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Clinical V̇ o 2peak is “part of the deal”

2017; American Physiological Society; Volume: 122; Issue: 5 Linguagem: Inglês

10.1152/japplphysiol.00187.2017

8750-7587

Eric van Breda, Paul F.M. Schoffelen, Guy Plasqui,

Chronic Obstructive Pulmonary Disease (COPD) Research

Letter to the EditorClinical V̇o2peak is “part of the deal”Eric van Breda, Paul F. M. Schoffelen, and Guy PlasquiEric van BredaFaculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy; Research Centre MOVANT, University of Antwerp, Antwerp, Belgium; and , Paul F. M. SchoffelenDepartment of Human Biology and Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands, and Guy PlasquiDepartment of Human Biology and Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The NetherlandsPublished Online:18 May 2017https://doi.org/10.1152/japplphysiol.00187.2017MoreSectionsPDF (51 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat to the editor: We read with much interest the invited review of Drs. Poole and Jones (3) in which they waived the concept of V̇o2peak, and as far as we believe, based on fragile scientific arguments. Still, we believe Poole and Jones’ review is of interest to all those involved in exercise testing, and their work provides an interesting pabulum on the topic. But notwithstanding, we would like to comment on a few aspects in their paper that, with all respect, do not meet clinical daily practice.Although we agree with the importance of the concept and theories of V̇o2max, we find it unfortunate that there is no reference to the both scientifically and clinically interesting and important parameters that can be identified in the phases before maximum or plateaued V̇o2, i.e., V̇o2max, and the absence of the scientific controversy regarding reliable breath-by-breath analysis in exercise testing. For instance, the concepts of aerobic/anaerobic and ventilatory thresholds encompass important clinical information that plays a major role to test a “training or therapeutic paradigm” in the sports and clinical setting without the necessity of having information of the maximum or plateau in V̇o2. We would also like to emphasis that the highest V̇o2 reached during a test, whether or not being a true V̇o2max, is of major clinical importance considering the wealth of information it provides concerning the subjective state of a patient under loading conditions and the therapeutic implications it has within a clinical setting.The other comment we would like to make is the fact that the authors used technological progress in indirect calorimetry as one of the most important factors for waiving the concept of V̇o2peak. The authors made a firm statement that the combination of an incremental-ramp test with breath-by-breath analysis is the method of choice for experimental and clinical cardiorespiratory assessment. We, however, showed that mixing chamber systems have better accuracy and precision than breath-by- breath systems, according to theoretical error analysis based on general error propagation theory (1). The differences in results between mixing chambers and breath-by-breath analysis are caused by the fact that the methods compute the average expired oxygen and carbon dioxide fractions FEO2 and FECO2 in a different way. Breath-by-breath systems calculate the expired gas volumes by integrating the product of flow and gas fractions, whereas mixing chamber systems measure FEO2 and FECO2directly in the mixing chamber. Moreover, Farmery et al. (2) showed that when employing breath-by-breath analysis, within-breath measurements are mandatory. Such measurements are an immediate function of time that cannot be provided by most clinical gas analyzers because of their slow response times (2).Finally, we would like to comment on the by Poole and Jones advocated “short constant-work rate verification phase” after the steep-ramp test. First of all, we believe it is, at least in a clinical setting, unrealistic and unethical in certain patient populations, and we, alas, have to disagree with such explicit recommendation. Second, in patient populations you have to accept that the day-to-day (patho)physiological variation caused by nonphysiological elements is “part of the deal.”DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSE.v.B. interpreted results of experiments; E.v.B. and G.P. drafted manuscript; E.v.B., P.F.S., and G.P. edited and revised manuscript; E.v.B., P.F.S., and G.P. approved final version of manuscript.REFERENCES1. Beijst C, Schep G, Breda E, Wijn PF, Pul C. Accuracy and precision of CPET equipment: a comparison of breath-by-breath and mixing chamber systems. J Med Eng Technol 37: 35–42, 2013. doi:10.3109/03091902.2012.733057. Crossref | PubMed | Google Scholar2. Farmery AD, Hahn CE. Response-time enhancement of a clinical gas analyzer facilitates measurement of breath-by-breath gas exchange. J Appl Physiol (1985) 89: 581–589, 2000. Link | ISI | Google Scholar3. Poole DC, Jones AM. CORP: Measurement of the Maximum Oxygen Uptake (VO2max): VO2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google ScholarAUTHOR NOTESAddress for reprint requests and other correspondence: E. van Breda, Universiteitsplein 1, 2610-Antwerp-Wilrijk, Belgium (e-mail: eric.[email protected]be). Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Collections Related ArticlesReply to Drs. Van Breda et al. 18 May 2017Journal of Applied PhysiologyCited ByCardiopulmonary exercise testing with supramaximal verification produces a safe and valid assessment of V̇o2max in people with cystic fibrosis: a retrospective analysisAdam J. Causer, Janis K. Shute, Michael H. Cummings, Anthony I. Shepherd, Victoria Bright, Gary Connett, Mark I. Allenby, Mary P. Carroll, Thomas Daniels, and Zoe L. Saynor22 October 2018 | Journal of Applied Physiology, Vol. 125, No. 4Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord InjuryArchives of Physical Medicine and RehabilitationThe Maximal Oxygen Uptake Verification Phase: a Light at the End of the Tunnel?8 December 2017 | Sports Medicine - Open, Vol. 3, No. 1Measurement of V̇o2max in clinical groups is feasible and necessaryCraig Anthony Williams, Zoe L. Saynor, Alan R. Barker, Patrick J. Oades, and Owen W. Tomlinson26 October 2017 | Journal of Applied Physiology, Vol. 123, No. 4Reply to Drs. Van Breda et al.David C. Poole and Andrew M. Jones18 May 2017 | Journal of Applied Physiology, Vol. 122, No. 5 More from this issue > Volume 122Issue 5May 2017Pages 1370-1370 Copyright & PermissionsCopyright © 2017 the American Physiological Societyhttps://doi.org/10.1152/japplphysiol.00187.2017PubMed28522747History Received 28 February 2017 Accepted 20 March 2017 Published online 18 May 2017 Published in print 1 May 2017 Metrics