius-Maximilians-University Wuerzburg, Am Hubland/Sports Center, 97074, Würzburg, Germany.
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Olaf Hoos
- Center for Sports and Physical Education, Faculty of Human Sciences, Julius-Maximilians-University Wuerzburg, Am Hubland/Sports Center, 97074, Würzburg, Germany
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10
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Iannetta D, Marinari G, Murias JM. Can the heart rate response at the respiratory compensation point be used to retrieve the maximal metabolic steady state? J Sports Sci 2023; 41:1025-1032. [PMID: 37722819 DOI: 10.1080/02640414.2023.2259206] [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: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023]
Abstract
The metabolic rate (VO2) at the maximal metabolic steady state (MMSS) is generally not different from the VO2 at the respiratory compensation point (RCP). Based on this, it is often assumed that the heart rate (HR) at RCP would also be similar to that at MMSS. The study aims to compare the HR at RCP with that at MMSS. Seventeen individuals completed a ramp-incremental test, a series of severe-intensity trials to estimate critical power and two-to-three 30-min trials to confirm MMSS. The HR at RCP was retrieved by linear interpolation of the ramp-VO2/HR relationship and compared to the HR at MMSS recorded at 10, 15, 20, 25 and 30 min. The HR at RCP was 166 ± 12 bpm. The HR during MMSS at the timepoints of interest was 168 ± 8, 171 ± 8, 175 ± 9, 177 ± 9 and 178 ± 10 bpm. The HR at RCP was not different from the HR at MMSS at 10 min (P > 0.05) but lower at subsequent timepoints (P < 0.05) with this difference becoming progressively larger. For all timepoints, limits of agreement were large (~30 bpm). Given these differences and the variability at the individual level, the HR at RCP cannot be used to control the metabolic stimulus of endurance exercise.
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Affiliation(s)
- Danilo Iannetta
- Department of Internal Medicine, University of Utah, Salt Lake City, USA
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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11
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Pryor JL, Lao P, Leija RG, Perez S, Morales J, Looney DP, Cochrane-Snyman KC. Verification Phase Confirms V̇O 2max in a Hot Environment in Sedentary Untrained Males. Med Sci Sports Exerc 2023; 55:1069-1075. [PMID: 36719655 DOI: 10.1249/mss.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE This study aimed to assess the V̇O 2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment. METHODS Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline. RESULTS Mean verification phase V̇O 2max (37.8 ± 4.3 mL·kg -1 ·min -1 ) was lower than GXT (39.8 ± 4.1 mL·kg -1 ·min -1 ; P = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a V̇O 2 plateau during the GXT. Verification phase confirmed GXT V̇O 2max in 100% of participants, whereas the traditional and the new age-dependent secondary V̇O 2max criteria indicated GXT V̇O 2max achievement at much lower rates (8/12 [67%] vs 7/12 [58%], respectively). Correlational indices between GXT and verification phase V̇O 2max were strong (intraclass correlation coefficient = 0.95, r = 0.86), and Bland-Altman analysis revealed a low mean bias of -2.1 ± 1.9 mL·kg -1 ·min -1 and 95% limits of agreement (-5.8 to 1.7 mL·kg -1 ·min -1 ). CONCLUSIONS Very few untrained males achieved a V̇O 2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm V̇O 2max in untrained males.
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Affiliation(s)
- J Luke Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Peter Lao
- Department of Kinesiology, California State University, Fresno, Fresno, CA
| | - Robert G Leija
- Exercise Physiology Laboratory, Department of Integrative Biology, University of California Berkeley, Berkeley, CA
| | - Sergio Perez
- Department of Kinesiology, California State University, Fresno, Fresno, CA
| | - Jacobo Morales
- Department of Kinesiology, California State University, Fresno, Fresno, CA
| | - David P Looney
- United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA
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12
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Reuter M, Rosenberger F, Barz A, Venhorst A, Blanz L, Hecksteden A, Meyer T. Does Higher Intensity Increase the Rate of Responders to Endurance Training When Total Energy Expenditure Remains Constant? A Randomized Controlled Trial. SPORTS MEDICINE - OPEN 2023; 9:35. [PMID: 37209213 DOI: 10.1186/s40798-023-00579-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Standardized training prescriptions often result in large variation in training response with a substantial number of individuals that show little or no response at all. The present study examined whether the response in markers of cardiorespiratory fitness (CRF) to moderate intensity endurance training can be elevated by an increase in training intensity. METHODS Thirty-one healthy, untrained participants (46 ± 8 years, BMI 25.4 ± 3.3 kg m-2 and [Formula: see text]O2max 34 ± 4 mL min-1 kg-1) trained for 10 weeks with moderate intensity (3 day week-1 for 50 min per session at 55% HRreserve). Hereafter, the allocation into two groups was performed by stratified randomization for age, gender and VO2max response. CON (continuous moderate intensity) trained for another 16 weeks at moderate intensity, INC (increased intensity) trained energy-equivalent for 8 weeks at 70% HRreserve and then performed high-intensity interval training (4 × 4) for another 8 weeks. Responders were identified as participants with VO2max increase above the technical measurement error. RESULTS There was a significant difference in [Formula: see text]O2max response between INC (3.4 ± 2.7 mL kg-1 min-1) and CON (0.4 ± 2.9 mL kg-1 min-1) after 26 weeks of training (P = 0.020). After 10 weeks of moderate training, in total 16 of 31 participants were classified as VO2max responders (52%). After another 16 weeks continuous moderate intensity training, no further increase of responders was observed in CON. In contrast, the energy equivalent training with increasing training intensity in INC significantly (P = 0.031) increased the number of responders to 13 of 15 (87%). The energy equivalent higher training intensities increased the rate of responders more effectively than continued moderate training intensities (P = 0.012). CONCLUSION High-intensity interval training increases the rate of response in VO2max to endurance training even when the total energy expenditure is held constant. Maintaining moderate endurance training intensities might not be the best choice to optimize training gains. Trial Registration German Clinical Trials Register, DRKS00031445, Registered 08 March 2023-Retrospectively registered, https://www.drks.de/DRKS00031445.
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Affiliation(s)
- Marcel Reuter
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany.
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany.
| | - Friederike Rosenberger
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andreas Barz
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
| | - Andreas Venhorst
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
| | - Laura Blanz
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
| | - Anne Hecksteden
- Institute of Psychology and Sport Science, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Tim Meyer
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
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Ozemek C, Arena R, Rouleau CR, Campbell TS, Hauer T, Wilton SB, Stone J, Laddu D, Williamson TM, Liu H, Chirico D, Austford LD, Aggarwal S. Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity. J Cardiopulm Rehabil Prev 2023; 43:109-114. [PMID: 36203224 DOI: 10.1097/hcr.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). METHODS This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. RESULTS Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. CONCLUSION Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Drs Ozemek, Arena, and Laddu); TotalCardiology Research Network, Calgary, Canada (Drs Arena, Rouleau, Campbell, Wilton, Stone, Chirico, and Aggarwal and Ms Austford); TotalCardiology™ Rehabilitation, Calgary, Canada (Drs Rouleau and Aggarwal and Ms Hauer); Departments of Psychology (Drs Rouleau, Campbell, and Aggarwal and Ms Williamson), Community Health Sciences (Dr Liu), and Kinesiology (Dr Chirico), University of Calgary, Calgary, Canada; and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada (Drs Wilton, Stone, and Liu)
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14
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Xie L, Gou B, Bai S, Yang D, Zhang Z, Di X, Su C, Wang X, Wang K, Zhang J. Unsupervised cluster analysis reveals distinct subgroups in healthy population with different exercise responses of cardiorespiratory fitness. J Exerc Sci Fit 2023; 21:147-156. [PMID: 36688000 PMCID: PMC9827383 DOI: 10.1016/j.jesf.2022.12.005] [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: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Background Considerable attention has been paid to interindividual differences in the cardiorespiratory fitness (CRF) response to exercise. However, the complex multifactorial nature of CRF response variability poses a significant challenge to our understanding of this issue. We aimed to explore whether unsupervised clustering can take advantage of large amounts of clinical data and identify latent subgroups with different CRF exercise responses within a healthy population. Methods 252 healthy participants (99 men, 153 women; 36.8 ± 13.4 yr) completed moderate endurance training on 3 days/week for 4 months, with exercise intensity prescribed based on anaerobic threshold (AT). Detailed clinical measures, including resting vital signs, ECG, cardiorespiratory parameters, echocardiography, heart rate variability, spirometry and laboratory data, were obtained before and after the exercise intervention. Baseline phenotypic variables that were significantly correlated with CRF exercise response were identified and subjected to selection steps, leaving 10 minimally redundant variables, including age, BMI, maximal oxygen uptake (VO2max), maximal heart rate, VO2 at AT as a percentage of VO2max, minute ventilation at AT, interventricular septal thickness of end-systole, E velocity, root mean square of heart rate variability, and hematocrit. Agglomerative hierarchical clustering was performed on these variables to detect latent subgroups that may be associated with different CRF exercise responses. Results Unsupervised clustering revealed two mutually exclusive groups with distinct baseline phenotypes and CRF exercise responses. The two groups differed markedly in baseline characteristics, initial fitness, echocardiographic measurements, laboratory values, and heart rate variability parameters. A significant improvement in CRF following the 16-week endurance training, expressed by the absolute change in VO2max, was observed only in one of the two groups (3.42 ± 0.4 vs 0.58 ± 0.65 ml⋅kg-1∙min-1, P = 0.002). Assuming a minimal clinically important difference of 3.5 ml⋅kg-1∙min-1 in VO2max, the proportion of population response was 56.1% and 13.9% for group 1 and group 2, respectively (P<0.001). Although group 1 exhibited no significant improvement in CRF at group level, a significant decrease in diastolic blood pressure (70.4 ± 7.8 vs 68.7 ± 7.2 mm Hg, P = 0.027) was observed. Conclusions Unsupervised learning based on dense phenotypic characteristics identified meaningful subgroups within a healthy population with different CRF responses following standardized aerobic training. Our model could serve as a useful tool for clinicians to develop personalized exercise prescriptions and optimize training effects.
