Heavy-intensity priming exercise extends the V̇O2max plateau and increases peak power output during ramp-incremental exercise.

PURPOSE: To investigate whether a heavy-intensity priming exercise precisely prescribed within the heavy-intensity domain would lead to a greater peak-power output (POpeak) and a longer maximal oxygen uptake (V̇O2max) plateau. METHODS: Twelve recreationally active adults participated in this study. Two visits were required: (i) a step-ramp-step test (RI control), and (ii) a RI-test preceded by a priming exercise within the heavy-intensity domain (RI primed). A piece-wise equation was used to quantify the V̇O2 plateau duration (V̇O2plateau-time). The mean response time (MRT) was computed during the RI control condition. The delta (Δ) V̇O2-slope (S; mL·min-1·W-1) and V̇O2-Y-intercept (Y; mL·min-1) within the moderate-intensity domain between conditions (RI primed minus RI control) was also assessed using a novel graphical analysis. RESULTS: V̇O2plateau-time (P = 0.001; d = 1.27) and POpeak (P = 0.003; d = 1.08) were all greater in the RI Primed. MRT (P < 0.001; d = 2.45) was shorter in the RI primed compared to the RI control. A larger ΔV̇O2plateau-time was correlated with a larger ΔMRT between conditions (r = -0.79; P = 0.002). CONCLUSIONS: This study demonstrated that heavy-intensity priming exercise lengthened the V̇O2plateau-time and increased POpeak. The overall faster RI-V̇O2 responses seem to be responsible for the longer V̇O2plateau-time. Specifically, a shorter MRT, but not changes in RI-V̇O2-slopes, was associated to a longer V̇O2plateau-time following priming exercise.

To what extent do physiological tolerances determine elevational range limits of mammals?

A key question in biology concerns the extent to which distributional range limits of species are determined by intrinsic limits of physiological tolerance. Here, we use common-garden data for wild rodents to assess whether species with higher elevational range limits typically have higher thermogenic capacities in comparison to closely related lowland species. Among South American leaf-eared mice (genus Phyllotis), mean thermogenic performance is higher in species with higher elevational range limits, but there is little among-species variation in the magnitude of plasticity in this trait. In the North American rodent genus Peromyscus, highland deer mice (Peromyscus maniculatus) have greater thermogenic maximal oxygen uptake ( V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ) than lowland white-footed mice (Peromyscus leucopus) at a level of hypoxia that matches the upper elevational range limit of the former species. In highland deer mice, the enhanced thermogenic V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ in hypoxia is attributable to a combination of evolved and plastic changes in physiological pathways that govern the transport and utilization of O2 and metabolic substrates. Experiments with Peromyscus mice also demonstrate that exposure to hypoxia during different stages of development elicits plastic changes in cardiorespiratory traits that improve thermogenic V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ via distinct physiological mechanisms. Evolved differences in thermogenic capacity provide clues about why some species are able to persist in higher-elevation habitats that lie slightly beyond the tolerable limits of other species. Such differences in environmental tolerance also suggest why some species might be more vulnerable to climate change than others.

Left atrial dysfunction can independently predict exercise capacity in patients with chronic heart failure who use beta-blockers.

