Limited benefit of Fatmax-test to derive training prescriptions.

The intensity that elicits maximal fat oxidation (Fatmax) is recommended for training fat metabolism. However, it remains unclear whether Fatmax leads to the highest fat oxidation rates during prolonged exercise. It was hypothesized that there are no differences in fat oxidation rates among 3 different exercise intensities. Therefore, fat metabolism was compared among 1-h constant load tests at Fatmax, a higher and a lower intensity. A cohort of 16 male cyclists (28±6 yrs, BMI: 22.5±1.2 kg/m2; n=8 with maximal oxygen uptake [VO2max] of 50-60 ml/min/kg [ET]; n=8 with VO2max>60 ml/min/kg [HET]) completed a maximal incremental cycling test, a submaximal incremental Fatmax-test and, thereafter, three 1-h constant-load tests in randomized order at Fatmax, one exercise stage below (LOW) and one above (HIGH). LOW, Fatmax and HIGH were performed at 52±13, 60±13 and 70±12% VO2max. Heart rate and blood lactate were significantly different (p<0.001). However, the fat oxidation rate showed no difference (p=0.61). This was also true within each subgroup (ET: p=0.69, HET p=0.61). In conclusion, the fat oxidation rate of endurance trained cyclists shows no difference between 1-h constant load exercise bouts at about 50-70% VO2max. The precision and necessity of Fatmax-tests for controlling the training of fat oxidation are therefore debatable.

Differences in adaptations to 1 year of aerobic endurance training: individual patterns of nonresponse.

Lacking responses to endurance training (ET) have been observed for several variables. However, detailed analyses of individuals' responses are scarce. To learn more about the variability of ET adaptations, patterns of response were analyzed for each subject in a 1-year ET study. Eighteen participants [42 ± 5 years, body mass index: 24 ± 3 kg/m(2), maximal oxygen uptake (VO(2max) ): 38 ± 5 mL/min/kg] completed a 1-year jogging/walking program on 3 days/week, 45 min/session at 60% heart rate (HR) reserve. VO(2max), resting HR (rHR), exercise HR (eHR) and individual anaerobic threshold (IAT) were determined by treadmill and cycling ergometry respectively. Intraindividual coefficients of variation were extracted from the literature to distinguish random changes from training responses. Eight participants showed improvements in all variables. In 10 participants, one or two variables did not improve (VO(2max), rHR, eHR and IAT remained unchanged in four, four, three and one cases, respectively). At least one variable improved in each subject. Data indicate that ET adaptations might be detected in each individual using multiple variables of different adaptation levels and intensity domains. Nonresponse seems to occur frequently and might affect all variables. Further studies should investigate whether nonresponders improve with altered training. Furthermore, associations between patterns of nonresponse and health benefits from ET are worth considering.

[Influencing of the PSA concentration in serum by physical exercise (especially bicycle riding)]. / Beeinflussung der PSA-Konzentration im Serum durch körperliche Belastung (insbesondere Fahrradfahren).

BACKGROUND: Sports and in particular cycling are assumed to influence PSA in serum. Controversial scientific results were the motivation to examine the influence of a standardized test on a cycling ergometer and a treadmill on PSA concentrations in elderly men with elevated PSA levels and a benign prostate hyperplasia. MATERIAL AND METHODS: A total of 21 male volunteers (aged 61 ± 5 years, tPSA 7.7 ± 3.0 ng/ml and benign prostate hyperplasia with a prostate volume of 54 ± 18 ml) performed a 1 h cycling test on a cycling ergometer. A subgroup of 15 volunteers also performed a 1 h test on a treadmill. Blood samples were drawn before and several times after the cycling stress test up to 7 days afterwards (up to 120 min after the test on the treadmill) to determine total PSA (tPSA), complexed PSA (cPSA) and free PSA (fPSA). RESULTS: The average increase in tPSA of 1.9 ± 1.7 ng/ml (25%) after the cycling exercise test was significant. After the treadmill exercise the PSA increase was not as high, but with 1.0 ± 1.0 ng/ml (12%) was also significant. On average the levels of PSA returned to the basic level 48 h after the cycling test, but in individual cases it took longer. fPSA showed the most noticeable increase after cycling with 92% on average. There was no correlation between increase in PSA and prostate volume. CONCLUSIONS: Men should abstain from physical exercise, especially from cycling for several days and at least for 24 h before PSA measurements are carried out. This applies to patients with elevated PSA levels (>4 ng/ml) when a PSA follow-up is being carried out.

