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Recommendations for endurance exercise prescription are often based on percentages of heart rate (HR) or the volume of oxygen consumption (V˙O2) maximum or reserve that is extrapolated to a power output (P) or velocity. Previous work has demonstrated dissociations of the expected responses to exercise anchored to the critical heart rate (CHR) compared with the P associated with CHR. However, it is unclear if similar dissociations due to reductions in P to maintain the designated intensity would be present during exercise anchored to the V˙O2 associated with CHR (V˙O2CHR). The purpose of this study was to examine the patterns in physiological (V˙O2, HR, P, respiration rate [RR], muscle oxygen saturation [%SmO2]), neuromuscular (electromyographic and mechanomyographic amplitude [EMG AMP, MMG AMP], mean power frequency [EMG MPF, MMG MPF]), and perceptual (rating of perceived exertion [RPE]) responses during exercise at V˙O2CHR (V˙O2-clamp). On separate days, ten participants (age: 25 ± 4 yr) performed a graded exercise test and four constant P trials at 85–100% of peak P (PP) to derive CHR and V˙O2CHR. Responses were recorded during a trial to exhaustion at V˙O2CHR (32.86 ± 7.12 mL·kg−1·min−1; TLim = 31.31 ± 21.37 min) and normalized in 10% intervals of TLim to their respective values at PP. The one-way repeated-measures ANOVA with post hoc, Bonferroni-corrected, pairwise comparisons indicated differences (p < 0.001) from baseline for HR (mean ± SD %change = 8 ± 3%), RR (43 ± 38%), P (−15 ± 5%), EMG MPF (10 ± 8%), and RPE (65 ± 38%), but no differences (p = 0.077–0.955) for %SmO2 (−17 ± 53%), EMG AMP (−3 ± 16%), MMG AMP (40 ± 61%), and MMG MPF (1 ± 7%). The loss in performance observed during V˙O2-Clamp exercise may provide a quantification of the inefficiency associated with the V˙O2 slow component phenomenon. The neuromuscular responses suggested constant muscle excitation despite the reductions in P, but the metabolic and perceptual responses suggested a combination of feedforward and feedback mechanisms regulating TLim. Future studies should further examine responses to the V˙O2-Clamp exercise at a uniform threshold.

This study aimed to investigate the test–retest reliability, mean, and individual responses in the measurement of maximal oxygen consumption (V˙O2max) during a cardiopulmonary exercise test (CPET) and the verification phase during cycle ergometry in women. Nine women (22 ± 2 yrs, 166.0 ± 4.5 cm, 58.6 ± 7.7 kg) completed a CPET, passively rested for 5 min, and then completed a verification phase at 90% of peak power output to determine the highest V˙O2 from the CPET (V˙O2CPET) and verification phase (V˙O2verification) on 2 separate days. Analyses included a two-way repeated measures ANOVA, intraclass correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). There was no test (test 1 versus test 2) × method (CPET vs. verification phase) interaction (p = 0.896) and no main effect for method (p = 0.459). However, test 1 (39.2 mL·kg−1·min−1) was significantly higher than test 2 (38.3 mL·kg−1·min−1) (p = 0.043). The V˙O2CPET (ICC = 0.984; CoV = 1.98%; SEM = 0.77 mL·kg−1·min−1; MD = 2.14 mL·kg−1·min−1) and V˙O2verification (ICC = 0.964; CoV = 3.30%; SEM = 1.27 mL·kg−1·min−1; MD = 3.52 mL·kg−1·min−1) demonstrated “excellent” reliability. Two subjects demonstrated a test 1 V˙O2CPET that exceeded the test 2 V˙O2CPET, and one subject demonstrated a test 1 V˙O2verification that exceeded the test 2 V˙O2verification by more than the respective CPET and verification phase MD. One subject demonstrated a V˙O2CPET that exceeded the V˙O2verification, and one subject demonstrated a V˙O2verification that exceeded the V˙O2CPET by more than the MD. These results demonstrate the importance of examining the individual responses in the measurement of the V˙O2max and suggest that the MD may be a useful threshold to quantify real individual changes in V˙O2.

