Long-term stability of the oxygen pulse curve during maximal exercise

Cardiorespiratory and Neuromuscular Improvements Plateau after 2 wk of Sprint Interval Training in Sedentary Individuals

INTRODUCTION

Previous studies ranging from 2 to 12 wk of sprint interval training (SIT) have reported improvements in maximal oxygen uptake (V̇O 2max ) and neuromuscular function in sedentary populations. However, whether the time course of the changes in these variables correlates with greater training volumes is unclear.

METHODS

Thirteen sedentary participants performed three all-out training weekly sessions involving 15-s sprints interspersed with 2 min of recovery on a cycle ergometer. The 6-wk training program was composed of three identical blocks of 2 wk in which training volume was increased from 10 to 14 repetitions over the first four sessions and reduced to 8 in the last session. The power output and the heart rate (HR) were monitored during the sessions. The V̇O 2max , the power-force-velocity profile, and the isometric force were assessed every 2 wk from baseline.

RESULTS

A significant increase in V̇O 2max was observed from the second week plateauing thereafter despite four additional weeks of training. The dynamic force production increased from the second week, and the speed production decreased by the end of the protocol. The isometric force and the maximal power output from the power-force-velocity profile did not change. Importantly, the time spent at high percentages of the maximal HR during the training sessions was lower in the second and third training block compared with the first.

CONCLUSIONS

SIT resulted in an effective approach for rapidly increasing V̇O 2max , and no change in the isometric force was found; cycling-specific neuromuscular adaptations were observed from the second week of training. SIT may be useful in the short term, but further improvement of overall physical fitness might need other training modalities like endurance and/or resistance training.

Step by Step: Evaluation of Cardiorespiratory Fitness in Healthy Children, Young Adults, and Patients with Congenital Heart Disease Using a Simple Standardized Stair Climbing Test

(1) Background: Cardiorespiratory fitness (CRF) is known to be a prognostic factor regarding long-term morbidity and mortality. This study aimed to develop a standardized Stair Climbing Test (SCT) with a reliable correlation to spiroergometry and the 6MWT which can be used in healthy children as well as patients with congenital heart disease (CHD) and a restricted exercise capacity. (2) Methods: A total of 28 healthy participants aged 10-18 years were included. We tested the individuals' CRF by cardiopulmonary exercise testing (CPET) on a treadmill, the 6MWT, and a newly developed Stair Climbing Test (SCT). For the SCT, we defined a standardized SCT protocol with a total height of 13.14 m to achieve maximal exercise effects while recording time and vital parameters. To compare the SCT, the 6 Min Walking Test, and CPET, we introduced an SCT-Index that included patient data (weight, height) and time. To assess the SCT's feasibility for clinical practice, we also tested our protocol with five adolescents with complex congenital heart disease (i.e., Fontan circulation). (3) Results: A strong correlation was observed between SCT-Index and O2 pulse (r = 0.921; p < 0.001). In addition, when comparing the time achieved during SCT (tSCT) with VO2max (mL/min/kg) and VO2max (mL/min), strong correlations were found (r = -0.672; p < 0.001 and r = -0.764; p < 0.001). Finally, we determined a very strong correlation between SCT-Index and VO2max (mL/min) (r = 0.927; p = <0.001). When comparing the 6MWD to tSCT, there was a moderate correlation (r = -0.544; p = 0.003). It appears to be feasible in patients with Fontan circulation. (4) Conclusions: We were able to demonstrate that there is a significant correlation between our standardized SCT and treadmill CPET. Therefore, we can say that the SCT can be used as an easy supplement to CPET and in certain contexts, it can also be used as a screening tool when CPET is not available. The advantages would be that the SCT is a simple, quick, cost-effective, and reliable standardized (sub)maximal exercise test to evaluate CRF in healthy children on a routine basis. We can even assume that it can be used in patients with congenital heart disease.

A 2-day cardiopulmonary exercise test in chronic fatigue syndrome patients who were exposed to humidifier disinfectants

