Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients.

BACKGROUND: Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. METHODS: We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). RESULTS: Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). CONCLUSIONS: Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).

Effect of maturity status on force-velocity relationships in a ballistic lower limb test in high-level soccer players.

This study aimed to investigate the effect of maturity status on force-velocity relationships in a ballistic lower limb (BLL) test in high-level soccer adolescents and young adults. The population was 61 adolescents (13.0-17.9 years) and 23 young adults (18.0-26.2 years). Subjects completed the BLL test on a ballistic ergometer equipped with two force plates and a linear encoder. Following Samozino's method, maximal power output (Pmax), force (F0) and velocity (v0) were determined. An allometric model was applied to Pmax and F0 with body mass (BM) and fat-free mass (FFM). Significant effects of maturity status were found for absolute Pmax, F0, relative Pmax to BM and FFM, relative F0 to FFM and F0 allometrically scaled to BM and FFM (p = 0.02 to p < 0.001; η = 0.10 to η = 0.49). There was no significant effect for Pmax allometrically scaled to BM and FFM, F0 relative to BM and v0. Body dimensions explain group differences in Pmax whereas for F0, qualitative factors explain the differences between the groups. As maturity status and body dimensions influence Pmax, these factors should be considered when assessing explosive short efforts. This could help to better identify potential athletic talent and adapt training content.

Automatic adjustment of cycle ergometer power output to accurately clamp heart rate.

We assessed the accuracy and inter-sessional reliability of traditional (manual) compared to automatic (AutoHR) heart rate (HR) clamping methods during submaximal intensity continuous cycling. On separate occasions, thirteen males cycled at an HR corresponding to 80% of the ventilatory threshold for 18 min. Cycling power output was adjusted using either manual or AutoHR methods, encompassing three trials per method. For the manual method, cycling power output was adjusted every 30 s by 0, 5 or 10 W at the experimenter's discretion. Conversely, AutoHR automatically adjusted power output based on the difference between target and actual HR. Participants' HR was measured at 1 Hz. Root-mean square error (RMSE) and intraclass correlation coefficients (ICC) were calculated from the difference between measured and target HR to represent accuracy and reliability of each method. The RMSE for the manual method (3.2 ± 2.6 bpm) was significantly higher compared to AutoHR (2.8 ± 2.3 bpm) (p < 0.01, r = 0.13); inter-day ICC were 0.92 and 0.89 for manual adjustment and AutoHR, respectively. Automatic methods to clamp HR are more accurate than manual approaches during submaximal intensity continuous cycling and can be easily implemented for uniform HR control in individual and group training sessions at minimal cost.

Determining V̇O2max in competitive swimmers: Comparing the validity and reliability of cycling, arm cranking, ergometer swimming, and tethered swimming.

OBJECTIVES: This study aims to identify the optimal method for determining V̇O2max in competitive swimmers in terms of validity and test-retest reliability. DESIGN: Controlled experiment. METHODS: Twenty competitive swimmers performed four maximal incremental exercise tests: cycling, arm cranking, ergometer swimming, and tethered swimming. Gas analysis was conducted to estimate V̇O2max. Validity was assessed in terms of the amount of variance of the performance on a 1500-m time trial explained by the estimated V̇O2max . Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). RESULTS: V̇O2max obtained from tethered swimming, ergometer swimming, and cycling explained a similar amount of variance of the 1500-m performance (R2 = 0.64, 0.64 and 0.65, respectively). However, ergometer swimming yielded significantly lower V̇O2max estimates (40.54 ±â€¯6.55 ml/kg/min) than tethered swimming (54.40 ±â€¯6.21 ml/kg/min) and cycling (54.39 ±â€¯5.63 ml/kg/min). Arm cranking resulted in both a lower explained variance (R2 = 0.41) and a significantly lower V̇O2max (43.14 ±â€¯7.81 ml/kg/min). Tethered swimming showed good reliability (ICC = 0.81). CONCLUSIONS: Bicycle and tethered swimming tests demonstrated high validity with comparable V̇O2max estimates, explaining a large proportion of differences in endurance performance. Choosing between these two methods involves a trade-off between a higher practical applicability and reliability of the bicycle test and the more sport-specific nature of the tethered swimming test.

Reference values for leg effort during incremental cycle ergometry in non-trained healthy men and women, aged 19-85.