BACKGROUND: Beta-blockers are first-line clinical drugs for the treatment of chronic heart failure (CHF). In the guidelines for cardiac rehabilitation, patients with heart failure who do or do not receive beta-blocker therapy have different reference thresholds for maximal oxygen uptake (VO2max). It has been reported that left atrial (LA) strain can be used to predict VO2max in patients with heart failure, which can be used to assess exercise capacity. However, most existing studies included patients who did not receive beta-blocker therapy, which could have a heterogeneous influence on the conclusions. For the vast majority of CHF patients receiving beta-blockers, the exact relationship between LA strain parameters and exercise capacity is unclear. METHODS: This cross-sectional study enrolled 73 patients with CHF who received beta-blockers. All patients underwent a thorough resting echocardiogram and a cardiopulmonary exercise test to obtain VO2max, which was used to reflect exercise capacity. RESULTS: LA reservoir strain, LA maximum volume index (LAVImax), LA minimum volume index (LAVImin) (P < 0.0001) and LA booster strain (P < 0.01) were all significantly correlated with VO2max, and LA conduit strain was significantly correlated with VO2max (P < 0.05) after adjusting for sex, age, and body mass index. LA reservoir strain, LAVImax, LAVImin (P < 0.001), and LA booster strain (P < 0.05) were significantly correlated with VO2max after adjusting for left ventricular ejection fraction, the ratio of transmitral E velocity to tissue Doppler mitral annulus e' velocity (E/e'), and tricuspid annular plane systolic excursion. LA reservoir strain with a cutoff value of 24.9% had a sensitivity of 74% and specificity of 63% for the identification of patients with VO2max < 16 mL/kg/min. CONCLUSION: Among CHF patients receiving beta-blocker therapy, resting LA strain is linearly correlated with exercise capacity. LA reservoir strain is a robust independent predictor of reduced exercise capacity among all resting echocardiography parameters. CLINICAL TRIAL REGISTRATION: This study is a part of the Baduanjin-Eight-Silken-Movement with Self-efficacy Building for Patients with Chronic Heart Failure (BESMILE-HF) trial NCT03180320 (ClinicalTrials.gov, registration date: 08/06/2017).

Skeletal muscle mass is a strong predictor of cardiorespiratory fitness in the Chinese population with obesity.

BACKGROUND AND AIMS: Although skeletal muscle is well-known as physiologically related to VO2max, the independent predictive value of skeletal muscle mass (SMM) VO2max in people with obesity has not been studied. This study aims to determine the relationships between maximal oxygen uptake (VO2max) and SMM in the Chinese population with obesity. METHODS AND RESULTS: Overall, 409 participants with obesity were included in this cross-sectional study. A maximal and graded exercise testing measured VO2max, and body compositions were measured by bioelectrical impedance analysis. Subsequently, correlation coefficients and stepwise multiple linear regression analyses were used to determine the relationships between VO2max and body compositions. SMM was found to have a significant correlation with VO2max (r = 0.290, P < 0.001) after adjusting for sex, age, body mass index (BMI), waist-to-hip ratio, and percent body fat (PBF). In previous studies, BMI was widely recognized as a strong predictor of VO2max. This study revealed surprising results: after SMM was controlled, the correlation between BMI and VO2max was reduced (from r = 0.381, P < 0.001 to r = 0.191, P < 0.001). SMM was found the most important independent predictor. In the regression model, the variance of VO2max was explained by the SMM which accounted for 27.4%. CONCLUSIONS: In summary, SMM is a stronger independent predictor of cardiorespiratory fitness in the Chinese population with obesity than sex, age, BMI, waist-to-hip ratio, and PBF.

Aerobic high-intensity intervals improve V̇O2max more than supramaximal sprint intervals in females, similar to males.

INTRODUCTION: Maximal oxygen uptake (V̇O2max ) is a pivotal factor for aerobic endurance performance. Recently, aerobic high-intensity interval training (HIIT) was documented to be superior to sprint interval training (SIT) in improving V̇O2max in well-trained males. However, as mounting evidence suggests that physiological responses to training are sex-dependent, examining the effects of HIIT versus SIT on V̇O2max , anaerobic capacity, and endurance performance in females is warranted. METHODS: We randomized 81 aerobically well-trained females (22 ± 2 years, 51.8 ± 3.6 mL∙kg-1 ∙min-1 V̇O2max ), training three times weekly for 8 weeks, to well-established protocols: (1) HIIT 4 × 4 min at ~95% of maximal aerobic speed (MAS), with 3 min active recovery (2) SIT 8 × 20 s at ~150% of MAS, with 10 s passive recovery (3) SIT 10 × 30 s at ~175% of MAS, with 3.5 min active recovery. RESULTS: Only HIIT 4 × 4 min increased V̇O2max (7.3 ± 3.1%), different from both SIT groups (all p < 0.001). Anaerobic capacity (maximal accumulated oxygen deficit) increased following SIT 8 × 20 s (6.5 ± 10.5%, p < 0.05), SIT 10 × 30 s (14.4 ± 13.7%, p < 0.05; different from HIIT 4 × 4 min, p < 0.05). SIT 10 × 30 s resulted in eight training-induced injuries, different from no injuries following HIIT 4 × 4 min and SIT 8 × 20 s (p < 0.001). All groups improved long-distance (3000-meter) and sprint (300-meter) running performance (all p < 0.001). SIT protocols improved sprint performance more than HIIT 4 × 4 min (p < 0.05). Compared to previous male results, no increase in V̇O2max following SIT 8 × 20 s (p < 0.01), and a higher injury rate for SIT 10 × 30 s (p < 0.001), were evident. CONCLUSIONS: In aerobically well-trained women, HIIT is superior to SIT in increasing V̇O2max while all-out treadmill running SIT is potentially more harmful.