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Affiliation(s)
- Lin Xie
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Bo Gou
- Department of Physical Activity and Public Health, Xi'an Physical Education University, Xi'an, 710068, China
| | - Shuwen Bai
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Dong Yang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhe Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaohui Di
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chunwang Su
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaoni Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Kun Wang
- Department of Physical Activity and Public Health, Xi'an Physical Education University, Xi'an, 710068, China,Corresponding author.
| | - Jianbao Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China,Corresponding author. Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, China.
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15
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Heinzel S, Schwefel M, Sanchez A, Heinen D, Fehm L, Henze R, Terán C, Kallies G, Rapp MA, Fydrich T, Ströhle A, Heissel A. Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial. J Affect Disord 2022; 319:90-98. [PMID: 36113693 DOI: 10.1016/j.jad.2022.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date. METHODS 120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT. RESULTS Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response. LIMITATIONS The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included. CONCLUSIONS High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.
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Affiliation(s)
- Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Melanie Schwefel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Alba Sanchez
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Darlene Heinen
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Romy Henze
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Terán
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Gunnar Kallies
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heissel
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Smith LE, Van Guilder GP, Dalleck LC, Harris NK. The Effects of a Single Session of High Intensity Functional Training on Energy Expenditure, VO2, and Blood Lactate. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2022. [DOI: 10.52082/jssm.2022.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High intensity functional training (HIFT) provides a potential option to meet public exercise recommendations for both cardiorespiratory and strength outcomes in a time efficient manner. To better understand the potential for HIFT as an exercise approach, energy expenditure (EE) and relative intensity need quantifying. In thirteen sedentary men and women with metabolic syndrome (MetS), we used both indirect calorimetry and blood lactate levels to calculate EE of a single session of HIFT. The HIFT session included four, 6-minute sets of consecutive functional exercises. Examples of the exercises involved were squats, deadlifts, suspension rows, suspension chest press, and planks. Intensity is described relative to individual ventilatory thresholds. The total group EE was 270.3 ± 77.3 kcal with approximately 5% attributed anaerobic energy production. VO2 ranged between 88.8 ± 12.3% and 99 ± 12% of the second ventilatory threshold (VT2), indicating a vigorous effort. After each work interval, peak blood lactate ranged between 7.9 ± 1.9 and 9.3 ± 2.9 mmol, and rate of perceived exertion between 6.9 ± 1.0 and 8.7 ± 0.8 arbitrary units from 1-10. These were achieved in approximately 46 minutes of exercise per participant. In conclusion, HIFT elicits the energy expenditure and effort requisite to result in the adaptive responses to produce the known suite of benefits of exercise for individuals with MetS.
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Kirton MJ, Burnley MT, Ramos JS, Weatherwax R, Dalleck LC. The Effects of Standardised versus Individualised Aerobic Exercise Prescription on Fitness-Fatness Index in Sedentary Adults: A Randomised Controlled Trial. J Sports Sci Med 2022; 21:347-355. [PMID: 36157386 PMCID: PMC9459763 DOI: 10.52082/jssm.2022.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/10/2022] [Indexed: 06/16/2023]
Abstract
A poor Fitness Fatness Index (FFI) is associated with type 2 diabetes incidence, other chronic conditions (Alzheimer's, cancer, and cardiovascular disease) and all-cause mortality. Recent investigations have proposed that an individualised exercise prescription based on ventilatory thresholds is more effective than a standardised prescription in improving cardiorespiratory fitness (CRF), a key mediator of FFI. Thus, the aim of the current study was to determine the effectiveness of individualised versus standardised exercise prescription on FFI in sedentary adults. Thirty-eight sedentary individuals were randomised to 12-weeks of: (1) individualised exercise training using ventilatory thresholds (n = 19) or (2) standardised exercise training using a percentage of heart rate reserve (n = 19). A convenience sample was also recruited as a control group (n=8). Participants completed CRF exercise training three days per week, for 12-weeks on a motorised treadmill. FFI was calculated as CRF in metabolic equivalents (METs), divided by fatness determined by waist to height ratio (WtHR). A graded exercise test was used to measure CRF, and anthropometric measures (height and waist circumference) were assessed to ascertain WtHR. There was a difference in FFI change between study groups, whilst controlling for baseline FFI, F (2, 42) = 19.382 p < .001, partial η2 = 0.480. The magnitude of FFI increase from baseline was significantly higher in the individualised (+15%) compared to the standardised (+10%) (p = 0.028) and control group (+4%) (p = <.001). The main finding of the present study is that individualised exercise prescription had the greatest effect on improving FFI in sedentary adults compared to a standardised prescription. Therefore, an individualised based exercise prescription should be considered a viable and practical method of improving FFI in sedentary adults.
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Affiliation(s)
- Michael J Kirton
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mitchel T Burnley
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Joyce S Ramos
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ryan Weatherwax
- University of Utah, Salt Lake City, Utah, United States of America
| | - Lance C Dalleck
- Western Colorado University, Gunnison, Colorado, United States of America
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Marini CF, Sisti D, Skinner JS, Sarzynski MA, Bouchard C, Amatori S, Rocchi MBL, Piccoli G, Stocchi V, Federici A, Lucertini F. Effect of individual characteristics and aerobic training on the %HRR-% V˙O 2R relationship. Eur J Sport Sci 2022:1-12. [PMID: 35960537 DOI: 10.1080/17461391.2022.2113441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study aimed to assess if, during incremental exercise, considering individual characteristics can make the relationship between the percentages of heart rate (HRR) and oxygen uptake (VO2R) reserve either 1:1 or more accurate. Cycle ergometer data of the maximal incremental exercise tests performed by 450 healthy and sedentary participants (17-66 years) of the HERITAGE Family Study, grouped for sex, ethnicity, age, body fat, resting HR, and VO2max, were used to calculate the individual linear regressions between %HRR and %VO2R. The mean slope and intercept of the individual linear regressions of each subgroup were compared with 1 and 0 (identity line), respectively, using Hotelling tests followed by post-hoc one-sample t-tests. Two multiple linear regressions were also performed, using either the slopes or intercepts of the individual linear regressions as dependent variables and sex, age, resting HR, and VO2max as independent variables. The mean %HRR-%VO2R relationships of all subgroups differed from the identity line. Moreover, individual linear regression intercepts (8.9±16.0) and slopes (0.971±0.190) changed (p<0.001) after 20 weeks of aerobic training (13.1±11.1 and 0.891±0.122). The multiple linear regressions could explain only 3.8% and 1.3% of the variance in the intercepts and slopes, whose variability remained high (standard error of estimate of 15.8 and 0.189). In conclusion, the %HRR-%VO2R relationship differs from the identity line regardless of individual characteristics and their difference increased after aerobic training. Moreover, due to the high interindividual variability, using a single equation for the whole population seems not suitable for representing the %HRR-%VO2R relationship of a given subject, even when several individual characteristics are considered.
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Affiliation(s)
- Carlo Ferri Marini
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Davide Sisti
- Department of Biomolecular Sciences - Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, Italy
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington (IN), USA
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia (SC), USA
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (LA), USA
| | - Stefano Amatori
- Department of Biomolecular Sciences - Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, Italy
| | - Marco B L Rocchi
- Department of Biomolecular Sciences - Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, Italy
| | - Giovanni Piccoli
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Vilberto Stocchi
- Department of Human Sciences for the Promotion of Quality of Life, University San Raffaele Roma, Rome, Italy
| | - Ario Federici
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Francesco Lucertini
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
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Lehtonen E, Gagnon D, Eklund D, Kaseva K, Peltonen JE. Hierarchical framework to improve individualised exercise prescription in adults: a critical review. BMJ Open Sport Exerc Med 2022; 8:e001339. [PMID: 35722045 PMCID: PMC9185660 DOI: 10.1136/bmjsem-2022-001339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/04/2022] Open
Abstract
Physical activity (PA) guidelines for the general population are designed to mitigate the rise of chronic and debilitating diseases brought by inactivity and sedentariness. Although essential, they are insufficient as rates of cardiovascular, pulmonary, renal, metabolic and other devastating and life-long diseases remain on the rise. This systemic failure supports the need for an improved exercise prescription approach that targets the individual. Significant interindividual variability of cardiorespiratory fitness (CRF) responses to exercise are partly explained by biological and methodological factors, and the modulation of exercise volume and intensity seem to be key in improving prescription guidelines. The use of physiological thresholds, such as lactate, ventilation, as well as critical power, have demonstrated excellent results to improve CRF in those struggling to respond to the current homogenous prescription of exercise. However, assessing physiological thresholds requires laboratory resources and expertise and is incompatible for a general population approach. A case must be made that balances the effectiveness of an exercise programme to improve CRF and accessibility of resources. A population-wide approach of exercise prescription guidelines should include free and accessible self-assessed threshold tools, such as rate of perceived exertion, where the homeostatic perturbation induced by exercise reflects physiological thresholds. The present critical review outlines factors for individuals exercise prescription and proposes a new theoretical hierarchal framework to help shape PA guidelines based on accessibility and effectiveness as part of a personalised exercise prescription that targets the individual.
