Ratio of Total Carbon Dioxide produced. during Graded Exercise Testing
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1 VOLUME 12.2, 2016 D.O.I: http: doi.org/ /jbe Ratio of Total Carbon Dioxide produced to Oxygen consumed is predictive of VO 2 max during Graded Exercise Testing David Bellar 1, Lawrence W. Judge 2 1 School of Kinesiology, University of Louisiana-Lafayette, Lafayette, LA School of Kinesiology, Sport & Exercise Science, Ball State University, Muncie, IN ABSTRACT The purpose of the present investigation was to examine the ratio between total CO 2 expiration and O 2 consumption to VO 2 max. Twenty-six male (VO 2 max: 55.4± 8.3 ml O 2 /kg*min) and thirtyfive female (VO 2 max: 44.1± 8.1 ml O 2 /kg*min) recreationally active adults volunteered. The participants underwent a custom ramped treadmill protocol (GXT) with expired gases monitored. Third order polynomial regression was undertaken for the VO 2 and VCO 2 by time (r>0.950). Regression equations were integrated from 60seconds after the start of the test (to negate any initial hyperventilation) until VO 2 max. This area under the curve calculation was equal to the total accumulated expired CO 2 and consumed O 2. The ratio of total CO 2 to O 2 was calculated (AUC ratio). Data analysis was undertaken using multiple linear regression analysis. The model included gender, RER at VO 2 max and AUC ratio as predictors and relative VO 2 max as the outcome. The model was significant with predictor variable gender (b =0.582, p<0.001) and AUC ratio (b=-0.298, p=0.019) significant in the model. Based upon these results it would appear that individuals who are more fit relying more heavily on oxidative pathways throughout the course of a GXT. Key Words: Endurance, Performance, Exercise Testing Aerobic Capacity, Graded Exercise Test
2 46 JBE VOL. 12.2, 2016 INTRODUCTION Maximum oxygen uptake (VO 2 max) is commonly studied among both recreational and athletic populations and is widely held to be the criterion measure by which cardiovascular fitness is judged. The determination of maximum aerobic capacity has been studied in conjunction with performance among athletes in different sports for many years [7,15,19,21]. Specifically for many endurance athletes VO 2 max testing is a usefully tool to examine changes in physiological response to training stimuli [10]. While much is known in regard to outcome of maximum aerobic capacity, particularly in athletic populations, less is known about the differences in expired and inspired gases during the test. Some information has been brought forth regarding the slow and fast components of VO 2 kinetics [23]. This suggests that some trends in the data collected during graded exercise tests contain valuable information. Though maximum aerobic capacity is primarily concerned with oxygen consumption, expired carbon dioxide has been shown to play an important role in performance in these tests. Hermiston and Faulkner [13] reported the ability to predict maximum oxygen capacity in young men using a stepwise regression technique that included the fraction of carbon dioxide in expired gas. Duncan, Howley and Johnson [9] argued that a plateau in oxygen consumption was not a necessity in determination of maximum aerobic capacity, and that secondary measures such as a respiratory exchange ratio of greater than or equal to 1.15 might suffice. Given that during a graded exercise test it is common knowledge that the subject will increasingly rely on carbohydrates as work output increases, it is not shocking that expired CO 2 can be linked to the maximum workload and maximum oxygen use during a VO 2 max assessment. Furthermore, markers such as RER 1.0 [4] and the Respiratory Compensation point [5], the V-slope method to determine the anaerobic threshold [3] and the PEC [6] have all incorporated expired carbon dioxide into a marker within an exercise test that can be used for predicting athletic performance. Further, carboxyhemoglobin levels above 4.3% have been shown to impair the ability to achieve maximum aerobic capacity [14]. It is clear that carbon dioxide has a role in determination of a subjects maximum aerobic capacity. Given that higher starting percentages of carboxyhemoglobin impair the attainment of higher levels of oxygen use, it can be suggested that individuals who have higher maximum aerobic capacities might show a different pattern of carbon dioxide production during a test of maximum aerobic capacity. However, given the large number of studies that suggest RER as a plausible marker for VO 2 max [2,9,18] and a recent study that found nearly 75% of surveyed exercise physiologist used a preidentified value of RER as a criteria for the determination of VO 2 max [20] it would appear that ultimately maximum aerobic capacity tests end with similar absolute
