Muscle oxygen transport and utilization in heart failure: implications for exercise (in)tolerance

The defining characteristic of chronic heart failure (CHF) is an exercise intolerance that is inextricably linked to structural and functional aberrations in the O(2) transport pathway. CHF reduces muscle O(2) supply while simultaneously increasing O(2) demands. CHF severity varies from moderate to severe and is assessed commonly in terms of the maximum O(2) uptake, which relates closely to patient morbidity and mortality in CHF and forms the basis for Weber and colleagues' (167) classifications of heart failure, speed of the O(2) uptake kinetics following exercise onset and during recovery, and the capacity to perform submaximal exercise. As the heart fails, cardiovascular regulation shifts from controlling cardiac output as a means for supplying the oxidative energetic needs of exercising skeletal muscle and other organs to preventing catastrophic swings in blood pressure. This shift is mediated by a complex array of events that include altered reflex and humoral control of the circulation, required to prevent the skeletal muscle "sleeping giant" from outstripping the pathologically limited cardiac output and secondarily impacts lung (and respiratory muscle), vascular, and locomotory muscle function. Recently, interest has also focused on the dysregulation of inflammatory mediators including tumor necrosis factor-α and interleukin-1β as well as reactive oxygen species as mediators of systemic and muscle dysfunction. This brief review focuses on skeletal muscle to address the mechanistic bases for the reduced maximum O(2) uptake, slowed O(2) uptake kinetics, and exercise intolerance in CHF. Experimental evidence in humans and animal models of CHF unveils the microvascular cause(s) and consequences of the O(2) supply (decreased)/O(2) demand (increased) imbalance emblematic of CHF. Therapeutic strategies to improve muscle microvascular and oxidative function (e.g., exercise training and anti-inflammatory, antioxidant strategies, in particular) and hence patient exercise tolerance and quality of life are presented within their appropriate context of the O(2) transport pathway.

The role of vascular function on exercise capacity in health and disease

Three sentinel parameters of aerobic performance are the maximal oxygen uptake ( V ̇ O 2 max ), critical power (CP) and speed of the V ̇ O 2 kinetics following exercise onset. Of these, the latter is, perhaps, the cardinal test of integrated function along the O2 transport pathway from lungs to skeletal muscle mitochondria. Fast V ̇ O 2 kinetics demands that the cardiovascular system distributes exercise-induced blood flow elevations among and within those vascular beds subserving the contracting muscle(s). Ideally, this process must occur at least as rapidly as mitochondrial metabolism elevates V ̇ O 2 . Chronic disease and ageing create an O2 delivery (i.e. blood flow × arterial [O2 ], Q ̇ O 2 ) dependency that slows V ̇ O 2 kinetics, decreasing CP and V ̇ O 2 max , increasing the O2 deficit and sowing the seeds of exercise intolerance. Exercise training, in contrast, does the opposite. Within the context of these three parameters (see Graphical Abstract), this brief review examines the training-induced plasticity of key elements in the O2 transport pathway. It asks how structural and functional vascular adaptations accelerate and redistribute muscle Q ̇ O 2 and thus defend microvascular O2 partial pressures and capillary blood-myocyte O2 diffusion across a ∼100-fold range of muscle V ̇ O 2 values. Recent discoveries, especially in the muscle microcirculation and Q ̇ O 2 -to- V ̇ O 2 heterogeneity, are integrated with the O2 transport pathway to appreciate how local and systemic vascular control helps defend V ̇ O 2 kinetics and determine CP and V ̇ O 2 max in health and how vascular dysfunction in disease predicates exercise intolerance. Finally, the latest evidence that nitrate supplementation improves vascular and therefore aerobic function in health and disease is presented.

A validated model of oxygen uptake and circulatory dynamic interactions at exercise onset in humans

At the onset of muscular exercise, the kinetics of pulmonary O2 uptake (Vo2P) reflect the integrated dynamic responses of the ventilatory, circulatory, and neuromuscular systems for O2 transport and utilization. Muscle O2 uptake (Vo2m) kinetics, however, are dissociated from Vo2P kinetics by intervening O2 capacitances and the dynamics of the circulation and ventilation. We developed a multicompartment computational model (MCM) to investigate these dynamic interactions and optimized and validated the MCM using previously published, simultaneously measured Vo2m, alveolar O2 uptake (Vo2A), and muscle blood flow (Qm) in healthy young men during cycle ergometry. The model was used to show that 1) the kinetics of Vo2A during exercise transients are very sensitive to preexercise blood flow distribution and the absolute value of Qm, 2) a low preexercise Qm exaggerates the magnitude of the transient fall in venous O2 concentration for any given Vo2m kinetics, necessitating a tighter coupling of Qm/Vo2m (or a reduction in the available work rate range) during the exercise transient to avoid limits to O2 extraction, and 3) information regarding exercise-related alterations in O2 uptake and blood flow in nonexercising tissues and their effects on mixed venous O2 concentration is required to accurately predict Vo2A kinetics from knowledge of Vo2m and Qm dynamics. Importantly, these data clearly demonstrate that Vo2A kinetics are nonexponential, nonlinear distortions of Vo2m kinetics that can be explained in a MCM by interactions among circulatory and cellular respiratory control processes before and during exercise.