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Affiliation(s)
- Elias Lehtonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Helsinki Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Dominique Gagnon
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Helsinki Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland.,School of Kinesiology, Laurentian University, Sudbury, Ontario, Canada.,Center for Research in Occupational Health and Safety, Laurentian University, Sudbury, Ontario, Canada
| | - Daniela Eklund
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Helsinki Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Kaisa Kaseva
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Helsinki Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Juha Evert Peltonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Helsinki Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland
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20
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Shaw SB, Levy Y, Mizzi A, Herman G, McKinnon MC, Heisz JJ, Becker S. Combined Aerobic Exercise and Neurofeedback Lead to Improved Task-Relevant Intrinsic Network Synchrony. Front Hum Neurosci 2022; 16:838614. [PMID: 35774480 PMCID: PMC9237564 DOI: 10.3389/fnhum.2022.838614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Lifestyle interventions such as exercise and mindfulness training have the potential to ameliorate mental health symptoms and restore dysregulated intrinsic connectivity network (ICN) dynamics, seen in many psychopathologies. Multiple lifestyle interventions, in combination, may interact synergistically for enhanced benefits. While the impacts of lifestyle interventions on subjective measures of mood are well-documented, their impacts on ICN dynamics are not well-established. In this study, we assessed the validity of EEG-derived measures of ICN dynamics as potential markers of mood disorders, by tracking ICN dynamics and mood symptoms through the course of a longitudinal exercise intervention. Specifically, we investigated the separate and combined effects of aerobic exercise and mindfulness-like neurofeedback training on task-linked ICN dynamics of the default mode network (DMN), central executive network (CEN), and salience network (SN). Participants were assigned pseudo-randomly into four experimental conditions—Control, Running, Neurofeedback, and Combined, performing the corresponding intervention for 16 sessions across 8 weeks. Intervention-linked changes in ICN dynamics were studied using EEG-based neuroimaging scans before and after the 8-week intervention, during which participants performed multiple blocks of autobiographical memory recall (AM) and working memory (WM) trials, designed to activate the DMN and CEN, respectively, and to activate the SN in conjunction with the task-appropriate network. The EEG-based features for classification of the three core networks had been identified in our prior research from simultaneously recorded EEG and fMRI during the same AM and WM tasks. We categorized participants as “responders” or “non-responders” based on whether the exercise intervention increased their aerobic capacity (VO2-max) (Running/Combined group), and/or neurofeedback increased the percentage time spent in the calm mindfulness state (Neurofeedback/Combined group). In responders, compared to each intervention alone, the combined exercise-neurofeedback intervention resulted in a more healthy CEN-SN synchrony pattern. Interestingly, non-responders to neurofeedback exhibited a maladaptive pattern of persistent, task-inappropriate DMN-SN synchrony which we speculate could be linked to depressive rumination. Furthermore, the CEN-SN synchrony at baseline predicted NFB response with up to 80% accuracy, demonstrating the potential utility of such network-based biomarkers in personalizing intervention plans.
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Affiliation(s)
- Saurabh Bhaskar Shaw
- Department of Psychiatry, Western University, London, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
| | - Yarden Levy
- Department of Psychology Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), Department of Linguistics and Languages, McMaster University, Hamilton, ON, Canada
| | - Allison Mizzi
- Department of Psychology Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), Department of Linguistics and Languages, McMaster University, Hamilton, ON, Canada
| | - Gabrielle Herman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Margaret C. McKinnon
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Jennifer J. Heisz
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Suzanna Becker
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Department of Psychology Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), Department of Linguistics and Languages, McMaster University, Hamilton, ON, Canada
- *Correspondence: Suzanna Becker
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21
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Bell LR, Gabbett TJ, Davis GM, Wallen MP, O’Brien BJ. Stubborn Exercise Responders-Where to Next? Sports (Basel) 2022; 10:sports10060095. [PMID: 35736835 PMCID: PMC9229615 DOI: 10.3390/sports10060095] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
There is a wide variance in the magnitude of physiological adaptations after resistance or endurance training. The incidence of “non” or “poor” responders to training has been reported to represent as high as 40% of the project’s sample. However, the incidence of poor responders to training can be ameliorated with manipulation of either the training frequency, intensity, type and duration. Additionally, global non-response to cardio-respiratory fitness training is eliminated when evaluating several health measures beyond just the target variables as at least one or more measure improves. More research is required to determine if altering resistance training variables results in a more favourable response in individuals with an initial poor response to resistance training. Moreover, we recommend abandoning the term “poor” responders, as ultimately the magnitude of change in cardiorespiratory fitness in response to endurance training is similar in “poor” and “high” responders if the training frequency is subsequently increased. Therefore, we propose “stubborn” responders as a more appropriate term. Future research should focus on developing viable physiological and lifestyle screening tests that identify likely stubborn responders to conventional exercise training guidelines before the individual engages with training. Exerkines, DNA damage, metabolomic responses in blood, saliva and breath, gene sequence, gene expression and epigenetics are candidate biomarkers that warrant investigation into their relationship with trainability. Crucially, viable biomarker screening tests should show good construct validity to distinguish between different exercise loads, and possess excellent sensitivity and reliability. Furthermore “red flag” tests of likely poor responders to training should be practical to assess in clinical settings and be affordable and non-invasive. Early identification of stubborn responders would enable optimization of training programs from the onset of training to maintain exercise motivation and optimize the impact on training adaptations and health.
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Affiliation(s)
- Leo R. Bell
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC 3350, Australia; (L.R.B.); (T.J.G.); (G.M.D.); (M.P.W.)
| | - Tim J. Gabbett
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC 3350, Australia; (L.R.B.); (T.J.G.); (G.M.D.); (M.P.W.)
- Gabbett Performance Solutions, Brisbane, QLD 4011, Australia
| | - Gregory M. Davis
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC 3350, Australia; (L.R.B.); (T.J.G.); (G.M.D.); (M.P.W.)
| | - Matthew P. Wallen
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC 3350, Australia; (L.R.B.); (T.J.G.); (G.M.D.); (M.P.W.)
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia
| | - Brendan J. O’Brien
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC 3350, Australia; (L.R.B.); (T.J.G.); (G.M.D.); (M.P.W.)
- Correspondence:
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22
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D'Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med 2022; 56:bjsports-2021-105261. [PMID: 35680397 DOI: 10.1136/bjsports-2021-105261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
| | | | | | | | - Martin Halle
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
- DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
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23
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Ferri Marini C, Federici A, Skinner JS, Piccoli G, Stocchi V, Zoffoli L, Correale L, Dell’Anna S, Naldini CA, Vandoni M, Lucertini F. Effect of steady-state aerobic exercise intensity and duration on the relationship between reserves of heart rate and oxygen uptake. PeerJ 2022; 10:e13190. [PMID: 35497191 PMCID: PMC9048681 DOI: 10.7717/peerj.13190] [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: 01/19/2022] [Accepted: 03/08/2022] [Indexed: 01/12/2023] Open
Abstract
Background The percentages of heart rate (%HRR) or oxygen uptake (%V̇O2R) reserve are used interchangeably for prescribing aerobic exercise intensity due to their assumed 1:1 relationship, although its validity is debated. This study aimed to assess if %HRR and %V̇O2R show a 1:1 relationship during steady-state exercise (SSE) and if exercise intensity and duration affect their relationship. Methods Eight physically active males (age 22.6 ± 1.2 years) were enrolled. Pre-exercise and maximal HR and V̇O2 were assessed on the first day. In the following 4 days, different SSEs were performed (running) combining the following randomly assigned durations and intensities: 15 min, 45 min, 60% HRR, 80% HRR. Post-exercise maximal HR and V̇O2 were assessed after each SSE. Using pre-exercise and post-exercise maximal values, the average HR and V̇O2 of the last 5 min of each SSE were converted into percentages of the reserves (%RES), which were computed in a 3-way RM-ANOVA (α = 0.05) to assess if they were affected by the prescription parameter (HRR or V̇O2R), exercise intensity (60% or 80% HRR), and duration (15 or 45 min). Results The %RES values were not affected by the prescription parameter (p = 0.056) or its interactions with intensity (p = 0.319) or duration and intensity (p = 0.117), while parameter and duration interaction was significant (p = 0.009). %HRRs and %V̇O2Rs did not differ in the 15-min SSEs (mean difference [MD] = 0.7 percentage points, p = 0.717), whereas %HRR was higher than %V̇O2R in the 45-min SSEs (MD = 6.7 percentage points, p = 0.009). Conclusion SSE duration affects the %HRR-%V̇O2R relationship, with %HRRs higher than %V̇O2Rs in SSEs of longer duration.
