Name: a rapidly incremented tethered-swimming maximal protocol for cardiorespiratory assessment of swimmers
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This work was supported by CIPER-Foundation for Science and Technology (FCT), Portugal (UID/DTP/00447/2019) and financed in part by the Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior - Brasil (CAPES) - Finance Code 001&#34;, and to the S&#227;o Paulo Research Foundation - FAPESP (PROCESS 2016/04544-3 and 2016/17735-1). Authors would like to thank Jo&#227;o Guilherme S. V. de Oliveira to the assistance in data sampling. M&#225;rio A. C. Espada acknowledge the financial support from IPDJ &#8211; Portuguese Institute of Sports and Youth.

Participants in the study from which the representative-subject data presented below were extracted20 (n = 11) were required to give their written informed consent prior to initiation of testing after the experimental procedures, associated risks and potential benefits of participation had been explained. The first visit comprised a familiarization session during which the swimmers were introduced to the concept of tethered swimming and the measurement techniques that would be in effect d...

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M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rapidly+incremented+tethered-swimming+test+for+defining+domain-specific+training+zones.">A rapidly incremented tethered-swimming test for defining domain-specific training zones.</a> Journal of Human Kinetics. 57 (1), 117-128 (2017).</li><li>Dopsaj, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+50m-freestyle+results+and+characteristics+of+tethered+forces+in+male+sprint+swimmers:+A+new+approach+to+tethered+swimming+test.">The relationship between 50m-freestyle results and characteristics of tethered forces in male sprint swimmers: A new approach to tethered swimming test.</a> Physical Education &amp; Sport. 1 (7), 15-22 (2000).</li><li>Wheatley, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Conducting+Maximal+and+Submaximal+Endurance+Exercise+Testing+to+Measure+Physiological+and+Biological+Responses+to+Acute+Exercise+in+Humans.">Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans.</a> Journal of Visualized Experiments. 17 (140), (2018).</li><li>Lansley, K. E., DiMenna, F. J., Bailey, S. J., Jones, A. 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W., McNaughton, L. R., Jones, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Training+to+enhance+the+physiological+determinants+of+long-distance+running+performance:+can+valid+recommendations+be+given+to+runners+and+coaches+based+on+current+scientific+knowledge?.">Training to enhance the physiological determinants of long-distance running performance: can valid recommendations be given to runners and coaches based on current scientific knowledge?.</a> Sports Medicine. 37 (10), 857-880 (2007).</li><li>Jones, A. M., DiMenna, F. J., Cardinale, M., Newton, R., Nosaka, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiovascular+Assessment+and+Aerobic+Training+Prescription.">Cardiovascular Assessment and Aerobic Training Prescription.</a> Strength and Conditioning: Biological Principles and Practical Applications. , 291-304 (2011).</li><li>Beneke, R., von Duvillard, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+maximal+lactate+steady+state+response+in+selected+sports+events.">Determination of maximal lactate steady state response in selected sports events.</a> Medicine and Science in Sports and Exercise. 28 (2), 241-246 (1996).</li><li>Beneke, R. M., H&#252;tler, M., Leith&#228;user, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maximal+lactate-steady-state+independent+of+performance.">Maximal lactate-steady-state independent of performance.</a> Medicine and Science in Sports and Exercise. 32 (6), 1135-1139 (2000).</li><li>Smith, C. G., Jones, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+critical+velocity,+maximal+lactate+steady-state+velocity+and+lactate+turnpoint+velocity+in+runners.">The relationship between critical velocity, maximal lactate steady-state velocity and lactate turnpoint velocity in runners.</a> European Journal of Applied Physiology. 85 (1-2), 19-26 (2001).</li><li>Pringle, J. S., Jones, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maximal+lactate+steady+state,+critical+power+and+EMG+during+cycling.">Maximal lactate steady state, critical power and EMG during cycling.</a> European Journal of Applied Physiology. 88 (3), 214-226 (2002).</li><li>Mattioni Maturana, F., Keir, D. A., McLay, K. M., Murias, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+measures+of+critical+power+precisely+estimate+the+maximal+metabolic+steady-state?.">Can measures of critical power precisely estimate the maximal metabolic steady-state?.</a> Applied Physiology Nutrition and Metabolism. 41 (11), 1197-1203 (2013).</li><li>Jones, A. M., Burnley, M., Black, M. I., Poole, D. C., Vanhatalo, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+maximal+metabolic+steady+state:+redefining+the+'gold+standard'.">The maximal metabolic steady state: redefining the 'gold standard'.</a> Physiological Reports. 7 (10), e14098 (2018).</li><li>Scheuermann, B. W., Kowalchuk, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Attenuated+respiratory+compensation+during+rapidly+incremented+ramp+exercise.">Attenuated respiratory compensation during rapidly incremented ramp exercise.</a> Respiratory Physiology. 114 (3), 227-238 (1998).</li><li>Morgan, D. 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An exercise challenge that involves enduring an incremental increase in WR until Tlim is reached is a standard testing protocol for assessment of endurance athletes. When such a test is performed with gradual, but rapid incrementation, it is particularly useful because in addition to the V&#775;O2max, gas exchange and ventilatory data collected during the test can be used to distinguish the region bounded by GET and RCP where acidosis is present, but arterial partial pressure of CO2 (PaCO...