This study investigated the effects of fatiguing unilateral exercise on the ipsilateral, exercised, and contralateral, non-exercised limb’s post-exercise performance in males and females. Ten males and ten females performed a fatiguing, unilateral isometric leg extension at 50% maximal voluntary isometric contraction (MVIC) force. Prior to and immediately after the fatiguing tasks, MVICs were performed for the exercised and non-exercised limb, with surface electromyographic (sEMG) and mechanomyography (sMMG) amplitude (AMP) and mean power frequency (MPF) recorded from each limb’s vastus lateralis. There were no fatigue-induced, sex-dependent, differences in time to task failure (p = 0.265) or ipsilateral performance fatigability (p = 0.437). However, there was a limb by time interaction (p < 0.001) which indicated decreases in MVIC force of the ipsilateral, exercised (p < 0.001), but not the contralateral, non-exercised limb (p = 0.962). There were no sex-dependent, fatigue-induced differences in neurophysiological outcomes between the limbs (p > 0.05), but there was a fatigue-induced difference in sEMG MPF (p = 0.005). To summarize, there were no differences in fatigability between males and females. Moreover, there was insufficient evidence to support the presence of a general crossover effect following submaximal unilateral isometric exercise. However, independent of sex, the neurophysiological outcomes suggested that competing inputs from the nervous system may influence the performance of both limbs following unilateral fatigue.

The study and application of the critical power (CP) concept has spanned many decades. The CP test provides estimates of two distinct parameters, CP and W′, that describe aerobic and anaerobic metabolic capacities, respectively. Various mathematical models have been used to estimate the CP and W′ parameters across exercise modalities. Recently, the CP model has been applied to dynamic constant external resistance (DCER) exercises. The same hyperbolic relationship that has been established across various continuous, whole-body, dynamic movements has also been demonstrated for upper-, lower-, and whole-body DCER exercises. The asymptote of the load versus repetition relationship is defined as the critical load (CL) and the curvature constant is L′. The CL and L′ can be estimated from the same linear and non-linear mathematical models used to derive the CP. The aims of this review are to (1) provide an overview of the CP concept across continuous, dynamic exercise modalities; (2) describe the recent applications of the model to DCER exercise; (3) demonstrate how the mathematical modeling of DCER exercise can be applied to further our understanding of fatigue and individual performance capabilities; and (4) make initial recommendations regarding the methodology for estimating the parameters of the CL test.

Pasquale J Palumbo1, Jonathan M Wert21Department of Endocrinology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA; 2BlueSpark Healthcare Communications, Basking Ridge, NJ, USAAbstract: Type 2 diabetes is associated with increased risk for the development of cardiovascular disease (CVD) secondary to hyperglycemia’s toxicity to blood vessels. The escalating incidence of CVD among patients with type 2 diabetes has prompted research into how lowering glycated hemoglobin (HbA1c) may improve CVD-related morbidity and mortality. Data from recent studies have shown that some patients with type 2 diabetes actually have increased mortality after achieving the lowest possible HbA1c using intensive antidiabetes treatment. Multiple factors, such as baseline HbA1c, duration of diabetes, pancreatic β-cell decline, presence of overweight/obesity, and the pharmacologic durability of antidiabetes medications influence diabetes treatment plans and therapeutic results. Hypertension and dyslipidemia are common comorbidities in patients with type 2 diabetes, which impact the risk of CVD independently of glycemic control. Consideration of all of these risk factors provides the best option for reducing morbidity and mortality in patients with type 2 diabetes. Based on the results of recent trials, the appropriate use of current antidiabetes therapies can optimize glycemic control, but use of intensive glucoselowering therapy will need to be tailored to individual patient needs and risks.Keywords: type 2 diabetes, diabetes treatment, incretin-based therapies, glucose control, HbA1c, cardiovascular disease

Aim: To develop clinical algorithms for the assessment and management of slow progress of labour. Population: Low‐risk singleton, term, pregnant women in labour. Setting: Institutional births in low‐ and middle‐income countries. Search strategy: We systematically reviewed the literature on normal labour progression, and guidance on clinical management of abnormally slow progression from 1 December 2015 to 1 October 2020 from relevant international guidelines, Cochrane reviews and primary research studies in PubMed by searching for international and national guidance documents, electronic databases and published systematic reviews using relevant keywords. Case scenarios: We developed two clinical algorithms: one for abnormally slow labour progression and arrest during first stage and one for the second stage. The algorithms provide definitions of suspected and confirmed slow progress of labour or arrest, initial assessment and ongoing monitoring, differential diagnosis, and management of the abnormalities, as well as links to other algorithms for labour management. Conclusions: Identifying abnormal progress of labour is often challenging. These algorithms may help healthcare providers identify abnormal labour progress and institute prompt management or referral where needed but also reduce misdiagnosis and unnecessary use of interventions to accelerate labour. Evidence‐based clinical algorithms may help and standardize early identification and management of abnormally slow labour progress or arrest. Evidence‐based clinical algorithms may help and standardize early identification and management of abnormally slow labour progress or arrest. [ABSTRACT FROM AUTHOR]

