Gerhard Tschakert

Special Needs to Prescribe Exercise Intensity for Scientific Studies

There is clear evidence regarding the health benefits of physical activity. These benefits follow a dose-response relationship with a particular respect to exercise intensity. Guidelines for exercise testing and prescription have been established to provide optimal standards for exercise training. A wide range of intensities is used to prescribe exercise, but this approach is limited. Usually percentages of maximal oxygen uptake (VO2) or heart rate (HR) are applied to set exercise training intensity but this approach yields substantially variable metabolic and cardiocirculatory responses. Heterogeneous acute responses and training effects are explained by the nonuniform heart rate performance curve during incremental exercise which significantly alters the calculations of %HRmax and %HRR target HR data. Similar limitations hold true for using %VO2max and %VO2R. The solution of these shortcomings is to strictly apply objective submaximal markers such as thresholds or turn points and to tailor exercise training within defined regions.

Effects of High-Intensity Interval Exercise versus Moderate Continuous Exercise on Glucose Homeostasis and Hormone Response in Patients with Type 1 Diabetes Mellitus Using Novel Ultra-Long-Acting Insulin.

Introduction We investigated blood glucose (BG) and hormone response to aerobic high-intensity interval exercise (HIIE) and moderate continuous exercise (CON) matched for mean load and duration in type 1 diabetes mellitus (T1DM). Material and Methods Seven trained male subjects with T1DM performed a maximal incremental exercise test and HIIE and CON at 3 different mean intensities below (A) and above (B) the first lactate turn point and below the second lactate turn point (C) on a cycle ergometer. Subjects were adjusted to ultra-long-acting insulin Degludec (Tresiba/ Novo Nordisk, Denmark). Before exercise, standardized meals were administered, and short-acting insulin dose was reduced by 25% (A), 50% (B), and 75% (C) dependent on mean exercise intensity. During exercise, BG, adrenaline, noradrenaline, dopamine, cortisol, glucagon, and insulin-like growth factor-1, blood lactate, heart rate, and gas exchange variables were measured. For 24 h after exercise, interstitial glucose was measured by continuous glucose monitoring system. Results BG decrease during HIIE was significantly smaller for B (p = 0.024) and tended to be smaller for A and C compared to CON. No differences were found for post-exercise interstitial glucose, acute hormone response, and carbohydrate utilization between HIIE and CON for A, B, and C. In HIIE, blood lactate for A (p = 0.006) and B (p = 0.004) and respiratory exchange ratio for A (p = 0.003) and B (p = 0.003) were significantly higher compared to CON but not for C. Conclusion Hypoglycemia did not occur during or after HIIE and CON when using ultra-long-acting insulin and applying our methodological approach for exercise prescription. HIIE led to a smaller BG decrease compared to CON, although both exercises modes were matched for mean load and duration, even despite markedly higher peak workloads applied in HIIE. Therefore, HIIE and CON could be safely performed in T1DM. Trial Registration ClinicalTrials.gov NCT02075567 http://www.clinicaltrials.gov/ct2/show/NCT02075567

Low endogenous thrombin potential in trained subjects

INTRODUCTION A paradox seems to exist: exercising leads to clotting activation in conventional clotting tests, but exercising persons have a low risk of thrombosis. In this study we tried to evaluate the effect of exercise performance status on in vitro plasma thrombin generation, which represents an overall function test of hemostasis. MATERIALS AND METHODS We compared 56 trained subjects to 98 healthy age matched sedentary volunteers. Blood samples were analyzed for thrombin generation using calibrated automated thrombography. Microparticles were quantified using ELISA. Additionally prothrombin fragments 1 + 2, thrombin-antithrombin complex, tissue factor pathway inhibitor, antithrombin and prothrombin were measured. The group of the trained subjects performed an incremental cycle-ergometer exercise test after taking the blood sample. RESULTS A significantly lower endogenous thrombin potential was observed in the group of the trained subjects compared to the sedentary individuals (p = 0.007). Microparticles (ELISA) were significantly lower in the trained subjects compared to the sedentary subjects (p = 0.001). Prothrombin fragments 1 + 2 (p < 0.001) and thrombin-antithrombin complex (p = 0.01) were significant higher in the trained subjects and antithrombin (p = 0.02) as well as prothrombin (p < 0.0001) were significantly lower in this group, whereas tissue factor pathway inhibitor values did not show significant differences. Both maximal and submaximal power output was significantly negatively related to endogenous thrombin potential (r = -0.43, r = -0.45) and thrombin peak (r = -0.44, r = -0.42). CONCLUSIONS Trained subjects have a lower endogenous thrombin potential than sedentary subjects possibly explaining the lower incidence of thrombosis in this group despite a higher acute clotting activation during strenuous exercise.

