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The measurement oflactate is straightforward and reliable. The sampling is normal­ ly dependable, although discrepancies between sample sites can occur if samples are drawn during other than steady state conditions or when blood flow to the site is low. Comparison of data between subjects should consider intra- and interindividu­ al variation. Interpretation of the significance of blood or even a muscle lactate concentration is extremely difficult and neither can be assumed to reflect rates of lactate release or production. Lactate metabolism appears to be very significant in short-term, high­ intensity work lasting a few seconds, but the exact role remains to be established. Blood lactate and the pulmonary aspects of anaerobic threshold are not necessarily causally related and the significance of anaerobic threshold as a metabolic measure remains obscure. There are numerous examples of changes in blood or muscle lac­ tate independent of oxygen availability, and factors such as H+ concentration ap­ pear to play an important, although undefined, role in regulating lactate production and/or release.

Inhaltsverzeichnis

Frontmatter

Welcoming Remarks

The 5th International Seminar on Ergometry of the International Council of Sports and Ergometry (ICSPE) continues the tradition of these Seminars, this being the first one held outside Berlin.

B. Stoeckle

Welcoming Address

On behalf of the Albert Ludwig University and our Medical Faculty I welcome you to the 5th International Seminar of the scientific committee of the ICSSPE, the International Council of Sport Sciences and Physical Education.

H. Just

Opening Remarks

I consider it a privilege to have been asked to open the 5th International Seminar on Ergometry in Titisee. Having participated in most of the preceding seminars, I am in a position to evaluate the remarkable progress that has been made over the years in respect to the scientific role played by the subject. Perhaps it is of interest today to recall the early beginnings of the studies to which our meeting is going to devote its time.

E. Jokl

Introductory Remarks

Ergometry has recently become an indispensable investigation method not only for sports medicine but also for industrial medicine, internal medicine, and rehabilitation. The continuously growing application of sports activity in primary and secondary prevention of the diseases of civilization gives ergometry a position of permanent importance with regard to noninvasive methods for the investigation of circulation and respiration.

J. Horák

Preliminary Remarks on the Present State and Future Tasks of Ergometry

During the four international seminars on ergometry held in Berlin 1965, 1967, 1972, and 1981, there was an opportunity to exchange experiences and results and to contribute to the development of ergometry. Our efforts at standardization, which were difficult and controversial, led to initial success in 1981.

H. Mellerowicz

Introductory Comments on Quality Control and Test Criteria in Ergometry

Quality control is an old approach in medicine. In Greek medicine, quality was achieved by control in the teacher-pupil relationship. Tradition and observation contributed to quality control. In the 15th to 18th centuries, quality control was a right of the medical faculties. General practitioners became members of the faculty when starting to practice. At the same time, some British authors requested quality control of medical performance (John Gregory of Edinburgh and Thomas Percival of Manchester). Especially Gregory claimed a quality control of medical performance as the basis of consulting colleagues [1].

H. Löllgen

Quality Control and Test Criteria in Ergometry

Quality control is an established requirement in medicine. It is strongly related to standardization on the one hand and to test criteria on the other. Quality assurance is a basic procedure in clinical chemistry, but it has been neglected in ergometry. Recent results on ergometer calibration tests yielded deviations between measured and indicated power output of about 50% [2,11]. Obviously, there is a need for quality control in cardiovascular testing, especially in stress testing. This can be underlined by recommendations proposed by the American Heart Association (AHA) [5] and by recent efforts of the German Society for Cardiovascular Research to establish quality control criteria. Further, as has been shown by Philbrick et al. [15], exercise testing requires methodological improvements in patient selection, data collection and data analysis. The enthusiasm about the Bayes’ theorem again highlights the need for an improved approach to interpretation of stress testing, another aspect of quality control [3,14,16, 20].

H. Löllgen

Methodological Aspects and Quality Control in Ergometry — Exercise Testing During Invasive Studies: Reproducibility and Effect of Posture

Bicycle exercise testing is employed to assess cardiac function and the effects of therapy during both noninvasive and invasive studies. Bicycle ergometry can be performed in the supine or upright position. However, it is often not appreciated that a period of exercise may modify subsequent hemodynamic data at rest and during exercise and that the posture by itself modifies hemodynamics. In this communication, the methodology of exercise testing during invasive studies is discussed and the literature on reproducibility and the effects of posture on hemodynamics at rest and during exercise is reviewed.

