Pricing above value: Selling to a market with selection problems.

This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine.

Application and performance of heart-rate-based methods to estimate oxygen consumption at different exercise intensities in postmenopausal women.

PURPOSE: Heart rate (HR) is a widespread method to estimate oxygen consumption ([Formula: see text]O2), exercise intensity, volume, and energy expenditure. Still, accuracy depends on lab tests or using indexes like HRnet and HRindex. This study addresses HR indexes' applicability in postmenopausal women (PMW), who constitute over 50% of the aging population and may have unique characteristics (e.g., heart size) affecting HR use. METHODS: Fourteen PMW underwent a cycling ramp incremental test to establish the relationships between [Formula: see text]O2 (in MET) and absolute HR, HRnet, and HRindex. In a second group of ten PMW, population-specific and general equations were tested to predict MET and energy expenditure during six constant work exercises at various intensities. Pulmonary gas exchange and HR were continuously measured using a metabolic cart. Correlations, Bland-Altman analysis, and two-way RM-ANOVA were used to compare estimated and measured values. RESULTS: Strong linear relationships between the three HR indexes and MET were found in Group 1. In Group 2, population-specific equations showed medium-to-high correlations, precision, and no significant biases when estimating MET and energy expenditure. HRnet and HRindex outperformed absolute HR in accuracy. General HR equations had similar correlations but exhibited larger biases and imprecision. Statistical differences between measured and estimated values were observed at all intensities with general equations. CONCLUSION: This investigation confirms the suitability of HR for estimating aerobic metabolism in one of the most significant aging populations. However, it emphasizes the importance of considering individual variability and developing population-specific models when utilizing HR to infer metabolism.

Effect of acute heat exposure on the determination of critical power and W' in women and men.

The goal of this study was to investigate to what extent acute heat exposure would affect the parameters of the power-duration relationship, i.e. CP and W', using multiple constant workload tests to task failure, in women and men. Twenty four young physically active participants (12 men, 12 women) performed 3-5 constant load tests to determine CP and W', both in temperate (TEMP; 18°C) and hot (HOT; 36°C) environmental conditions. A repeated-measures ANOVA was executed to find differences between TEMP and HOT, and between women and men. In HOT, CP was reduced by 6.5% (227 ± 50 vs. 212 ± 47 W), while W' increased 12.4% (16.4 ± 4.4 vs. 18.5 ± 5.6 kJ). No significant two-way sex × temperature interactions were observed, indicating that the environmental conditions did not have a different effect in men compared with women. The intersection of the average curvatures in TEMP and HOT occurred at 137 s and 280 W in women, and 153 s and 397 W in men. Acute heat exposure had an impact on the parameters CP and W', i.e. CP decreased whereas W' increased. The increase in W' might be a consequence of the mathematical modelling for the used test methodology, rather than a physiological accurate value of W' in HOT. No differences induced by heat exposure were observed between women and men.

The determination of CP and W' was done using multiple constant workload tests to task failure and acute heat exposure induced changes in CP (decrease) and W' (increase).The increase in W' with acute heat exposure might be a consequence of the mathematical modelling for the used test methodology, rather than a physiological accurate value of W'.Acute heat exposure had a similar effect on performance parameters in women and men.

Minimum generosity levels in a competitive health insurance market.

An important condition for optimal health insurance is that the level of health care coverage is inversely related to the elasticity of demand. We show that this condition is not satisfied for voluntary deductibles in the Netherlands, which are optional deductibles on top of the mandatory deductible introduced by the Dutch government. We find that low-risk types, that mainly choose voluntary deductibles, have a lower elasticity of demand than high-risk types. Moreover, we show that voluntary deductibles introduce equity problems as it results in non-trivial cross subsidies from high-risk to low-risk types. Capping the level of voluntary deductibles (imposing minimum generosity) is likely to be welfare enhancing in the Netherlands.

Critical power, W' and W' reconstitution in women and men.