Accuracy of Continuous Glucose Monitoring (CGM) during Continuous and High-Intensity Interval Exercise in Patients with Type 1 Diabetes Mellitus

Continuous exercise (CON) and high-intensity interval exercise (HIIE) can be safely performed with type 1 diabetes mellitus (T1DM). Additionally, continuous glucose monitoring (CGM) systems may serve as a tool to reduce the risk of exercise-induced hypoglycemia. It is unclear if CGM is accurate during CON and HIIE at different mean workloads. Seven T1DM patients performed CON and HIIE at 5% below (L) and above (M) the first lactate turn point (LTP1), and 5% below the second lactate turn point (LTP2) (H) on a cycle ergometer. Glucose was measured via CGM and in capillary blood (BG). Differences were found in comparison of CGM vs. BG in three out of the six tests (p < 0.05). In CON, bias and levels of agreement for L, M, and H were found at: 0.85 (−3.44, 5.15) mmol·L−1, −0.45 (−3.95, 3.05) mmol·L−1, −0.31 (−8.83, 8.20) mmol·L−1 and at 1.17 (−2.06, 4.40) mmol·L−1, 0.11 (−5.79, 6.01) mmol·L−1, 1.48 (−2.60, 5.57) mmol·L−1 in HIIE for the same intensities. Clinically-acceptable results (except for CON H) were found. CGM estimated BG to be clinically acceptable, except for CON H. Additionally, using CGM may increase avoidance of exercise-induced hypoglycemia, but usual BG control should be performed during intense exercise.

Acute Physiological Response to Aerobic Short-Interval Training in Trained Runners

PURPOSE To analyze the acute physiological response to aerobic short-interval training (AESIT) at various high-intensity running speeds. A minor anaerobic glycolytic energy supply was aimed to mimic the characteristics of slow continuous runs. METHODS Eight trained male runners (maximal oxygen uptake [VO(2max)] 55.5 ± 3.3 mL · kg(-1) · min(-1)) performed an incremental treadmill exercise test (increments: 0.75 km · h(-1)· min(-1)). Two lactate turn points (LTP1, LTP2) were determined. Subsequently, 3 randomly assigned AESIT sessions with high-intensity running-speed intervals were performed at speeds close to the speed (v) at VO(2max) (vVO(2max)) to create mean intensities of 50%, 55%, and 60% of vLTP1. AESIT sessions lasted 30 min and consisted of 10-s work phases, alternated by 20-s passive recovery phases. RESULTS To produce mean velocities of 50%, 55%, and 60% of vLTP1, running speeds were calculated as 18.6 ± 0.7 km/h (93.4% vVO(2max)), 20.2 ± 0.6 km/h (101.9% vVO(2max)), and 22.3 ± 0.7 km/h (111.0% vVO(2max)), which gave a mean blood lactate concentration (La) of 1.09 ± 0.31 mmol/L, 1.57 ± 0.52 mmol/L, and 2.09 ± 0.99 mmol/L, respectively. La at 50% of vLTP1 was not significantly different from La at vLTP1 (P = .8894). Mean VO(2) was found at 54.0%, 58.5%, and 64.0% of VO(2max), while at the end of the sessions VO(2) rose to 71.1%, 80.4%, and 85.6% of VO(2max), respectively. CONCLUSION The results showed that AESIT with 10-s work phases alternating with 20 s of passive rest and a running speed close to vVO(2max) gave a systemic aerobic metabolic profile similar to slow continuous runs.

Intensity- and Duration-Based Options to Regulate Endurance Training

The regulation of endurance training is usually based on the prescription of exercise intensity. Exercise duration, another important variable of training load, is rarely prescribed by individual measures and mostly set from experience. As the specific exercise duration for any intensity plays a substantial role regarding the different kind of cellular stressors, degree, and kind of fatigue as well as training effects, concepts integrating the prescription of both intensity and duration within one model are needed. An according recent approach was the critical power concept which seems to have a physiological basis; however, the mathematical approach of this concept does not allow applying the three zones/two threshold model of metabolism and its different physiological consequences. Here we show the combination of exercise intensity and duration prescription on an individual basis applying the power/speed to distance/time relationship. The concept is based on both the differentiation of intensities by two lactate or gas exchange variables derived turn points, and on the relationship between power (or velocity) and duration (or distance). The turn points define three zones of intensities with distinct acute metabolic, hormonal, and cardio-respiratory responses for endurance exercise. A maximal duration exists for any single power or velocity such as described in the power-duration relationship. Using percentages of the maximal duration allows regulating fatigue, recovery time, and adaptation for any single endurance training session. Four domains of duration with respect to induced fatigue can be derived from maximal duration obtained by the power-duration curve. For any micro-cycle, target intensities and durations may be chosen on an individual basis. The model described here is the first conceptual framework of integrating physiologically defined intensities and fatigue related durations to optimize high-performance exercise training.