Effects of one year aerobic endurance training on resting metabolic rate and exercise fat oxidation in previously untrained men and women. Metabolic endurance training adaptations.

Although metabolic training adaptations are considered to be an important aim of recreational endurance exercise, effects of aerobic endurance training on metabolism have hardly been recorded over longer training periods. The aim of the study was therefore to record changes in resting metabolic rate (RMR), substrate oxidation at rest and maximal exercise fat oxidation rate (MFO) after one year of recreational endurance training within the ACSM-recommendations. Seventeen sedentary participants (7 male symbol/10 female symbol, 42+/-5 yr, pre-training characteristics: BMI: 24.6+/-2.2 kg.m (-2), VO(2max): 37.5+/-4.7 ml.min (-1).kg (-1)) completed a 12 months jogging/walking program 3 days/week for 45 min/session at a constant heart rate (HR) prescription of 60% HR-reserve. Resting measurements and maximal incremental treadmill tests were conducted before the training program, after 6 and 12 months of training. Indirect calorimetry was used to assess metabolic parameters. After 12 months of training, body weight remained unchanged ( P=0.16), however, body fat was significantly reduced by 3.4+/-2.1% ( P<0.001). Neither RMR ( P=0.42) nor substrate oxidation at rest ( P=0.25) changed significantly. MFO increased significantly over time by 0.07+/-0.08 g.min (-1) ( P<0.01) and occurred at significantly higher exercise intensities (35+/-6 vs. 44+/-15 vs. 50+/-14%VO(2max), P<0.01). In summary one year of recreational endurance training does therefore not appear to influence RMR or substrate oxidation at rest in previously untrained non-obese participants. In contrast, a constant training stimulus within the ACSM-recommendations elicits sustained improvements in MFO over at least one year of training.

Echocardiography of the right ventricle in athlete's heart and hearts of normal size compared to magnetic resonance imaging: which measurements should be applied in athletes?

Right ventricular (RV) pathologic hypertrophy and cardiomyopathy have been reported to be related to ventricular arrhythmias and sudden cardiac death in athletes. However, it is unclear which echocardiographic measurements reflect RV dimensions in athlete's heart (AH) correctly. We aimed to compare two-dimensional echocardiography of the RV in AH and normal hearts to magnetic resonance imaging (MRI), and derive recommendations for RV echocardiography in athletes. Twenty-three healthy male endurance athletes with AH (A; 28+/-4 yrs) and 26 healthy untrained males (C; 26+/-4 yrs) matched for body-dimensions were examined. In recommended echocardiographic parasternal and 4-chamber views, three enddiastolic RV free wall-thicknesses (T1,T5,T9) and RV diameters were determined (M-mode enddiastolic diameter [RV-EDD]; longitudinal [RV-LAX], sagittal, outflow-tract and tricuspid valve anulus diameters). MRI determined RV enddiastolic volumes (RV-EDV) and masses (RVM) in A and C were: 162+/-29 vs. 136+/-15 ml and 76+/-10 vs. 59+/-13 g (p<0.001). Significant correlations between RV-EDV and RV-EDD (r=0.49; p=0.001) as well as RV-LAX (r=0.38; p=0.01), and RVM and T5 (r=0.52; p=0.01) were found. For RV echocardiography, significant differences between A and C were documented for RV-EDD (medians [quartiles]: A: 26 mm [24/29 mm]; C: 22 mm [21/27 mm]; p=0.04; measurable in 49/49 subjects), and in the parasternal short axis view for T5 (A: 6.0 mm [5.4/7.8 mm]; C: 5.0 mm [4.5/5.2 mm]; p=0.04; measurable in 22/49). In conclusion, two-dimensional echocardiographic RV measurements offer only a limited potential to reflect true RV dimensions. Only RV-EDD may differentiate between normal hearts and exercise related RV adaptations in AH, and is the only recommendable parameter to be measured in athletes routinely. In unclear cases additional methods should be used to examine the RV in athletes.

