Late Exercise Tolerance Testing Using a Dynamic High Intensity Interval Multidirectional Movement Protocol

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S8.1-S8
Author(s):  
Mohammad Mortazavi ◽  
Katelyn Paulsen ◽  
Tyler R. Marx ◽  
Monica Pita Other ◽  
Luke Muratalla Maes, Other ◽  
...  
Keyword(s):  
Exercise Testing ◽  
High Intensity ◽  
Exercise Tolerance ◽  
Late Phase ◽  
Force Plate ◽  
Retrospective Chart Review ◽  
Exercise Intolerance ◽  
Post Exercise ◽  
Average Change ◽  
High Intensity Interval

ObjectiveAnalyze the utility of a 5-step exertional rehab protocol (ERP) that included High Intensity Interval Multi-Directional Movement (HIIT-MD) or step 5. We assessed the incidence and etiologies of exercise intolerance (EI) during Step 5 in concussed patients who tolerated maximal linear exertion.BackgroundExertional testing can be used to determine appropriate levels of exercise tolerance (ET) in concussed patients. Traditionally linear modalities have been used to determine max ET prior to clearance. HIIT-MD protocols can be the next appropriate step to bridge clearance for more dynamic activities.Design/MethodsRetrospective chart review included 130 step 5 trials for EI; of those, 72 had pre/postexercise King Devick (KD) and force plate (FP) testing. Patients were 10–59 years old and clinic visits occurred 2019–2020. EI rate was recorded and failure reason was documented by our clinic's concussion specialist. The difference between pre/post exercise KD and FP was investigated.ResultsOf 130 step 5 trials, 21.54% failed due to EI. Reason for EI included the onset of symptoms (82.1%), followed by signs of dysautonomia (39.3%). Symptoms and dysautonomia combined were noted in 35.7% of those with EI. Symptoms appeared in combination with another marker 69.6% of the time. The average change in KD times pre/post exercise testing was +2.52 seconds longer in the EI group compared to −2.45 seconds shorter in the ET group (p = 0.62). The EI group demonstrated an average change of 0.36 deg/sec sway velocity increase after exercise compared to 0.13 deg/sec in the ET group (p = 0.93).ConclusionsThere is evidence for the utility of a HITT-MD protocol for dynamic exercise/sports clearance. Exercise testing progression and concussion clearance should include a dynamic HITT-MD protocol to ascertain no late phase dynamic EI. Dysautonomia and/or vestibulocular aggravation may be contributors to late phase EI. If EI exists, identifying and targeting underlying causes can aid optimal recovery.

Subclinical Vestibular Deficits Illustrated in Patients With Exercise Intolerance After mTBI Using Force Plate Protocols

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S4.1-S4
Author(s):  
Mohammad Mortazavi ◽  
Tyler R. Marx ◽  
Leslie Streeter ◽  
Arvind Balaji ◽  
Brett Dusenberry ◽  
...  
Keyword(s):  
Exercise Tolerance ◽  
Force Plate ◽  
Vestibular Function ◽  
Exercise Intolerance ◽  
Therapeutic Exercise ◽  
Patients Âgés ◽  
Average Change ◽  
Symptom Exacerbation ◽  
Before And After ◽  
Shed Light

ObjectiveInvestigate the changes in sway velocity vestibular markers in mTBI patients with exercise intolerance (EI) during exertional testing as part of a 5-Step Exertional Rehab Protocol (ERP).BackgroundExertional testing can be used to determine one's therapeutic exercise threshold. A number of systems have been shown to be related to Exercise Intolerance (EI) including autonomic, cervical, and vestibular, and visual. Vestibular function can be measured before and after exercise and may shed light into its impact on EI.Design/MethodsRetrospective review of 342 trials of exertional testing in mTBI patients, ages 10–60, in 2020. Exertional testing was completed with pre/post force plate sway velocity calculated. Protocol A involved single leg stances, while protocol B involved 2 feet stances. A concussion specialist determined exercise tolerance (ET) by evaluating for the onset of signs/symptoms or cardiovagal dysautonomia.ResultsOf 342 exertional test trials, 34.8% exhibited EI due to symptom exacerbation and/or signs of autonomic dysfunction. Vestibular Force Plate sway velocities in both protocol A and B were significantly worsened in the EI group by an average change of 0.32 deg/sec, compared to those in the ET group who exhibited only an average change of 0.03 deg/sec sway velocity (p = 0.0004). The EI group using protocol A, showed an average change of 0.86 deg/sec compared to those in the ET group using protocol A, who exhibited only an average change of 0.03 deg/sec sway velocity (p = 0.0041). EI group using protocol B, showed an average change of 0.12 deg/sec sway velocity compared to those in the ET group using protocol B, who also exhibited an average change of 0.03 deg/sec (p = 0.0013).ConclusionsSubclinical vestibular markers such as sway velocity measures may be used to identify etiologies for EI in mTBI. Furthermore, these vestibular testing may be a subclinical measure that can aid exercise and sport clearance decisions.

scholarly journals Post-exercise hypotension in response to high-intensity interval exercise: Potential mechanisms

2021 ◽  
Vol 40 (10) ◽  
pp. 797-799
Author(s):  
Raphael José Perrier-Melo ◽  
Antônio Henrique Germano-Soares ◽  
Aline Freitas Brito ◽  
Iago Vilela Dantas ◽  
Manoel da Cunha Costa
Keyword(s):  
High Intensity ◽  
Post Exercise ◽  
Interval Exercise ◽  
High Intensity Interval ◽  
Post Exercise Hypotension