An exercise test that involves an incremental increase in work rate (WR) from low to maximal (i.e., incremental exercise test; INC) provides the gold standard method of cardiorespiratory assessment for endurance athletes. In addition to the highest WR that the athlete can achieve (WRpeak), INC also allows for determination of the highest rate at which the individual can consume oxygen (O2) for that form of exercise (V&#775;O2peak) if gas exchange and ventilatory data are collected during the test1. The V&#775;O2peak represents the criterion measure of cardiorespiratory fitness. Moreover, analysis of gas exchange and ventilatory data collected as WR is increased provides a non-invasive way to identify the point at which blood-lactate concentration (blood [lactate]) increases above the baseline value (lactate threshold) and the point at which it begins to accumulate at an accelerated rate (lactate turnpoint)2. These metabolic breakpoints are estimated by determining the gas-exchange threshold (GET) and respiratory-compensation point (RCP), respectively3. Importantly, the GET provides a robust estimate of the point at which blood [lactate] initially increases whereas the &#34;hyperventilation&#34; that characterizes RCP is a more complex phenomenon that can be initiated by afferent input other than chemoreception per se. Consequently, conclusions based on identification of RCP should be made with caution.
When exercise is maintained at a constant rate of work (CWR), there are markedly different physiological response profiles based on the &#34;exercise-intensity domain&#34; within which the WR falls4,5. Specifically, achievement of a V&#775;O2 and blood [lactate] &#34;steady state&#34; is rapid in the moderate domain, delayed in the heavy domain and unattainable in the severe domain4,5. It is well established that the rate at which O2 can be consumed at GET during INC (V&#775;O2GET) serves as the metabolic rate that separates the moderate from heavy domain during CWR3,6. Although controversial, a number of recent observations indicate similar equivalence between the rate at which O2 can be consumed at RCP (V&#775;O2RCP) and heavy/severe separation7,8,9,10. Identification of V&#775;O2GET and V&#775;O2RCP from data collected during INC might, therefore, be useful for prescribing domain-specific training regimens for endurance athletes via metabolic rate with the caveat that aligning a metabolic rate with a specific work rate is more complex than simply doing so according to the V&#775;O2-work rate relationship derived from the incremental test8,11.
When the concept of testing to determine V&#775;O2max was initially explored, researchers had subjects perform bouts of track running to the limit of exercise tolerance (Tlim) at increasing speeds on separate days1. Research followed which confirmed that V&#775;O2max can also be determined from similar bouts performed to Tlim on the same day with rest periods interspersed12. Eventually, it was shown that a continuous protocol with WR increased in an incremental manner at specific time intervals (e.g., every 3 min) revealed the same V&#775;O2peak as the discontinuous tests13. Consequently, these &#34;graded exercise tests&#34; became the standard for determining this criterion measure of cardiorespiratory fitness. However, in 1981, Whipp and colleagues published research that indicated that for the purpose of V&#775;O2max measurement, INC could also be performed entirely in the non-steady state; that is, with WR increasing continuously as a &#34;smooth function of time&#34; (RAMP-INC)14. Unlike INC with extended stages and relatively large WR increases per stage, the gradual increase during RAMP-INC ensures that the &#34;isocapnic buffering region&#34; that separates GET and RCP will be clearly defined15. Furthermore, much like INC with stages, RAMP-INC can be used to assess &#34;exercise economy&#34; (i.e., the V&#775;O2 required per given WR); however, unlike INC with stages, in this case, it is the inverse of &#34;delta efficiency&#34; (i.e., the slope of the V&#775;O2-WR relationship) that is used for this purpose11 with consideration given to the fact that due to the complexities of the V&#775;O2 response to work rates across the intensity spectrum, this parameter will not be an immutable feature of INC per se (e.g., RAMP-INC initiated from different baseline work rates or characterized by different ramp slopes) or CWR exercise16.
