Incremental Test Research Articles

Influence of photobiomodulation on energy contribution in normoxia and hypoxia conditions in amateur runners: a single-blinded and randomized crossover pilot study.

This study aimed to investigate the influence of photobiomodulation therapy (PBMT) in hypoxia (HYP) and normoxia (NOR) on time to exhaustion and the energetic contribution of treadmill running in amateur athletes. Eleven male participants, aged between 18 and 29 years, were submitted to an incremental test to determine the iV̇O2max, and subsequently on separated days, to the PBMT application (irradiation = 720s; wavelength = 850nm), followed by four efforts to exhaustion, in treadmill running, under different conditions [NOR + placebo (PLA); NOR + PBMT; HYP + PLA; HYP + PBMT], in random order, to access energy contribution and maximal accumulated oxygen deficit alternative (MAODALT). Time to exhaustion and absolute aerobic contribution were lower in HYP than NOR, for both PLA and PBMT conditions (p < 0.05). In the percentage energy contribution of each metabolism during exhaustion effort, aerobic participation was lower, while MAODALT was higher in HYP than NOR, only in the PLA situation; alactic anaerobic participation was higher in HYP than NOR in the PBMT application situation (p = 0.002). The PBMT does not promote additional benefits over time to exhaustion in NOR and HYP conditions, however PBMT during exhaustive efforts in HYP results in an increase in anaerobiosis.

Greater improvement in aerobic capacity after a polarized training program including cycling interval training at low cadence (50-70 RPM) than freely chosen cadence (above 80 RPM).

This study compared the impact of two polarized training programs (POL) on aerobic capacity in well-trained (based on maximal oxygen uptake and training experience) female cyclists. Each 8-week POL program consisted of sprint interval training (SIT) consisting of 8-12 repetitions, each lasting 30 seconds at maximal intensity, high-intensity interval training (HIIT) consisting of 4-6 repetitions, each lasting 4 minutes at an intensity of 90-100% maximal aerobic power, and low-intensity endurance training (LIT) lasting 150-180 minutes with intensity at the first ventilatory threshold. Training sessions were organized into 4-day microcycles (1st day-SIT, 2nd day-HIIT, 3rd day-LIT, and 4th day-active rest), that were repeated throughout the experiment. In the first POL program, exercise repetitions during SIT and HIIT training were performed with freely chosen cadence above 80 RPM (POLFC group, n = 12), while in the second POL program with low cadence 50-70 RPM (POLLC group, n = 12). Immediately before and after the 8-week POL intervention, participants performed an incremental test to measure maximal aerobic power (Pmax), power achieved at the second ventilatory threshold (VT2), maximal oxygen uptake (VO2max), maximal pulmonary ventilation (VEmax), and gross efficiency (GE). Moreover, participants performed VO2max verification test. Analysis of variance showed a repeated measures effect for Pmax (F = 21.62; η2 = 0.5; p = 0.00), VO2max (F = 39.39; η2 = 0.64; p = 0.00) and VEmax (F = 5.99; η2 = 0.21; p = 0.02). A repeated measures x group mixed effect was demonstrated for Pmax (F = 4.99; η2 = 0.18; p = 0.03) and VO2max (F = 6.67; η2 = 0.23; p = 0.02). Post-hoc Scheffe analysis showed that increase in Pmax were statistically significant only in POLLC group. The Friedman test showed that VT2 differed between repeated measures only in the POLLC group (χ2 = 11; p = 0.001; W = 0.917). In conclusion, it was found that POL program where SIT and HIIT were performed at low cadence was more effective in improving aerobic capacity in well-trained female cyclists, than POL with SIT and HIIT performed at freely chosen cadence. This finding is a practical application for athletes and coaches in cycling, to consider not only the intensity and duration but also the cadence used during various interval training sessions.

Cigarette Smoking Impairs Cardiorespiratory and Metabolic Response at Peak Incremental Exercise and during Recovery in Young, Physically Active Adults