U. Thadani

Advantages of the Computerized Breath-by-Breath Method for the Interpretation of Spiroergometric Data

There are still only a few laboratories using breath-by-breath methods for the determination of spiroergometric data. The reason for this may be that commercially produced equipment — if available — is expensive and complicated to handle. This is a surprising fact because computers and microprocessors are starting to govern the world in all other areas. Most of the breath-by-breath equipment, therefore, are homemade like the methods described by Beaver et al. [1], Smidt and Finkenzeller [9], and Stegemann [10] using digital computers and the method of Wigertz [11] and Linnarson and Lindberg [7] who performed the computation by an analog device.

J. Stegemann, D. Essfeld

Quality Control in Exercise Testing, with Special Reference to Computer Processing of Exercise Electrocardiograms

The value of an exercise test, as well as any other diagnostic procedure, is dependent on the quality of the test itself as well as the knowledge of the physician who ordered the test. The indications for the test should be clear, while the physician should be able to correlate the test results with other information on the patient.

M. L. Simoons

Some General Functions and Their Differential Use

In ergometry the usual test validations can be complemented by a broader kind of construct and content validation that utilizes information from three different kinds of effort variables, viz, physiological, perceptual, and performance variables. Most importantly, estimates of reliability and validity can be obtained by analyzing the internal consistency of the total system of response variables. For a top athlete the test criterium is very simple: a medal in the Olympic games, preferably a gold medal. For predictions of performances of ordinary people engaged in industrial work, sports, or other leisure activities, there are, however, no such simple performance criteria.

G. Borg

Measurement and Interpretation of Lactate

With the exception of heart rate and VO2, blood lactate is probably the most common physiological measurement made in ergometry and sports medicine. It is commonly associated with theories of fatigue, pain, and perceived exertion and assumed to be diffusing across membranes passively and/or freely and to directly reflect muscle metabolism. Direct, conclusive evidence for many of these interpretations is lacking, and there is a growing body of knowledge that is demonstrating that our basic assumptions concerning lactate metabolism are simplistic. This report will attempt to review fundamental aspects concerning sampling and analyzing of lactate samples, interpretations of lactate levels, and some factors that can influence lactate levels independent of muscle activity.

T. E. Graham

OBLA Exercise Stress Testing in Health and Disease

During recent years there has been a marked increase in the number of published papers within the area of exercise stress testing based upon any expression for increased muscle metabolic acidosis (Fig.1). Thus, the library at the Karolinska Institute has in its computerized files a total of 37 papers published during 1982 in recognized, international medical and related journals as compared with six 5 years before (1977) and non another 5 years earlier (1972). Although the majority of the papers published in 1982 were methodological or basic physiological in nature, as many as 11 (or 30%) were related to different clinical aspects of exercise stress testing.

J. Karlsson, A. Holmgren, D. Linnarson, H. Åström

Specificity and Test Precision of the Anaerobic Threshold

The reference points of the aerobic-anaerobic transition are currently regarded in performance diagnostics as specific parameters for characterization of endurance capacity as well as for determination of the optimal intensity for extensive and intensive long-distance training. This is the case, although the physiological mutual effects of the determining factors are not adequately clarified, nor is the validity of these parameters histochemically or biochemically confirmed with reference to sports-type specificity, age, or pathological conditions. The models for individual threshold determination which have been worked out in recent years [1, 7,11,12, 15–17] indicate the efforts made to validate the endurance performance capacity.

N. Bachl

Anaerobic Threshold and Oxygen Pulse as Fitness Criteria in Submaximal and in Peak Exercise Testing

It has been well known since the studies of Daniels [2, 3] that in man, performance in endurance events can be improved by training without a concomitant increase in VO2 max. This emphasizes the usefulness of testing not only the aerobic capacity but also submaximal fitness in athletes. Therefore, it seemed interesting to study various criteria of submaximal fitness.

B. van den Eynde, M. Ostyn

Ergometry: A Method for the Adjusted Common Functional and Metabolic Response Testing

Recently the submaximal exercise protocol has been frequently used for endurance performance capacity analysis in sports medicine. Submaximal metabolic parameters estimated by both invasive as well as noninvasive techniques may be used for the anaerobic threshold determination [18, 20].

