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Commentaries on Viewpoint: V̇ o 2peak is an acceptable estimate of cardiorespiratory fitness but not V̇ o 2max
2018; American Physiological Society; Volume: 125; Issue: 1 Linguagem: Inglês
10.1152/japplphysiol.00319.2018
ISSN8750-7587
AutoresPaulo Henrique Silva Marques de Azevedo, Dharini M. Bhammar, Tony G. Babb, T. Scott Bowen, Klaus K. Witte, Harry B. Rossiter, Julien V. Brugniaux, Ben D. Perry, Ricardo Dantas de Lucas, Tiago Turnes, Jeann L. Sabino‐Carvalho, Thaís Lopes, Rodrigo Zacca, Ricardo J. Fernandes, Greg L. McKie, Tom J. Hazell, Lucas Helal, Anderson Donelli da Silveira, Craig McNulty, Regina Roberg, Tom E. Nightingale, Abdullah A. Alrashidi, Evgeny Mashkovskiy, Andrei V. Krassioukov, Pierre Clos, Davy Laroche, Benjamin Pageaux, David C. Poole, Andrew M. Jones, Gustavo Z. Schaun, Diego Santos Souza, T de Oliveira Barreto Lopes, Mary Vagula, Li Zuo, Tong Zhao,
Tópico(s)Cardiovascular Effects of Exercise
ResumoViewpointCommentaries on Viewpoint: V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2maxPublished Online:25 Jul 2018https://doi.org/10.1152/japplphysiol.00319.2018This article has been correctedMoreSectionsPDF (140 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat IS IT TIME TO WITHDRAW V̇o2peak TERMINOLOGY FROM SCIENTIFIC LITERATURE?Paulo Azevedo.Author AffiliationsExercise Physiology Studies and Research Group (GEPEFEX), Federal University of São Paulo, Santos, São Paulo, Brazil.to the editor: We can define V̇o2max as the highest oxygen delivered and utilized during exercise, and, if we increase the exercise intensity, the oxygen uptake will not increase. This assumption came from an original study of Hill and Lupton (2); they applied on different days higher intensities during a constant-work exercise. The authors observed that, above certain intensity, the O2 uptake does not increase. Because of the nature of the constant-work exercise, they observed a plateau phenomenon. Since then, plateau phenomenon has been the main “true” V̇o2max attainment criterion. If the plateau is not present, we consider it as V̇o2peak. However, the plateau is neither evident for ramp nor step protocol (5). The plateau appearance is dependent on data manipulation (4), subjects’ fitness, motivation, perceived exertion, and so on (3). Therefore, the plateau does not appear to be a natural physiological response in the face of the incremental exercise testing, and a plateau phenomenon is a wrong interpretation of Hill and Lupton study. As the maximum intensity achieved during incremental testing is dependent on, a priori, motivation (3), we must do the V̇o2max confirmation, independently of the plateau appearance, satisfying the main criterion “The O2 uptake does not increase irrespective of intensity increment.” In my view, the V̇o2peak is not a valid physiological index, and the terminology used in the Green and Askew (1) Viewpoint must be withdrawn from the scientific literature. The confirmation test is the best choice for cardiorespiratory assessments.REFERENCES1. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar2. Hill AV, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. QJM 16: 135–171, 1923. doi:10.1093/qjmed/os-16.62.135.Crossref | Google Scholar3. Noakes TD. Testing for maximum oxygen consumption has produced a brainless model of human exercise performance. Br J Sports Med 42: 551–555, 2008. doi:10.1136/bjsm.2008.046821. Crossref | PubMed | ISI | Google Scholar4. Robergs RA, Dwyer D, Astorino T. Recommendations for improved data processing from expired gas analysis indirect calorimetry. Sports Med 40: 95–111, 2010. doi:10.2165/11319670-000000000-00000. Crossref | PubMed | ISI | Google Scholar5. Rossiter HB, Kowalchuk JM, Whipp BJ. A test to establish maximum O2 uptake despite no plateau in the O2 uptake response to ramp incremental exercise. J Appl Physiol (1985) 100: 764–770, 2006. doi:10.1152/japplphysiol.00932.2005. Link | ISI | Google ScholarREFERENCES1. