COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance-A Prospective, Observational, Multicenter Cohort Study (CoSmo-S).

BACKGROUND: An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity. OBJECTIVE: We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified. METHODS: In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses. RESULTS: Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period. CONCLUSIONS: Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen. TRIAL REGISTRATION NUMBER: DRKS00023717; 06.15.2021-retrospectively registered.

Relationships between External, Wearable Sensor-Based, and Internal Parameters: A Systematic Review.

Micro electro-mechanical systems (MEMS) are used to record training and match play of intermittent team sport athletes. Paired with estimates of internal responses or adaptations to exercise, practitioners gain insight into players' dose-response relationship which facilitates the prescription of the training stimuli to optimize performance, prevent injuries, and to guide rehabilitation processes. A systematic review on the relationship between external, wearable-based, and internal parameters in team sport athletes, compliant with the PRISMA guidelines, was conducted. The literature research was performed from earliest record to 1 September 2020 using the databases PubMed, Web of Science, CINAHL, and SportDISCUS. A total of 66 full-text articles were reviewed encompassing 1541 athletes. About 109 different relationships between variables have been reviewed. The most investigated relationship across sports was found between (session) rating of perceived exertion ((session-)RPE) and PlayerLoad™ (PL) with, predominantly, moderate to strong associations (r = 0.49-0.84). Relationships between internal parameters and highly dynamic, anaerobic movements were heterogenous. Relationships between average heart rate (HR), Edward's and Banister's training impulse (TRIMP) seem to be reflected in parameters of overall activity such as PL and TD for running-intensive team sports. PL may further be suitable to estimate the overall subjective perception. To identify high fine-structured loading-relative to a certain type of sport-more specific measures and devices are needed. Individualization of parameters could be helpful to enhance practicality.

Effects on cardiorespiratory fitness of moderate-intensity training vs. energy-matched training with increasing intensity.

Introduction: The present study investigated the role of training intensity in the dose-response relationship between endurance training and cardiorespiratory fitness (CRF). The hypothesis was that beginners would benefit from an increase in training intensity after an initial training phase, even if the energy expenditure was not altered. For this purpose, 26 weeks of continuous moderate training (control group, CON) was compared to training with gradually increasing intensity (intervention group, INC) but constant energy expenditure. Methods: Thirty-one healthy, untrained subjects (13 men, 18 women; 46 ± 8 years; body mass index 25.4 ± 3.3 kg m-2; maximum oxygen uptake, VO2max 34 ± 4 ml min-1 kg-1) trained for 10 weeks with moderate intensity [3 days/week for 50 min/session at 55% heart rate reserve (HRreserve)] before allocation to one of two groups. A minimization technique was used to ensure homogeneous groups. While group CON continued with moderate intensity for 16 weeks, the INC group trained at 70% HRreserve for 8 weeks and thereafter participated in a 4 × 4 training program (high-intensity interval training, HIIT) for 8 weeks. Constant energy expenditure was ensured by indirect calorimetry and corresponding adjustment of the training volume. Treadmill tests were performed at baseline and after 10, 18, and 26 weeks. Results: The INC group showed improved VO2max (3.4 ± 2.7 ml kg-1 min-1) to a significantly greater degree than the CON group (0.4 ± 2.9 ml kg-1 min-1) (P = 0.020). In addition, the INC group exhibited improved Vmax (1.7 ± 0.7 km h-1) to a significantly greater degree than the CON group (1.0 ± 0.5 km h-1) (P = 0.001). The reduction of resting HR was significantly larger in the INC group (7 ± 4 bpm) than in the CON group (2 ± 6 bpm) (P = 0.001). The mean heart rate in the submaximal exercise test was reduced significantly in the CON group (5 ± 6 bpm; P = 0.007) and in the INC group (8 ± 7 bpm; P = 0.001), without a significant interaction between group and time point. Conclusion: Increasing intensity leads to greater adaptations in CRF than continuing with moderate intensity, even without increased energy expenditure. After 26 weeks of training in the moderate- and higher-intensity domain, energy-matched HIIT elicited further adaptations in cardiorespiratory fitness. Thus, training intensity plays a crucial role in the dose-response relationship between endurance training and fitness in untrained but healthy individuals. Clinical Trial Registration: https://www.drks.de/DRKS00031445, identifier DRKS00031445.

