Age-predicted Maximum Heart Rate Research Articles

Absolute and relative intensities of solo, free-form dancing in adults: A pilot study

Objectives Engaging in dance of various styles confers health benefits among adults; however, additional studies on free-form dancing are needed to quantify its intensity and advance research on dance and health. This study characterized the absolute and relative physical activity (PA) intensities of solo, free-form dancing at self-determined moderate and vigorous intensities in adults. Method Participants (N = 48) ages 18 to 83 years old, with 0 to 56 years of dance training experience, engaged in 5-minute free-form dance bouts at respectively self-determined moderate and vigorous intensities, both with and without music. Absolute intensity was measured during bouts using indirect calorimetry (metabolic equivalents; METs = V˙O2 ml·kg-1·min-1/3.5). Relative intensity was measured by ratings of perceived exertion (Borg scale) and heart rate. Linear mixed effects models were used to assess the relationship between absolute and relative intensity metrics and model covariates. Results On average, the relative intensity of self-determined moderate-to-vigorous intensity dancing, with and without music, was 76% of the age-predicted maximal heart rate; 74% of the heart rate reserve (HRR); and 13 on the Borg scale. By measure of %HRR, all adults reached at least a moderate PA intensity across all dance bouts. The mean absolute intensity of self-determined moderate intensity free-form dancing without music was 5.6 METs, and the presence of music (β = 0.6) and the intention to dance at a vigorous intensity (β = 1.1) were both significantly positively associated with METs, as participants engaged in free-form dance; METs were significantly inversely associated with age (β = -0.05) and BMI (β = -0.10). Conclusions When characterized using HRR, engaging in free-form dance at self-determined moderate-to-vigorous PA intensities provided a sufficient stimulus for all adults to reach a moderate PA intensity, which provides evidence that dancing however one wishes at such perceived intensities may support adults in accumulating the recommended weekly dose of 3150 minutes of moderate intensity PA.

Chronotropic Response to Exercise is Decreased in Patients With Congenital Heart Disease Compared to Cardiomyopathy Following Pediatric Heart Transplantation.

Two common indications for pediatric heart transplantation are congenital heart disease and cardiomyopathy. Prior studies suggest differences in chronotropy on cardiopulmonary exercise testing outcomes depending on indication for heart transplantation. We aimed to determine whether the number of pretransplant sternotomies is associated with differences in heart rate response during exercise testing. A retrospective analysis of our institutional pediatric heart transplant data between 2004 and 2022 was performed. Patients were categorized by indication for transplantation into a cardiomyopathy (CM) group if they had a congenital or acquired cardiomyopathy or a congenital heart disease (CHD) group including all other forms of congenital cardiac anatomic abnormalities. CHD patients (n = 40) differed from CM patients (n = 53) by mean number of sternotomies prior to transplant (2.4 ± 1.8 vs. 0.5 ± 0.9, p < 0.001). There were no significant differences in echocardiographic function or catheterization hemodynamics. In cardiopulmonary exercise testing performance, the congenital heart disease group had a significantly higher resting heart rate (91.8 ± 11.2 vs. 86.4 ± 10.2 bpm, p = 0.019), lower percent predicted age-predicted maximal heart rate achieved (78.3 ± 8.5% vs. 83.2 ± 11.4%, p = 0.032), and lower heart rate reserve (68.6 ± 19.8 vs. 84.4 ± 24.0 bpm, p = 0.001) despite a similar age and average time from transplantation. Regression analysis confirmed number of pretransplant sternotomies as a main predictor of heart rate metrics. There is greater chronotropic incompetence in patients who underwent transplantation due to congenital heart disease compared to cardiomyopathy. The groups differ significantly by number of sternotomies, potentially supporting the hypothesis that prior surgical disruption of cardiac innervation may cause decreased chronotropic response to exercise following transplantation.