The reliability of fat.

The exercise intensity eliciting maximal fat oxidation (Fat(max)) is typically determined during an incremental test. Its reproducibility, however, has not been thoroughly investigated so far. To address this issue, 21 healthy subjects (23.5+/-1.7 years; BMI 22.4+/-1.8 kg/m(2); VO(2peak) 47.4+/-11.3 mL/min/kg) carried out two identical cycling tests to determine Fat(max) after an initial incremental baseline test. The duration of each of five stages during the Fat(max) tests was 6 min. The first stage equalled the first increase in blood lactate during the baseline test; the highest stage corresponded to a respiratory exchange ratio of 1.00. Between these intensities the other three stages were distributed evenly. Fat(max) was 28.0+/-8.6 L/min (59.2+/-18.1% VO(2peak)) in the first test and 29.8+/-10.5 L/min (62.9+/-22.2% VO(2peak)) in the second one. There was no significant difference between both Fat(max) determinations [number of stage: P=0.31; total VO(2): P=0.20; VO(2) utilized for fat oxidation (VO(2Fat)): P=0.33]. Linear correlation coefficients between tests were r=0.84 (total VO(2); P<0.001) and r=0.83 (VO(2Fat); P<0.001). However, Bland-Altman plots revealed wide 95% limits of agreement of 0.91 L/min (total VO(2)) and 0.32 L/min (VO(2Fat)). In conclusion, spontaneous intraindividual variability in Fat(max) appears too large to recommend the use of this parameter for the prescription of training intensity.

Recovery training in cyclists: ergometric, hormonal and psychometric findings.

This randomized cross-over study aimed at comparing the recovery effect of 4 days of low-intensity, discipline-specific training of 1 vs 3 h daily. Eleven athletes completed two periods of 13 days intensive cycling training (IT), followed by a recovery period consisting of 4 days of low-intensity cycling for either 1 or 3 h each day. Before IT, after IT and after the recovery period, subjects were tested in the laboratory: venous blood sampling, "profile of mood states" (POMS), graded cycling test and a 30-min time trial (TT). Maximal heart rates and lactate concentrations decreased significantly after IT. Peak power output, maximal heart rates and maximal lactate concentrations changed significantly different during the recovery periods. Whereas these parameters were similar to pre-training values after 1-h daily active recovery, 3-h recovery training (REC) led to further decreases. Power output during TT was neither affected by IT nor by both recovery periods. TT-induced increases in cortisol, adrenocorticotropic hormone and prolactin were reduced only after 3-h REC. Total POMS and subscores fatigue and vigor changed significantly different during the recovery periods, a return to pre-training levels after 1 h active recovery and a further deterioration after 3 h REC. It is concluded that low-intensity training of a 1-h duration each day is more appropriate for recovery after an IT period than 3 h.

Volume vs. intensity in the training of competitive swimmers.