Clarifying the Link Between the Blood Lactate Concentration and Cardiovascular Risk.

The blood lactate value at rest (Lacrest) is linked to cardiovascular outcomes. It is unclear whether this association holds true in younger, healthy subjects, especially as the pathophysiological connection between Lacrest and cardiometabolic disease is not well understood. The aim of this study is clarifying the link between Lacrest and cardiovascular risk, and to study explanatory factors for the variance of Lacrest concerning metabolism and physical activity in a population of healthy patient-athletes. The distribution and intra-individual variability of Lacrest was assessed based on 9051 samples. The 10-year cardiovascular risk was then approximated using the Framingham risk score in a group of 1315 samples from patient-athletes. Cross-validated linear regression was used to analyze explanatory variables for Lacrest and 10-year cardiovascular risk. Lacrest is weakly associated with the Framingham score. This association disappears when adjusting for blood lipids. Lacrest is also linked to the predominant type of exercise with endurance athletes featuring a higher Lacrest. Lacrest does not independently predict the estimated cardiovascular risk but is associated with lipid parameters. Moreover, the intra-individual variability of Lacrest is high in a relevant number of subjects, which does not point towards the feasibility to use Lacrest as an individual risk factor.

COVID-19 in German Competitive Sports: Protocol for a Prospective Multicenter Cohort Study (CoSmo-S).

Objective: It is unclear whether and to what extent COVID-19 infection poses health risks and a chronic impairment of performance in athletes. Identification of individual health risk is an important decision-making basis for managing the pandemic risk of infection with SARS-CoV-2 in sports and return to play (RTP). Methods: This study aims 1) to analyze the longitudinal rate of seroprevalence of SARS-CoV-2 in German athletes, 2) to assess health-related consequences in athletes infected with SARS-CoV-2, and 3) to reveal effects of the COVID-19 pandemic in general and of a cleared SARS-CoV-2 infection on exercise performance. CoSmo-S is a prospective observational multicenter study establishing two cohorts: 1) athletes diagnosed positive for COVID-19 (cohort 1) and 2) federal squad athletes who perform their annual sports medical preparticipation screening (cohort 2). Comprehensive diagnostics including physical examination, laboratory blood analyses and blood biobanking, resting and exercise electrocardiogram (ECG), echocardiography, spirometry and exercise testing added by questionnaires are conducted at baseline and follow-up. Results and Conclusion: We expect that the results obtained, will allow us to formulate recommendations regarding RTP on a more evidence-based level.

Power Output and Efficiency During Supine, Recumbent, and Upright Cycle Ergometry.

Recumbent and supine cycling are common exercise modes in rehabilitation and clinical settings but the influence of postures on work efficiency is unclear. Therefore, the aim of this study was to compare metabolic and ventilatory efficiency during upright, recumbent, and supine postures. Potential differences should be assessed for suitable diagnostics and for prescriptions of training that probably is performed in alternative postures. Eighteen healthy subjects (age: 47.2 ± 18.4 years; 10 female, 8 male) participated in the study and each completed three incremental cycle ergometer tests until exhaustion in upright, recumbent (40°), and supine positions. Gas exchange, heart rate (HR), and lactate concentrations were analyzed and efficiency was calculated subsequently. Testing sessions were performed in random order within a 2-week period. Upright cycling resulted in significantly higher peak values [power output, oxygen uptake (Vo2), HR] as well as performance at lactate and ventilatory thresholds in comparison to recumbent or supine positions. Vco2/Vo2 slope and ventilatory efficiency (VE/Vco2 slope) were not affected by posture. Aerobic work efficiency (Vo2/P slope) and gross efficiency (GE) differed significantly between postures. Hereby, GE was lowest in supine cycling, particularly obvious in a mainly aerobic condition at 70 Watt [Median 11.6 (IQR 10.9-13.3) vs. recumbent: 15.9 (IQR 15.6-18.3) and upright: 17.4 (IQR 15.1-18.3)]. Peak power as well as GE and work efficiency values are influenced by cycling position, reinforcing the importance of adjusting test results for training prescriptions. Surprisingly, ventilatory efficiency was not affected in this study and therefore does not seem to falsify test results for pulmonary diagnostics.