This study examined the responses of force alterations, relative to critical force (CF), neuromuscular parameters, and muscle oxygenation (SmO2) for isometric handgrip holds to failure (HTF) anchored to ratings of perceived exertion (RPE) of 3 and 7. Twelve men completed pre-maximal voluntary isometric contractions (pre-MVIC), submaximal HTF at 4 percentages of pre-MVIC, HTF at RPE = 3 and 7, and post-MVIC. Mechanomyograpic (MMG) signals and SmO2 were recorded during the RPE HTF. Analyses included paired-samples t-tests and repeated-measures ANOVAsatan alpha level of p ≤ 0.05. Time to task failure was not different between RPE 3 (478.7 ± 196.6 s) and RPE 7 (495.8 ± 173.8 s). Performance fatigability (PF) and MMG amplitude (AMP) were greater for RPE 7 (PF: 37.9 ± 12.9%; MMG AMP: 15.7 ± 7.4% MVIC) than RPE 3 (PF: 30.0 ± 14.5%; MMG AMP: 10.2 ± 6.5% MVIC), but MMG mean power frequency (MPF) was greater for RPE 3 (146.2 ± 31.1% MVIC) than RPE 7 (128.8 ± 23.0% MVIC). There were RPE-dependent decreases in force (p ≤ 0.01) across 3 discernable phases during the HTF. There were decreases in MMG AMP across time for both RPEs, but there were no significant changes in MMG MPF or SmO2. There were overall similar motor unit control strategies and local metabolic demand between RPEs. The majority of the HTF performed below CF at RPE 3 and 7 indicated CF did not reflect the highest sustainable force. When prescribing isometric exercise anchored to RPE, practitioners should be aware of the magnitude of force loss and relative intensity of the task to be sure desired training loads are met. [ABSTRACT FROM AUTHOR]

To determine the effects of blood flow restriction (BFR) on the mean firing rate (MFR) and motor unit action potential amplitude (MUAPAMP) VS. recruitment threshold (RT) relationships during fatiguing isometric elbow flexions. Ten men (24.5 ± 4.0 years) performed isometric trapezoidal contractions at 50% maximum voluntary contraction to task failure with or without BFR, on 2 separate days. For BFR, a cuff was inflated to 60% of the pressure required for full brachial artery occlusion at rest. During both visits, surface electromyography was recorded from the biceps brachii of the dominant limb and the signal was decomposed. A paired-samples t test was used to determine the number of repetitions completed between BFR and CON. ANOVAS (repetition [first, last] × condition [BFR, CON]) were used to determine differences in MFR vs. RT and MUAPAMP VS. RT relationships. Subjects completed more repetitions during CON (12 ± 4) than BFR (9 ± 2; p = 0.012). There was no significant interaction (p > 0.05) between the slopes and y-intercepts during the repetition X condition interaction for MUAPAMP VS. MFR. However, there was a main effect of repetition for the slopes of the MUAPAMP VS. RT (p = 0.041) but not the y-intercept (p = 0.964). Post hoc analysis (collapsed across condition) indicated that the slopes of the MUAPAMP VS. RT during the first repetition was less than the last repetition (first: 0.022 ± 0.003 mv/%MVC; last: 0.028 ± 0.004 mv/%MVC; p = 0.041). Blood flow restriction resulted in the same amount of higher threshold MU recruitment in approximately 75% of the repetitions. Furthermore, there was no change in MFR for either condition, even when taken to task failure. Thus, BFR training may create similar MU responses with less total work completed than training without BFR. [ABSTRACT FROM AUTHOR]

