David Claxton

Pulmonary function, exercise performance, and growth in survivors of congenital diaphragmatic hernia

A cohort of survivors of congenital diaphragmatic hernia (CDH), with matched controls, was studied to assess growth, respiratory function, and exercise performance. Nineteen of 24 survivors from an 11 year period (79%) were compared with 19 matched controls. Subjects had detailed auxology, performed spirometry and cycle ergometry, and completed questionnaires about respiratory symptoms and exercise. There were no significant differences between the groups for height, weight, sitting height, head circumference, or body mass index expressed as SD scores. The mean (95% confidence interval) percentage predicted forced vital capacity (FVC) was 84.7% (79.1 to 90.3) in index cases and 96.5% (91.4 to 101.6) in controls (p < 0.01). There was no significant difference in total lung capacity. Expiratory flow rates corrected for FVC were also similar between groups, suggesting normal airway function relative to lung size. Mean maximum oxygen consumption in ml/kg/min was 40.1 (36.8 to 43.4) and 42.2 (38.5 to 45.8) in index and control cases. These differences were not significant. Index cases achieved a similar minute ventilation to controls by more rapid and shallower breathing. Index cases had lower perception of their own fitness and lower enjoyment of exercise, although habitual activity levels were similar. Survivors of CDH repair have reduced functional lung volumes, but normal airway function compared with matched controls. They have no growth impairment nor significant impairment of exercise performance, although they have more negative perceptions of their own fitness. They should be encouraged and expected to participate fully in sport and exercise.

Kinematics and neuromuscular recruitment during vertical treadmill exercise

The vertical treadmill (VertiRun) is an unresearched, partial weight-bearing exercise mode for lower limb rehabilitation. The user undertakes a “running-like” action whilst body weight is supported by a bench and the limb is drawn downwards against overhanging resistance cables on a vertically hung nonmotorised treadmill. This study sought to describe the kinematics and neuromuscular recruitment during VertiRun exercise in the supine, 40°, and 70° postures. Twenty-one healthy male participants (age, 25±7 years; stature, 1.79±0.07 m; body mass, 77.7±8.8 kg) volunteered for sagittal plane kinematic analysis of the ankle, knee and hip and electromyography of lower limb musculature in all three postures. Results indicated similar kinematic and neuromuscular profiles in the 40° and 70° postures which differed from the supine. Regardless of posture, a basic movement pattern was observed where the hamstrings and gastrocnemius muscles were active to extend the hip, flex the knee, plantarflex the ankle and draw the leg down the treadmill belt in the contact phase. The rectus femoris and tibialis anterior were active to flex the hip and knee, and dorsiflex the ankle to draw the leg upwards during the swing phase. The vasti muscles were not active during VertiRun exercise. The VertiRun demonstrated similar kinematic and neuro-muscular patterns to overground gait, allows workload progression based on effort and posture changes, and is a low-impact exercise mode that could maintain physical fitness without loading injured tissues. This study suggests that the VertiRun could supplement rehabilitation programmes for lower-limb injuries.

Exercise testing in children: an alternative approach.

In recent years there has been a call for new methods of evaluating the cardiorespiratory responses of children to exercise that complement their everyday exercise patterns. One potential method would be to use a sub-maximal, intermittent, pseudo-random binary sequence (PRBS) exercise test protocol to measure oxygen uptake kinetics (VO2 kinetics). Ten children of mean (SD) age 10.8 (± 1.5) years completed a 20–50 W cycle ergometer protocol of 17-min duration. An estimate of alveolar oxygen uptake (VO2) was calculated on a breath-by-breath basis. The VO2 kinetic parameters were expressed in the frequency domain as amplitude ratio and phase delay using standard Fourier techniques. Analysis was restricted to the frequency range 2.2 to 8.9 mHz. The mean (SD) amplitude ratio responses decreased from 10.33 (± 0.73) to 7.42 (± 0.99) ml min−1 W−1 and the mean phase delay increased from -26.78° (± 6.37°) to -81.93° (± 10.45°) over the frequency range 2.2-8.9 mHz. Significant correlations (p<0.05) were found between chronological age and amplitude ratio (r= 0.68 and 0.62), and chronological age and phase delay (r= -0.62 and -0.69) at the frequencies of 2.2 and 4.4 mHz, respectively. No significant correlations were found between VO2 kinetics and stature or VO2 kinetics and body mass. The observations demonstrated the use of the PRBS technique to measure VO2 kinetics in the frequency domain in children. This approach may be a useful addition to the tests that are used to quantify the oxygen uptake responses to exercise in children.

