Physiological and performance effects of dietary nitrate and N-acetylcysteine supplementation during prolonged heavy-intensity cycling.

The purpose of this study was to investigate effects of concurrent and independent administration of dietary nitrate (NO3-), administered as NO3--rich beetroot juice (BR; ~12.4 mmol of NO3-), and N-acetylcysteine (NAC; 70 mg·kg-1) on physiological responses during prolonged exercise and subsequent high-intensity exercise tolerance. Sixteen recreationally active males supplemented with NO3--depleted beetroot juice (PL) or BR for 6 days and ingested an acute dose of NAC or maltodextrin (MAL) 1 h prior to performing 1 h of heavy-intensity cycling exercise immediately followed by a severe-intensity time-to-exhaustion (TTE) test in four conditions: 1) PL+MAL, 2) PL+NAC, 3) BR+MAL and 4) BR+NAC. Pre-exercise plasma [NO3-] and nitrite ([NO2-]) were elevated following BR+NAC  and BR+MAL (both P < 0.01) compared with PL+NAC and PL+MAL; plasma [cysteine] was increased in PL+NAC  and BR+NAC (both P < 0.01) compared to PL+MAL. Muscle excitability declined over time during the prolonged cycling bout in all conditions  but was better preserved in PL+NAC  compared to BR+NAC (P < 0.01) and PL+MAL (P < 0.05). There was no effect of supplementation on subsequent TTE . These findings indicate that co-ingestion of BR and NAC does not appreciably alter physiological responses during prolonged heavy-intensity cycling or enhance subsequent exercise tolerance.

Physiological demands of running at 2-hour marathon race pace.

The requirements of running a 2-h marathon have been extensively debated but the actual physiological demands of running at ∼21.1 km/h have never been reported. We therefore conducted laboratory-based physiological evaluations and measured running economy (O2 cost) while running outdoors at ∼21.1 km/h, in world-class distance runners as part of Nike's "Breaking 2" marathon project. On separate days, 16 world-class male distance runners (age, 29 ± 4 yr; height, 1.72 ± 0.04 m; mass, 58.9 ± 3.3 kg) completed an incremental treadmill test for the assessment of V̇O2peak, O2 cost of submaximal running, lactate threshold and lactate turn-point, and a track test during which they ran continuously at 21.1 km/h. The laboratory-determined V̇O2peak was 71.0 ± 5.7 mL/kg/min with lactate threshold and lactate turn-point occurring at 18.9 ± 0.4 and 20.2 ± 0.6 km/h, corresponding to 83 ± 5% and 92 ± 3% V̇O2peak, respectively. Seven athletes were able to attain a steady-state V̇O2 when running outdoors at 21.1 km/h. The mean O2 cost for these athletes was 191 ± 19 mL/kg/km such that running at 21.1 km/h required an absolute V̇O2 of ∼4.0 L/min and represented 94 ± 3% V̇O2peak. We report novel data on the O2 cost of running outdoors at 21.1 km/h, which enables better modeling of possible marathon performances by elite athletes. Using the value for O2 cost measured in this study, a sub 2-h marathon would require a 59 kg runner to sustain a V̇O2 of approximately 4.0 L/min or 67 mL/kg/min.NEW & NOTEWORTHY We report the physiological characteristics and O2 cost of running overground at ∼21.1 km/h in a cohort of the world's best male distance runners. We provide new information on the absolute and relative O2 uptake required to run at 2-h marathon pace.

Dynamics of the power-duration relationship during prolonged endurance exercise and influence of carbohydrate ingestion.