Some survivors of humidifier disinfectants (HDs) complain of chronic, inexplicable fatigue, and post-exertional malaise (PEM). Two-day cardiopulmonary exercise tests (CPETs) performed 24 hours apart (2-day CPET protocol) are increasingly employed to evaluate PEM and related disabilities among individuals with chronic fatigue syndrome (CFS). The purpose of this study was to assess the reproducibility of CPET variables in individuals who had been exposed to HD and to show that 2-day CPET is an objective means of differentiating between fatigue conditions in people with CFS symptoms who have been exposed to HDs. Twenty-nine HD survivors with CFS symptoms were enrolled in this study. To document and assess PEM in CFS, a 2-day CPET was conducted to measure baseline functional capacity (CPET1) and provoke PEM. Twenty-four hours later, a second CPET assessed changes in related variables, focusing on PEM effects on functional capacity. This CPET also measured changes in energy production and physiological function, objectively documenting PEM effects. In the 2-day CPET, the peak oxygen consumption (VO2peak), VO2 at ventilatory threshold (VO2@VT), time to reach VO2peak, and time to reach VO2@VT were significantly decreased (p<0.001). The peak O2 pulse and O2 pulse at VT also decreased significantly (p<0.001). A 6-minute walk test revealed significantly decreased distance (p<0.01). This is the first study to conduct a 2-day consecutive CPET in previously exposed HD participants with CFS symptoms. Our results confirm previous work that demonstrated abnormal responses to PEM in CFS patients. Therefore, a 2-day CPET is an objective measure to differentiate fatigue conditions in people with CFS symptoms who have been exposed to HDs.

Determinants of whole-body maximal aerobic performance in young male and female athletes: The roles of lower extremity muscle size, strength and power

This study sought to determine whether lower extremity muscle size, power and strength could be a determinant of whole-body maximal aerobic performance in athletes. 20 male and 19 female young athletes (18 ± 4 years) from various sporting disciplines participated in this study. All athletes performed a continuous ramp-incremental cycling to exhaustion for the determination of peak oxygen uptake (V˙O2peak: the highest V˙O2 over a 15-s period) and maximal power output (MPO: power output corresponding to V˙O2peak). Axial scanning of the right leg was performed with magnetic resonance imaging, and anatomical cross-sectional areas (CSAs) of quadriceps femoris (QF) and hamstring muscles at 50% of thigh length were measured. Moreover, bilateral leg extension power and unilateral isometric knee extension and flexion torque were determined. All variables were normalised to body mass, and six independent variables (V˙O2peak, CSAs of thigh muscles, leg extension power and knee extension and flexion torque) were entered into a forward stepwise multiple regression model with MPO being dependent variable for males and females separately. In the males, V˙O2peak was chosen as the single predictor of MPO explaining 78% of the variance. In the females, MPO was attributed to, in the order of importance, V˙O2peak (p < 0.001) and the CSA of QF (p = 0.011) accounting for 84% of the variance. This study suggests that while oxygen transport capacity is the main determinant of MPO regardless of sex, thigh muscle size also has a role in whole-body maximal aerobic performance in female athletes.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

OBJECTIVES

Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O₂ pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE).

METHODS

Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891.

RESULTS

The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O₂ pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019).

CONCLUSION

Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O₂ pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.

Making Cardiopulmonary Exercise Testing Interpretable for Clinicians

ABSTRACT

Cardiopulmonary exercise testing (CPET) is a dynamic clinical tool for determining the cause for a person's exercise limitation. CPET provides clinicians with fundamental knowledge of the coupling of external to internal respiration (oxygen and carbon dioxide) during exercise. Subtle perturbations in CPET parameters can differentiate exercise responses among individual patients and disease states. However, perhaps because of the challenges in interpretation given the amount and complexity of data obtained, CPET is underused. In this article, we review fundamental concepts in CPET data interpretation and visualization. We also discuss future directions for how to best use CPET results to guide clinical care. Finally, we share a novel three-dimensional graphical platform for CPET data that simplifies conceptualization of organ system-specific (cardiac, pulmonary, and skeletal muscle) exercise limitations. Our goal is to make CPET testing more accessible to the general medical provider and make the test of greater use in the medical toolbox.

Peak oxygen pulse and mortality risk in healthy women and men: The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST)

Peak oxygen pulse (O₂ pulse_peak) may have predictive utility for health outcomes yet, presently, has only been examined in men and only using a single baseline measure.

PURPOSE

The primary aim of this investigation was to evaluate the relationship between O₂ pulse_peak and all-cause mortality in apparently healthy women and men. A secondary aim was to explore the relationship between longitudinal changes to O₂ pulse_peak and mortality.

METHODS

The sample included 3877 participants (43% women) for the primary aim and 759 participants (32% women) who performed two cardiopulmonary exercise tests ≥1 year apart for the secondary aim. Cox proportional hazard models were performed to determine the relationship between O₂ pulse_peak and mortality. Prognostic peak oxygen consumption (VO_2peak) and O₂ pulse_peak models were compared using the concordance index and Akaike information criterion (AIC).