Age-predicted maximal heart rate reserve as an alternative prognostic parameter in patients with heart failure with preserved ejection fraction -insights from PURSUIT-HFpEF registry-

Abstract Background Heart rate reserve (HRR), a measure of chronotropic response, is a prognostic parameter in patients with heart failure with preserved ejection fraction (HFpEF). However, exercise testing and measuring maximum heart rate (HR) are sometimes difficult in patients with heart failure with preserved ejection fraction (HFpEF). Assessing age-predicted maximal HRR (APHRR), defined as the difference between the resting HR and the age-predicted maximum HR (220 - age), would be a simple alternative to HRR. Purpose To assess the impact of APHRR at discharge on prognosis in patients with HFpEF. Methods An analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 1231 patients hospitalized for acute heart failure (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction ≥50% and brain natriuretic peptide level ≥100 pg/ml. Excluding patients with permanent pacemakers, we enrolled 918 patients (age, 81 ± 9 years; men, 45%; atrial fibrillation, 38%) whose follow-up data after survival discharge were available. Results There was a moderate correlation between HR (median 69, interquartile range [IQR] 61-79 beats per minute [bpm]) and APHRR at discharge (71, 59-81 bpm) (r² = 0.68, p &amp;lt;0.001). During the median follow-up period of 23.8 months [IQR, 12.5-36.3] after discharge, 267 patients (15.4%) died, and the mortality rates incrementally decreased according to the APHRR quartiles (Q1, 44.6%; Q2, 26.6%; Q3, 26.2%; Q4, 18.4%; p &amp;lt;0.001). Cox regression analysis revealed that both the resting HR (hazard ratio per quartile increase, 1.16; 95% confidence interval, 1.04-1.30, p = 0.008) and APHRR (0.67; 0.60-0.75, p &amp;lt;0.001) were associated with mortality. However, the diagnostic accuracy was significantly superior in the APHRR than in resting HR (area under the curve; 0.628 vs. 0.552, p &amp;lt;0.001). Conclusions Assessment of the APHRR at discharge was a simple and useful method for risk stratification of patients with HFpEF. An incremental favorable prognosis indicated the prognostic importance of having a functional reserve during physiologic stress.

The acute effect of heart rate monitor projection on exercise effort in school students

Heart rate (HR) monitoring during exercise represents a potentially useful strategy for teachers delivering physical education lessons. This study examined how projecting HR monitor data onto a screen acutely affected school students’ exercise intensity during a high-intensity interval training (HIIT) session. Twenty students (12.3 ± 0.9 years, male = 8, female = 12) from one primary school volunteered to participate. Using a randomised crossover design within a 4-week period, participants completed four sessions of HIIT with HR projection and four sessions of HIIT with no ability to view HR. During the HR projection condition all participants viewed their HR on a class screen in real-time, with a changing colour according to HR level. Target intensity was 90% of age-predicted maximum HR. Peak HR and time above 90% HR (RED) were collected in all sessions. Student focus groups and teacher interviews were conducted to gain perceptions around the effects of the projection. Peak HR ( p = 0.005, η2 effect size = 0.049) and RED ( p = 0.000, η2 effect size = 0.083) were significantly greater during the projected condition. Qualitative data indicated that projection improved student motivation to reach the target, and ignited competition amongst peers to work harder. Projecting HR data onto a screen can increase the acute exercise intensity of school students during HIIT. HR projection therefore represents a useful strategy for the delivery of exercise sessions with an emphasis on intensity, within physical education classes.

Target Heart Rate Formulas for Exercise Stress Testing: What Is the Evidence?

Exercise stress testing (EST) is commonly used to evaluate chest pain, with some labs using 85% of age-predicted maximum heart rate (APMHR) as an endpoint for EST. The APMHR is often calculated using the formula 220-age. However, the accuracy of this formula and 85% APMHR as an endpoint may be questioned. Moreover, failing to reach 85% APMHR (known as chronotropic insufficiency) may also indicate poor cardiovascular prognosis, but measurements, such as percentage heart rate reserve (%HRR), maximum rate pressure product (MRPP), and the maximum metabolic equivalent of tasks (METs) reached during EST may provide better prediction of cardiovascular outcomes than not reaching 85% of APMHR. There is a need to incorporate comprehensive measurements to improve the diagnostic and prognostic capabilities of EST.

An exploratory investigation of heart rate and heart rate variability responses to daylong heat exposure in young and older adults.

