Assessment of peak oxygen uptake during handcycling: Test-retest reliability and comparison of a ramp-incremented and perceptually-regulated exercise test

Evaluation of a standardized test protocol to measure wheelchair-specific anaerobic and aerobic exercise capacity in healthy novices on an instrumented roller ergometer

This study aims to evaluate whether a test protocol with standardized and individualized resistance settings leads to valid wheelchair Wingate tests (WAnT) and graded exercise tests (GXT) in healthy novices. Twenty able-bodied individuals (10M/10F, age 23 ± 2 years, body mass 72 ± 11 kg) performed an isometric strength test, sprint test, WAnT and GXT on a wheelchair ergometer. Using a previously developed set of regression equations, individuals’ isometric strength outcome was used to estimate the WAnT result (P30_est), from which an effective individual WAnT resistance was derived. The subsequently measured WAnT outcome (P30_meas) was used to estimate the GXT outcome (POpeak_est) and to scale the individual GXT resistance steps. Estimated and measured outcomes were compared. The WAnT protocol was considered valid when maximal velocity did not exceed 3 m·s^-1; the GXT protocol was considered valid when test duration was 8–12 min. P30_est did not significantly differ from P30_meas, while one participant did not have a valid WanT, as maximal velocity exceeded 3 m·s^-1. POpeak_est was 10% higher than POpeak_meas, and six participants did not reach a valid GXT: five participants had a test duration under 8 min and one participant over 12 min. The isometric strength test can be used to individually scale the WAnT protocol. The WAnT outcome scaled the protocol for the GXT less accurately, resulting in mostly shorter-than-desired test durations. In conclusion, the evaluated standardized and individualized test protocol was valid for the WAnT but less valid for the GXT among a group of novices. Before implementing the standardized individual test protocol on a broader scale, e.g. among paralympic athletes, it should be evaluated among different athletic wheelchair-dependent populations.

Toward Predicting Human Performance Outcomes From Wearable Technologies: A Computational Modeling Approach

Wearable technologies for measuring digital and chemical physiology are pervading the consumer market and hold potential to reliably classify states of relevance to human performance including stress, sleep deprivation, and physical exertion. The ability to efficiently and accurately classify physiological states based on wearable devices is improving. However, the inherent variability of human behavior within and across individuals makes it challenging to predict how identified states influence human performance outcomes of relevance to military operations and other high-stakes domains. We describe a computational modeling approach to address this challenge, seeking to translate user states obtained from a variety of sources including wearable devices into relevant and actionable insights across the cognitive and physical domains. Three status predictors were considered: stress level, sleep status, and extent of physical exertion; these independent variables were used to predict three human performance outcomes: reaction time, executive function, and perceptuo-motor control. The approach provides a complete, conditional probabilistic model of the performance variables given the status predictors. Construction of the model leverages diverse raw data sources to estimate marginal probability density functions for each of six independent and dependent variables of interest using parametric modeling and maximum likelihood estimation. The joint distributions among variables were optimized using an adaptive LASSO approach based on the strength and directionality of conditional relationships (effect sizes) derived from meta-analyses of extant research. The model optimization process converged on solutions that maintain the integrity of the original marginal distributions and the directionality and robustness of conditional relationships. The modeling framework described provides a flexible and extensible solution for human performance prediction, affording efficient expansion with additional independent and dependent variables of interest, ingestion of new raw data, and extension to two- and three-way interactions among independent variables. Continuing work includes model expansion to multiple independent and dependent variables, real-time model stimulation by wearable devices, individualized and small-group prediction, and laboratory and field validation.

Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia

STUDY DESIGN

Cross-sectional cohort study.

OBJECTIVES

To compare ratings of perceived exertion (RPE) on Borg's 6-20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only.

SETTING

University and rehabilitation centre-based laboratories in UK and Netherlands.

METHODS

Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O₂) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg's RPE scale and CR10. Thresholds were identified according to log-V̇O₂ plotted against log-blood lactate (LT₁), and 1.5 mmol L^-1 greater than LT₁ (LT₂).

RESULTS

RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R²: 0.965-0.970, P < 0.005). Though percentage peak V̇O₂ was significantly greater in TETRA (P < 0.005), there was no difference in RPE at LT₁ or LT₂ between groups on Borg's RPE scale or CR10.

CONCLUSION

Strong association between Borg's RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.

