Monitoring exercise intensity in diabetes: applicability of "heart rate-index" to estimate oxygen consumption during aerobic and resistance training.

PURPOSE: Accurate quantification and monitoring of exercise "dose", described by oxygen consumption (VO2), is necessary for exercise prescription and individualization. However, due to the complexity and elevated cost of direct, gold-standard methods, this is rarely done outside research laboratories. Heart rate-index (HRindex) is a new simple method to estimate VO2 in healthy and clinical populations. We tested the performance of HRindex to estimate VO2 in diabetic patients during aerobic (AT) and isotonic training (IT). METHODS: Data from 12 males (age: 64 ± 5 years; BMI: 26 ± 12) with type 2 diabetes were analysed. VO2 and heart rate were measured during one AT and one IT session. Furthermore, VO2 was indirectly estimated based on HRindex. Then, the correspondence between measured and estimated VO2 was evaluated by two-way RM-ANOVA, correlation and Bland-Altman analysis. RESULTS: Estimated average VO2 values during AT (1292 ± 366 ml/min) were not different from (p = 0.243) and highly correlated with (r = 0.87, p < 0.001) the measured values (1369 ± 417 ml/min), with a small bias and imprecision. Conversely during IT, HRindex overestimated VO2 compared to the actual measures (1048 ± 404 vs 667 ± 230 ml/min, p ≤ 0.001) and only a moderate correlation was found between values (r = 0.43, p ≤ 0.001), with a large bias and imprecision. CONCLUSION: VO2 of aerobic exercises can be accurately estimated in diabetes patients using HRindex. During isotonic exercise, this method is not recommended for monitoring metabolic intensity due to large overestimation and imprecision. In aerobic exercise, HRindex offers a simple and valid alternative to the direct VO2 determination and may favour the applicability of time-resolved measures of exercise "dose".

Quantification of energy expenditure of military loaded runs: what is the performance of laboratory-based equations when applied to the field environment?

INTRODUCTION: Performance during army loaded runs provides a synthetic indicator of a soldier's capacity to move while carrying loads and thereby remain able to execute a mission. The aim of this study was to estimate and compare the energy expenditure (EE) of army loaded runs, conducted in a field environment using laboratory-based equations and HR index (HRindex). METHODS: 45 Ranger recruits had HR monitored during three loaded runs (10, 15 and 20 km) in full military equipment in the field environment. EE was calculated using reference equations (EE-Eq) and estimates of oxygen consumption based on HRindex (EE-HRindex). Correspondence between EE-Eq and EE-HRindex estimates was evaluated using a two-way analysis of variance, correlation test and Bland-Altman analysis. RESULTS: EE-Eq relative to time and weight was significantly higher for the 10 km (0.175±0.016) compared with 15 and 20 km (0.163±0.016 and 0.160±0.013 kcal/kg/min, not different). The overall EE-Eq increased significantly with distance (1129±59, 1703±80 and 2250±115 kcal for 10, 15 and 20 km). EE-Eq was not different from and highly correlated with EE-HRindex, with a small and non-significant bias and good precision between methods. CONCLUSIONS: Our study provides the first comprehensive data on HR and EE during long-distance loaded army runs, in full combat equipment, in actual field conditions. Equation-based estimates of EE during these heavy-intensity activities were not significantly different from and highly correlated with HR-based estimates. This corroborates the general applicability of the predictive equations in the field environment. Furthermore, our study suggests that time-resolved HR-based estimates of EE during army runs can be used to evaluate for the effects of context specificity, individual variability and fatigue in movement economy.

Gokyo Khumbu/Ama Dablam Trek 2012: effects of physical training and high-altitude exposure on oxidative metabolism, muscle composition, and metabolic cost of walking in women.

PURPOSE: We investigated the effects of moderate-intensity training at low and high altitude on VO2 and QaO2 kinetics and on myosin heavy-chain expression (MyHC) in seven women (36.3 yy ± 7.1; 65.8 kg ± 11.7; 165 cm ± 8) who participated in two 12- to 14-day trekking expeditions at low (598 m) and high altitude (4132 m) separated by 4 months of recovery. METHODS: Breath-by-breath VO2 and beat-by-beat QaO2 at the onset of moderate-intensity cycling exercise and energy cost of walking (Cw) were assessed before and after trekking. MyHC expression of vastus lateralis was evaluated before and after low-altitude and after high-altitude trekking; muscle fiber high-resolution respirography was performed at the beginning of the study and after high-altitude trekking. RESULTS: Mean response time of VO2 kinetics was faster (P = 0.002 and P = 0.001) and oxygen deficit was smaller (P = 0.001 and P = 0.0004) after low- and high-altitude trekking, whereas ˙ QaO2 kinetics and Cw did not change. Percentages of slow and fast isoforms of MyHC and mitochondrial mass were not affected by low- and high-altitude training. After training altitude, muscle fiber ADP-stimulated mitochondrial respiration was decreased as compared with the control condition (P = 0.016), whereas leak respiration was increased (P = 0.031), leading to a significant increase in the respiratory control ratio (P = 0.016). CONCLUSIONS: Although training did not significantly modify muscle phenotype, it induced beneficial adaptations of the oxygen transport-utilization systems witnessed by faster VO2 kinetics at exercise onset.

