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The maximally attainable O₂ during exercise in humans: the peak vs. maximum issue

¹Department of Physiology, St. George's Hospital Medical School, London SW17 ORE, United Kingdom; ²Division of Physiology, Department of Medicine, University of California, San Diego, La Jolla 92092-0623; and ³Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, California 90509

Submitted 10 January 2003 ; accepted in final form 8 July 2003

The quantification of maximum oxygen uptake (O_{2 max}), a parameter characterizing the effective integration of the neural, cardiopulmonary, and metabolic systems, requires oxygen uptake (O₂) to attain a plateau. We were interested in whether a O₂ plateau was consistently manifest during maximal incremental ramp cycle ergometry and also in ascertaining the relationship between this peak O₂ (O_{2 peak}) and that determined from one, or several, maximal constant-load tests. Ventilatory and pulmonary gas-exchange variables were measured breath by breath with a turbine and mass spectrometer. On average, O_{2 peak} [3.51 ± 0.8 (SD) l/min] for the ramp test did not differ from that extrapolated from the linear phase of the response in 71 subjects. In 12 of these subjects, the O_{2 peak} was less than the extrapolated value by 0.1-0.4 l/min (i.e., a "plateau"), and in 19 subjects, O_{2 peak} was higher by 0.05-0.4 l/min. In the remaining 40 subjects, we could not discriminate a difference. The O_{2 peak} from the incremental test also did not differ from that of a single maximum constant-load test in 38 subjects or from the O_{2 max} in 6 subjects who undertook a range of progressively greater discontinuous constant-load tests. A plateau in the actual O₂ response is therefore not an obligatory consequence of incremental exercise. Because the peak value attained was not different from the plateau in the plot of O₂ vs. work rate (for the constant-load tests), the O_{2 peak} attained on a maximum-effort incremental test is likely to be a valid index of O_{2 max}, despite no evidence of a plateau in the data themselves. However, without additional tests, one cannot be certain.

oxygen uptake; plateau; incremental ramp; cycle ergometry

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