ABSTRACT Purpose: Cigarette smoking (CS) induces systemic changes that impair cardiorespiratory and muscular function both at rest and during exercise. Although these abnormalities are reported in sedentary, middle-aged smokers (SM) with pulmonary disease, few and controversial studies focused on young, physically active SM at the early stage of smoking history. This study aimed at assessing the impact CS on cardiorespiratory and metabolic response during an incremental test and the subsequent recovery in young, physically active SM without known lung or cardiovascular disease. Methods: After pulmonary function evaluation, 12 SM (age: 22±2 yr; body mass: 75±8 kg; stature: 1.78±0.06 m; 12±4 cigarette/day for 6±2 years; mean±SD) and 12 non-smokers (CTRL; age: 23±1 yr; body mass: 76±8 kg; stature: 1.79±0.08 m) matched for age and exercise habits, underwent an exhaustive incremental step test (25 W/2 min) on a cycle ergometer. Pulmonary O2 uptake (V’O2), expiratory ventilation (V’E), heart rate (f H) responses and lactate concentration were assessed during the test and subsequent recovery. Results: Despite similar static lung volumes, SM reported lower peak expiratory flow (-23%; P = 0.003) and maximal voluntary ventilation (-10%; P = 0.003). At submaximal exercise, no differences in the cardiorespiratory and metabolic were noted between the two groups. However, SM exhibited ventilatory (P &lt; 0.01) and lactate thresholds at lower work rates (P = 0.01). At peak exercise, SM exhibited lower V’O2 (-8%; P = 0.02), mechanical power (-11%; P = 0.02) and V’E (-9%; P = 0.01). During recovery, SM showed longer time constants (τ) in V’O2 (+52%; P = 0.002), V’E (+19%; P = 0.027) and f H (+21%; P = 0.022) and smaller f H at 30 s of recovery (HRR30; -31%; P = 0.032). Conclusions: These results are compatible with an early CS-related impairment of the cardiorespiratory and metabolic function even in young individuals with relatively short smoking history.

Pulmonary gas exchange in relation to exercise pulmonary hypertension in patients with heart failure with preserved ejection fraction.

Exercise pulmonary hypertension (ePH), defined as a mean pulmonary artery pressure (mPAP)/cardiac output (Qc) slope >3 WU during exercise, is common in patients with heart failure with preserved ejection fraction (HFpEF). However, the pulmonary gas exchange-related effects of an exaggerated ePH (EePH) response are not well-defined, especially in relation to dyspnea on exertion (DOE) and exercise intolerance. 48 HFpEF patients underwent invasive (pulmonary and radial artery catheters) constant-load (20W) and maximal incremental cycle testing. Hemodynamic measurements (mPAP and Qc), arterial blood and expired gases, and ratings of breathlessness (RPB, Borg 0-10) were obtained. The mPAP/Qc slope was calculated from rest-to-20W. Those with a mPAP/Qc slope >4.2 (median) were classified as HFpEF+EePH (n=24) and those with a mPAP/Qc slope <4.2 were classified as HFpEF (without EePH) (n=24). The A-aDO2, VD/VT (Bohr equation), and the VE/VCO2 slope (from rest-to-20W) were calculated. PaO2 was lower (p=0.03), and VD/VT was higher (p=0.03) at peak exercise in HFpEF+EePH compared with HFpEF. A-aDO2 was similar at peak exercise between groups (p=0.14); however, HFpEF+EePH achieved the peak A-aDO2 at a lower peak work rate (p<0.01). The VE/VCO2 slope was higher in HFpEF+EePH compared with HFpEF (p=0.01). RPB was ≥1-unit higher at 20W and VO2peak was lower (p<0.01) in HFpEF+EePH compared with HFpEF. These data suggest that EePH contributes to pulmonary gas exchange impairments during exercise by causing a V/Q mismatch that provokes both ventilatory inefficiency and hypoxemia, both of which seem to contribute to DOE and exercise intolerance in patients with HFpEF.

Version [formula omitted] — [CACP: Classification Algorithms Comparison Pipeline]

We present the first major release of the Classification Algorithms Comparison Pipeline (CACP). The proposed software enables one to compare newly developed classification algorithms in Python with other classifiers to evaluate classification performance and ensure both outcomes’ reproducibility and statistical reliability. CACP simplifies and accelerates the entire classifier evaluation process considerably and helps prepare the professional documentation of the experiments conducted. The upgrade introduces enhancements to existing tools and adds new features: (1) - support for River machine learning library datasets in incremental learning, (2) - capability to include user-defined datasets, (3) - use of River classifiers for incremental learning, (4) - use of River metrics for incremental learning, (5) - flexibility to create user-defined metrics, (6) - record-by-record testing for incremental learning, (7) - enhanced summary of incremental testing results with dynamic visualization of the learning process, (8) - Graphical User Interface (GUI).