PURPOSE: The aim of this study was to compare critical power (CP) and work capacity W', and W' reconstitution (W'REC) following repeated maximal exercise between women and men. METHODS: Twelve women ([Formula: see text]O2PEAK: 2.53 ± 0.37 L·min-1) and 12 men ([Formula: see text]O2PEAK: 4.26 ± 0.30 L·min-1) performed a minimum of 3 constant workload tests, to determine CP and W', and 1 maximal exercise repetition test with three work bouts (WB) to failure, to quantify W'REC during 2 recovery periods, i.e., W'REC1 and W'REC2. An independent samples t test was used to compare CP and W' values between women and men, and a repeated-measures ANOVA was used to compare W'REC as fraction of W' expended during the first WB, absolute W'REC, and normalized to lean body mass (LBM). RESULTS: CP normalized to LBM was not different between women and men, respectively, 3.7 ± 0.5 vs. 4.1 ± 0.4 W·kgLBM-1, while W' normalized to LBM was lower in women 256 ± 29 vs. 305 ± 45 J·kgLBM-1. Fractional W'REC1 was higher in women than in men, respectively, 74.0 ± 12.0% vs. 56.8 ± 9.5%. Women reconstituted less W' than men in absolute terms (8.7 ± 1.2 vs. 10.9 ± 2.0 kJ) during W'REC1, while normalized to LBM no difference was observed between women and men (174 ± 23 vs. 167 ± 31 J·kgLBM-1). W'REC2 was lower than W'REC1 both in women and men. CONCLUSION: Sex differences in W'REC (absolute women < men; fractional women > men) are eliminated when LBM is accounted for. Prediction models of W'REC might benefit from including LBM as a biological variable in the equation. This study confirms the occurrence of a slowing of W'REC during repeated maximal exercise.

Can muscle typology explain the inter-individual variability in resistance training adaptations?

Considerable inter-individual heterogeneity exists in the muscular adaptations to resistance training. It has been proposed that fast-twitch fibres are more sensitive to hypertrophic stimuli and thus that variation in muscle fibre type composition is a contributing factor to the magnitude of training response. This study investigated if the inter-individual variability in resistance training adaptations is determined by muscle typology and if the most appropriate weekly training frequency depends on muscle typology. In strength-training novices, 11 slow (ST) and 10 fast typology (FT) individuals were selected by measuring muscle carnosine with proton magnetic resonance spectroscopy. Participants trained both upper arm and leg muscles to failure at 60% of one-repetition maximum (1RM) for 10 weeks, whereby one arm and leg trained 3×/week and the contralateral arm and leg 2×/week. Muscle volume (MRI-based 3D segmentation), maximal dynamic strength (1RM) and fibre type-specific cross-sectional area (vastus lateralis biopsies) were evaluated. The training response for total muscle volume (+3 to +14%), fibre size (-19 to +22%) and strength (+17 to +47%) showed considerable inter-individual variability, but these could not be attributed to differences in muscle typology. However, ST individuals performed a significantly higher training volume to gain these similar adaptations than FT individuals. The limb that trained 3×/week had generally more pronounced hypertrophy than the limb that trained 2×/week, and there was no interaction with muscle typology. In conclusion, muscle typology cannot explain the high variability in resistance training adaptations when training is performed to failure at 60% of 1RM. KEY POINTS: This study investigated the influence of muscle typology (muscle fibre type composition) on the variability in resistance training adaptations and on its role in the individualization of resistance training frequency. We demonstrate that an individual's muscle typology cannot explain the inter-individual variability in resistance training-induced increases in muscle volume, maximal dynamic strength and fibre cross-sectional area when repetitions are performed to failure. Importantly, slow typology individuals performed a significantly higher training volume to obtain similar adaptations compared to fast typology individuals. Muscle typology does not determine the most appropriate resistance training frequency. However, regardless of muscle typology, an additional weekly training (3×/week vs. 2×/week) increases muscle hypertrophy but not maximal dynamic strength. These findings expand on our understanding of the underlying mechanisms for the large inter-individual variability in resistance training adaptations.

Muscle typology influences the number of repetitions to failure during resistance training.

This study examined whether muscle typology (muscle fibre type composition) is related to maximal strength and whether it can explain the high inter-individual variability in number of repetitions to failure during resistance training. Ninety-five resistance training novices (57 males) were assessed for their maximal isometric knee extension strength and muscle typology. Muscle typology was estimated by measuring carnosine in the soleus, gastrocnemius and/or vastus lateralis using proton magnetic resonance spectroscopy. Forty-four subjects (22 males) performed dynamic strength tests (1RM) and 3 sets of leg extensions and curls to failure (60%1RM) to determine the association between muscle typology and (total) number of repetitions. Twenty-one subjects performed additional biceps curls and triceps extensions (60%1RM) to assess influence of exercise, 23 subjects performed additional leg extensions and curls at 80% and 40%1RM to evaluate influence of training load. There was a weak but significant relationship between muscle typology and maximal isometric strength (r = 0.22, p = 0.03) favouring the fast typology individuals. Slow and fast typology individuals did not differ in upper arm and upper leg 1RM. Total number of repetitions was related to muscle typology at 80% (r = -0.42; p = 0.04) and 60% (p = -0.44; p = 0.003) but not at 40%1RM. Slow typology individuals performed more repetitions to failure at 60%1RM in the leg extension (p = 0.03), leg curl (p = 0.01) and biceps curl (p = 0.02). In conclusion, muscle typology has a small contribution to maximal isometric strength but not dynamic strength and partly determines the number of repetitions to failure during resistance training. This insight can help individualizing resistance training prescriptions.