Heart rate variability (HRV) has shown potential as a tool for monitoring thermal strain, but there is limited data to support its efficacy in older adults during prolonged heat exposures. We compared HRV between young (19-31 years, n=20) and older (61-78 years, n=39) adults during 9 hours of heat exposure (40°C, 9% RH). We also explored whether heart rate (HR) and/or HRV could be used to distinguish older adults who achieved elevated thermal strain, defined as either 1) an increase in core temperature >1.0°C (occurring in 39% [15/39]) or 2) a reduction in systolic blood pressure >10 mm Hg (occurring in 67% [26/39]). Percentage of age-predicted maximal HR and percentage of heart rate reserve (HRR) were higher, whereas standard deviation of normal RR intervals (SDNN), the square root of the mean of squared differences between successive RR intervals (RMSSD), high frequency power (HF), and cardiac vagal index (CVI) were lower in older compared to young adults (P≤0.004) during heat exposure. In older adults, increases in core temperature were correlated with percentage of age-predicted maximal HR, percentage of HRR, RMSSD, and CVI (P≤0.031), whereas changes in systolic blood pressure were not significantly associated with HR or HRV indices (P≤0.327). Receiver operating characteristic curve analysis indicated that HR and HRV indices had generally poor ability to identify older adults with elevated thermal strain (area under the curve ≤0.65). Age-related differences in HRV, consistent with vagal withdrawal among older adults, remained during daylong heat exposure, but marked heterogeneity of response likely contributed to HRV providing limited discriminatory value in identifying changes in core temperature or blood pressure in older adults.

Feasibility of a Recumbent Stepper for Short-Interval, Low-Volume High-Intensity Interval Exercise in Stroke.

Studies investigating high-intensity interval exercise (HIIE) in stroke typically emphasize treadmill training. However, a literature review suggested that seated devices such as a recumbent stepper or cycle offer a promising alternative for HIIE since exercise can be prescribed using peak power output (PPO). Therefore, this would give health care professionals the ability to monitor and adapt power output for the target heart rate range. The purpose of this secondary analysis was to examine the feasibility of prescribing short-interval, low-volume HIIE using PPO in chronic stroke. We used several methods to test feasibility: (1)Acceptability: Measured by the percentage of participants who completed the entire HIIE protocol; (2) Implementation was assessed by the number of reported cardiac or serious adverse events during submaximal exercise testing and HIIE and the average percentage of participants reaching vigorous intensity, defined by the American College of Sports Medicine as at least 77% of age-predicted maximal heart rate (HRmax). Data were available for 28 participants who were 32.2 (17.2) months post-stroke and 61.4 (11.9) years of age. Twenty-eight participants completed HIIE per protocol. No cardiac or serious adverse events occurred during the submaximal exercise test or during HIIE. The rapid switching between HIIE and recovery showed no evidence of blood pressure reaching unsafe thresholds. Average intensity during HIIE reached 76.8% HRmax, which is slightly below the target of 77.0%. A single bout of short-interval, low-volume HIIE, prescribed using PPO, was feasible in chronic stroke.

Does mild chronic obstructive pulmonary disease need a standard pulmonary rehabilitation program? A case report

Background: Patients with mild chronic obstructive pulmonary disease (COPD) are usually not recommended for a standard pulmonary rehabilitation (PR)program based on the GOLD guideline in mild COPD GOLD A classification. Especially, the scientific evidence on exercise capacity that can be identified for recruitment in PR programs has been less reported. Thus, a preliminary case study to identify the exercise capacity under cardiopulmonary responses by aerobic exercise testing among patients in mild COPD GOLD A classification was the aim of this study. Objective: To evaluate the cardiopulmonary responses from exercise capacity testing in individual COPD patients with mild COPD GOLD A Classification. Materials and methods: Four participants with mild COPD GOLD A performed an exercise endurance capacity test at home using Spot Marching Exercise Test (SMT), marching on the spot with high hip and arm raising. The load of SMT was indicated by a controlled stepping rate at 70, 80, 90, 100, and 110 steps/min. Every participant performed Incremental SMT (ISMT) with every 3 min incremental load, and the Constant SMT (CSMT) at the peak load. Both exercise tests were terminated at symptom limit. Resting time between ISMT and CSMT was at least 30 minutes. Cardiopulmonary exercise responses, Borg perceived breathlessness (RPB) and exertion (RPE) were monitored every minute during the exercise test. The duration of exercises was recorded. Results: Peak exercise capacity using ISMT was low with the end exercise load at 70, 80, 80, and 90 steps/min which is equivalent to moderate to high intensity at 81%, 62%, 65% and 93% of age-predicted maximum heart rate (HRmax). The exercise test was stopped by breathlessness at RPB 7, 8, 6, and 5. Respiratory rates (RR) were 36, 26, 38, and 38 breaths/min. With CSMT, the results showed very short exercise duration 1.78, 4.60, 2.15, and 2.47 mins with RPB 7, 8, 5, and 5 and RR of 33, 27, 34, and 41 breaths/min respectively. Conclusion: This preliminary report reveals that all four mild COPD GOLD A show low exercise capacity and very poor exercise endurance that should identify the appropriated standard PR program in the future.

