Serial assessment of peak VO2 and VO2 kinetics early after heart transplantation

PURPOSE: Serial evaluation of aerobic metabolism and exercise tolerance early after heart transplantation (HT). METHODS: Fifteen heart transplant recipients (HTR), aged 52.0 +/- 9.9 yr (mean +/- SD), not undergoing structured rehabilitation programs, were tested two to four times during the first 2 yr post-HT. As a reference, a group of 11 healthy untrained controls (C) was utilized. Peak heart rate (peak HR), peak O2 uptake (peak VO2), and ventilatory threshold (VT) were determined during incremental bicycle exercise to voluntary exhaustion. VO2 kinetics were evaluated during constant-load exercise below VT, with determination of the duration of the "cardiodynamic" component (TDp) and of the time constant of the "primary" component (taup). RESULTS: Peak VO2 (L.min-1) was positively related to months post-HT (y=1.17 + 0.02x, P=0.003), and it increased by approximately 30% during the investigated period, although values in HTR were lower than in C (2.19 +/- 0.24). Peak HR was lower in HTR (136 +/- 15 beats.min-1) than in C (168 +/- 5), and it was not related to time post-HT. TDp was longer in HTR (31.4 +/- 6.3 s) than in C (23.2 +/- 6.1), and it was not related to time post-HT. A subgroup of HTR with markedly longer taup during the first months post-HT showed a significant decrease of this parameter as a function of time post-HT. CONCLUSIONS: Aerobic metabolism is impaired in HTR. Both central (cardiovascular) and peripheral (skeletal muscle) factors contribute to the reduced exercise tolerance. HTR showed, during the first 2 yr post-HT, a significant increase in peak VO2 and (in the patients with the slowest VO2 kinetics during the first months after HT) a significant improvement of the VO2 kinetics. The main gains seem to occur at the peripheral level.     

Exercise-induced hypoxaemia in highly trained athletes

Traditionally, the pulmonary system has not been considered the limiting factor in determining maximal oxygen uptake (VO2max) in healthy individuals since arterial oxygen-haemoglobin saturation is thought to remain high during intense exercise. However, there appears to be a major exception to this rule. Recent evidence suggests that arterial hypoxaemia results during heavy exercise in well trained individuals with a high VO2max. Further, the degree of arterial desaturation is inversely related to VO2max. This exercise-induced hypoxaemia does not appear to be due to hypoventilation although athletes who have limited hyperventilation seem to exhibit the lowest arterial oxygen-haemoglobin saturation. A significant venoarterial shunt has been ruled out as a primary cause of the hypoxaemia based on both experimental and theoretical considerations. Therefore, it appears that the exercise-induced hypoxaemia seen in highly trained athletes during heavy exercise is primarily due to diffusion limitations and ventillation-perfusion inequality. It is postulated that incomplete diffusion in the healthy lung may be due to a rapid red blood cell transit time through the pulmonary capillary. In summary, recent findings suggest that the limits of the human pulmonary system may be reached or even exceeded during intense exercise in some individuals. In light of these findings the role of the pulmonary system as a limiting factor during maximal exercise in the highly trained endurance athlete warrants further investigation.     

Shoulder pain: a comparison of wheelchair athletes and nonathletic wheelchair users

PURPOSE: The purpose of this study was to directly compare the onset and prevalence of shoulder pain in athletic and nonathletic wheelchair users. METHODS: A questionnaire was distributed to athletic and nonathletic wheelchair-dependent populations. This inquired about presence and duration of shoulder pain, age of subject, level of injury, duration of time since injury, wheelchair use, involvement in sports, and training habits. A total of 257 subjects were involved in the study. RESULTS: The odds of having shoulder pain were twice as high among nonathletes as they were among athletes. This finding represents a significant difference over and above age differences, differences in years spent in a wheelchair, and differences in level of spinal cord injury. Athletes also have an average of 12 yr free of shoulder pain after becoming wheelchair bound, whereas nonathletes have only 8 yr. CONCLUSION: Promotion of active exercise for wheelchair users is encouraged to decrease shoulder pain, resulting in more functional, pain-free years.     