Heightened sensation of leg effort contributes importantly to poor exercise tolerance in patient populations. We aim to provide a sex- and age-adjusted frame of reference to judge symptom's normalcy across progressively higher exercise intensities during incremental exercise. Two-hundred and seventy-five non-trained subjects (130 men) aged 19-85 prospectively underwent incremental cycle ergometry. After establishing centiles-based norms for Borg leg effort scores (0-10 category-ratio scale) versus work rate, exponential loss function identified the centile that best quantified the symptom's severity individually. Peak O2 uptake and work rate (% predicted) were used to threshold gradually higher symptom intensity categories. Leg effort-work rate increased as a function of age; women typically reported higher scores at a given age, particularly in the younger groups (p < 0.05). For instance, "heavy" (5) scores at the 95th centile were reported at ~200 W (<40 years) and ~90 W (≥70 years) in men versus ~130 W and ~70 W in women, respectively. The following categories of leg effort severity were associated with progressively lower exercise capacity: ≤50th ("mild"), >50th to <75th ("moderate"), ≥75th to <95th ("severe"), and ≥ 95th ("very severe") (p < 0.05). Although most subjects reporting peak scores <5 were in "mild" range, higher scores were not predictive of the other categories (p > 0.05). This novel frame of reference for 0-10 Borg leg effort, which considers its cumulative burden across increasingly higher exercise intensities, might prove valuable to judging symptom's normalcy, quantifying its severity, and assessing the effects of interventions in clinical populations.

Torque-Cadence Profile and Maximal Dynamic Force in Cyclists: A Novel Approach.

We aimed to determine the feasibility, test-retest reliability and long-term stability of a novel method for assessing the force (torque)-velocity (cadence) profile and maximal dynamic force (MDF) during leg-pedaling using a friction-loaded isoinertial cycle ergometer and a high-precision power-meter device. Fifty-two trained male cyclists completed a progressive loading test up to the one-repetition maximum (1RM) on a cycle ergometer. The MDF was defined as the force attained at the cycle performed with the 1RM-load. To examine the test-retest reliability and long-term stability of torque-cadence values, the progressive test was repeated after 72 h and also after 10 weeks of aerobic and strength training. The participants' MDF averaged 13.4 ± 1.3 N·kg-1, which was attained with an average pedal cadence of 21 ± 3 rpm. Participants' highest power output value was attained with a cadence of 110 ± 16 rpm (52 ± 5% MDF). The relationship between the MDF and cadence proved to be very strong (R2 = 0.978) and independent of the cyclists' MDF (p = 0.66). Cadence values derived from this relationship revealed a very high test-retest repeatability (mean SEM = 4 rpm, 3.3%) and long-term stability (SEM = 3 rpm, 2.3%); despite increases in the MDF following the 10-week period. Our findings support the validity, reliability and long-term stability of this method for the assessment of the torque-cadence profile and MDF in cyclists.

Longitudinal development and tracking of cardiorespiratory fitness from childhood to adolescence.

BACKGROUND: Cardiorespiratory fitness (CRF) is an important indicator of health in childhood and adolescence but longitudinal studies on the development and tracking of CRF from childhood to adolescence are scarce. OBJECTIVES: The objectives of this study were (1) to assess longitudinal development and track CRF over 10 years from childhood to adolescence, and (2) to examine potential sex differences in the development and tracking of CRF during this period. METHODS: Participants were Icelandic children born in 1999, measured at the age of 7 (n = 190, 106 girls), 9 (n = 163, 95 girls), 15 (n = 239, 134 girls), and 17 (n = 202, 119 girls). CRF was assessed with a maximal cycle ergometer test and expressed as maximal power output (Max W) and maximal power output relative to lean mass (W/kgLM). Multilevel regression models were used to study the longitudinal development of CRF, and tracking was assessed with Spearman's rank correlation, logistic regression, and the percentage of participants remaining in low, moderate, or high CRF categories between measurements. RESULTS: Max W and W/kgLM increased for both boys and girls up to age 15. Max W plateaued for both boys and girls while W/kgLM plateaued for girls but declined for boys from age 15 to 17. Boys had higher Max W than girls from age 15 and higher W/kgLM from age 9. CRF tracked at low to moderate levels from childhood to adolescence and at high levels in adolescence, with higher values observed for boys than girls. CONCLUSIONS: Age 15 was a critical time point in the development of CRF, with values starting to plateau for girls and decline for boys. The results support early intervention for improved CRF in later years, with interventions targeting all children, regardless of their CRF level.

Short-Term High-Intensity Rowing Ergometry Training Improves Rowing Performance Equally in Healthy Weight and Obese Adolescents.