Improved VO2 uptake kinetics and shift in muscle fiber type in high-altitude trekkers.

The study investigated the effect of prolonged hypoxia on central [i.e., cardiovascular oxygen delivery (Q(a)O(2))] and peripheral (i.e., O(2) utilization) determinants of oxidative metabolism response during exercise in humans. To this aim, seven male mountaineers were examined before and immediately after the Himalayan Expedition Interamnia 8000-Manaslu 2008, lasting 43 days, among which, 23 days were above 5,000 m. The subjects showed a decrease in body weight (P < 0.05) and of power output during a Wingate Anaerobic test (P < 0.05) and an increase of thigh cross-sectional area (P < 0.05). Absolute maximal O(2) uptake (VO(2max)) did not change. The mean response time of VO(2) kinetics at the onset of step submaximal cycling exercise was reduced significantly from 53.8 s ± 10.9 to 39.8 s ± 10.9 (P < 0.05), whereas that of Q(a)O(2) was not. Analysis of single fibers dissected from vastus lateralis biopsies revealed that the expression of slow isoforms of both heavy and light myosin subunits increased, whereas that of fast isoforms decreased. Unloaded shortening velocity of fibers was decreased significantly. In summary, independent findings converge in indicating that adaptation to chronic hypoxia brings about a fast-to-slow transition of muscle fibers, resulting in a faster activation of the mitochondrial oxidative metabolism. These results indicate that a prolonged and active sojourn in hypoxia may induce muscular ultrastructural and functional changes similar to those observed after aerobic training.

Oxygen uptake, cardiac output and muscle deoxygenation at the onset of moderate and supramaximal exercise in humans.

VO2, Q and muscular deoxyhaemoglobin (HHb) kinetics were determined in 14 healthy male subjects at the onset of constant-load cycling exercise performed at 80% of the ventilatory threshold (80%(VT)) and at 120% of VO2max (120%(Wmax)). An innovative approach was applied to calculate the time constant (τ2) of the primary phase of VO2 and Q kinetics at 120%(Wmax). Data were linearly interpolated after a semilogarithmic transformation of the difference between required/steady state and measured values. Furthermore, VO2, Q and HHb data were fitted with traditional exponential models. τ2 of VO2 kinetics was longer (62.5 ± 20.9 s) at 120%(Wmax) than at 80%(VT) (27.8 ± 10.4 s). The τ2 of Q kinetics was unaffected by exercise intensity and, at 120% of VO2max, it was significantly faster (τ2 = 35.7 ± 28.4 s) than that of VO2 response. The time delay of HHb kinetics was shorter (4.3 ± 1.7 s) at 120%(Wmax) than at 80%(VT) (8.5 ± 2.6 s) suggesting a larger mismatch between O2 uptake and delivery at 120%(Wmax). These results suggest that VO2 at the onset of exercise is not regulated/limited by muscle's O2 utilisation and that a slower adaptation of capillary perfusion may cause the deceleration of VO2 kinetics observed during supramaximal exercise.

Adaptations to endurance training in the healthy elderly: arm cranking versus leg cycling.

The effect in healthy elderly subjects of cycle ergometer or arm ergometer training on peak oxygen consumption (VO(2peak)) and ventilatory threshold (VT) was studied. The aim was to determine the benefit of each training modality on specific and cross exercise capacity. The cross-effect was also evaluated as an index of the central nature of the adaptive response to training. Twelve non-smoking healthy males (age: 67 +/- 5 year; body mass: 75 +/- 9 kg) were randomly divided in two age-matched groups of six, performing an arm cranking (ARM) or a cycloergometer (CYC) training (12-week, 30 min, 3 times/week), while a third group of 6 subjects (age: 73 +/- 4 year; body mass: 80 +/- 8 kg) performed no training (control, C). At baseline and following the intervention, subjects carried out an incremental test to exhaustion both on the ergometer on which they trained (specific test) and on the other ergometer (cross test). Respiratory variables were measured breath by breath and heart rate (HR) was recorded. Peak oxygen consumption (VO(2peak)), ventilation (VE(peak)), oxygen pulse (O2P(peak)) and heart rate (HR(peak)) were averaged over the last 10 s of exercise. Following training, while HR(peak) remained unchanged, significantly higher W(peak), VO(2peak), VE(peak) and O2P(peak) were obtained in both training groups, on both ergometers. The amplitude of the increase in W(peak), VO(2peak) and O2P(peak) was significantly higher for specific than for cross tests ( approximately 19% vs. approximately 8 % in CYC; approximately 22% vs. approximately 9% in ARM, P < 0.01) while the increase in same test condition was similar. No change was observed in the C group. The results indicate that aerobic training brought about with different muscle masses, produce similar improvements in maximal and submaximal exercise capacity. Roughly half of such improvements are specific to exercise mode, which suggests peripheral adaptations to training. The other half is non-specific since it influences also the alternative exercise modality, and is probably due to central adaptations.

