Identifying physiological determinants of 800 m running performance using post-exercise blood lactate kinetics.

PURPOSE: The aims of the present study were to investigate blood lactate kinetics following high intensity exercise and identify the physiological determinants of 800 m running performance. METHODS: Fourteen competitive 800 m runners performed two running tests. First, participants performed a multistage graded exercise test to determine physiological indicators related to endurance performance. Second, participants performed four to six 30-s high intensity running bouts to determine post-exercise blood lactate kinetics. Using a biexponential time function, lactate exchange ability (γ1), lactate removal ability (γ2), and the quantity of lactate accumulated (QLaA) were calculated from individual blood lactate recovery data. RESULTS: 800 m running performance was significantly correlated with peak oxygen consumption (r = -0.794), γ1 and γ2 at 800 m race pace (r = -0.604 and -0.845, respectively), and QLaA at maximal running speed (r = -0.657). V ˙ O2peak and γ2 at 800 m race pace explained 83% of the variance in 800 m running performance. CONCLUSION: Our results indicate that (1) a high capacity to exchange and remove lactate, (2) a high capacity for short-term lactate accumulation and, (3) peak oxygen consumption, are critical elements of 800 m running performance. Accordingly, while lactate has primarily been utilized as a performance indicator for long-distance running, post-exercise lactate kinetics may also prove valuable as a performance determinant in middle-distance running.

A Comparison of Critical Speed and Critical Power in Runners Using Stryd Running Power.

PURPOSE: Although running traditionally relies on critical speed (CS) as an indicator of critical intensity, portable inertial measurement units offer a potential solution for estimating running mechanical power to assess critical power (CP) in runners. The purpose of this study was to determine whether CS and CP differ when assessed using the Stryd device, a portable inertial measurement unit, and if 2 running bouts are sufficient to determine CS and CP. METHODS: On an outdoor running track, 10 trained runners (V˙O2max, 59.0 [4.2] mL·kg-1·min-1) performed 3 running time trials (TT) between 1200 and 4400 m on separate days. CS and CP were derived from 2-parameter hyperbolic speed-time and power-time models, respectively, using 2 (CS2TT and CP2TT) and 3 (CS3TT and CP3TT) TTs. Subsequently, runners performed constant-intensity running for 800 m at their calculated CS3TT and CP3TT. RESULTS: Running at the calculated CS3TT speed (3.88 [0.44] m·s-1) elicited an average Stryd running power (271 [28] W) not different from the calculated CP3TT (270 [28]; P = .940; d = 0.02), with excellent agreement between the 2 values (intraclass correlation coefficient = .980). The CS2TT (3.97 [0.42] m·s-1) was not higher than CS3TT (3.89 [0.44] m·s-1; P = .178; d = 0.46); however, CP2TT (278 [29] W) was greater than CP3TT (P = .041; d = 0.75). CONCLUSION: The running intensities at CS and CP were similar, supporting the use of running power (Stryd) as a metric of aerobic fitness and exercise prescription, and 2 trials provided a reasonable, albeit higher, estimate of CS and CP.

Is Running Power a Useful Metric? Quantifying Training Intensity and Aerobic Fitness Using Stryd Running Power Near the Maximal Lactate Steady State.

We sought to determine the utility of Stryd, a commercially available inertial measurement unit, to quantify running intensity and aerobic fitness. Fifteen (eight male, seven female) runners (age = 30.2 [4.3] years; V·O2max = 54.5 [6.5] ml·kg-1·min-1) performed moderate- and heavy-intensity step transitions, an incremental exercise test, and constant-speed running trials to establish the maximal lactate steady state (MLSS). Stryd running power stability, sensitivity, and reliability were evaluated near the MLSS. Stryd running power was also compared to running speed, V·O2, and metabolic power measures to estimate running mechanical efficiency (EFF) and to determine the efficacy of using Stryd to delineate exercise intensities, quantify aerobic fitness, and estimate running economy (RE). Stryd running power was strongly associated with V·O2 (R2 = 0.84; p < 0.001) and running speed at the MLSS (R2 = 0.91; p < 0.001). Stryd running power measures were strongly correlated with RE at the MLSS when combined with metabolic data (R2 = 0.79; p < 0.001) but not in isolation from the metabolic data (R2 = 0.08; p = 0.313). Measures of running EFF near the MLSS were not different across intensities (~21%; p > 0.05). In conclusion, although Stryd could not quantify RE in isolation, it provided a stable, sensitive, and reliable metric that can estimate aerobic fitness, delineate exercise intensities, and approximate the metabolic requirements of running near the MLSS.

A "Step-Ramp-Step" Protocol to Identify Running Speed and Power Associated with the Maximal Metabolic Steady State.

