[French survey of patients on current and future pulmonary rehabilitation programs]. / Enquête nationale auprès des malades sur la réadaptation respiratoire actuelle et future.

INTRODUCTION: Over recent years, a growing number of studies have demonstrated the effectiveness of alternative models to centre-based pulmonary rehabilitation (PR) such as tele-PR or home-based unsupervised PR, offering perspectives for improved accessibility and adherence. Other studies have demonstrated the relevance and long-term benefits of maintenance PR programs. However, they remain poorly implemented in real-life settings. In order to encourage patient adherence to new PR models and to guide future orientations, we conducted a survey assessing patients' views on PR models and maintenance programs. METHOD: The survey (37 questions) was circulated to COPD patients of the French national respiratory patient F.F.A.A.I.R network and in five specialised PR centres. RESULTS: Among the 298 respondents, 75% had previously taken part in a PR program, mainly in hospital settings (91%), with a high degree of satisfaction. The main barriers to PR were being physically separated from their loved ones (21%) and fears of having to share a double room (47%). Regarding maintenance PR programs, patients expressed diversified opinions, in terms of ideal duration and frequency of follow-up, format of follow-up (home-based, telephone, videoconference) and type of professional involved. CONCLUSIONS: Diversified PR settings offer perspectives to increase access and improve the effectiveness of current programs. Furthermore, comprehensive personalization (professionals involved, content, setting, duration) seems to be the key to success in concrete implementation and achievement of patient satisfaction.

Ultrafast laser inscribed waveguides in tailored fluoride glasses: an enabling technology for mid-infrared integrated photonics devices.

Zirconium fluoride (ZBLAN) glass, the standard material used in fiber-based mid-infrared photonics, has been re-designed to enable the fabrication of high index-contrast low-loss waveguides via femtosecond laser direct writing. We demonstrate that in contrast to pure ZBLAN, a positive index change of close to 10-2 can be induced in hybrid zirconium/hafnium (Z/HBLAN) glasses during ultrafast laser inscription and show that this can be explained by an electron cloud distortion effect that is driven by the existence of two glass formers with contrasting polarizability. High numerical aperture (NA) type-I waveguides that support a well confined 3.1 µm wavelength mode with a mode-field diameter (MFD) as small as 12 µm have successfully been fabricated. These findings open the door for the fabrication of mid-infrared integrated photonic devices that can readily be pigtailed to existing ZBLAN fibers.

Arterial aging mediates the effect of TNF-α and ACE polymorphisms on mental health in elderly individuals: insights from IKARIA study.

BACKGROUND: Aging is characterized by an insidious decline in cognitive function. Several genetic and lifestyle factors have been implicated in the increased risk or early onset of dementia. AIM: We sought to assess the role of tumor necrosis factor (TNF) and angiotensin-converting enzyme (ACE) polymorphisms on the development of impaired mental health in respect to indices of arterial aging in nonagenarian individuals. DESIGN: 178 consecutive subjects above 75 years that permanently inhabit in the island of IKARIA, Greece were recruited. METHODS: Aortic distensibility (AoD) was calculated and genetic evaluation was performed on the ACE Insertion/Deletion gene polymorphism (intron 16) and the G/A transition (position -308) of the TNF gene. Cognitive function was evaluated using the Mini-mental State Examination (MMSE). RESULTS: The DD genotype for ACE was independently associated ( b = -0.44, P = 0.007) with AD while AoD remained an independent determinant of mental status (OR = 1.82, P = 0.036). Interestingly though, when a combined genetic index (GI) was calculated for both genes (ACE and TNF), subjects being double homozygous (DD for ACE and GG for TNF) for these loci presented significantly decreased MMSE (adjusted OR = 0.259, P = 0.033). This GI independently associated with AD (beta coefficient = -0.785, P = 0.002). When AoD was included, GI lost its predictive role (OR = 0.784, P = 0.783) towards MMSE. AoD has marginal indirect mediating effect in the association of the GI with MMSE ( P = 0.07). CONCLUSION: Vascular aging may modulates the genetic substrate of elderly subjects on the risk for developing dementia.

Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients.

STUDY QUESTION: Are in vitro maturation (IVM) rates of cumulus-oocyte complexes (COCs), retrieved from breast cancer patients seeking urgent fertility preservation (FP) before neoadjuvant chemotherapy, different between those recovered in the follicular or in the luteal phase of the cycle? SUMMARY ANSWER: The present investigation reveals no major difference in the number of COCs recovered or their IVM rates whatever the phase of the cycle at which egg retrieval is performed, suggesting that IVM is a promising tool for breast cancer patients seeking urgent oocyte cryopreservation. WHAT IS KNOWN ALREADY: FP now represents a standard of care for young cancer patients having to undergo gonadotoxic treatment. Mature oocyte cryopreservation after IVM of COCs has been proposed for urgent FP, especially in women, who have no time to undergo ovarian stimulation, or when it is contraindicated. STUDY DESIGN, SIZE, DURATION: From January 2011 to December 2014, we prospectively studied 248 breast cancer patients awaiting neoadjuvant chemotherapy, aged 18-40 years, candidates for oocyte vitrification following IVM, either at the follicular or the luteal phase of the cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS: Serum anti-Müllerian hormone and progesterone levels and antral follicle count (AFC) were measured prior to oocyte retrieval. Patients were sorted into two groups according to the phase of the cycle during which eggs were harvested (Follicular phase group, n = 127 and Luteal phase group, n = 121). Number of COCs recovered, maturation rates after 48 h of culture and total number of oocytes cryopreserved were assessed. Moreover, the oocyte retrieval rate (ORR) was calculated by the number of COCs recovered ×100/AFC. MAIN RESULTS AND THE ROLE OF CHANCE: In the Follicular and the Luteal phase groups, women were comparable in terms of age, BMI and markers of follicular ovarian status. There was no significant difference in the number of COCs recovered (mean ± SEM), 9.3 ± 0.7 versus 11.1 ± 0.8, and ORR (median (range)) 43.1 (1-100) versus 47.8 (7.7-100)%. Moreover, maturation rates after 48 h of culture (median (range)) were comparable in the follicular and luteal phase groups, 66.7 (20-100) versus 64.5 (0-100)%. Finally, the total number of oocytes cryopreserved (mean ± SEM) was similar in both groups (6.2 ± 0.4 versus 6.8 ± 0.5). LIMITATIONS, REASONS FOR CAUTION: Despite the intact meiotic competence of immature oocytes recovered during the follicular or the luteal phase, there is a dramatic lack of data regarding the outcome of IVM oocytes cryopreserved in cancer patients. WIDER IMPLICATIONS OF THE FINDINGS: IVM of oocytes may be an interesting method of FP in urgent situations. Improving the culture conditions will be needed to increase the maturation rates and the overall potential of in vitro matured oocytes. STUDY FUNDING/COMPETING INTERESTS: None. TRIAL REGISTRATION NUMBER: N/A.

[Role of PET-scan in the positive diagnosis of sarcoidosis in the work-up of uveitis]. / Apport du TEP-scan dans le diagnostic positif de la sarcoïdose, au cours du bilan d'uvéite indéterminée.