B. Semiginovský, L. Havličková, J. Vránová

Factorial Structure of Measures Assessing the Energetic Capacities of Trained Individuals

The assessment of the value of aerobic and anaerobic energetic capacity has at present become an inevitable, routine procedure in various medical fields, primarily within the field of sports medicine, occupational medicine, cardiology, and rehabilitation.

S. Heimer, R. Medved, K. Komirović

R Wave Response and Exercise ECG

Analysis of R wave amplitude changes that occur during exercise has been proposed for the diagnosis of coronary heart disease in recent years [2,5,6–8,18–22].

A. Tahy

Significance of Asymptomatic ST-Segment Depression During Exercise in Postinfarction Patients

The existence of myocardial ischemia without angina pectoris is no longer doubted today. The phenomenon has been called asymptomatic or silent myocardial ischemia [3].

L. Samek, P. Betz, H. Roskamm

Significance of Ambient Air Temperature and Humidity in Tropical Ergometry: The Critical Temperature

As is well known, physical exertion is strongly influenced by the environment, especially in the tropics. Air temperature and humidity have been found to chiefly affect the recovery period [1], but the work capacity is also affected [2]. Further it has been shown that measures which favor heat dissipation favorably influence work [3, 5], while prewarming of the body exerts an adverse effect [4]. To evaluate the influence of heat and humidity on ergometric work in more detail, the following investigations were carried out.

O. Ketusinh, C. Chintanaseri, S. Prasertsiripandh

Dependence of W170 Results on Ambient Temperature (16°C–24°C)

The shortened W170 test [7] is a modified W170 test procedure saving considerable time by using a rapid and almost continuous load increase of 5 W/10s without having significant influence on the test criteria [1–3]. This time-saving method has special significance for large-scale testing in industrial medicine, for example, in the investigation of working capacity in accordance with the German recommendations “G 26, G 30, and G 31” of the Industrial Injuries Insurance Companies [4].

H. Reißmann, H.-V. Ulmer

Factor Analysis of Physical Fitness: Comparison of Rowers with Cross Country Skiers

Rowing and cross country skiing require different types of cardiopulmonary and skeletomuscular capacities. The present study was designed to investigate by means of factor analysis the different adaptive mechanisms relevant for these two different kinds of sports activities.

J. Horák, J. Pirič, M. Jirásek

Quality Criteria and Power Calibration of Ergometers

Among other details, ergometers should give vital information such as: Is there coronary heart disease?What safe activity range is left to the patient after a myocardial infarction?What pathological diagnosis can be made under defined physical stress and could this reduce the economic occupation of the patient?

K. Goffloo, W. Sontopski

Performance Requirements for Bicycle Ergometers

Since 1979 the Physikalisch-Technische Bundesanstalt (PTB) has investigated the performances of ergometers which are used in the medical field. This is done in cooperation with the manufacturers of ergometers. For this work a special testing setup is used, which was described together with some measurement results at the 4th Internationales Seminar fur Ergometrie in Berlin in 1981 [1]. On the basis of these results and extensive discussions with physicians and manufacturers of ergometers, a draft for performance requirements [2] has been formulated. With these requirements, the PTB wants to support the standardization proposals of the physicians from the technical point of view. In the following section, the main points of the draft will be reported. In the subsequent section, some measurements obtained in the PTB are summarized and discussed in the frame of the requirements of the draft.

E. Cramer

Accuracy of Constant Load Electromagnetic Bicycle Ergometers: A Case Study

Electromagnetic bicycle ergometers are said to produce constant load, independent of revolution. Their system is generally based on the principle of the hyperbolic relationship of braking power and revolution of a rotating disc in a magnetic field. Braking itself is effected by a Pasqualini eddy current brake. Braking energy is thus produced as one rides the bicycle. Mechanical transmission is by means of internally lubricated roller chains running on chain wheels with a flywheel to ease the start and finish. Researchers often use electromagnetic ergometers with only the manufacturer’s original calibrations, as special equiqment required to check the hyperbolic relationship of braking power and revolution of a rotating copper disc in a magnetic field is not available in most exercise physiology laboratories. The matter is judged of importance with research-grade bicycle ergometers especially when data on physiological responses to set power outputs are wanted.

