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Background and purpose. Exercise therapy is an integral component of cardiac rehabilitation (CR). Currently, land-based exercise classes are prescribed in Phase IV CR. However, with its unique properties, water-based exercise potentially offers an alternative, or additional mode of exercise, that could be utilized by rehabilitating individuals. The purpose of this pilot study was to measure and compare the heart rate (HR) response and perception of exercise intensity between similar land-and water-based classes.

Rationale: Following prolonged endurance events such as marathons, elevated levels of cardiospecific biomarkers are commonly reported. Although transiently raised levels are generally not considered to indicate clinical myocardial damage, comprehension of this phenomenon remains incomplete. The popularity of high-intensity interval training highlights a paucity of research measuring cardiac biomarker response to this type of exercise. This a posteriori case report discusses the elevation of cardiac troponins (cTn) associated with short interval, high-intensity exercise. Patient concerns: In this case report, an apparently healthy 29-year-old recreationally active female presented clinically raised cardiac troponin I (cTnI) levels (>0.04 ng/mL), after performing high-intensity cycle ergometer sprints. As creatine kinase (CK) is expressed by multiple organs (e.g., skeletal muscle, brain, and myocardium), cTnI assays were performed to determine any changes in total serum CK levels not originating from skeletal muscle damage. Diagnosis: A posteriori the individual's daily energy expenditure indicated chronically low-energy availability. Psychometric testing suggested that the individual scored positive for disordered eating, highly for fatigue levels, and low in mental health components. Outcomes: The current case report provides novel evidence of elevated cTnI occurring as a result of performing short duration, high intensity, cycle ergometer exercise in an individual with self-reported chronically depleted energy balance. A schematic to identify potentially “at risk” individuals is presented. Lessons: Considering this as a case report, results cannot be generalized; however, the main findings suggest that individuals who habitually restrict their calorie intake below their bodies’ daily energy requirements, may have elevated biomarkers of exercise induced myocardial stress from performing high-intensity exercise.

We developed a standardized laboratory treadmill protocol for assessing physiological responses to a simulated backpack load-carriage task in trained soldiers, and assessed the efficacy of blood lactate thresholds (LTs) and economy in predicting future backpack running success over an 8-mile course in field conditions. LTs and corresponding physiological responses were determined in 17 elite British soldiers who completed an incremental treadmill walk/run protocol to exhaustion carrying 20 kg backpack load. Treadmill velocity at the breakpoint (r = −0.85) and Δ 1 mmol l−1 (r = −0.80)LTs, and relative VO2 at 4 mmol l−1 (r = 0.76) and treadmill walk/run velocities of 6.4 (r = 0.76), 7.4 (r = 0.80), 11.4 (r = 0.66) and 12.4 (r = 0.65) km h−1 were significantly associated with field test completion time. We report for the first time that LTs and backpack walk/run economy are major determinants of backpack load-carriage performance in trained soldiers.

The appearance of creatine kinase (CK) in blood has been generally considered to be an indirect marker of muscle damage, particularly for diagnosis of medical conditions such as myocardial infarction, muscular dystrophy, and cerebral diseases. However, there is controversy in the literature concerning its validity in reflecting muscle damage as a consequence of level and intensity of physical exercise. Nonmodifiable factors, for example, ethnicity, age, and gender, can also affect enzyme tissue activity and subsequent CK serum levels. The extent of effect suggests that acceptable upper limits of normal CK levels may need to be reset to recognise the impact of these factors. There is a need for standardisation of protocols and stronger guidelines which would facilitate greater scientific integrity. The purpose of this paper is to examine current evidence and opinion relating to the release of CK from skeletal muscle in response to physical activity and examine if elevated concentrations are a health concern.

Identifying field measures to estimate backpack load-carriage work intensity in elite soldiers is of interest to the military. This study developed rating of perceived exertion (RPE) and heart rate models to define metabolic workload for a backpack load-carriage task valid for a population of elite soldiers using serial data. Male soldiers (n = 18) from the British Parachute or Special Air Service Regiment completed an incremental treadmill walking and (or) running protocol while carrying a 20-kg backpack. Heart rate, RPE, and oxygen uptake were recorded at each incremental stage of the protocol. Linear mixed models were used to model the RPE and heart rate data in the metric of measured peak oxygen uptake. Workload was accurately estimated using RPE alone (SE = 6.03), percentage of estimated maximum heart rate (%E-MHR) (SE = 6.9), and percentage of measured maximum heart rate (%M-MHR) (SE = 4.9). Combining RPE and %E-MHR resulted in a field measure with an accuracy (SE = 4.9) equivalent to the %M-MHR model. We conclude that RPE, %E-MHR, and %M-MHR provide accurate field-based proxy measures of metabolic workload in elite British soldiers performing a backpack load-carriage task. The model is accurate for the metabolic range measured by these serial data for the backpack load-carriage task.