Ramp Protocol Research Articles

Standardization of a Continuous Ramp Ergometer Protocol for Clinical Exercise Testing in Children.

Developing a standardized protocol for pediatric exercise laboratories is challenging. Our objective was to report normal pediatric values for a continuous non-steady state cycle ergometer ramp protocol to achieve 8-10min of exercise based on sex and weight. One hundred seventeen patients (117) [mean age 13 ± 2.8years, range 7-18years (51% male)] referred for chest pain with normal cardiac evaluation underwent cardiopulmonary testing on a cycle ergometer. Patients entered one of the four continuous ramp protocols (10, 15, 20, and 25W/min ramp) to achieve an expected peak workload of 3W/kg at an increase of 0.3 to 0.35W/kg/min. Exercise test outcomes measured included duration, peak heart rate, work, respiratory exchange ratio, peak oxygen consumption, peak blood pressure, and ventilatory anaerobic threshold. An exercise duration of 8-10min was achieved in a majority of the study population; however, interactions with age (older, longer duration) and sex (males, longer duration) were present. Using our algorithm (0.3-0.35W/kg×weight), we demonstrated four non-steady state ramp bike ergometer protocols (10, 15, 20, and 25W/min) that can be applied to males and females of different ages and weights to achieve an exercise duration of 8-10min.

Novel Left Heart Catheterization Ramp Protocol to Guide Hemodynamic Optimization in Patients Supported With Left Ventricular Assist Device Therapy.

BackgroundLeft ventricular (LV) hemodynamic assessment has been sparsely performed in patients supported on continuous‐flow LV assist devices (cfLVADs). Insight into dynamic changes of left heart parameters during ramp studies may improve LV assist device optimization and evaluate pathology.Methods and ResultsTo complement right heart catheterization, a novel technique for left heart catheterization in patients with a cfLVAD was developed. Patients implanted with cfLVADs underwent hemodynamic ramp left heart catheterization and right heart catheterization with transthoracic echocardiography. Continuous aortic and LV pressures were measured along with right atrial, pulmonary artery, and pulmonary capillary wedge pressures. A novel index, the transaortic gradient (TAG) was established. Thirty eight patients with cfLVADs were evaluated at a median of 446 days (interquartile range, 183–742) after device implant. During left heart catheterization performed for hemodynamic optimization, drop‐in LV end‐diastolic pressure and pulmonary capillary wedge pressure were associated with a rise in TAG. A range was identified for TAG (20–40 mm Hg) as providing the most optimal level of hemodynamic offloading. Pathologic states deviated from normal responses to ramp. LV assist device thrombosis was associated with an inability to increase in TAG during speed ramp. Significant aortic insufficiency was associated with a marked increase in LV end‐diastolic pressure despite a concomitant decrease in pulmonary capillary wedge pressure with increasing LV assist device speeds.ConclusionsInclusion of left heart catheterization to a typical right heart catheterization LV assist device ramp protocol imparted unique insights to optimize cfLVAD speeds in different clinical scenarios. A novel index, the TAG was defined and provided additional resolution to optimized offloading.

Assessment of the physical fitness of road cyclists in the step and ramp protocols of the incremental test.

The incremental test in laboratory conditions is a method commonly used to evaluate the maximal oxygen uptake and peak power output, which are the good predictors of cycling performance. But the best-designed protocol remains unknown. Therefore, the aim of this study was to examine the physiological and biochemical responses in the incremental ramp on cycle ergometer and to compare with the commonly used step in young road cyclists. Fifty-seven road cyclists took part in the experiment. The tests included two visits to the laboratory during which the anthropometric measurements, incremental test on a cycle ergometer, and examination of acid-base balance and blood lactate concentration were made. A randomly selected half of the subjects made, as the first one, the STEP (50W·3min-1) Test and the RAMP Test (~0,27W·sec-1) a week later. The remaining cyclists made tests in the reverse order. The peak power output obtained in the RAMP was significantly higher than obtained in the STEP by 18.13W (P<0.05). The maximal oxygen uptake was higher by 1.5 (mL∙kg-1∙min-1) during the RAMP (P<0.05). The postexercise blood lactate concentration was significantly higher by 0.94 mmol∙L-1(P<0.05) in STEP. We recommend the use of RAMP Test with linearly increasing workload to determine peak power output, maximal oxygen uptake and ventilatory threshold to precisely programming and control training of young road cyclists.