PURPOSE: A previously established Step-Ramp-Step (SRS) exercise protocol was able to accurately predict the work rate associated with the maximal metabolic steady state (MMSS) in cyclists. The purpose of this study was to determine whether a modified SRS protocol could predict the running speed and power associated with the MMSS. METHODS: Fifteen (8 male; 7 female) runners (V̇O 2max 54.5 [6.5] mL·kg -1 ·min -1 ) were recruited for this investigation composed of four to five visits. In the first visit, runners performed a moderate intensity step (MOD), an incremental exercise test, and a heavy intensity step (HVY), on a motorized treadmill. This SRS protocol was used to predict the running speed and power associated with the MMSS (i.e., the SRS-MMSS), where running power was assessed by a wearable device (Stryd) attached to each runner's shoe. Subsequent visits were used to confirm the maximal lactate steady state (MLSS) as a proxy measure of the MMSS (i.e., the MLSS-MMSS) and to validate the SRS-MMSS speed and power estimates. RESULTS: The estimated SRS-MMSS running speed (7.2 [0.6] mph) was significantly lower than confirmed running speed at MLSS-MMSS (7.5 [0.8] mph; bias = 3.6%, P = 0.005); however, the estimated SRS-MMSS running power (241 [35] W) was not different than the MLSS-MMSS confirmed running power (240 [37] W; bias = -0.6%; P = 0.435). V̇O 2 at SRS-MMSS (3.22 [0.49] L·min -1 ) was not different than respiratory compensation point (3.26 [0.58] L·min -1 ; P = 0.430). Similarly, V̇O 2 at MLSS-MMSS (3.30 [0.54] L·min -1 ) was not different than respiratory compensation point ( P = 0.438). CONCLUSIONS: The SRS protocol allows MMSS, as measured by MLSS, to be accurately determined using running power (Stryd), but not speed, in a single laboratory visit.

Use of subject-specific models to detect fatigue-related changes in running biomechanics: a random forest approach.

Running biomechanics are affected by fatiguing or prolonged runs. However, no evidence to date has conclusively linked this effect to running-related injury (RRI) development or performance implications. Previous investigations using subject-specific models in running have demonstrated higher accuracy than group-based models, however, this has been infrequently applied to fatigue. In this study, two experiments were conducted to determine whether subject-specific models outperformed group-based models to classify running biomechanics during non-fatigued and fatigued conditions. In the first experiment, 16 participants performed four treadmill runs at or around the maximal lactate steady state. In the second experiment, nine participants performed five prolonged runs using commercial wearable devices. For each experiment, two segments were extracted from each trial from early and late in the run. For each participant, a random forest model was applied with a leave-one-run-out cross-validation to classify between the early (non-fatigued) and late (fatigued) segments. Additionally, group-based classifiers with a leave-one-subject-out cross validation were constructed. For experiment 1, mean classification accuracies for the single-subject and group-based classifiers were 68.2 ± 8.2% and 57.0 ± 8.9%, respectively. For experiment 2, mean classification accuracies for the single-subject and group-based classifiers were 68.9 ± 17.1% and 61.5 ± 11.7%, respectively. Variable importance rankings were consistent within participants, but these rankings differed from each participant to those of the group. Although the classification accuracies were relatively low, these findings highlight the advantage of subject-specific classifiers to detect changes in running biomechanics with fatigue and indicate the potential of using big data and wearable technology approaches in future research to determine possible connections between biomechanics and RRI.

Between-Day Reliability of Commonly Used IMU Features during a Fatiguing Run and the Effect of Speed.

The purpose of this study was to determine if fatigue-related changes in biomechanics derived from an inertial measurement unit (IMU) placed at the center of mass (CoM) are reliable day-to-day. Sixteen runners performed two runs at maximal lactate steady state (MLSS) on a treadmill, one run 5% above MLSS speed, and one run 5% below MLSS speed while wearing a CoM-mounted IMU. Trials were performed to volitional exhaustion or a specified termination time. IMU features were derived from each axis and the resultant. Feature means were calculated for each subject during non-fatigued and fatigued states. Comparisons were performed between the two trials at MLSS and between all four trials. The only significant fatigue state × trial interaction was the 25th percentile of the results when comparing all trials. There were no main effects for trial for either comparison method. There were main effects for fatigue state for most features in both comparison methods. Reliability, measured by an intraclass coefficient (ICC), was good-to-excellent for most features. These results suggest that fatigue-related changes in biomechanics derived from a CoM-mounted IMU are reliable day-to-day when participants ran at or around MLSS and are not significantly affected by slight deviations in speed.