Assessing and tailoring predictive equations of VO2max for women with multiple sclerosis with mild to moderate disability

BackgroundEstablished equations to predict peak oxygen uptake (VO2max) in healthy subjects are not directly applicable to patient populations, including people with multiple sclerosis (PwMS). PwMS, who commonly exhibit impaired cardiorespiratory and neuromuscular function, often require tailored predictive models. This study aimed at (1) testing the validity, reliability, and accuracy of four widely used formulae, developed in healthy populations, to estimate VO2max in mildly to moderately disabled women with MS, and (2) develop adjusted formulae tailored on MS features. MethodsFifty-one mildly to moderately disabled women (mean age 46, median EDSS 3.5) with relapsing-remitting multiple sclerosis (RRMS) underwent incremental cardiopulmonary exercise testing (CPET) using cycle ergometry. Gas exchanges were analyzed by open-circuit spirometry. Four commonly employed predictive equations (ACSM, Storer's, Uth's, and Myers’) were tested for reliability and accuracy against measured VO2max. Regressions were performed to identify significant VO2max predictors and to introduce adjustments to develop gender-specific equations aimed at estimating cardiorespiratory fitness with varying degrees of exercise involvement. ResultsACSM and Storer's equations underestimated VO2max (-6.09 %, Z = -3.22, p = 0.001; and -21.74 %, Z = -5.02, p < 0.001, respectively) whereas Uth's and Myers’ equations overestimated it (+20.19 %, Z = -5.92, p < 0.001; and +19.31 %, Z = -6.19, p < 0.001, respectively). Regressions for adjusted equations revealed work rate/bodyweight (WR/BW) (β = 0.867, p < 0.001) for ACSM adjusted; age (β = -0.275, p = 0.004), BW (β = -0.658, p < 0.001) and peak Watts (β = 0.485, p < 0.001) for Storer's adjusted; heart rate ratio (β = 0.512, p < 0.001) for Uth's adjusted, and age (β = -0.492, p < 0.001), BW (β = -0.483, p < 0.001) and EDSS (β = -0.211, p = 0.046) for Myers’ adjusted as predictors of VO2max. ConclusionsVO2max can be validly estimated in women with MS using established formulae, provided that specific adjustments are introduced to account for their signature functional impairments. The models proposed in this study enable reliable assessment of cardiorespiratory fitness with protocols at different levels of exercise involvement, making them practical for clinical and everyday use. This approach supports a translationally driven bench-to-bedside perspective, allowing for patient VO2max assessment in virtually all settings.

Carbon monoxide supplementation: evaluating its potential to enhance altitude training effects and cycling performance in elite athletes.

Altitude training is a cornerstone for endurance athletes for improving blood variables and performance, with optimal effects observed at ∼2,300-2,500 meters above sea level (m.a.s.l.). However, elite cyclists face challenges such as limited access to such altitudes, inadequate training facilities, and high expenses. To address these issues, a novel method involving daily exposure to carbon monoxide (CO) has been proposed to amplify altitude training adaptations at suboptimal altitudes. Thirty-one male cyclists were assigned to three groups: Live-High Train-High with CO inhalation (LHTHCO), Live-High Train-High (LHTH), and Live-Low Train-Low (LLTL). The LHTHCO group underwent CO inhalation twice daily in the afternoon/evening to elevate carboxyhemoglobin concentration to ∼10%. Hematological variables, in vivo muscle oxidative capacity, and physiological indicators of cycling performance were assessed before and after a 3-week altitude training camp at 2,100 m.a.s.l. LHTHCO demonstrated a larger increase in hemoglobin mass (Hbmass) compared to both LHTH and LLTL. Although there were no statistical differences between LHTHCO and LHTH in submaximal and maximal performance measures, LHTHCO displayed greater improvements in 1-min maximal power output during incremental testing (Wmax), power output at lactate threshold, and maximal oxygen consumption (V̇o2max) compared to LLTL. LHTH demonstrated a larger improvement than LLTL in Wmax and V̇o2max, with no group differences in Hbmass or submaximal measures. Muscle oxidative capacity did not differ between groups. These findings suggest that combining moderate-altitude training with daily CO inhalation promotes hematological adaptations more effectively than moderate altitude alone and enhances cycling performance metrics in cyclists more than sea-level training.NEW & NOTEWORTHY Three weeks of training at moderate altitude with exposure to low doses of CO can significantly enhance hematological adaptations in elite cyclists compared to moderate-altitude training alone. Cycling performance determinants improved more with CO inhalation at moderate altitude compared to sea-level training, whereas there were no differences in submaximal and maximal performance measures compared to moderate-altitude training alone. This study highlights the potential of CO supplementation as an effective adjunct to altitude training regimens.