Improving physical activity tolerance in sedentary overweight women under beta-alanine supplementation

Summary Objectives Today, obesity and inactivity are important health problems in the world and the effective treatments are needed. The aim of the present study was to investigate the effect of beta-alanine supplementation on time to exhaustion and one repetition maximum (1RM) in overweight sedentary women. Equipment and methods Forty 20–45-year old overweight female were recruited to the study. The participants were randomized to a beta-alanine supplement (n = 20) or placebo (n = 20) group. Body composition was measured by Body Impedance Analyzer. Time to exhaustion was evaluated on the treadmill using the ramp protocol. 1RM was measured for upper and lower extremities by body solid leg press and chest press machines. Results Thirty-four participants were analyzed at the end of the study. Change in the time to exhaustion was significant in the intervention group, after 6 weeks (P Conclusions Based on the results of the present study, six weeks of supplementation of beta-alanine in overweight women increased the time to exhaustion compared to the control group. Such results suggest that natural ergometric agents such as beta-alanine may be helpful for improving the adherence of obese patients to exercise protocols, and that this deserves further investigation.

Biophysical Properties of the Electropermeabilization-Induced Membrane Conductance in Patch Clamped Adrenal Chromaffin Cells

Our group recently showed that a single 5 ns high intensity electric pulse (NEP) elicited membrane permeabilization in whole-cell voltage clamped bovine adrenal chromaffin cells, inducing an instantaneous inward conductance at the holding potential of −70 mV. When Na+ was completely replaced in the bath solution with n-methyl-d-glucamine, the NEP-induced current was significantly reduced suggesting that the current was partially carried by Na+. Later, a slow voltage ramp protocol from −100 mV to 80 mV was used to inactivate Na+ channel, whereas K+ and Ca2+ channels were blocked by cesium, tetraethylammonium and nitrendipine. With this ramp protocol, the fact that the NEP-induced conductance showed a consistent reversal potential around −10 mV revealed the properties of the current that resembled protein ion channel-like activity. We further exposed cells to SKF-96365 and La3+, both compounds considered to be able to alter the activity of TRP channels. The results showed 33% and 59 % inhibition effect on the NEP-induced current. Therefore, one possibility of the NEP-induced conductance is a TRP-like channel that is activated via some sort of elctromechnical coupling triggered as a consequence of the NEP. It is known that many TRP channels are localized in caveolae, a subset of membrane lipid rafts involved in compartmentalized signal transduction. Methy-β-cyclodextrin, as cholesterol depletion drug which disrupts caveolae integrity, produced a strong inhibitory effect on the NEP-induced current suggesting the hypothesis that caveolae disruption altered TRP trafficking and/or compartmentalization leading to a diminished ability of NEP to activate these channels, although this observation cannot rule out the possibility that membrane cholesterol depletion altered the biophysical properties of the membrane in a way that would prevent or limit the formation of lipid-containing electronanopores.

Trends in cardiorespiratory fitness: The evolution of exercise treadmill testing at a single Academic Medical Center from 1970 to 2012