Feasibility and Reliability of a Novel Game-Based Test of Neurological Function in Youth: The Equilibrium Test Battery.

Background: An estimated 11% of Canadian adolescents will sustain a sport-related concussion each year. However, diagnostic tools to detect and monitor concussive outcomes are limited. Purpose: To evaluate the feasibility and test-retest reliability of the Highmark Interactive Equilibrium (HIEQ) test battery in uninjured adolescents. Study Design: Observational study with repeated measurements. Methods: Participants completed the HIEQ test battery, a game-based platform on an iPad application, that assesses balance, cognitive function, and visual function, for up to 15 consecutive school days in a group classroom setting. Feasibility for use of the HIEQ was evaluated by (1) recruitment rates; (2) retention rates; (3) test completion without assistance; and (4) adverse events. Test-retest reliability was examined using Bland Altman 95% limits of agreement and intraclass correlation coefficients comparing the first and second and second and third obtained scores. Reliability across multiple baseline assessments was also analyzed using intraclass correlations for the second to sixth and seventh to eleventh obtained scores. Results: Fifty-five uninjured high school students (31 females and 24 males, mean age = 16.24 [1.09]) from three high schools participated in the study. Three participants (5%) completed all 15 days of testing, and 73% completed at least 10 of 15 test days. No adverse events were reported. Although the test was feasible, all subtests showed wide limits of agreement from first to second and from second to third testing occasions. Results indicate poor-to-moderate reliability (<0.50 to 0.75) across those intervals, as well as across the second to sixth and seventh to eleventh testing occasions. Conclusion: The HIEQ is feasible in high school students; however, performance was characterized by wide limits of agreement and poor-to-moderate reliability across test occasions. Future evaluation of the HIEQ in visual and auditory distraction free individual testing settings is warranted. Level of Evidence: Level 3.

The effect of an exertional field-test on sport concussion assessment tool 5 subcomponents in University rugby and wrestling athletes: A pilot prospective case series.

OBJECTIVES: To evaluate how an exertional field-test impacts the Sport Concussion Assessment Tool 5 (SCAT5) subcomponents in uninjured athletes. DESIGN: Prospective case-series. SETTING: Sports medicine setting. PARTICIPANTS: A total of 37 rugby and wrestling athletes (76% female) with a median age of 19 years (range: 18-23). Twenty-one (57%) had a history of concussion. MAIN OUTCOME MEASURES: The SCAT5 was administered prior-to and following a volitionally fatiguing, field-based 30-15 Intermittent Fitness Test. The primary outcome measures included: total symptom scores and severity, standardized assessment of concussion, neurological screening, and balance errors during the modified balance error scoring system. Wilcoxon signed-rank tests examined differences in ordinal data between pre- and post-exertion with Bonferroni corrections (alpha = 0.006). Data were also stratified into time to SCAT5 administration post-exertion and compared via Cliff's Delta (d). RESULTS: The SCAT5 was administered a median of 20-min (interquartile range: 14-26-min) following exertion. No differences were found pre- and post-exertion across all SCAT5 metrics (p > 0.048). Within the post-exertion 0-10-min stratification, total symptoms and severity scores appeared to be elevated with a large effect size (d ≥ 0.64). CONCLUSIONS: While SCAT5 metrics were not statistically altered when quantified a median of 20-min following high-intensity exertion; greater symptom reporting may occur 10-min following exertion.

One-year stability of preseason Sport Concussion Assessment Tool 5 (SCAT5) values in university level collision and combative sport athletes.

OBJECTIVES: To determine the stability of the Sport Concussion Assessment Tool (SCAT) 5 between consecutive seasons in uninjured collision and combative varsity athletes. METHODS: Thirty-six athletes (19 females) were recruited to participate (wrestling [n = 12], rugby [n = 14], and hockey [n = 10]). The SCAT5 was administration at the start of the 2017 and 2018 seasons. Median baseline demographics for 2017 were as follows: age (19 years [range: 17-24 years]), height (174 cm [range: 149-195 cm]), and weight (76 kg [range: 57-118 kg]). Outcome metrics included subcomponents of the SCAT5: symptom reporting, standardized assessment of concussion (SAC), neurological screening, and balance performance measured with the modified balance error scoring system (mBESS). Wilcoxon signed-rank tests and Cronbach's alpha (α) values were calculated to determine the stability between consecutive years for the SCAT5 variables in the same cohort of athletes. Bonferroni corrections were applied for Wilcoxon signed-rank tests, where alpha = 0.006 (0.05/9). RESULTS: Between the 2017 and 2018 seasons, no differences were noted in symptom reporting (p = 0.14), SAC (p = 0.32), neurological screening (p = 0.98), and balance performance on the mBESS (p = 0.01). The Cronbach's alpha displayed unacceptable to questionable levels of within-subject stability (range: α = 0.34-0.70) for all subcomponents, except months in reverse order (α = 0.92). CONCLUSIONS: While no statistical differences were present for all SCAT5 subcomponent metrics between 2017 and 2018 baselines, all but one displayed unacceptable to questionable stability (α ≤ 0.70) when retested one year later. Further research is needed to understand the appropriate time duration baseline SCAT5 values can reliably be utilized within longitudinal studies; as well as the normal variation of SCAT5 reporting/scoring.