Impact of Right Ventricular Function on Cardiopulmonary Exercise Capacity in Mitral Regurgitation Patients Undergoing Transcatheter Mitral Valve Intervention

Transcatheter mitral valve interventions (TMVI) has been proven to reduce symptom burden and improve outcome in patients with severe mitral regurgitation (MR). However, the impact of right ventricular function (RVF) on exercise capacity in MR patients is less well understood. Cardiopulmonary exercise testing (CPET) is the most comprehensive approach to assess maximum exercise capacity. Submaximal exercise capacity (SEC), assessed by constant work rate exercise time testing (CWRET), is presumed to be relevant in daily life activities, and gives a more differentiated physiological insight into the nature of exercise intolerance. Thus, 28 MR patients underwent CPET and CWRET (at 75% of maximum work rate in the initial incremental exercise test) prior to TMVI and 3-months post-procedurally. Patients´ mean age was 75.0±8.7 years and 32.1% were female. One patient presented with a MR reduction of less than 2 grades. RVF was at least moderately impaired in 25% of the patients. SEC of these patients was lower, but did not significantly differ (416.4s±359.6 vs. 296.1±216.5s; p=) from patients without RVF-deterioration. At follow up, the SEC improved significantly (from 337.4±262.2s to 517.4±393.5s; p=0.006). Maximum oxygen uptake (peakVO2) showed a positive trend, but no statistically significant difference (10.3±3.1ml/min/kg vs. 11.3±3.4ml/min/kg; p=0.06). RVF improved in 35.7% of the patients and these patients showed a significantly higher SEC increase (471.7±153.9s vs. 82.7±47.0s, p=0.003). SEC is significantly increased in MR patients undergoing TMVI, reflecting an improvement especially regarding daily life activities. This may be related to TMVI´s beneficial effect on right ventricular remodeling.

Middle cerebral artery blood velocity and end-tidal carbon dioxide responses to moderate intensity cycling in children, adolescents, and adults.

This study investigated the middle cerebral artery blood velocity (MCAv) response to constant work-rate moderate-intensity cycling exercise in 21 children (9.3 ± 0.8 yr), 17 adolescents (12.3 ± 0.4 yr), and 20 young adults (23.6 ± 2.4 yr). Participants completed an incremental ramp test to exhaustion on a cycle ergometer to determine maximal oxygen uptake and gas exchange threshold (GET) before completing three 6-min transitions at a moderate intensity (90% GET) on separate visits. On each visit, bilateral MCAv was measured by transcranial Doppler ultrasonography and breath-by-breath end-tidal carbon dioxide ([Formula: see text]) via a metabolic cart. Data were ensemble-averaged for each participant and analyzed using a monoexponential model. Absolute MCAv was significantly higher throughout exercise in children and adolescents compared with adults (P < 0.001). Children had a significantly lower relative increase in MCAv from baseline (∼12%) compared with adolescents (∼20%) and adults (∼18%, P < 0.040). All adolescents and adults had a monoexponential rise in MCAv and [Formula: see text], but this was observed in only eight children. Children and adolescents had a significantly faster MCAv time constant (τ, 12 ± 6 and 14 ± 8 s, respectively) compared with adults (27 ± 9 s, P < 0.001). MCAv τ was positively associated with faster [Formula: see text] τ in adolescents (r = 0.70, P = 0.002) but not in children (r = -0.20, P = 0.640). Time- and amplitude-based response parameters of MCAv kinetics were significantly associated with [Formula: see text] kinetics in adults (r = 0.50-0.74, P ≤ 0.025), but not in children (r = -0.19 to -0.48, P > 0.227). These findings suggest that the transition from childhood to adulthood impacts the MCAv response to exercise and the relationships between [Formula: see text] and MCAv kinetics during exercise.NEW & NOTEWORTHY This is the first study to find that children have smaller increases in Δ%MCAv (∼12%) during moderate-intensity exercise compared with adolescents and adults (∼18%-20%). Furthermore, MCAv kinetics were significantly faster in children and adolescents, compared with adults. MCAv kinetic responses were significantly and positively associated with [Formula: see text] kinetics in adults, but not in children. These novel data also suggest that the regulatory role of [Formula: see text] on MCAv during exercise begins to strengthen during adolescence.

Fibrolytic efficiency of the large intestine microbiota may benefit running speed in French trotters: A pilot study.