Myocardial Blood Flow in Newly Diagnosed Breast Cancer Patients at Rest and During Exercise

Heart depends critically on continuous supply of blood, but it is unknown whether cancer, without any treatments, affects myocardial blood flow (MBF) at rest or during exercise. This study therefore aimed at measuring MBF in cancer patients and control subjects and it was hypothesized that MBF is affected by cancer. The study included recently-diagnosed breast cancer patients (n=18) who had not started their oncologic treatments and age-matched female control participants (n=32). Controls were women referred to cardiac diagnostic testing but who were by this testing judged to be free of obstructive coronary artery disease. MBF was quantified with [15O]H2O positron emission tomography (PET) at rest in both groups and additionally during 10-min supine bicycling exercise in the breast cancer patients. Furthermore, cardiac morphological changes were analyzed with a breast cancer mice-model four weeks after the inoculation of 13TC mammary tumor cells. Respective mice without tumors served as controls. Resting heart rate (HR) and rate pressure product (RPP) correlated positively with resting MBF, but were similar in both groups resulting also in similar resting MBF in cancer patients and controls. MBF increased significantly from rest during exercise in breast cancer patients (p&lt;0.0001) and exercising MBF correlated positively with the histologic grade of cancer (r=0.54, p=0.021). However, cancer grade did not associate with exercise intensity measures such as HR, RPP or HR percentage from age-predicted maximal HR. In the mouse model, the breast cancer did not affect heart weight, cardiomyocyte size, myocardial capillary density, or capillary-to-myocyte size ratio. In conclusion, resting MBF in humans or myocardial capillarity in mice appear not to be affected by breast cancer. However, the more severe is the histologic grade of cancer, the higher is the MBF during exercise in patients with breast cancer, independently of the intensity of the exercise suggesting dysregulation of myocardial blood supply with cancer. This novel finding requires further investigations. This study was financially supported by Academy of Finland and Hospital District of South-West Finland. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Use of the Buffalo Concussion Treadmill Test in community adult patients with mild traumatic brain injury.

The Buffalo Concussion Treadmill Test (BCTT) is used to establish exercise tolerance for rehabilitation and identify injury subtypes for youth athletes after mild traumatic brain injury (mTBI). Its utility in adult community members is unknown. Primary: To describe how adults with and without mTBI tolerate the BCTT. Secondary: To explore relationships between baseline factors, mTBI-related symptoms, and BCTT duration. Prospective, observational, longitudinal. Academic medical center. Thirty-seven adults treated in a level 1 trauma center emergency department with mTBI; 24 uninjured controls (UC). N/A. Participants completed two visits 3 weeks apart (1 week and 1 month after mTBI) including a 15-minute BCTT, the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and preinjury International Physical Activity Questionnaire. Analyses characterized BCTT response and associations between baseline factors, RPQ scores, and BCTT duration. Persons with mTBI discontinued earlier than UC at 1-week postinjury using standard discontinuation criteria for exercise intolerance. The percentage of mTBI participants with signs of possible mTBI-related intolerance was 55.6% at 1 week (36.1% for mTBI-related symptom exacerbation, 19.4% for exertion/fatigue before reaching 85% of one's age-predicted maximum heart rate [HR]) and 48.0% at 1 month (40.0% mTBI-related symptom exacerbation, 8.0% exertion without reaching the target HR). Thirty percent of UCs completed the BCTT at both assessments. UCs met discontinuation criteria for increased nonspecific symptoms (eg, pain/general discomfort and increased Visual Analog Scale ratings; 39-61%) and physical exertion (9-26%). Shorter duration was associated with higher body mass index (r = -0.42 - -0.45), shorter height (r = 0.22-0.29), female gender (r = -0.26 - -0.27), and greater RPQ symptoms (r = -0.28 - -0.47). The BCTT exacerbates mTBI-related symptoms in adult community members. Participant characteristics and noninjury factors influence performance. The findings imply the BCTT could be useful in clinical assessments of adults with mTBI. Interpretation should account for the unique characteristics of nonathletes.

Feasibility and Safety of Early Post-COVID-19 High-Intensity Gait Training: A Pilot Study.

