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Mobilization of circulating endothelial progenitor cells (EPCs) is increased after acute exercise and training. This study aims to evaluate whether, in a low performance population, EPC levels may be related to exercise capacity in steady state conditions. Study population consisted of sixteen hemodialysis patients. The distance walked in the 6-minute walking test (6 MWD) and the maximal speed attained in an incremental treadmill test were used to assess the exercise capacity. Physical functioning was measured by the scale on the SF36 questionnaire. Quantification of peripheral blood CD34(+) cells and enumeration of EPCs, assessed as CD34(+) cells coexpressing AC 133 and vascular endothelial growth factor receptor-2, were performed. Hemoglobin concentration, white blood cells, high-sensitivity C-reactive protein, total cholesterol, and triglycerides were measured. Statistical analysis examined the relationship between blood progenitors cells versus performance parameters, laboratory parameters, age, body mass index, hemodialysis duration, and erythropoietin therapy. Univariate analysis revealed a significant association between percentage values of EPC and performance parameters only: 6 MWD (r=0.720; p=0.0017), maximal treadmill speed (r=0.721; p=0.0016), and physical functioning score (r=0.506; p=0.0453). A similar statistical association between EPC absolute values and performance parameters was found. No correlation between CD34 (+) and any parameter under study was observed. Multivariate analysis indicated 6 MWD as the most significant independent factor associated with EPC level. EPC percentage value was significantly lower (p=0.0087) in the worse (6 MWD < 300 m, n=8) than in the better performing group (6 MWD > 300 m, n=8). In a group of renal patients, mobilization of EPCs was related to the degree of exercise capacity, suggesting a possible connection with the cardiovascular risk in low performance populations limited by chronic diseases.

The repeatability of the the speed/heart rate (S/HR) relationship obtained with the incremental test developed by Conconi et al. (5) was examined by having 75 subjects perform the same running test twice in the course of a few days. From the data obtained, comparisons were made of four variables: 1) speed of deflection, 2) heart rate of deflection, 3) slope, and 4) intercept on the y-axis of the linear portion of the S/HR relationship. Straight-line equations, correlation coefficients (r), and technical errors of measurement (TEM) were obtained by comparing data from the two successive tests. Data analysis suggests that in two successive tests there are some variations in the linear portion of the S/HR relationship. However, the straight lines obtained from the two tests converge at the same deflection point. The problem of assigning a single value to the point of deflection, when determined by means of visual analysis of the S/HR graph, was also examined. For this part of the study, speed and heart rate data previously obtained for 65 subjects were used. The selected tests had been carried out during the course of various studies. The 65 sets of test data were plotted on graph paper and given to six observers for independent evaluation of speed and heart rate of deflection. These observers had different levels of experience in interpreting Conconi test results. The speed and heart rate of deflection values assigned by each observer were compared to the values obtained through mathematical analysis of the tests by computer. Straight-line equations, correlation coefficients (r), and technical errors of measurement (TEM) obtained by comparing visually determined data to those determined through mathematical analysis were calculated for each observer. Only for observers with little experience were some differences found between the observer-assigned and computer-determined results; these differences occurred for both speed and heart rate of deflection. We conclude that visual analysis provides information that is very similar to that obtained through computer analysis. The accuracy of the visually obtained information varies according to the observer's experience.

The protocol for the determination of the speed/heart rate relationship during incremental exercise previously described (so-called Conconi test) has been refined and in part modified during 12 years of application. The new protocol calls for time-based increments in exercise intensity that are uniform up to submaximal speeds and progressively greater in the final phase. As in the original article (18), the speed/heart rate relationship is linear at low to moderate speed and curvilinear from submaximal to maximal speeds. A method is presented for the mathematical definition of this relationship, with the calculation of the straight-line equation of the linear phase and the identification of the point of transition from the linear to the curvilinear phase (deflection point or heart rate break-point). Analysis of 300 tests selected at random from those in our data base (more than 5,000 tests) has enabled us to show that the speed at which the deflection point occurs is significantly lower (p < 0.001) than that at which the acceleration of the final phase begins. This fact demonstrates that the break-point is not brought on by the final acceleration called for in the test protocol. Analysis of the speed/heart rate relationship allows for the determination of the following additional functional indices: 1) maximal heart rate (in 21 athletes the maximal heart rate attained in the test and that attained while racing were equal); 2) range of heart beats defining the linear part of the speed/heart rate relationship; 3) range of heart beats from the deflection point to maximal heart rate; and 4) maximal aerobic exercise intensity, obtained through extrapolation of the straight-line equation to maximal heart rate. Data are provided on the conditions of the test subject that modify his speed/heart rate relationship, such as incomplete recovery from previous efforts, inadequate warm-up, or inadequate test procedure with too rapid increments in exercise intensity. Finally, criteria for test acceptability are presented.