Data collection, handling, and fitting strategies to optimize accuracy and precision of oxygen uptake kinetics estimation from breath-by-breath measurements

Phase 2 pulmonary oxygen uptake kinetics (ϕ2 τV̇o_2P) reflect muscle oxygen consumption dynamics and are sensitive to changes in state of training or health. This study identified an unbiased method for data collection, handling, and fitting to optimize V̇o_2P kinetics estimation. A validated computational model of V̇o_2P kinetics and a Monte Carlo approach simulated 2 × 10⁵ moderate-intensity transitions using a distribution of metabolic and circulatory parameters spanning normal health. Effects of averaging (interpolation, binning, stacking, or separate fitting of up to 10 transitions) and fitting procedures (biexponential fitting, or ϕ2 isolation by time removal, statistical, or derivative methods followed by monoexponential fitting) on accuracy and precision of V̇o_2P kinetics estimation were assessed. The optimal strategy to maximize accuracy and precision of τV̇o_2P estimation was 1-s interpolation of 4 bouts, ensemble averaged, with the first 20 s of exercise data removed. Contradictory to previous advice, we found optimal fitting procedures removed no more than 20 s of ϕ1 data. Averaging method was less critical: interpolation, binning, and stacking gave similar results, each with greater accuracy compared with analyzing repeated bouts separately. The optimal procedure resulted in ϕ2 τV̇o_2P estimates for transitions from an unloaded or loaded baseline that averaged 1.97 ± 2.08 and 1.04 ± 2.30 s from true, but were within 2 s of true in only 47-62% of simulations. Optimized 95% confidence intervals for τV̇o_2P ranged from 4.08 to 4.51 s, suggesting a minimally important difference of ~5 s to determine significant changes in τV̇o_2P during interventional and comparative studies.NEW & NOTEWORTHY We identified an unbiased method to maximize accuracy and precision of oxygen uptake kinetics (τV̇o_2P) estimation. The optimum number of bouts to average was four; interpolation, bin, and stacking averaging methods gave similar results. Contradictory to previous advice, we found that optimal fitting procedures removed no more than 20 s of phase 1 data. Our data suggest a minimally important difference of ~5 s to determine significant changes in τV̇o_2P during interventional and comparative studies.

August Krogh's theory of muscle microvascular control and oxygen delivery: a paradigm shift based on new data

August Krogh twice won the prestigious international Steegen Prize, for nitrogen metabolism (1906) and overturning the concept of active transport of gases across the pulmonary epithelium (1910). Despite this, at the beginning of 1920, the consummate experimentalist was relatively unknown worldwide and even among his own University of Copenhagen faculty. But, in early 1919, he had submitted three papers to Dr Langley, then editor of The Journal of Physiology in England. These papers coalesced anatomical observations of skeletal muscle capillary numbers with O₂ diffusion theory to propose a novel active role for capillaries that explained the prodigious increase in blood-muscle O₂ flux from rest to exercise. Despite his own appraisal of the first two papers as "rather dull" to his friend, the eminent Cambridge respiratory physiologist, Joseph Barcroft, Krogh believed that the third one, dealing with O₂ supply and capillary regulation, was"interesting". These papers, which won Krogh an unopposed Nobel Prize for Physiology or Medicine in 1920, form the foundation for this review. They single-handedly transformed the role of capillaries from passive conduit and exchange vessels, functioning at the mercy of their upstream arterioles, into independent contractile units that were predominantly closed at rest and opened actively during muscle contractions in a process he termed 'capillary recruitment'. Herein we examine Krogh's findings and some of the experimental difficulties he faced. In particular, the boundary conditions selected for his model (e.g. heavily anaesthetized animals, negligible intramyocyte O₂ partial pressure, binary open-closed capillary function) have not withstood the test of time. Subsequently, we update the reader with intervening discoveries that underpin our current understanding of muscle microcirculatory control and place a retrospectroscope on Krogh's discoveries. The perspective is presented that the imprimatur of the Nobel Prize, in this instance, may have led scientists to discount compelling evidence. Much as he and Marie Krogh demonstrated that active transport of gases across the blood-gas barrier was unnecessary in the lung, capillaries in skeletal muscle do not open and close spontaneously or actively, nor is this necessary to account for the increase in blood-muscle O₂ flux during exercise. Thus, a contemporary model of capillary function features most muscle capillaries supporting blood flow at rest, and, rather than capillaries actively vasodilating from rest to exercise, increased blood-myocyte O₂ flux occurs predominantly via elevating red blood cell and plasma flux in already flowing capillaries. Krogh is lauded for his brilliance as an experimentalist and for raising scientific questions that led to fertile avenues of investigation, including the study of microvascular function.

Prior exercise speeds pulmonary oxygen uptake kinetics and increases critical power during supine but not upright cycling

