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Objective: To validate VO2 max testing with society of thoracic surgeon (STS) score in the preoperative assessment of patients undergoing coronary artery bypass graft surgery. Study Design: This was a single center and observational study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi Methodology: Forty four adult patients undergoing elective on pump coronary artery bypass graft surgery with an EF of >45% were included in this study as per inclusion criteria through non probability consecutive sampling. Five patients were lost to follow up. In 39 patients preoperative society of thoracic surgeons scoring was done and VO2 max of these patients was calculated. After coronary artery bypass graft surgery these patients were followed for mortality and morbidity. The discriminative capacity of VO2 max was compared with the STS risk scoring system using Receiver Operating Characteristic curves (ROC-curves). Results: We analyzed the data of 39 patients male 35 (89.7%), female 4 (10.3%). Mean age of our study population was 55.0 ± 10.2 years and a mean BMI of 26.8 ± 3.81. There were 20 (54.1%) hypertensives, 2 (5.4%) diabetics and 5 (13.5%) smokers. There was only one patient with a history of previous myocardial infarction. Majority of the patients belonged to NYHA class II 30 (76.9%) with a mean EF of 56.6 ± 5.17. Prolonged Ventilation (>24 hrs) was significantly associated with lesser values of VO2 max with a p-value of 0.01. Similarly, post-operative mortality and prolonged hospital stay in the low VO2 max groups correlated with the trends predicted by the society of thoracic surgeons scoring system. Conclusion: We conclude from this study that low preoperative VO2 max levels correlated well with STS scoring system for predicting mortality, ventilation time and length of hospital stay.

We investigated age-related differences for peak oxygen uptake (peak VO ) improvement with exercise training during cardiac rehabilitation (CR). This was a retrospective cohort study of the Mayo Clinic Rochester CR program including adult patients who attended CR (≥1 session) for any eligible indication between 1999 and 2017 and who had a cardiopulmonary exercise test pre and post CR with VO data (peak respiratory exchange ratio ≥1.0). Younger (20-49 yrs), midlife (50-64 yrs), and older adults (≥65 yrs) were compared using ANOVA for delta and percent change in peak VO ; and percentage of peak VO responders (>0% change). 708 patients (age: 60.8 ± 12.1 years; 24% female) met inclusion criteria. Delta and percent change in peak VO was lower for older adults (1.6 ± 3.2 mL.kg.min ; 12 ± 27%) compared with younger (3.7 ± 4.0 mL.kg.min , < 0.001; 23 ± 28%, = 0.002) and midlife adults (2.8 ± 3.8 mL.kg.min , < 0.001; 17 ± 28%, = 0.04). For midlife, delta change, but not percent change in peak VO was significantly lower ( = 0.02) compared with younger. Percentage of responders was only different between older and younger (72 vs. 86%; = 0.008). Sensitivity analyses in non-surgical patients showed similar differences for delta change, and differences in percent change remained significant between older and younger adults (10 ± 20% vs. 16 ± 18%; = 0.04). In CR patients, older adults had lower improvement in cardiorespiratory fitness than younger and midlife adults. While excluding surgical patients reduced age-related differences, older adults still had lower cardiorespiratory fitness improvement during CR. These findings may have implications for individualizing CR programming in aging populations to reduce future cardiovascular risk.

This study compared the validity of reported equations as predictors of peak V O 2 in 8–10-year-old children. Participants (90 boys and girls aged 8–10 years) performed the multistage-shuttle-run-test (MSRT) and peak V O 2 was measured in field using a portable gas analyser. The equations that estimated peak V O 2 from the MSRT performance were chosen according to the age range of this study. As follows, the FITNESSGRAM reports and the equations of Leger et al. (Can J Appl Sport Sci 5: 77–84, 1988 ), Barnett et al. (Pediatr Exerc Sci 5:42–50, 1993 ), Matsuzaka et al. (Pediatr Exerc Sci 16:113–125, 2004 ) and Fernhall et al. (Am J Ment Retard 102:602–612, 1998 ) were used to estimate the peak V O 2 and compared with the directly measured value. The equation of Leger et al. (Can J Appl Sport Sci 5: 77–84, 1988 ) provided a mean difference ( d ) of 4.7 ml kg −1  min −1 and a 1.0 slope. The equation of Matsuzaka et al. (Pediatr Exerc Sci 16:113–125, 2004 )(a) using maximal speed (MS) showed a higher d (5.4) than the remaining using total laps d (4.2). The equation of Barnett et al. (Pediatr Exerc Sci 5:42–50, 1993 )(a) that includes triceps skinfold and MS showed the highest d (6.1) but the smallest range (24.1) and slope (0.6). Data from the FITNESSGRAM had the smallest d (1.8 ml kg −1  min −1 ), but also had the highest range between limits of agreement (28.6 ml kg −1  min −1 ) and a 1.2 slope. The lowest slope (0.4) and range (22.2 ml kg −1  min −1 ) were observed using the equation of Fernhall et al. (Am J Ment Retard 102:602–612, 1998 ). Log transformation of the data revealed that the equations of Matsuzaka et al. (Pediatr Exerc Sci 16:113–125, 2004 )(a) (1.1*/÷1.25) and Fernhall et al. (Am J Ment Retard 102:602–612, 1998 ) (1.17*/÷1.25) showed the closest agreement among all, but they still yield unsatisfactory accuracy.