Moment-knee angle relation in well trained athletes

The purpose of this work was to investigate whether different modes of long-term competitive physical activity cause functional differences in the moment-knee angle relation of the M. quadriceps femoris (QF). Therefore, a sample (n = 40) of young male competitive endurance runners, cyclists, triathletes and tennis players performed isometric maximal voluntary knee extensions (MVC) with their stronger leg at six different knee joint angles while keeping the hip joint angle constant. Muscle activation of QF-muscles during MVC was estimated using surface electromyography (EMG). Moments and EMG data of each subject were normalized to the largest value produced at any knee joint position [% Max.]. No significant differences in the normalized [% Max.] moment-knee angle relation of the QF were found between endurance runners, cyclists and triathletes. Despite few unsystematic exceptions, no functional differences in the normalized moment-knee angle relation of the QF occurred among tennis players and the endurance-oriented athletic groups. Obtained by curve fitting, the optimal knee joint angle for moment production was not significantly different among all athletic groups. We conclude that long-term competitive endurance running, cycling, triathlon and tennis do not provoke functional differences in the moment-knee angle relation of the whole QF.     

Validity of VO2max equations for aerobically trained males and females

PURPOSE: The purpose of this investigation was to cross-validate existing VO2max prediction equations on samples of aerobically trained males and females. METHODS: A total of 142 aerobically trained males (mean +/- SD; 39.0 +/- 11.1 yr, N = 93) and females (39.7 +/- 10.1 yr, N = 49) performed a maximal incremental test to determine actual VO2max on a cycle ergometer. The predicted VO2max values from 18 equations (nine for each gender) were compared with actual VO2max by examining the constant error (CE), standard error of estimate (SEE), correlation coefficient (r), and total error (TE). RESULTS: The results of this investigation indicated that all of the equations resulted in significant (P < 0.006) CE values ranging from -216 to 1415 mL x min(-1) for the males and 132 to 1037 mL x min(-1) for the females. In addition the SEE, r, and TE values ranged from 266 to 609 mL x min(-1), 0.36 to 0.88, and 317 to 1535 mL x min(-1), respectively. Furthermore, the lowest TE values for the males and females represented 10% and 12% of the mean actual VO2max values, respectively. CONCLUSIONS: The results of the analysis indicated that the two equations using age, body weight, and the power output achieved at VO2 as predictor variables had the lowest SEE (7.7-9.8% of actual VO2max) and TE (10-12% of actual VO2max) values and are recommended for estimating VO2max in aerobically trained males and females. The magnitude of the TE values (>or= 20% of actual VO2max) associated with the remaining 16 equations, however, were too large to be of practical value for estimating VO2max.     

The influence of ramp rate on VO2peak and "excess" VO2 during arm crank ergometry

The principal aim of this study was to examine how different ramp rates influenced the attainment of peak physiological responses during incremental arm crank ergometry (ACE). Additionally, the study examined whether there was any evidence for the development of an "excess" VO (2) during ACE due to upward curvi-linearity in the VO (2)-work rate relationship, and whether this was influenced by the ramp rate. Sixteen physically active, though non-specifically trained, men (mean +/- S age 30 +/- 8 years; height 1.79 +/- 0.07 m; body mass 84.7 +/- 13.2 kg) volunteered to participate. Having completed a familiarisation test, all subjects returned to the laboratory to complete two ramp tests on an electrically-braked ergometer in a counter-balanced order. Both ramp tests started at 60 W with work rate subsequently incremented by either 6 or 12 W . min (-1). Pulmonary gas exchange was measured breath-by-breath throughout the tests. Subjects achieved a greater final work rate during the 12 W . min (-1) test compared to the 6 W . min (-1) test (168 +/- 28 vs. 149 +/- 26 W; p < 0.001). The VO (2peak) (3.06 +/- 0.65 vs. 2.96 +/- 0.48 L . min (-1); p = 0.27), HR (peak) (179 +/- 15 vs. 177 +/- 16 b . min (-1); p = 0.17) and V.E (peak) (112 +/- 22 vs. 105 +/- 16 L . min (-1); p = 0.09) were not different between the tests, but VCO (2peak) (3.54 +/- 0.64 vs. 3.27 +/- 0.46 L . min (-1); p = 0.01) RER (peak) (1.17 +/- 0.07 vs. 1.11 +/- 0.06; p < 0.001), and end-exercise blood (lactate) (11.9 +/- 2.1 vs. 10.8 +/- 2.6 mmol . L (-1); p = 0.005) were all higher in the 12 W . min (-1) test. An "excess" VO (2) was observed in 13 out of 16 tests at 12 W . min (-1) and in 15 out of 16 tests at 6 W . min (-1). Neither the magnitude of the "excess" VO (2) (0.42 +/- 0.41 vs. 0.37 +/- 0.18 L . min (-1); p = 0.66) nor the VO (2) at which the V.O (2)-work rate relationship departed from linearity (2.17 +/- 0.34 vs. 2.18 +/- 0.32 L . min (-1); p = 0.94) were significantly different between the two ramp tests. These data indicate that differences in ramp rate within the range of 6 - 12 W . min (-1) influence the peak values of work rate, VCO (2) and RER, but do not influence peak values of VO (2) or HR during ACE. The development of an "excess" VO (2) appears to be a common feature of ramp exercise in ACE, although the mechanistic basis for this effect is presently unclear.     