NEW FINDINGS

What is the central question of this study? Critical power (CP) represents the highest work rate for which a metabolic steady state is attainable. The physiological determinants of CP are unclear, but research suggests that CP might be related to the time constant of phase II oxygen uptake kinetics (τV̇O2). What is the main finding and its importance? We provide the first evidence that τV̇O2 is mechanistically related to CP. A reduction of τV̇O2 in the supine position was observed alongside a concomitant increase in CP. This effect may be contingent on measures of oxygen availability derived from near-infrared spectroscopy. Critical power (CP) is a fundamental parameter defining high-intensity exercise tolerance and is related to the time constant of phase II pulmonary oxygen uptake kinetics (τV̇O2). To test the hypothesis that this relationship is causal, we determined the impact of prior exercise ('priming') on CP and τV̇O2 in the upright and supine positions. Seventeen healthy men were assigned to either upright or supine exercise groups, whereby CP, τV̇O2 and muscle deoxyhaemoglobin kinetics (τ_[HHb] ) were determined via constant-power tests to exhaustion at four work rates with (primed) and without (control) priming exercise at ∼31%Δ. During supine exercise, priming reduced τV̇O2 (control 54 ± 18 s versus primed 39 ± 11 s; P < 0.001), increased τ_[HHb] (control 8 ± 4 s versus primed 12 ± 4 s; P = 0.003) and increased CP (control 177 ± 31 W versus primed 185 ± 30 W, P = 0.006) compared with control conditions. However, priming exercise had no effect on τV̇O2 (control 37 ± 12 s versus primed 35 ± 8 s; P = 0.82), τ_[HHb] (control 10 ± 5 s versus primed 14 ± 10 s; P = 0.10) or CP (control 235 ± 42 W versus primed 232 ± 35 W; P = 0.57) during upright exercise. The concomitant reduction of τV̇O2 and increased CP following priming in the supine group, effects that were absent in the upright group, provide the first experimental evidence that τV̇O2 is mechanistically related to critical power. The increased τ_[HHb+Mb] suggests that this effect was mediated, at least in part, by improved oxygen availability.

Top 10 Research Questions Related to Youth Aerobic Fitness

Peak oxygen uptake ([Formula: see text]₂) is internationally recognized as the criterion measure of youth aerobic fitness, but despite pediatric data being available for almost 80 years, its measurement and interpretation in relation to growth, maturation, and health remain controversial. The trainability of youth aerobic fitness continues to be hotly debated, and causal mechanisms of training-induced changes and their modulation by chronological age, biological maturation, and sex are still to be resolved. The daily physical activity of youth is characterized by intermittent bouts and rapid changes in intensity, but physical activity of the intensity and duration required to determine peak [Formula: see text]₂ is rarely (if ever) experienced by most youth. In this context, it may therefore be the transient kinetics of pulmonary [Formula: see text]₂ that best reflect youth aerobic fitness. There are remarkably few rigorous studies of youth pulmonary [Formula: see text]₂ kinetics at the onset of exercise in different intensity domains, and the influence of chronological age, biological maturation, and sex during step changes in exercise intensity are not confidently documented. Understanding the trainability of the parameters of youth pulmonary [Formula: see text]₂ kinetics is primarily based on a few comparative studies of athletes and nonathletes. The underlying mechanisms of changes due to training require further exploration. The aims of the present article are therefore to provide a brief overview of aerobic fitness during growth and maturation, increase awareness of current controversies in its assessment and interpretation, identify gaps in knowledge, raise 10 relevant research questions, and indicate potential areas for future research.

Pulmonary O2 uptake and leg blood flow kinetics during moderate exercise are slowed by hyperventilation-induced hypocapnic alkalosis

The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (VO2p) and leg femoral conduit artery ("bulk") blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) approximately 40 mmHg] and sustained hyperventilation (Hypo; PetCO2 approximately 20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). VO2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (Delta[HHb])-, oxy (Delta[O2Hb])-, and total hemoglobin-myoglobin (Delta[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of VO2p, LBF, and Delta[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 VO2p (Hypo, 49+/-26 s; Con, 28+/-8 s) and LBF (Hypo, 46+/-16 s; Con, 23+/-6 s) were greater (P<0.05) in Hypo compared with Con. However, the mean response time for the overall Delta[HHb] response was not different between conditions (Hypo, 23+/-5 s; Con, 24+/-3 s), whereas the Delta[HHb] amplitude was greater (P<0.05) in Hypo (8.05+/-7.47 a.u.) compared with Con (6.69+/-6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given DeltaVO2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of VO2p (and muscle O2 utilization) kinetics.

Estimating oxygen uptake and energy expenditure during treadmill walking by neural network analysis of easy-to-obtain inputs

The study of oxygen uptake (V̇o₂) dynamics during walking exercise transitions adds valuable information regarding fitness. However, direct V̇o₂ measurements are not practical for general population under realistic settings. Devices to measure V̇o₂ are associated with elevated cost, uncomfortable use of a mask, need of trained technicians, and impossibility of long-term data collection. The objective of this study was to predict the V̇o₂ dynamics from heart rate and inputs from the treadmill ergometer by a novel artificial neural network approach. To accomplish this, 10 healthy young participants performed one incremental and three moderate constant work rate treadmill walking exercises. The speed and grade used for the moderate-intensity protocol was related to 80% of the V̇o₂ response at the gas exchange threshold estimated during the incremental exercise. The measured V̇o₂ was used to train an artificial neural network to create an algorithm able to predict the V̇o₂ based on easy-to-obtain inputs. The dynamics of the V̇o₂ response during exercise transition were evaluated by exponential modeling. Within each participant, the predicted V̇o₂ was strongly correlated to the measured V̇o₂ ( = 0.97 ± 0.0) and presented a low bias (~0.2%), enabling the characterization of the V̇o₂ dynamics during treadmill walking exercise. The proposed algorithm could be incorporated into smart devices and fitness equipment, making them suitable for tracking changes in aerobic fitness and physical health beyond the infrequent monitoring of patients during clinical interventions and rehabilitation programs.

