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ryinc

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 #1 
Here is a new case study. At this stage i will keep details light to allow freedom of interpretation.

However note the following;
  • The CSV file attached includes the data directly from Moxy and other data recorded. Note though that the heart rate data, power data etc was only recorded from the 3 min calibration phase and to the end of the 3 min calibration phase (i.e. there is additional Moxy data both before and after the assessment). The 3 min calibration at the start of the formal assessment starts at point 1489 in the data. In the images i have attached below - i am only showing the from the 3 min calibration (i.e not showing Moxy data before and after the assessment, as is included in the data).
  • Cycling 5-1-5 assessment,
  • Fully rested state
  • 3 min calibration phase at start and calibration phase at end
  • Muscle oxygenation sensor placed on right vastus lateralus (“VL”) muscle
  • In all rest periods, right foot in the 6 o clock position
  • Slope used instead of fixed wattage (-2.5%; -1.5%; 0%, 0.5%; 1%) – the first two sets of loads produced a very similar wattage 
  • Wattage calculation produced by trainer not necessarily accurate
  • Sp02 on right index finger values were manually taken with a Sp02 sensor. Readings were taken at
    • 30 seconds into the calibration phase;
    • 4 min 30 seconds and end of each load during for the 5 min steps
    • 30 seconds and end of the break, for the 1 min rests
  • There were some data problems (e.g. see just before the start of the assessment)
  • I have done an interpretation but will keep thoughts to myself for now, to get others' input
First the data problems highlighted (includes periods before and after the formal part of the assessment). Potential data problems.jpg 
Sm02 alone
Sm02 overall.png 
tHb
tHb overall.png 
Heart rate
Heart rate overall.png 
Sm02 with Sp02 (manual readings - light green bars)
Sm02 vs Sp02.png 

Bias traces
Sm02 vs Sp02.png 
Finally heart rate, tHb and SmO2 together
Heart rate tHb and Sm02 overall.png 

 
Attached Files
csv Full_Time_Synched_Data_Final.csv (268.71 KB, 5 views)

juergfeldmann

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 #2 
Nice datas . Interesting is  the  reaction  or  lack of  in the  1 min rest in SmO2. tHb has a reaction as   you can see but  SmO2 not. In fact thb  goes  where as SmO2 has a  minimal reaction  so relative  seen  it still   is  an increase in  O2Hb. More  b   and same  SmO2 % . Will be fun to look at  HHb  and O2Hb in this case.
 One interesting  personnel  assessment you can do is. Sit on the bike  keep  right leg as in the assessment  for 3   +- min  at 6 o'clock  and than changed  to  12  O  clock  for the same time  to see how in your case the tHb  changes  due to change in hip angle  and therefor  blood  flow reaction as well as the position of he    femur in  6  o  clock and in  12 o'clock . We see very different reactions  in this case  so positional influence is   very individual. Question to  SpO2 .   I assume  you had it on a finger  and  how  was your hand position during the SpO2  reading. What  where  the pulse rate  compared  to the  HR  feedback  from your  HR belt ? I  did not yet looked  at the  csv  file  but  are there  the actual  numbers  of SpO2  there  as it s not  too easy to see  the actual values  on the graph. ?
Summary : Fascinating the overall SmO2 trend  and if there woudl be no  info's  it  could look as a  graph  just like a 5 min  step test  without one min breaks.   This graph  is  what we use in fitness centers  5 min step test  for an  individual  design  intensity feedback  with  what some  people  would call "zoning"  three    zoning's really  as in the good old  days.
  1. Intensity , where   delivery of  O2  is   higher than utilization. ( SmO2  up )   than  a homeostasis  so  SmO2  " flat  as delivery and  utilization are  balanced.
  than  last section where SmO2  drops  so  more  utilization than delivery. This than is the  esy  individual way  for a  daily fast  " calibration , when they do their  planned intensity  workout  as   this  can change  due  to  overload  the day before  or other  reason.
 The major different to  traditional  ideas of  zoning is clear. We  not base it on a    maximal  found intensity   which than is called  100 %  and than use a  calculator, we base it  on physiological reaction. I  can than make a  "HIIT " in the   intensity , where  under  " normal " loads  I would see an increase in SmO2  . BUT
  Physiologically HIIT is  actually a MISS. MISS stand  for  maximal individual specific  stimulation.  HIIT's  as you can see in Andri's  webinar  are based on  high  loads  , where as  MISS  are based on high stimulation of  physiological reactions  under a minimal loads.
In  classical HITs  we  ale  ways  load  or  create a delivery limitation in most cases .
In MISS we   target a specif physiological reaction and try to avoid  overloading other  physiological systems. 
 So  I can desaturate much lower in a MISS  without  or  even  with dropping CO  (  HR )  and not   or minimal load  . 