We tested the hypotheses that the parameters of the power-duration relationship, estimated as the end-test power (EP) and work done above EP (WEP) during a 3-min all-out exercise test (3MT), would be reduced progressively after 40 min, 80 min, and 2 h of heavy-intensity cycling and that carbohydrate (CHO) ingestion would attenuate the reduction in EP and WEP. Sixteen participants completed a 3MT without prior exercise (control), immediately after 40 min, 80 min, and 2 h of heavy-intensity exercise while consuming a placebo beverage, and also after 2 h of heavy-intensity exercise while consuming a CHO supplement (60 g/h CHO). There was no difference in EP measured without prior exercise (260 ± 37 W) compared with EP after 40 min (268 ± 39 W) or 80 min (260 ± 40 W) of heavy-intensity exercise; however, after 2 h EP was 9% lower compared with control (236 ± 47 W; P < 0.05). There was no difference in WEP measured without prior exercise (17.9 ± 3.3 kJ) compared with after 40 min of heavy-intensity exercise (16.1 ± 3.3 kJ), but WEP was lower (P < 0.05) than control after 80 min (14.7 ± 2.9 kJ) and 2 h (13.8 ± 2.7 kJ). Compared with placebo, CHO ingestion negated the reduction of EP following 2 h of heavy-intensity exercise (254 ± 49 W) but had no effect on WEP (13.5 ± 3.4 kJ). These results reveal a different time course for the deterioration of EP and WEP during prolonged endurance exercise and indicate that EP is sensitive to CHO availability.NEW & NOTEWORTHY The parameters of the power-duration relationship [critical power (CP) and the curvature constant (W')] have typically been considered to be static. Here we report the time course for reductions in CP and W', as estimated with the 3-min all-out cycle test, during 2 h of heavy-intensity exercise. We also show that carbohydrate ingestion during exercise preserves CP, but not W', without altering muscle glycogen depletion. These results provide new mechanistic and practical insight into the power-duration curve and its relationship to exercise-related fatigue development.

Changes in the power-duration relationship following prolonged exercise: estimation using conventional and all-out protocols and relationship with muscle glycogen.

It is not clear how the parameters of the power-duration relationship [critical power (CP) and W'] are influenced by the performance of prolonged endurance exercise. We used severe-intensity prediction trials (conventional protocol) and the 3-min all-out test (3MT) to measure CP and W' following 2 h of heavy-intensity cycling exercise and took muscle biopsies to investigate possible relationships to changes in muscle glycogen concentration ([glycogen]). Fourteen participants completed a rested 3MT to establish end-test power (Control-EP) and work done above EP (Control-WEP). Subsequently, on separate days, immediately following 2 h of heavy-intensity exercise, participants completed a 3MT to establish Fatigued-EP and Fatigued-WEP and three severe-intensity prediction trials to the limit of tolerance (Tlim) to establish Fatigued-CP and Fatigued-W'. A muscle biopsy was collected immediately before and after one of the 2-h exercise bouts. Fatigued-CP (256 ± 41 W) and Fatigued-EP (256 ± 52 W), and Fatigued-W' (15.3 ± 5.0 kJ) and Fatigued-WEP (14.6 ± 5.3 kJ), were not different (P > 0.05) but were ~11% and ~20% lower than Control-EP (287 ± 46 W) and Control-WEP (18.7 ± 4.7 kJ), respectively (P < 0.05). The change in muscle [glycogen] was not significantly correlated with the changes in either EP (r = 0.19) or WEP (r = 0.07). The power-duration relationship is adversely impacted by prolonged endurance exercise. The 3MT provides valid estimates of CP and W' following 2 h of heavy-intensity exercise, but the changes in these parameters are not primarily determined by changes in muscle [glycogen].

Time-trial performance is not impaired in either competitive athletes or untrained individuals following a prolonged cognitive task.

It has been reported that mental fatigue decreases exercise performance during high-intensity constant-work-rate exercise (CWR) and self-paced time trials (TT) in recreationally-trained individuals. The purpose of this study was to determine whether performance is impaired following a prolonged cognitive task in individuals trained for competitive sport. Ten trained competitive athletes (ATH) and ten untrained healthy men (UNT) completed a 6-min severe-intensity CWR followed by a 6-min cycling TT immediately following cognitive tasks designed to either perturb (Stroop colour-word task and N-back task; PCT) or maintain a neutral (documentary watching; CON) mental state. UNT had a higher heart rate (75 ± 9 v. 69 ± 7 bpm; P = 0.002) and a lower positive affect PANAS score (19.9 ± 7.5 v. 24.3 ± 4.6; P = 0.036) for PCT compared to CON. ATH showed no difference in heart rate, but had a higher negative affect score for PCT compared to CON (15.1 ± 3.7 v. 12.2 ± 2.7; P = 0.029). Pulmonary O2 uptake during CWR was not different between PCT and CON for ATH or UNT. Work completed during TT was not different between PCT and CON for ATH (PCT 103 ± 12 kJ; CON 102 ± 12 kJ; P > 0.05) or UNT (PCT 75 ± 11 kJ; CON 74 ± 12 kJ; P > 0.05). Compared to CON, during PCT, UNT showed unchanged psychological stress responses, whereas ATH demonstrated increased psychological stress responses. However, regardless of this distinction, exercise performance was not affected by PCT in either competitive athletes or untrained individuals.