Recommendations for endurance exercise prescription are often based on percentages of heart rate (HR) or the volume of oxygen consumption ( V ˙ O2) maximum or reserve that is extrapolated to a power output (P) or velocity. Previous work has demonstrated dissociations of the expected responses to exercise anchored to the critical heart rate (CHR) compared with the P associated with CHR. However, it is unclear if similar dissociations due to reductions in P to maintain the designated intensity would be present during exercise anchored to the V ˙ O2 associated with CHR ( V ˙ O2CHR). The purpose of this study was to examine the patterns in physiological ( V ˙ O2, HR, P, respiration rate [RR], muscle oxygen saturation [%SmO2]), neuromuscular (electromyographic and mechanomyographic amplitude [EMG AMP, MMG AMP], mean power frequency [EMG MPF, MMG MPF]), and perceptual (rating of perceived exertion [RPE]) responses during exercise at V ˙ O2CHR ( V ˙ O2-clamp). On separate days, ten participants (age: 25 ± 4 yr) performed a graded exercise test and four constant P trials at 85–100% of peak P (PP) to derive CHR and V ˙ O2CHR. Responses were recorded during a trial to exhaustion at V ˙ O2CHR (32.86 ± 7.12 mL·kg−1·min−1; TLim = 31.31 ± 21.37 min) and normalized in 10% intervals of TLim to their respective values at PP. The one-way repeated-measures ANOVA with post hoc, Bonferroni-corrected, pairwise comparisons indicated differences (p < 0.001) from baseline for HR (mean ± SD %change = 8 ± 3%), RR (43 ± 38%), P (−15 ± 5%), EMG MPF (10 ± 8%), and RPE (65 ± 38%), but no differences (p = 0.077–0.955) for %SmO2 (−17 ± 53%), EMG AMP (−3 ± 16%), MMG AMP (40 ± 61%), and MMG MPF (1 ± 7%). The loss in performance observed during V ˙ O2-Clamp exercise may provide a quantification of the inefficiency associated with the V ˙ O2 slow component phenomenon. The neuromuscular responses suggested constant muscle excitation despite the reductions in P, but the metabolic and perceptual responses suggested a combination of feedforward and feedback mechanisms regulating TLim. Future studies should further examine responses to the V ˙ O2-Clamp exercise at a uniform threshold. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the test–retest reliability, mean, and individual responses in the measurement of maximal oxygen consumption ( V ˙ O2max) during a cardiopulmonary exercise test (CPET) and the verification phase during cycle ergometry in women. Nine women (22 ± 2 yrs, 166.0 ± 4.5 cm, 58.6 ± 7.7 kg) completed a CPET, passively rested for 5 min, and then completed a verification phase at 90% of peak power output to determine the highest V ˙ O2 from the CPET ( V ˙ O2CPET) and verification phase ( V ˙ O2verification) on 2 separate days. Analyses included a two-way repeated measures ANOVA, intraclass correlation coefficients (ICC2,1), standard errors of the measurement (SEM), minimal differences (MD), and coefficients of variation (CoV). There was no test (test 1 versus test 2) × method (CPET vs. verification phase) interaction (p = 0.896) and no main effect for method (p = 0.459). However, test 1 (39.2 mL·kg−1·min−1) was significantly higher than test 2 (38.3 mL·kg−1·min−1) (p = 0.043). The V ˙ O2CPET (ICC = 0.984; CoV = 1.98%; SEM = 0.77 mL·kg−1·min−1; MD = 2.14 mL·kg−1·min−1) and V ˙ O2verification (ICC = 0.964; CoV = 3.30%; SEM = 1.27 mL·kg−1·min−1; MD = 3.52 mL·kg−1·min−1) demonstrated "excellent" reliability. Two subjects demonstrated a test 1 V ˙ O2CPET that exceeded the test 2 V ˙ O2CPET, and one subject demonstrated a test 1 V ˙ O2verification that exceeded the test 2 V ˙ O2verification by more than the respective CPET and verification phase MD. One subject demonstrated a V ˙ O2CPET that exceeded the V ˙ O2verification, and one subject demonstrated a V ˙ O2verification that exceeded the V ˙ O2CPET by more than the MD. These results demonstrate the importance of examining the individual responses in the measurement of the V ˙ O2max and suggest that the MD may be a useful threshold to quantify real individual changes in V ˙ O2. [ABSTRACT FROM AUTHOR]