Maximal lactate accumulation rate and post-exercise lactate kinetics in handcycling and cycling

The aim of this study was to assess lactate kinetics, maximal lactate accumulation rate (⩒La_max) and peak power output (PO_max) in a 15-s all-out exercise in handcycling (HC) and cycling (C) in terms of (1) reliability, (2) differences and (3) correlations between HC and C. Eighteen female and male competitive triathletes performed two trials (separated by one week) of a 15-s all-out sprint test in HC and C. Tests were performed in a recumbent racing handcycle and on the participants' own road bike that were attached to an ergometer. Reliability was assessed using intraclass correlation coefficient (ICC). PO_max and ⩒La_max demonstrated high reliability in HC (ICC = 0.972, ICC = 0.828) and C (ICC = 0.937, ICC = 0.872). PO_max (d = -2.54, P < 0.0005) and ⩒La_max (d = -1.62, P < 0.0005) were lower in HC compared to C. PO_max and ⩒La_max correlated in HC (r = 0.729, P = 0.001) and C (r = 0.710, P = 0.001). There was no significant correlation between HC and C in PO_max (r = 0.442, P = 0.066) and ⩒La_max (r = 0.455, P = 0.058). Whereas the exchange velocity of lactate (k₁) was similar in HC and C, the removal velocity (k₂) was significantly higher in HC. ⩒La_max and PO_max during sprint exercise are highly reliable and demonstrate a correlation in both HC and C. However, since ⩒La_max and PO_max are significantly higher in C and not correlated between HC and C, ⩒La_max and PO_max seem to be extremity-specific.

Perceived exertion responses to wheelchair propulsion differ between novice able-bodied and trained wheelchair sportspeople

OBJECTIVES

To investigate peripheral (RPE_P) and central (RPE_C) Ratings of Perceived Exertion during wheelchair propulsion in untrained able-bodied (AB) participants, and trained wheelchair rugby athletes with and without cervical spinal cord injury (CSCI).

DESIGN

Cross-sectional study.

METHODS

38 participants (AB: n=20; wheelchair rugby athletes with CSCI: n=9; without CSCI: n=9) completed an incremental wheelchair propulsion test to exhaustion on a motorised treadmill. Gas exchange measures and heart rate (HR) were collected throughout. RPE_P and RPE_C on the Category Ratio-10 were verbally recorded each minute. Blood lactate concentration ([BLa]) was determined post-test.

RESULTS

Between 50-100% peak oxygen uptake (V̇O_2peak), RPE_P was greater than RPE_C in AB (p<0.05), but not in athletes with (p=0.07) or without (p=0.16) CSCI. RPE_P was greater in AB compared to players with CSCI (Effect sizes: 1.24-1.62), as were respiratory exchange ratio (1.02±0.10 vs 0.82±0.11, p<0.05) and [BLa]_peak (7.98±2.53 vs 4.66±1.57mmol·L^-1). RPE_C was greater in athletes without CSCI compared to those with CSCI (Effect sizes: 0.70-1.38), as were HR (166±20 vs 104±15 beats·min^-1, p<0.05) and ventilation (59.2±28.8 vs 35.1±16.6L·min^-1, p=0.01).

CONCLUSIONS

RPE_P was dominant over RPE_C during wheelchair propulsion for untrained AB participants. For athletes with CSCI, lower RPE_P and RPE_C were reported at the same %V̇O_2peak compared to those without CSCI. The mechanism for this remains to be fully elucidated.

Effects of different increments in workload and duration on peak physiological responses during seated upper-body poling

PURPOSE

To compare the effects of test protocols with different increments in workload and duration on peak oxygen uptake ([Formula: see text]O_2peak), and related physiological parameters during seated upper-body poling (UBP).

METHODS

Thirteen upper-body trained, male individuals completed four UBP test protocols with increments in workload until volitional exhaustion in a counterbalanced order: 20 W increase/every 30 s, 20 W/60 s, 10 W/30 s and 10 W/60 s. Cardio-respiratory parameters and power output were measured throughout the duration of each test. Peak blood lactate concentration (bLa_peak) was measured after each test.

RESULTS

The mixed model analysis revealed no overall effect of test protocol on [Formula: see text]O_2peak, peak minute ventilation (VE_peak), peak heart rate (HR_peak), bLa_peak (all p ≥ 0.350), whereas an overall effect of test protocol was found on peak power output (PO_peak) (p = 0.0001), respiratory exchange ratio (RER) (p = 0.024) and test duration (p < 0.001). There was no difference in PO_peak between the 20 W/60 s (175 ± 25 W) and 10 W/30 s test (169 ± 27 W; p = 0.092), whereas PO_peak was lower in the 10 W/60 s test (152 ± 21 W) and higher in the 20 W/30 s test (189 ± 30 W) compared to the other tests (all p = 0.001). In addition, RER was 9.9% higher in the 20 W/30 s compared to the 10 W/60 s test protocol (p = 0.003).