Having a fast muscle typology is positively associated with maximal isometric strength delivery in resistance training novices.The muscle typology seems to be a determining characteristic in the number of repetitions that can be performed during resistance training as slow typology individuals perform significantly more repetitions to failure compared to fast typology individuals.This study indicates the importance for coaches to shift from using traditional load-repetition tables and 1RM prediction equations to individualized 1RM testing and training volume prescriptions.

Can We Accurately Predict Critical Power and W' from a Single Ramp Incremental Exercise Test?

PURPOSE: The purpose of this study was to examine the suitability of a single ramp incremental test to predict critical power (CP) and W' . We hypothesized that CP would correspond to the corrected power output (PO) at the respiratory compensation point (RCP) and W' would be calculable from the work done above RCP. METHODS: One hundred fifty-three healthy young people (26 ± 4 yr, 51.4 ± 7.6 mL·min -1 ·kg -1 ) performed a maximal ramp test (20, 25, or 30 W·min -1 ), followed by three to five constant load trials to determine CP and W' . CP and W' were estimated using a "best individual fit" approach, selecting the mathematical model with the smallest total error. The RCP was identified by means of gas exchange analysis and then translated into its appropriate PO by applying a correction strategy in order to account for the gap in the V̇O 2 /PO relationship between ramp and constant load exercise. We evaluated the agreement between CP and the PO at RCP, and between W' and the total work done above CP ( W'RAMP > CP ) and above RCP ( W'RAMP > RCP ) during the ramp test. RESULTS: The CP was significantly higher than the PO at RCP (Δ = 8 ± 16 W, P < 0.001). W'RAMP > CP was significantly lower than W' (Δ = 1.9 ± 3.3 kJ, P < 0.001), whereas W'RAMP > RCP and W' did not differ from each other (Δ = -0.6 ± 5.8 kJ, P = 0.21). CONCLUSIONS: Despite the fact that CP and RCP occurred in close proximity, the estimation of W' from ramp exercise may be problematic given the likelihood of underestimation and considering the large variability. Therefore, we do not recommend the interchangeable use of CP and W' values derived from constant load versus ramp exercise, in particular, when the goal is to obtain accurate estimates or to predict performance capacity.

Easy Prediction of the Maximal Lactate Steady-State in Young and Older Men and Women.

Maximal Lactate steady-state (MLSS) demarcates sustainable from unsustainable exercise and is used for evaluation/monitoring of exercise capacity. Still, its determination is physically challenging and time-consuming. This investigation aimed at validating a simple, submaximal approach based on blood lactate accumulation ([Δlactate]) at the third minute of cycling in a large cohort of men and women of different ages. 68 healthy adults (40♂, 28♀, 43 ± 17 years (range 19-78), VO2max 45 ± 11 ml-1·kg-1·min-1 (25-68)) performed 3-5 constant power output (PO) trials with a target duration of 30 minutes to determine the PO corresponding to MLSS. During each trial, [Δlactate] was calculated as the difference between the third minute and baseline. A multiple linear regression was computed to estimate MLSS based on [Δlactate], subjects` gender, age and the trial PO. The estimated MLSS was compared to the measured value by paired t-test, correlation, and Bland-Altman analysis. The group mean value of estimated MLSS was 180 ± 51 W, not significantly different from (p = 0.98) and highly correlated with (R2 = 0.89) measured MLSS (180 ± 54 watts). The bias between values was 0.17 watts, and imprecision 18.2 watts. This simple, submaximal, time- and cost-efficient test accurately and precisely predicts MLSS across different samples of healthy individuals (adjusted R2 = 0.88) and offers a practical and valid alternative to the traditional MLSS determination.