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Affiliation(s)
- Carlo Ferri Marini
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Ario Federici
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - James S. Skinner
- Department of Kinesiology, Indiana University, Bloomington, IN, USA
| | - Giovanni Piccoli
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
| | - Vilberto Stocchi
- Department of Human Sciences for the Promotion of Quality of Life, University San Raffaele Roma, Rome, RM, Italy
| | - Luca Zoffoli
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy,Scientific Research & Innovation Department, Technogym S.p.A., Cesena, FC, Italy
| | - Luca Correale
- Sports Science Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
| | - Stefano Dell’Anna
- Sports Science Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy,Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy
| | - Carlo Alberto Naldini
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, PV, Italy
| | - Francesco Lucertini
- Department of Biomolecular Sciences –Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, PU, Italy
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24
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Augustsson J, Augustsson SR. Development of a Novel Nordic Hamstring Exercise Performance Test Device: A Reliability and Intervention Study. Sports (Basel) 2022; 10:sports10020026. [PMID: 35202065 PMCID: PMC8875831 DOI: 10.3390/sports10020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022] Open
Abstract
There is evidence that a knee flexor exercise, the Nordic hamstring exercise (NHE), prevents hamstring injuries. The purpose of this study was therefore to develop, and to determine the reliability of, a novel NHE test device and, further, to determine the effectiveness of a 10-week low volume NHE program on NHE performance. Twenty female football (soccer) players, aged 16–30 years, participated in this study. From a kneeling position on the device, with the ankles secured under a heavy lifting sling, participants leaned forward in a controlled manner as far as possible (eccentric phase) and then returned to the starting position (concentric phase). A tape measure documented the forward distance achieved by the participants in cm. Participants completed three separate occasions to evaluate test-retest reliability. Additionally, 14 players performed a low volume (1 set of 5 repetitions) NHE program once weekly for 10 weeks. No significant test-retest differences in NHE performance were observed. The intra-class correlation coefficient was 0.95 and the coefficient of variation was 3.54% between tests. Mean improvement in the NHE performance test by the players following training was 22% (8.7 cm), p = 0.005. Our test device reliably measured NHE performance and is easy to perform in any setting. Further, NHE performance was improved by a 10-week low volume NHE program. This suggests that even a small dose (1 set of 5 repetitions once weekly) of the NHE may enhance NHE performance.
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25
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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26
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Sabbahi A, Canada JM, Babu AS, Severin R, Arena R, Ozemek C. Exercise training in cardiac rehabilitation: Setting the right intensity for optimal benefit. Prog Cardiovasc Dis 2022; 70:58-65. [PMID: 35149002 DOI: 10.1016/j.pcad.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/18/2022]
Abstract
Cardiac rehabilitation (CR) programs are recommended standard-of-care by all major cardiovascular medicine professional organizations. Exercise training is the cornerstone for CR, with aerobic training being the primary form of training. The benefits of exercise training are multiple; however, improved cardiorespiratory fitness is of utmost importance. Moderate-intensity continuous training, supplemented with resistance training, has traditionally been the most common form of exercise training in CR. This review discusses the role of aerobic exercise training in CR and the importance of effective and personalized exercise prescription for optimized results. We also focus on the benefits and utility of high-intensity interval training across different clinical populations commonly seen in the CR setting.
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Affiliation(s)
- Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; School of Physical Therapy, South College, Knoxville, TN, USA.
| | - Justin M Canada
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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27
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Is the Tyme Wear Smart Shirt Reliable and Valid at Detecting Personalized Ventilatory Thresholds in Recreationally Active Individuals? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031147. [PMID: 35162172 PMCID: PMC8835019 DOI: 10.3390/ijerph19031147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the extent to which the Tyme Wear smart shirt is as reliable and valid in detecting personalized ventilatory thresholds when compared to the Parvo Medics TrueOne 2400. In this validation study, 19 subjects were recruited to conduct two graded exercise test (GXT) trials. Each GXT trial was separated by 7 to 10 days of rest. During the GXT, gas exchange and heart rate data were collected by the TrueOne 2400 (TRUE) in addition to the ventilation data collected by the Tyme Wear smart shirt (S-PRED). Gas exchange data from TRUE were used to detect ventilatory threshold 1 (VT1) and ventilatory threshold 2 (VT2). TRUE and S-PRED VT1 and VT2 were compared to determine the reliability and validity of the smart shirt. Of the 19 subjects, data from 15 subjects were used during analysis. S-PRED exhibited excellent (intraclass correlation coefficient—CC > 0.90) reliability for detection of VT1 and VT2 utilizing time point and workload and moderate (0.90 > ICC > 0.75) reliability utilizing heart rate. TRUE exhibited excellent reliability for detection of VT1 and VT2 utilizing time point, workload, and heart rate. When compared to TRUE, S-PRED appears to underestimate the VT1 workload (p > 0.05) across both trials and heart rate (p < 0.05) for trial 1. However, S-PRED appears to underestimate VT2 workload (p < 0.05) and heart rate (p < 0.05) across both trials. The result from this study suggests that the Tyme Wear smart shirt is less valid but is comparable in reliability when compared to the gold standard. Moreover, despite the underestimation of S-PRED VT1 and VT2, the S-PRED-detected personalized ventilatory thresholds provide an adequate training workload for most individuals. In conclusion, the Tyme Wear smart shirt provides easily accessible testing to establish threshold-guided training zones but does not devalue the long-standing laboratory equivalent.
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28
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Hutchinson MJ, Goosey-Tolfrey VL. Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of "moderate to vigorous" intensity? Spinal Cord 2022; 60:484-490. [PMID: 34880442 PMCID: PMC9209328 DOI: 10.1038/s41393-021-00733-2] [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: 07/26/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To investigate and critique different methods for aerobic exercise intensity prescription in adults with spinal cord injury (SCI). SETTING University laboratory in Loughborough, UK. METHODS Trained athletes were split into those with paraplegia (PARA; n = 47), tetraplegia (TETRA; n = 20) or alternate health condition (NON-SCI; n = 67). Participants completed a submaximal step test with 3 min stages, followed by graded exercise test to exhaustion. Handcycling, arm crank ergometry or wheelchair propulsion were performed depending on the sport of the participant. Oxygen uptake (V̇O2), heart rate (HR), blood lactate concentration ([BLa]) and ratings of perceived exertion (RPE) on Borg's RPE scale were measured throughout. Lactate thresholds were identified according to log-V̇O2 plotted against log-[BLa] (LT1) and 1.5 mmol L-1 greater than LT1 (LT2). These were used to demarcate moderate (<LT1), heavy (>LT1, < LT2) and severe (>LT2) exercise intensity domains. RESULTS Associations between percentage of peak V̇O2 (%V̇O2peak) and HR (%HRpeak) with RPE differed between PARA and TETRA. At LT1 and LT2, %V̇O2peak and %HRpeak were significantly greater in TETRA compared to PARA and NON-SCI (P < 0.05). The variation in %V̇O2peak and %HRpeak at lactate thresholds resulted in large variability in the domain distribution at fixed %V̇O2peak and %HRpeak. CONCLUSIONS Fixed %V̇O2peak and %HRpeak should not be used for aerobic exercise intensity prescription in adults with SCI as the method does not lead to uniform exercise intensity domain distribution.
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Affiliation(s)
- Michael J. Hutchinson
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- grid.6571.50000 0004 1936 8542Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Vonbank K, Lehmann A, Bernitzky D, Gysan MR, Simon S, Krotka P, Zwick RH, Idzko M, Burtscher M. Comparison of heart rates at fixed percentages and the ventilatory thresholds in patients with interstitial lung disease. Scand J Med Sci Sports 2021; 32:754-764. [PMID: 34923682 PMCID: PMC9304263 DOI: 10.1111/sms.14117] [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: 06/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Heart rate (HR) responses to maximal exercise are commonly used for the prescription of training intensities in pulmonary rehabilitation. Those intensities are usually based on fixed percentages of peak HR (HRpeak), heart rate reserve (HRR), or peak work load (Wpeak), and rarely on HRs at the individual ventilatory thresholds (VT1 and VT2) derived from cardiopulmonary exercise testing (CPET). For patients suffering from interstitial lung disease (ILD), data on cardiorespiratory responses to CPET are scarce. Thus, the aim of this study was to record cardiorespiratory responses to CPET and to compare fixed HR percentages with HRs at VT1 and VT2 in ILD patients. A total of 120 subjects, 80 ILD patients and 40 healthy controls, underwent a symptom‐limited CPET. From the ILD patient, 32 suffered from idiopathic pulmonary fibrosis (IPF), 37 from connective tissue disease (CTD), and 11 from sarcoidosis. HRs at fixed percentages, that is, at 70%HRpeak, at 70%Wpeak, and at 60%HRR were significantly lower in the ILD patients compared with the control group (p‐values: 0.001, 0.044, and 0.011). Large percentages of HR values at 70%Wpeak and 60%HRR ranged between the HRs at VT1 and VT2 in ILD subgroups and controls as well. HRs at 70%HRpeak were lower than HRs at VT1 in 66% of the IPF patients, 54% of the CTD patients, and 55% of patients with sarcoidosis compared with 18% in the control group. Our findings demonstrate a considerable scattering of fixed HR percentages compared with HRs at the individual VTs derived from CPET in ILD patients. These findings may provide valuable information for the prescription of exercise intensity in pulmonary rehabilitation of ILD patients.