CONCLUSIONS

The UBP test protocols with different increments in workload and duration did not influence [Formula: see text]O_2peak, and can therefore be used interchangeably when [Formula: see text]O_2peak is the primary outcome. However, PO_peak and RER depend upon the test protocol applied and the UBP test protocols can, therefore, not be used interchangeably when the latter is the primary outcome parameter.

Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users

This study compares test-retest reliability and peak exercise responses from ramp-incremented (RAMP) and maximal perceptually-regulated (PRET_max) exercise tests during arm crank exercise in individuals reliant on manual wheelchair propulsion (MWP). Ten untrained participants completed four trials over 2-weeks (two RAMP (0-40 W + 5-10 W · min^-1) trials and two PRET_max. PRET_max consisted of five, 2-min stages performed at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20). Participants freely changed the power output to match the required RPE. Gas exchange variables, heart rate, power output, RPE and affect were determined throughout trials. The V̇O_2peak from RAMP (14.8 ± 5.5 ml · kg^-1 · min^-1) and PRET_max (13.9 ± 5.2 ml · kg^-1 · min^-1) trials were not different (P = 0.08). Measurement error was 1.7 and 2.2 ml · kg^-1 · min^-1 and coefficient of variation 5.9% and 8.1% for measuring V̇O_2peak from RAMP and PRET_max, respectively. Affect was more positive at RPE 13 (P = 0.02), 15 (P = 0.01) and 17 (P = 0.01) during PRET_max. Findings suggest that PRET_max can be used to measure V̇O_2peak in participants reliant on MWP and leads to a more positive affective response compared to RAMP.

Comparison of Peak Oxygen Uptake and Test-Retest Reliability of Physiological Parameters between Closed-End and Incremental Upper-Body Poling Tests

Objective: To compare peak oxygen uptake (VO_2peak) and the test-retest reliability of physiological parameters between a 1-min and a 3-min closed-end and an incremental open-end upper-body poling test. Methods: On two separate test days, 24 healthy, upper-body trained men (age: 28.3 ± 9.3 years, body mass: 77.4 ± 8.9 kg, height: 182 ± 7 cm) performed a 1-min, a 3-min and an incremental test to volitional exhaustion in the same random order. Respiratory parameters, heart rate (HR), blood lactate concentration (BLa), rating of perceived exertion (RPE), and power output were measured. VO_2peak was determined as the single highest 30-s average. Relative reliability was assessed with the intra-class correlation coefficient (ICC_{2, 1}) and absolute reliability with the standard error of measurement (SEM) and smallest detectable change (SDC). Results: The incremental (3.50 ± 0.46 L·min^-1 and 45.4 ± 5.5 mL·kg^-1·min^-1) and the 3-min test (3.42 ± 0.47 L·min^-1 and 44.5 ± 5.5 mL·kg^-1·min^-1) resulted in significantly higher absolute and body-mass normalized VO_2peak compared to the 1-min test (3.13 ± 0.40 L·min^-1 and 40.4 ± 5.0 mL·kg^-1·min^-1) (all comparisons, p < 0.001). Furthermore, the incremental test resulted in a significantly higher VO_2peak as compared to the 3-min test (p < 0.001). VO_2peak was significantly higher on day 1 than day 2 for the 1-min test (p < 0.05) and displayed a trend toward higher values on day 2 for the incremental test (p = 0.07). High and very high ICCs across all physiological parameters were found for the 1-min (0.827-0.956), the 3-min (0.916-0.949), and the incremental test (0.728-0.956). The SDC was consistently small for HR (1-min: 4%, 3-min: 4%, incremental: 3%), moderate for absolute and body-mass normalized VO_2peak (1-min: 5%, 3-min: 6%, incremental: 7%) and large for BLa (1-min: 20%, 3-min: 12%, incremental: 22%). Conclusions: Whereas both the 3-min and the incremental test display high relative reliability, the incremental test induces slightly higher VO_2peak. However, the 3-min test seems to be more stable with respect to day-to-day differences in VO_2peak. The 1-min test would provide a reliable alternative when short test-duration is desirable, but is not recommended for testing VO_2peak due to the clearly lower values.