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Is Ca dio espi a o y Op imal Poin Measu ed Du ing he Maximal Ca diopulmona y
Exe cise Tes a Rele an Indica o o Spo s Pe o mance?
© Au ho , 2018
Published e sion
Laukkanen, Ja i
Laukkanen, J. (2018). Is Ca dio espi a o y Op imal Poin Measu ed Du ing he Maximal
Ca diopulmona y Exe cise Tes a Rele an Indica o o Spo s Pe o mance?. In e na ional
Jou nal o Ca dio ascula Sciences, 31(4), 320-321. h ps://doi.o g/10.5935/2359-
4802.20180041
2018
DOI: 10.5935/2359-4802.20180041
320
EDITORIAL
In e na ional Jou nal o Ca dio ascula Sciences. 2018;31(4)320-322
Mailing Add ess: Ja i A. Laukkanen
Seminaa inka u 15. PO Box 35. FI-40014. Uni e si y o Jy äskylä, Jy äskylä - Finland
E-mail: ja i.a.laukk[email p o ec ed]
Is Ca dio espi a o y Op imal Poin Measu ed Du ing he Maximal Ca diopulmona y
Exe cise Tes a Rele an Indica o o Spo s Pe o mance?
Ja i A. Laukkanen
Ins i u e o Public Heal h and Clinical Nu i ion - Uni e si y o Eas e n Finland,1 Kuopio - Finland
Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä,2 Jy äskylä - Finland
Cen al Finland Heal h Ca e Dis ic , Depa men o Medicine,3 Jy äskylä - Finland
Exe cise; Respi a o y Func ion Tes s; A hle es;
Ca dio espi a o y Fi ness; A hle ic Pe o mance.
Keywo ds
Ca dio espi a o y i ness (CRF) is conside ed he
gold s anda d o assessing ae obic pe o mance
among a hle es and no mal popula ion and has
ecen ly been named as a clinical i al sign, being an
essen ial indica o o ca dio ascula and pulmona y
unc ion.1 Ca dio espi a o y i ness is associa ed wi h
lowe isk o non- a al and a al ca dio ascula disease
(CVD) e en s, wi h s udies demons a ing a consis en ,
in e se associa ion be ween CRF and mo ali y e en
a e adjus men o he adi ional isk ac o bu den.2
Addi ionally, bo h maximal oxygen consump ion
(VO2max) and VO2 a en ila o y h eshold (VT) ha e
been associa ed wi h a educed isk o ad e se heal h
ou comes.1,3-5 A li e a u e-based me a-analysis o 33
obse a ional coho s udies has be e delinea ed he
ela ionship o CRF wi h CVD and all-cause mo ali y
ou comes.2 Howe e , VO2max and VT a e o en used
o e alua e a hle es’ pe o mance and o moni o hei
aining esponses. Du ing he ca diopulmona y exe cise
es (CPX), many a iables could be used o assess speci ic
aining esponses o he ca dio ascula , espi a o y
and musculoskele al sys ems based on he analysis o
submaximal and maximal esponses o a p og essi ely
inc emen al exe cise.
Mode n CPX sys ems allow o he analysis o gas
exchange a es , du ing mild, mode a e and maximal
exe cise le els, and du ing eco e y and yield measu es
o VO2, ca bon dioxide ou pu (VCO2), and en ila ion
(VE).6 These ad anced compu e ized sys ems p o ide
bo h simple and complex analyses o hese da a ha
a e easy o e ie e and s o e, which makes CPX widely
a ailable. Oxygen up ake a VT, o en e e ed o as he
anae obic h eshold, is a a iable assessed a submaximal
le el o CPX.6 Fo majo i y o heal hy indi iduals, he
anae obic h eshold lies a exe cise in ensi ies be ween
50% and 75% o VO2max, while in ained endu ance
a hle es, i can each in ensi ies as high as 80% o
VO2max.6
Obse ing he oxygen en ila o y equi alen s ( he
a io be ween VE in l/min and VO2 in l/min, VE/VO2)
in a gi en minu e du ing CPX, i is possible o iden i y a
U-shaped pa e n wi h a clea minimal alue. Ramos e
al.7 ha e named his minimal VE/VO2, a dimensionless
a iable, as ca dio espi a o y op imal poin (COP) wi h
age- and sex- e e ence da a and sugges ed ha COP
e lec s ci cula ion- espi a ion in eg a ion and he mos
economical use o en ila ion o ob ain oxygen o he
ac i e issues du ing exe cise.