The VO2max of recreational athletes before and after pregnancy.

This study was designed to test the hypothesis that pregnancy has an added training effect (increases "absolute" VO2max) in well-conditioned, recreational athletes. VO2max was measured serially in 20 nonpregnant recreational athletes who maintained their exercise within +/- 10% of initial levels over a 15-month period and 20 similar women who conceived and continued exercise at a reduced level during pregnancy with a return to within 20% of initial levels by 12 wk postpartum. Initially the two groups were similar in terms of age (30 +/- 1 vs 30 +/- 2 yr), weight 57.6 +/- 7.2 vs 59.7 +/- 7.5 kg), max pulse rate (189 +/- 8 vs 187 +/- 10 bpm), and absolute (3083 +/- 469 vs 3138 +/- 464 ml.min-1) VO2max. In the nonpregnant group the values obtained 15 months later were unchanged (weight = 57.8 +/- 6.6 kg, max pulse = 191 +/- 7 bpm, VO2max = 2977 +/- 397 ml.min-1) while those who conceived had a significant increase in absolute VO2max that was evident 12-20 wk postpartum and was maintained at the time of final testing 36-44 wk postpartum (3368 +/- 435 ml.min-1). Both weight (60.1 +/- 8.1 kg) and maximum pulse rate (185 +/- 12 bpm) were unchanged. These data indicate that pregnancy is followed by a small but significant increase in VO2max in recreational athletes who maintain a moderate to high level of exercise performance during and after pregnancy.     

Effects of training specificity on the lactate threshold and VO2 peak

We examined the effects of training specificity on the lactate threshold (LT) and VO2peak. Sixteen male subjects completed VO2peak/LT protocols on the cycle ergometer (CE) and treadmill (TM) before and after a training program. The subjects were assigned to run training (N = 5), cycle training (N = 6), and control groups (N = 5). Subjects trained 4 day/week for 10 weeks at approximately 89% of pre-training VO2peak. Results indicated that run training increased VO2 at LT (VO2LT) within both the CE and TM protocols (17.9 to 22.5 ml/kg.min-1 for CE, 22.7 to 36.0 ml/kg.min-1 for TM, p less than 0.05) with the 58.5% increase in VO2LT for TM being greater than the 30.3% increase for CE (p less than 0.05). Cycle training resulted in a 38.7% increase in CE VO2LT (19.7 to 27.4 ml/kg.min-1, p less than 0.05) with no significant improvement in TM VO2LT (23.6 to 24.0 ml/kg.min-1). Similar increases in VO2peak were observed for CE and TM protocols for both cycle and run training groups (VO2peak increased by 11.9 to 20.7% in both CE and TM regardless of training mode). No changes were observed in the control group for any variable. The present data suggest that increases in LT resulting from training may be specific to the mode of exercise.     

A new nonexercise-based VO2(max) equation for aerobically trained females

PURPOSE: The purposes of the present study were to (a) modify previously published VO2(max) equations using the constant error (CE) values for aerobically trained females, (b) cross-validate the modified equations to determine their accuracy for estimating VO2(max) in aerobically trained females, (c) derive a new nonexercise-based equation for estimating VO2(max) in aerobically trained females if the modified equations are found to be inaccurate, and (d) cross-validate the new VO2(max) equation using the PRESS statistic and an independent sample of aerobically trained females. METHODS: A total of 115 aerobically trained females (mean +/- SD: age = 38.5 +/- 9.4 yr) performed a maximal incremental test on a cycle ergometer to determine actual VO2(max). The predicted VO2(max) values from nine published equations were compared with actual VO2(max) by examining the CE, standard error of estimate (SEE), validity coefficient (r), and total error (TE). RESULTS: Cross-validation of the modified nonexercise-based equations on a random subsample of 50 subjects resulted in a %TE > or = 13% of the mean of actual VO2(max). Therefore, the following nonexercise-based VO2(max) equation was derived on a random subsample of 80 subjects: VO2(max) (mL x min(-1)) = 18.528 (weight in kg) + 11.993 (height in cm) - 17.197(age in yr) + 23.522 (h x wk(-1) of training) + 62.118 (intensity of training using the Borg 6-20) + 278.262 (natural log of years of training) - 1375.878 (R = 0.83, R2 adjusted = 0.67, and SEE = 259 mL x min(-1)). Cross-validation of this equation on the remaining sample of 35 subjects resulted in a %TE of 10%. CONCLUSIONS: The nonexercise equation presented here is recommended over previously published equations for estimating VO2(max) in aerobically trained females.     