The effects of intensity on V̇O2 kinetics during incremental free swimming

Swimming and training are carried out with wide variability in distances and intensities. However, oxygen uptake kinetics for the intensities seen in swimming has not been reported. The purpose of this study was to assess and compare the oxygen uptake kinetics throughout low-moderate to severe intensities during incremental swimming exercise. We hypothesized that the oxygen uptake kinetic parameters would be affected by swimming intensity. Twenty male trained swimmers completed an incremental protocol of seven 200-m crawl swims to exhaustion (0.05 m·s(-1) increments and 30-s intervals). Oxygen uptake was continuously measured by a portable gas analyzer connected to a respiratory snorkel and valve system. Oxygen uptake kinetics was assessed using a double exponential regression model that yielded both fast and slow components of the response of oxygen uptake to exercise. From low-moderate to severe swimming intensities changes occurred for the first and second oxygen uptake amplitudes (P ≤ 0.04), time constants (P = 0.01), and time delays (P ≤ 0.02). At the heavy and severe intensities, a notable oxygen uptake slow component (>255 mL·min(-1)) occurred in all swimmers. Oxygen uptake kinetics whilst swimming at different intensities offers relevant information regarding cardiorespiratory and metabolic stress that might be useful for appropriate performance diagnosis and training prescription.

Oxygen kinetics during 6-minute walk tests in patients with cardiovascular and pulmonary disease

BACKGROUND

The 6-Minute Walk Test (6MWT) is representative of daily-life activities and reflects the functional capacity of patients. The change of oxygen uptake (VO2) in the initial phase of low-intensity exercise (VO2 kinetics) can be used to assess submaximal exercise performance of patients.The objective of the following study was to analyse VO2 kinetics in patients with different pulmonary and cardiovascular diseases. In addition, we investigated the extent to which VO2 kinetics at the onset of the 6MWT were associated with exercise capacity, morbidity and mortality.

METHODS

VO2 kinetics of 204 patients and 16 healthy controls were obtained using mobile telemetric cardiopulmonary monitoring during a 6MWT. A new mean response time (MRT) index (wMRT) was developed to quantify VO2 kinetics by correcting MRT for work rate. The differences in wMRT between disease categories as well as the association between wMRT and patients' exercise capacity and outcome - time to hospitalization/death- were tested.

RESULTS

The assessment of a robust wMRT was feasible in 86% (244/284) patients. wMRT was increased in patients compared to healthy controls (p <0.001). wMRT was largest in patients with pulmonary arterial hypertension (PAH). There were significant associations between wMRT and exercise capacity in all patients. High wMRT was found to be associated with a high rate of death and re-hospitalization in patients with CHF (p = 0.024). In patients with pulmonary diseases and pulmonary hypertension wMRT was not associated with outcome (p = 0.952).

CONCLUSIONS

Submaximal exercise performance of patients is reduced. O2 kinetics at the onset of exercise are associated with exercise capacity in all patients. wMRT was found to be an important prognostic factor in patients with congestive heart failure (CHF), but not with pulmonary diseases.

VO₂FITTING: A Free and Open-Source Software for Modelling Oxygen Uptake Kinetics in Swimming and other Exercise Modalities

The assessment of oxygen uptake (VO₂) kinetics is a valuable non-invasive way to evaluate cardiorespiratory and metabolic response to exercise. The aim of the study was to develop, describe and evaluate an online VO₂ fitting tool (VO₂FITTING) for dynamically editing, processing, filtering and modelling VO₂ responses to exercise. VO₂FITTING was developed in Shiny, a web application framework for R language. Validation VO₂ datasets with both noisy and non-noisy data were developed and applied to widely-used models (n = 7) for describing different intensity transitions to verify concurrent validity. Subsequently, we then conducted an experiment with age-group swimmers as an example, illustrating how VO₂FITTING can be used to model VO₂ kinetics. Perfect fits were observed, and parameter estimates perfectly matched the known inputted values for all available models (standard error = 0; p < 0.001). The VO₂FITTING is a valid, free and open-source software for characterizing VO₂ kinetics in exercise, which was developed to help the research and performance analysis communities.

Limitations to exercise tolerance in type 1 diabetes: the role of pulmonary oxygen uptake kinetics and priming exercise

We compared the time constant (τV̇O2) of the fundamental phase of pulmonary oxygen uptake (V̇o₂) kinetics between young adult men with type 1 diabetes and healthy control subjects. We also assessed the impact of priming exercise on τV̇O2, critical power, and muscle deoxygenation in a subset of participants with type 1 diabetes. Seventeen men with type 1 diabetes and 17 healthy male control subjects performed moderate-intensity exercise to determine τV̇O2. A subset of seven participants with type 1 diabetes performed an additional eight visits, in which critical power, τV̇O2, and muscle deoxyhemoglobin + myoglobin ([HHb+Mb], via near-infrared spectroscopy) kinetics (described by a time constant, τ_[HHb+Mb]) were determined with (PRI) and without (CON) a prior 6-min bout of heavy exercise. τV̇O2 was greater in participants with type 1 diabetes compared with control subjects (type 1 diabetes 50 ± 13 vs. control 32 ± 12 s; P < 0.001). Critical power was greater in PRI compared with CON (PRI 161 ± 25 vs. CON 149 ± 22 W; P < 0.001), whereas τV̇O2 (PRI 36 ± 15 vs. CON 50 ± 21 s; P = 0.006) and τ_[HHb+Mb] (PRI 10 ± 5 vs. CON 17 ± 11 s; P = 0.037) were reduced in PRI compared with CON. Type 1 diabetes patients showed slower pulmonary V̇o₂ kinetics compared with control subjects; priming exercise speeded V̇o₂ and [HHb + Mb] kinetics and increased critical power in a subgroup with type 1 diabetes. These data therefore represent the first characterization of the power-duration relationship in type 1 diabetes and the first experimental evidence that τV̇O2 is an independent determinant of critical power in this population.NEW & NOTEWORTHY Patients with type 1 diabetes demonstrated slower oxygen uptake (V̇o₂) kinetics compared with healthy control subjects. Furthermore, a prior bout of high-intensity exercise speeded V̇o₂ kinetics and increased critical power in people with type 1 diabetes. Prior exercise speeded muscle deoxygenation kinetics, indicating that V̇o₂ kinetics in type 1 diabetes are limited primarily by oxygen extraction and/or intracellular factors. These findings highlight the potential for interventions that decrease metabolic inertia for enhancing exercise tolerance in this condition.