This pilot study sought to explore the contribution of the large intestine microbiota to energy metabolism and exercise performance through its ability to degrade fibers into short-chain fatty acids (SCFAs). To investigate this, a correlational study was carried out on athlete horses under the same management conditions. Fecal microbiota diversity and composition, fibrolytic efficiency and SCFAs were analyzed. An incremental running test was carried out to estimate the maximal running speed (MRS) of the horses, and blood samples were taken to measure energy metabolism parameters. MRS was positively correlated with the efficiency of the fecal microbiota in degrading cellulose invitro (r = 0.51; p = 0.02). The abundance of fibrolytic bacterial taxa was not associated with MRS, but functional inference analysis revealed a positive association between MRS and pathways potentially related to fibrolytic activity (r = 0.54; p = 0.07 and r = 0.56; p = 0.05 for butyrate metabolism and thiamine metabolism, respectively). In contrast, the metabolic pathway of starch degradation appeared negatively associated with MRS (r = -0.55; p = 0.06). The present findings suggest a potential contribution of the large intestine microbiota and dietary fibers digestion to exercise capacity in equine athletes.

Ketogenic diet in adult patients with mitochondrial myopathy

BackgroundThis study aimed to explore the feasibility, safety and efficacy of a Modified Atkins Diet (MAD) in patients with mitochondrial myopathy (MM). MethodsPatients with genetically proven mitochondrial disorder and exercise intolerance or muscle weakness followed a twelve week MAD. Feasibility was measured by diet duration and ketone levels. Safety was assessed by monitoring adverse events (AE). Efficacy was assessed by a maximal incremental test and a muscle performance test. ResultsEight out of twenty patients completed the twelve week intervention. Reasons to discontinue were the occurrence of AE: rhabdomyolysis (n = 3), vomiting (n = 1), fatigue (n = 6), constipation (n = 1), in combination with a lack of improvement and adherence difficulties. On an individual level, various positive effects were reported including improvements in VO2peak (n = 6), anaerobic threshold (n = 9), muscle fatigue resistance (n = 5), muscle strength (n = 7), fatigue (n = 6), glucose tolerance (n = 7), migraine (n = 3), sleep (n = 3), and gastrointestinal complaints (n = 2). Lipid profile improved and thirteen patients lost weight. All patients with mitochondrial DNA (mtDNA) deletions, experienced muscle related AE. The five patients with the m.3243A>G mutation achieved the longest diet duration. Discussion/conclusionMAD feasibility, safety and efficacy is variable in MD patients. MAD appears to be unsuitable for MD patients with mtDNA deletions. All patients should be monitored closely for adverse events when initiating the diet. Further research should focus on predictive factors to consider the diet, effectiveness of less stringent carbohydrate restricted diets.

How to evaluate exertional breathlessness using normative reference equations in research.

Breathlessness is a common, distressing and limiting symptom in people with advanced disease, but is challenging to assess as the symptom intensity depends on the level of exertion (symptom stimulus) during the assessment. This review outlines how to use recently developed normative reference equations to evaluate breathlessness responses, accounting for level of exertion, for valid assessment in symptom research. Published normative reference equations are freely available to predict the breathlessness intensity response (on a 0-10 Borg scale) among healthy people after a 6-minute walking test (6MWT) or an incremental cycle cardiopulmonary exercise test (iCPET). The predicted normal values account for individual characteristics (including age, sex, height, and body mass) and level of exertion (walk distance for 6MWT; power output, oxygen uptake, or minute ventilation at any point during the iCPET). The equations can be used to (1) construct a matched healthy control dataset for a study; (2) determine how abnormal an individual's exertional breathlessness is compared with healthy controls; (3) identify abnormal exertional breathlessness (rating>upper limit of normal); and (4) validly compare exertional breathlessness levels across individuals and groups. Methods for standardized and valid assessment of exertional breathlessness have emerged for improved symptoms research.

Changes in lactate concentration are accompanied by opposite changes in the pattern of fat oxidation: Dose-response relationship.

It is unknown whether changes in lactate concentration produced by different situations (e.g., glycogen depletion or heat) modify fat oxidation. If confirmed, we could determine a dose-response relationship between lactate and fat. The aim of this study was to determine whether changes in lactate concentration (due to glycogen depletion or heat) alter fat oxidation during exercise. 11 males and eight females performed an incremental exercise test under three situations: control, glycogen depletion, and heat. At rest, in the last minute of each step and immediately post-exhaustion, lactate was analyzed and fat oxidation was estimated by indirect calorimetry. Lactate concentration was inversely associated with fat oxidation in the three aforementioned situations (r>0.88 and p<0.05). The highest lactate concentration was found in the heat situation, followed by the control situation, and finally the glycogen depletion situation (all p<0.05). The opposite was found for fat oxidation, with the highest fat oxidation found in the glycogen depletion situation, followed by the control situation, and finally the heat situation (all p<0.05). There is no association between the changes in lactate concentration between situations at each intensity and the changes in fat oxidation between situations at each intensity in males or females (p>0.05). In conclusion, lactatemia is strongly and inversely associated with fat oxidation under the three different situations. Furthermore, the lowest lactate concentrations were accompanied by the highest fat oxidations in the glycogen depletion situation, whereas the highest lactate concentrations were accompanied by the lowest fat oxidations in the heat situation.