In his con ex , i is wo hwhile o commen ha
VO2max depends on pe o ming a uly maximal
exe cise es . Al hough VT can be assessed a he
submaximal le el,5 i also equi es a mo e in ense
exe cise le el compa ed o he assessmen o COP, and
VT measu emen may be hinde ed by he exis ence
o se e al dis inc c i e ia o i s iden i ica ion and/o
cha ac e iza ion, because i canno be accu a ely de ined
in all cases, limi ing i s use in bo h clinical p ac ice and
spo s pe o mance.
Applicabili y o he COP o he assessmen o he
a hle es’ exe cise pe o mance is po en ially in e es ing.8
In addi ion o he ac ha , as a submaximal a iable
o CPX, he use o COP is pa icula ly in e es ing o
people unable o achie e a maximal CPX because o
unc ional limi a ions. In he spo s scena io, whe e
321
Laukkanen
Is ca dio espi a o y op imal poin a ele an indica o o spo s pe o mance?
In J Ca dio asc Sci. 2018;31(4)320-322
Edi o ial
he e a e e y limi ed oppo uni y o in en ion o ha e
he a hle es pe o ming epea ed maximal CPX du ing
he compe i ion season, COP could be a much easie and
accep able a iable o be measu ed and ollowed along
he season.8 As p e iously desc ibed by he same esea ch
g oup,9 he COP alue inc eases wi h age and ends o
be sligh ly highe in women, wi h associa ions being
modes wi h o he en ila ion measu es, sugges ing
an independen and po en ial con ibu ion in he
in e p e a ion o he ca dio espi a o y esponse a he
CPX. Indeed, Ramos and A aujo,9 ha e also showed
ha COP p o ides aluable in o ma ion on he isk o
all-cause mo ali y in middle-aged and olde men and
women. In heal hy subjec s wi h COP < 22, he e we e
no dea hs du ing he six-yea ollow-up sugges ing ha
he lowes le el o COP is an indica o o good p ognosis.
O e he yea s, one can conside ha he e is a wo sening
in VE and a educ ion in VO2max, i.e. a iables di ec ly
in ol ed in he calcula ion o he COP. Howe e , i is
possible ha he decline in pulmona y en ila ion is less
signi ican o nume ically impo an han he educ ion
in VO2, he eby explaining he highe COP alues in
olde indi iduals.9
The s udy published in his issue o he In J
Ca dio asc Sci by de Souza e Sil a e al.10 is he i s
one o desc ibe he COP p o ile in a hle es, as i was
based on high-le el socce playe s unde going CPX on
a eadmill ollowing he amp p o ocol. They ound
ha COP alues did no signi ican ly a y wi hin he
a hle e’s ield posi ion.10 The absence o associa ion wi h
VO2max and VT indica es ha COP p o ides addi ional
in o ma ion on he op o con en ional CPX pa ame e s;
howe e , i emains o be de e mined i his COP
plays a signi ican ole in e ms o socce pe o mance
and/o o he moni o ing o he aining esponses
along he compe i i e season. No wi hs anding, he
in o ma ion p o ided by his no el s udy10 is o iginal
and i should be con i med by u u e s udies including
he in e p e a ion o he a ious CPX a iables in
a hle es, especially o hose pa icipan ing in e y long
endu ance spo e en s, such as ma a hon o ia hlon,
si ua ions in which he a hle e pe o ms a an exe cise
in ensi y ha is below VT and likely close o COP.
In conclusion, COP, de ined as he lowes VE/VO2
alue in a gi en minu e o CPX, has been associa ed wi h
all-cause mo ali y in a popula ion ha is equen ly seen
o ou ine clinical exe cise es ing. COP is a ep oducible
and physiologically-based CPX a iable. Addi ionally,
he a ailabili y o age- and sex- e e ence da a in a la ge
sample o heal hy subjec s is an ad an age compa ed
o o he CPX indices o en ob ained in a maximal CPX.