The Relationship Between Repeated-Sprint Ability, Aerobic Capacity, and Oxygen Uptake Recovery Kinetics in Female Soccer Athletes

This study investigated the relationship between repeated-sprint ability, aerobic capacity, and oxygen uptake kinetics during the transition between exercise and recovery (off-transient) in female athletes of an intermittent sport modality. Eighteen professional soccer players completed three tests: 1) a maximal incremental exercise test; 2) a constant speed time-to-exhaustion test; and 3) a repeated-sprint ability test consisting of six 40-m sprints with 20 s of passive recovery in-between. Correlations between time-to-exhaustion, repeated-sprint ability, and oxygen uptake kinetics were calculated afterwards. The level of significance was set at p < 0.05. A performance decrement during repeated-sprint ability was found to be related to: 1) time-to-exhaustion (e.g., exercise tolerance; r = -0.773, p < 0.001); 2) oxygen uptake recovery time (r = 0.601, p = 0.008); and 3) oxygen uptake mean response time of recovery (r = 0.722, p < 0.001). Moreover, the best sprint time (r = -0.601, p = 0.008) and the mean sprint time (r = -0.608, p = 0.007) were found to be related to maximal oxygen uptake. Collectively, these results reinforce the relation between oxygen uptake kinetics and the ability to maintain sprint performance in female athletes. These results may contribute to coaches and training staff of female soccer teams to focus on training and improve their athletes’ aerobic capacity and recovery capacity to improve intermittent exercise performance.

Elevated baseline work rate slows pulmonary oxygen uptake kinetics and decreases critical power during upright cycle exercise

Critical power is a fundamental parameter defining high-intensity exercise tolerance, and is related to the phase II time constant of pulmonary oxygen uptake kinetics (τV˙O2). Whether this relationship is causative is presently unclear. This study determined the impact of raised baseline work rate, which increases τV˙O2, on critical power during upright cycle exercise. Critical power was determined via four constant-power exercise tests to exhaustion in two conditions: (1) with exercise initiated from an unloaded cycling baseline (U→S), and (2) with exercise initiated from a baseline work rate of 90% of the gas exchange threshold (M→S). During these exercise transitions, τV˙O2 and the time constant of muscle deoxyhemoglobin kinetics (τ[HHb + Mb] ) (the latter via near-infrared spectroscopy) were determined. In M→S, critical power was lower (M→S = 203 ± 44 W vs. U→S = 213 ± 45 W, P = 0.011) and τV˙O2 was greater (M→S = 51 ± 14 sec vs. U→S = 34 ± 16 sec, P = 0.002) when compared with U→S. Additionally, τ[HHb + Mb] was greater in M→S compared with U→S (M→S = 28 ± 7 sec vs. U→S = 14 ± 7 sec, P = 0.007). The increase in τV˙O2 and concomitant reduction in critical power in M→S compared with U→S suggests a causal relationship between these two parameters. However, that τ[HHb + Mb] was greater in M→S exculpates reduced oxygen availability as being a confounding factor. These data therefore provide the first experimental evidence that τV˙O2 is an independent determinant of critical power. Keywords critical power, exercise tolerance, oxygen uptake kinetics, power-duration relationship, muscle deoxyhemoglobin kinetics, work-to-work exercise.

"Work-to-Work" exercise slows pulmonary oxygen uptake kinetics, decreases critical power, and increases W' during supine cycling

We have previously demonstrated that the phase II time constant of pulmonary oxygen uptake kinetics ( τ v ˙ o 2 ) is an independent determinant of critical power (CP) when O2 availability is not limiting, that is, during upright cycle exercise in young, healthy individuals. Whether this causative relationship remains when O2 availability is impaired remains unknown. During supine exercise, which causes an O2 availability limitation during the exercise transition, we therefore determined the impact of a raised baseline work rate on τ v ˙ o 2 and CP. CP, τ v ˙ o 2 , and muscle oxygenation status (the latter via near-infrared spectroscopy) were determined via four severe-intensity constant-power exercise tests completed in two conditions: (1) with exercise initiated from an unloaded cycling baseline (U→S), and (2) with exercise initiated from a moderate-intensity baseline work rate of 90% of the gas exchange threshold (M→S). In M→S, critical power was lower (U→S = 146 ± 39 W vs. M→S = 132 ± 33 W, P = 0.023) and τ v ˙ o 2 was greater (U→S = 45 ± 16 sec, vs. M→S = 69 ± 129 sec, P = 0.001) when compared to U→S. There was no difference in tissue oxyhemoglobin concentration ([HbO2  + MbO2 ]) at baseline or during exercise. The concomitant increase in τ v ˙ o 2 and reduction in CP during M→S compared to U→S shows for the first time that τ v ˙ o 2 is an independent determinant of CP in conditions where O2 availability is limiting.