For general fitness testing, INC is usually performed on a leg ergometer or treadmill because these modalities are more available and leg cycling and walking/running are familiar to the average person. Moreover, administration of RAMP-INC requires the ability to increase WR continuously in small increments (e.g., 1 W every 2 s); hence, an ergometer (typically leg cycling) is best suited for this type of testing. However, athlete assessment is more complex because athletes must be tested while performing the specific mode of exercise required for their sport. For cyclists and individuals who participate in sports that involve running, this is not problematic because of the accessibility and applicability of the aforementioned testing machines. Conversely, ecologically-valid testing with gas exchange and ventilatory data collection and the gradual WR incrementation required for RAMP-INC is more challenging when assessing aquatic athletes.
Prior to the advent of automated collection systems, gas-exchange assessment of swimmers was often performed using Douglas-bag collection following a maximal swim17. Once automated systems were developed, &#34;real-time&#34; collection took place, but not under &#34;real-swimming&#34; conditions (e.g., while swimmers swam in a flume which controlled WR)17. Unfortunately, the former method has inherent limitations due to the assumptions of &#34;backward extrapolation&#34; while the latter raises concerns regarding the degree to which flume swimming changes technique17. The current state of the art involves the use of portable breath-by-breath collection systems which move with the swimmer alongside the pool during free swimming17. While this type of measurement improves ecological validity, gradual WR incrementation is challenging. Indeed, INC during free swimming typically involves intervals of set distance (e.g., 200 m) at progressively-increasing velocities14,15. This means that a test consists of lengthy stages with large unequal WR increments. It is, therefore, not surprising that only a single metabolic breakpoint (typically called the &#34;anaerobic threshold&#34;) is reported by researchers who employ this test18,19. Instead, we have recently shown that both V&#775;O2GET and V&#775;O2RCP can be determined from data collected while swimmers performed stationary swimming in a pool against a load that was increased gradually and rapidly (i.e., incremental tethered swimming)20. While the unique breathing pattern that is present during swimming might render the aforementioned breakpoints harder to identify compared to typical modes of assessment (personal observation), we believe that this method of testing might be suitable as a &#34;swim ergometer&#34; that can be used for cardiorespiratory assessment of swimmers in a manner similar to how a stationary cycle is used for cyclists. Indeed, we have shown that V&#775;O2GET, V&#775;O2RCP and exercise economy (as indicated by the V&#775;O2-load slope) can all be determined from the rapidly incremented tethered-swimming protocol that is described below20.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3-L syringe</td>
			<td>Hans Rudolph</td>
			<td></td>
			<td>Calibration device</td>
		</tr>
		<tr>
			<td>Aquatrainer</td>
			<td>COSMED</td>
			<td></td>
			<td>Snorkel system/gas-exchange measurement</td>
		</tr>
		<tr>
			<td>K4b2</td>
			<td>COSMED</td>
			<td></td>
			<td>Portable CPET unit/gas-exchange measurement</td>
		</tr>
		<tr>
			<td>N200PRO</td>
			<td>Cefise</td>
			<td></td>
			<td>Software program for analysis of force signal</td>
		</tr>
		<tr>
			<td>Pacer 2 Swim</td>
			<td>Kulzer TEC</td>
			<td></td>
			<td>Swimming velocity management/underwater LED line</td>
		</tr>
		<tr>
			<td>Tether-system</td>
			<td>Own design</td>
			<td></td>
			<td>Pulley-Rope system/loading management</td>
		</tr>
		<tr>
			<td>Tether attachment</td>
			<td>CEFISE</td>
			<td></td>
			<td>Bracket for attachment to swimmer</td>
		</tr>
	</tbody>
</table>