Abstract Rationale The prognostic value of cardiopulmonary exercise testing (CPET) for survival in cystic fibrosis (CF) in the context of current clinical management, when controlling for other known prognostic factors, is unclear. Objectives To determine the prognostic value of CPET-derived measures beyond peak oxygen uptake (V7 o2peak) following rigorous adjustment for other predictors. Methods Data from 10 CF centers in Australia, Europe, and North America were collected retrospectively. A total of 510 patients completed a cycle CPET between January 2000 and December 2007, of which 433 fulfilled the criteria for a maximal effort. Time to death/lung transplantation was analyzed using Cox proportional hazards regression. In addition, phenotyping using hierarchical Ward clustering was performed to characterize high-risk subgroups. Measurements and Main Results Cox regression showed, even after adjustment for sex, FEV1% predicted, body mass index (z-score), age at CPET, Pseudomonas aeruginosa status, and CF-related diabetes as covariates in the model, that V7 o2peak in % predicted (hazard ratio [HR], 0.964; 95% confidence interval [CI], 0.944–0.986), peak work rate (% predicted; HR, 0.969; 95% CI, 0.951–0.988), ventilatory equivalent for oxygen (HR, 1.085; 95% CI, 1.041–1.132), and carbon dioxide (HR, 1.060; 95% CI, 1.007–1.115) (all P < 0.05) were significant predictors of death or lung transplantation at 10-year follow-up. Phenotyping revealed that CPET-derived measures were important for clustering. We identified a high-risk cluster characterized by poor lung function, nutritional status, and exercise capacity. Conclusions CPET provides additional prognostic information to established predictors of death/lung transplantation in CF. High-risk patients may especially benefit from regular monitoring of exercise capacity and exercise counseling.

The main purpose of the present meta-analysis was to examine the criterion-related validity of the 20-m shuttle run test for estimating cardiorespiratory fitness. Relevant studies were searched from twelve electronic databases up to December 2014, as well as from several alternative modes of searching. The Hunter-Schmidt's psychometric meta-analysis approach was conducted to estimate the population criterion-related validity of the 20-m shuttle run test. From 57 studies that were included in the present meta-analysis, a total of 78 correlation values were analyzed. The overall results showed that the performance score of the 20-m shuttle run test had a moderate-to-high criterion-related validity for estimating maximum oxygen uptake (r p = 0.66-0.84), being higher when other variables (e.g. sex, age or body mass) were used (r p = 0.78-0.95). The present meta-analysis also showed that the criterion-related validity of Léger's protocol was statistically higher for adults (r p = 0.94, 0.87-1.00) than for children (r p = 0.78, 0.72-0.85). However, sex and maximum oxygen uptake level do not seem to affect the criterion-related validity values. When an individual's maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness. In adults the performance score only seems to be a strong estimator of cardiorespiratory fitness, in contrast among children the performance score should be combined with other variables. Nevertheless, as in the application of any physical fitness field test, evaluators must be aware that the performance score of the 20-m shuttle run test is simply an estimation and not a direct measure of cardiorespiratory fitness. Key pointsOverall the 20-m shuttle run test has a moderate-to-high mean criterion-related validity for estimating cardiorespiratory fitness.The criterion-related validity of the 20-m shuttle run test is significantly higher for adults than for children. However, when the performance score is combined with other variables, the criterion-related validity value increases considerably among children.Sex and maximum oxygen uptake level of individuals seem not to affect the criterion-related validity of the 20-m shuttle run test.When individuals' maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness.

