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Costa VAB, Midgley AW, Baumgart JK, Carroll S, Astorino TA, Schaun GZ, Fonseca GF, Cunha FA. Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols. PLoS One 2024; 19:e0299563. [PMID: 38547136 PMCID: PMC10977812 DOI: 10.1371/journal.pone.0299563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND AIM A plateau in oxygen uptake ([Formula: see text]) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake ([Formula: see text]) criteria have been shown to commonly underestimate the actual [Formula: see text]. The verification phase protocol might determine the occurrence of 'true' [Formula: see text] in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming 'true' [Formula: see text] in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest [Formula: see text] values attained in the CPET and verification phase. METHODS Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak [Formula: see text] from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in [Formula: see text] according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level [Formula: see text] data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots. RESULTS Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean [Formula: see text] values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1, p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar [Formula: see text] between the CPET and verification phase (p > 0.05, LoE: limited to strong). Across all 30 studies, [Formula: see text] was not affected by differences in test protocols (p > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher [Formula: see text] value in the verification phase versus the CPET or reported or supplied participant-level [Formula: see text] data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher [Formula: see text] value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher [Formula: see text] in the verification phase ranged from 0% to 88.9%). CONCLUSION Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited [Formula: see text], or a reproducible [Formula: see text], for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited [Formula: see text], or a reproducible [Formula: see text], however, more research reporting participant-level data is required before evidence-based guidelines can be given. TRIAL REGISTRATION PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.
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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, England, United Kingdom
| | - Julia K. Baumgart
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norway, University of Science and Technology, Trondheim, Norway
| | - Sean Carroll
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, England, United Kingdom
| | - Todd A. Astorino
- Department of Kinesiology, California State University, San Marcos, CA, United States of America
| | - Gustavo Z. Schaun
- Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Guilherme F. Fonseca
- 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
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Fonseca GF, Michalski AC, Ferreira AS, Costa VAB, Massaferri R, Farinatti P, Cunha FA. Is postexercise hypotension a method-dependent phenomenon in chronic stroke? A crossover randomized controlled trial. Clin Physiol Funct Imaging 2023. [PMID: 36646496 DOI: 10.1111/cpf.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study assessed the reproducibility of postexercise hypotension (PEH) detection after two bouts of mixed circuit training (MCT) using three approaches that accounts the pre-exercise values and/or a control session (CTL) to calculate PEH [i.e., ( A 1 = post - exercise - pre - exercise ${A}_{1}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise}$ ); ( A 2 = post - exercise - post - CTL ) $({A}_{2}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{post}{\rm{ \mbox{-} }}\text{CTL})$ ; A 3 = ( post - exercise - pre - exercise ) - ( post - CTL - pre - CTL ) ] ${A}_{3}=(\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise})-(\text{post}{\rm{ \mbox{-} }}\text{CTL}-\text{pre}{\rm{ \mbox{-} }}\text{CTL})]$ in chronic stroke (i.e., ≥6 months poststroke). The proportion of PEH responders determined using different cut-off values for PEH was also compared (4 mmHg vs. minimal detectable difference). METHODS Seven participants (age: 56 ± 12 years; time post-stroke: 91 ± 55 months) performed two bouts of MCT and a CTL. The MCT involved 10 exercises with 3 sets of 15-repetition maximum, with each set interspersed with 45 s of walking. The systolic (SBP) and diastolic (DBP) blood pressures were assessed 10-min before and every 10-min along 40-min after CTL and MCT. RESULTS The two-way random intraclass correlation coefficient for single measurements (ICC2,1 ) ranges for SBP were: A1 : 0.580-0.829, A2 : 0.937-0.994, A3 : 0.278-0.774; for DBP: A1 : 0.497-0.916, A2 : 0.133-0.969, A3 : 0.175-0.930. The proportion of PEH responders detected using 4 mmHg or the minimal detectable difference as cut-off values was not different in 97% of analyses (p > 0.05), and higher when using 4 mmHg in 3% of analyses (p = 0.031). The standard error of measurement was ≥4 mmHg in 47% of analyses for SBP, and 40% for DBP. CONCLUSIONS The most reliable approach for determining PEH in chronic stroke was to subtract the postexercise from the post-CTL values. The proportion of PEH responders was not affected by the cut-off values applied.