a rapidly incremented tethered-swimming maximal protocol for cardiorespiratory assessment of swimmers

Incremental exercise testing is the standard means of assessing cardiorespiratory capacity of endurance athletes. While the maximal rate of oxygen consumption is typically used as the criterion measurement in this regard, two metabolic breakpoints that reflect changes in the dynamics of lactate production/consumption as the work rate is increased are perhaps more relevant for endurance athletes from a functional standpoint. Exercise economy, which represents the rate of oxygen consumption relative to performance of submaximal work, is also an important parameter to measure for endurance-athlete assessment. Ramp incremental tests comprising a gradual but rapid increase in work rate until the limit of exercise tolerance is reached are useful for determining these parameters. This type of test is typically performed on a cycle ergometer or treadmill because there is a need for precision with respect to work-rate incrementation. However, athletes should be tested while performing the mode of exercise required for their sport. Consequently, swimmers are typically assessed during free-swimming incremental tests where such precision is difficult to achieve. We have recently suggested that stationary swimming against a load that is progressively increased (incremental tethered swimming) can serve as a &#34;swim ergometer&#34; by allowing sufficient precision to accommodate a gradual but rapid loading pattern that reveals the aforementioned metabolic breakpoints and exercise economy. However, the degree to which the peak rate of oxygen consumption achieved during such a protocol approximates the maximal rate that is measured during free swimming remains to be determined. In the present article, we explain how this rapidly incremented tethered-swimming protocol can be employed to assess the cardiorespiratory capacity of a swimmer. Specifically, we explain how assessment of a short-distance competitive swimmer using this protocol revealed that his rate of oxygen uptake was 30.3 and 34.8 mL&#8729;min-1&#8729;kg-1BM at his gas-exchange threshold and respiratory compensation point, respectively.

The data presented in Table 1 and depicted in Figures 1-4 represents the response profiles observed for a male swimmer (age, 24 years). At the time of data collection, the swimmer had been training for competitive swimming for 7 years. His specialty was short-distance (i.e., 50 m and 100 m) freestyle events.
The initial load on INC was set at a load that exceeded that which was required for this...

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A Rapidly Incremented Tethered-Swimming Maximal Protocol for Cardiorespiratory Assessment of Swimmers

As opposed to measurement during free swimming, which presents inherent challenges and limitations, determination of important parameters of cardiorespiratory function for swimmers can be made using a more feasible and easier to administer tethered-swimming rapidly incremented protocol with gas exchange and ventilatory data collection.

Incremental exercise testing is the standard means of assessing cardiorespiratory capacity of endurance athletes. While the maximal rate of oxygen ...