Retrospective Analysis of Training and Its Response in Marathon Finishers Based on Fitness App Data.

Objective: Finishing a marathon requires to prepare for a 42.2 km run. Current literature describes which training characteristics are related to marathon performance. However, which training is most effective in terms of a performance improvement remains unclear. Methods: We conducted a retrospective analysis of training responses during a 16 weeks training period prior to an absolved marathon. The analysis was performed on unsupervised fitness app data (Runtastic) from 6,771 marathon finishers. Differences in training volume and intensity between three response and three marathon performance groups were analyzed. Training response was quantified by the improvement of the velocity of 10 km runs Δv 10 between the first and last 4 weeks of the training period. Response and marathon performance groups were classified by the 33.3rd and 66.6th percentile of Δv 10 and the marathon performance time, respectively. Results: Subjects allocated in the faster marathon performance group showed systematically higher training volume and higher shares of training at low intensities. Only subjects in the moderate and high response group increased their training velocity continuously along the 16 weeks of training. Conclusion: We demonstrate that a combination of maximized training volumes at low intensities, a continuous increase in average running speed up to the aimed marathon velocity and high intensity runs ≤ 5 % of the overall training volume was accompanied by an improved 10 km performance which likely benefited the marathon performance as well. The study at hand proves that unsupervised workouts recorded with fitness apps can be a valuable data source for future studies in sport science.

Duration-Specific Peak Acceleration Demands During Professional Female Basketball Matches.

Purpose: Describing the most intense periods of match-play is important in player monitoring and the development of specific training programs. The aim of this study was to extract maximum accelerations during basketball match-play and describe those as a function over time durations. Methods: Twelve professional female basketballers were monitored during 13 official matches to calculate acceleration profiles. Moving medians of time durations ranging from 0.3 to 1,800 s were computed to extract peak acceleration and deceleration magnitudes for the resultant (|accres|), horizontal (|acchor|), and vertical (|accvert|) planes. The relationship between peak magnitudes and time durations was modeled by an exponential function. Distinct curve characteristics can be described by the function parameters scale and decrease rate, which refer to an athlete's ability to perform maximum acceleration intensities over short-time (scale) and middle-time intervals (decrease rate). Generalized linear mixed-models were calculated to determine plane-specific differences in acceleration and deceleration capacities. Results: Function parameters differed significantly between |accres|, |acchor| and |accvert| [effect size (ES) = 0.33-1.15]. Comparisons within each movement plane revealed significant differences between positive and negative |accres| for the parameters scale (ES = 0.34) and decrease rate (ES = 0.39). All function parameters differed significantly between |accvert|+ and |decvert| (ES = 0.39-0.71). Rank analyses between players revealed significant inter-individual differences for all function parameters in all groups. Conclusions: Modeling peak acceleration magnitudes as a function over log-transformed time durations provides an opportunity to systematically quantify the most intense periods of match-play over short, middle and long time intervals (0.3-1,800 s). Detailed knowledge about these periods may positively contribute to training prescriptions, which intend to prepare players for highest intensities experienced during match-play in order to improve performance and prevent injuries. Derived function parameters allow inter-individual comparisons and provide insights into players' physical capabilities. This study further examines plane-specific intensity demands of professional female basketball, emphasizing the need for coaches to prepare players for maximum decelerations in the vertical plane.

Validation of Wearable Sensors during Team Sport-Specific Movements in Indoor Environments.

The aim of this study was to determine possible influences, including data processing and sport-specific demands, on the validity of acceleration measures by an inertial measurement unit (IMU) in indoor environments. IMU outputs were compared to a three-dimensional (3D) motion analysis (MA) system and processed with two sensor fusion algorithms (Kalman filter, KF; Complementary filter, CF) at temporal resolutions of 100, 10, and 5 Hz. Athletes performed six team sport-specific movements whilst wearing a single IMU. Mean and peak acceleration magnitudes were analyzed. Over all trials (n = 1093), KF data overestimated MA resultant acceleration by 0.42 ± 0.31 m∙s-2 for mean and 4.18 ± 3.68 m∙s-2 for peak values, while CF processing showed errors of up to 0.57 ± 0.41 m∙s-2 and -2.31 ± 2.25 m∙s-2, respectively. Resampling to 5 Hz decreased the absolute error by about 14% for mean and 56% for peak values. Still, higher acceleration magnitudes led to a large increase in error. These results indicate that IMUs can be used for assessing accelerations in indoor team sports with acceptable means. Application of a CF and resampling to 5 Hz is recommended. High-acceleration magnitudes impair validity to a large degree and should be interpreted with caution.