PURPOSE: Childhood obesity is a major health concern and physical activity is commonly proposed as an intervention strategy to combat the increasing prevalence of overweight and obesity in young people. The aim of this study was to examine the effect of high-intensity, supervised, rowing ergometer training on maximal and submaximal rowing performance in healthy weight and centrally obese adolescents (12-13 yr). METHODS: Participants were randomized to either 6 wk of supervised rowing ergometry, comprising of 2 sessions per week with each session comprising of 2 × 3-min bouts of high-intensity rowing ergometry ( n = 57), or a control group who continued with their habitual activities ( n = 45). At baseline and follow-up, rowing performance was assessed via a submaximal test and a 3-min maximal test. RESULTS: Six weeks of rowing ergometer training significantly improved maximal exercise performance; total distance rowed in a 3-min maximal effort improved by 19.7 m (2.7%) (time × group, P = 0.018) and produced a significant reduction in perceived effort in response to a set submaximal load (60 W) (time × group, P = 0.040). At baseline total distance rowed during the 3-min maximal test was significantly affected by body mass (main effect of body mass, P = 0.002), whereby a higher body mass was associated with enhanced rowing performance. However, the pattern of change over time was not different between healthy weight and centrally obese adolescents (time × group × waist centile, P = 0.577). CONCLUSIONS: A 6-wk high-intensity rowing ergometry training intervention improved maximal rowing performance. This improvement was similar in healthy weight versus overweight and obese adolescents; yet overall overweight and obese adolescents had superior rowing performance compared to their healthy weight counterparts, suggesting that rowing may be an attractive exercise modality for interventions in overweight and obese young people.

Signal Variability Comparative Analysis of Healthy Early- and Late-Pubertal Children during Cardiopulmonary Exercise Testing.

PURPOSE: The kinetics of physiological responses to exercise have traditionally been characterized by estimating exponential equation parameters using iterative best-fit techniques of heart rate (HR) and gas exchange (respiratory rate, oxygen uptake (V̇O 2 ), carbon dioxide output, and ventilation). In this study, we present a novel approach to characterizing the maturation of physiological responses to exercise in children by accounting for response uncertainty and variability. METHODS: Thirty-seven early-pubertal (17 females, 20 males) and 44 late-pubertal (25 females, 19 males) participants performed three multiple brief exercise bouts (MBEB). MBEB consisted of ten 2-min bouts of cycle ergometry at constant work rate interspersed by 1-min rest. Exercise intensity was categorized as low, moderate, or high, corresponding to 40%, 60%, and 80% of peak work rate, and performed in random order on 3 separate days. We evaluated sample entropy (SampEn), approximate entropy, detrended fluctuation analysis, and average absolute local variability of HR and gas exchange. RESULTS: SampEn of HR and gas-exchange responses to MBEB was greater in early- compared with late-pubertal participants (e.g., V̇O 2 early-pubertal vs late-pubertal, 1.70 ± 0.023 vs 1.41 ± 0.027; P = 2.97 × 10 -14 ), and decreased as MBEB intensity increased (e.g., 0.37 ± 0.01 HR for low-intensity compared with 0.21 ± 0.014 for high intensity, P = 3.56 × 10 -17 ). Females tended to have higher SampEn than males (e.g., 1.61 ± 0.025 V̇O 2 for females vs 1.46 ± 0.031 for males, P = 1.28 × 10 -4 ). Average absolute local variability was higher in younger participants for both gas exchange and HR (e.g., early-pubertal vs late-pubertal V̇O 2 , 17.48 % ± 0.56% vs 10.24 % ± 0.34%; P = 1.18 × 10 -21 ). CONCLUSIONS: The greater entropy in signal response to a known, quantifiable exercise perturbation in the younger children might represent maturation-dependent, enhanced competition among physiological controlling mechanisms that originate at the autonomic, subconscious, and cognitive levels.

The Effects of a 90-km Outdoor Cycling Ride on Performance Outcomes Derived From Ramp-Incremental and 3-Minute All-Out Tests.