The feasibility and safety of rehabilitation interventions for individuals recovering from COVID-19 after the acute stage is not well understood. This pilot study aims to provide a preliminary investigation of the feasibility and safety of providing high-intensity gait training (HIT) with a targeted cardiovascular intensity of 70-85% of the age-predicted maximum heart rate (HRmax) for individuals undergoing rehabilitation post-COVID-19. Consecutive patients who were medically cleared for HIT were invited to participate in the study. Participants practiced walking in varied contexts (treadmill, overground, and stairs), aiming to spend as much time as possible within their target cardiovascular intensity zone during scheduled physical therapy (PT) sessions. Training characteristics and adverse events were collected to determine the feasibility and safety of HIT. The severity of adverse events was graded on a 1-5 scale according to the Common Terminology Criteria for Adverse Events. The participants (n = 20) took a mean of 2093 (±619) steps per PT session. The average peak heart rate during PT sessions was 81.1% (±9.4) of HRmax, and 30.1% (±21.0) of the session time was spent at heart rates ≥ 70% HRmax. Mild adverse events (grade 1) occurred in <5% of the sessions, and no intervention-requiring or life-threatening adverse events (grade 2-5) occurred. This pilot study provides preliminary evidence that HIT may be feasible and safe during inpatient rehabilitation for patients post-COVID-19 following medical clearance.

FEASIBILITY OF AEROBIC FITNESS TESTING IN AMNESTIC MILD COGNITIVE IMPAIRMENT FROM THE ACT TRIAL

Abstract Aerobic fitness has been postulated as a physiological mechanism of action for aerobic exercise to modify Alzheimer’s disease, but it has not been adequately studied in older adults with (MCI). The purpose of this study is to evaluate the feasibility of a gold-standard, laboratory-based, symptom-limited cycle-ergometer exercise testing (GXT) in older adults with amnestic mild cognitive impairment (aMCI) to assess peak oxygen consumption (VO2max [ml/kg/min]) using baseline data from the ACT Trial. The test was categorized as a submax, near-max, and max test based on if 0, 1, and ≥2 of the American College of Sports Medicine criteria was met: &amp;gt;90% of age-predicted maximum heart rate, plateau in VO2Peak, respiratory exchange ratio &amp;gt;1.10, and rating of perceived exertion &amp;gt;17. VO2max was predicted as 3.5*maximal metabolic equivalents (METs). Among 146 enrolled participants (73.8±5.7 years old with 16.9±2.9 years of education, 51.4% men, and 91.8% Caucasian), 145 completed GXTs. Sixteen GXTs (11.0%) were submax (VO2Peak 13.5±4.4), 53 (36.6%) were near-max (VO2Peak 16.5±4.1), and 76 (52.4%) were max (VO2Peak 18.4±5.1). Predicted VO2max were 21.6±6.8, 28.7±26.3, and 30.0±20.5 from submax, near-max, and max tests, respectively. Among max GXTs, VO2max was 19.5±4.9 in men (n=37) and 17.4±5.1 in women (n=39). In conclusion, GXTs was feasible for ~52% of the participants. METs-based prediction overly inflates VO2max estimates, in comparison to VO2max obtained from max GXTs. VO2max levels are substantially lower in older adults with aMCI than peers (23.1±6.3 in men and 21.1±3.4 in women), suggesting aerobic exercise as an important intervention for this population.

Does Exercise Testing with Arm Crank Ergometer Substitute for Cycle Ergometer to Evaluate Exercise Capacity?

Using the upper limbs to test cardiopulmonary exercise can be a useful option in the case of individuals who are unable to pedal a bicycle due to lower limb injury or disability. We evaluated whether exercise testing with the upper limbs can be used equivalently to that of the lower limbs in assessing exercise capacity. Nine collegiate rowers and eight collegiate cyclists underwent incremental exercise testing with an arm crank ergometer (ACE) and cycle ergometer (CE). Heart rate (HR) and oxygen uptake (VO2) were monitored throughout the tests. Segmental muscle mass and flow-mediated dilation of brachial artery were measured to assess the training status of the upper limbs. The muscle mass of the brachium, upper limb, and trunk were greater in the rowers than in the cyclists (p &lt; 0.05). The correlations between HR and VO2 was significantly different depending on exercise modalities, ACE and CE, in both groups (p &lt; 0.001). The estimated maximal VO2 using the correlation formula and age-predicted maximal HR was significantly lower in the exercise testing group with ACE than in the group with CE in rowers and cyclists (41.7 ± 7.3 vs. 52.6 ± 8.6 mL/kg/min, p = 0.010 and 35.5 ± 14.2 vs. 50.4 ± 13.4 mL/kg/min, p = 0.011, respectively). The results suggested that exercise capacity assessed by exercise testing with ACE is underestimated, regardless of the training status of the upper limbs. Further research is needed to verify factors which affect the correlations between HR and VO2 during upper- and lower-limb exercise.