Player Monitoring in Indoor Team Sports: Concurrent Validity of Inertial Measurement Units to Quantify Average and Peak Acceleration Values.

The increasing interest in assessing physical demands in team sports has led to the development of multiple sports related monitoring systems. Due to technical limitations, these systems primarily could be applied to outdoor sports, whereas an equivalent indoor locomotion analysis is not established yet. Technological development of inertial measurement units (IMU) broadens the possibilities for player monitoring and enables the quantification of locomotor movements in indoor environments. The aim of the current study was to validate an IMU measuring by determining average and peak human acceleration under indoor conditions in team sport specific movements. Data of a single wearable tracking device including an IMU (Optimeye S5, Catapult Sports, Melbourne, Australia) were compared to the results of a 3D motion analysis (MA) system (Vicon Motion Systems, Oxford, UK) during selected standardized movement simulations in an indoor laboratory (n = 56). A low-pass filtering method for gravity correction (LF) and two sensor fusion algorithms for orientation estimation [Complementary Filter (CF), Kalman-Filter (KF)] were implemented and compared with MA system data. Significant differences (p < 0.05) were found between LF and MA data but not between sensor fusion algorithms and MA. Higher precision and lower relative errors were found for CF (RMSE = 0.05; CV = 2.6%) and KF (RMSE = 0.15; CV = 3.8%) both compared to the LF method (RMSE = 1.14; CV = 47.6%) regarding the magnitude of the resulting vector and strongly emphasize the implementation of orientation estimation to accurately describe human acceleration. Comparing both sensor fusion algorithms, CF revealed slightly lower errors than KF and additionally provided valuable information about positive and negative acceleration values in all three movement planes with moderate to good validity (CV = 3.9 - 17.8%). Compared to x- and y-axis superior results were found for the z-axis. These findings demonstrate that IMU-based wearable tracking devices can successfully be applied for athlete monitoring in indoor team sports and provide potential to accurately quantify accelerations and decelerations in all three orthogonal axes with acceptable validity. An increase in accuracy taking magnetometers in account should be specifically pursued by future research.

The relationship between movement speed and duration during soccer matches.

The relationship between the time duration of movement (t(dur)) and related maximum possible power output has been studied and modeled under many conditions. Inspired by the so-called power profiles known for discontinuous endurance sports like cycling, and the critical power concept of Monod and Scherrer, the aim of this study was to evaluate the numerical characteristics of the function between maximum horizontal movement velocity (HSpeed) and t(dur) in soccer. To evaluate this relationship, GPS data from 38 healthy soccer players and 82 game participations (≥30 min active playtime) were used to select maximum HSpeed for 21 distinct t(dur) values (between 0.3 s and 2,700 s) based on moving medians with an incremental t(dur) window-size. As a result, the relationship between HSpeed and Log(t(dur)) appeared reproducibly as a sigmoidal decay function, and could be fitted to a five-parameter equation with upper and lower asymptotes, and an inflection point, power and decrease rate. Thus, the first three parameters described individual characteristics if evaluated using mixed-model analysis. This study shows for the first time the general numerical relationship between t(dur) and HSpeed in soccer games. In contrast to former descriptions that have evaluated speed against power, HSpeed against t(dur) always yields a sigmoidal shape with a new upper asymptote. The evaluated curve fit potentially describes the maximum moving speed of individual players during the game, and allows for concise interpretations of the functional state of team sports athletes.

Resting limb muscle perfusion during inspiratory muscle loading in hypoxia and normoxia.