To identify temporal trends in the use of exercise treadmill testing (ETT) and cardiorespiratory fitness (CRF) estimated by ETT in metabolic equivalents (METs). We compiled an ETT database of all available treadmill tests-including those with concomitant stress echocardiography and nuclear perfusion imaging studies-performed at Duke University Hospital from January 1, 1970- December 31, 2012. Six different ramp protocols were used in these combined modalities. CRF at maximal exertion was estimated using established metrics. Eligible patients were required to have no missing data on maximal treadmill speed, grade, and protocol. The most commonly used ETT protocol was the Bruce (n = 28,877), followed by manual test (n = 7390). Since the 1980's, the use of ETT for clinical purposes declined substantially; there was a decreased trend in utilization of 9.4% over the decades 1990-1999 and 2000-2009. When standard protocol (Bruce) was assessed in isolation, trends in CRF decreased progressively from 1970 to 2012 (mean METs (standard deviation): 11.7 (4.3) to 10.5 (3.5)). After adjusting for baseline comorbidities, the trend was reduced to a lesser degree. The use of ETT at our institution has declined over time, perhaps due to changes in clinical practice. In patients undergoing ETT using the standard Bruce protocol, CRF decreased progressively over the last five decades. Future studies are needed to clarify the etiology of the decrease in use of such a powerful predictor of clinical outcomes in our medical care environment.

Ramp and step increases in shear stress result in a similar magnitude of brachial artery flow-mediated dilation.

There is evidence that the endothelium is responsive to both the rate and magnitude of increases in shear stress. However, whether flow-mediated dilation stimulated by sustained increases in shear stress (SS-FMD) is rate sensitive in humans is unknown. The purpose of this investigation was to test whether ramp (gradual) and step (instantaneous) increases in shear stress elicit disparate SS-FMD. Young, healthy men (n = 18, age = 22 ± 2years, body mass index = 25 ± 3kgm-2) performed two 11-min bouts of rhythmic handgrip exercise; one with a 5.5-min ramp-increase in shear stress and one with an immediate step increase in shear stress. Ramp increases in shear stress were achieved through incremental increases in handgrip exercise intensity [increases of 4% maximum voluntary contraction (MVC) every 30s for 5.5min, ending at 44% MVC] and step increases in shear stress were achieved through a combination of arterial compression and commencing handgrip exercise at 44% MVC. Shear rate was greater in the step versus ramp protocol in minutes 1-6, but not different thereafter. Similarly, SS-FMD was greater in the step versus ramp protocol during minutes 2-6, but similar in minutes 7-11 (minute 11: ramp 8.7 ± 4.6%; step 9.4 ± 3.6%; P = 0.343). SS-FMD continued to increase over time with maintenance of a steady shear stress stimulus (step minutes 2-11: 0.51 ± 0.36%min-1; ramp minutes 7-11: 0.64 ± 0.57%min-1; P = 0.259). These findings indicate that in the brachial artery of humans, the magnitude of SS-FMD is determined by the magnitude and duration, but not the rate, of increases in shear stress.

Oxygen consumption and heart rate obtained in a ramp protocol are equivalent during exercise session of rectangular loading at ventilatory thresholds for athletes

Abstract Training near or at ventilatory threshold (VT) is an adequate stimulus to improve the thresholds for sedentary subjects, but a higher intensity is necessary for conditioned subjects. The choice of cardiopulmonary exercise testing (CPx) protocol has an influence on VTs identification and can reduce their reliability for exercise prescription. This study tested if VO2 and heart rate (HR) corresponding to first (VT1) and second ventilatory threshold (VT2) determined during a ramp protocol were equivalent to those observed in rectangular load exercises at the same intensity in runners elite athletes (EA) and non-athletes (NA). Eighteen health subjects were divided into two groups: EA (n = 9, VO2max 68.6 mL·kg-1·min-1) and NA (n = 9, VO2max 47.2 mL·kg-1·min-1). They performed CPx and 48h and 96h later, a continuous running lasting 1 h for VT1 and until exhaustion for VT2. The results showed that EA at VT1 session, presented delta differences for VO2 (+9.1%, p = 0.125) vs. NA (+20.5%, p = 0.012). The Bland-Altman plots for VT1 presented biases of (4.4 ± 6.9) and (5.5 ± 5.6 mLO2·kg-1·min-1) for AE and NA, respectively. In VT2, the VO2 and HR of the NA showed biases of (0.4 ± 2.9 mLO2·kg-1·min-1) and (4.9 ± 4.2 bpm). The ramp protocol used in this study was inappropriate for NA because it underestimates the values of VO2 and HR at VT1 found in the rectangular load exercise. The HR showed good agreement at VT2 with CPx and may be a good parameter for controlling exercise intensity.