The present study aimed at comparing a high-volume, low-intensity vs. low-volume, high-intensity swim training. In a randomized cross-over design, 10 competitive swimmers performed two different 4-week training periods, each followed by an identical taper week. One training period was characterized by a high-training volume (HVT) whereas high-intensity training was prevalent during the other program (HIT). Before, after two and four weeks and after the taper week subjects performed psychometric and performance testing: profile of mood states (POMS), incremental swimming test (determination of individual anaerobic threshold, IAT), 100 m and 400 m. A small significant increase in IAT was observed after taper periods compared to pre-training (+ 0.01 m/s; p = 0.01). Maximal 100-m and 400-m times were not significantly affected by training. The POMS subscore of "vigor" decreased slightly after both training periods (p = 0.06). None of the investigated parameters showed a significant interaction between test-time and training type (p > 0.13). Nearly all (83 %) subjects swam personal best times during the 3 months after each training cycle. It is concluded that, for a period of 4 weeks, high-training volumes have no advantage compared to high-intensity training of lower volume.

Exercise-induced increases in NT-proBNP are not related to the exercise-induced immune response.

OBJECTIVE: To investigate if the exercise-induced immune response contributes to the exercise-induced increase in brain natriuretic peptide (BNP) in healthy athletes. This has previously been speculated, as elevated concentrations of BNP or N-terminal pro brain natriuretic peptide (NT-proBNP) in cardiovascular patients were found to be related to immune reactions and elevations in inflammatory cytokines such as interleukin 6 (IL-6). METHODS: Stored serum samples were analysed for NT-proBNP concentrations of 14 healthy endurance athletes (mean age: 25 (SD 5) years; VO(2peak) 67 (SD 6) ml/min/kg), who had been examined previously for exercise-induced immune reactions and their dependence on carbohydrate supplementation (6 or 12% carbohydrate vs placebo beverages) after three bouts of 4 h cycling at a given workload of 70% of the individual anaerobic threshold. Venous blood samples were taken before, immediately after, and 1 h and 1 day after exercise. Leucocyte subpopulations were determined immediately after blood sampling by flow cytometry. Serum samples for posterior analysis of C-reactive protein (CRP), IL-6, cortisol and NT-proBNP were stored at -80 degrees C. RESULTS: The exercise-induced increases in NT-proBNP (p<0.001) were not related to the exercise-induced immune response, although exercise induced marked (CHOS-dependent) increases in IL-6, CRP, cortisol, leucocytes, neutrophils, monocytes and natural killer cells. CONCLUSION: It is unlikely that the exercise-induced increases in NT-proBNP or BNP in healthy athletes are caused by the exercise-induced immune response. Therefore, exercise-induced increases in NT-proBNP or BNP in healthy athletes have to be differentiated from increases in cardiovascular patients with systemic inflammation.

Cardiac tissue Doppler in steroid users.

Anabolic steroids cause a variety of side effects, among them a slight concentric left ventricular hypertrophy. The objective of the present study was to clarify if they also induce alterations in left ventricular function. 14 male body builders with substantial intake of anabolic steroids (users) were examined by standard echocardiography and cardiac tissue Doppler imaging. They were compared to 11 steroid-free strength athletes (non-users) and 15 sedentary control subjects. Users showed an increased left ventricular muscle mass index. The ratio of peak transmitral blood flow velocities during early diastolic filling and atrial contraction did not differ between groups (users: 1.4 +/- 0.3; non-users: 1.7 +/- 0.5; controls: 1.4 +/- 0.4). In contrast an analogous tissue Doppler parameter, the ratio of myocardial velocities during early and late ventricular filling in the basal septum, was significantly lower in users (1.2 +/- 0.4) when compared to non-users (1.6 +/- 0.5) or controls (1.6 +/- 0.6). The velocity gradient during myocardial E-wave in the posterior wall showed significantly lower values in users (3.8 +/- 1.3 1/s) as compared to controls (5.8 +/- 2.5 1/s). There were no differences in systolic function. Summarizing strength athletes abusing anabolic steroids show negative alterations in diastolic function.

Effectiveness of low-intensity endurance training.