INTRODUCTION: Fatiguing of respiratory muscles reduces peripheral muscle perfusion. Further, acute hypoxia enhances respiratory muscle fatigue. This study investigated the effects of inspiratory muscle loading (IML) on resting locomotor muscle perfusion in hypoxia compared to normoxia. METHODS: Ten subjects completed two study days of fatiguing IML (blinded, randomized) in normobaric hypoxia (targeted oxygen saturation 80%) and normoxia, respectively. Contrast-enhanced ultrasound (CEUS) of the gastrocnemius muscle and popliteal doppler ultrasonography were used to monitor muscle perfusion. Based on CEUS and monitored cardiac output, perfusion surrogate parameters (CLPaer and CLPap) were established. RESULTS: Muscle perfusion declines early during IML in normoxia (CLPaer: -54±25%, p<0.01; CLPap: -58±32%, p<0.01) and hypoxia (CLPaer: -43±23%, p<0.01; CLPap: -41±20%, p<0.01). Hypoxia compared to normoxia increased cardiac output before (+23±19%, p<0.01 ANOVA) and during (+22±20%, p<0.01 ANOVA) IML, while local muscle perfusion during IML remained unchanged (CLPaer: p=0.41 ANOVA; CLPap: p=0.29 ANOVA). CONCLUSION: Acute hypoxia compared to normoxia does not affect locomotor muscle perfusion during fatiguing IML.

Reference-Free Adjustment of Respiratory Inductance Plethysmography for Measurements during Physical Exercise.

OBJECTIVE: Respiratory inductance plethysmography (RIP) provides an unobtrusive method for measuring breathing characteristics. Accurately adjusted RIP provides reliable measurements of ventilation during rest and exercise if data are acquired via two elastic measuring bands surrounding the rib cage (RC) and abdomen (AB). Disadvantageously, the most accurate reported adjusted model for RIP in literature-least squares regression-requires simultaneous RIP and flowmeter (FM) data acquisition. An adjustment method without simultaneous measurement (reference-free) of RIP and FM would foster usability enormously. METHODS: In this paper, we develop generalizable, functional, and reference-free algorithms for RIP adjustment incorporating anthropometric data. Further, performance of only one-degree of freedom (RC or AB) instead of two (RC and AB) is investigated. We evaluate the algorithms with data from 193 healthy subjects who performed an incremental running test using three different datasets: training, reliability, and validation dataset. The regression equation is improved with machine learning techniques such as sequential forward feature selection and 10-fold cross validation. RESULTS: Using the validation dataset, the best reference-free adjustment model is the combination of both bands with 84.69% breaths within  20% limits of equivalence compared to 43.63% breaths using the best comparable algorithm from literature. Using only one band, we obtain better results using the RC band alone. CONCLUSION: Reference-free adjustment for RIP reveals tidal volume differences of up to 0.25 l when comparing to the best possible adjustment currently present which needs the simultaneous measurement of RIP and FM. SIGNIFICANCE: This demonstrates that RIP has the potential for usage in wide applications in ambulatory settings.

Diaphragmatic fatigue during inspiratory muscle loading in normoxia and hypoxia.

INTRODUCTION: Diaphragmatic fatigue (DF) occurs during strenuous loading of respiratory muscles (e.g., heavy-intensity whole-body exercise, normocapnic hyperpnea, inspiratory resistive breathing). DF develops early on during normoxia, without further decline toward task failure; however, its progression during inspiratory muscle loading in during hypoxia remains unclear. Therefore, the present study used volume-corrected transdiaphragmatic pressures during supramaximal magnetic phrenic nerve stimulation (Pdi,twc) to investigate the effect of hypoxia on the progression of diaphragmatic fatigue during inspiratory muscle loading. METHODS: Seventeen subjects completed two standardized rounds of inspiratory muscle loading (blinded, randomized) under the following conditions: (i) normoxia, and (ii) normobaric hypoxia (SpO2 80%), with Pdi,twc assessment every 45 s. RESULTS: In fatiguers (i.e., Pdi,twc reduction >10%, n=10), biometric approximation during normoxia is best represented by Pdi,twc=4.06+0.83 exp(-0.19 × x), in contrast to Pdi,twc=4.38-(0.05 × x) during hypoxia. CONCLUSION: Progression of diaphragmatic fatigue during inspiratory muscle loading assessed by Pdi,tw differs between normoxia and normobaric hypoxia: in the former, Pdi,tw follows an exponential decay, whereas during hypoxia, Pdi,tw follows a linear decline.

Postural Control in Dual-Task Situations: Does Whole-Body Fatigue Matter?