Effects of Two Hours of Heavy-Intensity Exercise on the Power-Duration Relationship.

INTRODUCTION: Changes in the parameters of the power-time relationship (critical power (CP) and W') during endurance exercise would have important implications for performance. We tested the hypotheses that CP and W', estimated using the end-test power (EP) and the work done above EP (WEP), respectively, during a the 3-min all-out test (3MT), can be reliably determined, and would be lower, after completing 2 h of heavy-intensity exercise. METHODS: In study 1, six cyclists completed a 3MT immediately after 2 h of heavy-intensity exercise on two occasions to establish the reliability of EP and WEP. In study 2, nine cyclists completed a control 3MT, and a fatigued 3MT and constant power output tests to 30 min or the limit of tolerance (Tlim) below and above F-EP after 2 h of heavy-intensity exercise. RESULTS: In study 1, EP (273 ± 52 vs 276 ± 58 W) and WEP (12.4 ± 4.3 vs 12.8 ± 4.3 kJ) after 2 h of heavy-intensity exercise were not different (P > 0.05) and were highly correlated (r = 0.99; P < 0.001). In study 2, both EP (F-EP: 282 ± 52 vs C-EP: 306 ± 56 W; P < 0.01) and WEP (F-WEP: 14.7 ± 4.9 vs C-WEP: 18.3 ± 4.1 kJ; P < 0.05) were lower after 2-h heavy-intensity exercise. However, maximum O2 uptake was not achieved during exercise >F-EP and Tlim was shorter than 30 min during exercise

Normative Data for Critical Speed and D' for High-Level Male Rugby Players.

Kramer, M, Clark, IE, Jamnick, N, Strom, C, and Pettitt, RW. Normative data for critical speed and D' for high-level male rugby players. J Strength Cond Res 32(3): 783-789, 2018-The critical speed (CS) concept helps characterize the aerobic and anaerobic fitness of an athlete. Rugby players should, hypothetically, have modest CS values but extremely high curvature constant (D') values, yet, normative data are currently unavailable. To develop normative data of CS and D' for high-level male rugby players, a total of 30 male rugby players were recruited from the Eastern Cape of South Africa. All subjects performed the running 3-minute all-out exercise test (3 MT) using global positioning system (GPS) technology to determine CS and D'. The GPS data were used to determine the total distance and velocities performed, and to examine for pacing effects. Summary statistics of mean ± SD are provided. High total running speeds for the initial 150 seconds (S150s = 5.79 ± 0.59 m·s), and total distance (3 MT distance = 871.5 ± 71.9 m) were observed. A total of 13 of 30 subjects surpassed the 300 m D' value (mean D' = 288.2 ± 49.1 m). The CS of the total group was 3.87 ± 0.55 m·s. All 3 MT-derived data were categorized using standard nine (stanine) tables that allowed for the generation of normative data with which future performances, performances across similar sporting domains, and more accurate contrasts across the literature can be compared. Skewing of CS and D' was observed between forwards and backs, therefore, between-group differences in neither CS nor D' were observed (p > 0.05). Comparisons with previous literature indicate that male rugby players have higher CS values than female rugby players. When compared with Olympic distance runners, male rugby players have markedly higher D' values and markedly lower CS values. The 3 MT provides a useful procedure for assessing and prescribing high-intensity interval training for rugby athletes.

Validity of the 3-Minute All-Out Exercise Test on the CompuTrainer.