Hemoglobin mass and performance responses during 4 weeks of normobaric "live high-train low and high".

PURPOSE: To investigate whether 4 weeks of normobaric "live high-train low and high" (LHTLH) causes different hematological, cardiorespiratory, and sea-level performance changes compared to living and training in normoxia during a preparation season. METHODS: Nineteen (13 women, 6 men) cross-country skiers competing at the national or international level completed a 28-day period (∼18 h day-1 ) of LHTLH in normobaric hypoxia of ∼2400 m (LHTLH group) including two 1 h low-intensity training sessions per week in normobaric hypoxia of 2500 m while continuing their normal training program in normoxia. Hemoglobin mass (Hbmass ) was assessed using a carbon monoxide rebreathing method. Time to exhaustion (TTE) and maximal oxygen uptake (VO2max ) were measured using an incremental treadmill test. Measurements were completed at baseline and within 3 days after LHTLH. The control group skiers (CON) (seven women, eight men) performed the same tests while living and training in normoxia with ∼4 weeks between the tests. RESULTS: Hbmass in LHTLH increased 4.2 ± 1.7% from 772 ± 213 g (11.7 ± 1.4 g kg-1 ) to 805 ± 226 g (12.5 ± 1.6 g kg-1 ) (p < 0.001) while it was unchanged in CON (p = 0.21). TTE improved during the study regardless of the group (3.3 ± 3.4% in LHTLH; 4.3 ± 4.8% in CON, p < 0.001). VO2max did not increase in LHTLH (61.2 ± 8.7 mL kg-1 min-1 vs. 62.1 ± 7.6 mL kg-1 min-1 , p = 0.36) while a significant increase was detected in CON (61.3 ± 8.0-64.0 ± 8.1 mL kg-1 min-1 , p < 0.001). CONCLUSIONS: Four-week normobaric LHTLH was beneficial for increasing Hbmass but did not support the short-term development of maximal endurance performance and VO2max when compared to the athletes who lived and trained in normoxia.

What is the optimal classical style sub-technique during uphill roller skiing in elite male cross-country skiers?

PURPOSE: To compare performance, physiological and biomechanical responses between double poling (DP) and diagonal stride (DIA) during treadmill roller skiing in elite male cross-country skiers. METHOD: Twelve skiers (VO2peak DIAup; 74.7 ± 3.7 ml kg-1 min-1) performed two DP conditions at 1° (DPflat) and 8° (DPup) incline, and one DIA condition, 8° (DIAup). Submaximal gross efficiency (GE) and maximal 3.5 min time-trial (TT) performance, including measurements of VO2peak and maximal accumulated O2-deficit (MAOD), were determined. Temporal patterns and kinematics were assessed using 2D video, while pole kinetics were obtained from pole force. RESULTS: DIAup induced (mean, [95% confidence interval]) 13% [4, 22] better 3.5-min TT performance, 7%, [5, 10]) higher VO2peak and 3% points [1, 5] higher GE compared to DPup (all P < 0.05). DPup induced 120% higher MAOD compared to DPflat, while no significant differences were observed for VO2peak or GE between DPflat and DPup. There was a large correlation between performance and GE in DP and a large correlation between performance and VO2peak for DIAup (all r = 0.7-0.8, P < 0.05). No correlations were found between performance and VO2peak for any of the DP conditions, nor between performance and GE for DIAup (r = 0.0-0.2, P > 0.1). CONCLUSION: At 8º uphill roller skiing, DIAup induce higher VO2peak, GE, and superior time-trial performance than DPup in elite male skiers. There was no difference between VO2peak or GE between DPflat and DPup. A large correlation was observed between DIAup performance and DIAup VO2peak, while DP performance was best correlated to submaximal GE.