ABSTRACT: Bitel, M, Keir, DA, Grossman, K, Barnes, M, Murias, JM, and Belfry, GR. The effects of a 90-km outdoor cycling ride on performance outcomes derived from ramp-incremental and 3-minute all-out tests. J Strength Cond Res 38(3): 540-548, 2024-The purpose of this study was to determine whether laboratory-derived exercise intensity and performance demarcations are altered after prolonged outdoor cycling. Male recreational cyclists ( n = 10; RIDE) performed an exhaustive ramp-incremental test (RAMP) and a 3-minute all-out test (3MT) on a cycle ergometer before and after a 90-km cycling ride. RAMP-derived maximal oxygen uptake (V̇O 2max ), gas exchange threshold (GET), respiratory compensation point (RCP), and associated power output (PO), as well as 3MT-derived critical power (CP) and work performed above CP, were compared before and after ∼3 hours of outdoor cycling. Six active men served as "no-exercise" healthy controls (CON), who, instead, rested for 3 hours between repeated RAMP and 3MT tests. During the 90-km ride, the duration within the moderate-intensity, heavy-intensity, and severe-intensity domains was 59 ± 24%, 40 ± 24%, and 1 ± 1%, respectively. Compared with pre-90 km, post-RAMP exhibited reductions in (a) V̇O 2max (4.04 ± 0.48 vs. 3.80 ± 0.38 L·min -1 ; p = 0.026) and associated PO (392 ± 30 W vs. 357 ± 26 W; p = 0.002); (b) the V̇O 2 and PO at RCP (3.49 ± 0.46 vs. 3.34 ± 0.43 L·min -1 ; p = 0.040 and 312 ± 40 W vs. 292 ± 24 W; p = 0.023); and (c) the PO (214 ± 32 W vs. 198 ± 25 W; p = 0.027), but not the V̇O 2 at GET (2.52 ± 0.44 vs. 2.44 ± 0.38 L·min -1 ; p = 0.388). Pre-90 km vs. post-90 km 3MT variables showed reduced W' (9.8 ± 3.4 vs. 6.8 ± 2.6 kJ; p = 0.002) and unchanged CP (304 ± 26 W and 297 ± 34 W; p = 0.275). In the CON group, there were no differences in V̇O 2max , GET, RCP, W', CP, or associated power outputs ( p > 0.05) pre-to-post 3 hours of rest. The preservation of critical power demonstrates that longer-duration maximal efforts may be sustained after long-duration cycle. However, shorter sprints and higher-intensity efforts eliciting V̇O 2max will exhibit decreased PO after 3 hours of a predominantly moderate-intensity cycle.

Shifting the Energy Toward Los Angeles: Comparing the Energetic Contribution and Pacing Approach Between 2000- and 1500-m Maximal Ergometer Rowing.

PURPOSE: To compare the energetic contribution and pacing in 2000- and 1500-m maximal rowing-ergometer performances. METHODS: On separate visits (>48 h apart, random order), 18 trained junior (16.7 [0.4] y) male rowers completed 3 trials: a 7 × 4-minute graded exercise test, a 2000-m time trial (TT2000), and a 1500-m TT (TT1500). Respiratory gases were continuously measured throughout each trial. The submaximal power-to-oxygen-consumption relationship from the graded exercise test was used to determine the accumulated oxygen deficit for each TT. Differences in mean power output (MPO), relative anaerobic contribution, percentage of peak oxygen uptake, pacing index, maximum heart rate, rating of perceived exertion, and blood lactate concentration were assessed using linear mixed modeling. RESULTS: Compared to TT2000 (324 [24] W), MPO was 5.2% (3.3%) higher in TT1500 (341 [29 W]; P < .001, ηp2=.70). There was a 4.9% (3.3%) increase (P < .001, ηp2=.71) in anaerobic contribution from 17.3% (3.3%) (TT2000) to 22.2% (4.3%) (TT1500). Compared to TT1500, maximum heart rate, rating of perceived exertion, and blood lactate concentration were all greater (P < .05) in TT2000. The pacing index was not different between trials. Percentage increase in MPO from TT2000 to TT1500 was negatively associated with pacing variance in TT1500 (R2 = .269, P = .027). CONCLUSIONS: Maximal ergometer performance over 1500 m requires a significantly greater anaerobic contribution compared with 2000 m. Junior male athletes adopt a consistent pacing strategy across both distances. However, those who experienced greater percentage increases in MPO over the shorter test adopted a more even pacing strategy. To prepare for 1500-m performance, greater emphasis should be placed on developing capacity for work in the severe domain and completing race simulations with a more even pacing strategy.

The effects of separate and simultaneous upper and lower body cycling on cardiorespiratory responses in young men.