CLINIMEX Aerobic Fitness Questionnaire: Proposal and Validation

Background: Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO2max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject’s aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary. Objectives: a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO2max; and c) to analyze the influence of some potentially relevant variables on the error of estimate. Methods: We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) - ranging from 0.9 to 21 METs. Results: Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs - r2 = 0.83 (Sy.x = 1.63; p < .001) - with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores. Conclusion: C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET’s measured VO2max.

The effect of aerobic training program on cardiopulmonary parameters and oxygen saturation in elite judokas

The aim of this study is to examine the effect of aerobic training program on cardiopulmonary parameters and oxygen saturation in elite judokas. Total of 22 male elite judokas, aged between 18 and 25 participated in the study voluntarily. Subjects were randomly divided into two groups as experimental group (n=11, age:21.60±2.06) and control group (n=11, age:20.50±1.77). The experimental group was given an aerobic exercise program for 3 days a week for 8 weeks. Before and after the aerobic exercise program, body weight, body mass index (BMI), body fat percentage (BF%), systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate (RHR), maximal heart rate (HRmax), maximal work rate (WRmax), maximal minute ventilation (VEmax) and maximal oxygen consumption capacity (VO2max) were measured. Individual oxygen consumption capacities were determined using the Ramp protocol in the gas analysis system. Paired Sample t test was used for intra-group comparison and Independent Sample t test was used for statistical analysis of the data. The level of significance was determined as p<0.05. When the pre-test and post-test results of the aerobic training program applied to the experimental group were compared, p<0.05 significance was found in the experimental group, SBP, DBP, RHR, HRmax, %BF, VO2max, WRmax, VEmax and SpO2 values. Significant differences were found between the groups in favor of the experimental group (p<0.05) for SBP, DBP, RHR, HRmax, WRmax, VEmax, VO2max and SpO2 values. It can be said that the aerobic training program applied to the judokas has a positive effect on cardiopulmonary parameters and oxygen saturation.

Prevalence of exercise intolerance in obese adults undergoing cardiopulmonary exercise testing

We hypothesized that the prevalence of exercise intolerance (EI, peak O2 uptake &lt; 83%pred.) is not significantly affected by body mass index (BMI) in adults undergoing cardiopulmonary exercise testing (CPET). We aimed to evaluate the prevalence of EI and the influence of BMI in asymptomatic adults. The results of 780 adults (age 41 ± 13 years) who underwent CPET were evaluated. Participants were stratified according to BMI: normal weight (n = 227), overweight (n = 198), and obese class 1 (n = 155), 2 (n = 131), and 3 (n = 69). After cardiovascular risk assessment, the participants underwent CPET on a treadmill ramp protocol. The prevalence of EI was 20, 16, 21, 25, and 21% in the stratified groups respectively, and no significant differences were found. Predictors of EI were physical inactivity, age, and smoking. The prevalence of EI in asymptomatic adults is considerable, regardless of BMI. The obesity-related reduction in cardiorespiratory fitness seems to be as clinically relevant as in non-obese counterparts.

C-Reactive Protein and N-Terminal Pro-brain Natriuretic Peptide Levels Correlate With Impaired Cardiorespiratory Fitness in Patients With Heart Failure Across a Wide Range of Ejection Fraction.