F. Landry, C. Bouchard, D. Prud’homme, D. Marceau

Body Weight and the Evaluation of the Spiroergometric Test Criteria

Both physical loads under natural conditions and spiroergometric tests reveal close correlations between the total body indices (body weight in particular), the energy consumption, and the working capacity of the vegetative systems supplying body energy. The obvious limiting effect of body size on the working capacity and performance of athletes has led to the introduction of weight classes in wrestling, boxing, weight lifting, and other sports and to specific morphological and functional selection in most sports and sports branches.

I. Iliev

Comparability of Absolute and Body-Related Performance Capacity in Ergometry

In the older literature concerning physiology, physiological performance indicators, such as VO2max, heart volume, or exercise performance are mostly published without relation to individual body parameters. In Germany it is still a convention to characterize the critical heart weight as “500 g” [6, 8,11], without regard to the constitution of the athletes. In recent studies, however, there is an increasing tendency to uniformly calculate all physiological results in relation to body weight, in spite of the fact that, for example, Astrand and Rodahl wrote in 1977: “In work and exercise where the body is lifted (as in walking or running), the oxygen uptake should be related to the body weight” [1].

H.-V. Ulmer

Physical, Physiological and Body Compositional Differences of Male and Female Septuagenarians

Historically, aging has been a neglected area of scientific investigations in the United States. Physical activity or inactivity was one of many problems associated with the aging process. In recognition of the importance of exercise to overall well being of people, the Senate Sub-Committee on Aging in 1975 provided money for the sole purpose of educating and enlisting participation of elderly people in physical activities.

L. P. Novak, H. West

Normal Values for Blood Pressure in Bicycle Ergometry

The measurement of blood pressure during exercise has received increasing interest recently as diagnostic and prognostic procedures for the development of hypertension, which will appear at a future time, as well as from the point of view of the necessity to treat the so-called exercise hypertension [6,1].

H. Heck, R. Rost, W. Hollmann

Prognostic Significance of an Overshooting Exercise Blood Pressure as an Indicator for Subsequent Manifestation of Hypertension

Ergometry provides the possibility of performing a stress test of the arterial blood pressure under defined conditions. Hollmann [2] was the first to initiate the development of an automatic blood pressure device adapted to exercise blood pressure measurement as early as the 1950s. Particular interest in exercise blood pressure was raised by the investigations of Franz [1]. Besides his studies, only one follow-up study about the prognostic significance of the exercise blood pressure is available [4]. Therefore, the opinions about the diagnostic value of an overshooting exercise blood pressure in relation to a subsequent manifestation of hypertension are still controversial. Particularly, data on patients with exercise hypertension but normal pressure at rest are not available. The investigations of Franz [1] are based on borderline hypertensive subjects, who were divided into “exercise-positive” and “exercise-negative” ones.

F. Amecke, R. Rost

Significance of Longitudinal Variance of Ergometric Measurements

Ergometric measurements are well-established, standard methods for assessment of cardiopulmonary parameters in healthy and diseased persons. Especially regarding long-term observations, ergometric data can give important information about functional changes due to training or disease. A very desirable goal would be to detect such functional changes in an individual as early as possible.

H. Wollschläger, H. Löllgen, A. Zeiher, B. Wieland, H. Just

Low Work Load During Physical Stress Testing Is Mental Stress Testing

The typical physiologic response to exercise is a rapid increase in systolic blood pressure (SBP) and heart rate (HR). Diastolic blood pressure (DBP) does not increase significantly in healthy young persons. In the literature, the blood pressure response to physical exercise tests has yielded conflicting results regarding blood pressure (BP) reactions of hypertensives or normotensive patients. Most studies show no difference in the reaction pattern of hypertensives and normotensives [10, 11, 15] unless the patients are older or already have an impaired vascular system [17]. Pickering and co-workers [14] reported last year, for example, that 20 normotensive, 19 borderline hypertensive, and 15 hypertensive outpatients showed similar increases in BP (44/0, 52/ – 1,48/ – 1 mmHg respectively).