Physiological characteristics and performance of a world-record breaking tower runner.

This study reports the physiological and performance profiles of a world-class tower runner during a 6-week period surrounding a successful Guinness World Record (WR) attempt, and discusses the efficacy of a tower running specific field test. The world-ranked number 2 tower runner completed four exercise tests [laboratory treadmill assessment (3 weeks before the WR attempt), familiarisation to a specific incremental tower running field test (1 week before), tower running field test (1 week after), and tower running time trial (TT) (3 weeks after)] and the WR attempt within 6-week period. Peak oxygen consumption (VO2peak) during the laboratory test, field test, and TT were 73.3, 75.5 and 78.3 mL·kg-1·min-1, respectively. The VO2 corresponding to the second ventilatory threshold was 67.3 mL·kg-1·min-1 (89.1% of VO2peak), identified at stage 4 (tempo; 100 b·min-1), during the field test. The duration of the TT was 10 min 50 s, with an average VO2 of 71.7 mL·kg-1·min-1 (91.6% of VO2peak), HR of 171 b·min-1 (92% of peak HR), vertical speed of 0.47 m·s-1, and cadence was 117 steps·min-1. A world-class tower runner possesses a well-developed aerobic capacity. A specific, field-based test revealed greater VO2peak than a laboratory test, indicating a need for sport-specific testing procedures.

Associations of the serum n-6 PUFA with exercise cardiac power in men.

Low intake or tissue concentrations of the n-6 PUFA, especially to the major n-6 PUFA linoleic acid (LA), and low exercise cardiac power (ECP) are both associated with CVD risk. However, associations of the n-6 PUFA with ECP are unknown. The aim of the present study was to explore cross-sectional associations of the serum total n-6 PUFA, LA, arachidonic acid (AA), γ-linolenic acid (GLA) and dihomo-γ-linolenic acid (DGLA) concentrations with ECP and its components. In total, 1685 men aged 42-60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study and free of CVD were included. ANCOVA was used to examine the mean values of ECP (maximal oxygen uptake (VO2max)/maximal systolic blood pressure (SBP)) and its components in quartiles of the serum total and individual n-6 PUFA concentrations. After multivariable adjustments, higher serum total n-6 PUFA concentration was associated with higher ECP and VO2max (for ECP, the extreme-quartile difference was 0·77 ml/mmHg (95 % CI 0·38, 1·16, Pfor trend across quartiles < 0·001) and for VO2max 157 ml/min (95 % CI 85, 230, Pfor trend < 0·001), but not with maximal SBP. Similar associations were observed with serum LA concentration. Higher serum AA concentration was associated with higher ECP but not with VO2max or maximal SBP. The minor serum n-6 PUFA GLA and DGLA were associated with higher maximal SBP during exercise test and DGLA also with higher VO2max but neither with ECP. In conclusion, especially LA concentration was associated with higher ECP. This may provide one mechanism for the cardioprotective properties of, especially, LA.

Salutary effects of moderate but not high intensity aerobic exercise training on the frequency of peripheral T-cells associated with immunosenescence in older women at high risk of breast cancer: a randomized controlled trial.