Intra-dialytic training accelerates oxygen uptake kinetics in hemodialysis patients

BACKGROUND

End-stage renal disease is associated with several hemodynamic and peripheral muscle abnormalities that could slow the rate of change in oxygen uptake ([Formula: see text]O2) at the onset and at the end of exercise. This study was performed to determine whether an intra-dialytic aerobic training program would speed [Formula: see text]O2 kinetics at the transition to and from moderate and high-intensity exercise.

DESIGN

This study was a randomized controlled trial.

METHODS

Twenty-four patients with end-stage renal disease (14 females; 47.0 ± 11.9 years) were randomly assigned to either 12-week cycle ergometer-based training at moderate exertion or a similar control period. At initial and final evaluations, patients underwent 6 min moderate and high-intensity tests to exercise intolerance (Tlim).

RESULTS

Training improved Tlim by ∼90% (median (inter-quartile range) = 232 (59) s to 445 (451) s, p < 0.05); in contrast, Tlim decreased by ∼30% in controls (291 (134) s to 202 (131) s). [Formula: see text]O2 kinetics at the onset of moderate-intensity exercise were significantly accelerated with training leading to lower oxygen (O2) deficit (mean ± standard deviation (SD) = 3.2 ± 1.3 l vs 2.3 ± 1.2 l). Similar positive effects were found at the high-intensity test either at the onset of, or recovery from, exercise (p < 0.05). "Excess" [Formula: see text]O2 at the high-intensity test was also lessened with training. Changes in Tlim correlated with faster [Formula: see text]O2 kinetics and lower "excess" [Formula: see text]O2 (Spearman's ρ = -0.56 and -0.75, respectively; p < 0.01).

CONCLUSIONS

A symptom-targeted intra-dialytic training program improved sub-maximal aerobic metabolism and endurance exercise capacity. [Formula: see text]O2 kinetics are valuable in providing relatively effort-independent information on the efficacy of exercise interventions in this patient population.

Biophysical Impact of 5-Week Training Cessation on Sprint Swimming Performance

PURPOSE

To assess changes in swimming performance, anthropometrics, kinematics, energetics, and strength after 5-week training cessation.

METHODS

Twenty-one trained and highly trained swimmers (13 males: 17.4 [3.1] y; 50-m front crawl 463 [77] FINA points; 8 females: 16.7 [1.7] y; 50-m front crawl 535 [48] FINA points) performed a 50-m front-crawl all-out swim test, dryland and pool-based strength tests, and 10-, 15-, 20-, and 25-m front-crawl all-out efforts for anaerobic critical velocity assessment before and after a 5-week training cessation. Heart rate and oxygen uptake (V˙O2) were continuously measured before and after the 50-m swim test (off-kinetics).

RESULTS

Performance was impaired 1.9% (0.54 s) for males (P = .007, d = 0.91) and 2.9% (0.89 s) for females (P = .033, d = 0.93). Neither the anthropometrical changes (males: r2 = .516, P = .077; females: r2 = .096, P = .930) nor the physical activities that each participant performed during the off-season (males: r2 = .060, P = .900; females: r2 = .250, P = .734) attenuated performance impairments. Stroke rate and clean swimming speed decreased (P < .05), despite similar stroke length and stroke index (P > .05). Blood lactate concentrations remained similar (P > .05), but V˙O2 peak decreased in females (P = .04, d = 0.85). Both sexes showed higher heart rate before and after the 50-m swim test after 5 weeks (P < .05). Anaerobic metabolic power deterioration was only observed in males (P = .035, d = 0.65). Lower in-water force during tethered swimming at zero speed was observed in males (P = .033, d = 0.69). Regarding dryland strength, lower-body impairments were observed for males, while females showed upper-body impairments (P < .05).

CONCLUSIONS

A 5-week training cessation yielded higher heart rate in the 50-m front crawl, anaerobic pathways, and dryland strength impairments. Coaches should find alternatives to minimize detraining effects during the off-season.

Impact of type 2 diabetes on cardiorespiratory function and exercise performance

The aim of this study was to examine the impact of well‐controlled uncomplicated type 2 diabetes (T2D) on exercise performance. Ten obese sedentary men with T2D and nine control participants without diabetes matched for age, sex, and body mass index were recruited. Anthropometric characteristics, blood samples, resting cardiac, and pulmonary functions and maximal oxygen uptake (VO_2max) and ventilatory threshold were measured on a first visit. On the four subsequent visits, participants (diabetics: n = 6; controls: n = 7) performed step transitions (6 min) of moderate‐intensity exercise on an upright cycle ergometer from unloaded pedaling to 80% of ventilatory threshold. VO₂ (τVO₂) and HR (τHR) kinetics were characterized with a mono‐exponential model. VO_2max (27.0 ± 3.4 vs. 26.7 ± 5.0 mL kg⁻¹ min⁻¹; P = 0.85), τVO₂ (43 ± 6 vs. 43 ± 10 sec; P = 0.73), and τHR (42 ± 17 vs. 43 ± 13 sec; P = 0.94) were similar between diabetics and controls respectively. The remaining variables were also similar between groups, with the exception of lower maximal systolic blood pressure in diabetics (P = 0.047). These results suggest that well‐controlled T2D is not associated with a reduction in VO_2max or slower τVO₂ and τHR.