The magnitude and time-course of physiological responses to 9 weeks of incremental ramp testing.

PURPOSE: The aims of this study were to assess (1) the day-to-day variability in, and (2) the magnitude and time-course of adaptation of physiological parameters (i.e., maximal oxygen uptake [VO2 max], heart rate [HR], blood lactate concentration, respiratory exchange ratio [RER], ratings of perceived exertion [RPE], and time-to-exhaustion [TTE]) in response to an intervention involving three incremental ramp tests per week for 9 weeks. METHODS: Twelve participants (25 ± 4 yrs, VO2 max, 47.8 ± 5.2 mL∙min-1 ∙kg-1 (means ± SD)) completed the entire experimental procedure. The tests comprised a 5-min constant workload to obtain submaximal parameters followed by an incremental protocol until exhaustion. RESULTS: The mean day-to-day variability for the maximal value of VO2 was 2.8%, 1.1% for HR, 18.1% for blood lactate concentration, 2.1% for RER, 1.1% for RPE, and 5.0% for TTE. The values for the corresponding submaximal variables were 3.8% for VO2 , 2.1% for HR, 15.6% for blood lactate concentration, 2.6% for RER and 6.0% for RPE. VO2 max (+4.7% ± 3.5%), TTE (+17.9% ± 8.6%), and submaximal HR (-3.2 ± 3.5%) improved significantly. Except for RPE (p < 0.01), there were no alterations in the coefficient of variation for any parameter. On the group level, the first changes greater than the day-to-day variability in VO2 max, TTE, and submaximal HR were observed after 21, 12, and 9 training sessions, respectively. CONCLUSION: Based on our findings, we recommend that training studies include assessment of the reliability of the measurements, for example, the CVs in the specific laboratory to be able to judge if the changes detected are actually physiological.

Training Load and Acute Performance Decrements Following Different Training Sessions.

PURPOSE: To examine the differences in training load (TL) metrics when quantifying training sessions differing in intensity and duration. The relationship between the TL metrics and the acute performance decrement measured immediately after the sessions was also assessed. METHODS: Eleven male recreational cyclists performed 4 training sessions in a random order, immediately followed by a 3-km time trial (TT). Before this period, participants performed the time TT in order to obtain a baseline performance. The difference in the average power output for the TTs following the training sessions was then expressed relative to the best baseline performance. The training sessions were quantified using 7 different TL metrics, 4 using heart rate as input, 2 using power output, and 1 using the rating of perceived exertion. RESULTS: The load of the sessions was estimated differently depending on the TL metrics used. Also, within the metrics using the same input (heart rate and power), differences were found. TL using the rating of perceived exertion was the only metric showing a response that was consistent with the acute performance decrements found for the different training sessions. The Training Stress Score and the individualized training impulse demonstrated similar patterns but overexpressed the intensity of the training sessions. The total work done resulted in an overrepresentation of the duration of training. CONCLUSION: TL metrics provide dissimilar results as to which training sessions have higher loads. The load based on TL using the rating of perceived exertion was the only one in line with the acute performance decrements found in this study.

The effect of acute heat exposure on the determination of exercise thresholds from ramp and step incremental exercise.

PURPOSE: The aim of this study was to examine how respiratory (RT) and lactate thresholds (LT) are affected by acute heat exposure in the two most commonly used incremental exercise test protocols (RAMP and STEP) for functional evaluation of aerobic fitness, exercise prescription and monitoring training intensities. METHODS: Eleven physically active male participants performed four incremental exercise tests, two RAMP (30 W·min-1) and two STEP (40 W·3 min-1), both in 18 °C (TEMP) and 36 °C (HOT) with 40% relative humidity to determine 2 RT and 16 LT, respectively. Distinction was made within LT, taking into account the individual lactate kinetics (LTIND) and fixed value lactate concentrations (LTFIX). RESULTS: A decrease in mean power output (PO) was observed in HOT at LT (-6.2 ± 1.9%), more specific LTIND (-5.4 ± 1.4%) and LTFIX (-7.5 ± 2.4%), compared to TEMP, however not at RT (-1.0 ± 2.7%). The individual PO difference in HOT compared to TEMP over all threshold methods ranged from -53 W to +26 W. Mean heart rate (HR) did not differ in LT, while it was increased at RT in HOT (+10 ± 8 bpm). CONCLUSION: This study showed that exercise thresholds were affected when ambient air temperature was increased. However, a considerable degree of variability in the sensitivity of the different threshold concepts to acute heat exposure was found and a large individual variation was noticed. Test design and procedures should be taken into account when interpreting exercise test outcomes.