BACKGROUND: Immunosenescence is described as age-associated changes within the immune system that are responsible for decreased immunity and increased cancer risk. Physically active individuals have fewer 'senescent' and more naïve T-cells compared to their sedentary counterparts, but it is not known if exercise training can rejuvenate 'older looking' T-cell profiles. We determined the effects of 12-weeks supervised exercise training on the frequency of T-cell subtypes in peripheral blood and their relationships with circulating levels of the muscle-derived cytokines (i.e. 'myokines') IL-6, IL-7, IL-15 and osteonectin in older women at high risk of breast cancer. The intervention involved 3 sessions/week of either high intensity interval exercise (HIIT) or moderate intensity continuous exercise (MICT) and were compared to an untrained control (UC) group. RESULTS: HIIT decreased total granulocytes, CD4+ T-cells, CD4+ naïve T-cells, CD4+ recent thymic emigrants (RTE) and the CD4:CD8 ratio after training, whereas MICT increased total lymphocytes and CD8 effector memory (EM) T-cells. The change in total T-cells, CD4+ naïve T-cells, CD4+ central memory (CM) T-cells and CD4+ RTE was elevated after MICT compared to HIIT. Changes in [Formula: see text] after training, regardless of exercise prescription, was inversely related to the change in highly differentiated CD8+ EMRA T-cells and positively related to changes in ß2-adrenergic receptor (ß2-AR) expression on CM CD4+ and CM CD8+ T-cells. Plasma myokine levels did not change significantly among the groups after training, but individual changes in IL-7 were positively related to changes in the number of ß2-AR expressing CD4 naïve T cells in both exercise groups but not controls. Further, CD4 T-cells and CD4 naive T-cells were negatively related to changes in IL-6 and osteonectin after HIIT but not MICT, whereas CD8 EMRA T-cells were inversely related to changes in IL-15 after MICT but not HIIT. CONCLUSIONS: Aerobic exercise training alters the frequency of peripheral T-cells associated with immunosenescence in middle aged/older women at high risk of breast cancer, with HIIT (pro-senescent) and MICT (anti-senescent) evoking divergent effects. Identifying the underlying mechanisms and establishing whether exercise-induced changes in peripheral T-cell numbers can alter the risk of developing breast cancer warrants investigation.

Individual variations in pre-altitude hemoglobin mass influence hemoglobin mass responses to repeated altitude sojourns.

INTRODUCTION: Previous studies have shown variable within-subject hemoglobin mass (Hbmass ) responses to altitude training. We investigated whether Hbmass responses depend on individual variations in pre-altitude Hbmass during repeated altitude sojourns. METHODS: Nine elite endurance athletes carried out 3-5 altitude sojourns over 17 ± 10 months (mean ± 95% confidence interval), at an altitude of 1976 ± 62 m, for 21 ± 1 days, and a total hypoxic dose of 989 ± 46 km·h, with Hbmass assessed before and after each sojourn (carbon monoxide rebreathing). The individual mean baseline was calculated as the mean of all pre-altitude Hbmass values for an athlete, and it was investigated whether the percent deviation from the individual mean baseline affected the altitude-induced Hbmass response. RESULTS: On average, Hbmass increased by 3.4 ± 1.1% (p < 0.001) from pre- to post-altitude. The intra-individual changes in Hbmass were highly inconsistent (coefficient of variation, CV: 88%), and we found no relationship between Hbmass changes in successive altitude sojourns (r = 0.01; p = 0.735). However, the percent increase in Hbmass was highly correlated with the pre-altitude Hbmass , expressed as the percent deviation from the individual mean baseline (y = -0.7x + 3.4; r = 0.75; p < 0.001). Linear mixed-model analysis confirmed a -0.6 ± 0.2% smaller increase in Hbmass for each 1% higher pre-altitude Hbmass than the individual mean baseline (p < 0.001) after adjusting for the covariates hypoxic dose (p = 0.032) and the relative Hbmass (g·kg-1 body weight; p = 0.031). CONCLUSION: Individual variations in pre-altitude Hbmass significantly influence the athletes' Hbmass responses to repeated altitude sojourns, with a potentiated response after traveling to altitude with a low pre-altitude Hbmass .

Can linear regression confirm VO2max was attained in middle-aged and older adults?