Background: Impaired cardiorespiratory fitness (CRF) is a hallmark of heart failure (HF). Serum levels of C-reactive protein (CRP), a systemic inflammatory marker, and of N-terminal pro-brain natriuretic peptide (NT-proBNP), a biomarker of myocardial strain, independently predict adverse outcomes in HF patients. Whether CRP and/or NT-proBNP also predict the degree of CRF impairment in HF patients across a wide range of ejection fraction is not yet established.Methods: Using retrospective analysis, 200 patients with symptomatic HF who completed one or more treadmill cardiopulmonary exercise tests (CPX) using a symptom-limited ramp protocol and had paired measurements of serum high-sensitivity CRP and NT-proBNP on the same day were evaluated. Univariate and multivariate correlations were evaluated with linear regression after logarithmic transformation of CRP (log10) and NT-proBNP (logN).Results: Mean age of patients was 57 ± 10 years and 55% were male. Median CRP levels were 3.7 [1.5–9.0] mg/L, and NT-proBNP levels were 377 [106–1,464] pg/ml, respectively. Mean peak oxygen consumption (peak VO2) was 16 ± 4 mlO2•kg−1•min−1. CRP levels significantly correlated with peakVO2 in all patients (R = −0.350, p < 0.001) and also separately in the subgroup of patients with reduced left ventricular ejection fraction (LVEF) (HFrEF, N = 109) (R = −0.282, p < 0.001) and in those with preserved EF (HFpEF, N = 57) (R = −0.459, p < 0.001). NT-proBNP levels also significantly correlated with peak VO2 in all patients (R = −0.330, p < 0.001) and separately in patients with HFrEF (R = −0.342, p < 0.001) and HFpEF (R = −0.275, p = 0.032). CRP and NT-proBNP did not correlate with each other (R = 0.05, p = 0.426), but independently predicted peak VO2 (R = 0.421, p < 0.001 and p < 0.001, respectively).Conclusions: Biomarkers of inflammation and myocardial strain independently predict peak VO2 in HF patients. Anti-inflammatory therapies and therapies alleviating myocardial strain may independently improve CRF in HF patients across a large spectrum of LVEF.

Modifiable Cardiovascular Risk Factors in Adults with Sickle Cell Disease

Introduction:Body composition, cardiorespiratory fitness (CRF) and muscular strength(MusS) are important predictors of cardiovascular (CV) mortality and morbidity. Poor CRF, body composition and MusS are each associated with higher rates of musculoskeletal injury, inflammation, heart disease, and all-cause mortality. Fortunately, these parameters in the general population, are partly influenced by lifestyle habits and can improve with modifying unhealthy behaviors such as increasing activity levels. Few studies have examined fitness parameters, in particularly MusS, in adults with sickle cell disease (SCD). As cardiopulmonary disease is a leading cause of death in SCD, we sought to better characterize fitness and body composition in adults with SCD. The objective of this study is to describe modifiable CV risk factors of fitness along with other risk factors of smoking, hypertension, and cholesterol in a population of adults with SCD.Methods:Forty-six participants (ages 21-66 yrs.; 74% female; sickle cell anemia n =29, sickle variant genotype n=17) were recruited from a comprehensive adult sickle center. Non-pregnant adults in steady-state SCD disease without an absolute contraindications to exercise were eligible to participate. CRF was measured using symptom-limited exercise testing performed on a cycle ergometer following an incremental ramp protocol. Maximal oxygen uptake (VO2 max), a key measure of CRF, was calculated during exercise testing. MusS was assessed using an isokinetic dynamometer, the Biodex system 3, the gold standard to measure MusS in rehabilitative medicine. Peak isokinetic torques of knee extension and flexion were determined at 60 degrees per second, and adjusted for body weight on the Biodex system 3. A medical history, fitness assessments, anthropometric testing, and laboratory testing were completed on all SCD participants. Sixteen SCD participants had dual energy x-ray absorptiometry imaging to assess fat, lean, and bone mass. The remaining 30 SCD patients underwent isokinetic CRF and MusS testing. Lean muscle mass and body fat of participants were compared to US national guidelines, VO2max was compared to predicted norms. As there are no well-established normative values for MusS, we compared values to a cohort of 60 adults without SCD (age 21-40 yrs.; 63% female) who underwent MusS testing as a part of a separate study. For muscle strength, multivariate regression was performed to control for the effects of age, BMI, gender, and SCD status on peak torques.Results:All SCD and control participants were able to complete testing safely without any adverse events. 34.7% of SCD participants (n=16) had a smoking history with a mean pack year history of 9 years (Table 1). 18% of participants (n=10) received medical treatment for hypertension (Table 1). 64% (n=32) of participants had reduced HDL levels and 8% (n=3) had elevated triglycerides. Median (IQR) waist-hip circumference (F=0.89(0.14), M=0.93 (0.11)) and total percent body fat (F=37.7(11.5), M=22.3(11.5)) for SCD participants were higher than national normative values and 66% were classified as obese (Table 1). SCD participants had reduced mean (SD) VO2max, 16.77 (3.29) and 19.56 (7.27) ml/min/kg for females and males respectively compared with norms. In 90% of SCD participants (n=28), percent-predicted VO2max was less than normal (i.e. < 84 percent-predicted) with 4 adults having markedly reduced VO2max with a percent-predicted value less than 50%. Hemoglobin, hydroxyurea use and SCD genotype were not predictive of VO2max. Compared to controls, mean (SD) peak torque values for knee extension (82.7 Nm (19) vs 44.33 Nm (18.85), p<0.0001) and flexion ( 38.6 Nm (9.03)vs 19.19 Nm (13.2), p<0.0001) at 60 degrees were lower in SCD participants even after adjusting for age, sex, and body mass index (BMI) (Table1).Limitations: Study limitations include a small sample size, and the lack of controls matched for race, age, BMI, and hemoglobin.Conclusion:In this pilot study we show that both CRF and MusS are decreased in adults with SCD. Additionally, this cohort had a number of CV risk factors including smoking, hypertension and reduced HDL levels. As we know these are important predictors of poor CV outcomes additional research is needed to determine whether a carefully designed exercise and diet program can improve these modifiable CV risk factors and ultimately health status in adults living with SCD. [Display omitted] DisclosuresWang:PCORI: Research Funding. Lanzkron:Pfizer: Consultancy, Research Funding; NHLBI: Research Funding; Ironwood: Research Funding; PCORI: Research Funding; GBT: Consultancy, Research Funding; Selexys: Research Funding; Prolong: Research Funding.

