Relationship between oxygen uptake, heart rate, and perceived effort in an aquatic incremental test in older women

Different parameters can be used to control the intensity of aerobic exercises, a choice that should consider the population and exercise environment targeted. Therefore, our study aimed to verify the relationship between oxygen uptake (VO2), heart rate (HR), rating of perceived exertion (RPE), and cadence during an aquatic incremental test in older women. Nine older women (64.3 ± 4.4 years) engaged in a water-based aerobic training performed an aquatic incremental test using the stationary running exercise (cadence increases of 15 b·min−1 every 2 min) until participants’ volitional exhaustion. VO2, HR, and RPE data were measured, and the percentage of peak VO2 (%VO2peak) and percentage of maximal HR (%HRmax) were calculated. Linear and polynomial regression analyses were performed (α = 0.05). Polynomial regressions revealed the best adjustments for all analyses. Data showed a significant relationship (p < 0.001) between %VO2peak and %HRmax (r = 0.921), %VO2peak and RPE (r = 0.870), and %HRmax and RPE (r = 0.878). Likewise, significant relationships between cadence (p < 0.001) and %VO2peak (r = 0.873), %HRmax (r = 0.874), and RPE (r = 0.910) were also observed. In summary, the physiological, subjective, and mechanical variables investigated were highly associated during an aquatic incremental test to exhaustion in older women. Therefore, these different parameters can be employed to adequately prescribe water-based programs according to preference and availability

Confirming the attainment of maximal oxygen uptake within special and clinical groups: a systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols

Background and aim A plateau in oxygen uptake (V̇O2) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake (V̇O2max) criteria have been shown to commonly underestimate the actual V̇O2max. The verification phase protocol might determine the occurrence of ‘true’ V̇O2max in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming ‘true’ V̇O2max in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest V̇O2 values attained in the CPET and verification phase. Methods Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak V̇O2 from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in V̇O2max according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level V̇O2 data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots. 3 Results Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean V̇O2 values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1 , p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar V̇O2max between the CPET and verification phase (p &gt; 0.05, LoE: limited to strong). Across all 30 studies, V̇O2max was not affected by differences in test protocols (p &gt; 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher V̇O2 value in the verification phase versus the CPET or reported or supplied participant-level V̇O2 data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher V̇O2 value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher V̇O2 in the verification phase ranged from 0% to 88.9%). Conclusion Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited V̇O2max, or a reproducible V̇O2peak, for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited V̇O2max, or a reproducible V̇O2peak, however, more research reporting participant-level data is required before evidence-based guidelines can be given

The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017

Water-based continuous and interval training in older women: Cardiorespiratory and neuromuscular outcomes (WATER study)

The purpose of this study was to investigate the effects of two water-based aerobic programs on cardiorespiratory and neuromuscular outcomes in older women. Forty-one women (60 to 75 years old) volunteered to participate in the study. Participants were randomized into a water-based continuous (CTG; n = 21; 63.9 ± 2.5 years) or an interval (ITG; n = 20; 64.8 ± 3.6 years) aerobic training group. Both training programs were performed for 12 weeks (45-min sessions twice a week), with exercise intensity based on rating of perceived exertion (Borg's RPE 6-20 Scale). Pre and post training assessments of cardiorespiratory and neuromuscular outcomes were performed. Data analyses were conducted using Generalized Estimating Equations and Bonferroni post-hoc test (α = 0.05). After the intervention, the CTG and the ITG displayed similar improvements in time to exhaustion (8% vs. 11%), peak oxygen uptake (9% vs. 7%), maximal dynamic knee extension strength (5% vs. 6%), dynamic muscular endurance of knee extensors (10% vs. 11%), maximal vastus lateralis electromyographic signal amplitude (13% vs. 35%), as well as an increase in muscle thickness (5% vs. 6%) and decrease in muscle echo intensity (-2% vs. -3%) of the quadriceps femoris. In conclusion, older women benefited from water-based exercise training prescribed based on participants' RPE, with both the interval and the continuous training programs resulting in similar increases in the cardiorespiratory and neuromuscular parameters