During stationary swimming against an increasing load, the gas-exchange threshold and respiratory compensation point can be readily discerned, two important parameters to measure during free swimming at increasing velocity. Intensity progression via load increases during incremental exercise can be symmetrical, gradual, and rapid during tethered swimming, which is not the case during incremental free swimming at an increasing velocity. Administering the procedure will be Leandro Oliveira, Luiz Gustavo Santos, and Camila Vasconcelos, graduate students from my laboratory.The swimmer will be Julia Kato who has been in involved in competitive swim training for five years. To prepare the 500-kilogram load cell that will be used to measure the highest force that the swimmer can exert during two trials comprising 30 seconds of all-out swimming, open the N2000PRO software program, and open the Help menu to verify the communication link between the computer and the load-cell analyzer. When the connection to the RS232 interface is established, a green signal will appear.Set the countdown to start the test, the sampling duration, and the rest interval. Then set the frames per second at 100 hertz. Set the unit of force measurement, then set the acquisition time in milliseconds.Then calibrate the load cell with zero-and 10-kilogram loads with the swimmer outside of the pool. Before beginning the two-trial test, provide instructions regarding the correct performance of all-out front-crawl swimming, and have the swimmer practice the stretching and arm and leg swings at poolside. Next, have the swimmer enter the pool and perform a standard warm-up protocol comprised of front-crawl swimming for 800 meters at a light intensity.At the end of the warm-up, allow the swimmer to rest at poolside for 10 minutes. At the end of the rest period, attach a load cell to the start block via the L-shaped flattened iron bar for the tethered swimming measurements, and attach one end of the inelastic rope to the load cell. Use a custom-designed belt that has ropes attached to both hips such that leg kicking will not interfere with the force measurement, and attach the other end of the rope to the swimmer.Then determine the load required to maintain the swimmer's body horizontally with a minimum amount of tension on the measurement system. When the swimmer is ready, signal the swimmer to begin the trial in the water, monitoring the swimmer and providing verbal encouragement throughout the 30-second test. At the end of the trial, signal the swimmer to end the test, and detach the swimmer from the inelastic rope.Instruct the swimmer to perform a standard cool-down protocol comprised of front-crawl swimming at a light intensity, and let the swimmer rest for 30 minutes at poolside. At the end of the rest period, reattach the swimmer to the inelastic rope, and signal the swimmer to begin the second trial of all-out tethered swimming. At the end of the trial, signal the swimmer to stop the test and to perform a second standard cool-down protocol comprised of front-crawl swimming at a light intensity.At the end of the cool-down, allow the swimmer to exit the pool. For an incremental tethered swimming test, after calculating the loads to resist the swimmer's forward displacement during the test, verify the communication link between the computer and the automated portable metabolic unit within the unit's software. Power on the unit to allow the unit to warm up for 45 minutes, and confirm that the batteries are fully charged.Then enter the subject data, ambient temperature, and humidity. To prepare the swimmer for the incremental test, install a face mask and a snorkel on the swimmer. Instruct the swimmer to rest at poolside to collect the baseline gas exchange and ventilatory data.After 10 minutes, instruct the swimmer to perform a standard warm-up protocol comprised of front-crawl swimming at a light intensity wearing the snorkel system to ensure familiarization. At the end of the warm-up, detach an inelastic rope to the belt with the other end of the rope attached to the loading system. Secure the belt around the swimmer's waist.Instruct the swimmer to enter the pool and to use the two markers from the bottom of the pool for reference points to allow them to maintain a relatively fixed position within the pool. When the swimmer is ready, signal to begin the test, and monitor the swimming during the trial. A research assistant experienced in monitoring this type of testing should hold the gas analysis unit at poolside without impeding the swimmer's displacement or elevating the swimmer's head.This test requires a synchronized effort that includes changing the load, encouraging the swimmer, monitoring the position in the water, and the data that are being collected. During the trial, increase the load while timing the 60-second stages. When the swimmer is no longer able to maintain the requisite position despite strong verbal encouragement, terminate the test, and record the time to limit of exercise tolerance.Use the time to the limit of exercise tolerance to calculate the stages completed and record the loads for each stage and the peak load. Then detach the swimmer from the inelastic rope, and instruct the swimmer to perform a standard cool-down protocol comprised of front-crawl swimming at a low-to-moderate intensity before exiting the pool. The initial load on the incremental exercise test was set at a load that exceeded that which was required for the swimmer to maintain body alignment prior to initiation of the all-out swim by 30%of the difference between the average force measured during the all-out swim and the initial all-out swim.The load was then increased by 0.7 kilograms for every 60-second stage. The limit of exercise tolerance for the swimmer occurred at stage 10 after 576 seconds. When the breath-by-breath oxygen uptake data collected during the baseline and exercise portions of the incremental exercise test were averaged into consecutive nine-second bins, the highest three-point rolling average was 3.44 liters per minute, and the oxygen uptake load slope was 261 milliliters per minute per kilogram.During the rapid incremental exercise test, the decline in arterial blood carbon dioxide and end-tidal carbon dioxide that characterizes respiratory compensation and response to metabolic acidosis does not occur for at least two or more minutes, during which the work and metabolic rates continue to increase. For this swimmer, the metabolic rates characterizing these distinct changes in gas exchange and ventilatory response driven by the increased contribution of the anaerobic pathway to energy demand occurred at 75%and 86%of the peak oxygen uptake, respectively. The technicians administering the test must be coordinated as precise timing is required, and swimmer must be highly motivated and familiar with the novel aspects of tethered swimming.As the metabolic response to a linear increase in work is not linear, this type of test allows identification of the breakpoints that defines an athlete's nonlinearity.

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