Evidence that mitral and/or tricuspid regurgitation diminishes stroke volume increase during exercise

Abstract Background and Purpose The severity of heart failure can be evaluated by peak oxygen consumption (VO2). Cardiac output is one of the major essential factors to determine the VO2. Therefore, cardiac output increases linearly as the exercise intensity increases. However, in mitral regurgitation, effective stroke volume decreases due to some blood flowing back into the left atrium from the left ventricle. This reduction may compromise oxygen delivery to working muscles and diminish oxygen uptake. Peak VO2/HR is known to indicate the stroke volume at the peak exercise, but since c(A-V)O2 difference shows almost a similar change pattern during a ramp protocol, VO2/HR during the load is also reported to be an indicator of stroke volume (SV) at that work rate. However, there are no investigations that have examined the extent to which the increase in cardiac output during stress is affected by the severity of mitral regurgitation. Therefore, we investigated the influence of the degree of regurgitant volume in mitral regurgitation (MR) and tricuspid regurgitation (TR) affects the SV increasing response to exercise load. Additionally, we examined whether blunted SV increase influences on the peak VO2. Methods Among 525 patients who underwent cardiopulmonary exercise test (CPX) at our institution from January 2023 to October 2023, 518 patients (143 females, 375 males, mean age 65.2±15.0 years old) where precise analyses of CPX was possible. CPX was performed using breath-by-breath gas analysis, and an incremental load test (10watts/min) was administered until exhaustion. The rate of increase in VO2/HR per watt during an incremental loading (Δ(VO2/HR)/ΔWR) was used as an indicator of the degree of increase in SV. Typically, SV increases up to 60% of maximum load, around AT, after which it stops increasing and plateaus. Therefore, the slope of Δ(VO2/HR)/ΔWR was examined from the initiation of ramp loading to AT. The degree of reflux was evaluated by echocardiography and classified as none/trivial, mild and moderate/severe. The number of people in each group of None/trivial, mild, moderate/severe was, 392, 83, 30 for MR, and 416, 64, 24 for TR. Δ(VO2/HR)/ΔWR was evaluated for each degree of reflux, using ANOVA to determine whether there was a difference between groups. Results As shown in the Figure1, Δ(VO2/HR)/ΔWR decreased as the reflux flow rate increased for both MR and TR. Concurrently, peak VO2 also decreased in the moderate/severe group compared to the non/trivial-reflux group for both MR and TR (MR: 17.5±5.4 mL/min/kg vs. 14.9±3.5 mL/min/kg, TR: 17.2±5.3 mL/min/kg vs. 13.6±3.8 mL/min/kg). Conclusion The Δ(VO2/HR)/ΔWR obtained through CPX has been shown to be an index that can evaluate the severity of reflux. Additionally, it was also demonstrated that as regurgitation flow increased, true stroke volume decreases, which is correlated with a reduction in peak VO2.

A Probability-Based Model for Course Completion Prediction in Online Asynchronous Learning

The sheer scale of Massive Open Online Courses (MOOCs), presents a significant challenge in delivering personalized learning experiences and effective student support. With vast participation numbers, it becomes difficult for instructors to track individual progress, pinpoint specific areas where students struggle, and understand the underlying reasons for failure to complete the course. This lack of individualized attention can lead to disengagement and higher dropout rates. A probability-based analysis offers a solution by generating student-specific predictions about their likelihood of completion. This empowers educators to proactively identify those at risk, tailor interventions, optimize resource allocation, and potentially improve the overall learning experience within the MOOC environment. This study focuses on developing a robust predictive framework to accurately estimate the probability of students completing an introductory programming course offered on the Open Learning Platform of the University of Moratuwa, Sri Lanka. The approach began with a classification model to determine the likelihood of course completion. Building upon this, a regression model was developed to generate a specific probability percentage representing the chance of a student successfully completing the course within a designated time frame. Initial findings suggested that predictions from the classification model achieved the highest accuracy when students have completed approximately 42.8% of the course materials. It is anticipated that further refinements to the methodology will improve the reliability of the predictions. A crucial aspect of this research involves determining the optimal percentage of course progress needed to yield reliable probability predictions. This is investigated through systematic analysis and experimentations including incremental model testing. The dataset encompasses diverse demographic and educational variables, enabling the identification of influential factors affecting course completion. This study provides insights on developing personalized learning strategies, intervention tactics and academic planning within online asynchronous education.