Postural control is important to cope with demands of everyday life. It has been shown that both attentional demand (i.e., cognitive processing) and fatigue affect postural control in young adults. However, their combined effect is still unresolved. Therefore, we investigated the effects of fatigue on single- (ST) and dual-task (DT) postural control. Twenty young subjects (age: 23.7 ± 2.7) performed an all-out incremental treadmill protocol. After each completed stage, one-legged-stance performance on a force platform under ST (i.e., one-legged-stance only) and DT conditions (i.e., one-legged-stance while subtracting serial 3s) was registered. On a second test day, subjects conducted the same balance tasks for the control condition (i.e., non-fatigued). Results showed that heart rate, lactate, and ventilation increased following fatigue (all p < 0.001; d = 4.2-21). Postural sway and sway velocity increased during DT compared to ST (all p < 0.001; d = 1.9-2.0) and fatigued compared to non-fatigued condition (all p < 0.001; d = 3.3-4.2). In addition, postural control deteriorated with each completed stage during the treadmill protocol (all p < 0.01; d = 1.9-3.3). The addition of an attention-demanding interference task did not further impede one-legged-stance performance. Although both additional attentional demand and physical fatigue affected postural control in healthy young adults, there was no evidence for an overadditive effect (i.e., fatigue-related performance decrements in postural control were similar under ST and DT conditions). Thus, attentional resources were sufficient to cope with the DT situations in the fatigue condition of this experiment.

Predictive value of ventilatory inflection points determined under field conditions.

The aim of this study was to evaluate the predictive potential provided by two ventilatory inflection points (VIP1 and VIP2) examined in field without using gas analysis systems and uncomfortable facemasks. A calibrated respiratory inductance plethysmograph (RIP) and a computerised routine were utilised, respectively, to derive ventilation and to detect VIP1 and VIP2 during a standardised field ramp test on a 400 m running track on 81 participants. In addition, average running speed of a competitive 1000 m run (S1k) was observed as criterion. The predictive value of running speed at VIP1 (SVIP1) and the speed range between VIP1 and VIP2 in relation to VIP2 (VIPSPAN) was analysed via regression analysis. VIPSPAN rather than running speed at VIP2 (SVIP2) was operationalised as a predictor to consider the covariance between SVIP1 and SVIP2. SVIP1 and VIPSPAN, respectively, provided 58.9% and 22.9% of explained variance in regard to S1k. Considering covariance, the timing of two ventilatory inflection points provides predictive value in regard to a competitive 1000 m run. This is the first study to apply computerised detection of ventilatory inflection points in a field setting independent on measurements of the respiratory gas exchange and without using any facemasks.

Respiratory inductance plethysmography-a rationale for validity during exercise.

INTRODUCTION: The aim of this study was to provide a rationale for future validations of a priori calibrated respiratory inductance plethysmography (RIP) when used under exercise conditions. Therefore, the validity of a posteriori-adjusted gain factors and accuracy in resultant breath-by-breath RIP data recorded under resting and running conditions were examined. METHODS: Healthy subjects, 98 men and 88 women (mean ± SD: height = 175.6 ± 8.9 cm, weight = 68.9 ± 11.1 kg, age = 27.1 ± 8.3 yr), underwent a standardized test protocol, including a period of standing still, an incremental running test on treadmill, and multiple periods of recovery. Least square regression was used to calculate gain factors, respectively, for complete individual data sets as well as several data subsets. In comparison with flowmeter data, the validity of RIP in breathing rate (fR) and inspiratory tidal volume (VTIN) were examined using coefficients of determination (R). Accuracy was estimated from equivalence statistics. RESULTS: Calculated gains between different data subsets showed no equivalence. After gain adjustment for the complete individual data set, fR and VTIN between methods were highly correlated (R = 0.96 ± 0.04 and 0.91 ± 0.05, respectively) in all subjects. Under conditions of standing still, treadmill running, and recovery, 86%, 98%, and 94% (fR) and 78%, 97%, and 88% (VTIN), respectively, of all breaths were accurately measured within ± 20% limits of equivalence. CONCLUSION: In case of the best possible gain adjustment, RIP confidentially estimates tidal volume accurately within ± 20% under exercise conditions. Our results can be used as a rationale for future validations of a priori calibration procedures.