Comparison of VO2max Estimations for Maximal and Submaximal Exercise Tests in Apparently Healthy Adults.

Due to limited accessibility, direct measurement of VO2max is rarely performed in clinical settings or sports centers. As a result, regression equations have been developed and are currently used during exercise tests to provide an indirect estimation. The American College of Sports Medicine (ACSM) has recommended a regression equation for running to provide an indirect estimation of VO2. However, significant differences have been observed between these estimations and directly measured VO2max. Additionally, since submaximal assessments may be more convenient for both athletes and sedentary/diseased individuals, they were included in the analysis. This study aimed to evaluate the accuracy of VO2max estimations provided using the ACSM running equation when used during both maximal and submaximal exercise tests among adult runners. A total of 99 apparently healthy and active adults (age: 39.9 ± 12.2 years; VO2max: 47.4 ± 6.0 mL O2/kg∙min-1) participated in this study. Two types of submaximal estimations were performed to predict VO2max: one based on age-predicted maximal heart rate (HRmax) (ACSMsubmax,Fox), and the second using the actual HRmax measured during the exercise test (ACSMsubmax,measured). The measured VO2max was compared to these estimations obtained from a single exercise test. Both maximal and submaximal exercise tests significantly overestimated VO2max (ACSMmax: +9.8, p < 0.001; ACSMsubmax,Fox: +3.4, p < 0.001; ACSMsubmax,measured: +3.8 mL O2/kg∙min-1, p < 0.001). However, the submaximal estimations were closer to the measured VO2max (p < 0.001). This analysis demonstrated that the included methods overestimated the true VO2max. Nonetheless, the submaximal exercise tests provided a more accurate prediction of VO2max compared to the maximal exercise tests when using the ACSM running equation.

Aerobic and Anaerobic Fitness Levels of Pre-Professional Contemporary Dancers: An Exploration of 2 Dance-Specific Field Tests.

The primary aim of this study was to present descriptive heart rate (HR), heart rate recovery (HRR) and RPE data for the DAFT and HIDT within one sample of contemporary dance students. The second aim was to explore if objective (HR) and subjective (RPE) data were correlated between tests. 40 (11 males, 29 females) university dance students with a mean age of 18.8 ± 1.8 years performed the DAFT and HIDT on 2 separate occasions within 1 week. Measurements were HR after 4 minutes in all stages of the DAFT, the percentage of age-predicted maximal HR (%HRmax) of all stages of the DAFT and at the end of the HIDT, and peak HR (HRpeak) at the end of both tests. Subjective ratings of perceived exertion (RPE) and HR recovery after 1 minute of rest (HRR) were determined after the tests. HRpeak of the DAFT and HIDT were 188.1 ± 11.0 and 185.3 ± 7.3 beats·min-1, respectively. There were high positive correlations between HRpeak of the HIDT and stages 3 to 5 of the DAFT (r = 0.716-0.740, all P-values < .01). HRR (r = .678, P < .01) and %HRmax (r = .746, P < .01) showed moderate to high correlations between the DAFT and HIDT. The anaerobic training zone was reached in stages 4 and 5 of the DAFT and at the end of the HIDT. The subjective RPE scores did not significantly correlate between DAFT and HIDT, neither with objective HR data. Although the DAFT and HIDT differ in intensity and work-to-rest ratio, there were high correlations between HR and HRR data of both tests and both tests reached intensities above the anaerobic threshold (%HRmax > 85%).

Effect of Short Bouts of Vigorous Stair Climbing on Cardiorespiratory Fitness in Women with Overweight and Obesity: A Pilot Feasibility Study.