DNA methylation‐based age estimators (DNAm ageing clocks) are currently one of the most promising biomarkers for predicting biological age. However, the relationships between cardiorespiratory fitness (CRF), measured directly by expiratory gas analysis, and DNAm ageing clocks are largely unknown. We investigated the relationships between CRF and the age‐adjusted value from the residuals of the regression of DNAm ageing clock to chronological age (DNAmAgeAcceleration: DNAmAgeAccel) and attempted to determine the relative contribution of CRF to DNAmAgeAccel in the presence of other lifestyle factors. DNA samples from 144 Japanese men aged 65–72 years were used to appraise first‐ (i.e., DNAmHorvath and DNAmHannum) and second‐ (i.e., DNAmPhenoAge, DNAmGrimAge, and DNAmFitAge) generation DNAm ageing clocks. Various surveys and measurements were conducted, including physical fitness, body composition, blood biochemical parameters, nutrient intake, smoking, alcohol consumption, disease status, sleep status, and chronotype. Both oxygen uptake at ventilatory threshold (VO2/kg at VT) and peak oxygen uptake (VO2/kg at Peak) showed a significant negative correlation with GrimAgeAccel, even after adjustments for chronological age and smoking and drinking status. Notably, VO2/kg at VT and VO2/kg at Peak above the reference value were also associated with delayed GrimAgeAccel. Multiple regression analysis showed that calf circumference, serum triglyceride, carbohydrate intake, and smoking status, rather than CRF, contributed more to GrimAgeAccel and FitAgeAccel. In conclusion, although the contribution of CRF to GrimAgeAccel and FitAgeAccel is relatively low compared to lifestyle‐related factors such as smoking, the results suggest that the maintenance of CRF is associated with delayed biological ageing in older men. The contribution of cardiorespiratory fitness (CRF) to GrimAgeAcceleration and FitAgeAcceleration are relatively low compared to lifestyle‐related factors such as serum triglyceride, daily intake of carbohydrate, smoking, and calf circumference. There is a negative correlation between CRF and GrimAgeAcceleration, even after adjusting for chronological age, smoking, and alcohol consumption, and maintenance of CRF above reference values is negatively correlated with delayed GrimAgeAcceleration.

In patients with congenital heart disease (CHD), reduced exercise capacity can be a predictor for late complications and may be used to guide interventions. Yet, the interpretation of exercise capacity is challenged by changes in body composition during growth. Our aim was to create an overview of disease-specific exercise capacity in children with CHD. We performed a multicentre retrospective study of exercise capacity of CHD patients, aged 6–18 years, tested between January 2001 and October 2018. Sex-specific distribution graphs were made using the LMS method and height to relate to body size. We included all CHD with N  > 50, including severe defects (e.g., univentricular heart, tetralogy of Fallot) and “simple” lesions as ventricular septum defect and atrial septum defect. We included 1383 tests of 1208 individual patients for analysis. The peak oxygen uptake (VO 2 peak, 37.3 ml/min/kg (25th–75th percentile 31.3–43.8)) varied between specific defects; patients with univentricular hearts had lower VO 2peak compared with other CHD. All groups had lower VO 2peak compared to healthy Dutch children. Males had higher VO 2peak , W peak and O 2 pulse peak than females. Sex- and disease-specific distribution graphs for VO 2peak , W peak and O2pulse peak showed increase in variation with increase in height.    Conclusion : Disease-specific distribution graphs for exercise capacity in children with CHD from a large multicentre cohort demonstrated varying degrees of reduced VO 2peak and W peak . The distribution graphs can be used in the structured follow-up of patients with CHD to predict outcome and identify patients at risk. What is Known: •  Children with congenital heart disease (COnHD) are at risk to develop heart failure, arrhytmia’s and other complications. Exercise capacity may be an important predictor for outcome in children with ConHD. In children, the interpretation of exercise capacity poses an additional challenge related to physical changes during growth. What is New: •  In this report of a multi-center cohort >1300 childrewn with ConHD, we related the changes in exercise capacity to length. We demonstrated that exercise capacity was reduced as compared with healthy children and we observed variation between disease groups. Patients with a univentricular circulation (Fontan) had worse exercise capacity. We constructed disease specific charts of development of exercise capacity throughout childhood, accessible via a web-site. These graphs may help practitioner to guide children with ConHD.