PURPOSE: Evaluate the efficacy of a regression method for identifying a VO2 plateau to confirm the attainment of VO2max compared to a verification trial in middle-aged and older adults. METHODS: Eleven men and ten women (age 61.0 ± 8.1, VO2max 21.8-50.3 ml/kg/min, n = 21) completed an individualized ramp graded exercise test (GXT) on the cycle ergometer, and one hour later, a verification trial at 105% of their maximal work rate (WR) achieved during the GXT. A plateau in VO2 was used to confirm VO2max was attained. VO2 plateau was identified using the difference between the highest VO2 between the two trials and a linear regression analysis of the VO2-WR relationship during the GXT. McNemar's test of marginal homogeneity was used to detect differences in the proportion of paired data of individuals' attainment of VO2max criteria. RESULTS: Of the 21 participants, 15 (71.4%) met the verification criterion while 6 (28.6%) did not, compared to the regression method where 16 (76.2%) achieved the regression criterion while 5 (23.8%) did not. McNemar's test revealed no significant difference between participants' ability to achieve the regression and verification criteria (p = 0.999). CONCLUSION: The regression method is an effective strategy for confirming VO2max was attained with middle-aged and older adults on a cycle ergometer. This time-efficient regression method is comparable with the verification criterion but does not require a second maximal test, which may be advantageous for those where the verification trial may not be practical.

High-intensity resistance exercise is not as effective as traditional high-intensity interval exercise for increasing the cardiorespiratory response and energy expenditure in recreationally active subjects.

PURPOSE: Traditional high-intensity interval exercise (HIIE) highly stimulates the cardiorespiratory system and increases energy expenditure (EE) during exercise. High-intensity resistance exercise (HIRE) has become more popular in recreationally active subjects. The physiological responses to HIRE performed with light or moderate load is currently largely unknown. Here, we examined the effect of the type of interval exercise [HIRE at 40% (HIRE40) and 60% (HIRE60) 1-RM vs. traditional HIIE] on the cardiorespiratory response and EE during and after exercise. METHODS: Fifteen recreationally active adults randomly completed traditional HIIE on an ergocyle, HIRE40 and HIRE60. The sessions consisted of two sets of ten 30-s intervals (power at 100% VO2max during HIIE; maximal number of repetitions for 10 different free-weight exercises during HIRE40 and HIRE60) separated by 30-s active recovery periods. Gas exchange, heart rate (HR) and EE were assessed during and after exercise. RESULTS: VO2mean, VO2peak, HRmean, the time spent above 90% VO2max and HRmax, and aerobic EE were lower in both HIRE sessions compared with HIIE (P < 0.05). Anaerobic glycolytic contribution to total exercise EE was higher in HIRE40 and HIRE60 compared with HIIE (P < 0.001). EE from excess post-exercise oxygen consumption (EPOC) was similar after the three sessions. Overall, similar cardiorespiratory responses and EE were found in HIRE40 and HIRE60. CONCLUSIONS: HIRE is not as effective as HIIE for increasing the cardiorespiratory response and EE during exercise, while EPOC remains similar in HIRE and HIIE. These parameters are not substantially different between HIRE40 and HIRE60.

Comprehensive cardiopulmonary profile of individuals with Down syndrome.

BACKGROUND: Individuals with Down syndrome (DS) have low levels of cardiorespiratory fitness and previous studies have shown that these low levels of fitness have a physiological cause. During exercise, the cardiovascular, ventilatory and muscular systems are simultaneously active. While individual parameters of these systems have been investigated in DS before, the interaction between these parameters and systems have not been discussed in detail. Doing so may provide important insight regarding the aetiology of low cardiorespiratory fitness and which parameters of the cardiovascular, pulmonary and muscular systems are altered in individuals with DS compared with their peers without DS. METHODS: Cardiopulmonary exercise tests were performed in healthy adults with and without DS. Parameters related to the cardiovascular, ventilatory and muscular systems were collected until VO2peak . In total, 51 participants were included in analysis, of which 21 had DS. RESULTS: Individuals with DS showed lower peak values for all collected outcomes (P ≤ 0.001) compared with those without DS, except for ventilatory threshold as a percentage of maximal oxygen uptake and VE /VCO2 slope, which were similar. CONCLUSIONS: Our results show that individuals with DS present impairments across the cardiovascular, ventilatory and muscular aspects of the cardiopulmonary system.