Performance Enhancing Effect of Metabolic Pre-conditioning on Upper-Body Strength-Endurance Exercise

High systemic blood lactate (La) was shown to inhibit glycolysis and to increase oxidative metabolism in subsequent anaerobic exercise. Aim of this study was to examine the effect of a metabolic pre-conditioning (MPC) on net La increase and performance in subsequent pull-up exercise (PU). Nine trained students (age: 25.1 ± 1.9 years; BMI: 21.7 ± 1.4) performed PU on a horizontal bar with legs placed on a box (angular hanging) either without or with MPC in a randomized order. MPC was a 26.6 ± 2 s all out shuttle run. Each trial started with a 15-min warm-up phase. Time between MPC and PU was 8 min. Heart rate (HR) and gas exchange measures (VO2, VCO2, and VE) were monitored, La and glucose were measured at specific time points. Gas exchange measures were compared by area under the curve (AUC). In PU without MPC, La increased from 1.24 ± 0.4 to 6.4 ± 1.4 mmol⋅l−1, whereas with MPC, PU started at 9.28 ± 1.98 mmol⋅l−1 La which increased to 10.89 ± 2.13 mmol⋅l−1. With MPC, net La accumulation was significantly reduced by 75.5% but performance was significantly increased by 1 rep (4%). Likewise, net oxygen uptake VO2 (50% AUC), pulmonary ventilation (VE) (34% AUC), and carbon dioxide VCO2 production (26% AUC) were significantly increased during PU but respiratory exchange ratio (RER) was significantly blunted during work and recovery. MPC inhibited glycolysis and increased oxidative metabolism and performance in subsequent anaerobic upper-body strength-endurance exercise.

Different heart rate patterns during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes

To investigate the heart rate during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes (T1D) compared to healthy (CON) individuals. Fourteen people (seven individuals with T1D and seven CON individuals) performed a CPX test until volitional exhaustion to determine the first and second lactate turn points (LTP1 and LTP2), ventilatory thresholds (VT1 and VT2), and the heart rate turn point. For these thresholds cardio-respiratory variables and percentages of maximum heart rate, heart rate reserve, maximum oxygen uptake and oxygen uptake reserve, and maximum power output were compared between groups. Additionally, the degree and direction of the deflection of the heart rate to performance curve (kHR) were compared between groups. Individuals with T1D had similar heart rate at LTP1 (mean difference) −11, [(95% confidence interval) −27 to 4 b.min−1], at VT1 (−12, −8 to 33 b.min−1) and at LTP2 (−7, −13 to 26 b.min−1), at VT2 (−7, −13 to 28 b.min−1), and at the heart rate turn point (−5, −14 to 24 b.min−1) (p = 0.22). Heart rate expressed as percentage of maximum heart rate at LTP1, VT1, LTP2, VT2 and the heart rate turn point as well as expressed as percentages of heart rate reserve at LTP2, VT2 and the heart rate turn point was lower in individuals with T1D (p < 0.05). kHR was lower in T1D compared to CON individuals (0.11 ± 0.25 vs. 0.51 ± 0.32, p = 0.02). Our findings demonstrate that there are clear differences in the heart rate response during CPX testing in individuals with T1D compared to CON individuals. We suggest using submaximal markers to prescribe exercise intensity in people with T1D, as the heart rate at thresholds is influenced by kHR. Clinical Trial Identifier: NCT02075567 (https://clinicaltrials.gov/ct2/show/NCT02075567).

Allgemeine Grundlagen, Planung und Organisation des Trainings

Das Wissen um trainingswissenschaftliche Grundlagen ist ein integraler Bestandteil der sportmedizinischen Betreuung von Sportlern und Sportlerinnen aller Leistungsklassen. Aufgrund der Komplexitat und der Vielfalt der unterschiedlichen Trainingsmasnahmen in den verschiedensten Sportarten kann die sportmedizinische Beratung meist nur auf wesentliche Grundlagen, die allen Sportarten gemeinsam sind, eingehen. Eine Basiskenntnis uber die grundlegenden Ziele, Inhalte und Methoden sportlichen Trainings sowie deren gesetzmasige Abhangigkeiten und Ablaufe ist Voraussetzung fur eine, uber die rein klinisch-medizinische Betreuung hinausgehende sportspezifische Beratung von Sportlern und Sportlerinnen. In diesem Kapitel werden die Grundlagen der Trainingslehre komprimiert zusammengefasst dargestellt.

Training der Hauptkomponenten der Leistungsfähigkeit – Trainingsmethoden und Trainingsberatung

Da die Ausdauer diejenige Hauptkomponente der Leistungsfahigkeit darstellt, die fur den Sportmediziner das groste Feld fur trainingsrelevante Masnahmen und Beratung bietet, wird ihr ein Grosteil des folgenden Kapitels gewidmet. Dabei stehen insbesondere physiologische Akutreaktionen wahrend der Belastung, die dadurch uber spezifische Pfade der Signalgebung ausgelosten molekularen Prozesse und die mittel- und langfristigen Trainingsanpassungen (etwa des Skelettmuskels) im Mittelpunkt der Betrachtung und werden mit den durch Krafttraining ausgelosten Adaptionsprozessen verglichen.