Ventilatory threshold in various groups of highly trained athletes

The ventilatory threshold (VT) was determined on a treadmill in highly trained male marathon, male and female long-distance, young male long-distance, adult male and female and young female middle-distance runners, modern pentathlonists, adult canoeists of both sexes, young male canoeists and football players, and on a bicycle ergometer in table tennis players, water slalom paddlers, young female canoeists rowers, and ice hockey players. Young female canoeists were also examined on the paddling ergometer and rowers on the rowing ergometer. VT expressed in %VO2 max was higher the longer the duration of racing performance (in marathoners 86.7%). %VO2 max at the VT level depends on the type of load and is higher the better the organism is adapted to a load. In young female canoeists and rowers examined on the bicycle ergometer, we found the VT level at 74.2% and 74.6% of %VO2 max, respectively. In the case of specific loading, we recorded 84.8% and 85.0% of %VO2 max, respectively, in the same athletes. In the case of nonspecific loading highly trained individuals may have low VT values close to the level characteristic for normal subjects. In relatively equally trained young and adult athletes we did not find significant differences in %VO2 max at the VT level (for long-distance runners, 85.2% and 85.3%, respectively, in female middle-distance runners, 82.8% and 82.7%, respectively, and in canoeists 81.3% and 78.9% of %VO2 max, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Fluid ingestion attenuates the decline in VO2peak associated with cardiovascular drift

INTRODUCTION/PURPOSE: This study investigated whether manipulation of cardiovascular drift (CV drift) by changing exercise duration or by fluid ingestion is associated with altered peak oxygen uptake VO(2peak). METHODS: VO(2peak) was measured in 11 trained men immediately after they cycled at 60% control VO(2max) in 30 degrees C, 40% relative humidity for 15, 60, and 120 min with no fluid (15 NF, 60 NF, 120 NF) or 120 min with fluid (120 F). Stroke volume (SV), heart rate (HR), and related measures were measured in 120 NF and 120 F at 15, 60, and 120 min. RESULTS: Body mass decreased 0.7, 2.3, and 3.7% in 120 F, 60 NF, and 120 NF. SV at the end of submaximal exercise and VO(2peak) measured immediately thereafter were reduced significantly (P < 0.05) from 15-min values in 120 NF (13.8 and 8.7%) but not in 60 NF (4.6 and 1.2%) or 120 F (2.1 and 1.9%). CONCLUSIONS: The progressive decline in SV during prolonged, constant-rate submaximal exercise in a warm environment, reflective of increased cardiovascular strain associated with hyperthermia, dehydration, and other changes that occur over time, reduces VO(2peak). Fluid ingestion improves performance in prolonged exercise, in part, by mitigating the decline in SV and its determinants, and preserving VO(2peak).     

Thermoregulatory and physiological responses of wheelchair athletes to prolonged arm crank and wheelchair exercise.

Seven wheelchair athletes participated in this study. On separate occasions all athletes performed 60 min of arm crank ergometry and wheelchair ergometry at 60% of the ergometer specific VO2peak in cool conditions (21.5+/-1.3 degrees C; 54.2+/-6.3% relative humidity, 21.2+/-1.9 degrees C; 55.5+/-11.9% relative humidity, respectively). The order of testing was randomised. Aural and skin temperatures were continually measured throughout the 60 min test. Expired air was collected at 5, 15, 30, 45, and 60 min during the exercise period. Oxygen consumption was similar for both trials (1.09+/-0.21 and 1.16+/-0.331 x min-(-1), for the ACE and WCE trials, respectively). Heat storage was calculated at these time-points. Aural temperature was elevated from rest between 25 to 45 min of wheelchair ergometry (0.5+/-0.3 degrees C; P < 0.05) when compared to between 20 min of exercise and 5 min of recovery (0.6+/-0.3 degrees C; P<0.05) during the arm crank ergometry trial. On the cessation of arm crank ergometry, heat storage was elevated above values observed at 5 min of exercise (P < 0.05). On the cessation of wheelchair ergometry, heat storage was not elevated above values at 5 minutes of exercise. Upper arm skin temperature was cooler during wheelchair ergometry when compared to arm crank ergometry (P<0.05). All other skin temperature responses were similar during both exercise modes. The efficiency of arm crank ergometry was greater than wheelchair ergometry throughout the exercise period (18.5+/-3.5 % and 8.9+/-3.7% at 60 minutes of exercise, respectively; P < 0.05). The results of this study suggest that although ACE demonstrates greater efficiency than WCE prolonged arm crank ergometry elicited greater thermal and physiological strain when compared with prolonged wheelchair ergometry. The lower thermal strain during WCE was suggested to be related to the propulsion biomechanics which may result in some degree of local cooling, and consequently heat dissipation, when compared to ACE. Due to the greater thermal strain during arm crank ergometry, it is recommended that for studies examining the exercise responses of wheelchair users wheel-chair ergometry should be employed.     