Physical Preparation of a World-Class Lightweight Men's Double Sculls Team for the Tokyo 2020 Olympics.

PURPOSE: To analyze the physical profile and training program of a world-class lightweight double sculls rowing crew toward the Tokyo 2020 Olympics. METHOD: A case study in which both rowers performed physical testing in November 2020 and April 2021 (anthropometrics, incremental rowing test, and power profiling). The training program (38 wk) in the buildup to the Olympics was analyzed, providing insight into training characteristics (volume; contribution of rowing, alternative, and strength training; prescribed and recorded [heart rate] training-intensity distribution). The entire period was split into 3 phases: preparation period (8 wk), competition period 1 (11 wk), and competition period 2 (9 wk), and training characteristics were compared. RESULTS: In the April 2021 testing, rower A (1.89 m, 74.6 kg, 4.4% body fat) had a peak oxygen uptake of 5.8 L·min-1 (77.8 mL·min-1·kg-1) and a peak power output of 491 W. Rower B (1.82 m, 70.6 kg, 7.8% body fat) had a peak oxygen uptake of 5.5 L·min-1 (77.9 mL·min-1·kg-1) and a peak power output of 482 W. The mean weekly training volume was 14 hours 47 minutes (4 h 5 min), of which 58.5% (14.6%) consisted of rowing, 13.4% (6.8%) strength training, and 28.1% (2.6%) alternative training. Heart-rate training-intensity distribution was 77.8% (4.2%) in zone 1, 16.6% (3.7%) in zone 2, and 5.6% (2.8%) in zone 3 with a lower contribution of zone 1 in competition period 1 (P = .029) and competition period 2 (P = .023) compared with the preparation period, and a higher contribution of zone 3 in competition period 1 (P = .018) and competition period 2 (P = .011) compared with the preparation period. CONCLUSION: The crew combined a high volume of rowing, alternative, and strength training in a pyramidal heart-rate training-intensity distribution throughout the year.

Modeling V̇o2 on-kinetics based on intensity-dependent delayed adjustment and loss of efficiency (DALE).

This study presents and evaluates a new mathematical model of V̇o2 on-kinetics, with the following properties: 1) a progressively slower primary phase following the size-principle of motor unit recruitment, explaining the delayed V̇o2 steady state seen in the heavy exercise intensity domain, and 2) a severe-domain slow component modeled as a time-dependent decrease in efficiency. Breath-by-breath V̇o2 measurements from eight subjects performing step cycling transitions, in the moderate, heavy, and severe exercise domains, were fitted to the conventional three-phase model and the new model. Model performance was evaluated with a residual analysis and by comparing Bayesian (BIC) and corrected Akaike (AICc) information criteria. The residual analysis showed no systematic deviations, except perhaps for the initial part of the primary phase. BIC favored the new model, being 9.3 (SD 7.1) lower than the conventional model whereas AICc was similar between models. Compared with the conventional three-phase model, the proposed model distinguishes between the kinetic adaptations in the heavy and severe domains by predicting a delayed steady-state V̇o2 in the heavy and no steady-state V̇o2 in the severe domain. This allows to determine when stable oxygen costs of exercise are attainable and it also represents a first step in defining time-dependent oxygen costs when stable energy conversion efficiency is not attainable.NEW & NOTEWORTHY We propose and assess a new minimalistic integrated model for the V̇o2 on-kinetics, inspired by the currently available best evidence of the underlying mechanisms. We show that the model provides a similar fit as the conventionally used three-phase model, even though a stricter data fitting method is used for the proposed model. The proposed model clarifies misconceptions related to the V̇o2 slow component's behavior, by clearly predicting that steady-state V̇o2 is attainable in the moderate and heavy exercise intensity domains. Furthermore, the model opens new possibilities for assessing oxygen cost during severe intensity exercise without the fallible assumption of time-constant energy-conversion efficiency.

A longitudinal study on the interchangeable use of whole-body and local exercise thresholds in cycling.