INTRODUCTION: Sarcoidosis is a multisystem granulomatous inflammatory disease, which may present as uveitis. Work-up includes the search for pulmonary and extra-pulmonary sites, with the assistance of PET-scanning. MATERIAL AND METHODS: We present six patients enrolled retrospectively from March 2012 to November 2013 with uveitis, for whom a systemic work-up was performed, along with specific tests for sarcoidosis. 18-FDG PET-scan was performed when histology was inconclusive for epithelioid granulomata and giant cells, or when CT and/or chest X-ray were normal, in cases of uveitis clinically suggestive of sarcoidosis. RESULTS: Hypermetabolic foci were found in all patients, in inflammatory areas with foci mainly located in the mediastinal (65%), hilar (33%), cervical, and supraclavicular regions. There was no correlation between ACE levels and positivity of the PET-scan, since only two patients exhibited ACE > 70 IU/L. DISCUSSION: PET-scan is a promising technique in the field of sarcoid uveitis; however, histologic proof remains the gold standard. CONCLUSION: This study demonstrates the value of PET-scan in the assessment of indeterminate uveitis, by screening for sarcoidosis, and permits an assessment of the extent of the disease.

Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors.

The identification of a hot spot of exceptional longevity, the Longevity Blue Zone (LBZ), in the mountain population of Sardinia has aroused considerable interest toward its traditional food as one of the potential causal factors. This preliminary study on the traditional Sardinian diet has been supported by the literature available, which has been carefully reviewed and compared. Up to a short time ago, the LBZ population depended mostly upon livestock rearing, and consumption of animal-derived foods was relatively higher than in the rest of the island. The nutrition transition (NT) in urbanized and lowland areas began in the mid-1950s, fueled by economic development, whereas in the LBZ it started later owing to prolonged resistance to change by a society organized around a rather efficient pastoral economy. Even nowadays a large proportion of the population in this area still follows the traditional diet based on cereal-derived foods and dairy products. The LBZ cohorts comprising individuals who were of a mature age when NT began may have benefited both from the high-quality, albeit rather monotonous, traditional diet to which they had been exposed most of their life and from the transitional diet, which introduced positive changes such as more variety, increased consumption of fruits and vegetables and moderate meat intake. It could be speculated that these changes may have brought substantial health benefits to this particular aging group, which was in need of nutrient-rich food at this specific time in life, thereby resulting in a decreased mortality risk and, in turn, life-span extension.

Lifestyle and nutrition related to male longevity in Sardinia: an ecological study.

BACKGROUND AND AIMS: A demographic analysis in the Mediterranean island of Sardinia revealed marked differences in extreme longevity across the 377 municipalities and particularly identified a mountain inner area where the proportion of oldest subjects among male population has one of the highest validated value worldwide. The cause(s) of this unequal distribution of male longevity may be attributed to a concurrence of environmental, lifestyle and genetic factors. METHODS AND RESULTS: In this study we focussed on some lifestyle and nutrition variables recorded in the island's population in early decades of 20th century, when agricultural and pastoral economy was still prevalent, and try to verify through ecological spatial models if they may account for the variability in male longevity. By computing the Extreme Longevity Index (the proportion of newborns in a given municipality who reach age 100) the island's territory was divided in two areas with relatively higher and lower level of population longevity. Most nutritional variables do not show any significant difference between these two areas whereas a significant difference was found with respect to pastoralism (P = 0.0001), physical activity estimated by the average slope of the territory in each municipality (P = 0.0001), and average daily distance required by the active population to reach the usual workplace (P = 0.0001). CONCLUSION: Overall, these findings suggest that factors affecting the average energy expenditure of male population such as occupational activity and geographic characteristics of the area where the population mainly resides, are important in explaining the spatial variation of Sardinian extreme longevity.

Design, recruitment, logistics, and data management of the GEHA (Genetics of Healthy Ageing) project.

In 2004, the integrated European project GEHA (Genetics of Healthy Ageing) was initiated with the aim of identifying genes involved in healthy ageing and longevity. The first step in the project was the recruitment of more than 2500 pairs of siblings aged 90 years or more together with one younger control person from 15 areas in 11 European countries through a coordinated and standardised effort. A biological sample, preferably a blood sample, was collected from each participant, and basic physical and cognitive measures were obtained together with information about health, life style, and family composition. From 2004 to 2008 a total of 2535 families comprising 5319 nonagenarian siblings were identified and included in the project. In addition, 2548 younger control persons aged 50-75 years were recruited. A total of 2249 complete trios with blood samples from at least two old siblings and the younger control were formed and are available for genetic analyses (e.g. linkage studies and genome-wide association studies). Mortality follow-up improves the possibility of identifying families with the most extreme longevity phenotypes. With a mean follow-up time of 3.7 years the number of families with all participating siblings aged 95 years or more has increased by a factor of 5 to 750 families compared to when interviews were conducted. Thus, the GEHA project represents a unique source in the search for genes related to healthy ageing and longevity.

Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease.

BACKGROUND: Overweight and obesity have been associated with better survival in patients with chronic obstructive pulmonary disease (COPD). On the other hand, excess body weight is associated with abnormal metabolic and inflammatory profiles that define the metabolic syndrome and predispose to cardiovascular diseases. This study was undertaken to evaluate the impact of overweight and obesity on the prevalence of the metabolic syndrome and on the metabolic and inflammatory profiles in patients with COPD. METHODS: Twenty-eight male patients with COPD were divided into an overweight/obese group [ n = 16, body mass index (BMI) = 33.5 +/- 4.2 kg/m(2)] and normal weight group (n = 12, BMI = 21.1 +/- 2.6 kg/m(2)). Anthropometry, pulmonary function and body composition were assessed. The metabolic syndrome was diagnosed according to waist circumference, circulating levels of triglyceride and high-density lipoprotein cholesterol levels, fasting glycemia and blood pressure. C-reactive protein, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), leptin and adiponectin plasma levels were measured. RESULTS: Airflow obstruction was less severe in overweight/obese compared with normal weight patients (forced expiratory volume(1): 51 +/- 19% versus 31 +/- 12% predicted, respectively, P < 0.01). The metabolic syndrome was diagnosed in 50% of overweight/obese patients and in none of the normal weight patients. TNF-alpha, IL-6 and leptin were significantly higher in overweight/obese patients whereas the adiponectin levels were reduced in the presence of excess weight. CONCLUSIONS: The metabolic syndrome was frequent in overweight/obese patients with COPD. Obesity in COPD was associated with a spectrum of metabolic and inflammatory abnormalities.

[Incidence of individualized training on exercise-induced desaturation in COPD patients]. / Effets d'un réentraînement individualisé sur la désaturation à l'exercice des sujets atteints de BPCO.

BACKGROUND: Exercise-induced desaturation is a well-described phenomenon in COPD patients during exercise assessments such as the six minute walk test (6MWT). Some of the pathophysiological mechanisms involved in this O2 desaturation could be modified by individualized exercise training as part of a pulmonary rehabilitation programme. The aim of this study was to determine the effect of pulmonary rehabilitation on O2 desaturation exhibited by COPD patients during a 6MWT. METHODS: Twenty COPD patients (FEV1=61.1 +/- 3.2% predicted) who exhibited O2 desaturation before rehabilitation (mean 7.3 +/- 0.7% with a mean duration of 5.3 +/- 0.1 min) participated. They performed four weeks of RP including individualized whole-body exercise training achieving a mean 9.3 +/- 0.27 hours per week of exercise tailored to their ventilatory threshold. RESULTS: Dyspnoea at the end of the test, ventilatory threshold and FEV1 were retained as correlates of desaturation before rehabilitation. After rehabilitation, 6MWT distance increased (p<0.01) with reduced dyspnoea (p<0.05). Two sub-groups were identified: persistent desaturaters (DS, n=13) and non-desaturaters group (NDS, n=7). There were no baseline differences between the two groups. After rehabilitation only the persistent desaturaters showed a significant increase in distance achieved during 6MWT associated with a reduced dyspnea (p<0.05). This group showed a mean O2 desaturation equal to 8.1 +/- 0.9% which persisted to 5 +/- 0.3 min. A tendency to a lower dyspnoea at the end of 6MWT performed before rehabilitation was observed in NDS compared with DS (p<0.058). CONCLUSION: It seems that responses to a pulmonary rehabilitation programme including individualized exercise training could act on O2 desaturation. Indeed 7 of 20 (35%) COPD patients exhibiting O2 desaturation during a 6MWT showed no O2 desaturation after rehabilitation programme while 13 on 20 (65%) do it.