BACKGROUND: The aim of the present study was to examine the relative cardiorespiratory and perceptual responses to upper body ergometry, lower body ergometry, and combined upper and lower body ergometry at increasing exercising intensities. METHODS: Eight healthy males between 19 and 30 years of age completed three exercise sessions over seven days that included graded leg ergometry, arm ergometry, and combined arm and leg ergometry in counterbalanced fashion. During leg-only and arm-only sessions, participants exercised at workloads of 0, 32, 64, and 95 W. The combined session involved simultaneous arm and leg ergometry at 0, 32, 64, and 95 W, thus eliciting double the total power output of arm-only and leg-only sessions. RESULTS: At all workloads, oxygen consumption and minute ventilation responses were greater during combined arm and leg exercise than during leg-only or arm-only exercise. However, the pattern of changes in heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion (RPE) were similar in response to arm-only and combined upper and lower body exercise, despite combined exercise involving double the workload. These cardiorespiratory and perceptual responses were significantly lower during leg-only only exercise. CONCLUSIONS: The results of the study add to limited research comparing physiological and perceptual responses to upper, lower, and combined upper and lower body exercise. The findings highlight heightened cardiorespiratory and perceptual responses to upper body exercise alone or in combination with lower body exercise. Training that combines upper and lower body may create higher power output and elicit greater caloric expenditure while eliciting similar cardiovascular responses as upper body only exercise at moderate and higher intensities.

Acute Effect of Different Velocity-Based Training Protocols on 2000-meter Rowing Ergometer Performance.

ABSTRACT: Leandro Quidel-Catrilelbún, ME, Ruiz-Alias, SA, García-Pinillos, F, Ramirez-Campillo, R, and Pérez-Castilla, A. Acute effect of different velocity-based training protocols on 2000-m rowing ergometer performance. J Strength Cond Res 38(1): e8-e15, 2024-This study aimed to explore the acute effect of 4 velocity-based resistance training (VBT) protocols on 2000-m rowing ergometer (RE2000) time trial, as well as the behavior of the maximal neuromuscular capacities when RE2000 is performed alone or preceded by VBT protocols in the same session. Fifteen male competitive rowers (15-22 years) undertook 5 randomized protocols in separate occasions: (a) RE2000 alone (control condition); (b) VBT against 60% of 1 repetition maximum (1RM) with a velocity loss in the set of 10% followed by RE2000 (VBT60-10 + RE2000); (c) VBT against 60% 1RM with a velocity loss in the set of 30% followed by RE2000 (VBT60-30 + RE2000); (d) VBT against 80% 1RM with a velocity loss in the set of 10% followed by RE2000 (VBT80-10 + RE2000); (e) VBT against 80% 1RM with a velocity loss in the set of 30% followed by RE2000 (VBT80-30 + RE2000). The load-velocity relationship (load-axis intercept [L0], velocity-axis intercept [v0], and area under the load-velocity relationship line [Aline]) was used to evaluate the maximal neuromuscular capacities during the prone bench pull exercise before and after each protocol. The time trial was significantly longer for VBT60-30 + RE2000 and VBT80-30 + RE2000 than for RE2000, VBT60-10 + RE2000 and VBT80-10 + RE2000 (all p < 0.001; ES = 0.10-0.15). L0 and Aline were significantly reduced after all protocols (p < 0.001; ES = 0.10-0.13), with Aline reduction more accentuated for VBT60-10 + RE2000, VBT60-30 + RE2000, VBT80-30 + RE2000, and RE2000 (all p = 0.001; ES = 0.11-0.18) than for VBT80-10 + RE2000 (p = 0.065; ES = 0.05). Therefore, VBT protocols with greater velocity loss in the set (30% vs. 10%) negatively affected subsequent rowing ergometer performance, in line with impairment in Aline pulling performance.

El puntaje de Framingham ayudaría en la estratificación del riesgo de pacientes con ergometría positiva y SPECT normal / The Framingham score could help in risk stratification of patients with positive ergometry and normal SPECT