PURPOSE: This study longitudinally examined the interchangeable use of critical power (CP), the maximal lactate steady state (MLSS) and the respiratory compensation point (RCP) (i.e., whole-body thresholds), and breakpoints in muscle deoxygenation (m[HHb]BP) and muscle activity (iEMGBP) (i.e., local thresholds). METHODS: Twenty-one participants were tested on two timepoints (T1 and T2) with a 4-week period (study 1: 10 women, age = 27 ± 3 years, [Formula: see text] = 43.2 ± 7.3 mL min-1kg-1) or a 12-week period (study 2: 11 men, age = 25 ± 4 years, [Formula: see text] = 47.7 ± 5.9 mL min-1 kg-1) in between. The test battery included one ramp incremental test (to determine RCP, m[HHb]BP and iEMGBP) and a series of (sub)maximal constant load tests (to determine CP and MLSS). All thresholds were expressed as oxygen uptake ([Formula: see text]) and equivalent power output (PO) for comparison. RESULTS: None of the thresholds were significantly different in study 1 ([Formula: see text]: P = 0.143, PO: P = 0.281), but differences between whole-body and local thresholds were observed in study 2 ([Formula: see text]: P < 0.001, PO: P = 0.024). Whole-body thresholds showed better 4-week test-retest reliability (TEM = 88-125 mL min-1 or 6-10 W, ICC = 0.94-0.98) compared to local thresholds (TEM = 189-195 mL min-1 or 15-18 W, ICC = 0.58-0.89). All five thresholds were strongly associated at T1 and T2 (r = 0.75-0.99), but their changes from T1 to T2 were mostly uncorrelated (r = - 0.41-0.83). CONCLUSION: Whole-body thresholds (CP/MLSS/RCP) showed a close and consistent coherence taking into account a 3-6%-bandwidth of typical variation. In contrast, local thresholds (m[HHb]BP/iEMGBP) were characterized by higher variability and did not consistently coincide with the whole-body thresholds. In addition, we found that most thresholds evolved independently of each other over time. Together, these results do not justify the interchangeable use of whole-body and local exercise thresholds in practice.

The Fitness-Fatigue Model: What's in the Numbers?

PURPOSE: The purpose of this commentary is to outline some of the pitfalls when using the fitness-fatigue model to unravel the interaction between training load and performance. By doing so, we encourage sport scientists and coaches to interpret the parameters from the model with some extra caution. CONCLUSIONS: Caution is needed when interpreting the fitness-fatigue model since the parameter values are influenced by the starting parameter values, the modeling technique, and the input of the model. Also, the use of general constants should be avoided since they do not account for interindividual differences and differences between training-load methods. Therefore, we advise sport scientists and coaches to use the model as a way to work more data-informed rather than working data-driven.

Six weeks of static apnea training does not affect Hbmass and exercise performance.

Acute apnea is known to induce decreases in oxyhemoglobin desaturation (SpO2) and increases in erythropoietin concentration ([EPO]). This study examined the potential of an apnea training program to induce erythropoiesis and increase hematological parameters and exercise performance. Twenty-two male subjects were randomly divided into an apnea and control group. The apnea group performed a 6-wk apnea training program consisting of a daily series of five maximal static apneas. Before and after training, subjects visited the lab on 3 test days to perform 1) a ramp incremental test measuring V̇o2peak, 2) CO-rebreathing for Hbmass determination and a 3-km time trial, and 3) an apnea test protocol with continuous finger SpO2 registration. Venous blood samples were drawn before and 180 min after the apnea test for analysis of [EPO]. Minimal SpO2 reached during the apnea test protocol was 91 ± 7% pre and 82 ± 7% post apnea training. The apnea test protocol did not elicit an acute increase in [EPO] (P = 0.685) before nor after the training program. Consequently, resting [EPO] (P = 0.170), Hbmass (P = 0.134), V̇o2peak (P = 0.796), and 3-km cycling time trial performance (P = 0.509) were not affected either. The apnea test and training protocol, consisting of five maximal static apneas, did not induce a sufficiently strong hypoxic stimulus to cause erythropoiesis and therefore did not result in an increase in resting [EPO], Hbmass, V̇o2peak, or time trial performance. Longer and/or more intense training sessions inducing a stronger hypoxic stimulus are probably needed to obtain changes in hematological and exercise parameters.NEW & NOTEWORTHY Apnea training has been suggested as a promising method to improve exercise performance for over a decade. However, to our knowledge, this study is the first to evaluate its value on both hematological parameters and exercise performance, including Hbmass and a control group. No changes in Hbmass nor exercise performance were observed. Contradicting previous research, no acute increase in [EPO] following apnea was observed either, indicating that more intense protocols are needed, at least in nonapnea-trained individuals.