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1 Department of Physiology, St. George's Hospital Medical School, London, United Kingdom
2 Department of Physiology, St. George's Hospital Medical School, London, United Kingdom; Department of Medicine, Division of Physiology, University of California, San Diego, La Jolla, CA, USA
3 Department of Physiology, St. George's Hospital Medical School, London, United Kingdom; Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
* To whom correspondence should be addressed. E-mail: bwhipp{at}rei.edu.
The maximum oxygen uptake (VO2 max), is one of the most widely used parameters characterising the effective integration of the neural, cardio-pulmonary and metabolic systems. Its quantification requires VO2 to reach a value such that further increases in work rate do not result in further increases in VO2: a plateau is attained. However, it has been suggested that during incremental ramp tests, plateaux of VO2 are rarely attained despite "good effort" from the subjects. We were therefore interested in: a) whether a VO2 plateau was a consistent manifestation of ramp incremental cycle ergometry performed to the limit of tolerance and, b) the relationship between the peak VO2 from this test and that determined from a maximal constant-load test and from a series of progressive-discontinuous constant-load tests. Ventilatory and pulmonary gas exchange variables were measured breath-by-breath using a turbine and mass spectrometer. On average, VO2 peak (3.51 ± 0.8 l/min; SD) attained during the incremental ramp test did not differ from that extrapolated from the linear phase of the response in 71 subjects. In 12 of these subjects the VO2 peak was less than the extrapolated value by 0.1 to 0.4 l/min (i.e. a 'plateau'): in 19, VO2 peak was higher by 0.05 to 0.4 l/min: In the remaining 40 subjects we could not discriminate a difference. The VO2 peak from the incremental test also did not differ from that of a single maximum constant-load test in the 38 subjects who performed both tests. Furthermore the VO2 peak did not differ from VO2 max in the 6 subjects who undertook a range of progressively greater discontinuous constant-load tests. In conclusion, therefore, a plateau in the actual VO2 response is not an obligatory consequence of incremental exercise testing. As the peak value attained was not different from the plateau obtained in the plot of VO2 vs. work rate (for the constant load tests) these data suggest that the VO2 peak attained on a maximum effort incremental test is likely to be a valid index of VO2 max - despite no evidence of a plateau in the data themselves. However, without additional tests one cannot be certain.
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