Antecedentes. El valor pronóstico de una ergometría positiva en el contexto de imágenes tomográficas de perfusión miocárdica de estrés y reposo (SPECT) normales no está bien establecido. Objetivos. Documentar la incidencia de infarto, muerte y revascularización coronaria en pacientes con una ergometría positiva de riesgo intermedio e imágenes de perfusión SPECT normales, y explorar el potencial valor del puntaje de riesgo de Framingham en la estratificación pronóstica de estos pacientes. Métodos. Cohorte retrospectiva integrada por pacientes que habían presentado síntomas o hallazgos electrocardiográficos compatibles con enfermedad arterial coronaria durante la prueba de esfuerzo, con criterios de riesgo intermedio en la puntuación de Duke y perfusión miocárdica SPECT normal. Fueron identificados a partir de la base de datos del laboratorio de cardiología nuclear del Instituto de Cardiología y Cirugía Cardiovascular de la ciudad de Posadas, Argentina. Resultados. Fueron elegibles 217 pacientes. El seguimiento fue de 3 1,5 años. La sobrevida libre de eventos (muerte,infarto de miocardio no fatal, angioplastia coronaria o cirugía de bypass de arteria coronaria) a uno, tres y cinco años fue significativamente menor (Log-rank test, p= 0,001) en el grupo con puntaje de Framingham alto o muy alto (77, 71y 59 %, respectivamente) que en el grupo de puntaje bajo o intermedio (89, 87 y 83 %). Tomando como referencia a los pacientes con riesgo bajo en el puntaje de Framingham, luego de ajustar por edad, sexo y puntaje de Duke, los pacientes categorizados en los estratos alto y muy alto riesgo del puntaje de Framingham presentaron una incidencia del evento combinado cercana al triple (hazard ratio [HR] 2,81; intervalo de confianza [IC] del 95 % 0,91 a 8,72; p= 0,07 y HR 3,61;IC 95 % 1,23 a 10,56; p= 0,019 respectivamente). Conclusiones. La estimación de riesgo con el puntaje de Framingham sería de ayuda en la estratificación pronóstica de los pacientes con ergometría positiva y SPECT normal. (AU)

Background. The prognostic value of positive exercise testing with normal SPECT myocardial perfusion imaging is not well established. Objectives. To document the incidence of infarction, death, and coronary revascularization in patients with a positive intermediate-risk exercise test and normal SPECT perfusion images and to explore the potential value of the Framingham Risk Score in the prognostic stratification of these patients. Methods. A retrospective cohort comprised patients who presented symptoms or electrocardiographic findings compatible with coronary artery disease during the stress test, with intermediate risk criteria in the Duke score and normal SPECT myocardial perfusion. They were identified from the database of the nuclear cardiology laboratory of the Instituto de Cardiología y Cirugía Cardiovascular of Posadas, Argentina. Results. 217 patients were eligible. Follow-up was 3 1.5 years. Event-free survival (death, non-fatal myocardial infarction, coronary angioplasty, or coronary artery bypass surgery) at one, three, and five years was significantly lower (Log-ranktest, p: 0.001) in the group with a score of Framingham high or very high (77, 71 and 59 %, respectively) than in the lowor intermediate score group (89, 87 and 83 %). Taking as reference the low-risk patients in the Framingham score, after adjusting for age, sex, and Duke score, the patients categorized in the high-risk and very high-risk strata showed about three times higher incidence of the combined event (hazard ratio [HR] 2.81; 95 % confidence interval [CI] 0.91 to 8.72;p=0.07 and HR 3.61; 95 % CI 1.23 to 10.56; p=0.019 respectively). Conclusions. Risk estimation with the Framingham score would be helpful in the prognostic stratification of patients with positive exercise testing and normal SPECT. (AU)

El dilema clínico frente a los pacientes con ergometría positiva y prueba de perfusión miocárdica con SPECT normal / The clinical dilemma facing patients with positive stress test and normal SPECT myocardial perfusion imaging

La evaluación de la perfusión miocárdica con SPECT combina una prueba de esfuerzo (ergometría o estrés farmacológico) junto a imágenes de perfusión con radioisótopos. Este estudio es útil para establecer el diagnóstico de enfermedad arterial coronaria, estratificar el riesgo de infarto y tomar decisiones terapéuticas. Un resultado normal aporta un alto valor predictivo negativo, es decir, una muy baja probabilidad de que el paciente presente eventos cardiovasculares. El hallazgo de signos de isquemia en la ergometría podría poner en jaque el valor predictivo negativo de una perfusión normal. En presencia de este resultado, el paso siguiente es evaluar los predictores de riesgo en la ergometría, el riesgo propio del paciente en función de los antecedentes clínicos y el puntaje cálcico coronario, cuando este se encuentra disponible. Ante la presencia concomitante de otros marcadores de riesgo se sugiere completar la evaluación con un estudio anatómico.El uso de nuevas tecnologías podría mejorar la precisión en la predicción de eventos. (AU)

Assessment of myocardial perfusion with SPECT combines a stress test (ergometry or pharmacological stress) with radioisotope perfusion imaging. This test is helpful to diagnose coronary artery disease, stratify the risk of heart attack, and make therapeutic decisions. A normal result provides a high negative predictive value; therefore, the probability of cardiovascular events is very low. Signs of ischemia on an ergometry could jeopardize the negative predictive value of normal perfusion. In this clinical setting, the next step is to evaluate the risk predictors in the stress test, the individual risk based on the clinical history, and the coronary calcium score when available. Given the simultaneous presence of other risk markers,completing the evaluation with an anatomical study is suggested. The use of new technologies could improve the accuracy of event prediction. (AU)

Physiological characteristics of a 92-yr-old four-time world champion indoor rower.