Modified ventilatory response characteristics to exercise in breath-hold divers.

Specific adjustments to repeated extreme apnea are not fully known and understood. While a blunted ventilatory chemosensitivity to CO2 is described for elite breath-hold divers (BHDs) at rest, it is unclear whether specific adaptations affect their response to dynamic exercise. Eight elite BHDs with a previously validated decrease in CO2 chemosensitivity, 8 scuba divers (SCDs), and 8 matched control subjects were included in a study where markers of ventilatory response, Fowler's dead space, partial pressure of carbon dioxide (pCO2), and blood lactate concentrations during cycle exercise were measured. Maximal power output did not differ between the groups, but lactate threshold (θL) appeared at a significantly lowered respiratory compensation point (RCP) and at a higher VO2 for the BHDs. End-tidal (petCO2) and estimated arterial pCO2 (paCO2) were significantly higher in BHDs at θL, the RCP, and maximum exhaustion. BHDs showed a significantly (P < .01) slower breathing pattern in relation to a given tidal volume at a specific work rate. In summary, BHDs presented signs of a metabolic shift from aerobic to anaerobic energy supply, decreased chemosensitivity during exercise, and a distinct ventilatory-response pattern during cycle exercise that differs from SCDs and controls.

Respiratory muscle function during a six-week period of normocapnic hyperpnoea training.

Respiratory muscle endurance training (normocapnic hyperpnoea, RMET) improves maximal volitional ventilation (MVV) and respiratory muscle endurance while volitionally-assessed respiratory muscle strength remains unchanged (prior-to-post comparison). What remains unclear is how respiratory muscle function changes/adapts during a defined period of RMET in highly-trained subjects. This study assessed respiratory muscle function during a six-week period of RMET in 13 highly-trained, healthy subjects. Weekly-assessed twitch mouth pressure (prior/post 2.20 ± 0.41 kPa vs. 2.43 ± 0.61 kPa; p=0.14); twitch transdiaphragmatic pressure (prior/post 3.04 ± 0.58 kPa vs. 3.13 ± 0.48 kPa; p=0.58) and maximal inspiratory pressure (prior/post 12.6 ± 3.6 kPa vs. 13.9 ± 3.8 kPa; p=0.06) did not increase. MVV (prior/post 175 ± 18 l/min vs. 207 ± 30 l/min; p=0.001), sniff nasal pressure (prior/post 11.8 ± 2.8 kPa vs. 14.0 ± 2.9 kPa; p=0.003) and maximal expiratory pressure (prior/post 16.9 ± 5.8 kPa vs. 20.9 ± 4.9 kPa; p=0.006) each increased. In conclusion, non-volitionally assessed diaphragmatic strength does not increase during six weeks of RMET in highly-trained subjects, while expiratory muscle strength and MVV rose. Future studies should clarify if these findings apply when assessed during respiratory muscle strength rather than endurance training.

Biometric approximation of diaphragmatic contractility during sustained hyperpnea.

Imposing load on respiratory muscles results in a loss of diaphragmatic contractility that develops early, is independent of task failure, and levels off following the initial decrease. This study assessed the progression of diaphragmatic contractility during sustained normocapnic hyperpnea and applied a biometric approximation (hypothesis: non-linear decay). Ten healthy subjects performed three consecutive hyperpnea bouts (I:6 min warm up/II:9 min/III:task failure 28.6 ± 11.5 min; mean ± SD) at maximal voluntary ventilation fractions (I:30-60%/II:70%/III:70%), followed by recovery periods (I:18 min/II:6 min/III:30 min). Twitch transdiaphragmatic pressure (TwPdi) was assessed throughout the protocol. Bouts II and III induced diaphragmatic fatigue (TwPdi baseline vs. Recovery -19 ± 17% and -30 ± 16%, both p < 0.05 RM-ANOVA) while bout I did not. During sustained hyperpnea (II/III), TwPdi followed an exponential decay (r(2) = 0.91). The reduction in diaphragmatic contractility closely follows a non-linear function with an early loss in diaphragmatic contractility during sustained hyperpnea, levels off thereafter, and is independent of task failure. Thus, reasons other than diaphragmatic fatigue are likely to be responsible for task failure during sustained hyperpnea.