Maximal oxygen uptake is underestimated during incremental testing in hypertensive older adults: findings from the HAEL study

Purpose: The present cross-sectional study aimed to investigate whether a maximal oxygen uptake (VO2max) verification phase (VER) could improve the accuracy of a previous graded exercise test (GXT) to assess individual VO2max in hypertensive individuals. Methods: Thirtythree older adults with hypertension (24 women) taking part in the Hypertension Approaches in the Elderly Study (NCT03264443) were recruited. Briefly, after performing a treadmill GXT to exhaustion, participants rested for 10 min and underwent a multistage VER to confirm GXT results. Individual VO2max, respiratory exchange ratio (RER), maximal heart rate (HRmax), and rating of perceived exertion (RPE) were measured during both GXT and VER tests. Mean values were compared between bouts using paired sample t-tests and VO2max was also compared between GXT and VER on an individual basis. Results: Testing was well tolerated by all participants. Both absolute (p=0.011) and relative (p=0.014) VO2max values were higher in VER than in GXT. RER (p<0.001) and RPE (p=0.002) were lower in VER, whereas HRmax (p=0.286) was not different between the two trials. Individual VO2max comparisons revealed that 54.6% of the participants (18/33) achieved a VO2max value that was ≥3% during VER (mean: 13.5%, range: from +3% to +22.1%, ES=0.062), whereas 87.9% (29/33) of the tests would have been validated as a maximal effort if the classic criteria were employed (i.e. VO2 plateau or at least two secondary criteria). Conclusion: In sedentary older individuals with hypertension, GXT to exhaustion underestimated VO2max in more than half of tested participants, even when established but criticized criteria were used to confirm whether a maximal effort was attained. Employing VER after GXT is a quick approach to assist with the verification of an individual’s VO2max

High-velocity resistance training in middle-aged adults and older adults with- and without mobility limitations: neuromuscular adaptations and its effects on functional performance.

This doctoral thesis aimed to evaluate and compare the neuromuscular, morphological and functional adaptations of a high-velocity resistance training program in middle-aged adults (40-55 years), older adults (60+ years) and mobility-limited older adults (Short Physical Performance Battery; SPPB ≤ 9). For this, 43 participants were recruited (19 adults, 18 older adults, and 8 mobility-limited older adults) and tested for maximal isometric strength and neuromuscular activity, as well as maximal dynamic strength (1RM) and power, force, and velocity at a wide range of submaximal intensities (30- 90%1RM). Muscle thickness and quality were also measured, as well as functional performance, assessed through the SPPB test, maximal and usual gait speed, 30 s sitto-stand, stair climb, timed up-and-go, and the 6-min walk test. Participants underwent 12 weeks of high-velocity resistance training with a frequency of two sessions per week and repeated the tests at the end of the intervention. Specifically, two studies make up the volume of this thesis. The first corresponds to a narrative review article and analyzes the effects of high-velocity resistance training in older adults with and without mobility limitations, in addition to presenting an overview of the main effects of neuromuscular aging on the functional capacity of these individuals. The second article presents the results of the intervention on the neuromuscular, morphological and functional capacity outcomes investigated, which are accompanied by an extensive set of supplementary materials. Overall, our results demonstrate that a short-term high-velocity resistance training intervention leads to an important functional reserve in middle-aged individuals, while it also mitigates physiological and functional impairments already present in older adults with and without mobility limitation.Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul - FAPERGSA presente tese de doutorado teve como objetivo avaliar e comparar as adaptações neuromusculares, morfológicas e funcionais de um programa de treino de potência em indivíduos adultos de meia idade (40-55 anos), idosos (60+ anos) e idosos com limitações na mobilidade (Short Physical Performance Battery; SPPB ≤ 9). Para isso, 43 participantes foram recrutados (19 adultos, 18 idosos e 8 idosos com limitação de mobilidade) e avaliados quanto à força isométrica máxima e atividade neuromuscular, assim como a força dinâmica máxima (1RM) e a força, potência e velocidade em intensidades submáximas (30-90%1RM). Também foram mensuradas a espessura e qualidade muscular, assim como o desempenho funcional, avaliado através dos testes SPPB, velocidade máxima e habitual de marcha, sentar e levantar, subir escadas, timed up and go, teste de caminhada de 6 min e força de preensão manual. Os participantes passaram por 12 semanas de treino de potência com frequência de duas sessões por semana, sendo reavaliados novamente ao término da intervenção. Especificamente, dois estudos compõe o volume desta tese. O primeiro corresponde ao artigo de revisão narrativa e analisa os efeitos do treino de potência em indivíduos idosos saudáveis e com limitações de mobilidade, além de apresentar um apanhado dos principais efeitos do envelhecimento neuromuscular na capacidade funcional desses indivíduos. O segundo artigo, por sua vez, apresenta os principais resultados provenientes da intervenção aplicada. Nele são apresentados os dados dos principais desfechos neuromusculares, morfológicos e de capacidade funcional, os quais são acompanhados por um extenso conjunto de materiais suplementares. De modo geral, nossos resultados demonstram que uma intervenção de curto prazo de treino de potência resulta na formação de uma importante reserva funcional em indivíduos de meia-idade, ao mesmo tempo que é capaz de mitigar deficiências fisiológicas e funcionais já presentes em idosos com e sem limitação de mobilidade