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Affiliation(s)
- Guilherme F Fonseca
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - André C Michalski
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Arthur S Ferreira
- Graduate Program in Rehabilitation Sciences, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Victor A B Costa
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Renato Massaferri
- Graduate Program in Operational Human Performance, Air Force University, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Felipe A Cunha
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Fonseca GF, Midgley AW, Billinger SA, Michalski AC, Costa VAB, Monteiro W, Farinatti P, Cunha FA. Acute effects of mixed circuit training on hemodynamic and cardiac autonomic control in chronic hemiparetic stroke patients: A randomized controlled crossover trial. Front Physiol 2022; 13:902903. [PMID: 35928565 PMCID: PMC9343773 DOI: 10.3389/fphys.2022.902903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: To investigate whether a single bout of mixed circuit training (MCT) can elicit acute blood pressure (BP) reduction in chronic hemiparetic stroke patients, a phenomenon also known as post-exercise hypotension (PEH). Methods: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and a single bout of MCT on separate days and in a randomized counterbalanced order. The MCT included 10 exercises with 3 sets of 15-repetition maximum per exercise, with each set interspersed with 45 s of walking. Systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP), cardiac output (Q), systemic vascular resistance (SVR), baroreflex sensitivity (BRS), and heart rate variability (HRV) were assessed 10 min before and 40 min after CTL and MCT. BP and HRV were also measured during an ambulatory 24-h recovery period. Results: Compared to CTL, SBP (∆-22%), DBP (∆-28%), SVR (∆-43%), BRS (∆-63%), and parasympathetic activity (HF; high-frequency component: ∆-63%) were reduced during 40 min post-MCT (p < 0.05), while Q (∆35%), sympathetic activity (LF; low-frequency component: ∆139%) and sympathovagal balance (LF:HF ratio: ∆145%) were higher (p < 0.001). In the first 10 h of ambulatory assessment, SBP (∆-7%), MAP (∆-6%), and HF (∆-26%) remained lowered, and LF (∆11%) and LF:HF ratio (∆13%) remained elevated post-MCT vs. CTL (p < 0.05). Conclusion: A single bout of MCT elicited prolonged PEH in chronic hemiparetic stroke patients. This occurred concurrently with increased sympathovagal balance and lowered SVR, suggesting vasodilation capacity is a major determinant of PEH in these patients. This clinical trial was registered in the Brazilian Clinical Trials Registry (RBR-5dn5zd), available at https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd. Clinical Trial Registration:https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd, identifier RBR-5dn5zd
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Affiliation(s)
- Guilherme F. Fonseca
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Sandra A. Billinger
- Department of Neurology at University of Kansas Medical Center, Kansas City, MO, United States
- KU Alzheimer’s Disease Center, Fairway, KS, United States
| | - André C. Michalski
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Victor A. B. Costa
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Walace Monteiro
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Felipe A. Cunha
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- *Correspondence: Felipe A. Cunha,
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Dos Santos TR, Billinger SA, Midgley AW, Michalski AC, Costa VAB, Fonseca GF, Cunha FA. Appetite and energy intake following a bout of circuit resistance training in chronic hemiparetic stroke patients: a preliminary randomized controlled trial. Top Stroke Rehabil 2022; 30:309-322. [PMID: 35112661 DOI: 10.1080/10749357.2022.2035577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The main aim of this study was to investigate the effects of circuit resistance training (CRT) on post-exercise appetite and energy intake in chronic hemiparetic stroke patients. A secondary aim was to evaluate the reproducibility of these effects. METHODS Seven participants met the eligibility criteria and, in a randomized order, participated in a non-exercise control session (CTL) and two bouts of CRT. The CRT involved 10 exercises with 3 sets of 15-repetition maximum per exercise, performed using a vertical loading approach, with each set interspersed with 45s of walking. Expired gases were carried out to calculate the net energy cost of the exercise and the relative energy intake post-CTL/CRT. Hunger, fullness, desire to eat, and energy intake were assessed at baseline and for 12 h after CTL and CRT. RESULTS Compared to CTL, hunger, desire to eat (P < .001), and relative energy intake (P < .05) were significantly lower after CRT, whereas the perception of fullness was significantly higher (P < .001). Significant differences between CTL and CRT were observed only for the first 9 h of the post-exercise period for hunger, fullness, and desire to eat (P < .05). No significant differences in appetite or relative energy intake were observed between the two bouts of CRT. CONCLUSIONS A bout of CRT elicited decreased post-exercise appetite and relative energy intake in chronic hemiparetic stroke patients. Decreased appetite perceptions lasted for around 9 h and were reproducible.