The ecen s udy by de Souza e Sil a e al.10 mo es COP
one s ep ahead by sugges ing i s po en ial use among
adul p o essional socce playe s. Fu u e longi udinal
s udies a e needed o con i m COP ele ance and i i s
measu emen would become a possible subs i u e o
some o he ele an CPX en ila o y a iables, such as
VT o VO2max in a hle es.
1. Ross R, Blai SN, A ena R, Chu ch TS, Desp es JP, F anklin BA, e al;
Ame ican Hea Associa ion Physical Ac i i y Commi ee o he Council
on Li es yle and Ca diome abolic Heal h; Council on Clinical Ca diology;
Council on Epidemiology and P e en ion; Council on Ca dio ascula and
S oke Nu sing; Council on Func ional Genomics and T ansla ional Biology;
S oke Council. Impo ance o assessing ca dio espi a o y i ness in clinical
p ac ice: a case o i ness as a clinical i al sign: a scien i ic s a emen F om
he Ame ican Hea Associa ion. Ci cula ion. 2016;134(24):e653-99.
2. Kodama S, Sai o K, Tanaka S, Maki M, Yachi Y, Asumi M, e al.
Ca dio espi a o y i ness as a quan i a i e p edic o o all-cause mo ali y
and ca dio ascula e en s in heal hy men and women: a me a-analysis.
JAMA. 2009;301(19):2024-35.
3. Laukkanen JA, Ku l S, Salonen R, Rau amaa R, Salonen JT. The p edic i e
alue o ca dio espi a o y i ness o ca dio ascula e en s in men wi h
a ious isk p o iles: a p ospec i e popula ion-based coho s udy. Eu
Hea J. 2004;25(16):1428-37.
4. Laukkanen JA, Zacca di F, Khan H, Ku l S, Jae SY, Rau amaa R. Long-
e m change in ca dio espi a o y i ness and all-cause mo ali y: a
popula ion-based ollow-up s udy. Mayo Clin P oc. 2016;91(9):1183-8.
5. Kunu so SK, Ku l S, Khan H, Zacca di F, Laukkanen JA. Associa ions
o ca dio ascula and all-cause mo ali y e en s wi h oxygen up ake a
en ila o y h eshold. In J Ca diol. 2017 Jun 1;236:444-50.
6. Balady GJ, A ena R, Sie sema K, Mye s J, Coke L, Fle che GF, e al;
Ame ican Hea Associa ion Exe cise, Ca diac Rehabili a ion, and
P e en ion Commi ee o he Council on Clinical Ca diology; Council
on Epidemiology and P e en ion; Council on Pe iphe al Vascula
Disease; In e disciplina y Council on Quali y o Ca e and Ou comes
Resea ch. Clinician's guide o ca diopulmona y exe cise es ing in adul s:
a scien i ic s a emen om he Ame ican Hea Associa ion. Ci cula ion.
2010;122(2):191-225.
7. Ramos PS, Rica do DR, A aujo CG. Ca dio espi a o y op imal poin : a
submaximal a iable o he ca diopulmona y exe cise es ing. A q B as
Ca diol. 2012;99(5):988-96.
8. Ramos PS, Sa dinha A, Na di AE, de A aujo CG. Ca dio espi a o y
op imal poin : a submaximal exe cise a iable o assess panic diso de
pa ien s. PLoS One. 2014;9(8):e104932.
9. Ramos PS, A aujo CG. Ca dio espi a o y op imal poin du ing
exe cise es ing as a p edic o o all-cause mo ali y. Re Po Ca diol.
2017;36(4):261-9.
10. de Souza e Sil a CG, Cas o CL, F anca JF, Bo ino A, Mye s J, A aujo
CG. Ca dio espi a o y op imal poin in p o essional socce playe s:
a no el submaximal a iable du ing exe cise. In J Ca dio asc Sci.
2018. (in p ess).
Re e ences
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Laukkanen
Is ca dio espi a o y op imal poin a ele an indica o o spo s pe o mance?
In J Ca dio asc Sci. 2018;31(4)320-322
Edi o ial
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