The 3-minute all-out exercise test (3MT) has emerged as a useful procedure for identifying critical power (CP) and the finite work capacity above CP (W') within a single visit. The CP concept enables for the prediction of exhaustive time limits (T(LIMs)) for a wide range of severe intensity power outputs and is a method for prescribing high-intensity interval training (HIIT). Road cyclists often use the CompuTrainer for indoor HIIT. The purpose of this study was to validate the 3MT for use on the CompuTrainer. On 4 separate visits, 10 competitive cyclists performed a 3MT, and three separate constant-load bouts projected to yield exhaustive T(LIMs) of 3, 6, and 9 minutes, respectively, using the Computrainer. Actual CP and W' were calculated using the linear work-time (W-t) and power-inverse time (1/t) models. The results for CP (W) from the 3MT (215 ± 40), the W-t model (212 ± 36), and the 1/t model (213 ± 36) did not differ (F = 2.96, p = 0.11, η2(p) = 0.43). Similarly, the results for W' (kJ) for the 3MT (11.2 ± 4.0), the W-t model (12.1 ± 6.5), and the 1/s model (11.7 ± 6.3) did not differ (F = 2.40, p = 0.15, η2(p) = 0.375). We conclude that use of the 3MT and the CP concept for performance assessment and HIIT prescription on the CompuTrainer is a valid procedure.

Applying the critical velocity model for an off-season interval training program.

The critical velocity (CV) model offers an opportunity to prescribe and to test empirically different velocity-time (V-t) configurations of high-intensity interval training (HIIT); however, such experiments are lacking. We evaluated a group of competitive, female soccer players (age = 19 ± 1 years, height = 168 ± 6 cm, mass = 61 ± 6 kg) completing 1 of 2 different HIIT regimes: a short group (n = 6) completing higher V and shorter t configurations, and a long group (n = 10) completing lower V, longer t configurations. Both groups trained 2 d·wk for 4 weeks. For each workout, both groups ran at velocities exceeding CV and designed to deplete identical fractional percentages of the finite work capacity above CV (D'). The metrics of CV and D' were evaluated at pretraining and posttraining using the 3-minute all-out exercise test on an indoor track using video digitizing of displacement relative to time. Despite differences in the V-t configurations, both groups increased their CV (+0.22 m·s, +6%) and decreased their D' (-24 m, -13%; p < 0.05). We conclude that 2- to 5-minute HIIT bouts are suitable for increasing CV, in previously trained athletes, but they result in a decline of D'. To increase D', we suggest examining HIIT of intensities that are <2 minutes and >130% of maximum oxygen uptake.

Alternative procedures for the three-minute all-out exercise test.

The cycling 3-minute all-out exercise test (3 MT) provides the measures of critical power (CP) and the curvature constant (W') for the relationship between power and time limit to exhaustion in the severe exercise domain. The original procedures for the 3 MT required a preliminary graded exercise test (GXT) to establish the linear factor and the fixed load for the test. We evaluated a new procedure of establishing the load for the 3 MT using a percentage of body mass (% BM). Fifteen subjects of varied fitness levels completed a custom GXT-verification protocol to establish the gas exchange threshold and V[Combining Dot Above]O2max, a 3 MT using a load derived with the linear factor, and a 3 MT using a % BM. The subjects also completed a subsequent exhaustive bout at 10% above CP. The CP and W' estimated from either protocol did not differ. The CP estimates were consistent (α = 0.97, SEM = 7.1 W, coefficient of variation = 4%); however, W' was less reliable, a finding true of any method of measuring W'. The V[Combining Dot Above]O2 evoked during the 3 MT was lower than the values evoked by the exhaustive GXT-verification bouts and the 10% above CP bout after the 3 MT. All individual V[Combining Dot Above]O2 values in the 10% above CP bout were "≥" values measured in the 3 MT. Our findings indicate that several viable procedures for administering the 3 MT are plausible.

Gas exchange threshold and VO2max testing for athletes: an update.

Standardized graded exercise test (GXT) protocols are ineffective for testing endurance athletes. Scientists have called for the abandonment of traditional techniques for corroborating "true" maximum oxygen uptake (VO2max), as measured during a GXT. Instead, a new technique, the verification bout subsequent to the GXT, has emerged for establishing the "true" VO2max. The addition of the verification bout reframes how the GXT should be viewed. In this article, we summarize the methods for developing custom GXT protocols, identifying threshold and interpolating power or outdoor running velocity, and implicating the verification bout.

Effect of hang cleans or squats paired with countermovement vertical jumps on vertical displacement.