A field test for the determination of anaerobic threshold (AT) based on the relationship between work intensity and heart rate was previously developed in adult runners (4) and then applied in various sports activities (3, 5, 9). In the current study the same relationship between running speed (S) and heart rate (HR) was determined in 274 healthy children and adolescents (169 males and 105 females). All tests were performed either outdoors on a 400-m track (n = 159, 110 males and 49 females) or indoors in a gymnasium (n = 115, 59 males and 56 females). The subjects increased their work intensity progressively from low to submaximal speeds. HR was determined by a heart rate monitor (Sport Tester TM PE 3000, Polar Electro, Kempele, Finland). In every subject examined, the linearity of the S-HR relationship was lost at a speed, called deflection speed (Sd), above which the increase in S exceeded the increase in HR. HR at Sd was defined as HRd. The respective test-retest correlation coefficients for Sd, HRd, and slope of the linear part of the graph were 0.990, 0.824, and 0.953 when determined outdoors and 0.996, 0.840, and 0.932 when determined indoors. The outdoor-indoor correlation coefficients were 0.934, 0.855, and 0.282, respectively, for Sd, HRd, and slope. The results suggest that application of this test to children and adolescents in running may prove useful in cross-sectional and longitudinal studies of the development of aerobic power during growth.

Serum erythropoietin (Epo) activity, hemoglobin (Hb), and hematocrit (Ht) were determined in 21 cross-country skiers during the training season. The Epo levels were not significantly reduced in the skiers relative to the normal population (P less than 0.01 and P less than 0.001, respectively). In 11 athletes Epo, Ht, urinary gamma-glutamyltransferase, N-acetyl-beta-glucosaminidase, and microalbuminuria were determined before and after a 50-km ski race at 1600 m above sea level. A significant increase of these variables (except for Ht) was found after the competition (P less than 0.001). It is concluded that while the reductions in Hb and Ht, which are typical of several endurance exercises, are not accompanied by a renal hypoxia sufficient to stimulate Epo overproduction, the renal hypoxia reached during the strenuous exercise of the race at altitude may be effective in determining blood increases in Epo.

The relationship between swimming velocity (V) and heart rate (HR) was determined in 60 swimmers. The athletes were asked to increase their work intensity progressively, from low to submaximal velocities; HRs were determined by a telemetric cardiofrequency meter. In all the athletes examined and for each style employed, the linearity of the V3-HR relationship was maintained up to a submaximal velocity (deflection velocity, Vd), beyond which the increase in work intensity exceeded the increase in HR. The test-retest correlation for Vd determined in nine pent-athletes was 0.99. Vd and anaerobic threshold (AT), determined through lactate measurements, were correlated in six swimmers (r = 0.84). Vd and average swimming velocities in a modern pentathlon swimming race (300 m free-style) were also correlated (n = 9, r = 0.91), thus suggesting that AT is critical in determining the speed in middle-distance swimming events.

In vivo 31P NMR spectroscopy was used to determine the ratios of creatine phosphate (PCr) to adenosine triphosphate (ATP) and inorganic phosphate (Pi) in leg and arm muscles of four sprinters, one marathon runner, and two sedentary subjects. Both ratios were definitely higher in the sprinters indicating that, since muscle ATP and Pi concentrations are constant, the PCr muscle content of these athletes is higher than usual. Sprinters are known to have higher percentages of fast-twitch fibers, which are richer in PCr than slow-twitch fibers. It is concluded that measurements of muscle ATP, PCr, and Pi through in vivo NMR spectroscopy could be used to determine muscle fiber composition.