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Affiliation(s)
- Karin Vonbank
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Antje Lehmann
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Simon
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Pavla Krotka
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ralf-Harun Zwick
- ThermeWienMed, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Burtscher
- Department of Sports Sciences, Medical Section, University of Innsbruck, Innsbruck, Austria
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Bonafiglia JT, Preobrazenski N, Gurd BJ. A Systematic Review Examining the Approaches Used to Estimate Interindividual Differences in Trainability and Classify Individual Responses to Exercise Training. Front Physiol 2021; 12:665044. [PMID: 34819869 PMCID: PMC8606564 DOI: 10.3389/fphys.2021.665044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Many reports describe statistical approaches for estimating interindividual differences in trainability and classifying individuals as "responders" or "non-responders." The extent to which studies in the exercise training literature have adopted these statistical approaches remains unclear. Objectives: This systematic review primarily sought to determine the extent to which studies in the exercise training literature have adopted sound statistical approaches for examining individual responses to exercise training. We also (1) investigated the existence of interindividual differences in trainability, and (2) tested the hypothesis that less conservative thresholds inflate response rates compared with thresholds that consider error and a smallest worthwhile change (SWC)/minimum clinically important difference (MCID). Methods: We searched six databases: AMED, CINAHL, EMBASE, Medline, PubMed, and SportDiscus. Our search spanned the aerobic, resistance, and clinical or rehabilitation training literature. Studies were included if they used human participants, employed standardized and supervised exercise training, and either: (1) stated that their exercise training intervention resulted in heterogenous responses, (2) statistically estimated interindividual differences in trainability, and/or (3) classified individual responses. We calculated effect sizes (ESIR) to examine the presence of interindividual differences in trainability. We also compared response rates (n = 614) across classification approaches that considered neither, one of, or both errors and an SWC or MCID. We then sorted response rates from studies that also reported mean changes and response thresholds (n = 435 response rates) into four quartiles to confirm our ancillary hypothesis that larger mean changes produce larger response rates. Results: Our search revealed 3,404 studies, and 149 were included in our systematic review. Few studies (n = 9) statistically estimated interindividual differences in trainability. The results from these few studies present a mixture of evidence for the presence of interindividual differences in trainability because several ESIR values lay above, below, or crossed zero. Zero-based thresholds and larger mean changes significantly (both p < 0.01) inflated response rates. Conclusion: Our findings provide evidence demonstrating why future studies should statistically estimate interindividual differences in trainability and consider error and an SWC or MCID when classifying individual responses to exercise training. Systematic Review Registration: [website], identifier [registration number].
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Affiliation(s)
- Jacob T Bonafiglia
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | | | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Kominami K, Nishijima H, Imahashi K, Katsuragawa T, Murakami M, Akino M. Gas exchange threshold to guide exercise training intensity of older individuals during cardiac rehabilitation. Medicine (Baltimore) 2021; 100:e27540. [PMID: 34678888 PMCID: PMC8542148 DOI: 10.1097/md.0000000000027540] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/29/2021] [Indexed: 01/05/2023] Open
Abstract
The gas exchange threshold (GET), which is determined during incremental exercise (Inc-Ex) testing, is often considered a safe training intensity for cardiac rehabilitation. However, there are only a limited number of reports on the actual implementation of this method. We assessed the applicability of GET-guided exercise using a constant load exercise (CL-Ex) protocol.We recruited 20 healthy older individuals (healthy, age: 69.4 ± 6.8 years) and 10 patients with cardiovascular diseases or risk factors (patient, age: 73.0 ± 8.8 years). On day 1, we determined the GET during symptomatic maximal Inc-Ex. On day 2, CL-Ex at work rate (watt: W) where the GET manifested during Inc-Ex (therefore, not corrected for the known oxygen response delay) was maintained for 20 minute. Arterialized blood lactate (BLa) levels were also determined.Oxygen uptake reached a steady state in all participants, with a mean respiratory exchange ratio of < 1.0. The mean BLa at the GET during Inc-Ex was 1.51 ± .29 mmol·l-1 in the healthy group and 1.78 ± .42 mmol·L-1 in the patient group, which was about .5 mmol·L-1 above the resting level. During CL-Ex, BLa increased significantly over the value at the GET (Inc-Ex). However, it reached a steady-state level of 2.65 ± 1.56 (healthy) and 2.53 ± 0.95 (patient) mmol·L-1. The %peak oxygen uptake, %peak heart rate, and %heart rate reserve during CL-Ex were 58.8 ± 11.5, 71.8 ± 10.3, and 44.9 ± 17.4, respectively. All participants could complete CL-Ex with mean perceived exertion ratings (Borg/20) of 11.8 ± 1.3 (healthy) and 12.2 ± 1.3 (patient). These heart rate-related indices and exertion ratings were all within the recommended international guidelines for cardiac rehabilitation.CL-Ex at the GET appears to be the optimal exercise intensity for cardiac rehabilitation.
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Affiliation(s)
- Kazuyuki Kominami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Hirotaka Nishijima
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
- Department of Cardiovascular Medicine, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Keiko Imahashi
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Toko Katsuragawa
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Mitsuyo Murakami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Masatoshi Akino
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
- Department of Cardiovascular Medicine, Sapporo Ryokuai Hospital, Sapporo, Japan
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Hrubeniuk TJ, Bonafiglia JT, Bouchard DR, Gurd BJ, Sénéchal M. Directions for Exercise Treatment Response Heterogeneity and Individual Response Research. Int J Sports Med 2021; 43:11-22. [PMID: 34399428 DOI: 10.1055/a-1548-7026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Treatment response heterogeneity and individual responses following exercise training are topics of interest for personalized medicine. Proposed methods to determine the contribution of exercise to the magnitude of treatment response heterogeneity and categorizing participants have expanded and evolved. Setting clear research objectives and having a comprehensive understanding of the strengths and weaknesses of the available methods are vital to ensure the correct study design and analytical approach are used. Doing so will ensure contributions to the field are conducted as rigorously as possible. Nonetheless, concerns have emerged regarding the ability to truly isolate the impact of exercise training, and the nature of individual responses in relation to mean group changes. The purpose of this review is threefold. First, the strengths and limitations associated with current methods for quantifying the contribution of exercise to observed treatment response heterogeneity will be discussed. Second, current methods used to categorize participants based on their response to exercise will be outlined, as well as proposed mechanisms for factors that contribute to response variation. Finally, this review will provide an overview of some current issues at the forefront of individual response research.
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Affiliation(s)
- Travis J Hrubeniuk
- Interdisciplinary Studies, University of New Brunswick, Fredericton, Canada.,Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, Canada
| | - Jacob T Bonafiglia
- School of Kinesiology and Health Studies, Queen's University, Kingston ON, Canada
| | - Danielle R Bouchard
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, Canada.,Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston ON, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise and Lifestyle Laboratory, University of New Brunswick, Fredericton, Canada.,Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Ardavani A, Aziz H, Phillips BE, Doleman B, Ramzan I, Mozaffar B, Atherton PJ, Idris I. Indicators of response to exercise training: a systematic review and meta-analysis. BMJ Open 2021; 11:e044676. [PMID: 34301648 PMCID: PMC8728353 DOI: 10.1136/bmjopen-2020-044676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Means-based analysis of maximal rate of oxygen consumption (VO2max) has traditionally been used as the exercise response indicator to assess the efficacy of endurance (END), high intensity interval (HIIT) and resistance exercise training (RET) for improving cardiorespiratory fitness and whole-body health. However, considerable heterogeneity exists in the interindividual variability response to the same or different training modalities. OBJECTIVES We performed a systematic review and meta-analysis to investigate exercise response rates in the context of VO2max: (1) in each training modality (END, HIIT and RET) versus controls, (2) in END versus either HIIT or RET and (3) exercise response rates as measured by VO2max versus other indicators of positive exercise response in each exercise modality. METHODS Three databases (EMBASE, MEDLINE, CENTRAL) and additional sources were searched. Both individual response rate and population average data were incorporated through continuous data, respectively. Of 3268 identified manuscripts, a total of 29 studies were suitable for qualitative synthesis and a further 22 for quantitative. Stratification based on intervention duration (less than 12 weeks; more than or equal to 12 weeks) was undertaken. RESULTS A total of 62 data points were procured. Both END and HIIT training exhibited differential improvements in VO2max based on intervention duration. VO2max did not adequately differentiate between END and HIIT, irrespective of intervention length. Although none of the other exercise response indicators achieved statistical significance, LT and HRrest demonstrated common trajectories in pooled and separate analyses between modalities. RET data were highly limited. Heterogeneity was ubiquitous across all analyses. CONCLUSIONS The potential for LT and HRrest as indicators of exercise response requires further elucidation, in addition to the exploration of interventional and intrinsic sources of heterogeneity.
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Affiliation(s)
- Arash Ardavani
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Hariz Aziz
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Bethan E Phillips
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Brett Doleman
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Imran Ramzan
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Boshra Mozaffar
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Philip J Atherton
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Iskandar Idris
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
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Strohacker K, Keegan R, Beaumont CT, Zakrajsek RA. Applying P-Technique Factor Analysis to Explore Person-Specific Models of Readiness-to-Exercise. Front Sports Act Living 2021; 3:685813. [PMID: 34250469 PMCID: PMC8267010 DOI: 10.3389/fspor.2021.685813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Recent research in exercise prescription and periodization has emphasized the importance of subjective experience, both in medium- and long-term monitoring, but also in the acute experience. Emerging evidence also highlights an important role of subjective readiness (pre-exercise mental and physical states) in determining how exercise is experienced, and in acutely modifying the prescribed exercise intensity. The concept of "readiness-to-exercise" shows promise in enabling and informing this acute decision-making to optimize the experiences and outcomes of exercise. While subjective experiences can be effectively assessed using psychometric scales and instruments, these are often developed and deployed using cross-sectional samples, with resulting structures that reflect a normative pattern (nomothetic). These patterns may fail to reflect individual differences in sensitivity, experience and saliency (idiographic). We conducted this research with the primary aim of comparing the nomothetical and idiographic approaches to modeling the relatively novel concept of readiness-to-exercise. Study 1 (nomothetic) therefore analyzed data collected from 572 participants who completed a one-time survey using R-technique factor analysis. Results indicated a four-factor structure that explained 60% of the variance: "health and fitness;" "fatigue;" "vitality" and "physical discomfort." Study 2 (idiographic) included a sample of 29 participants who completed the scale multiple times, between 42 and 56 times: permitting intra-individual analysis using separate P-technique factor analyses. Our analyses suggested that many individuals displayed personal signature, or "profiles" of readiness-to-exercise that differed in structure from the nomothetic form: only two participants' personal signatures contained four structures as modeled in Study 1, whereas the majority demonstrated either two or three factors. These findings raise important questions about how experiential data should be collected and modeled, for use in research (conceptual development and measurement) and applied practice (prescribing, monitoring)-as well as in more applied research (implementation, effectiveness).