We examined the effect of 4 weeks of a brief vigorous stair climbing exercise on cardiorespiratory fitness (CRF) and body composition in women with overweight or obesity. Twenty-six participants (age, 25.4±4.9 years; body mass index [BMI], 25.3±1.8 kg/m2) were randomly assigned to either a stair climbing exercise group (n=13) or a non-exercising control group (n=13). The stair climbing exercise group performed 20 sessions (supervised, five sessions/week over 4 weeks) of brief intermittent stair climbing exercise consisting of a 3-minute warm-up followed by three bouts of 20 seconds of stair climbing (≥80% of age-predicted maximum heart rate) interspersed with 2-minute recovery periods (total exercise duration=10 minutes/session). Peak oxygen uptake (VO2peak) was measured using a graded maximal treadmill test with the use of a standard open-circuit spirometry technique. Body composition was assessed with bioelectrical impedance analysis. All participants, except one who dropped out due to coronavirus disease 2019 (COVID-19) infection, completed the study with 100% attendance rates. There were significant interaction effects (group×time) on body weight, BMI, waist circumference, and CRF such that the stair climbing exercise group had significant (P≤0.01) reductions in body weight (66.5±4.6 to 65.2±4.6 kg), BMI (24.8±1.2 to 24.4±1.1 kg/m2), and waist circumference (78.0±3.7 to 76.5±4.1 cm) and improvements in VO2peak (31.6±2.5 to 34.9±2.6 mL/kg/min) compared with controls. Short bouts of vigorous stair climbing is a feasible and time-efficient exercise strategy for improving CRF in previously sedentary, young women with overweight and obesity.

Comparison of supine bicycle exercise versus treadmill exercise echocardiography in a cycling-naive population

Abstract Introduction Exercise echocardiography is a useful diagnostic test for the evaluation of coronary artery disease. Supine bicycle exercise echocardiography has the advantage of continuous monitoring of wall motion during exercise. On the contrary, the heart rate and workload is usually lower compared to treadmill exercise, especially between patients not used to cycling as is the case of many old adults. The aim of this study is to compare both exercise modalities. Methods A group of consecutive patients with chest pain underwent supine bicycle exercise echocardiography under a protocol adapted to the individual requirements. The operator chose between three protocols: light (5 watts every minute), medium (5 watts every 30 seconds) or intensive (10 watts every 30 seconds) according to age, sex and physical condition. The other group underwent treadmill exercise echocardiography using the Ball State University/Bruce Ramp protocol. Results A total of 902 patients were included. Of them, 258 patients underwent supine bicycle exercise echocardiography and 644 patients underwent treadmill exercise echocardiography. Mean age was 62.1 years (SD=13.4) and 48.5% of patients were women. Baseline characteristics were comparable in both groups, without significant differences regarding age, sex, body mass index, pre-test probability or image quality. There were no significant differences in the percentage of positive tests (5.0 vs. 5.3%, p = 0.883). However, the percentage of patients that achieved at least 85% of the predicted workload was significantly higher in the group of treadmill exercise echocardiography (91.3 vs. 45.0%, p &amp;lt; 0.001). The percentage of patients that achieved at least 85% of the age-predicted maximum heart rate was also significantly higher in the group of treadmill exercise echocardiography (76.7 vs. 44.2%, p &amp;lt; 0.001). Conclusions This study suggests that in a population not used to cycling, the use of supine bicycle exercise echocardiography, as opposed to the use of treadmill, hinders the achievement of an adequate maximum heart rate and workload, which can lead to inconclusive results. This should be considered while selecting the ischemic test to use.

Validation of the maximal cardiopulmonary exercise test in adolescents with major depressive disorder and comparison of cardiorespiratory fitness with sex- and age-related control values

Endurance training has been shown to be effective in treating adolescents with major depressive disorder (MDD). To integrate endurance training into the therapeutic setting and the adolescents' daily lives, the current performance status of the adolescents should be accurately assessed. This study aims to examine adolescents with MDD concerning exhaustion criteria during a cardiopulmonary exercise test (CPET), as well as to compare the values obtained thereon with sex- and age-related control values. The study included a retrospective examination of exhaustion criteria ((i) oxygen consumption (V̇O2) plateau, (ii) peak respiratory exchange ratio (RERpeak) > 1.0, (iii) peak heart rate (HRpeak) ≥ 95% of the age-predicted maximal HR, and (iv) peak blood lactate concentration (BLCpeak) > 8.0 mmol⋅L−1) during a graded CPET on a cycle ergometer in adolescents with MDD (n = 57). Subsequently, maximal V̇O2, peak minute ventilation, V̇O2 at the first ventilatory threshold, and peak work rate of participants who met at least two of four criteria were compared with published control values using an independent-sample t-test. Thirty-three percent of the total population achieved a V̇O2 plateau and 75% a RERpeak > 1.0. The HR and BLC criteria were met by 19% and 22%, respectively. T-test results revealed significant differences between adolescents with MDD and control values for all outcomes. Adolescents with MDD achieved between 56% and 83% of control values. Conclusions: The study shows that compared with control values, fewer adolescents with MDD achieve the exhaustion criteria on a CPET and adolescents with MDD have significantly lower cardiorespiratory fitness. Clinical trial registration: No. U1111-1145–1854.What is Known:• It is already known that endurance training has a positive effect on depressive symptoms.What is New:• A relevant proportion of adolescents with major depressive disorder do not achieve their V̇O2max during a graded cardiopulmonary exercise test.• Adolescents with major depressive disorder have significantly lower cardiorespiratory fitness compared to sex- and age-related control values.