RESULTS

In the assessment from baseline, there were 730 deaths over a 24.7 ± 11.8 year follow-up period. For men, a single measure of O₂ pulse_peak was inversely associated with risk for mortality (P < 0.05). However, the concordance index and AIC indicated lower discrimination compared to VO_2peak models and O₂ pulse_peak did not provide complementary benefit to VO_2peak models. For women, O₂ pulse_peak was not associated with mortality risk. In the longitudinal analysis, there were 168 deaths over a follow-up of 20.1 ± 11.4 years. Changes to O₂ pulse_peak were not significantly related to mortality in either sex.

CONCLUSIONS

Within an apparently healthy cohort, a single assessment of O₂ pulse_peak is related to all-cause mortality in men but not women. Further, longitudinal changes to O₂ pulse_peak are not predictive of mortality in either sex. These findings suggest O₂ pulse_peak may have limited prognostic utility in healthy individuals, particularly within healthy women.

The utility of the oxygen pulse recovery as a marker of the cardiac output response to exercise in patients with chronic heart failure

PURPOSE

The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of chronic heart failure (CHF). The recovery of the oxygen pulse (OP) is a non-invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central haemodynamic response to exercise remains to be determined. We hypothesized that an impaired OP recovery is associated with a reduced CO response to exercise in CHF patients.

METHODS

Sixty one CHF patients performed cardiopulmonary exercise test with simultaneous measurement of CO. Impaired OP recovery was defined as an overshoot during the first minute of recovery or OP at 1-min recovery as a percentage of peak OP (OP_RR ).

RESULTS

An OP overshoot was observed in 9% (n = 5) of patients. In these patients, peak CO and VO₂ were significantly lower (peak CO 7.9 ± 0.8 versus 11.2 ± 4.3 L/min and peak VO₂ 14.1 ± 4.7 versus 19.6 ± 5.8 ml min^-1  kg^-1 ). Mean relative recovery of OP was 78 ± 20%. Slow OP recovery (negative OP_RR ) was seen in 13% (n = 8). Peak CO and VO₂ were significantly lower in the negative OP_RR group (11 ± 4 versus 8 ± 0.7 L/min and 19.7 ± 5.9 versus 14.6 ± 3.7 ml kg min^-1 ). There was a significant relation between OP_RR and stroke volume (SV) _RR (r = .57), as well as between OP_RR and a-v O₂ diff _RR (r_s  = .4).

CONCLUSION

An impaired OP recovery is associated with a reduced CO response to exercise and worse functional status. Therefore, the OP recovery can be used to grade the severity of CHF.

The Physiological Characteristics of an 83-Year-Old Champion Female Master Runner

PURPOSE

To examine the cardiorespiratory, muscular, and skeletal characteristics of an 83-year-old champion female master athlete (called DL in this study) who had set multiple world running records in the 80-to-84-year-old age group.

METHODS

Measures of maximal oxygen uptake, maximal heart rate, maximal isometric torque for knee extensor muscles, thigh and triceps surae muscle volumes, and bone mineral density (BMD) of the proximal femur region were evaluated. Based on previously published equations, physiological age was determined for maximal oxygen uptake, maximal heart rate, and maximal isometric torque. Muscle volumes for the dominant leg were compared with previously published sex- and age-matched data using z scores. For BMD, T score and z score were calculated.

RESULTS

DL had the highest maximal oxygen uptake (42.3 mL·min-1·kg-1) ever observed for a female older than 80 years of age, which gave her a remarkable physiological age (27 y). By contrast, she had a physiological age closer to her biological age for maximal isometric torque (90 y) and maximal heart rate (74 y). The z scores for thigh (0.4) and triceps surae (1.1) muscle volumes revealed that DL's leg muscles were affected almost as much as her sex- and age-matched peers. The T score (-1.7) for BMD showed that DL had osteopenia but no osteoporosis, and the z score (0.7) showed that DL's BMD was similar to that of females of the same age.

CONCLUSION

This single case study shows that the remarkable cardiorespiratory fitness coupled with intensive endurance training observed in a female master athlete was not associated with specific preservation of her muscular and skeletal characteristics.

The effects of Jilin sika Deer's (Cervus dybowski) tendon liquid supplementation on endurance drop jumps performance, biochemistry profile of free boxing players

ETHNOPHARMACOLOGICAL RELEVANCE

Risk of anterior cruciate ligament is a persistent and severe problem in athletes owing to strenuous exercise-induced lower-body injury. Tendon of deer liquid (TD) a familiar traditional Chinese medicine, has been used for strengthening the bones and muscles.

AIM OF THE STUDY

In this study, we seek to demonstrate the application of TD in improving endurance exercise performance and reducing the risk of endurance training injury for free boxing players.

MATERIALS AND METHODS

Sixteen male free boxing players were randomly assigned to the TD and placebo groups. Body composition, clinical biochemistry profiles, kinematic and physiology exercise tests were evaluated at 2 time points - pre-supplementation (pre-) and after 6 weeks post-supplementation (post-).