The Maximal Oxygen Uptake Verification Phase: a Light at the End of the Tunnel?

Abstract Commonly performed during an incremental test to exhaustion, maximal oxygen uptake (V̇O2max) assessment has become a recurring practice in clinical and experimental settings. To validate the test, several criteria were proposed. In this context, the plateau in oxygen uptake (V̇O2) is inconsistent in its frequency, reducing its usefulness as a robust method to determine “true” V̇O2max. Moreover, secondary criteria previously suggested, such as expiratory exchange ratios or percentages of maximal heart rate, are highly dependent on protocol design and often are achieved at V̇O2 percentages well below V̇O2max. Thus, an alternative method termed verification phase was proposed. Currently, it is clear that the verification phase can be a practical and sensitive method to confirm V̇O2max; however, procedures to conduct it are not standardized across the literature and no previous research tried to summarize how it has been employed. Therefore, in this review the knowledge on the verification phase was updated, while suggestions on how it can be performed (e.g. intensity, duration, recovery) were provided according to population and protocol design. Future studies should focus to identify a verification protocol feasible for different populations and to compare square-wave and multistage verification phases. Additionally, studies assessing verification phases in different patient populations are still warranted

Multimodal and conventional resistance training interventions improve muscle function in older adults: Findings from the Training IMCT study

Age-associated remodeling processes affect the intramuscular connective tissue (IMCT) network, which may significantly impair muscle function. Thus, we aimed to test whether including exercises shown to efficiently target the IMCT to a conventional resistance exercise intervention (CONV) would result in greater functional gains as compared to CONV alone. Fifty-three men and women (66.2 ± 3.3 years) were assigned to either CONV (n = 15), multimodal training (MULTI; n = 17) or a control (CTRL; n = 21) group. All subjects were tested at baseline, and those assigned to CONV or MULTI underwent a 16-week training intervention. The CONV group followed a progressive resistance training program, in which the number of weekly training sessions gradually increased from 1 to 3. In the MULTI group, one of these sessions was replaced with plyometric training, followed by self-myofascial release. Testing included maximal strength and power, imaging-based muscle volume, architecture, and functional performance. The intervention effects were analyzed using two- or three-way repeated measures ANOVA models (α = 0.05). Briefly, the maximal knee extension isometric contraction, one-repetition maximum, and isokinetic peak torque increased in all groups (p < 0.05), albeit to a lesser extent in CTRL. On the other hand, quadriceps femoris muscle volume (p = 0.019) and vastus lateralis pennation angle (p < 0.001) increased only in the MULTI group. Handgrip strength did not change in response to the intervention (p = 0.312), whereas Sit-to-Stand performance improved in all groups after the first 8-wks, but only in MULTI and CONV after 16-wks (all p < 0.001). In conclusion, we found that a resistance training intervention in which one weekly training session is replaced by plyometric training is feasible and as effective as a program consisting solely of conventional strength training sessions for inducing gains in muscle strength and function in older adults. Muscle size and architecture improved only in the MULTI group. German Clinical Trials: DRKS00015750