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar2. Hill AV, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. QJM 16: 135–171, 1923. doi:10.1093/qjmed/os-16.62.135.Crossref | Google Scholar3. Noakes TD. Testing for maximum oxygen consumption has produced a brainless model of human exercise performance. Br J Sports Med 42: 551–555, 2008. doi:10.1136/bjsm.2008.046821. Crossref | PubMed | ISI | Google Scholar4. Robergs RA, Dwyer D, Astorino T. Recommendations for improved data processing from expired gas analysis indirect calorimetry. Sports Med 40: 95–111, 2010. doi:10.2165/11319670-000000000-00000. Crossref | PubMed | ISI | Google Scholar5. Rossiter HB, Kowalchuk JM, Whipp BJ. A test to establish maximum O2 uptake despite no plateau in the O2 uptake response to ramp incremental exercise. J Appl Physiol (1985) 100: 764–770, 2006. doi:10.1152/japplphysiol.00932.2005. Link | ISI | Google ScholarCOMMENTARY ON VIEWPOINT: V̇o2peak IS AN ACCEPTABLE ESTIMATE OF CARDIORESPIRATORY FITNESS BUT NOT V̇o2maxDharini M. Bhammar1 and Tony G. Babb2.Author Affiliations1Kinesiology and Nutrition Sciences, School of Allied Health Sciences, University of Nevada-Las Vegas, Las Vegas, NV.2Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX.to the editor: Green and Askew (2) contend that V̇o2max is the maximum rate of oxygen uptake and V̇o2peak is the highest rate of oxygen uptake measured during a single “maximum” test. However, this definition does not clarify the V̇o2max versus V̇o2peak issue. The question we must ask ourselves is: can the highest rate of oxygen uptake during a single “maximum” test (i.e., V̇o2peak) also be V̇o2max? Relatively small studies have showed that 29% of normal weight children (1), 44% of obese children (1), and 32% of obese adults (5) do not exhibit a higher verification test V̇o2 compared with a maximum test V̇o2, suggesting that the highest V̇o2 from a single “maximum” test can also be V̇o2max. The goal of verification testing is to elicit a “higher” V̇o2 if possible or confirm V̇o2max from the “maximum” test as suggested by Poole and Jones (4). To label the highest V̇o2 from a single “maximum” test as “V̇o2peak” as recommended by Green and Askew (2) without evidence that a “higher” V̇o2max is actually possible may not be methodologically sound. However, we recognize that errors in measuring V̇o2max and in presenting V̇o2max (i.e., ml/kg vs. %predicted) (3) may lead to greater interpretation errors than testing without verification. Furthermore, confirming attainment of V̇o2max is probably less important while testing patient populations, because potentially small differences between the maximum and verification test do not justify cost, time, effort, or risks to the patient, especially in symptom-limited patients (2). Nevertheless, V̇o2max need not be an elusive measurement.REFERENCES1. Bhammar DM, Stickford JL, Bernhardt V, Babb TG. Verification of maximal oxygen uptake in obese and nonobese children. Med Sci Sports Exerc 49: 702–710, 2017. doi:10.1249/MSS.0000000000001170. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Lorenzo S, Babb TG. Quantification of cardiorespiratory fitness in healthy nonobese and obese men and women. Chest 141: 1031–1039, 2012. doi:10.1378/chest.11-1147. Crossref | PubMed | ISI | Google Scholar4. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar5. Sawyer BJ, Tucker WJ, Bhammar DM, Gaesser GA. Using a verification test for determination of VO2max in sedentary adults with obesity. J Strength Cond Res 29: 3432–3438, 2015. doi:10.1519/JSC.0000000000001199. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Bhammar DM, Stickford JL, Bernhardt V, Babb TG. Verification of maximal oxygen uptake in obese and nonobese children. Med Sci Sports Exerc 49: 702–710, 2017. doi:10.1249/MSS.0000000000001170. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Lorenzo S, Babb TG. Quantification of cardiorespiratory fitness in healthy nonobese and obese men and women. Chest 141: 1031–1039, 2012. doi:10.1378/chest.11-1147. Crossref | PubMed | ISI | Google Scholar4. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar5. Sawyer BJ, Tucker WJ, Bhammar DM, Gaesser GA. Using a verification test for determination of VO2max in sedentary adults with obesity. J Strength Cond Res 29: 3432–3438, 2015. doi:10.1519/JSC.0000000000001199. Crossref | PubMed | ISI | Google ScholarCOMMENTARY ON VIEWPOINT: V̇o2peak IS AN ACCEPTABLE ESTIMATE OF CARDIORESPIRATORY FITNESS BUT NOT V̇o2maxT. Scott Bowen,1 Klaus K. Witte,2 and Harry B Rossiter13.Author Affiliations1Faculty of Biological Sciences, University of Leeds, Leeds, UK.2Faculty of Medicine, University of Leeds, Leeds, UK.3Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.to the