RESULTS

TD group exhibited significant increase in levels of serum total protein (TP) compared to the placebo group after a 6-week supplementation. Following the treadmill test, serum glucose and maximal oxygen consumption (VO₂ max) levels were increased in the TD group. In the endurance test consisting of 200 counts of drop vertical jumps (DVJs), subjects in the TD group also showed an increase in vertical jump height and reduced risk of musculoskeletal system injuries.

CONCLUSIONS

TD supplementation leads to better physiological adaptation in free boxing players and has the potential for use as a nutrient supplement toward a variety of benefits for endurance athletes.

Gut microbiota diversity is associated with cardiorespiratory fitness in post-primary treatment breast cancer survivors

NEW FINDINGS

What is the central question of this study? Does the link between cardiorespiratory fitness and gut microbiota diversity persist after adjusting for the potential effects of percentage body fat and activity-related energy expenditure (AEE)? What is the main finding and its importance? This is the first study to examine the link between cardiorespiratory fitness and gut microbiota diversity while accounting for the underlying effects of percentage body fat and free-living AEE. Results from the present work suggest that cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity among post-primary treatment, non-metastatic breast cancer survivors.

ABSTRACT

Cancer treatment uniquely triggers multiple physiological shifts detrimental to overall health. Although previous research indicates a link between the gut microbiota and cardiorespiratory fitness, it is unclear whether these findings are attributable to potential underlying effects of percentage body fat or free-living activity energy expenditure (AEE). The microbe composition of faecal specimens from 37 breast cancer survivors was determined using 16S microbiome analyses. Individual-sample microbiota diversity (α-diversity) and between-sample community differences (β-diversity) were examined. Peak oxygen uptake ( V ̇ O 2 peak ) was estimated from a graded exercise test consistent with the modified Naughton protocol, in which exercise terminates at 85% of age-predicted maximal heart rate. The AEE was measured over 10 days using doubly labelled water, wherein the percentage body fat was calculated from total body water. Pearson correlations revealed α-diversity indices (Chao1, observed species, PD whole tree and Shannon) to be positively associated with V ̇ O 2 peak (r = 0.34-0.51; P < 0.05), whereas the percentage of maximal heart rate during stages 1-4 of the graded exercise test (r = -0.34 to -0.50; P < 0.05) and percentage body fat (r = -0.32 to -0.41; P < 0.05) were negatively associated with the same α-diversity indices. Multiple linear regression models showed that V ̇ O 2 peak accounted for 22 and 26% of the variance in taxonomic richness (observed species) and phylogenic diversity after adjustment for percentage body fat and menopausal status. Unweighted UniFrac (β-diversity) was significant for several outcomes involving cardiorespiratory fitness, and significant taxa comparisons were found. Associations between gut microbiota and free-living AEE were not found. Results from the present work suggest that cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity.

Relative peak exercise oxygen pulse is related to sudden cardiac death, cardiovascular and all-cause mortality in middle-aged men

Background

Preliminary evidence suggests that peak exercise oxygen pulse – peak oxygen uptake/heart rate-, a variable obtained during maximal cardiopulmonary exercise testing and a surrogate of stroke volume, is a predictor of mortality. We aimed to assess the associations of peak exercise oxygen pulse with sudden cardiac death, fatal coronary heart disease and cardiovascular disease and all-cause mortality.

Design

A prospective study.

Methods

Peak exercise oxygen pulse was assessed in a maximal cycling test at baseline in 2227 middle-aged men of the Kuopio Ischaemic Heart Disease cohort study using expired gas variables and electrocardiograms. Relative peak exercise oxygen pulse was obtained by dividing the absolute value by body weight.

Results

During a median follow-up of 26.1 years 1097 subjects died; there were 220 sudden cardiac deaths, 336 fatal coronary heart diseases and 505 fatal cardiovascular diseases. Relative peak exercise oxygen pulse (mean 19.5 (4.1) mL per beat/kg/102) was approximately linearly associated with each outcome. Comparing extreme quartiles of relative peak exercise oxygen pulse, hazard ratios (95% confidence intervals) for sudden cardiac death, fatal coronary heart disease and cardiovascular disease, and all-cause mortality on adjustment for cardiovascular risk factors were 0.55 (0.36–0.83), 0.58 (0.42–0.81), 0.60 (0.46–0.79) and 0.59 (0.49–0.70), respectively ( P < 0.001 for all). The hazard ratios were unchanged on further adjustment for C-reactive protein and the use of beta-blockers. The addition of relative peak exercise oxygen pulse to a cardiovascular disease mortality risk prediction model significantly improved risk discrimination (C-index change 0.0112; P = 0.030).