Maximum heart rate prediction equations based on field-tests with adequate clinical applicability for aerobic exercise prescription to individuals after stroke

Objectives 1) to develop two maximum heart rate (HRmax) prediction equations for individuals after stroke; 2) to investigate its validity. Methods The HRmax was obtained by a Cardiopulmonary Exercise Test (CPET). Participants also completed the Six-minute Walking Test (6MWT) and the Incremental Shuttle Walking Test (ISWT). Results 60 individuals (54(12) years; 64(69) months after stroke) were included. Twenty individuals (58(10) years; 67(61) months after stroke) were included in the cross-validation group. For the first model, the following equation was generated (equation-1): HRmax= 87.655 + 0.726 (HRpeak in the 6MWT) − 0.386 (age in years), (R2=0.53; Standard Error of the Estimate (SEE)= 15.35; p < 0.0001). For the second model, the following equation was generated (equation-2): HRmax= 96.523 + 0.681 (HRpeak in the ISWT) − 0.039 (walking distance in meters in the ISWT) − 0.400 (age in years), (R2=0.53; SEE = 15.51; p < 0.0001). Significant and high magnitude agreement was found between the HRmax obtained by the CPET and the predicted HRmax by equation-1 (ICC= 0.85; 95% CI= 0.63 − 0.94) and equation-2 (ICC= 0.72; 95% CI= 0.29 − 0.89). Conclusions Two HRmax prediction equations have been developed and showed adequate validity. Professionals will have the option of choosing one of the two equations to use.

Females have better metabolic flexibility in different metabolically challenging stimuli.

The first aim was to explore the difference in metabolic flexibility between sexes in response to changing exercise intensity under control conditions. The second aim was to evaluate metabolic flexibility between sexes in response to exercise intensity adding two different metabolically challenging stimuli (glycogen depletion and heat). Eleven males (22±3yrs, 176.2±4cm, 68.4±4.9kg and 60.2±4.1ml/kgFFM/min) and nine females (22±2yrs, 166.7±4.5cm, 61.9±2.9kg, 64.2±5.6 ml/kgFFM/min) performed a maximal incremental exercise test (30W every 3min) on a cycle ergometer under three conditions: control (24h high-carbohydrate diet followed by the incremental test), glycogen depletion (glycogen-depletion protocol followed by 24h low-carbohydrate diet and then the incremental test) and heat (24h high-carbohydrate diet followed by 30 min passive heating and then the incremental test in heat). In the last minute of each step, lactate was analysed, fat (FATox/FFM) and carbohydrate oxidation (CHox/FFM) and energy expenditure (EE/FFM) normalized to fat free mass was estimated by indirect calorimetry. Females presented a greater FATox/FFM as exercise intensity increases across conditions (control, glycogen depletion and heat) (p=0.006). In contrast, CHox/FFM was not significantly different between sexes at any specific intensity across conditions (p>0.05). Consequently, EE/FFM was higher in females throughout the different intensities across conditions (p=0.002). Finally, lactate concentration was not different between sexes at the same intensities across conditions (p=0.87). In conclusion, females present a greater metabolic flexibility, due to the higher FATox/FFM throughout the different intensities, regardless of whether the test is performed in a conditions emphasizing the oxidative pathway (glycogen depletion) or the glycolytic pathway (heat). Clinical trials:NCT05703100.

The effect of 12-week high-dose Colostrum Bovinum supplementation on immunological, hematological and biochemical markers in endurance athletes: a randomized crossover placebo-controlled study.