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Affiliation(s)
- Kelley Strohacker
- Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Richard Keegan
- Research Institute for Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Cory T Beaumont
- Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Rebecca A Zakrajsek
- Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, United States
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Meyler S, Bottoms L, Muniz-Pumares D. Biological and methodological factors affecting V ̇ O 2 max response variability to endurance training and the influence of exercise intensity prescription. Exp Physiol 2021; 106:1410-1424. [PMID: 34036650 DOI: 10.1113/ep089565] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
NEW FINDINGS What is the topic of this review? Biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogeneous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest as more homogeneous chronic adaptations thereby reducing response variability. ABSTRACT Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself, including the type, volume and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g., ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g., maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF or both. Future research is warranted to elucidate whether more homogeneous chronic adaptations manifest over time among individuals, as a result of exposure to more homogeneous exercise stimuli elicited by threshold-based practices.
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Affiliation(s)
- Samuel Meyler
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Sitko S, Cirer-Sastre R, Corbi F, LÓpez-Laval I. Relationship between functional threshold power, ventilatory threshold and respiratory compensation point in road cycling. J Sports Med Phys Fitness 2021; 62:626-632. [PMID: 33728842 DOI: 10.23736/s0022-4707.21.12285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to assess the relationship between power output and relative power output at the functional threshold power, ventilatory threshold and respiratory compensation point in road cyclists. METHODS Forty-six road cyclists (age 38 ± 9 years; height 177 ± 9 cm; body mass 71.4 ± 8.6 kg; body mass index 22.7 ± 2.2 kg·m-1; fat mass 7.8 ± 4%, VO2max 61.1 ± 9.1 ml·min-1·kg-1) performed a graded exercise test in which power output and relative power output at the ventilatory landmarks were identified. Functional threshold power was established as 95% of the power output during a 20-minute test. RESULTS Power output and relative power output at the functional threshold power were higher than at the ventilatory threshold (p < 0.001). There were very large to near perfect correlations for power output (95% CI for r from 0.71 to 0.9) and relative power output (95% CI for r from 0.79 to 0.93) at the functional threshold power and respiratory compensation point. Mean bias in power ouput and relative power output measured at RCP compared with FTP was not significant (mean bias 95% CI from -7 to 10 W and - 0.1 to 0.1 W/kg, respectively). CONCLUSIONS Power output and relative power output at the functional threshold power are higher than at the ventilatory threshold. Power output and relative power output at the functional threshold power and respiratory compensation point are strongly related, but caution is required when using both concepts indistinctly.
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Affiliation(s)
- Sebastian Sitko
- Section of Physical Education and Sports, Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, Spain -
| | - Rafel Cirer-Sastre
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, (UdL), Lleida, Spain
| | - Francisco Corbi
- National Institute of Physical Education of Catalonia (INEFC), University of Lleida, (UdL), Lleida, Spain
| | - Isaac LÓpez-Laval
- Section of Physical Education and Sports, Department of Physiatry and Nursery, Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, Spain
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Exploring Differences in Cardiorespiratory Fitness Response Rates Across Varying Doses of Exercise Training: A Retrospective Analysis of Eight Randomized Controlled Trials. Sports Med 2021; 51:1785-1797. [PMID: 33704698 DOI: 10.1007/s40279-021-01442-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study tested the hypothesis that greater mean changes in cardiorespiratory fitness (CRF), in either the absence or presence of reduced interindividual variability, explain larger CRF response rates following higher doses of exercise training. METHODS We retrospectively analyzed CRF data from eight randomized controlled trials (RCT; n = 1590 participants) that compared at least two doses of exercise training. CRF response rates were calculated as the proportion of participants with individual confidence intervals (CIs) placed around their observed response that lay above 0.5 metabolic equivalents (MET). CIs were calculated using no-exercise control group-derived typical errors and were placed around each individual's observed CRF response (post minus pre-training CRF). CRF response rates, mean changes, and interindividual variability were compared across exercise groups within each RCT. RESULTS Compared with lower doses, higher doses of exercise training yielded larger CRF response rates in eight comparisons. For most of these comparisons (7/8), the higher dose of exercise training had a larger mean change in CRF but similar interindividual variability. Exercise groups with similar CRF response rates also had similar mean changes. CONCLUSION Our findings demonstrate that larger CRF response rates following higher doses of exercise training are attributable to larger mean changes rather than reduced interindividual variability. Following a given dose of exercise training, the proportion of individuals expected to improve their CRF beyond 0.5 METs is unrelated to the heterogeneity of individual responses.
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Costa VAB, Midgley AW, Carroll S, Astorino TA, de Paula T, Farinatti P, Cunha FA. Is a verification phase useful for confirming maximal oxygen uptake in apparently healthy adults? A systematic review and meta-analysis. PLoS One 2021; 16:e0247057. [PMID: 33596256 PMCID: PMC7888616 DOI: 10.1371/journal.pone.0247057] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/30/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The 'verification phase' has emerged as a supplementary procedure to traditional maximal oxygen uptake (VO2max) criteria to confirm that the highest possible VO2 has been attained during a cardiopulmonary exercise test (CPET). OBJECTIVE To compare the highest VO2 responses observed in different verification phase procedures with their preceding CPET for confirmation that VO2max was likely attained. METHODS MEDLINE (accessed through PubMed), Web of Science, SPORTDiscus, and Cochrane (accessed through Wiley) were searched for relevant studies that involved apparently healthy adults, VO2max determination by indirect calorimetry, and a CPET on a cycle ergometer or treadmill that incorporated an appended verification phase. RevMan 5.3 software was used to analyze the pooled effect of the CPET and verification phase on the highest mean VO2. Meta-analysis effect size calculations incorporated random-effects assumptions due to the diversity of experimental protocols employed. I2 was calculated to determine the heterogeneity of VO2 responses, and a funnel plot was used to check the risk of bias, within the mean VO2 responses from the primary studies. Subgroup analyses were used to test the moderator effects of sex, cardiorespiratory fitness, exercise modality, CPET protocol, and verification phase protocol. RESULTS Eighty studies were included in the systematic review (total sample of 1,680 participants; 473 women; age 19-68 yr.; VO2max 3.3 ± 1.4 L/min or 46.9 ± 12.1 mL·kg-1·min-1). The highest mean VO2 values attained in the CPET and verification phase were similar in the 54 studies that were meta-analyzed (mean difference = 0.03 [95% CI = -0.01 to 0.06] L/min, P = 0.15). Furthermore, the difference between the CPET and verification phase was not affected by any of the potential moderators such as verification phase intensity (P = 0.11), type of recovery utilized (P = 0.36), VO2max verification criterion adoption (P = 0.29), same or alternate day verification procedure (P = 0.21), verification-phase duration (P = 0.35), or even according to sex, cardiorespiratory fitness level, exercise modality, and CPET protocol (P = 0.18 to P = 0.71). The funnel plot indicated that there was no significant publication bias. CONCLUSIONS The verification phase seems a robust procedure to confirm that the highest possible VO2 has been attained during a ramp or continuous step-incremented CPET. However, given the high concordance between the highest mean VO2 achieved in the CPET and verification phase, findings from the current study would question its necessity in all testing circumstances. PROSPERO REGISTRATION ID CRD42019123540.
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Affiliation(s)
- Victor A. B. Costa
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, England
| | - Sean Carroll
- Department of Sport, Health and Exercise Science, University of Hull, Hull, England
| | - Todd A. Astorino
- Department of Kinesiology, California State University, San Marcos, California, United States of America
| | - Tainah de Paula
- Department of Clinical Medicine, Clinics of Hypertension and Associated Metabolic Diseases, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Felipe A. Cunha
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- * E-mail: ,
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Brief Report: Effects of Low-Volume High-Intensity Interval Training in Hispanic HIV+ Women: A Nonrandomized Study. J Acquir Immune Defic Syndr 2021; 84:285-289. [PMID: 32530906 DOI: 10.1097/qai.0000000000002353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Low cardiorespiratory fitness (CRF) is usually observed in people living with HIV. The effect of a low-volume high-intensity interval training (LV-HIIT) on CRF in HIV+ and HIV- Hispanic women was evaluated in this study. SETTING A nonrandomized clinical trial with pre-test and post-test using a LV-HIIT intervention was conducted in the AIDS Clinical Trials Unit and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico Medical Sciences Campus. METHODS Twenty-nine HIV+ and 13 HIV- Hispanic women recruited from community-based programs and clinics, and able to engage in daily physical activities, volunteered to participate. Of these, 20 HIV+ (69%) and 11 HIV- (85%) completed the study and were included in the analyses. LV-HIIT consisted of 6-week, 3 d/wk, 8-10 high-intensity and low-intensity intervals on a cycle ergometer at 80%-90% of heart rate reserve. Main outcome measures were CRF (defined as VO2peak), peak workload, and time to peak exercise. RESULTS Average peak workload and time to peak exercise increased after training (P < 0.05) in both groups. However, average CRF was significantly higher after training only in the HIV- group. Gains in CRF were observed in 100% of HIV- and 50% of HIV+ women. This was not influenced by exercise testing, habitual physical activity, or anthropometric variables. CONCLUSIONS Given the lack of change in CRF observed in the HIV+ group after LV-HIIT intervention, it is important to focus on variations that may occur within groups.