Endothelial dysfunction and cellular repair in heart failure with preserved ejection fraction: response to a single maximal exercise bout

Endothelial dysfunction and cellular repair in heart failure with preserved ejection fraction: response to a single maximal exercise bout

Physiological Comparisons of Elite Male Visma Ski Classics and National Level Cross-Country Skiers During Uphill Treadmill Roller Skiing.

Longer distance cross-country ski (14–220 km) races such as the Visma Ski Classics (VSC) has recently gained attention in addition to the traditional Olympic distances (5–50 km) associated with cross-country (XC) skiing. These long-distance races are characterized by extensive use of the upper body while double poling (DP). While there is a substantial amount of research on Olympic distance XC skiing, the physiological capacities of VSC skiers has not yet been explored. We recruited seven elite male VSC skiers and seven well-trained national level male XC skiers to undergo three tests in the laboratory: (1) a one repetition maximum (1RM) strength test in a cable pulldown; (2) roller skiing tests on a treadmill (10.5% inclination) for determination of gross efficiency (GE) at submaximal speeds (8 and 10 km·h−1) in DP and diagonal stride (DS); (3) two ramp protocols to exhaustion (15% inclination, starting speed 7 km·h−1) in DP and DS for the assessment of peak and maximal oxygen uptake (O2peak and O2max), respectively. Compared with the national level XC skiers, the VSC skiers performed similar in the 1RM cable pulldown, displayed 12.2% higher GE in DP at 8 km·h−1 but did not display any difference at 10 km·h−1, and had lower blood lactate concentration and heart rate at both submaximal speeds. The VSC skiers had longer time to exhaustion compared with the national level XC skiers during the two ramp protocols in DS (18%) and in DP (29%). The O2max was 10% higher in DS compared with DP, with no differences between the groups. The O2peak/O2max-ratio of 90% did not differ between the two groups. In conclusion, the main differences were lower cardiorespiratory and metabolic responses at submaximal speeds as well as longer time to exhaustion in VSC skiers compared with national level XC skiers. This suggest efficiency to be the main difference between VSC and national level XC skiers.