The impact of gender, body dimension and body composition on hand-grip strength in healthy children.

Maximum hand-grip (HG) strength, body composition and main anthropometric variables were evaluated in 278 children with normal weight and growth, aged 5-15 yr divided into 3 age groups: group 1, age+/-SD: 7.6+/-0.9 yr 7.6+/-0.9 SD (Tanner stage 1); group 2, age: 10.8+/-0.7 yr (Tanner stage: 2-3); group 3, age: 13.2+/-0.9 yr (Tanner stage: 4-5). Weight, height, body surface area (BSA), BMI, percent body fat (BF) and fat free mass (FFM) increased progressively and significantly from the younger to the older age group. A significant difference between genders was detected only for BF and FFM, females having a higher fat mass and a lower FFM compared to males. Most children were right-handed (91%). In either genders, a curvilinear relation was detected between HG strength and age, with best fit for the dominant (d) hand given by the equations: dHG=5.891 *10(0.051) age, r2=0.986, p<0.001 in males and dHG=6.163 *10(0.045) age r2=0.973, p<0.001 in females. The increase in HG strength after 11 yr appears to be steeper in males as compared with that found in females. In both d and non-dominant (nd) hand, a significant difference in HG strength was detected between males and females, the average difference being about 10% at all ages. For both genders, nd hand was significantly weaker than d hand in the older age groups (2 and 3), but not in the younger group 1. Age and gender-dependent differences in HG strength (but not differences between d and nd hand) disappear if HG strength is normalized for FFM. Thus, in general, dHG strength normalized for FFM resulted on average to be 0.67+/-0.11 kg/kg. A multiple linear regression analysis indicated that HG was positively correlated with BMI, BSA, stature, stature2 and FFM (p<0.001 for all correlations) without differences between genders, while a negative correlation was found between HG strength and %BF. The most significant correlation was found between HG strength and FFM, without any significant difference between genders, so that the overall equation describing the line for the d hand was: dHG strength= 2.32+0.63 FFM, r2=0.72, p<0.001. In conclusion, the present study indicates that the age-dependent increase of HG strength as well as the between-gender differences are strongly related to changes of FFM values occurring during childhood. Moreover, the study provides a standard normative value of maximal HG strength for the healthy children population in Northern Italy.

Influence of low and high dietary fat on physical performance in untrained males.

PURPOSE: Dietary manipulations have been used in athletes to enhance aerobic performance. We intended to verify whether the quality of energy substrate provided by food (percentage of total calories from fat and carbohydrates) per se has the ability to affect aerobic performance in sedentary humans. METHOD: Fourteen healthy sedentary males were sequentially submitted to 4-wk eucaloric diets (spontaneous diet: 30% of total calories from fat; low-fat, 15% fat; high-fat, 55% fat; and spontaneous, 30% fat). After each diet period, individual body mass, percentage body fat (plicometry), VO2max (incremental bicycle-ergometry) and endurance (pedaling time to exhaustion at 75%VO2max) were measured. VO2, VCO2, VE, R, and heart rate (HR) were measured at rest and during exercise tests. Body composition and performance data (VO2max and endurance) were compared for significant differences by repeated measures ANOVA. RESULTS: Subjects' body weight, percentage body fat, and fitness status (indicated by intercept and slope of the HR/VO2 linear relationship) did not change significantly during the study, thus ruling out the influence of these potential confounders. For a given workload, VO2, VE, and R were unaffected by diet composition. VO2max and endurance time were not significantly modified by the different diets. CONCLUSIONS: Our study showed no impact, positive or negative, of diet's macronutrient composition on physical performance. It appears that the quality of energy substrate provided by food does not have the ability to affect either maximal or submaximal aerobic performance in untrained individuals.

Effect of gravity on lung exhaled nitric oxide at rest and during exercise.

Exhaled nitric oxide (NO) from the lungs (VNO) in nose-clipped subjects increases during exercise. This may be due to endothelial shear stress secondary to changes in pulmonary blood flow. We measured VNO after modifying pulmonary blood flow with head-out water immersion (WI) or increased gravity (2 Gz) at rest and during exercise. Ten sedentary males were studied during exercise performed in air and WI. Nine subjects were studied at 1 and 2 Gz. Resting NO concentrations in exhaled air ([NO]) were 16.3 +/- 8.2 ppb (air). 15 +/- 8.2 ppb (WI) and 17.4 +/- 5 ppb (2 Gz). VNO (ppb/min) was calculated as [NO]VE and was unchanged at rest by either WI or 2 Gz. VNO increased linearly with Vo2, VE and fii during exercise in air, WI and at 2 Gz. These relationships did not differ among the experimental conditions. Therefore, changes in pulmonary blood flow failed to alter the output of NO exhaled from the lungs at rest or during exercise.