editor: A wealth of data supports robustly the conclusion that V̇o2peak provides a valuable index of cardiorespiratory fitness. The most important evidence clearly documents an indisputable association between a symptom limited V̇o2peak and human disease severity or survival (3, 4). We agree fully that without meeting Hill and Lupton’s empirical definition, i.e., where power output, but not V̇o2, continues to increase, the methodological validity implicit in the term “V̇o2max” is lost. We find considerable merit, however, in Green and Askew’s (2) question: What is the additional clinical benefit associated with the increase in V̇o2 during the verification phase? This raises at least two, as yet unanswered, lines of inquiry. Given that the cardiopulmonary exercise test identifies disease and stratifies severity: 1) What are the physiological mechanisms that allow some, but not all, to access a so called “aerobic reserve”? and 2) Does a significant increased V̇o2 during verification improve our ability to direct treatment or predict prognosis? In collecting over 200 ramp-incremental tests with a verification phase in heart failure patients in a clinical setting (unpublished observations), we found that—unlike reports of V̇o2max verification in health—~40% of heart failure patients could significantly increase V̇o2peak during verification, based on previously published criteria (1). The prognostic value of this ability awaits resolution. Nevertheless, whether a treatment can be developed to harness this “aerobic reserve,” e.g., for use during activities of daily living, and whether it would have a beneficial impact on morbidity, quality of life, or mortality, remains to be determined.REFERENCES1. Bowen TS, Cannon DT, Begg G, Baliga V, Witte KK, Rossiter HB. A novel cardiopulmonary exercise test protocol and criterion to determine maximal oxygen uptake in chronic heart failure. J Appl Physiol (1985) 113: 451–458, 2012. doi:10.1152/japplphysiol.01416.2011. Link | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 83: 778–786, 1991. doi:10.1161/01.CIR.83.3.778. Crossref | PubMed | ISI | Google Scholar4. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346: 793–801, 2002. doi:10.1056/NEJMoa011858. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Bowen TS, Cannon DT, Begg G, Baliga V, Witte KK, Rossiter HB. A novel cardiopulmonary exercise test protocol and criterion to determine maximal oxygen uptake in chronic heart failure. J Appl Physiol (1985) 113: 451–458, 2012. doi:10.1152/japplphysiol.01416.2011. Link | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 83: 778–786, 1991. doi:10.1161/01.CIR.83.3.778. Crossref | PubMed | ISI | Google Scholar4. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346: 793–801, 2002. doi:10.1056/NEJMoa011858. Crossref | PubMed | ISI | Google ScholarV̇o2peak IS A USEFUL AND OFTEN NECESSARY PREDICTOR OF CARDIORESPIRATORY FITNESSJulien V. Brugniaux, and Ben D. Perry.Author AffiliationsSchool of Science & Health, Western Sydney University, Australia.to the editor: The recent Viewpoint by Green and Askew (2) rejuvenated the debate regarding the validity of V̇o2peak testing as a measure cardiovascular fitness. We agree with the authors’ concerns regarding the methodology proposed by Poole and Jones (4) for determination of V̇o2max. Furthermore, as highlighted by Green and Askew (2), to obtain a truly maximal V̇o2max, exercise modes would be required to be personalized to participants, an unrealistic goal in most research circumstances. We would further propose that the use of V̇o2peak or a mode-specific assumption of V̇o2max is often a logistical necessity for many studies with both clinical and nonclinical populations. For example, we assessed V̇o2max with secondary testing criteria to compare the cerebrovascular response of a group of “trained” participants with their sedentary counterparts (1). However, one could argue our participants never stood a chance to achieve their “true” V̇o2max as the test was conducted on a semirecumbent bike. Because the primary outcome was the assessment of cerebral blood flow velocity (CBFv via Doppler ultrasound), this methodology was a necessary compromise. Furthermore, V̇o2peak testing with adequate familiarization and motivation still provides valuable insight into cardiorespiratory fitness and is effective for prescribing exercise intensity, even with unorthodox exercise modes such as one-legged cycling, which we used to investigate the effects of unilateral disuse (3). Therefore, although the terms “V̇o2peak” and “V̇o2max” should certainly not be used interchangeably, this does not discard the merit and utility of V̇o2peak testing for assessment of cardiovascular fitness in research.REFERENCES1. Brugniaux JV, Marley CJ, Hodson DA, New KJ, Bailey DM. Acute exercise stress reveals cerebrovascular benefits associated with moderate gains in cardiorespiratory fitness. J Cereb Blood Flow Metab 34: 1873–1876, 2014. doi:10.1038/jcbfm.2014.142. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Perry BD, Wyckelsma VL, Murphy RM, Steward CH, Anderson M, Levinger I, Petersen AC, McKenna MJ. Dissociation between short-term unloading and resistance training effects on skeletal muscle Na+,K+-ATPase, muscle function, and fatigue in humans. J Appl Physiol (1985) 121: 1074–1086, 2016. doi:10.1152/japplphysiol.00558.2016. Link | ISI | Google Scholar4. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google ScholarREFERENCES1. Brugniaux JV, Marley CJ, Hodson DA, New KJ, Bailey DM. Acute exercise stress reveals cerebrovascular benefits associated with moderate gains in cardiorespiratory fitness. J Cereb Blood Flow Metab 34: 1873–1876, 2014. doi:10.1038/jcbfm.2014.142. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Perry BD, Wyckelsma VL, Murphy RM, Steward CH, Anderson M, Levinger I, Petersen AC, McKenna MJ. Dissociation between short-term unloading and resistance training effects on skeletal muscle Na+,K+-ATPase, muscle function, and fatigue in humans. J Appl Physiol (1985) 121: 1074–1086, 2016. doi:10.1152/japplphysiol.00558.2016. Link | ISI | Google Scholar4. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google ScholarINSIGHTS FROM ATHLETES WITH SPINAL CORD INJURYRicardo Dantas de Lucas, and Tiago Turnes.Author AffiliationsPhysical Effort Laboratory, Sports Centre, Federal University of Santa Catarina, Brazil.to the editor: Regarding the interesting Viewpoint of Green and Askew (3), we would like to introduce another aspect when assessing cardiorespiratory fitness in Paralympic athletes, especially in individuals with spinal cord injury (SCI). In the clinical population, and recognizing the difficulties when conducting a verification phase, we agree with the “symptom-limited V̇o2peak” premise (3), therefore accepting that V̇o2peak estimates cardiorespiratory fitness. Alternatively, many SCI athletes performing handcycling or wheelchair exercises can perform “maximal” effort during testing to reach a “true” V̇o2max (based on plateau criteria). However, it is common to refer to it as V̇o2peak because the cardiorespiratory system is not functioning at maximal level during the upper-body exercise (1). Interestingly, exercise tolerance in this population can also be limited by symptoms (depending on the level of injury), triggering a premature interruption during an incremental test due to the thermoregulation impairment (4). In this case, premature exhaustion could preclude the attainment of maximal functionality of the aerobic system. Additionally, as the peak heart rate parameter is not valid for persons with lesions at or above T4 (2), this secondary criteria is not helpful, which highlights the laboratory-based verification phase as a useful solution to confirm V̇o2max in this population (5). Finally, we have assessed handcycling athletes in our laboratory using an oversize treadmill and we determined the verification of V̇o2peak through constant speed trials until exhaustion to derive critical speed. It could be a robust alternative to provide verification of V̇o2peak and provide additional information about the functional index.REFERENCES1. Baumgart JK, Brurok B, Sandbakk Ø. Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis. PLoS One 13: e0192903, 2018 [Erratum in PLoS One 13: e0200326.] doi:10.1371/journal.pone.0192903. Crossref | PubMed | ISI | Google Scholar2. Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil 40: 497–521, 2018. doi:10.1080/09638288.2017.1287623. Crossref | PubMed | ISI | Google Scholar3. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar4. Griggs KE, Leicht CA, Price MJ, Goosey-Tolfrey VL. Thermoregulation during intermittent exercise in athletes with a spinal-cord injury. Int J Sports Physiol Perform 10: 469–475, 2015. doi:10.1123/ijspp.2014-0361. Crossref | PubMed | ISI | Google Scholar5. Leicht CA, Tolfrey K, Lenton JP, Bishop NC, Goosey-Tolfrey VL. The verification phase and reliability of physiological parameters in peak testing of elite wheelchair athletes. Eur J Appl Physiol 113: 337–345, 2013. doi:10.1007/s00421-012-2441-6. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Baumgart JK, Brurok B, Sandbakk Ø. Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis. PLoS One 13: e0192903, 2018 [Erratum in PLoS One 13: e0200326.] doi:10.1371/journal.pone.0192903. Crossref | PubMed | ISI | Google Scholar2. Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil 40: 497–521, 2018. doi:10.1080/09638288.2017.1287623. Crossref | PubMed | ISI | Google Scholar3. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar4. Griggs KE, Leicht CA, Price MJ, Goosey-Tolfrey VL. Thermoregulation during intermittent exercise in athletes with a spinal-cord injury. Int J Sports Physiol Perform 10: 469–475, 2015. doi:10.1123/ijspp.2014-0361. Crossref | PubMed | ISI | Google Scholar5. Leicht CA, Tolfrey K, Lenton JP, Bishop NC, Goosey-Tolfrey VL. The verification phase and reliability of physiological parameters in peak testing of elite wheelchair athletes. Eur J Appl Physiol 113: 337–345, 2013. doi:10.1007/s00421-012-2441-6. Crossref | PubMed | ISI | Google ScholarCOMMENTARY ON VIEWPOINT: V̇o2peak IS AN ACCEPTABLE ESTIMATE OF CARDIORESPIRATORY FITNESS BUT NOT V̇o2maxJeann L. Sabino-Carvalho1 and Thiago Ribeiro Lopes2.Author Affiliations1NeuroVASQ – Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil.2Federal University of São Paulo, São Paulo, SP, Brazil.to the editor: Green and Askew raised several aspects to discuss about “what does this criterion that has gained prominence lately give us in face of what already exists in the literature?” (1). Studies have used traditional criteria (i.e., V̇o2 plateau) established over more than 40 yr ago to determine V̇o2max (5). Since V̇o2 plateau is only observed in ~50% of subjects during incremental test, other criteria have arisen to overcome the lack of consistency of V̇o2 plateau attainment (3). However, these criteria (respiratory exchange ratio; heart rate; capillary blood lactate concentration; and perceived effort) are as inconsistent as the first (3). Thus, the verification protocol gained prominence in the midst of such haziness (3). We recently showed that V̇o2peak obtained in well-trained endurance runners with discontinuous, incremental exercise protocol was confirmed as V̇o2max with verification protocol in all subjects (4). Additionally, a recent study has shown that the V̇o2peak obtained during continuous maximal incremental ramp test was not different from the obtained during verification protocol (2). In this sense, the verification protocol could strengthen the analysis; however, it does not add any relevant result to be used by coaches as training prescription or by physicians as stratification of cardiovascular risk. Also, regard to increased stress imposed by subsequent exercise bouts and the more time spent, verification phase becomes not practical to perform. In summary, further studies are needed to clarify the usefulness of verification protocol against the established criteria, but we cannot say that V̇o2peak is no longer acceptable.REFERENCES1. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar2. Murias JM, Pogliaghi S, Paterson DH. Measurement of a true V̇o2max during a ramp incremental test is not confirmed by a verification phase. Front Physiol 9: 143, 2018. doi:10.3389/fphys.2018.00143. Crossref | PubMed | ISI | Google Scholar3. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar4. Sabino-Carvalho JL, Lopes TR, Obeid-Freitas T, Ferreira TN, Succi JE, Silva AC, Silva BM. Effect of ischemic preconditioning on endurance performance does not surpass placebo. Med Sci Sports Exerc 49: 124–132, 2017. doi:10.1249/MSS.0000000000001088. Crossref | PubMed | ISI | Google Scholar5. Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardio-respiratory performance. J Appl Physiol 8: 73–80, 1955. doi:10.1152/jappl.1955.8.1.73. Link | ISI | Google ScholarREFERENCES1. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar2. Murias JM, Pogliaghi S, Paterson DH. Measurement of a true V̇o2max during a ramp incremental test is not confirmed by a verification phase. Front Physiol 9: 143, 2018. doi:10.3389/fphys.2018.00143. Crossref | PubMed | ISI | Google Scholar3. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar4. Sabino-Carvalho JL, Lopes TR, Obeid-Freitas T, Ferreira TN, Succi JE, Silva AC, Silva BM. Effect of ischemic preconditioning on endurance performance does not surpass placebo. Med Sci Sports Exerc 49: 124–132, 2017. doi:10.1249/MSS.0000000000001088. Crossref | PubMed | ISI | Google Scholar5. Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardio-respiratory performance. J Appl Physiol 8: 73–80, 1955. doi:10.1152/jappl.1955.8.1.73. Link | ISI | Google ScholarCOMMENTARY ON VIEWPOINT: V̇o2peak IS AN ACCEPTABLE ESTIMATE OF CARDIORESPIRATORY FITNESS BUT NOT V̇o2maxRodrigo Zacca123 and Ricardo J. Fernandes12.Author Affiliations1Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal.2Porto Biomechanics Laboratory, University of Porto, Porto, Portugal.3CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil.to the editor: It was asserted that V̇o2peak is no longer acceptable as a V̇o2max measure (3) and replied that the former should not be construed as the latter (2). Even based on significant experience from their different primary activity areas, those authors converged in the same direction. That is good, with science and practice growing with it. In fact, although the referred concepts have been occasionally used interchangeably, the scientific community should accept their usefulness, but never as synonymous. Unless there is an evidence of a V̇o2 plateau (mainly in inexperienced or patient populations), its maximum value should not be considered as V̇o2max (3), with V̇o2peak being also useful (2). However, although there is a maximum V̇o2 for each subject (1), V̇o2max and its related kinetic parameters are estimated, not actually measured. Moreover, there is still no consensus about some methodological issues such as the applied filters (i.e., exclusion of aberrant values, interpolation, average in a box and moving average), which can significantly influence the (maximal and peak) V̇o2, the amount of “plateaus” and, therefore, the comparison between studies (1, 3, 4). Since it is still arguable whether the V̇o2 plateau can accurately indicate that a limiting condition has been reached (1, 3, 4), this over-skepticism seems to be lengthening the bridge between science and practice. Although issues like the “incorporation of a second constant-work rate test” (3), pronounced fluctuations and inherently low signal-to-noise ratio in V̇o2 kinetics are even greater challenges for experiments in swimming (our primary area of activity), the V̇o2max rules (5).REFERENCES1. Beltrami FG, Froyd C, Mauger AR, Metcalfe AJ, Marino F, Noakes TD. Conventional testing methods produce submaximal values of maximum oxygen consumption. Br J Sports Med 46: 23–29, 2012. doi:10.1136/bjsports-2011-090306. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar4. Schaun GZ. The maximal oxygen uptake verification phase: a light at the end of the tunnel? Sports Med Open 3: 44, 2017, doi:10.1186/s40798-017-0112-1.Crossref | Google Scholar5. Sousa A, Figueiredo P, Zamparo P, Pyne DB, Vilas-Boas JP, Fernandes RJ. Exercise modality effect on bioenergetical performance at V̇o2max intensity. Med Sci Sports Exerc 47: 1705–1713, 2015. doi:10.1249/MSS.0000000000000580. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Beltrami FG, Froyd C, Mauger AR, Metcalfe AJ, Marino F, Noakes TD. Conventional testing methods produce submaximal values of maximum oxygen consumption. Br J Sports Med 46: 23–29, 2012. doi:10.1136/bjsports-2011-090306. Crossref | PubMed | ISI | Google Scholar2. Green S, Askew C. V̇o2peak is an acceptable estimate of cardiorespiratory fitness but not V̇o2max. J Appl Physiol; doi:10.1152/japplphysiol.00850.2017.Link | ISI | Google Scholar3. Poole DC, Jones AM. Measurement of the maximum oxygen uptake V̇o2max: V̇o2peak is no longer acceptable. J Appl Physiol (1985) 122: 997–1002, 2017. doi:10.1152/japplphysiol.01063.2016. Link | ISI | Google Scholar4. Schaun GZ. The maximal oxygen uptake verification phase: a light at the end of the tunnel? Sports Med Open 3: 44, 2017, doi:10.1186/s40798-017-0112-1.Crossref | Google Scholar5. Sousa A, Figueiredo P, Zamparo P, Pyne DB, Vilas-Bo
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