Aerobic and anaerobic power of Canadian wheelchair track athletes

The aerobic and anaerobic capabilities of six wheelchair track athletes were determined on a wheelchair ergometer prior to their competition in the 7th World Wheelchair Games. The sample included two male tetraplegics, one female paraplegic, and three male paraplegics, each in different competitive classifications. The evaluation of the anaerobic capabilities of the athletes involved determination of the total work accomplished during a 30-s all-out effort and the peak power output (PO) during a 5-s interval of this test. Aerobic capability was determined as the peak oxygen uptake and associated PO over a 1-min time period during a continuous progressive intensity test to exhaustion. Peak oxygen uptakes ranged from 1.00 to 3.43 1 X min-1 (16.9 to 50.7 ml X kg-1 X min-1) and aerobic PO from 19 to 120 W. Peak anaerobic PO was 21 to 70% higher (31 to 148 W) than aerobic PO, and total work in 30 s ranged from 740 to 4345 J. The male paraplegics displayed the highest values while the class 1A tetraplegic had the lowest. These laboratory findings were in general agreement with the athletes' performances in their track events.     

Postexercise hypotension in moderately trained athletes after maximal exercise

PURPOSE: A similar postexercise hypotension (PEH) has been reported in sedentary and mildly endurance-trained individuals of both sexes after a single dynamic submaximal exercise. In endurance-trained men, the hypotension was associated with a reduction of cardiac output, whereas the peripheral vasodilatation was the main mechanism of this fall in other groups. The present study investigated the occurrence and mechanisms of PEH after a short maximal exercise in professional soccer players with greater endurance capacity than previously reported in PEH studies. METHODS: Arterial blood pressure, cardiac output (Q), heart rate (HR), and diffusing lung capacity for carbon monoxide (DLCO) before and 30 and 60 min after short maximal field exercise were studied in 20 professional soccer players. RESULTS: Diastolic blood pressure (DBP) and systolic blood pressure (SBP), Q, stroke volume, and DLCO decreased, whereas HR increased at both times after exercise. Decreases in DBP were greater in subjects with lesser VO2max (r = -0.73, P = 0.0001), whereas SBP was more decreased the higher it was at baseline (r = 0.51, P = 0.023). Total peripheral resistance (TPR) did not change significantly after exercise. CONCLUSION: These findings indicate that, in moderately trained athletes, postexercise hypotension is associated primarily with reduced cardiac output because of reduced stroke volume, suggesting venous pooling. In addition, the occurrence of hypotension is more frequent in trained subjects with lower cardiopulmonary fitness level or higher resting SBP.     

Hemoglobin desaturation in highly trained athletes during heavy exercise

It has been generally accepted that during exercise at sea level, the pulmonary system of normal, healthy individuals is capable of maintaining arterial oxygen tension at near resting levels. However, recent evidence questions whether this generalization applies to the highly trained endurance athlete who is capable of achieving very high levels of metabolic demand. Hence, the purpose of these experiments was to examine the relationship between maximal oxygen consumption (VO2max) and arterial oxygen-hemoglobin saturation (%SaO2) during short-term heavy exercise in trained athletes and untrained individuals. Ten trained distance runners and 7 untrained males exercised at 95% of VO2max for 3 min. Minute-by-minute measurement of %SaO2 was obtained via ear oximetry. The correlation coefficients between %SaO2 and VO2max during exercise were r = -0.68, r = -0.74, and r = -0.72 (P less than 0.05) for minutes 1 through 3, respectively. In general those individuals with the highest VO2max showed the greatest decrease in %SaO2. By comparison there was no difference (P greater than 0.05) in resting %SaO2 between the trained (96.3 +/- 0.2% [SE]) and the untrained (96.3 +/- 0.4%) subjects. However, at minute 3 of exercise, %SaO2 was significantly lower (P less than 0.05) in the trained subjects (87.0 +/- 0.7%) than in the untrained subjects (92.6 +/- 0.7%). These data demonstrate that arterial desaturation occurs in healthy, highly trained endurance athletes during heavy exercise and that the level of the arterial desaturation is inversely related to VO2max.