Complex training is characterized by pairing resistance exercise with plyometric exercise to exploit the postactivation potentiation (PAP) phenomenon, thereby promising a better training effect. Studies on PAP as measured by human power performances are equivocal. One issue may be the lack of analyses across multiple sets of paired exercises, a common practice used by athletes. We evaluated countermovement vertical jump (CMJ) performance in 19 women, collegiate athletes in 3 of the following trials: (a) CMJs-only, where 1 set of CMJs served as a conditioning exercise, (b) heavy-load, back squats paired with CMJs, and (c) hang cleans paired with CMJs. The CMJ vertical displacement (3-attempt average), as measured with digital video, served as the dependent variable of CMJ performance. Across 3 sets of paired-exercise regimens, CMJ-only depreciated 1.6 cm and CMJ paired with back squats depreciated 2.0 cm (main effect, p < 0.05). Conversely, CMJ paired with hang cleans depreciated 0.30 cm (interaction, p < 0.05). Thus, the best complex training scheme was achieved by pairing CMJs with hang cleans in comparison to back squats or CMJs in and of themselves. Future research on exercise modes of complex training that best help athletes preserve and train with the highest power possible, in a given training session, is warranted.

The effect of primary care management on lipids testing and LDL-C control of elderly patients with comorbidities.

PURPOSE: This article presents results of a randomized clinical trial evaluating the effectiveness of the Medicare Coordinated Care Demonstration, Illinois site, on selected clinical outcomes over 36 months. PRIMARY PRACTICE SETTINGS: Interdisciplinary teams, located at primary care practices, provided case and disease management services to 999 patients. RESULTS: Intervention group patients had higher lipids-testing rates during the first 2 years than control group patients. Once tested, more than 80% of patients in both groups were retested in subsequent years. There were no differences in the percentage of intervention group patients who were in low-density lipoprotein cholesterol (LDL-C) control at program entry and at the end of 36 months as compared with control group patients (maintained control). However, a higher percentage of intervention group patients who were not in the LDL-C control at baseline were in control after 36 months as compared with control group patients (achieved control). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This study suggests that physician-nurse case management team care has the potential to augment the effectiveness of primary care by increasing adherence to testing protocols among elderly patients with multiple chronic illnesses, but this effect diminishes over time as guidelines are adopted into general practice. It suggests that LDL-C therapeutic control can be improved through increased lipids testing and the use of lipid-lowering medications. The results also indicate that care management strategies targeting more intensive patients versus less intensive patients are cost-effective strategies that can be expanded beyond lipids testing and control to other clinical health status measures.

Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people.

AIM: The purpose of this study was to test the effectiveness of a collaborative primary care nurse case management intervention emphasising collaboration between physicians, nurses and patients, risk identification, comprehensive assessment, collaborative planning, health monitoring, patient education and transitional care on healthcare utilisation and cost for community dwelling chronically ill older persons. BACKGROUND: Primary care teams comprised of nurses and primary care physicians have been suggested as a model for providing quality care to the chronically ill, but this type of intervention has not been systematically evaluated. DESIGN: A non-randomised, 36 month comparison of two geographically distinct primary care populations was conducted. METHODS: Six hundred and seventy-seven persons aged 65 and older were determined to be at high-risk for mortality, functional decline, or increased health service use. The treatment group (n = 400) received the intervention and the comparison group (n = 277) received usual care. Health plan claims files provided data on number of hospitalisations and bed days, emergency department (ED) visits, physician visits and total cost of care. RESULTS: After adjustment for baseline variables, there were no significant differences between the treatment and comparison group in the percentage of patients hospitalised or ED visits. However, among those hospitalised in the treatment group, the likelihood of being re-hospitalised was significantly reduced by 34% (p = 0·032). After adjusting for the cost of the intervention, although not statistically significant, the reduced hospital use resulted in cost savings of $106 per patient per month in the treatment group. CONCLUSIONS: The results indicate that a collaborative primary care nurse case management intervention has the potential to be an effective alternative to current primary care delivery system practice. RELEVANCE TO CLINICAL PRACTICE: The study suggests that a chronic care intervention emphasising collaboration between physicians, nurses and patients, may be more effective when implemented in integrated provider networks.