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Affiliation(s)
- Tatiana R Dos Santos
- 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
| | - Sandra A Billinger
- Department of Physical Therapy, And Rehabilitation Science and Athletic Training at University of Kansas Medical Center, Kansas City, Kansas, USA.,KU Alzheimer's Disease Center, Fairway, Kansas, USA
| | - Adrian W Midgley
- Department of Sport and Physical Activity, Edge Hill University, Lancashire, UK
| | - André C Michalski
- 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
| | - 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
| | - Guilherme F Fonseca
- 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
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Michalski AC, Fonseca GF, Costa VAB, Pryor TB, Junior PC, Lima TP, Cunha FA. Recovery Pattern of Cardiac Autonomic Control Following Aerobic Exercise with Different Volumes in Hypertensive Men. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561247.74944.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fonseca GF, Farinatti PTV, Midgley AW, Ferreira A, de Paula T, Monteiro WD, Cunha FA. Continuous and Accumulated Bouts of Cycling Matched by Intensity and Energy Expenditure Elicit Similar Acute Blood Pressure Reductions in Prehypertensive Men. J Strength Cond Res 2018; 32:857-866. [PMID: 29120987 DOI: 10.1519/jsc.0000000000002317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fonseca, GF, Farinatti, PTV, Midgley, AW, Ferreira, A, de Paula, T, Monteiro, WD, and Cunha, FA. Continuous and accumulated bouts of cycling matched by intensity and energy expenditure elicit similar acute blood pressure reductions in prehypertensive men. J Strength Cond Res 32(3): 857-866, 2018-This study investigated differences in postexercise hypotension (PEH) after continuous vs. accumulated isocaloric bouts of cycling. Ten prehypertensive men, aged 23-34 years, performed 2 bouts of cycling at 75% oxygen uptake reserve, with total energy expenditures of 400 kcal per bout. One exercise bout was performed continuously (CONTIN) and the other as 2 smaller bouts each expending 200 kcal (INTER1 and INTER2). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and cardiac autonomic control were monitored in a supine position for 10 minutes before and 60 minutes after each exercise bout, and during a control session. Compared with control, blood pressure was significantly reduced after CONTIN (SBP: [INCREMENT] - 3.4 mm Hg, p < 0.001; MAP: [INCREMENT] - 2.5 mm Hg, p = 0.001), INTER1 (SBP: [INCREMENT] - 2.2 mm Hg, p = 0.045), and INTER2 (SBP: [INCREMENT] - 4.4 mm Hg, p < 0.001; DBP: [INCREMENT] - 2.7 mm Hg, p = 0.045; MAP: [INCREMENT] - 3.3 mm Hg, p = 0.001). The PEH was similar in CONTIN and INTER2, whereas INTER2 elicited greater PEH than INTER1 (SBP and MAP: [INCREMENT] - 2.0 and [INCREMENT] - 1.8 mm Hg, respectively, p ≤ 0.05). Increases in sympathovagal balance from baseline were inversely related to changes in SBP and DBP after CONTIN and INTER2 (r = -0.64 to -0.71; p = 0.021-0.047). These findings indicate that similar amounts of PEH are observed when exercise is performed as a single 400-kcal exercise bout or 2 × 200-kcal bouts and that the exercise recovery pattern of cardiac autonomic activity may be important in eliciting PEH.
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Affiliation(s)
- Guilherme F Fonseca
- Post-Graduate Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Paulo T V Farinatti
- Post-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.,Post-Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil
| | - Adrian W Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, England
| | - Arthur Ferreira
- Post-Graduate Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Tainah de Paula
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Post-Graduate Program in Medical Sciences, Faculty of Medical Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Walace D Monteiro
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Post-Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil
| | - Felipe A Cunha
- Post-Graduate Program in Rehabilitation Sciences, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil.,Post-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
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