Recent studies point to the preventive efficacy of low-intensity endurance training in terms of cardiovascular risk factor modification and mortality reduction. In addition, it is frequently recommended as a means of stimulating fat metabolism. It was the intention of this study to clarify if endurance training effectiveness remains unimpaired when exercise intensity is reduced by a certain amount from "moderate" to "low", but total energy expenditure held constant. For this purpose, 39 healthy untrained subjects (44 +/- 7 yrs, 82 +/- 19 kg; 173 +/- 9 cm) were stratified for endurance capacity and sex and randomly assigned to 3 groups: "moderate intensity" (MOD, n = 13, 5 sessions per week, 30 min each, intensity 90 % of the anaerobic threshold [baseline lactate + 1.5 mmol/l]), "low intensity" (LOW, n = 13, 5 sessions per week, intensity 15 bpm below MOD, duration proportionally longer to arrive at the same total energy output as MOD), and control (CO, n = 13, no training). Training was conducted over 12 weeks and each session monitored by means of portable heart rate (HR) recorders. Identical treadmill protocols prior to and after the training program served for exercise prescription and documentation of endurance effects. VO (2max) improved similarly in both training groups (MOD + 1.5 ml x min (-1) x kg (-1); LOW + 1.7 ml x min (-1) x kg (-1); p = 0.97 between groups). Compared with CO (- 1.0 ml x min (-1) x kg (-1)) this effect was significant for LOW (p < 0.01) whereas there was only a tendency for MOD (p = 0.07). However, objective criteria (HR (max), maximal blood lactate) indicated that a different degree of effort was responsible for this finding. In comparison with CO (mean decrease of 3 bpm), average HR during incremental exercise decreased significantly by 9 bpm (MOD, p < 0.05 vs. CO) and 6 bpm (LOW, p = 0.26), respectively. However, there was no significant difference between MOD and LOW (p = 0.60), but for changes in oxygen uptake at the anaerobic threshold (VO (2AT)) it was observed that MOD was significantly more effective than CO (p = 0.048) and LOW (p = 0.04). It is concluded that within a middle-aged population of healthy untrained subjects, endurance training effectiveness might be slightly impaired when the training heart rate is chosen 15 bpm lower as compared to moderate intensity, but the total energy output held equal.

Risk factors for injuries in elite female soccer players.

OBJECTIVE: To describe risk factors for injuries in elite female soccer. METHODS: A total of 143 female soccer players from the German national league participated in the study. Baseline information on player characteristics--for example, anthropometric measurements and playing position--and medical history were recorded at the start of the study. During one outdoor season, injuries and training and match exposure times were prospectively documented for each player. RESULTS: The risk of a new anterior cruciate ligament (ACL) rupture was significantly increased in players with a previous rupture (odds ratio (OR) = 5.24, p = 0.01). This was not the case for ankle sprain (OR = 1.39) or knee sprain (OR = 1.50). In addition, no significantly increased risk of new sprains or ACL ruptures was found when the injured leg was the unit of analysis. Injury incidence was considerably higher in defenders (9.4 injuries per 1000 hours exposure) and strikers (8.4/1000 hours) than goalkeepers (4.8/1000 hours) and midfielders (4.6/1000 hours). Ten per cent of all players (n = 14) sustained more than three injuries. Most of these were defenders (n = 8) or strikers (n = 4). Significantly more injuries occurred to the dominant leg (105 v 71, p = 0.01); this was particularly true for contact injuries (52 v 29, p = 0.01). CONCLUSIONS: Injury risk should be assessed on an individual basis. Therefore it seems appropriate to individualise preventive training programmes, as is recommended for other training content. Evaluating the existing rules of soccer and their appropriate application may also help to decrease injury risk, particularly in contact situations.

Inhaled beta2 agonists and performance in competitive athletes.