3 AOC Ratio of CO 2 /O 2 and VO 2 max 47 ratios of expired carbon dioxide to consumed oxygen. However, overall ratios of expired carbon dioxide to oxygen consumed through an entire graded exercise test have yet to be investigated and may offer some insight as to the end point aerobic capacity. Based upon the association between higher carboxyhemoglobin levels and reduced aerobic capacity, and the likelihood of a higher absolute value of expired carbon dioxide near the end of a graded exercise test it can be hypothesized that persons with higher maximum aerobic capacity might maintain a lower overall ratio of expired carbon dioxide to consumed oxygen in a maximum aerobic assessment independent of RER at the conclusion of the test. MATERIALS AND METHODS Participants Twenty male (age: 20.0±1.0yrs, weight: 71.3±9.7kg, VO 2 max: 56.6± 8.6 ml O 2 /kg*min, RER at VO 2 max 1.18±0.08, HR at VO 2 max 187.5± 9.6) and eighteen female male (age: 21.1± 0.6yrs,weight: 55.8±7.2kg, VO 2 max: 44.8± 9.9 ml O 2 / kg*min, RER at VO 2 max 1.17±0.08, HR at VO 2 max 191.2±8.8) college aged students who were recreationally active volunteered for the present investigation. (see Table 1). All subjects gave informed consent prior to participating. Table 1 Participant Characteristics Age (yrs) VO 2 max Weight (kg) Male (N=26) 23.3± ± ±11.2 Female (N=35) 22.2± ± ±7.6 Table 1: Participant characteristics given in Means ± SD for male (n=26) and female (n=35) participants. Graded Exercise Testing Participants were asked to report to the Human Performance Lab for a graded exercise test to determine VO 2 max. The subjects ran on a Track Master TMX 425 treadmill (Full Vision Inc., Newton, KS.) during the assessment. Participants expired air was sampled and analyzed with a ParvoMedic TrueOne 2400 metabolic measurement system (ParvoMedics, Sandy, UT.) The system utilizes a mixing chamber and was set to sample expired air every 20 seconds. The system was
4 48 JBE VOL. 12.2, 2016 calibrated prior to each test according to the manufacturers specifications. Drift in the sensors was not appreciable during testing (<1.5%). Listed accuracy for the gas sensors in the unit are: paramagnetic O 2 analyzer ±0.1%, infrared CO 2 analyzer ±0.1%. pneumotach ± 2%. For the assessment a custom ramp protocol was used [4,6]. The test was concluded when the oxygen consumption was determined to have reach a plateau, or the participant volitionally quit exercise. In the present investigation most subjects demonstrated a plateau in oxygen consumption at the conclusion of the test. For the remaining subjects a VO 2 peak was determined from the best stage completed at an RER values of greater than Heart rate during the test was determined through a Polar Wear Link heart rate sensor (Polar Electro Inc., Lake Success, NY.) that was linked to a receptor on the metabolic measurement system. Area Under the Curve (CO 2 /O 2 ) Determination Third order polynomial regression was undertaken for the VO 2 (see example, Figure 1) and VCO 2 (see example, Figure 2) by time (r>0.950). Regression equations were then integrated from 60seconds after the start of the test (to negate any initial hyperventilation) until the point at which maximum oxygen consumption was determined to have occurred. This area under the curve calculation was equal to the total accumulated expired CO 2 and consumed O 2 during this time period. The values for carbon dioxide were then divided by the values for oxygen and a ratio score was created (AUC ratio). This ratio was then compared against the results of the VO 2 max test. AOC Ratio = VO 2 max 60 sec VO 2 max 60 sec 3rd order polynomial VCO 2 3rd order polynomial VCO 2
5 AOC Ratio of CO 2 /O 2 and VO 2 max 49 Figure 1. Example third order polynomial regression for VO 2 by time. Figure 2. Example third order polynomial regression for VCO 2 by time.