H. Rüddel, M. E. McKinney, J. C. Buell, R. S. Eliot, H. Otten, W. Schulte, W. Langewitz, A. W. von Eiff

Reaction of Cardiopulmonary Parameters and Lactate During Submaximum and Maximum Work Loads Depending on Different Tests and Input Loads

Although bicycle ergometry has become a standard procedure for diagnosis in sport medicine, the standardization of test protocol remains a matter of discussion. Recently, new recommendations have been published [1, 4, 5]. In spite of all these efforts (and even in these new proposals), there are still a lot of different test protocols recommended, concerning the input load as well as the increase of performance during stress testing [6]. Therefore we asked if there is an influence on the reactions of cardiopulmonary and metabolic parameters, depending on the different test schedules and various input loads for submaximum and maximum work load.

A. Reinke, H. Heck, R. Rost

A Comparison of Bicycle, Paddling, and Treadmill Spiroergometry in Top Paddlers

Functional predispositions of top sportsmen can be estimated by various types of spiroergometric tests. There is wide evidence that specific functional and metabolic adaptations could be verified only by means of adequate, specific performance tests [3,11]. On the other hand some authors did not confirm this opinion [1]. The problem is discussed especially in paddlers, whose adaptation for arm work was tested by cranking [5, 12, 13] or on a speciflcly adjusted ergometer [3] or isokinetic pully-trainer [1]. Another problem pertains to the possibility of extrapolation of laboratory results to the racing performance where many other factors (e. g., technique, tactics, psychological factors) are involved.

J. Heller, V. Bunc, J. Novák, I. Kuta

Activity of Energy Metabolism Enzymes in the Vastus Lateralis of Young Men of Different Performance Levels

The level of activity of those enzymes involved in energy metabolism is considered as a sensitive indicator of the level of energy release in muscle tissue. This level represents the adaptive response to the intensity and duration of physical exercise [11, 5,4,6,9]. Gollnick [3] showed that the properties of muscle tissue differ according to muscle fiber distribution and/or to different enzyme activities, which characterize athletes from each another.

E. V. Macková, Š. Šprynarová, J. Melichna, A. Bass, K. Vondra

Comparative Measurements of VO2max and PWC170 in Schoolchildren

The determination of maximal oxygen uptake (VO2max) is generally accepted as a global index of aerobic work capacity and cardiorespiratory fitness. However, this procedure requires expensive apparatus.

I.-W. Franz, D. Wiewel, H. Mellerowicz

Response to Maximal Ergometric Load of Different Types and Relation of Cardiorespiratory Parameters to Specific Performance in Young Swimmers

In competitive swimming, 77% of disciplines last about 2 min at the longest. According to Astrand’s design [5], the relative contribution in percent of total energy yield is covered from 65%–70% by anaerobic processes and from 30%–35% aerobically in 100 m races, while in 200 m races both processes are approximately equally important. Other authors [6,25] presume that anaerobic sources participate to a higher extent. Therefore, it is important for competitive swimmers to develop both aerobic and anaerobic power to reach maximal performance in 100 m and 200 m races. It seems to be expedient to distinguish functional predispositions for these two components for appropriate orientation of the training process. Moreover, in freestylers it is possible to choose the race length according to these characteristics. The aims of this study were (a) to distinguish differences in cardiorespiratory and metabolic response to two kinds of ergometric load: first, load corresponding to the duration of swimming races and second, a stepwise increased load to vita maxima conditions, and (b) to compare obtained data with specific performance level of the swimmers.

J. Novák, T. Jurimae, V. Bunc, E. V. Macková, M. Čermák, T. Paul

Determination of the Anaerobic Threshold in Various Ergometric Tests

Since the evaluation of the effects of training and rehabilitation is primarily based on submaximal energy expenditure, the corresponding work load in ergometry is in the range of the anaerobic threshold (AT). AT in this context means the transition from aerobic to anaerobic metabolism and is defined as the maximum work load with a constancy of lactate production and utilization [9,14]. In addition to the approach using the AT as a measure of submaximal power output, relative values of maximal oxygen uptake (VO2max) are often used to characterize submaximal work intensity. For untrained subjects, AT is in the range of 50%–70% VO2max [8,10,11, 18, 22], whereas in trained persons the AT lies in the range of 80%–90% VO2max [11–13,15,18,22]. VO2max depends on the methodological approach to exercise testing and on the specificity of the exercise testing device [26,27].

V. Bunc, J. Heller, I. Bojanovský, Š. Šprynarová, J. Novák

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