The Respiratory Compensation Point and the Deoxygenation Break Point Are Valid Surrogates for Critical Power and Maximum Lactate Steady State.

The Respiratory Compensation Point and the Deoxygenation Break Point Are Valid Surrogates for Critical Power and Maximum Lactate Steady State.

Eliciting Higher Maximal and Submaximal Cardiorespiratory Responses During a New Taekwondo-Specific Aerobic Test.

To propose and validate new taekwondo-specific cardiopulmonary exercise tests. Twelve male national-level taekwondo athletes (age 20 [2]y, body mass 67.5 [5.7]kg, height 175 [8]cm, and training experience 7 [3]y) performed 3 separate exercise tests in a randomized counterbalanced order: (1)a treadmill running cardiopulmonary exercise test (CPET) and (2)continuous and (3)interval taekwondo-specific cardiopulmonary exercise tests (cTKDet and iTKDet, respectively). The CPET was administered using an individualized ramp protocol. Taekwondo tests comprised sequences of turning kicks performed on a stationary target. The impacts were recorded via an electronic scoring sensor used in official competition. Stages on the cTKDet and iTKDet lasted 1 min and progressively reduced the kick interval duration. These were guided by a sound signal, starting with 4.6 s between kicks and reducing by 0.4 s every minute until the test ended. Oxygen uptake ([Formula: see text]), heart rate (HR), capillary blood lactate, and ratings of perceived exertion were measured. Modest differences were identified in [Formula: see text] between the tests (F2,22 = 3.54; P = .046; effect size [ES] = 0.16). Maximal HR (HRmax) was higher during both taekwondo tests (F2,22 = 14.3; P = .001; ES = 1.14) compared with CPET. Specific tests also yielded higher responses in the first ventilatory threshold [Formula: see text] (F2,22 = 6.5; P = .04; ES = 0.27) and HR (F2,22 = 12.3; P < .001; ES = 1.06), and HR at the second ventilatory threshold (F2,22 = 5.7; P = .02; ES = 0.72). Taekwondo-specific cardiopulmonary tests enhance the validity of some cardiopulmonary responses and might therefore be considered to optimize routine diagnostic testing and training prescription for this athletic group.

Limited thermal acclimation capacity in cave beetles

Thermal tolerance is a key vulnerability factor for species that cannot cope with changing conditions by behavioural adjustments or dispersal, such as subterranean species. Previous studies of thermal tolerance in cave beetles suggest that these species may have lost some of the thermoregulatory mechanisms common in temperate insects, and appear to have a very limited thermal acclimation ability. However, it might be expected that both thermal tolerance and acclimation ability should be related with the degree of specialization to deep subterranean environments, being more limited in highly specialized species. To test this hypothesis, we use an experimental approach to determine the acclimation capacity of cave beetles within the tribe Leptodirini (family Leiodidae) with different degrees of specialization to the deep subterranean environment. For this, we acclimate groups of individuals at a temperature close to their upper thermal limit (20ºC) or a control temperature (approximately that of the cave in which they were found) for 2 or 10 days (short- vs. long-term acclimation). a temperature close to their upper thermal limit (20ºC) or a control temperature (approximately that of the cave in which they were found) for 2 or 10 days (short- vs. long-term acclimation). Upper thermal limits (heat coma temperature, HC) are then measured for each individual using a ramping protocol (rate of increase of 1ºC/min) combined with infrared thermography and video recording. Preliminary results in a deep subterranean species (Speonomidius crotchi, with an intermediate degree of specialization) showed no significant effect of acclimation temperature in HC at any of the exposure times. Such reduced thermal plasticity could be also expected for other highly specialized subterranean species. The potential implications of these findings for subterranean biodiversity in a climate change context are discussed.

Cardiopulmonary fitness assessment on maximal and submaximal exercise testing in patients with Fabry disease.