6 50 JBE VOL. 12.2, 2016 Statistical Analysis AUC ratio score was analyzed for normality via a Shapiro-Wilks test. Linear regressions (with for gender and RER at VO 2 max) were used to compare AOC ratio to the VO 2 max. Statistical significance was set a priori at alpha < A modern statistical software package was utilized for all analysis (JMP 12.0 Pro). RESULTS The analysis for normality of the AOC ratio data suggested a normal distribution, as the Shapiro Wilks test was non-significant (p>0.05). Additionally, analysis for problems of multicollinearity were not revealed during analysis (VIF<1.5). Area Under the Curve Analysis Data analysis examining the relationship between the AOC ratio and VO 2 max was undertaken using multiple regression analysis with gender as a descriptive variable. The results of the analysis showed a significant model (F=12.81, p<0.001) where AOC ratio was a negatively associated with VO2 max (b=-0.298, p=0.019), gender was a significant predictor in the model (b=0.582, p<0.001) but RER at VO 2 max was non significant (b=0.043, p=0.731). DISCUSSION The data from the present investigation suggest that individuals who achieve higher maximum aerobic capacities produce less carbon dioxide per unit of oxygen during a VO 2 max test independent of the final RER. In general, increases in expired CO 2 during exercise precede changes in blood lactate concentration but manifest the same trend of increasing with increased anaerobic metabolism [1]. Based upon this understanding, the smaller AOC ratio in higher fitness subjects might be attributed to a lesser amount of anaerobic contribution to exercise performance during the graded exercise test. Some evidence exists for this as it is known that the lactate threshold occurs at a higher percentage of VO 2 max in endurancetrained populations [17]. The findings from the present study expand upon the understand of a anaerobic threshold at a greater oxygen consumption in high fit individuals by suggesting that a lesser percentage of anaerobic metabolism contributes to the totality of an exercise test in high fit persons. This is further evidenced by the fact that RER at the conclusion of the GXT was not associated with aerobic fitness.
7 AOC Ratio of CO 2 /O 2 and VO 2 max 51 Past research has demonstrated that training induces changes in expired CO 2 at submaximal exercise intensities. Davis et al. [8] found that after training a submaximal exercise bout resulted in lower expired CO 2 without a concomitant decrease in VO 2. This again suggests that as people adapt to endurance training, the role of anaerobic metabolism in submaximal exercise is reduced. There are known changes in VO 2 max that occur with aging [11,12,22]. However, it has been found in athletes that performance can increase through time even in the face of declining maximum aerobic capacity [16]. Future studies will need to be conducted to examine the change in AOC ratio during exercise testing longitudinally. Given the decline in VO 2 max with age, and the potential to increase exercise performance with continued training [16] there may be changes in the AOC ratio that can contribute to the explanation for the observations. The present study is limited in scope based upon the modality of exercise, and the population that took part in the experiment. The results may not be generalizable to populations other than young adults, and may not be similar to data from exercise tests conducted on ergometers, nordic trainers or other common exercise modalities employed during exercise testing. CONCLUSIONS For those individuals engaged in exercise testing or training of healthy young adults the present study demonstrates that in aerobic exercise that is not maximal in intensity fit persons will use less anaerobic metabolism. Therefore, as a person s aerobic fitness increases even exercise at match intensities via percentages of VO 2 max will elicit less respiratory by product associated with anaerobic metabolism. Overall, individuals who are more fit will need to work at higher relative intensities as compared to less fit persons in order to engage in submaximal training that targets anaerobic bioenergetics. REFERENCES 1. Anderson GS and Rhodes EC. Relationship between blood lactate and excess CO 2 in elite cyclists. J Sports Sci 9(2): , Astorino TA, Robergs RA, Ghiasvand F, Marks D, and Burns S. Incidence of the oxygen plateau at VO2 max during exercise testing to volitional fatigue. Journal of Exercise Physiology Online 3(4): 1-12, Beaver WL, Wasserman K and Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60(6): , 1986.