This study assessed the physiological, performance, nutritional intake, and training characteristics of a 92-yr-old four-time master world champion indoor male rower. Body composition was assessed via bioelectrical impedance. Oxygen uptake, carbon dioxide production, ventilation, and heart rate were measured at rest and during a 2,000-m time trial on a rowing ergometer. Maximal power was assessed to compute anaerobic power reserve. Training included ≈ 30 km/wk on the rowing ergometer. Herein, 70% of distances were covered at light intensities (RPE, 10-12), 20% at hard (RPE, 13-17), and 10% at near maximal or maximal (RPE, 17-20). Resistance training was performed during ≈ 2 sessions/wk, and involved three sets of dumbbell lunges, rows, and curls, respectively, taken close (or to) failure. Dietary intake was high in protein [2.3 ± 0.1 g·kg-1 lean body mass (LBM)], conferring a caloric intake of 33.4 ± 1.7 kcal·kg-1 LBM. The participant demonstrated muscle mass of 47.7 kg, fat mass of 9.1 kg (15.4% body fat), forced vital capacity of 3.36 L, time constant (τ) to steady state of 30.2 s, peak relative oxygen pulse of 0.18 ([mL·O2/beats/min]/kg), peak heart rate of 153 beats/min, and maximum power of 220 W (140 W anaerobic power reserve). This 92-yr-old athlete demonstrated remarkably fast oxygen uptake kinetics, akin to values for a healthy young adult, indicating well-developed and/or maintained cardiopulmonary function. The high values for cardiopulmonary function, muscle mass, metabolic efficiency, and maximum power output may infer the pliability of these systems to maintain high functionality at an advanced age.NEW & NOTEWORTHY To our knowledge, this study is the first to characterize the physiological attributes of a competitive rower (4-time master world champion) at an advanced age (≥ 85 yr). The participant demonstrated a high muscle mass (47.7 kg; 80.6% body mass), maximal power (220 W), and exceptional oxygen uptake kinetics (τ of 30.2 s), similar to values reported for healthy young adults.

Effects of poling camber angle on the biomechanics of cross-country sit-skiing.

Cross-country sit-skiers use double poling (DP) technique to drive the slide. The aim of this study is to analyze how poling camber angle affect the capacity of power output and biomechanical parameters of the DP process. Twenty-four non-disabled college students (24.67 ± 1.46 years old) were recruited to perform three successive 30-s maximal effort tests with different poling camber angles of 0°, 15°, 24° and 30° using a sit-skiing ergometer. The biomechanical parameters, output power and muscle activation of the subjects were analyzed. The results showed that DP output power increased with the increase of poling camber angle at 15° (597.78 ± 150.31 J), 24° (610.94 ± 158.96 J, P = 0.011) and 30° (629.10 ± 168.78 J, P < 0.001) compared with 0° (590.65 ± 148.95 J). However, effective output power decreased with the increase of camber angle. Poling with camber angle of 24° had the shortest cycle time 1.53 ± 0.17 s, compared with other abduction angle (0°, 1.57 ± 0.19 s, 15°, 1.55 ± 0.16 s, and 30°, 1.56 ± 0.19 s). Compared with 0° (1.02 ± 0.14 m), the cycle distance significantly increased at poling camber angles of 24° (1.07 ± 0.12 m, P = 0.029) and 30° (1.11 ± 0.13 m, P < 0.001). With the increase of poling camber angle, the shoulder and elbow joint range of motions and joint moments were significantly increased. This study found that poling with shoulder abducted increased the output power but decreased the efficiency. By analyzing the poling angle and poling force, we find that the optimal poling camber angle may depend on the terrain or the skiing speed. These results may guide the competition techniques and tactics in the matches, and may further influence the strength-training programs of cross-country sit-skiing athletes.

Six-minute rowing test: a practical tool for training prescription, from ventilatory thresholds and power outputs, in amateur male rowers.

