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Purpose: This study had 2 objectives: (1) to examine whether the validity of the supramaximal verification test for maximal oxygen uptake ( V ˙ O 2 max) differs in children and adolescents when stratified for sex, body mass, and cardiorespiratory fitness and (2) to assess sensitivity and specificity of primary and secondary objective criteria from the incremental test to verify V ˙ O 2 max. Methods: In total, 128 children and adolescents (76 male and 52 females; age: 9.3–17.4 y) performed a ramp-incremental test to exhaustion on a cycle ergometer followed by a supramaximal test to verify V ˙ O 2 max. Results: Supramaximal tests verified V ˙ O 2 max in 88% of participants. Group incremental test peak V ˙ O 2 was greater than the supramaximal test (2.27 [0.65] L·min−1 and 2.17 [0.63] L·min−1; P <.001), although both were correlated (r =.94; P <.001). No differences were found in V ˙ O 2 plateau attainment or supramaximal test verification between sex, body mass, or cardiorespiratory fitness groups (all Ps >.18). Supramaximal test time to exhaustion predicted supramaximal test V ˙ O 2 max verification (P =.04). Primary and secondary objective criteria had insufficient sensitivity (7.1%–24.1%) and specificity (50%–100%) to verify V ˙ O 2 max. Conclusion: The utility of supramaximal testing to verify V ˙ O 2 max is not affected by sex, body mass, or cardiorespiratory fitness status. Supramaximal testing should replace secondary objective criteria to verify V ˙ O 2 max. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the kinetic response of middle cerebral artery blood velocity (MCAv) to moderate- and heavy-intensity cycling in adults, and explore the relationship between maximal oxygen uptake (V_ O2max) and MCAv kinetics. Seventeen healthy adults (23.8 ± 2.4 yr, 9 females) completed a ramp incremental test to exhaustion on a cycle ergometer to determine V_ O2max and the gas exchange threshold (GET). Across six separate visits, participants completed three 6-min transitions at a moderate intensity (90% GET) and three at a heavy intensity (40% of the difference between GET and V_ O2max). Bilateral MCAv was measured using transcranial Doppler (TCD) ultrasonography and analyzed using a monoexponential model with a time delay. The time constant (s) of the MCAv response was not different between moderate- and heavy-intensity cycling (25 ± 10 vs. 26 ± 8 s, P = 0.82), as was the time delay (29 ± 11 vs. 29 ± 10 s, P = 0.95). The amplitude of the exponential increase in MCAv from baseline was greater during heavy-intensity cycling (23.9 ± 10.0 cm·s-1, 34.1 ± 14.4%) compared with moderate-intensity cycling (12.7 ± 4.4 cm·s-1, 18.7 ± 7.5%; P < 0.01). Following the exponential increase, a greater fall in MCAv was observed during heavy-intensity exercise compared with moderate-intensity exercise (9.5 ± 6.9 vs. 2.8 ± 3.8 cm·s-1, P < 0.01). MCAv after 6 min of exercise remained elevated during heavy-intensity exercise compared with moderate-intensity exercise (85.2 ± 9.6 vs. 79.3 ± 7.7 cm·s-1, P < 0.01). V_ O2max was not correlated with MCAv s or amplitude (r = 0.11–0.26, P > 0.05). These data suggest that the intensity of constant-work rate exercise influences the amplitude, but not time-based, response parameters of MCAv in healthy adults, and found no relationship between cardiorespiratory fitness and MCAv kinetics. [ABSTRACT FROM AUTHOR]