Aerobic system analysis based on oxygen uptake and hip acceleration during random over-ground walking activities

Deteriorated aerobic response to moderate exercise might precede the manifestation of clinical symptoms of noncommunicable diseases. The purpose of the current study was to verify that the use of current wearable technologies for analysis of pulmonary oxygen uptake (V̇o₂) dynamics during a pseudorandom ternary sequence (PRTS) over-ground walking protocol is a suitable procedure for the investigation of the aerobic response in more realistic settings. A wearable accelerometer located at the hip assessed the magnitude of the input changes delivered to the aerobic system. Eight adults (24 ± 4 yr old, 174 ± 7 cm, and 71.4 ± 7.4 kg) performed two identical PRTS over-ground walking protocols. In addition, they performed on the cycle ergometer two identical pseudorandom binary sequence (PRBS) protocols and one incremental protocol for maximal V̇o₂ determination. In the frequency domain, mean normalized gain amplitude (MNG in %) quantified V̇o₂ dynamics. The MNG during PRTS was correlated (r = -0.80, P = 0.01) with the V̇o₂ time constant (τ) obtained during cycling. The MNG estimated during PRBS was similar to the MNG estimated during PRTS (r = 0.80, P = 0.01). The maximal V̇o₂ correlated with the MNG obtained during the PRBS (r = 0.79, P = 0.01) and PRTS (r = 0.78, P = 0.02) protocols. In conclusion, PRTS over-ground walking protocol can be used to evaluate the aerobic system dynamics by the simultaneous measurement of V̇o₂ and hip acceleration. In addition, the aerobic response dynamics from PRBS and PRTS were correlated to maximal V̇o₂ This study has shown that wearable technologies in combination with assessment of MNG, a novel indicator of system dynamics, open new possibilities to monitor cardiorespiratory health under conditions that better simulate activities of daily living than cardiopulmonary exercise testing performed in a medical environment.

Linear and non-linear contributions to oxygen transport and utilization during moderate random exercise in humans

NEW FINDINGS

What is the central question of this study? The pulmonary oxygen uptake (pV̇O2) data used to study the muscle aerobic system dynamics during moderate-exercise transitions is classically described as a mono-exponential function controlled by a complex interaction of the oxygen delivery-utilization balance. This elevated complexity complicates the acquisition of relevant information regarding aerobic system dynamics based on pV̇O2 data during a varying exercise stimulus. What is the main finding and its importance? The elevated complexity of pV̇O2 dynamics is a consequence of a multiple-order interaction between muscle oxygen uptake and circulatory distortion. Our findings challenge the use of a first-order function to study the influences of the oxygen delivery-utilization balance over the pV̇O2 dynamics. The assumption of aerobic system linearity implies that the pulmonary oxygen uptake (pV̇O2) dynamics during exercise transitions present a first-order characteristic. The main objective of this study was to test the linearity of the oxygen delivery-utilization balance during random moderate exercise. The cardiac output (Q̇) and deoxygenated haemoglobin concentration ([HHb]) were measured to infer the central and local O₂ availability, respectively. Thirteen healthy men performed two consecutive pseudorandom binary sequence cycling exercises followed by an incremental protocol. The system input and the outputs pV̇O2, [HHb] and Q̇ were submitted to frequency-domain analysis. The linearity of the variables was tested by computing the ability of the response at a specific frequency to predict the response at another frequency. The predictability levels were assessed by the coefficient of determination. In a first-order system, a participant who presents faster dynamics at a specific frequency should also present faster dynamics at any other frequency. All experimentally obtained variables (pV̇O2, [HHb] and Q̇) presented a certainly degree of non-linearity. The local O₂ availability, evaluated by the ratio pV̇O2/[HHb], presented the most irregular behaviour. The overall [HHb] kinetics were faster than pV̇O2 and Q̇ kinetics. In conclusion, the oxygen delivery-utilization balance behaved as a non-linear phenomenon. Therefore, the elevated complexity of the pulmonary oxygen uptake dynamics is governed by a complex multiple-order interaction between the oxygen delivery and utilization systems.

The Slow Component of Oxygen Uptake and Efficiency in Resistance Exercises: A Comparison With Endurance Exercises

Introduction

There is a lack of information regarding the slow component of oxygen uptake (VO₂sc) and efficiency/economy in resistance exercises despite the crucial role played in endurance performance.

Purpose

this study aimed to compare the VO₂sc, efficiency/economy, metabolic, cardiorespiratory responses, rating of perceived effort and mechanical fatigue between cycling and half-squat (HS) exercises during a constant-load test at lactate threshold (LT₁) intensity.

Methods

Twenty-one healthy men were randomly assigned in a crossover design to perform cycle-ergometer or HS tests. The order of the two cycle ergometer tests was an incremental test for determining load-intensity in watts (W) at LT₁, followed by a constant-load test at the LT₁ intensity. For the three HS tests, the order was a 1RM test to determine the load (kg) corresponding to the 1RM percentages to be used during the second test, incremental HS exercise to establish the load (kg) at the LT₁ intensity, and finally, a constant-load HS test at the LT₁ intensity. A rest period of 48 h between each test was established. During the HS and cycle-ergometer constant-load tests, cardiorespiratory and metabolic responses were recorded. Lower limbs fatigue was determined by a jump test before and after the constant-load tests.

Results

A significant exercise mode × time interaction effect was detected in VO₂, heart rate, energy expenditure (EE), gross efficiency (GE), and economy (p < 0.05). A significant and sustained VO₂ raise was confirmed in HS exercise (p < 0.05) and a steady-state VO₂ was revealed in cycle-ergometer. A higher GE and economy were obtained in HS test than in cycle-ergometer exercise (p < 0.001). In both exercises, a non-significant decrease was observed in GE and economy (p > 0.05). Lower limbs fatigue was only detected after constant-load HS test.