The cardiopulmonary exercise test (CPET) is a valuable tool to assess a patient's aerobic fitness and cardiac function, including the response to stress. There have been few studies using CPET to evaluate cardiopulmonary exercise capacity in patients with Fabry disease. We performed a retrospective chart review of patients with Fabry disease from 2001 to 2016, compared to age, gender, and size-matched normal controls. A total of 18 patients were evaluated using the Bruce protocol (treadmill) and 11 patients were evaluated with the ramp protocol (cycle ergometer). The Fabry group demonstrated significantly lower heart rate at peak exercise (151.2 ± 22.5 vs. 178.6 ± 16.2, p < .05), max indexed VO2 (23.7 ± 7 vs. 33.9 ± 8.4, p < .05), and peak index oxygen pulse (12.1 ± 3 vs. 15.2 ± 4.2, p < .05). When the groups were further separated into treadmill or cycle ergometry testing only, there remained statistically significant differences in peak indexed oxygen pulse, heart rate at peak exercise, and max indexed VO2 . There was a statistically significant difference between the Fabry patients evaluated by treadmill testing for systolic blood pressure at peak exercise that was not seen in the cycle ergometry group. Additionally, when looking at the patients who had concurrent cardiac MRI (cMRI) with their CPET, there was a positive correlation with max indexed VO2 and right ventricular end-diastolic volume (r = .55, p = .007) and end-systolic volume (r = .59, p = .007). Patients with Fabry disease have impaired cardiopulmonary exercise capacity as measured by CPET. Additionally, in patients with Fabry disease there is a positive correlation with functional capacity and right ventricular volumes on cMRI.

Influence of Different Treadmill Inclinations on V̇o2max and Ventilatory Thresholds During Maximal Ramp Protocols.

Silva, SC, Monteiro, WD, Cunha, FA, and Farinatti, P. Influence of different treadmill inclinations on V̇o2max and ventilatory thresholds during maximal ramp protocols. J Strength Cond Res 35(1): 233-239, 2021-Ramp protocols for cardiopulmonary exercise testing (CPET) lack precise recommendations, including optimal treadmill inclination. This study investigated the impact of treadmill grades applied in ramp CPETs on maximal oxygen uptake (V̇o2max), ventilatory thresholds (VT1/VT2), and V̇o2 vs. workload relationship. Twenty-one healthy men (age 33 ± 8 years; height 176.6 ± 5.8 cm; body mass 80.4 ± 8.7 kg; and V̇o2max 44.9 ± 5.7 ml·kg-1·min-1) and 12 women (age 29 ± 7 years; height 163.3 ± 6.7 cm; body mass 56.6 ± 6.3 kg; and V̇o2max 39.4 ± 4.9 ml·kg-1·min-1) underwent ramp CPETs with similar speed increments and different treadmill grades: CPET0%, CPET2%, CPET3.5%, and CPET5.5%. The V̇o2max was similar across protocols (42.8-43.2 ml·kg-1·min-1, p = 0.76), albeit duration of CPETs shortened when treadmill inclination increased (CPET0% 12.7 minutes; CPET2% 9.1 minutes; CPET3.5% 8.0 minutes; and CPET5.5% 6.6 minutes; p < 0.01). The %V̇o2max corresponding to VT1 was slightly lower in CPET0% (63.6%) and higher in CPET5.5% (75.8%) vs. CPET2% (67.8%) and CPET3.5% (69.5%; p < 0.05), whereas VT2 was not affected by treadmill inclination (95.1-95.8% V̇o2max; p > 0.05). V̇o2max and ventilatory thresholds were similar in CPETs performed with different treadmill inclinations and similar initial/final speeds. However, linear regressions between workload and V̇o2 were closer to the identity line in CPETs performed with smaller (CPET0% and CPET2%) than with greater (CPET3.5% and CPET5.5%) inclinations. These data suggest that in healthy young adults, ramp CPETs performed with inclinations of 0-2% degree should be preferred over protocols with greater inclinations.