Concurrent Validity of a Stationary Cycling Test and the Buffalo Concussion Treadmill Test in Adults With Concussion.

CONTEXT: After concussion, a multifaceted assessment is recommended, including tests of physical exertion. The current criterion standard for exercise testing after concussion is the Buffalo Concussion Treadmill Test (BCTT); however, validated tests that use alternative exercise modalities are lacking. OBJECTIVE: To evaluate the feasibility and concurrent validity of a universal cycling test of exertion compared with the BCTT in adults who sustained a sport-related concussion. DESIGN: Crossover study. SETTING: University sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: Twenty adults (age = 18-60 years) diagnosed with a sport-related concussion. INTERVENTION(S): Participants completed the BCTT and a cycling test of exertion in random order, approximately 48 hours apart. MAIN OUTCOME MEASURE(S): The primary outcome of interest was maximum heart rate (HRmax; beats per minute [bpm]). Secondary outcomes of interest were the total number of symptoms endorsed on the Post-Concussion Symptom Scale, whether the participant reached volitional fatigue (yes or no), the symptom responsible for test cessation (Post-Concussion Symptom Scale), maximum rating of perceived exertion, symptom severity on a visual scale (0-10), and the time to test cessation. RESULTS: Of the 20 participants, 19 (10 males, 9 females) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT (171 bpm; interquartile range = 139-184 bpm) was not different from the median HRmax for the cycle (173 bpm; interquartile range = 160-182 bpm; z = -0.63; P = .53). For both tests, the 3 most frequently reported symptoms responsible for test cessation were headache, dizziness, and pressure in the head. Of interest, most participants (64%) reported a different symptom responsible for cessation of each test. CONCLUSIONS: On the novel cycling test of exertion, participants achieved similar HRmax and test durations and, therefore, this test may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.

The effect of high-intensity physical exertion on measures of cervical spine, vestibular/ocular-motor screening, and vestibulo-ocular reflex function in university level collision and combative sport athletes.

OBJECTIVES: To examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function. DESIGN: Case series. SETTING: Sports Medicine Centre. PARTICIPANTS: A total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17-23 years]). MAIN OUTCOME MEASURES: Outcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30-15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p < 0.004. RESULTS: Cervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p < 0.001), but not on the right between conditions (z = -1.49; p = 0.14). Athletes reported increased dizziness (z = -3.55; p = 0.004) and had reduced DVA following exertion (z = -2.78; p < 0.001). All other metrics were not significantly different following exertion (p > 0.011). CONCLUSION: Reduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.

Validity of electrical impedance myography to estimate percent body fat: comparison to bio-electrical impedance and dual-energy X-ray absorptiometry.

BACKGROUND: Assessment of percent body fat (%BF) is typically measured with bioelectrical impedance (BIA) as a proxy for dual-energy X-ray absorptiometry (DXA). Notably, poorer agreement between BIA and DXA among persons who are overweight or obese has been reported. The use of electrical impedance myography (EIM) as a proxy for DXA has not been validated. The objective was to evaluate an EIM device and two multi-frequency BIA devices with the reference standard (DXA) stratified by weight status and gender. METHODS: In a convenience sample of 82 adults, %BF assessed by EIM and two BIA devices was compared to DXA. Agreement between devices was tested with intra-class correlation coefficients (ICC) and Bland-Altman plots. RESULTS: Agreement between DXA and EIM (ICC=0.77) was poorer than the agreement between either BIA device with DXA (ICC>0.87). Stratified by sex, agreement between EIM and DXA was greater for men than women (ICC=0.81 and ICC=0.61, respectively). Stratified by BMI, agreement between EIM and DXA was best for normal-weight individuals (ICC=0.89) and progressively poorer for overweight (ICC=0.80) and obese (ICC=0.67) individuals. Bland-Altman plots revealed wide limits of agreement and an increase in EIM mean difference as average %BF increased. Similar trends were seen in BIA assessments. CONCLUSIONS: EIM and BIA substantially underestimate %BF in overweight and obese individuals. Wide limits of agreement coupled with variable ICC limit device interchangeability with one another and limit clinical utility.