Undiagnosed exercise-induced bronchoconstriction in ski-mountaineers.

Because the practise conditions put the ski-mountaineering athletes potentially at risk for exercise-induced bronchoconstriction (EIB), this study was conducted to estimate the prevalence of EIB in this population. Thirty-one highly-trained ski-mountaineers with racing experience participating in the race were evaluated. EIB was determined after a European race at high altitude and frigid conditions. Pre-race investigations included pulmonary function measurements and a questionnaire enquiring about i) training habits, ii) respiratory history during training and/or competition. Pulmonary function was also tested after the race. None of the athletes reported a basal airway obstruction. Two groups were determined after post-race airway response: i) EIB (+) group exhibiting a fall in FEV (1) > or = 10 % (n = 15) and ii) EIB (-) without fall in FEV (1) or fall < 10 % (n = 16). Neither training habits nor baseline lung function were associated with the post-race airway response. Six of the 31 ski-mountaineers had a previous physician-made diagnosis of asthma and/or EIB, nevertheless 23 of our athletes complained about at least one characteristic symptom of asthma during practise. Four of our 15 EIB (+) had a previous physician-made diagnosis of asthma/EIB indicating that 73 % of EIB (+) athletes were undiagnosed for EIB. The proportion of allergic athletes was not significantly different between EIB (+) and EIB (-). This study showed that approximatively half of highly-trained ski-mountaineers with racing experience can develop EIB after a race and that 73 % of them are unaware of the problem.

Effect of acute hyperoxia during exercise on quadriceps electrical activity in active COPD patients.

AIMS: This study investigated whether acute hyperoxia improves electrical muscle activity in active chronic obstructive pulmonary disease (COPD) patients with mild hypoxemia (rest PaO(2) = 9.1 +/- 0.4 kPa). METHODS: Two identical incremental exercise tests were performed by nine patients while breathing either air or 30% oxygen. Pulmonary gas exchanges, venous concentrations of lactate and pyruvate, and the electromyographic signal of the quadriceps muscle (vastus lateralis and vastus medialis) were sampled each minute. RESULTS: Peak working capacity increased significantly in hyperoxia (94.4 +/- 5.2W) compared with normoxia (85.4 +/- 5.8W, P < 0.01). During hyperoxic exercise and for a given work load, oxygen uptake was increased (P < 0.001) and ventilation decreased (P < 0.05). Lactate concentration was significantly decreased (P < 0.01) at isowork level and during recovery (respectively - 26% and at least - 15%). In the quadriceps muscle, M-wave amplitude (P < 0.05), root mean square (P < 0.01) and root mean square/oxygen uptake ratio (P < 0.001) were significantly increased during hyperoxic exercise compared with room air. Although median frequency values did not differ between conditions, the median frequency was significantly decreased for higher exercise intensity in hyperoxic condition. These modifications reflected better aerobic metabolism, later emergence of muscle fatigue, and greater muscle excitability and activation for the same level of exercise under hyperoxic condition. CONCLUSION: These data suggest that the acute addition of oxygen in active COPD patients improves their muscle electrical activity during dynamic exercise. Hypoxemia-induced skeletal muscle dysfunction most probably acts through mechanisms based on oxygen availability.

Prediction of VO(2peak) in wheelchair-dependent athletes from the adapted Léger and Boucher test.