Conclusion

Relative peak exercise oxygen pulse measured during maximal exercise was linearly and inversely associated with fatal cardiovascular and all-cause mortality events in middle-aged men. In addition, relative peak exercise oxygen pulse provided significant improvement in cardiovascular disease mortality risk assessment beyond conventional risk factors.

Effects of AMPD1 common mutation on the metabolic-chronotropic relationship: Insights from patients with myoadenylate deaminase deficiency

PURPOSE

Current evidence indicates that the common AMPD1 gene variant is associated with improved survival in patients with advanced heart failure. Whilst adenosine has been recognized to mediate the cardioprotective effect of C34T AMPD1, the precise pathophysiologic mechanism involved remains undefined to date. To address this issue, we used cardio-pulmonary exercise testing data (CPX) from subjects with myoadenylate deaminase (MAD) defects.

METHODS

From 2009 to 2013, all the patients referred in our laboratory to perform a metabolic exercise testing, i.e. a CPX with measurements of muscle metabolites in plasma during and after exercise testing, were prospectively enrolled. Subjects that also underwent an open muscle biopsy for diagnosis purpose were finally included. The metabolic-chronotropic response was assessed by calculating the slope of the linear relationship between the percent heart rate reserve and the percent metabolic reserve throughout exercise. MAD activity was measured using the Fishbein's technique in muscle biopsy sample. The common AMPD1 mutation was genotyped and the AMPD1 gene was sequenced to screen rare variants from blood DNA.

RESULTS

Sixty-seven patients were included in the study; 5 had complete MAD deficiency, 11 had partial MAD deficiency, and 51 had normal MAD activity. Compared with normal MAD activity subjects, MAD deficient subjects appeared to have a lower-than-expected metabolic-chronotopic response during exercise. The metabolic-chronotropic relationship is more closely correlated with MAD activity in skeletal muscle (Rs = 0.57, p = 5.93E-7, Spearman correlation) than the presence of the common AMPD1 gene variant (Rs = 0.34, p = 0.005). Age-predicted O2 pulse ratio is significantly increased in MAD deficient subjects, indicating a greater efficiency of the cardiovascular system to deliver O2 (p < 0.01, Scheffé's post hoc test).

CONCLUSION

The metabolic-chronotropic response is decreased in skeletal muscle MAD deficiency, suggesting a biological mechanism by which AMPD1 gene exerts cardiac effect.

Endothelin inhibitors lower pulmonary vascular resistance and improve functional capacity in patients with Fontan circulation

OBJECTIVES

To evaluate the effects of endothelin inhibitors (ERAs) on hemodynamic and functional parameters in patients post-Fontan procedure with high pulmonary vascular resistance (PVR).

METHODS

Among our cohort of patients with Fontan circulation, 8 children, 8 adolescents, and 8 adults had PVR ≥2 WU*m². These patients were treated with ERAs (minors with bosentan, adults with macitentan) and reevaluated after 6 months. Pre- and posttreatment hemodynamic variables were assessed by cardiac catheterization. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). Our primary endpoint was to obtain a reduction of PVR; the secondary endpoint was to obtain an improvement of functional capacity.

RESULTS

Under treatment, New York Heart Association class improved for adolescents and adults. PVR decreased (P = .01) in all groups: in children from the median value 2.3 (interquartile range 2.0-3.1) to 1.9 (1.4-2.3) WU*m², in adolescents from 2.3 (2.1-2.4) to 1.7 (1.4-1.8) WU*m², and in adults from 2.8 (2.0-4.7) to 2.1 (1.8-2.8)WU*m². In 71% of patients, PVR fell to less than 2 WU*m². Cardiac index increased in adolescents from 2.6 (2.4-3.3) to 3.6 (3.4-4.3) L/min/m², P = .04, and in adults from 2.1 (2.0-2.3) to 2.8 (2.3-4.7) L/min/m², P = .03. CPET showed that only adolescents displayed a significant functional improvement. Anaerobic threshold improved from 17 (13-19) to 18 (13-20) mL/kg/min, P = .03; oxygen consumption and VO₂ max increased from 1.3 (1.0-1.6) to 1.7 (1.1-1.9) L/min, P = .02 and from 25 (21-28) to 28 (26-31) L/min, P = .02, respectively. Oxygen pulse increased from 7.9 (5.7-10.4) to 11.2 (8.2-13.0) L/beat, P = .01.

CONCLUSIONS

This is the first study that assesses by cardiac catheterization and CPET the effects of ERA in patients with Fontan circulation with increased PVR. These results suggest that ERAs might provide most pronounced hemodynamic and functional improvement in adults and adolescents.