A triathlon is an extremely high-intensity exercise and a challenge for physiological adaptation. A triathlete’s microbiome might be modulated by diet, age, medical treatments, lifestyle, and exercise, thereby maintaining aerobiosis and optimum health and performance. Probiotics, prebiotics, and synbiotics have been reported to have health-promoting activities (e.g., immunoregulation and cancer prevention). However, few studies have addressed how probiotics affect the microbiota of athletes and how this translates into functional activities. In our previous study, we found that Lactobacillus plantarum PS128 could ameliorate inflammation and oxidative stress, with improved exercise performance. Thus, here we investigate how the microbiota of triathletes are altered by L. plantarum PS128 supplementation, not only for exercise performance but also for possible physiological adaptation. The triathletes were assigned to two groups: an L. plantarum 128 supplement group (LG, 3 × 1010 colony-forming units (CFU)/day) and a placebo group (PG). Both groups continued with their regular exercise training for the next 4 weeks. The endurance performance, body composition, biochemistries, blood cells, microbiota, and associated metabolites were further investigated. PS128 significantly increased the athletes’ endurance, by about 130% as compared to the PG group, but there was no significant difference in maximal oxygen consumption (VO2max) and composition between groups. The PS128 supplementation (LG) modulated the athlete’s microbiota with both significant decreases (Anaerotruncus, Caproiciproducens, Coprobacillus, Desulfovibrio, Dielma, Family_XIII, Holdemania, and Oxalobacter) and increases (Akkermansia, Bifidobacterium, Butyricimonas, and Lactobacillus), and the LG showed lower diversity when compared to the PG. Also, the short-chain fatty acids (SCFAs; acetate, propionate, and butyrate) of the LG were significantly higher than the PG, which might be a result of a modulation of the associated microbiota. In conclusion, PS128 supplementation was associated with an improvement on endurance running performance through microbiota modulation and related metabolites, but not in maximal oxygen uptake.

Purpose To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. Methods This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18–70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. Results The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) ( r  = 0.419; p  < 0.001; n  = 126), (ii) a weak correlation with absolute VO2peak (ml/min) ( r  = 0.241; p  = 0.008; n  = 120), and (iii) a moderate correlation with the 6MWD ( r  = 0.440; p  < 0.001; n  = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD ( r 2  = 0.390; r 2  = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). Conclusion The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

Peak oxygen uptake (V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$ ) and V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$on/off‐kinetics are key indicators of exercise capacity and health outcomes, but their assessment often requires separate laboratory visits, which limits feasibility. This cross‐sectional study aimed to develop a single cardiopulmonary exercise test (CPET) for both assessments. We designed a single‐session combined CPET protocol using an upright cycle ergometer in healthy volunteers (n = 20). V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$was first estimated using an a priori formula. The constant work rate (CWR) part of the test (on‐kinetics) was set to an intensity of 30% V̇O2reserve ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{reserve}}}$ . After an incremental test to measure V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$ , a 10‐min recovery period was used to evaluate off‐kinetics. Twenty volunteers (9 females and 11 males), 28.0 ± 8.1 years completed the protocol. No significant differences were found between predicted and measured V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$(P = 0.47). A strong correlation (r = 0.88) and good agreement (Bland–Altman bias = −0.82 mL kg−1 min−1) were found between the calculated/actual individuals’ 30% V̇O2reserve ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{reserve}}}$(mL kg−1 min−1) and the measured steady‐state V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$at CWR. The measured exercise intensity at CWR closely matched the target of 30%, with no statistical differences, with an average difference of 0.2 percentage points. Small–medium Cohen's d (0.16) indicated high similarity between predicted and measured V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$ . V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$on‐ and off‐kinetics analyses were also performed for all participants with mono‐exponential fittings. A single‐session protocol for the combined assessment of V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$and V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$on/off‐kinetics was developed. This protocol will enable greater recruitment and participation in research and enhanced detail for clinical CPET use. Future research should evaluate intra‐ and inter‐participant reproducibility over repeated sessions. What is the central question of this study? Peak oxygen uptake (V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$ ) and V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$on/off‐kinetics are key indicators of exercise capacity and health outcomes, but their assessment often requires separate laboratory visits: can a single cardiopulmonary exercise test (CPET) for both assessments be developed? What is the main finding and its importance? A single‐session protocol for the combined assessment of V̇O2peak ${{\\dot{V}}_{{{\\mathrm{O}}}_2}{\\mathrm{peak}}}$and V̇O2 ${{\\dot{V}}_{{{\\mathrm{O}}}_2}}}$on/off‐kinetics was developed. This protocol will enable greater recruitment and participation in research and enhanced detail for clinical CPET use.