High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise

2019 ◽  
Vol 119 (5) ◽  
pp. 1235-1243 ◽  
Author(s):  
Flávia C. Pimenta ◽  
Fábio Tanil Montrezol ◽  
Victor Zuniga Dourado ◽  
Luís Fernando Marcelino da Silva ◽  
Gabriela Alves Borba ◽  
...  
Keyword(s):  
High Intensity ◽  
Moderate Intensity ◽  
Post Exercise ◽  
Interval Exercise ◽  
Continuous Exercise ◽  
High Intensity Interval ◽  
Post Exercise Hypotension

scholarly journals Menopause Delays the Typical Recovery of Pre-Exercise Hepcidin Levels after High-Intensity Interval Running Exercise in Endurance-Trained Women

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3866
Author(s):  
Víctor Alfaro-Magallanes ◽  
Pedro Benito ◽  
Beatriz Rael ◽  
Laura Barba-Moreno ◽  
Nuria Romero-Parra ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
High Intensity ◽  
Iron Homeostasis ◽  
Premenopausal Women ◽  
The Body ◽  
Peak Oxygen Consumption ◽  
Post Exercise ◽  
Running Exercise ◽  
Maximal Aerobic Speed ◽  
High Intensity Interval

Menopause commonly presents the gradual accumulation of iron in the body over the years, which is a risk factor for diseases such as cancer, osteoporosis, or cardiovascular diseases. Running exercise is known to acutely increase hepcidin levels, which reduces iron absorption and recycling. As this fact has not been studied in postmenopausal women, this study investigated the hepcidin response to running exercise in this population. Thirteen endurance-trained postmenopausal women (age: 51.5 ± 3.89 years; height: 161.8 ± 4.9 cm; body mass: 55.9 ± 3.6 kg; body fat: 24.7 ± 4.2%; peak oxygen consumption: 42.4 ± 4.0 mL·min−1·kg−1) performed a high-intensity interval running protocol, which consisted of 8 × 3 min bouts at 85% of the maximal aerobic speed with 90-second recovery. Blood samples were collected pre-exercise, 0, 3, and 24 hours post-exercise. As expected, hepcidin exhibited higher values at 3 hours post-exercise (3.69 ± 3.38 nmol/L), but also at 24 hours post-exercise (3.25 ± 3.61 nmol/L), in comparison with pre-exercise (1.77 ± 1.74 nmol/L; p = 0.023 and p = 0.020, respectively) and 0 hour post-exercise (2.05 ± 2.00 nmol/L; p = 0.021 and p = 0.032, respectively) concentrations. These differences were preceded by a significant increment of interleukin-6 at 0 hour post-exercise (3.41 ± 1.60 pg/mL) compared to pre-exercise (1.65 ± 0.48 pg/m, p = 0.003), 3 hours (1.50 ± 0.00 pg/mL, p = 0.002) and 24 hours post-exercise (1.52 ± 0.07 pg/mL, p = 0.001). Hepcidin peaked at 3 hours post-exercise as the literature described for premenopausal women but does not seem to be fully recovered to pre-exercise levels within 24 hours post-exercise, as it would be expected. This suggests a slower recovery of basal hepcidin levels in postmenopausal women, suggesting interesting applications in order to modify iron homeostasis as appropriate, such as the prevention of iron accumulation or proper timing of iron supplementation.

Pulmonary O2 uptake kinetics as a determinant of high-intensity exercise tolerance in humans

2011 ◽  
Vol 110 (6) ◽  
pp. 1598-1606 ◽  
Author(s):  
Scott R. Murgatroyd ◽  
Carrie Ferguson ◽  
Susan A. Ward ◽  
Brian J. Whipp ◽  
Harry B. Rossiter
Keyword(s):  
Steady State ◽  
High Intensity ◽  
Exercise Tolerance ◽  
Slow Component ◽  
Progressive Increase ◽  
High Intensity Exercise ◽  
Exercise Intolerance ◽  
Exercise Onset ◽  
O2 Uptake Kinetics ◽  
Two Parameters

Tolerance to high-intensity constant-power (P) exercise is well described by a hyperbola with two parameters: a curvature constant (W′) and power asymptote termed “critical power” (CP). Since the ability to sustain exercise is closely related to the ability to meet the ATP demand in a steady state, we reasoned that pulmonary O2 uptake (V̇o2) kinetics would relate to the P-tolerable duration (tlim) parameters. We hypothesized that 1) the fundamental time constant (τV̇o2) would relate inversely to CP; and 2) the slow-component magnitude (ΔV̇o2sc) would relate directly to W′. Fourteen healthy men performed cycle ergometry protocols to the limit of tolerance: 1) an incremental ramp test; 2) a series of constant-P tests to determine V̇o2max, CP, and W′; and 3) repeated constant-P tests (WR6) normalized to a 6 min tlim for τV̇o2 and ΔV̇o2sc estimation. The WR6 tlim averaged 365 ± 16 s, and V̇o2max (4.18 ± 0.49 l/min) was achieved in every case. CP (range: 171–294 W) was inversely correlated with τV̇o2 (18–38 s; R2 = 0.90), and W′ (12.8–29.9 kJ) was directly correlated with ΔV̇o2sc (0.42–0.96 l/min; R2 = 0.76). These findings support the notions that 1) rapid V̇o2 adaptation at exercise onset allows a steady state to be achieved at higher work rates compared with when V̇o2 kinetics are slower; and 2) exercise exceeding this limit initiates a “fatigue cascade” linking W′ to a progressive increase in the O2 cost of power production (V̇o2sc), which, if continued, results in attainment of V̇o2max and exercise intolerance. Collectively, these data implicate V̇o2 kinetics as a key determinant of high-intensity exercise tolerance in humans.

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