Exercise Prescription Enhances Maximal Oxygen Uptake and Anaerobic Threshold in Young Single Ventricle Patients with Fontan Circulation.

A modified Fontan procedure is performed to palliate single ventricle malformations. This hemodynamic arrangement sets systemic venous pressure unphysiologically high which predisposes the patient to severe long-term complications. As a means of self-care, exercise may ease transpulmonary flow. We investigated the effects of 6-month exercise prescription on pediatric Fontan patients. Eighteen stable Fontan patients (14 ± 2.6 years, 160.4 ± 11.3 cm, and 51.4 ± 14.4 kg) were recruited. Baseline fitness was assessed by physical activity questionnaire, body composition, cardiorespiratory performance, and muscle fitness tests. Exercise prescription was individually tailored for a 6-month training period at home. At entrance to the study, Fontan patients had lower than normal maximal oxygen uptake (VO2max) of 28. ± 5.9 ml/kg/min (61 ± 11% of normal). VO2max significantly correlated with weekly amount of habitual exercise and muscle mass of the lower limbs (p < 0.001 for both). After 6 months of training, the patients had improved their anaerobic threshold of 18 ± 3.5 vs 20 ± 4.8 ml/kg/min, p = 0.007, and workload tolerance of 119 ± 39 vs 132.4 ± 44 W, p = 0.001. At EUROFIT tests, the patient muscle fitness was below age-matched reference, but correlations existed between VO2max and lower limb muscle tests. Our patients with Fontan hemodynamics were able to positively respond to an exercise program by enhancing submaximal performance which should be beneficial for getting through daily activities. Future studies should correlate whether hemodynamic findings at Fontan completion influence physical activity and exercise reserves, and whether these predict predisposition to chronic complications.

Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis.

Background: /Objective: Combining blood flow restriction (BFR) with endurance training is exponentially increasing although the benefits are unclear in trained athletes. We aimed to describe the effects of aerobic and/or anaerobic training programmes combined with BFR on the aerobic capacity and related sport performance of trained athletes. Methods: Databases used were MEDLINE, SPORTDiscus, LILACS, IBECS, CINHAL, COCHRANE, SCIELO and PEDro, through October 2021. For study selection, criteria included (a) clinical trials that recruited trained healthy athletes, that (b) proposed BFR in combination with aerobic/anaerobic training programmes (≥8 sessions) and that (c) evaluated either aerobic capacity or related sport performance. For data extraction, a reviewer extracted the data, and another reviewer independently verified it. The tool RoB 2 (Risk of bias 2) was used to assess risk of bias. Results: Ten studies met the eligibility criteria, capturing a total of 207 participants. Although it did not reveal any significant effects from training with BFR on aerobic capacity compared to the same training without BFR, effect sizes were extremely high. Subgroup analyses according to the intensity of the training programmes found similar results for low-to-moderate or high-intensity training compared to the same sessions without BFR. Conclusion: Although adding BFR to training sessions always produce benefits from baseline in aerobic capacity and sport performance of trained athletes, these results are not better than those observed after the same training sessions without BFR. The reduced number of studies, small sample sizes and some concerns regarding risk of bias should be highlighted as limitations. Registration number: CRD42021248212.