Key Role of Pacing Site as Determinant Factor of Exercise Testing Performance in Pediatric Patients with Chronic Ventricular Pacing

Chronic right ventricular (RV) apical pacing has been associated with deterioration of functional capacity and chronotropic incompetence during exercise testing in children. The effects of alternative pacing site on exercise performance in pediatric population remain unknown. We evaluated the influence of ventricular pacing site on exercise capacity in pediatric patients with complete congenital atrioventricular block requiring permanent pacemaker therapy. Sixty-four children paced from RV apex (n = 26), RV midseptum (n = 15) and left ventricular (LV) apex (n = 23) were studied cross-sectionally. Treadmill exercise stress testing was performed according to modified Bruce protocol. LV apical pacing was associated with greater exercise capacity. In comparison with the other study groups, children with RV apical pacing showed significantly lower VO₂peak (37 ± 4.11; p = 0.003), O₂ pulse (8.78 ± 1.15; p = 0.006), metabolic equivalents (7 ± 0.15; p = 0.001) and exercise time (6 ± 3.28; p = 0.03). Worse values in terms of maximum heart rate (139 ± 8.83 bpm; p = 0.008) and chronotropic index (0.6 ± 0.08; p = 0.002) were detected in the RV apical pacing group although maximal effort (respiratory exchange ratio) did not differ among groups (p = 0.216). Pacing from RV apex (odds ratio 9.4; confidence interval 2.5-18.32; Wald 4.91; p = 0.0036) and low peak heart rate achieved (odds ratio 3.66; confidence interval 0.19-7.4; Wald 4.083; p = 0.015) predicted significantly decrease in exercise capacity. Duration of pacing, gender, VVIR mode, baseline heart rate and QRS duration had not significant impact on exercise capacity. The site of ventricular pacing has the major impact on exercise capacity in children requiring permanent pacing. Among the sites assessed, LV apex is related to the better exercise performance.

Effects of reduced-volume of sprint interval training and the time course of physiological and performance adaptations

This study sought to determine the time course of training adaptations to two different sprint interval training programmes with the same sprint: rest ratio (1:8) but different sprint duration. Nine participants (M: 7; F: 2) were assigned to 15-second training group (15TG) consisting of 4-6 × 15-second sprints interspersed with 2-minute recovery, whereas eight participants (M: 5; F: 3) were assigned to 30-second training group (30TG) consisting of 4-6 × 30 second sprints interspersed with 4-minute recovery. Both groups performed their respective training twice per week over 9 weeks and changes in peak oxygen uptake (V˙O2peak) and time to exhaustion (TTE) were assessed every 3 weeks. Additional eight healthy active adults (M: 6; F: 2) completed the performance assessments 9 weeks apart without performing training (control group, CON). Following 9 weeks of training, both groups improved V˙O2peak (15TG: 12.1%; 30TG: 12.8%, P<.05) and TTE (15TG: 16.2%; 30TG: 12.8%, P<.01) to a similar extent. However, while both groups showed the greatest gains in V˙O2peak at 3 weeks (15TG: 16.6%; 30TG: 17.0%, P<.001), those in TTE were greatest at 9 weeks. CON did not change any of performance variables following 9 weeks. This study demonstrated that while the changes in cardiorespiratory function plateau within several weeks with sprint interval training, endurance capacity (TTE) is more sensitive to such training over a longer time frame in moderately-trained individuals. Furthermore, a 50% reduction in sprint duration does not diminish overall training adaptations over 9 weeks.

Case Studies in Physiology: Maximal oxygen consumption and performance in a centenarian cyclist

The purpose of this study was to examine the physiological characteristics of an elite centenarian cyclist who, at 101 yr old, established the 1-h cycling record for individuals ≥100 yr old (24.25 km) and to determine the physiological factors associated with his performance improvement 2 yr later at 103 yr old (26.92 km; +11%). Before each record, he performed an incremental test on a cycling ergometer. For 2 yr, he trained 5,000 km/yr with a polarized training that involved cycling 80% of mileage at "light" rate of perceived exertion (RPE) ≤12 and 20% at "hard" RPE ≥15 at a cadence between 50 and 70 rpm. His body weight and lean body mass did not change, while his maximal oxygen consumption (V̇o_2max) increased (31-35 ml·kg^-1·min^-1; +13%). Peak power output increased from 90 to 125 W (+39%), mainly because of increasing the maximal pedaling frequency (69-90 rpm; +30%). Maximal heart rate did not change (134-137 beats/min) in contrast to the maximal ventilation (57-70 l/min, +23%), increasing with both the respiratory frequency (38-41 cycles/min; +8%) and the tidal volume (1.5-1.7 liters; +13%). Respiratory exchange ratio increased (1.03-1.14) to the same extent as tolerance to V̇co₂ In conclusion, it is possible to increase performance and V̇o_2max with polarized training focusing on a high pedaling cadence even after turning 100 yr old.NEW & NOTEWORTHY This study shows, for the first time, that maximal oxygen consumption (+13%) and performance (+11%) can still be increased between 101 and 103 yr old with 2 yr of training and that a centenarian is able, at 103 yr old, to cover 26.9 km/h in 1 h.