Conclusion

Although the VO₂, heart rate and EE responses were higher in cycling exercise, the constant-load HS test induced a greater VO₂sc and EE raise than the cycling test in a predominantly aerobic metabolism. These results could explain a decrease observed in jump performance only after HS test. GE and economy could benefit from the eccentric phase of the HS exercise.

Relationship between maximal aerobic power with aerobic fitness as a function of signal-to-noise ratio

Efforts to better understand cardiorespiratory health are relevant for the future development of optimized physical activity programs. We aimed to explore the impact of the signal quality on the expected associations between the ability of the aerobic system in supplying energy as fast as possible during moderate exercise transitions with its maximum capacity to supply energy during maximal exertion. It was hypothesized that a slower aerobic system response during moderate exercise transitions is associated with a lower maximal aerobic power; however, this relationship relies on the quality of the oxygen uptake data set. Forty-three apparently healthy participants performed a moderate constant work rate (CWR) followed by a pseudorandom binary sequence (PRBS) exercise protocol on a cycle ergometer. Participants also performed a maximum incremental cardiopulmonary exercise testing (CPET). The maximal aerobic power was evaluated by the peak oxygen uptake during the CPET, and the aerobic fitness was estimated from different approaches for oxygen uptake dynamics analysis during the CWR and PRBS protocols at different levels of signal-to-noise ratio. The product moment correlation coefficient was used to evaluate the correlation level between variables. Aerobic fitness was correlated with maximum aerobic power, but this correlation increased as a function of the signal-to-noise ratio. Aerobic fitness is related to maximal aerobic power; however, this association appeared to be highly dependent on the data quality and analysis for aerobic fitness evaluation. Our results show that simpler moderate exercise protocols might be as good as maximal exertion exercise protocols to obtain indexes related to cardiorespiratory health.NEW & NOTEWORTHY Optimized methods for cardiorespiratory health evaluation are of great interest for public health. Moderate exercise protocols might be as good as maximum exertion exercise protocols to evaluate cardiorespiratory health. Pseudorandom or constant workload moderate exercise can be used to evaluate cardiorespiratory health.

Mean Normalized Gain: A New Method for the Assessment of the Aerobic System Temporal Dynamics during Randomly Varying Exercise in Humans

The temporal dynamics of the oxygen uptake ([Formula: see text]) during moderate exercise has classically been related to physical fitness and a slower [Formula: see text] dynamics was associated with deterioration of physical health. However, methods that better characterize the aerobic system temporal dynamics remain challenging. The purpose of this study was to develop a new method (named mean normalized gain, MNG) to systematically characterize the [Formula: see text] temporal dynamics. Eight healthy, young adults (28 ± 6 years old, 175 ± 7 cm and 79 ± 13 kg) performed multiple pseudorandom binary sequence cycling protocols on different days and time of the day. The MNG was calculated as the normalized amplitude of the [Formula: see text] signal in frequency-domain. The MNG was validated considering the time constant τ obtained from time-domain analysis as reference. The intra-subject consistency of the MNG was checked by testing the same participant on different days and times of the day. The MNG and τ were strongly negatively correlated (r = -0.86 and p = 0.005). The MNG measured on different days and periods of the day was similar between conditions. Calculations for the MNG have inherent filtering characteristics enhancing reliability for the evaluation of the aerobic system temporal dynamics. In conclusion, the present study successfully validated the use of the MNG for aerobic system analysis and as a potential complementary tool to assess changes in physical fitness.

Effects of heavy-intensity priming exercise on pulmonary oxygen uptake kinetics and muscle oxygenation in heart failure with preserved ejection fraction

Exercise intolerance is a hallmark feature in heart failure with preserved ejection fraction (HFpEF). Prior heavy exercise ("priming exercise") speeds pulmonary oxygen uptake (V̇o_2p) kinetics in older adults through increased muscle oxygen delivery and/or alterations in mitochondrial metabolic activity. We tested the hypothesis that priming exercise would speed V̇o_2p on-kinetics in patients with HFpEF because of acute improvements in muscle oxygen delivery. Seven patients with HFpEF performed three bouts of two exercise transitions: MOD1, rest to 4-min moderate-intensity cycling and MOD2, MOD1 preceded by heavy-intensity cycling. V̇o_2p, heart rate (HR), total peripheral resistance (TPR), and vastus lateralis tissue oxygenation index (TOI; near-infrared spectroscopy) were measured, interpolated, time-aligned, and averaged. V̇o_2p and HR were monoexponentially curve-fitted. TPR and TOI levels were analyzed as repeated measures between pretransition baseline, minimum value, and steady state. Significance was P < 0.05. Time constant (τ; tau) V̇o_2p (MOD1 49 ± 16 s) was significantly faster after priming (41 ± 14 s; P = 0.002), and the effective HR τ was slower following priming (41 ± 27 vs. 51 ± 32 s; P = 0.025). TPR in both conditions decreased from baseline to minimum TPR ( P < 0.001), increased from minimum to steady state ( P = 0.041) but remained below baseline throughout ( P = 0.001). Priming increased baseline ( P = 0.003) and minimum TOI ( P = 0.002) and decreased the TOI muscle deoxygenation overshoot ( P = 0.041). Priming may speed the slow V̇o_2p on-kinetics in HFpEF and increase muscle oxygen delivery (TOI) at the onset of and throughout exercise. Microvascular muscle oxygen delivery may limit exercise tolerance in HFpEF.