Bovine colostrum (COL) is assumed to be one of the strongest natural immune stimulants. Regular ingestion of COL may contribute to improved immune response in athletes exposed to high training loads. Twenty-eight endurance-trained males aged 31.1 ± 10.2 years (body mass 81.9 ± 9.0kg; height 1.82 ± 0.06m) completed this randomized double-blind placebo(PLA)-controlled crossover study aimed at investigating the effect of 12-week COL supplementation (25gCOL·day-1) on resting (REST), exercise-induced (POST-EX), and short-term post-exercise recovery (REC; 1h after test exercise) changes in selected saliva and blood immunoglobulins (Ig), white blood cell (WBC) count and differential; as well as blood hematological, nutritional status and muscle damage indices. The protocol assumed 4 study visits - before/after supplementation with COL (COLPRE and COLPOST ) and PLA (PLAPRE and PLAPOST ). During testing sessions, incremental rowing test to exhaustion and swimming-specific performance test were introduced as exercise stimuli. At COLPOST visit the secretory IgA (SIgA) concentration in saliva was significantly higher at POST-EX and REC compared to REST (p<0.05). COL supplementation had no effect on blood IgA, IgE, IgD, IgG, and IgM concentrations. Furthermore, after COL supplementation decrease of hematocrit at REC (p<0.05) was revealed. 12-week supplementation with 25 gCOL·day-1 in endurance-trained male athletes resulted in a favorable increase in post-exercise concentration of salivary SIgA. COL seems to be a potential stimulator of local immune defense after exercise-induced homeostasis disturbances. Nevertheless, the lack of effect on blood markers indicates the need for further research in the area of mechanisms underlying the effect of the supposed COL immunological capacity.

Acute Effects of Taurine Supplementation on Maximal Fat Oxidation and FATmax in Recreational Endurance Runners: A Randomized, Placebo-Controlled, Crossover, and Triple-Blinded Study.

Taurine (TAU) has been shown to improve time to exhaustion (TTE) and fat oxidation during exercise; however, no studies have examined the effect of acute TAU supplementation on maximal fat oxidation (MFO) and related intensity to MFO (FATmax). Our study aimed to investigate the effect of acute TAU supplementation on MFO, FATmax, VO2peak, and TTE. Eleven recreationally trained male endurance runners performed three incremental running tests. The first visit included a familiarization to the test, followed by two subsequent visits in which exercise was performed 90min after ingestion of either 6-g TAU or placebo (PLA) using a triple-blind randomized crossover design. There was no effect of TAU on MFO (p = .89, d = -0.07, TAU: 0.48 ± 0.22g/min; PLA: 0.49 ± 0.15g/min or FATmax (p = .26, d = -0.66; TAU: 49.17 ± 15.86 %V˙O2peak; PLA: 56.00 ± 13.27 %V˙O2peak). TTE was not significantly altered (TAU: 1,444.8 ± 88.6s; PLA: 1,447.6 ± 87.34s; p = .65, d = -0.04). TAU did not show any effect on V˙O2peak in comparison with PLA (TAU: 58.9 ± 8.4ml·kg-1·min-1; PLA: 56.5 ± 5.7ml·kg-1·min-1, p = .47, d = 0.48). However, V˙O2 TAU at most stages of exercise with large effect sizes (ηp2=.43). The acute ingestion of 6 g of TAU before exercise did not enhance MFO, FATmax, or TTE. However, it did increase the oxygen cost of running fixed intensities in recreationally trained endurance runners.

Nebulized fentanyl does not improve exercise capacity or dyspnoea in fibrosing interstitial lung disease.

Exercise intolerance and exertional dyspnoea are hallmarks of fibrosing interstitial lung disease (FILD) and are associated with worse prognosis and quality of life. Activation of pulmonary vagal afferents influences the ventilatory pattern and contributes to the sensation of dyspnoea. We tested the hypothesis that nebulized fentanyl, which might attenuate aberrant pulmonary afferent activity in FILD, reduces ventilation and dyspnoea while extending exercise endurance time (EET). In this randomized, single-blind, placebo-controlled study, eight FILD patients (two males, 71±6years of age) performed incremental cardiopulmonary cycle exercise tests following nebulization of either fentanyl citrate (100 µg) or 0.9% saline. Previous work indicated that this dose was unlikely to produce central effects. Comparisons between treatment conditions at rest were undertaken using Student's paired t-test, and exercise data were evaluated with two-way ANOVA with repeated measures. Dyspnoea was assessed using the Borg dyspnoea scale. Resting respiratory variables were not different following treatment with fentanyl and saline; however, resting heart rate was lower following fentanyl (P=0.002) and remained lower throughout exercise compared with placebo (P=0.008). Fentanyl did not increase EET (placebo 334±117s vs. fentanyl 348±126s, P=0.250) although overall minute ventilation was reduced slightly (mean difference: -0.97 L/min, P=0.022). There were no differences in ratings of dyspnoea intensity or unpleasantness between the conditions either at rest or at end-exercise. Nebulized fentanyl did not improve EET or exercise dyspnoea but did decrease minute ventilation during exercise, although the extent of this reduction appears clinically insignificant. These findings suggest that nebulized fentanyl is unlikely to offer significant benefits for enhancing exercise capacity in FILD.