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Ferri Marini C, Sisti D, Leon AS, Skinner JS, Sarzynski MA, Bouchard C, Rocchi MBL, Piccoli G, Stocchi V, Federici A, Lucertini F. HRR and V˙O2R Fractions Are Not Equivalent: Is It Time to Rethink Aerobic Exercise Prescription Methods? Med Sci Sports Exerc 2021; 53:174-182. [PMID: 32694364 DOI: 10.1249/mss.0000000000002434] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION According to current guidelines, the intensity of health-enhancing aerobic exercise should be prescribed using a percentage of heart rate reserve (%HRR), which is considered to be more closely associated (showing a 1:1 relation) with the percentage of oxygen uptake reserve (%V˙O2R) rather than with the percentage of maximal oxygen uptake (%V˙O2max) during incremental exercise. However, the associations between %HRR and %V˙O2R and between %HRR and %V˙O2max are under debate; hence, their actual relationships were investigated in this study. METHODS Data from each stage of a maximal incremental exercise test performed by 737 healthy and physically inactive participants of the HERITAGE Family Study were screened and filtered then used to calculate the individual linear regressions between %HRR and either %V˙O2R or %V˙O2max. For each relationship, the mean slope and intercept of the individual linear regression were compared with 1 and 0 (i.e., the identity line), respectively, using one-sample t-tests. The individual root mean square errors of the actual versus the 1:1 predicted %HRR were calculated for both relationships and compared using a paired-sample t-test. RESULTS The mean slopes (%HRR-%V˙O2R, 0.972 ± 0.189; %HRR-%V˙O2max, 1.096 ± 0.216) and intercepts (%HRR-%V˙O2R, 8.855 ± 16.022; %HRR-%V˙O2max, -3.616 ± 18.993) of both relationships were significantly different from 1 and 0, respectively, with high interindividual variability. The average root mean square errors were high and revealed that the %HRR-%V˙O2max relationship was more similar to the identity line (P < 0.001) than the %HRR-%V˙O2R relationship (7.78% ± 4.49% vs 9.25% ± 5.54%). CONCLUSIONS Because both relationships are different from the identity line and using a single equation may not be appropriate to predict exercise intensity at the individual level, a rethinking of the relationships between the intensity variables may be necessary to ensure that the most suitable health-enhancing aerobic exercise intensity is prescribed.
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Affiliation(s)
- Carlo Ferri Marini
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Davide Sisti
- Department of Biomolecular Sciences, Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, ITALY
| | - Arthur S Leon
- Department of Kinesiology, University of Minnesota, Minneapolis, MN
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington, IN
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | - Marco B L Rocchi
- Department of Biomolecular Sciences, Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, ITALY
| | - Giovanni Piccoli
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Vilberto Stocchi
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Ario Federici
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Francesco Lucertini
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
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Schneider J, Schlüter K, Sprave T, Wiskemann J, Rosenberger F. Exercise intensity prescription in cancer survivors: ventilatory and lactate thresholds are useful submaximal alternatives to VO 2peak. Support Care Cancer 2020; 28:5521-5528. [PMID: 32173766 PMCID: PMC7546976 DOI: 10.1007/s00520-020-05407-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/06/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Most studies with cancer survivors use percentages of peak oxygen uptake (VO2peak) for intensity prescription. Lactate or ventilatory thresholds might be useful submaximal alternatives, but this has never been investigated. Therefore, we aimed at comparing three training sessions prescribed using %VO2peak (reference), lactate thresholds, and ventilatory thresholds in terms of meeting the vigorous-intensity zone, physiological, and psychological responses. METHODS Twenty breast (58 ± 10 years) and 20 prostate cancer survivors (68 ± 6 years), 3.6 ± 2.4 months after primary therapy, completed a maximal cardiopulmonary exercise test and three vigorous training sessions in randomized order: 38 min of cycling at 70% VO2peak (M-VO2peak), 97% of individual anaerobic lactate threshold (M-IAT), and 67% between ventilatory thresholds 1 and 2 (M-VT). Heart rate (HR), blood lactate concentration (bLa), perceived exertion, and enjoyment were assessed. RESULTS Cancer survivors exercised at 75 ± 23, 85 ± 18, and 79 ± 19 W during M-VO2peak, M-IAT, and M-VT (p > .05). Sessions could not be completed in 3, 8, and 6 cases. Session completers showed HR of 82 ± 7, 83 ± 9, and 84 ± 8 %HRpeak and bLa of 3.7 ± 1.9, 3.9 ± 0.9, and 3.9 ± 1.5 mmol·l-1, which was not different between sessions (p > .05). However, variance in bLa was lower in M-IAT compared to M-VO2peak (p = .001) and to M-VT (p = .022). CONCLUSION All intensity prescription methods on average met the targeted intensity zone. Metabolic response was most homogeneous when using lactate thresholds. IMPLICATIONS FOR CANCER SURVIVORS Submaximal thresholds are at least as useful as VO2peak for intensity prescription in cancer survivors. Overall, slightly lower percentages should be chosen to improve durability of the training sessions.
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Affiliation(s)
- Justine Schneider
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Kathrin Schlüter
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg and National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Friederike Rosenberger
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), Saarbrücken, Germany.
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Haapala EA, Gao Y, Vanhala A, Rantalainen T, Finni T. Validity of traditional physical activity intensity calibration methods and the feasibility of self-paced walking and running on individualised calibration of physical activity intensity in children. Sci Rep 2020; 10:11031. [PMID: 32620888 PMCID: PMC7335054 DOI: 10.1038/s41598-020-67983-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
There are no practical and valid methods for the assessment of individualised physical activity (PA) intensity in observational studies. Therefore, we investigated the validity of commonly used metabolic equivalent of tasks (METs) and pre-determined PA intensity classification methods against individualised PA intensity classification in 35 children 7–11-years-of-age. Then, we studied validity of mean amplitude deviation (MAD) measured by accelerometry during self-paced walking and running in assessment of individualised PA intensity. Individualised moderate PA (MPA) was defined as V̇O2 ≥ 40% of V̇O2reserve and V̇O2 < ventilatory threshold (VT) and vigorous PA (VPA) as V̇O2 ≥ VT. We classified > 3–6 (or alternatively > 4–7) METs as MPA and > 6 (> 7) METs as VPA. Task intensities were classified according to previous calibration studies. MET-categories correctly identified 25.9–83.3% of light PA, 85.9–90.3% of MPA, and 56.7–82.2% of VPA. Task-specific categories correctly classified 53.7% of light PA, 90.6% of MPA, and 57.8% of VPA. MAD during self-paced walking discriminated MVPA from light PA (sensitivity = 67.4, specificity = 88.0) and MAD during self-paced running discriminated VPA from MPA (sensitivity = 78.8, specificity = 79.3). In conclusion, commonly used methods may misclassify PA intensity in children. MAD during self-paced running may provide a novel and practical method for determining individualised VPA intensity in children.
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Affiliation(s)
- Eero A Haapala
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland. .,Physiology, Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Ying Gao
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland.,Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
| | - Anssi Vanhala
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland.,Department of Education, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Timo Rantalainen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
| | - Taija Finni
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
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Castro A, Duft RG, Zeri ACDM, Cavaglieri CR, Chacon-Mikahil MPT. Commentary: Metabolomics-Based Studies Assessing Exercise-Induced Alterations of the Human Metabolome: A Systematic Review. Front Physiol 2020; 11:353. [PMID: 32390864 PMCID: PMC7188905 DOI: 10.3389/fphys.2020.00353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Alex Castro
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Renata Garbellini Duft
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, Brazil
| | | | - Claudia Regina Cavaglieri
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, Brazil
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CAEN KEVIN, BOONE JAN, BOURGOIS JANG, COLOSIO ALESSANDROL, POGLIAGHI SILVIA. Translating Ramp V˙O2 into Constant Power Output: A Novel Strategy that Minds the Gap. Med Sci Sports Exerc 2020; 52:2020-2028. [DOI: 10.1249/mss.0000000000002328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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IANNETTA DANILO, INGLIS ERINCALAINE, MATTU ANMOLT, FONTANA FEDERICOY, POGLIAGHI SILVIA, KEIR DANIELA, MURIAS JUANM. A Critical Evaluation of Current Methods for Exercise Prescription in Women and Men. Med Sci Sports Exerc 2020; 52:466-473. [DOI: 10.1249/mss.0000000000002147] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Seward S, Ramos J, Drummond C, Dalleck A, Byrd B, Kehmeier M, Dalleck L. Inter-Individual Variability in Metabolic Syndrome Severity Score and VO 2max Changes Following Personalized, Community-Based Exercise Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234855. [PMID: 31816818 PMCID: PMC6926895 DOI: 10.3390/ijerph16234855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
This study sought to examine the effectiveness of a personalized, community-based exercise program at reducing MetS severity and consequently Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. One-hundred and fifty physically inactive participants (aged 18-83 years) were randomized to a non-exercise control group (n = 75; instructed to continue their usual lifestyle habits) or treatment group (n = 75). Participants randomized to the treatment group completed a 12 week personalized exercise training program based on the American Council on Exercise (ACE) Integrated Fitness Training (IFT) model guidelines. Z-scores were derived from levels of metabolic syndrome risk factors to determine the severity of MetS (MetS z-score). After 12 weeks, the treatment group showed a significant favorable change in MetS z-score, whereas the control group demonstrated increased severity of the syndrome (between-group difference, p < 0.05). The proportion of MetS z-score responders (Δ > -0.48) was greater following the exercise intervention (71%, 50/70) compared to control (10%, 7/72) (between group difference, p < 0.001). The inter-individual variability in VO2max change also showed a similar trend. These findings provide critical translational evidence demonstrating that personalized exercise programming based upon the ACE IFT model guidelines can be successfully implemented within the community setting to reduce T2DM and CVD risk.