A Novel Custom Cycle Ergometer Protocol to Determine V̇O2max: Validation with ACSM’s Cycle Ergometry Metabolic Equation

ABSTRACT Introduction Protocols for determination of maximal oxygen consumption (V̇O2max) on a cycle ergometer should be easily administered while maximizing physiological efficiency and minimizing premature local muscle fatigue for individuals of variable fitness levels. Current protocols typically increase workload by adding resistance to the flywheel; however, increasing pedal rate later in the test, rather than resistance, may provide increased physiological efficiency, yielding a more valid determination of V̇O2max. Purpose The purpose of this study was to design and validate a novel V̇O2max cycle ergometer protocol that can be used for measuring and predicting submaximal oxygen consumption (V̇O2) and V̇O2max during exercise testing in healthy, asymptomatic adults. Methods Subjects (n = 60, 19–60 yr old) performed a V̇O2max test using the new cycle ergometer protocol. Workload increases were based on predetermined incremental target heart rates (ITHR) using heart rate reserve. Stages commenced at a workload of 150 kg·m·min−1 (0.5 kg, 50 rpm) and increased every 2 min by adding 0.5 or 1.0 kg resistance based on ITHR. When an ITHR representing ≥60% heart rate reserve was achieved, workloads increased by 10 rpm for subsequent stages. Pearson’s r was used to examine relationships between predicted (American College of Sports Medicine cycle equation) and measured V̇O2 at workload intensities representing moderate, vigorous, and maximal exercise. Bland–Altman plots were used to display predicted and measured V̇O2 at all exercise intensities and heart rate values at maximal exercise. Results There was a strong and statistically significant correlation between predicted and measured V̇O2 at moderate (r = 0.92, P &lt; 0.001), vigorous (r = 0.94, P &lt; 0.001), and maximal (r = 0.90, P &lt; 0.001) exercise intensities. All subjects reached ≥90% of age-predicted maximum heart rate. Conclusion This novel cycle ergometer protocol was demonstrated to be a viable tool to predict and/or measure submaximal V̇O2 and V̇O2max in a population of healthy, asymptomatic adults.

Exercise Intolerance After Mild Traumatic Brain Injury Occurs in All Subtypes in the Adult Population.

Thematically grouped symptom clusters are present during the acute timeline of post-mild traumatic brain injuries (mTBI), representing clinical profiles called subtypes. Exercise intolerance has not been evaluated within the subtype classifications and, because guidelines support early submaximal aerobic exercise, further knowledge is required in regard to the exercise capabilities among the concussion subtypes. This cross-sectional study (n = 78) aimed to characterize the presence of exercise intolerance within the clinical subtypes and to explore performance on the Buffalo Concussion Treadmill Test (BCTT) in the adult subacute (2-12 weeks post-injury) mTBI population. All participants were evaluated using the BCTT to determine exercise tolerance. We first used the Neurobehavioral Symptom Inventory (NSI) questionnaire to assign each participant a primary subtype(s). To further explore all five subtypes (headache, cognitive, vestibular, ocular motor, and mood), participants were assessed using a multitude of thematically grouped assessments including self-reported questionnaires, clinical tests of vestibular and ocular motor function, balance function, and computerized cognitive testing. Thirty-seven (47%) subjects were exercise tolerant and 41 (53%) were exercise intolerant. There was no difference in the distribution of primary subtypes between the exercise tolerant and exercise intolerant groups. In addition, no significant differences were found between the exercise tolerant and exercise intolerant groups on other thematically grouped subtype assessments. The exercise intolerant group had a significantly higher resting heart rate (HR), lower percentage of age-predicted maximum HR achieved, lower Borg Rate of Perceived Exertion (RPE), and could walk on the treadmill for less time (lower duration) compared with the exercise tolerant group. The current findings suggest that exercise intolerance is common and pervasive across all five mTBI subtypes. A comprehensive mTBI assessment should include evaluation for exercise intolerance regardless of the primary clustering of symptoms and across patient populations. Therefore, early referral to physical therapists, athletic trainers, or medical clinics that can perform the BCTT may be helpful to initiate appropriate exercise prescriptions for patients with mTBI.