Characterising the application of the “progressive overload” principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme

Background: Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. Design: Observational study. Methods: We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. Results: Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). Conclusion: The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes

A 1-Year Study of Endurance Runners: Training, Laboratory Tests, and Field Tests

Purpose: To compare critical speed (CS) measured from a single-visit field test of the distance–time relationship with the “traditional” treadmill time-to-exhaustion multivisit protocol. Methods: Ten male distance runners completed treadmill and field tests to calculate CS and the maximum distance performed above CS (D′). The field test involved 3 runs on a single visit to an outdoor athletics track over 3600, 2400, and 1200 m. Two field-test protocols were evaluated using either a 30-min recovery or a 60-min recovery between runs. The treadmill test involved runs to exhaustion at 100%, 105%, and 110% of velocity at VO2max, with 24 h recovery between runs. Results: There was no difference in CS measured with the treadmill and 30-min- and 60-minrecovery field tests (P .05). A typical error of the estimate of 0.14 m/s (95% confidence limits 0.09–0.26 m/s) was seen for CS and 88 m (95% confidence limits 60–169 m) for D′. A coefficient of variation of 0.4% (95% confidence limits: 0.3–0.8%) was found for repeat tests of CS and 13% (95% confidence limits 10–27%) for D′. Conclusion: The single-visit method provides a useful alternative for assessing CS in the field

A study of the 200-metre fast walk test as a possible new assessment tool to predict maximal heart rate and define target heart rate for exercise training of coronary heart disease patients

International audienceOBJECTIVE: To develop a new predictive model of maximal heart rate based on two walking tests at different speeds (comfortable and brisk walking) as an alternative to a cardiopulmonary exercise test during cardiac rehabilitation. DESIGN: Evaluation of a clinical assessment tool. SETTING: A Cardiac Rehabilitation Department in France. SUBJECTS: A total of 148 patients (133 men), mean age of 59 +/-9 years, at the end of an outpatient cardiac rehabilitation programme. MAIN MEASURES: Patients successively performed a 6-minute walk test, a 200 m fast-walk test (200mFWT), and a cardiopulmonary exercise test, with measure of heart rate at the end of each test. An all-possible regression procedure was used to determine the best predictive regression models of maximal heart rate. The best model was compared with the Fox equation in term of predictive error of maximal heart rate using the paired t-test. RESULTS: Results of the two walking tests correlated significantly with maximal heart rate determined during the cardiopulmonary exercise test, whereas anthropometric parameters and resting heart rate did not. The simplified predictive model with the most acceptable mean error was: maximal heart rate = 130 - 0.6 x age + 0.3 x HR200mFWT (R(2) = 0.24). This model was superior to the Fox formula (R(2) = 0.138). The relationship between training target heart rate calculated from measured reserve heart rate and that established using this predictive model was statistically significant (r = 0.528, p \textless 10(-6)). CONCLUSIONS: A formula combining heart rate measured during a safe simple fast walk test and age is more efficient than an equation only including age to predict maximal heart rate and training target heart rate

Blood lactate in trained cyclists during cycle ergometry at critical power

The purposes of this investigation were to determine the validity of critical power (CP) as a measure of the work rate that can be maintained for a very long time without fatigue and to determine whether this corresponded with the maximal lactate steady-state (lass,max). Eight highly trained endurance cyclists (maximal oxygen uptake 74.1 ml.kg-1.min-1, SD 5.3) completed four cycle ergometer tests to exhaustion at pre-determined work rates (360, 425, 480 and 520 W). From these four co-ordinates of work and time to fatigue the regression of work limit on time limit was calculated for each individual (CP). The cyclists were then asked to exercise at their CP for 30 min. If CP could not be maintained, the resistance was reduced minimally to allow the subject to complete the test and maintain a blood lactate plateau. Capillary blood was sampled at 0,5,10,20 and 30 min into exercise for the analysis of lactate. Six of the eight cyclists were unable to maintain CP for 30 min without fatigue. In these subjects, the mean power attained was 6.4% below that estimated by CP. Mean blood lactates (n = 8) reached a steady-state (8.9 mmol.l-1 SD 1.6) during the last 20 min of exercise indicating that CP slightly overestimated lass,max, Individual blood lactates during the last 20 min of exercise were more closely related to the gamma-intercept of the CP curve (r = 0.78, P less than 0.05) than either CP (0.34, NS) or mean power output (r = 0.42, NS)

Cardiac dimensions over 5 years in highly trained long-distance runners and sprinters

Aims We assessed the changes in cardiac morphology between elite endurance-trained runners (n = 42) and elite sprinters (n = 34) over a 5-year period. In addition, we studied the relationship between heart size and maximum oxygen consumption (VO2 max). Methods At the beginning of 5 consecutive seasons, all athletes underwent an incremental running test to determine VO2 max and a color-coded pulsed Doppler examination to determine baseline echocardiographic variables. We hypothesized that cardiac morphology had reached its upper limit in elite athletes, and showed only minor changes during 5 years of regular training. Results Although all echocardiographic variables remained stable in nearly all sprinters studied, in the endurance runners (who presented higher cardiac cavity dimensions compared with sprinters), variations in heart morphology became evident from the third season, and were within established physiological limits. Conclusion Only 6 (17%) endurance runners and 3 (9%) sprinters showed a left ventricular internal diameter of > 60 mm (the threshold pathological value) at end diastole at some point during the observational period. Moreover, no statistically significant association was detected between changes in VO2 max and changes in heart size. After 5 years of intense training, the changes of the echocardiographic variables examined remained different between endurance runners and sprinters