PURPOSE: :The purpose of this study was to provide a predictive peak oxygen uptake ([V]O(2) peak) equation in wheelchair-dependent athletes using the Adapted Léger and Boucher test. SUBJECTS AND PROTOCOL: :Fifty-six wheelchair-dependent athletes, 47 males and nine females (30.3+/-4 years), underwent a clinical examination to assess their anthropometric characteristics: height, mass, body mass index (BMI), lean body mass, arm length, and muscular arm volume. They performed a deceleration field test to assess the subject-wheelchair resistance defined as a mechanical variable, and they then performed the Adapted Léger and Boucher test to assess physiological data at maximal exercise ([V]O(2) peak, heart rate max) concomitantly with biomechanical (number of pushes) and performance variables (maximal aerobic velocity Va(max) and maximal distance). The [V]O(2) peak was measured directly using a portable telemetric oxygen analyzer. Subjects were then randomly assigned to an experimental group (n=49) to determine the predictive equation, and a validation group (n=7) to check the external validity of the equation. RESULTS: A stepwise multiple regression with [V]O(2) peak (l min(-1)) as the dependent variable led to the following equation: [V]O(2) peak=0.22 Va(max) - 0.63 log(age)+0.05 BMI 0.25 level+0.52, with r(2)=0.81 and SEE=0.01. Paraplegic subjects with high and low lesion level spinal injuries were attributed the coefficient of 1 and 0, respectively. The external validity of the equation was positive since the predicted [V]O(2) peak values did not significantly differ from directly measured [V]O(2) peak (P>0.05). CONCLUSION: We concluded that [V]O(2) peak in wheelchair-dependent athletes was predictable using the equation of the present study and the described incremental test.

[Daltonism and the genetics of aging]. / Le daltonisme et la génétique du vieillissement.

In order to test whether mutations giving rise to color vision deficiencies are more frequently inherited from older fathers, an exhaustive screening of births in the Namur region has allowed to isolate a sample of 225 descending sons of maternal grandfathers who were older than 45 years at their daughter's birth. The incidence of color vision defects was compared between this set of cases and three control groups totalling 959 boys from independent families. While these comparisons were not conclusive, we propose new hypotheses concerning the population dynamics of color vision deficiencies. Neomutations in X-linked pigment genes may be a marker of the overall genetic load borne by the X chromosome. Selection against such loaded X chromosomes may occur in the second generation, either in the course of embryogenesis, or during female gametogenesis. The future assessment of these novel hypotheses relies on the arbitration of molecular genetics.

Reproducibility of the Adapted Leger and Boucher Test for wheelchair-dependent athletes.

STUDY DESIGN: This study analyzed the reproducibility of a field test. In a previous study, we showed that this test, the Adapted Leger and Boucher Test (ALBT), was progressive and maximal. The Leger and Boucher predictive equation for able-bodied subjects was not accurate for WD athletes, however, and a new predictive equation is needed. OBJECTIVES: To determine the reproducibility of an adapted incremental field test for wheelchair-dependent (WD) athletes. SETTING: France at Montpellier. METHODS: The proposed protocol was conducted on a 400 m track. Eight male paraplegics (mean age: 30.8+/-5.1 years) performed the test three times in the same conditions, ie same time of day, same wheelchair, same material. Maximal heart rate (HRmax) and maximal speed (Smax) were measured. RESULTS: We found no significant differences (P>0.05) between tests for either variable. The Bland and Altman graphic analyses showed a good reproducibility for both variables. Lastly, the reproducibility coefficients of HRmax and Smax were very low (2% and 1%, respectively). CONCLUSION: The ALBT is reproducible concerning measurements of HRmax and Smax. A valid predictive equation of maximal oxygen uptake from the Smax is now needed for WD athletes during this field test.

Aerobic metabolism and cardioventilatory responses in paraplegic athletes during an incremental wheelchair exercise.