OBJECTIVES: To provide an overview of the current literature on the use of inhaled beta2 agonists in non-asthmatic competitive athletes, and to assess the performance enhancing effect of inhaled beta2 agonists. METHODS: Review of the literature. RESULTS: Twenty randomised, placebo controlled studies (19 double blind, one single blind) were located. Only three studies reported a performance enhancing effect of inhaled beta2 agonists. However, methodological shortcomings were most likely responsible for these findings (for example, non-elite athletes, inconsistent results in different tests, subgroups with above-average responsiveness). CONCLUSIONS: This review reveals that there is no ergogenic potential of inhaled beta2 agonists in non-asthmatic athletes. In view of the epidemiology of asthma in athletes and the considerable workload involved in provision of therapeutic use exemptions the inclusion of inhaled beta2 agonists on the list of prohibited substances should be reconsidered.

Characteristics of inline speedskating--incremental tests and effect of drafting.

Competitive inline speedskating combines a movement pattern similar to speedskating on ice with pack-oriented competition modes known from cycling. The deep-seated body position leads to high static load and, thus, restricted blood flow within propulsive muscles. This condition may affect lactate kinetics and limit V.O (2peak). The present study compares physiologic reactions to graded cycling and skating exercise among top-level inline speedskaters and quantifies the effect of drafting. Eight male inline speedskaters of the top national level were examined. The study consisted of two graded exhaustive exercise tests (cycling and speedskating) and a pairwise drafting test. All tests were carried out with simultaneous gas exchange (MetaMax 2, Cortex, Germany) and heart rate measurements as well as determination of blood lactate concentrations. Maximal values of oxygen consumption (cycling: 4.91 +/- 0.60; skating: 4.85 +/- 0.50 l . min (-1); p = 0.78), lactate concentration, or heart rate were similar for cycling and skating. At workloads corresponding to blood lactate concentrations of 4 mmol . l (-1) oxygen uptake (cycling: 3.24 +/- 0.65; skating: 3.97 +/- 0.40 l . min (-1); p < 0.05) and heart rate (cycling: 162 +/- 9; skating: 173 +/- 6 min (-1); p < 0.05) were significantly higher during skating. The differences in heart rate ranged between - 2 and 23 min (-1). The drafting effect was 15 +/- 6 % at 30 km . h (-1) (3.34 +/- 0.19 vs. 2.83 +/- 0.29 l . min (-1)) and 14 +/- 5 % at 33 km . h (-1) (3.87 +/- 0.26 vs. 3.32 +/- 0.27 l . min (-1)). During inline speedskating the attainment of VO2peak is not impaired when compared to cycling exercise. However, the derivation of exercise prescriptions from a stepwise cycling test does not seem appropriate. The drafting effect of inline speedskating is within the range known from cycling.

Bicuspid aortic valve: evaluation of the ability to participate in competitive sports: case reports of two soccer players.

UNLABELLED: Two competitive soccer players aged 23 and 17 years with known bicuspid aortic valve presented for sports-medical pre-participation screening. Both athletes were well trained and had a maximal oxygen uptake of 61 and 60 ml/min/kg, respectively. Echocardiography of the first athlete revealed an eccentric hypertrophy of the left ventricle (end-diastolic diameter 58-59 mm, septal and posterior myocardial wall thickness 12-13 mm) with good systolic and diastolic function and a functional bicuspid aortic valve with mild regurgitation. In the second athlete, echocardiography showed a bicuspid aortic valve with moderate regurgitation and a relative stenosis, a hypertrophied left ventricle (end-diastolic diameter 62-63 mm, myocardial wall thickness 13-16 mm) and dilation of the ascending aorta of 46 mm, which was confirmed by magnetic resonance imaging. According to international guidelines, the first athlete was allowed to participate in competitive soccer. Nevertheless, regular cardiologic examinations in intervals of 6 months were recommended. In the second case, the athlete was not allowed to take part in competitive sports due to the extended ecstasy of the ascending aorta and the concomitant risk of an aortic rupture. In addition, the left ventricular hypertrophy has to be considered as pathologic. Therefore, the athlete was only allowed to exercise in recreational sports with low and easily controllable intensities. CONCLUSION: In athletes with bicuspid aortic valve, besides the evaluation of the aortic valve, physiologic adaptations of the heart have to be differentiated from pathological changes. Furthermore, the aorta deserves special attention, because in the case of a (probably genetically determined) dilated ascending aorta, an elevated risk for aortic rupture is present during intensive and competitive exercise. A general judgement in athletes with bicuspid aortic valves on their ability to participate in competitive sports is, therefore, not possible.