8 52 JBE VOL. 12.2, Bellar D, Judge. LW Modeling and relationship of respiratory exchange ratio to athletic performance. J Strength Cond Res 26(9): , Bellar DM, Judge LW, Davis GR. Description and predictive value of a novel method for determining the respiratory compensation point using standard scores. J Strength Cond Res 29(5): , Bellar D, Tomescu V, Judge LW. Relationship of an equivalence point for change in VCO2 and VO2 to endurance performance. J Strength Cond Res 27(5): , Davis JA, Brewer J, and Atkin D. Pre-season physiological characteristics of english first and second division soccer players. J Sports Sci 10(6): , Davis JA, Frank MH, Whipp BJ, and Wasserman K. Anaerobic threshold alterations caused by endurance training in middle-aged men. J Appl Physiol 46(4): , Duncan GD, Howley ET and Johnson BN. Applicability of VO 2 max criteria: discontinuous versus continuous protocols. Med Sci Sports Exerc 29(2): , Fiskerstrand A and Seiler KS. Training and performance characteristics among Norwegian international rowers Scand J Med Sci Sports 14(5): , Fitzgerald MD, Tanaka H, Tran ZV and Seals DR. Age-related declines in maximal aerobic capacity in regularly exercising vs. sedendary women: a meta-analysis. J Appl Physiol, 83(1): , Fleg JL, Morrell CH, Bos AG, Brant LJ, Talbot LA, Wright JG, Lakatta EG. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 112: , Hermiston RT and Faukner JA. Prediction of maximum oxygen uptake by a stepwise regression technique. J Appl Physiol 30(6): , Horvath SM, Raven PB, Dahms TE, and Gray DJ. Maximal aerobic capacity at different levels of carboxyhemoglobin. J Appl Physiol 38(2): , Ingjer F. Maximal oxygen uptake as a predictor of performance ability in women and men elite cross-country skiers. Scand J Med Sci Sports 1(1):25-30, Jones AM. A five year physiological case study of an Olympic runner. Br J Sports Med 2: 39-43, Myers J, Ashley E. Dangerous Curves: A perspective on Exercise, Lactate, and the Anaerobic Threshold. Chest 111(3): , Noonan V and Dean E. Submaximal exercise testing: clinical application and interpretation. Physical Therapy 80(8): , Rankovic G, Mutavdzic V, Toskic D, Preljevic A, Kocic M, Nedin Rankovic G, and Damjanovic N. Aerobic capacity as an indicator in different kinds of sports. Bosn J Basic Med Sci 10(1): 44-48, 2010.
9 AOC Ratio of CO 2 /O 2 and VO 2 max Robergs RA, Dywer D, Astorino T. Recommendations for improved data processing from expired gas analysis indirect calorimetry. Sports Med 40(2): , Smith DJ, Roberts D, and Watson B. Physical, physiological and performance differences between Canadian national team and Universidad volleyball players. J Sports Sci 10(2): , Wilson TM and Tanaka H. Meta-analysis of the age-associated decline in maximal aerobic capacity in men: relation to training status. Am J Physiol Heart Circ Physiol 278(3): H829-H834, Xu F, Rhodes EC. Oxygen uptake kinetics during exercise. Sports Med 27(5): , Address for correspondence: Dr. David Bellar 225 Cajundome Blvd Department of Kinesiology University of Louisiana Lafayette dmb1527@louisiana.edu Cell Phone: (216) Fax Number: (337)
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