The aims of the present study were: (1) to assess aerobic metabolism in paraplegic (P) athletes (spinal lesion level, T4-L3) by means of peak oxygen uptake (VO2peak) and ventilatory threshold (VT), and (2) to determine the nature of exercise limitation in these athletes by means of cardioventilatory responses at peak exercise. Eight P athletes underwent conventional spirographic measurements and then performed an incremental wheelchair exercise on an adapted treadmill. Ventilatory data were collected every minute using an automated metabolic system: ventilation (l x min[-1]), oxygen uptake (VO2, l x min[-1], ml x min[-1] x kg[-1]), carbon dioxide production (VCO2, ml x min[-1]), respiratory exchange ratio, breathing frequency and tidal volume. Heart rate (HR, beats x min[-1]) was collected with the aid of a standard electrocardiogram. VO2peak was determined using conventional criteria. VT was determined by the breakpoint in the VCO2 - VO2 relationship, and is expressed as the absolute VT (VO2, ml x min[-1] x kg[-1]) and relative VT (percentage of VO2peak). Spirometric values and cardioventilatory responses at rest and at peak exercise allowed the measurement of ventilatory reserve (VR), heart rate reserve (HRr), heart rate response (HRR), and O2 pulse (O2 P). Results showed a VO2peak value of 40.6 (2.5) ml x min(-1) x kg(-1), an absolute VT detected at 23.1 (1.5) ml x min(-1) x kg(-1) VO2 and a relative VT at 56.4 (2.2)% VO2peak. HRr [15.8 (3.2) beats min(-1)], HRR [48.6 (4.3) beat x l(-1)], and O2 P [0.23 (0.02) ml x kg(-1) x beat(-1)] were normal, whereas VR at peak exercise [42.7 (2.4)%] was increased. As wheelchair exercise excluded the use of an able-bodied (AB) control group, we compared our VO2peak and VT results with those for other P subjects and AB controls reported in the literature, and we compared our cardioventilatory responses with those for respiratory and cardiac patients. The low VO2peak values obtained compared with subject values obtained during an arm-crank exercise may be due to a reduced active muscle mass. Absolute VT was somewhat comparable to that of AB subjects, mainly due to the similar muscle mass involved in wheelchair and arm-crank exercise by P and AB subjects, respectively. The increased VR, as reported in patients with chronic heart failure, suggested that P athletes exhibited cardiac limitation at peak exercise, and this contributed to the lower VO2peak measured in these subjects.

Validation of an incremental field test for the direct assessment of peak oxygen uptake in wheelchair-dependent athletes.

The aim of this study was to validate an incremental field test performed by wheelchair-dependent (WD) athletes. Nine male paraplegic subjects (mean age 28.9 +/- 4.2 years) performed an incremental field test (FT) and a comparable laboratory test (LT) with their own usual wheelchairs. Both tests started with an initial speed of 4 km.hr(-1) and increased by increments of 1 km.hr(-1) every minute until volitional exhaustion. The FT was an adapted Léger and Boucher test (ALBT) and was conducted on a 400 m tartan field marked-off every 50 m with pylons. Ventilatory data were collected every 15 s using a portable telemetric system (Cosmed K2, JFB International, Italy). The LT was performed on an adapted treadmill (Sopur, Germany) and ventilatory data were collected every minute using a breath-by-breath automated system (CPX, Medical Graphics, MN, USA). The LT and the FT were not significantly different for duration (8 min 50 +/- 1 min 24 vs 9 min 55 +/- 29 s), percentage of maximal heart rate (HR, 86.2 +/- 3.9 vs 89.7 +/- 5.3%), maximal minute ventilation (VE, 101.6 +/- 28.5 vs 96.8 +/- 28.2 1.min(-1)) and peak oxygen uptake (VO2 peak, 39.7 + 7.3 vs 36.1 + 5.8 ml.kg(-1).min(-1) assessed with the CPX and the K2, respectively. We concluded that the FT proposed in the present study is a valid test for direct VO2 peak assessment in wheelchair athletes using a portable VO2 telemetric system. Nonetheless, the Léger and Mercier model equation did not accurately predict VO2 max and further investigation is needed to determine a valid VO2 max prediction equation for these subjects during the FT.