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

Three sentinel parameters of aerobic performance are the maximal oxygen uptake ( V̇O2max ), critical power (CP) and speed of the V̇O2 kinetics following exercise onset. Of these, the latter is, perhaps, the cardinal test of integrated function along the O2 transport pathway from lungs to skeletal muscle mitochondria. Fast V̇O2 kinetics demands that the cardiovascular system distributes exercise-induced blood flow elevations among and within those vascular beds subserving the contracting muscle(s). Ideally, this process must occur at least as rapidly as mitochondrial metabolism elevates V̇O2 . Chronic disease and ageing create an O2 delivery (i.e. blood flow × arterial [O2 ], Q̇O2 ) dependency that slows V̇O2 kinetics, decreasing CP and V̇O2max , increasing the O2 deficit and sowing the seeds of exercise intolerance. Exercise training, in contrast, does the opposite. Within the context of these three parameters (see Graphical Abstract), this brief review examines the training-induced plasticity of key elements in the O2 transport pathway. It asks how structural and functional vascular adaptations accelerate and redistribute muscle Q̇O2 and thus defend microvascular O2 partial pressures and capillary blood-myocyte O2 diffusion across a ∼100-fold range of muscle V̇O2 values. Recent discoveries, especially in the muscle microcirculation and Q̇O2 -to- V̇O2 heterogeneity, are integrated with the O2 transport pathway to appreciate how local and systemic vascular control helps defend V̇O2 kinetics and determine CP and V̇O2max in health and how vascular dysfunction in disease predicates exercise intolerance. Finally, the latest evidence that nitrate supplementation improves vascular and therefore aerobic function in health and disease is presented.

Cardiorespiratory fitness is not associated with reduced risk of prostate cancer: A cohort study and review of the literature.

BACKGROUND: Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective association of CRF with prostate cancer risk using a cohort study and review of the literature. MATERIAL AND METHODS: Cardiorespiratory fitness was assessed using a respiratory gas exchange analyser during exercise testing in 2204 cancer-free middle-aged men. Hazard ratios (HRs) with 95% confidence interval (CIs) were estimated. We corrected for within-person variability in CRF levels using repeat measurements. RESULTS: During a median follow-up of 24.9 years, 216 prostate cancer cases occurred. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI: 0.53-0.64). The HR (95% CI) of prostate cancer per 1 standard deviation increase in CRF in age-adjusted analysis was 1.10 (0.95-1.27). The association remained consistent after further adjustment for several risk factors (HR 1.13; 95% CI 0.96-1.33). The corresponding adjusted HRs were 1.24 (95% CI: 0.87-1.77) and 1.28 (95% CI: 0.87-1.88), respectively, when comparing the extreme tertiles of CRF levels. Previous studies mostly reported no evidence of an association or an increased risk of prostate cancer in relation to high CRF. Studies reporting positive associations had short-term follow-up durations (<10 years). CONCLUSIONS: Primary data and a review of previous studies suggest that elevated CRF is not associated with reduced prostate cancer risk. Previous findings of significant evidence of associations could be attributed to increased screening and detection as well as reverse causation bias.

Physiological basis of interval training for performance enhancement.

NEW FINDINGS: What is the topic of this review? This review considers the physiological basis of interval training for performance enhancement, with an emphasis on the capacity for aerobic energy provision. What advances does it highlight? It highlights advances regarding the effect of interval training on primary physiological determinants of aerobic energy provision, which are associated with performance. ABSTRACT: Interval training refers to an intermittent style of exercise, in which bouts of more intense effort are interspersed with recovery periods within a given training session. Physiological responses to interval training depend on numerous factors, including the specific nature of the intervention and the initial training state of the individual. Interval training improves performance in part by enhancing the capacity for aerobic energy provision, even in those who are already trained. Two primary mechanisms in this regard are an increased whole-body maximal oxygen uptake and an enhanced capacity for oxidative metabolism in skeletal muscle owing to an increase in mitochondria. In comparison to moderate-intensity continuous exercise, interval training can elicit superior responses when total work is matched, and similar responses despite a reduced training volume and time commitment.

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study.

BACKGROUND: Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. METHODS: In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg-1 min-1 and peak oxygen consumption (VO2 peak) >16 ml kg-1 min-1, cut-points that represent a reduced risk of postoperative complications. RESULTS: Five questions were identified to have dominance in predicting AT>11 ml kg-1 min-1 and VO2 peak>16 ml.kg-1min-1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg-1.min-1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO2 peak>16 ml.kg-1.min-1 and VO2 peak<16 ml.kg-1.min-1. CONCLUSIONS: The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.