Cardiocirculatory and metabolic responses at different walking intensities.

OBJECTIVES: Although walking is a common physical activity, scientifically based training guidelines using standardised tests have not been established. Therefore this explorative study investigated the cardiovascular and metabolic load resulting from different walking intensities derived from maximal velocity (Vmax) during an incremental treadmill walking test. METHODS: Oxygen uptake, heart rate (HR), blood concentrations of lactate and catecholamines, and rating of perceived exertion were recorded in 16 recreational athletes (mean (SD) age 53 (9) years) during three 30 minute walking trials at 70%, 80%, and 90% of Vmax (V70, V80, and V90) attained during an incremental treadmill walking test. RESULTS: Mean (SD) oxygen uptake was 18.2 (2.3), 22.3 (3.1), and 29.3 (5.0) ml/min/kg at V70, V80, and V90 respectively (p<0.001). V70 led to a mean HR of 110 (9) beats/min (66% HRmax), V80 to 124 (9) beats/min (75% HRmax), and V90 to 152 (13) beats/min (93% HRmax) (p<0.001). Mean (SD) lactate concentrations were 1.1 (0.2), 1.8 (0.6), and 3.9 (2.0) mmol/l at V70, V80, and V90 respectively (p<0.001). There were no significant differences between catecholamine concentrations at the different intensities. Rating of perceived exertion was 10 (2) at V70, 12 (2) at V80, and 15 (2) at V90. Twelve subjects reported muscular complaints during exercise at V90 but not at V70 and V80. CONCLUSIONS: Intensity and heart rate prescriptions for walking training can be derived from an incremental treadmill walking test. The cardiovascular and metabolic reactions observed suggest that V80 is the most efficient workload for training in recreational athletes. Further studies are needed to confirm these findings.

Peak oxygen uptake. Myth and truth about an internationally accepted reference value.

This article critically examines the execution of VO(2)-peak testing in cardiac patients and questions their appropriate interpretation. In the first part, the most common clinical implications of VO(2)peak measurements are discussed: assessment of (changes in) functional capacity, evaluation of the necessity of invasive diagnostic/therapeutic measures, reference for exercise prescriptions, determination of prognosis. In the second part, important methodological problems and constraints are addressed and illustrated by references to scientific studies. Finally, recommendations are given for meaningful VO(2)peak testing. It is evident that failure to strictly follow such recommendations might result in misleading ergometric findings and, thus, in over- or underestimation of endurance capacity and/ or training effects.

Ambulatory gas exchange measurements--current status and future options.

This article summarizes the scientific literature on portable devices used for the measurement of gas exchange during exercise. Firstly, the results from validity investigations are reviewed in terms of accuracy, reliability, and influence of additional weight during field testing. On the basis of these findings, at least two of the most often tested portable devices, MetaMax I/II and K2/K4 b (2), can be regarded as valid, with their results not differing substantially from (stationary) metabolic carts. The second part of the article provides an overview of ambulatory gas exchange applications which have been investigated so far. There is a number of descriptive (cross-sectional) studies that characterize the physiological profiles of different sports. In addition, some diagnostic tests of functional capacity have been validated, and a few investigations have assessed nutritional interventions and their effect on metabolism. Some indicate potential future directions including an evaluation of the efficacy of modifying metabolic pathways during exercise, e. g. by specifically designed training. Also, the extension of descriptive/cross-sectional investigations to typical training sessions will be worthwhile.