Background: The 6-minute rowing ergometer test (6-minRT) is valid and reliable for establishing maximal aerobic power (MAP) in amateur male rowers. However, ventilatory thresholds (VTs) have not yet been established with their mechanical correspondence in this test. Objective: The primary objective was to determine the VTs in the 6-minRT achieved by amateur male rowers, while the secondary objective was to determine the correspondence between ventilatory, mechanical, and heart rate (HR) outcomes of the 6-minRT. Methods: Sixteen amateur male rowers were part of the study. All participants were instructed to perform an incremental test (IT) and a 6-minRT. Determination of the ventilatory parameters for the first ventilatory threshold (VT1), the second ventilatory threshold (VT2), and 6minRTVO2max were performed by correlating the outcomes of VT1, VT2, and VO2max obtained in the IT, with the outcomes of 6-minRT. For these purposes, Pearson's test was used, with the following criteria: trivial, <0.1; small, 0.1-0.3; moderate, 0.3-0.5; high, 0.5-0.7; very high, 0.7-0.9; or practically perfect, >0.9. The significance level was p < 0.05. Results: The IT analysis determined that VT1 and VT2 correspond to 55 and 80% of VO2max, respectively. A high correlation was observed between IT outcomes in VT1, VT2, and VO2max, with the outcomes of 6-minRT (r > 0.6). Conclusion: Based on IT ventilatory parameters and concordance analysis, VT1 and VT2 of 6-minRT are determined at 55 and 80%, respectively, of both ventilatory parameters and their corresponding mechanical outcomes and HR.

Feedback control of heart rate during treadmill exercise based on a two-phase response model.

This work investigated automatic control of heart rate during treadmill exercise. The aim was to theoretically derive a generic feedback design strategy that achieves a constant input sensitivity function for linear, time-invariant plant models, and to empirically test whether a compensator C2 based on a second-order model is more dynamic and has better tracking accuracy than a compensator C1 based on a first-order model. Twenty-three healthy participants were tested using first and second order compensators, C1 and C2, respectively, during 35-minute bouts of constant heart rate treadmill running. It was found that compensator C2 was significantly more accurate, i.e. it had 7% lower mean root-mean-square tracking error (1.98 vs. 2.13 beats per minute, p = 0.026), and significantly more dynamic, i.e. it had 17% higher mean average control signal power (23.4 × 10-4 m2/s2 vs. 20.0 × 10-4 m2/s2, p = 0.011), than C1. This improvement likely stems from the substantially and significantly better fidelity of second-order models, compared to first order models, in line with classical descriptions of the different phases of the cardiac response to exercise. These outcomes, achieved using a treadmill, are consistent with previous observations for the cycle ergometer exercise modality. In summary, whenever heart rate tracking accuracy is of primary importance and a more dynamic control signal is acceptable, the use of a compensator based on a second-order nominal model is recommended.

Classifying Intensity Domains From Arm Cycle Ergometry Differs Versus Leg Cycling Ergometry.

ABSTRACT: Astorino, TA, Robson, T, and McMillan, DW. Classifying intensity domains from arm cycle ergometry differs versus leg cycling ergometry. J Strength Cond Res 37(11): 2192-2199, 2023-This study compared the distribution of exercise intensity domains in response to progressive leg cycle ergometry (LCE) and arm cycle ergometry (ACE). Seventeen active men and women (age and body fat = 26 ± 7 years and 18 ± 3%) initially performed graded exercise on each modality to assess maximal oxygen uptake (V̇o2max) and peak power output (PPO). Using a randomized crossover design, they subsequently performed moderate intensity continuous exercise consisting of three 15-minute bouts at 20, 40, and 60% PPO on each modality. Gas exchange data (V̇o2, V̇co2, and VE), respiratory exchange ratio, heart rate (HR), blood lactate concentration (BLa), and perceptual responses were acquired. Only 2 subjects were classified in the same intensity domains across modalities, with LCE eliciting more subjects exercising at "vigorous" and "near-maximal" intensities than ACE. Time spent above 70 (22 ± 7 vs. 15 ± 8 minutes, d = 1.03) and 80 %HRmax (15 ± 6 vs. 9 ± 6 minutes, d = 1.04) was significantly greater with LCE vs. ACE. Compared with ACE, LCE revealed significantly higher (p < 0.05) peak (94 ± 6 vs. 88 ± 9 %HRmax, d = 0.81) and mean HR (73 ± 6 vs. 66 ± 6 %HRmax, d = 1.20), V̇o2 (54 ± 5 vs. 50 ± 7 %V̇o2max, d = 0.68), and BLa (5.5 ± 2.0 vs. 4.7 ± 1.5 mM, d = 0.48). The results exhibit that progressive leg cycling at identical intensities elicits a greater cardiometabolic stimulus than ACE.