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Affiliation(s)
- Sophie Seward
- Recreation, Exercise & Sport Science, Western Colorado University, Gunnison, CO 81231, USA; (S.S.); (A.D.); (B.B.); (M.K.)
| | - Joyce Ramos
- SHAPE Research Centre, Exercise Science and Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide 5024, Australia; (J.R.); (C.D.)
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia
| | - Claire Drummond
- SHAPE Research Centre, Exercise Science and Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide 5024, Australia; (J.R.); (C.D.)
| | - Angela Dalleck
- Recreation, Exercise & Sport Science, Western Colorado University, Gunnison, CO 81231, USA; (S.S.); (A.D.); (B.B.); (M.K.)
| | - Bryant Byrd
- Recreation, Exercise & Sport Science, Western Colorado University, Gunnison, CO 81231, USA; (S.S.); (A.D.); (B.B.); (M.K.)
| | - Mackenzie Kehmeier
- Recreation, Exercise & Sport Science, Western Colorado University, Gunnison, CO 81231, USA; (S.S.); (A.D.); (B.B.); (M.K.)
| | - Lance Dalleck
- Recreation, Exercise & Sport Science, Western Colorado University, Gunnison, CO 81231, USA; (S.S.); (A.D.); (B.B.); (M.K.)
- SHAPE Research Centre, Exercise Science and Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide 5024, Australia; (J.R.); (C.D.)
- Correspondence: or ; Tel.: +1-970-943-3095
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Schneider J, Schlüter K, Wiskemann J, Rosenberger F. Do we underestimate maximal oxygen uptake in cancer survivors? Findings from a supramaximal verification test. Appl Physiol Nutr Metab 2019; 45:486-492. [PMID: 31604021 DOI: 10.1139/apnm-2019-0560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cancer survivors demonstrate a reduced maximal oxygen uptake, which is clinically relevant in terms of overall survival. However, it remains uncertain whether they attain their "true maximal oxygen uptake" in a cardiopulmonary exercise test (CPET). In the present study, a supramaximal verification bout (Verif) was applied in cancer survivors to confirm attainment of maximal oxygen uptake. Seventy-five participants (age, 61 ± 12 years; n = 43 females with breast cancer and n = 32 males with prostate cancer, 6-52 weeks after primary therapy) performed a CPET on a cycle ergometer and a Verif at 110% peak power output. As verification criterion, maximal oxygen uptake in Verif should not exceed maximal oxygen uptake in CPET by >3%. On average, maximal oxygen uptake was significantly lower in Verif compared with CPET (1.60 ± 0.38 L·min-1 vs. 1.65 ± 0.36 L·min-1, p = .023). On the individual level, n = 51 (68%) satisfied the verification criterion, whereas n = 24 (32%) demonstrated a higher maximal oxygen uptake in Verif. n = 69 (92%) fulfilled ≥2 secondary criteria for maximal exhaustion in the CPET. While maximal oxygen uptake was not underestimated in the CPET on average, one-third of cancer survivors did not attain their true maximal oxygen uptake. Verif appears feasible and beneficial to confirm true maximal oxygen uptake in this population. Furthermore, it might be more reliable than secondary criteria for maximal exhaustion. Novelty In about one-third of cancer survivors, maximal oxygen uptake is underestimated by a CPET. This underestimation of maximal oxygen uptake is not necessarily indicated by secondary criteria for maximal exhaustion. A supramaximal verification bout appears feasible and helpful for the determination of maximal oxygen uptake in cancer survivors.
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Affiliation(s)
- Justine Schneider
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Kathrin Schlüter
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Sports and Sport Science, Heidelberg University, 69120 Heidelberg, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Friederike Rosenberger
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123 Saarbrücken, Germany
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Hansen D, Bonné K, Alders T, Hermans A, Copermans K, Swinnen H, Maris V, Jansegers T, Mathijs W, Haenen L, Vaes J, Govaerts E, Reenaers V, Frederix I, Dendale P. Exercise training intensity determination in cardiovascular rehabilitation: Should the guidelines be reconsidered? Eur J Prev Cardiol 2019; 26:1921-1928. [DOI: 10.1177/2047487319859450] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims In the rehabilitation of cardiovascular disease patients a correct determination of the endurance-type exercise intensity is important to generate health benefits and preserve medical safety. It remains to be assessed whether the guideline-based exercise intensity domains are internally consistent and agree with physiological responses to exercise in cardiovascular disease patients. Methods A total of 272 cardiovascular disease patients without pacemaker executed a maximal cardiopulmonary exercise test on bike (peak respiratory gas exchange ratio >1.09), to assess peak heart rate (HRpeak), oxygen uptake (VO2peak) and cycling power output (Wpeak). The first and second ventilatory threshold (VT1 and VT2, respectively) was determined and extrapolated to %VO2peak, %HRpeak, %heart rate reserve (%HRR) and %Wpeak for comparison with guideline-based exercise intensity domains. Results VT1 was noted at 62 ± 10% VO2peak, 75 ± 10% HRpeak, 42 ± 14% HRR and 47 ± 11% Wpeak, corresponding to the high intensity exercise domain (for %VO2peak and %HRpeak) or low intensity exercise domain (for %Wpeak and %HRR). VT2 was noted at 84 ± 9% VO2peak, 88 ± 8% HRpeak, 74 ± 15% HRR and 76 ± 11% Wpeak, corresponding to the high intensity exercise domain (for %HRR and %Wpeak) or very hard exercise domain (for %HRpeak and %VO2peak). At best (when using %Wpeak) in only 63% and 72% of all patients VT1 and VT2, respectively, corresponded to the same guideline-based exercise intensity domain, but this dropped to about 48% and 52% at worst (when using %HRR and %HRpeak, respectively). In particular, the patient’s VO2peak related to differently elicited guideline-based exercise intensity domains ( P < 0.05). Conclusion The guideline-based exercise intensity domains for cardiovascular disease patients seem inconsistent, thus reiterating the need for adjustment.
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Affiliation(s)
- Dominique Hansen
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
- Jessa Hospital, Heart Center Hasselt, Belgium
- BIOMED – Biomedical Research Center, Hasselt University, Belgium
| | - Kim Bonné
- Jessa Hospital, Heart Center Hasselt, Belgium
| | - Toon Alders
- Jessa Hospital, Heart Center Hasselt, Belgium
| | - Ann Hermans
- Jessa Hospital, Heart Center Hasselt, Belgium
| | | | | | - Vincent Maris
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
| | - Thomas Jansegers
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
| | - Wout Mathijs
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
| | - Laura Haenen
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
| | - Johan Vaes
- Jessa Hospital, Heart Center Hasselt, Belgium
| | | | | | - Ines Frederix
- Jessa Hospital, Heart Center Hasselt, Belgium
- BIOMED – Biomedical Research Center, Hasselt University, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Paul Dendale
- Jessa Hospital, Heart Center Hasselt, Belgium
- BIOMED – Biomedical Research Center, Hasselt University, Belgium
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Khushhal A, Nichols S, Carroll S, Abt G, Ingle L. Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: A United Kingdom perspective. PLoS One 2019; 14:e0217654. [PMID: 31194759 PMCID: PMC6563987 DOI: 10.1371/journal.pone.0217654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background In recent years, criticism of the percentage range approach for individualised exercise prescription has intensified and we were concerned that sub-optimal exercise dose (especially intensity) may be in part responsible for the variability in the effectiveness of cardiac rehabilitation (CR) programmes in the United Kingdom (UK). The aim was to investigate the fidelity of a structured Phase III CR programme, by monitoring and quantifying exercise training intensity. Design Observational study. Methods The programme comprised 16 sessions over 8 weeks, where patients undertook an interval, circuit training approach within national guidelines for exercise prescription (40–70% heart rate reserve [HRR]). All patients wore an Apple Watch (Series 0 or 2, Watch OS2.0.1, Apple Inc., California, USA). We compared the mean % heart rate reserve (%HRR) achieved during the cardiovascular training component (%HRR-CV) of a circuit-based programme, with the %HRR during the active recovery phases (%HRR-AR) in a randomly selected cohort of patients attending standard CR. We then compared the mean %HRR-CV achieved with the minimal exercise intensity threshold during supervised exercise (40% HRR) recommended by national governing bodies. Results Thirty cardiac patients (83% male; mean age [SD] 67 [10] years; BMI 28.3 [4.6] kg∙m-2) were recruited. We captured 332 individual training sessions. The mean %HRR-CV and %HRR-AR were 37 (10) %, and 31 (13) %, respectively. There was weak evidence to support the alternative hypothesis of a difference between the %HRR-CV and 40% HRR. There was very strong evidence to accept the alternative hypothesis that the mean %HRR-AR was lower than the mean %HRR-CV, median standardised effect size 1.1 (95%CI: 0.563 to 1.669), with a moderate to large effect. Conclusion Mean exercise training intensity was below the lower limit of the minimal training intensity guidelines for a Phase III CR programme. These findings may be in part responsible for previous reports highlighting the significant variability in effectiveness of UK CR services and poor CRF improvements observed from several prior investigations.
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Affiliation(s)
- Alaa Khushhal
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Sean Carroll
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Grant Abt
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
- * E-mail:
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