Effect of yelling on maximal aerobic power during an incremental test of cycling performance

BACKGROUND

People experiencing strong feelings of fatigue during exercise sometimes subconsciously yell to refocus their efforts and, thus, maintain exercise performance. The present study examined the influence of yelling during high-intensity exercise by analysing cardiorespiratory reactions and integrated electromyography (iEMG) changes in the vastus lateralis during a cycle ergometer test.

METHODS

A total of 23 moderately trained people were recruited. The cycling test began with a resistance of 25 W/min, which was gradually increased. During the experimental trial, the participants were required to yell at least 3 times when they felt exhausted; during the controlled trial, they were not allowed to produce any yelling sounds. The testing order was randomly assigned and the 2 trials were completed within an interval between 3-10 days. Two-way repeated measures ANOVA was applied to analyse the differences within and between the trials, and interaction of trial and time.

RESULTS

The peak power and time to exhaustion (p < 0.01) in the yelling trial were higher than those in the control trial. However, the vastus lateralis iEMG values of both trials at peak power were not significantly different. During the yelling period at 90%-100% of the maximal effort, a significant time-by-trial interaction (p < 0.05) was observed in oxygen consumption (VO₂), CO₂ production, O₂ pulse, ventilation, and respiratory rate. All the above measures showed a significant between-trial difference (p < 0.02). However, heart rate, respiratory exchange ratio, end-tidal oxygen pressure, and ventilatory equivalent for oxygen showed only significant between-trial difference (p < 0.05), but without interaction of trial and time.

CONCLUSION

Yelling enhances the peak O₂ pulse and VO₂ and maintains CO₂-exclusion efficiency during high-intensity exercise. It may enable maintaining muscle activation without stronger EMG signals being required during high-intensity exercise.

Effects of high intensity interval versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients

Background. We tested the hypothesis that high intensity interval training (HIIT) would be more effective than moderate intensity continuous training (MIT) to improve newly emerged markers of cardiorespiratory fitness in coronary heart disease (CHD) patients, as the relationship between ventilation and carbon dioxide production (VE/VCO₂ slope), oxygen uptake efficiency slope (OUES), and oxygen pulse (O₂P). Methods. Seventy-one patients with optimized treatment were randomly assigned into HIIT (n = 23, age = 56 ± 12 years), MIT (n = 24, age = 62 ± 12 years), or nonexercise control group (CG) (n = 24, age = 64 ± 12 years). MIT performed 30 min of continuous aerobic exercise at 70–75% of maximal heart rate (HRmax), and HIIT performed 30 min sessions split in 2 min alternate bouts at 60%/90% HRmax (3 times/week for 16 weeks). Results. No differences among groups (before versus after) were found for VE/VCO₂ slope or OUES (P > 0.05). After training the O₂P slope increased in HIIT (22%, P < 0.05) but not in MIT (2%, P > 0.05), while decreased in CG (−20%, P < 0.05) becoming lower versus HIIT (P = 0.03). Conclusion. HIIT was more effective than MIT for improving O₂P slope in CHD patients, while VE/VCO₂ slope and OUES were similarly improved by aerobic training regimens versus controls.

Prediction of peak oxygen pulse (O2Ppeak) without exercise testing in older adults

Peak oxygen pulse has been considered a surrogate of cardiovascular function and an independent predictor of all cause mortality. However, O2P(peak) depends on maximal volitional effort which may limit its utility in older subjects. The aim of this study was to develop a model to estimate O2P(peak) without exercise in an elderly sample. This cross-sectional study enrolled 67 community-dwelling older adults (69.4±7.1 years; 41 men) for the non-exercise model development and 30 community-dwelling older adults (67.7±6.4 years; n=30; 17 men) for cross-validation. The non-exercise model was derived through hierarchical regression model and cross-validated by means of PRESS statistics and comparison against an independent sample. Classification accuracy of the model for tertiles of estimated and actual O2P(peak) was tested by gamma (γ) nonparametric correlation. The following prediction equation was generated: -3.416+0.137 × weight (kg)+1.226 × Veterans Specific Activity Questionnaire (VSAQ) (metabolic equivalents, METs)+1.987 × gender (0=women, 1=men)-2.045 × β-Blockers use (0=no, 1=yes)-0.044 × resting heart rate (HR) (R(2)=0.83; standard error of estimate (SEE)=1.68 mL beat(-1)). Correlation in cross-validation group was 0.80 (P<0.001). A high probability was observed for the model to rank the values in the same tertile in validation and cross-validation groups (γ=0.98; γ=0.92, respectively, P<0.05). In conclusion, O2P(peak) can be estimated with reasonable precision without exercise testing, providing an alternative for elder subjects not capable to perform maximal effort.

Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment

BACKGROUND

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterized, in part, by increased fatigue following minimal exertion, cognitive impairment, poor recovery to physical and other stressors, in addition to other symptoms. Unlike healthy subjects and other diseased populations who reproduce objective physiological measures during repeat cardiopulmonary exercise tests (CPETs), ME/CFS patients have been reported to fail to reproduce results in a second CPET performed one day after an initial CPET. If confirmed, a disparity between a first and second CPET could serve to identify individuals with ME/CFS, would be able to document their extent of disability, and could also provide a physiological basis for prescribing physical activity as well as a metric of functional impairment.

METHODS

22 subjects diagnosed with ME/CFS completed two repeat CPETs separated by 24 h. Measures of oxygen consumption (VO₂), heart rate (HR), minute ventilation (Ve), workload (Work), and respiratory exchange ratio (RER) were made at maximal (peak) and ventilatory threshold (VT) intensities. Data were analyzed using ANOVA and Wilcoxon's Signed-Rank Test (for RER).

RESULTS

ME/CFS patients showed significant decreases from CPET1 to CPET2 in VO₂peak (13.8%), HRpeak (9 bpm), Ve peak (14.7%), and Work@peak (12.5%). Decreases in VT measures included VO₂@VT (15.8%), Ve@VT (7.4%), and Work@VT (21.3%). Peak RER was high (≥1.1) and did not differ between tests, indicating maximum effort by participants during both CPETs. If data from only a single CPET test is used, a standard classification of functional impairment based on VO₂peak or VO₂@VT results in over-estimation of functional ability for 50% of ME/CFS participants in this study.

CONCLUSION

ME/CFS participants were unable to reproduce most physiological measures at both maximal and ventilatory threshold intensities during a CPET performed 24 hours after a prior maximal exercise test. Our work confirms that repeated CPETs warrant consideration as a clinical indicator for diagnosing ME/CFS. Furthermore, if based on only one CPET, functional impairment classification will be mis-identified in many ME/CFS participants.

Exercise and its interactions with various aspects of man and animal lives

To review recently published papers in the Brazilian Scientific press on the general subject of physical exercise. All articles published in 2010/2011 found through the keyword exercise were collected from 11 Brazilian Journals. They were hand filtered to exclude all but original research papers. They were grouped according to subject categories and subcategories. A brief summary of all included articles was produced, comparing similar articles between them. The most commonly found interactions refer to exercise vs. the cardiovascular system, metabolism and the locomotor system, in this order. The volume of scientific research in the field is high and of sufficient quality to justify highlighting.

The slope of the oxygen pulse curve does not depend on the maximal heart rate in elite soccer players

INTRODUCTION

It is unknown whether an extremely high heart rate can affect oxygen pulse profile during progressive maximal exercise in healthy subjects.

OBJECTIVE

Our aim was to compare relative oxygen pulse (adjusted for body weight) curves in athletes at their maximal heart rate during treadmill cardiopulmonary exercise testing.

METHODS

A total of 180 elite soccer players were categorized in quartiles according to their maximum heart rate values (n = 45). Oxygen consumption, maximum heart rate and relative oxygen pulse curves in the extreme quartiles, Q1 and Q4, were compared at intervals corresponding to 10% of the total duration of a cardiopulmonary exercise testing.

RESULTS

Oxygen consumption was similar among all subjects during cardiopulmonary exercise testing; however subjects in Q1 started to exhibit lower maximum heart rate values when 20% of the test was complete. Conversely, the relative oxygen pulse was higher in this group when cardiopulmonary exercise testing was 40% complete (p<.01). Although the slopes of the lines were similar (p = .25), the regression intercepts differed (p<.01) between Q1 and Q4. During the last two minutes of testing, a flat or decreasing oxygen pulse was identified in 20% of the soccer players, and this trend was similar between subjects in Q1 and Q4.

CONCLUSION

Relative oxygen pulse curve slopes, which serve as an indirect and non-invasive surrogate for stroke volume, suggest that the stroke volume is similar in young and aerobically fit subjects regardless of the maximum heart rate reached.