Sprint interval training on the vertical treadmill improves aerobic and anaerobic running performance

The vertical treadmill (VertiRun) is an unresearched mode of exercise where users engage in a “running-like” action whilst body weight is supported by a recumbent bench and overhanging resistance cables are tethered to the user’s ankles. The purpose of this study was to determine the effects of training on a VertiRun and any cross-training effect on running performance. Thirty active males (age, 22±4 years; stature, 1.79±0.08 m; body mass, 78.5±12.6 kg) volunteered for this study. Participants’ aerobic and anaerobic running performance were determined by incremental maximum rate of oxygen consumption (VO2max) treadmill test and a maximum anaerobic running test (MART), respectively. Participants were matched and then randomly assigned to either a VertiRun group, 20-m shuttle sprint group or control group. The intervention consisted of 4–6, 30-sec all-out efforts with 4-min recovery between bouts, 3 days a week for 6 weeks. The pre- and postintervention VO2max and MART were analysed using a mixed repeated measures analysis of variance. MART increased by 4.5% in the VertiRun group (P=0.006) and 4% in the sprint group (P<0.001). VO2max increased by 6.2% in the VertiRun group (P=0.009) and 5.5% in the sprint group (P=0.020). The MART and VO2max of the control group were unchanged (P=0.910 and P=0.915, respectively). These data suggest that the VertiRun could be an effective cross-training mode for running and could supplement training programmes. Also, as VertiRun is a low-impact exercise it might be useful in the physical preparation of athletes returning to sport following lower limb injury.

Effects of running retraining on biomechanical factors associated with lower limb injury

Injury risk is an important concern for runners; however, limited evidence exists regarding changes to injury risk following running style retraining. Biomechanical factors, such as absolute peak free moment, knee abduction impulse, peak foot eversion and foot eversion excursion, have been shown to predict lower limb injury. The aim of this study was to assess the effects of Pose running retraining on biomechanical factors associated with lower limb running injury. Twenty uninjured recreational runners were pair-matched based on their five km run time performance and randomly assigned to control (n = 10) and intervention (three 2-h Pose running retraining sessions) groups (n = 10). Three dimensional kinetic and kinematic data were collected from all participants running at relative (REL: 1.5 km·h-1 below respiratory compensation point) and absolute (ABS: 4.5 m·s-1) speeds. Biomechanical factors associated with lower limb injury, as well as selected kinematic variables (to aid interpretation), were assessed. Following a six-week, non-coached time-period, all assessments were repeated. No changes to the biomechanical factors associated with lower limb injury examined in this study were observed (P > .05). Intervention group participants (presented as pre- and post-intervention respectively) exhibited an increased foot strike index (REL speed: 21.79-42.66%; ESW = 4.73; P = .012 and ABS speed: 22.38-46.98%; ESW = 2.83; P = .008), reduced take-off distance (REL speed: -0.35 to -0.32 m; ESW = 0.75; P = .012), increased knee flexion at initial contact (REL speed: -14.11 to -18.50°; ESW = -0.88; P = .003), increased ankle dorsiflexion at terminal stance (REL speed: -33.61 to -28.35°; ESW = 1.57; P = .036) and reduced stance time (ABS speed: 0.21-0.19 s; ESW = -0.85; P = .018). Finally, five km run time did not change (22:04-22:19 min; ESW = 0.07; P = .229). It was concluded that following Pose running retraining, retrained participants adopted a running style that was different to their normal style without changing specific, biomechanical factors associated with lower limb injury or compromising performance.

TIME DOMAIN ANALYSIS OF OXYGEN UPTAKE KINETICS IN ELITE RUNNERS BY PSEUDO RANDOM BINARY SEQUENCE (PRBS) EXERCISE

Oxygen uptake kinetics assessed in the frequency domain are known to be differentially faster in elite endurance runners than in elite sprinters. Breath-by-breath data from PRBS testing have routinely been analysed by application of Fourier methods, however, it is possible to analyse the data in the time domain in the form of a Total Lag Time (TLT). In this study, correlational techniques were applied to yield an output response to a work rate input. An autocorrelation function was performed on the input work rate (WR) and a cross correlation function was performed on input (WR) and output (vO₂). The cross correlation function was analysed by fitting a linear summation of the ramp form of a two-component exponential function to a triangular pulse. Twelve elite male sprinters and 12 elite male endurance runners completed 3 identical PRBS cycles of 300 s with 20 s work rate changes between 25 and 85 W on an electrically braked cycle ergometer at a pedal cadence of 1 Hz. Oxygen uptake was measured on a breath-by-breath basis using a respiratory mass spectrometer. Statistical analysis using the analysis of variance revealed significantly faster oxygen uptake kinetics (TLT) in the elite endurance runners compared with the elite sprinters (33.3 s 3.39SD and 39.91 s 7.14SD respectively) (p < 0.01). The results of this study show that time domain analysis represents a possible alternative to frequency analysis in the study of oxygen uptake kinetics described by PRBS exercise.