The Role of Water-Based Exercise on Vertical Ground Reaction Forces in Overweight Children: A Pilot Study

The aquatic environment represents an adequate and safe alternative for children with overweight to exercise. However, the magnitude of the vertical ground reaction force (Fz) during these exercises is unknown in this population. Therefore, our study aimed to compare the Fz during the stationary running exercise between the aquatic and land environments in children with overweight or obesity. The study is characterized as a cross-over study. Seven children, two with overweight and five with obesity (4 boys and 3 girls; 9.7 &plusmn; 0.8 years), performed two experimental sessions, one on land and another in the aquatic environment. In both conditions, each participant performed 15 repetitions of the stationary running exercise at three different cadences (60, 80, and 100 b min&minus;1) in a randomized order. Their apparent weight was reduced by 72.1 &plusmn; 10.4% on average at the xiphoid process depth. The peak Fz, impulse, and loading rate were lower in the aquatic environment than on land (p &lt; 0.001). Peak Fz was also lower at 80 b min&minus;1 compared to 100 b min&minus;1 (p = 0.005) and loading rate was higher at 100 b min&minus;1 compared to 80 b min&minus;1 (p = 0.003) and 60 b min&minus;1 (p &lt; 0.001) in the aquatic environment, whereas impulse was significantly reduced (p &lt; 0.001) with the increasing cadence in both environments. It can be concluded that the aquatic environment reduces all the Fz outcomes investigated during stationary running and that exercise intensity seems to influence all these outcomes in the aquatic environment

Relationship between Oxygen Uptake, Heart Rate, and Perceived Effort in an Aquatic Incremental Test in Older Women

Different parameters can be used to control the intensity of aerobic exercises, a choice that should consider the population and exercise environment targeted. Therefore, our study aimed to verify the relationship between oxygen uptake (VO2), heart rate (HR), rating of perceived exertion (RPE), and cadence during an aquatic incremental test in older women. Nine older women (64.3 &plusmn; 4.4 years) engaged in a water-based aerobic training performed an aquatic incremental test using the stationary running exercise (cadence increases of 15 b&middot;min&minus;1 every 2 min) until participants&rsquo; volitional exhaustion. VO2, HR, and RPE data were measured, and the percentage of peak VO2 (%VO2peak) and percentage of maximal HR (%HRmax) were calculated. Linear and polynomial regression analyses were performed (&alpha; = 0.05). Polynomial regressions revealed the best adjustments for all analyses. Data showed a significant relationship (p &lt; 0.001) between %VO2peak and %HRmax (r = 0.921), %VO2peak and RPE (r = 0.870), and %HRmax and RPE (r = 0.878). Likewise, significant relationships between cadence (p &lt; 0.001) and %VO2peak (r = 0.873), %HRmax (r = 0.874), and RPE (r = 0.910) were also observed. In summary, the physiological, subjective, and mechanical variables investigated were highly associated during an aquatic incremental test to exhaustion in older women. Therefore, these different parameters can be employed to adequately prescribe water-based programs according to preference and availability