A field test for the evaluation of the speed generated by the anaerobic lactacid mechanism has been developed in runners. The test consists of 1200 m of continuous running: in the first 1000 m the speed corresponding to the anaerobic threshold is progressively reached; in the last 200 m an all-out sprint is performed. The speed at the anaerobic threshold is subtracted from the speed reached in the final 200-m all-out sprint. In 39 runners examined (marathon runners, n = 13; 5000-10000-m runners, n = 10; 400-800-m runners, n = 7; sprinters, n = 9), the additional speed generated above the anaerobic threshold was correlated with the venous blood lactate concentration reached 5 min after the all-out effort (r = 0.93). The anaerobic speeds measured by the test were in keeping with the characteristics of the runners under study, i.e., anaerobic speeds were highest for the sprinters, intermediate for the middle-distance runners, and lowest for the marathon runners. Since the speed generated above the anaerobic threshold by the aerobic fuel breakdown can be subtracted, the contribution of creatine phosphate is minimal, and the speed exceeding the anaerobic threshold is highly correlated with lactate accumulation, the present test should measure the speed generated by anaerobic glycolysis.

Hematological variables of 40 professional cyclists, all receiving intravenous iron supplementation, were followed during a 15-month period. Mean values for red blood cells (RBC), hemoglobin (Hb), and hematocrit (Ht) were significantly lower during the racing season (RS) than during the nonracing periods (NRP) (RBC: RS = 4.53 +/- 0.34 millions/mm3, NRP = 5.09 +/- 0.36 millions/mm3; line 7 of abstract: Hb: RS = 14.2 +/- 0.9 g/dl, MRS = 15.2 +/- 0.9 g/dl; Ht: RS = 40.7 +/- 2.7% NRP = 44.4 +/- 2.9%; P less than 0.001 for all). However, mean values for ferritin and mean corpuscular hemoglobin (MCH) were significantly higher during the racing season (ferritin: RS = 422 +/- 398 ng/ml, NRP = 311 +/- 321 ng/ml, P less than 0.05; MCH: RS = 31.5 +/- 1.3 pg, NRP = 30.0 +/- 1.4 pg; P less than 0.001). These results suggest that the reductions in RBC, Hb, and Ht found in professional cyclists during the racing season are not the consequence of a diminution of iron stores but rather of reduced erythropoiesis and increased RBC destruction.

Red blood cell indices, serum iron, and serum ferritin concentration were determined in 45 marathon runners, 56 ultramarathon runners, and 32 healthy sedentary controls. A significant reduction of hemoglobin concentration, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, serum iron, and serum ferritin were found in marathon runners compared to control subjects. The same variables were also reduced, but to a lesser extent, in the less trained ultramarathon runners. The decreased hemoglobin concentration demonstrated in the runners examined is related to both a reduced mean corpuscular hemoglobin concentration and a reduced hematocrit and may depend on a reduction of the body iron stores.

Serum testosterone concentration was determined before and after physical activities of different duration. The subjects under study were: (1) 7 competitive walkers before and after a 20-km race (average race time 1 h 30 min); (2) 9 middle-distance runners before and after 1-h training; (3) 16 marathon runners before and after a marathon run (average running time 2 h 33 min); (4) 30 ultramarathon runners before and after a 107-km race (average running time 14 h). Serum testosterone increased by 51.8% (NS) in competitive walkers, by 38.2% (P less than 0.05) in middle-distance runners, and by 44.9% (P less than 0.01) in marathon runners; it decreased by 31.9% (P less than 0.001) in the ultramarathon runners. These findings, and similar variations of serum testosterone observed in an ultramarathon runner during a 6-h training session, suggest that serum testosterone increases during physical activities lasting up to 3 h and decreases to or even below the pre-exercise values for longer physical efforts. The possible mechanisms responsible for these differences are discussed.

The effect of a low-dose treatment (10 mg/day) of stanozolol on the anaerobic threshold (AT) and on maximal velocity (Vmax) was studied in ten well-trained runners in a 6-week trial experiment. The serum levels of testosterone (T), interstitial cell-stimulating hormone (ICSH), and of follicle-stimulating hormone (FSH) were determined before, during, and after the steroid administration. No improvements of AT and Vmax were found. No improvement of the competition running times was observed during the experimental period. The ICSH and FSH serum concentrations did not change significantly, while a marked decrease of the T serum concentration was observed. It is concluded that a low-dose treatment of stanozolol, sufficient to depress the testicular function, does not improve athletic performance.