New Findings: What is the central question of the study?What is the reliability of middle cerebral artery velocity cerebrovascular reactivity (CVR) when using traditional and novel outcomes, as measured by transcranial Doppler?What is the main finding and its importance?Traditional CVR approaches presented acceptable reproducibility but should be expressed as an absolute CVR. Large within‐ and between‐individual differences in the middle cerebral artery velocity response profile support using a dynamic peak, rather than a set time point, for the most reliable interpretation. The study highlights the utility of novel kinetic CVR outcomes, but due to increased variability in time‐based metrics, this analysis requires larger sample sizes than traditional methods. Cerebrovascular reactivity (CVR) of middle cerebral artery velocity (MCAv) to CO2 is a common method to assess cerebrovascular function. Yet, the approaches used to calculate CVR outcomes vary. The aim of this study was to explore the within‐ and between‐day reliability of traditional CVR outcomes. The second aim was to explore the reliability of novel kinetic‐based analyses. Healthy adults (n = 10, 22.3 ± 3.4 years) completed assessments of CVR over 4 min using a fixed fraction of inspired CO2 (6%). This was repeated across four separate visits (between‐day), and on one visit measures were repeated 2.5 h later (within‐day). No mean biases were present between assessments for traditional CVR metrics, expressed as absolute (cm/s/mmHg) or relative (%/mmHg) outcomes (minute 3, minute 4, peak 1 s, peak 30 s) (between‐day: P > 0.14, ηp2 < 0.20; within‐day: P > 0.22, d > 0.27). Absolute, rather than relative, CVR yielded the most reproducible parameters (coefficient of variation: 8.1–13.2% vs. 14–83%, respectively). There were significant differences between CVR outcomes (P < 0.001, ηp2 > 0.89) dependent on the time point used to determine CVR, as a steady state MCAv response was rarely observed. Furthermore, the MCAv response was not reproducible within an individual (κ = 0.15, P = 0.09). No mean differences were present for novel kinetic outcomes (amplitude, time‐delay, time constant) (between‐day: P > 0.05, d < 0.33; within‐day: P > 0.38, d < 0.25). The results support the need for standardisation and indicate CVR should be defined as a dynamic peak, rather than a set time point for increased reliability. For novel kinetic outcomes variability was greater (CV: 8.7–120.9%) due to the nature of time‐based metrics. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction of the internal carotid artery (ICA) is a risk factor for cerebrovascular diseases (such as stroke, dementia and Alzheimer's disease), but whether brachial FMD is associated with cerebral endothelium-dependent vasodilation is unknown. These novel findings merit further discussion with respect to: (1) the lack of association between baseline cerebrovascular and peripheral artery shear-mediated function and (2) the lack of association between ICA endothelium-dependent function and traditional CVR outcomes. CVR tests are often considered to reflect cerebrovascular endothelial function, but these results indicate that "typical" CVR outcomes (ICA dilation, ICA-CVR and MCA-CVR expressed as %/mmHg) do not reflect shear-mediated ICA function. [Extracted from the article]

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 years), 17 adolescents (12.3±0.4 years) and 20 young adults (23.6±2.4 years). 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-minute 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 (P ET CO 2 ) via a metabolic cart. Data were ensemble-averaged for each participant and analysed using a mono-exponential model. Absolute MCAv was significantly higher throughout exercise in children and adolescents, compared to adults (P<0.001). Children had a significantly lower relative increase in MCAv from baseline (~12%) compared to adolescents (~20%) and adults (~18%, P<0.040). All adolescents and adults had a mono-exponential rise in MCAv and P ET CO 2 , 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 to adults (27±9 s, P<0.001). MCAv τ was positively associated with faster P ET CO 2 τ in adolescents (r=0.70, P=0.002) but not children (r=-0.20, P=0.640).Time- and amplitude-based response parameters of MCAv kinetics were significantly associated with P ET CO 2 kinetics in adults (r=0.50 to 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 P ET CO 2 and MCAv kinetics during exercise.

Purpose: To examine the effect of normobaric hypoxia on pulmonary oxygen uptake (V˙O2) and muscle oxygenation kinetics during incremental and moderate-intensity exercise in children., Methods: Eight prepubertal boys (9-11 y) performed incremental cycle tests to exhaustion in both normoxia and hypoxia (fraction of inspired O2 of 15%) followed by repeat 6-minute transitions of moderate-intensity exercise in each condition over subsequent visits., Results: Maximal oxygen uptake (V˙O2max) was reduced in hypoxia compared with normoxia (1.69 [0.20] vs 1.87 [0.26] L·min-1, P = .028), although the gas exchange threshold was not altered in absolute terms (P = .33) or relative to V˙O2max (P = .78). During moderate-intensity exercise, the phase II V˙O2 time constant (τ) was increased in hypoxia (18 [9] vs 24 [8] s, P = .025), with deoxyhemoglobin τ unchanged (17 [8] vs 16 [6], P ≥ .28)., Conclusions: In prepubertal boys, hypoxia reduced V˙O2max and slowed V˙O2 phase II kinetics during moderate-intensity exercise, despite unchanged deoxyhemoglobin kinetics. These data suggest an oxygen delivery dependence of V˙O2max and moderate-intensity V˙O2 kinetics under conditions of reduced oxygen availability in prepubertal boys.