This is important in  case, where we may have  an injury  or  other reasons, where I may not like to  load  the  cardiac systems but like to maintain or improve  desaturation. Example Post  heart valve replacement.
This  than leads  to a very interesting  discussion, where I not  completely agree with  Andris  explanation in the  HIIT  where we  see SmO2  dropping low  and than we  maintain a   flat SmO2  level on a low   %. Read careful o listen  and than ask  some questions   energetic  wise. Than  repeat  the  SmO2 trend  and add a SEMG  to it  and look what the SmO2  / thB  and SEMG  may reveal. 
ryinc

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 #3 
I meant to post the bias traces here they are; Bias 02Hb.png 
ryinc

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 #4 
Jeurg just to answer your other questions.

Sp02 was on the right index finger, he was holding the bars and so finger was pointing slightly downwards. I did not take the pulse readings from the Sp02 sensor to compare to the HR numbers.

The Sp02 values are manually recorded into the CSV file - i agree it is hard to see the values on the graph.
juergfeldmann

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 #5 

Thanks  great feedback  you an see  O2Hb in the biased  graph  and you an see there  the change in O2Hb during rest. Great example how , when we look SmO2  as a %  of tHb alone may give a different  impression. The increase in tHb  and the  " stable" SmO2   is  still an increase in O2 during the  rest. The second    information n the biased  feedback  you can see  s  that  O2Hb and HHb  are NOT  always symmetrically. There are symmetrically IF the  O2  delivery  and utilization  is  the same  so you use 4  O2  you increase  HHb  by 4  and  reduce  O2Hb  by  for as a  super stupid  example.

Now  why is  this interesting. If  you   create a venous occlusion  or  an arterial occlusion  you  will have a different   O2Hb  and HHb  trend.

So  venous occlusion  we have an inflow   but no outflow. How  will this be  visualized on a HHb  and O2Hb graph.

Now    think.
 The discussion we have about priority and non priority muscle.
 A non priority muscle ,  who may actually  shift blood  from  the arms into  the legs(  actually it is not the muscle  who  creates  the shift  it is  the central governor. ( brain )  as CO  can not  delivery  the O2  demand anymore  will have  the same resting   metabolic  O2  use but now  we have less  O2  delivery due to the  shift of blood but the  same O2  resting use.
 Can you see where we  go with this ?  Next  SpO2.   Look   exactly  how  SpO2  was collected.

Sp02 was on the right index finger, he was holding the bars and so finger was pointing slightly downwards

. If  in this position , and it happens very often  the  wrist  was  pushed into a dorsal flexion , than this changes the  space in he  carpal tunnel  and the first 2  structures  who react are  the nerve  reaction  or the  blood flow.
 Remember  the  SpO2   needs free  blood flow  so the what some call HR  is  actually really pulse rate. It  never measures  the HR  it always tries  to  measure  Puls rate  which in  many cases  is  the same  rate  as HR  but it can be off  by a lot if  the blood flow is interrupted  due to  for example mechanical  pressure or  due to muscle compression like  an occlusion. In  the handle bar position case it  can be  mainly a mechanical  blood flow restriction.
 So  when we  test  SpO2  the  client has  to let go the  handle bar  so free  no pressure flow  and than we  compare  HR  and pulse rate  and it has to be the  same.

 There is a huge  hype  about   HR  tester  without  belt. You see  what they actually sll  ??
 There is a  lawsuit  going on  for a  very big  company  whit puls rate   tester   who  claim it is a HR  and  they are   in many sports off by a  lot  and lot  can by  20 +- beats  and more.
 Many  tried  to get  proper  Pulse rate  so it  equals  HR  many try  to actually use   pulse rate  and  ague  they can get  even HRV  out of  it ???

 May be  but  very big companies  worked and work on this  since many years   and did not yet  at least solved  the  problem. So HR    equals  proper HR feedback , pulse rate  equals  hopefully  decent   feed back on possible  HR.

 Next  part you look . HR   after the first 5 min load   look the  drop  of the HR in the 1 min rest. Than  if properly done he loaded the  same wattage again  for  5 min. so  same load. Look  the " recovery " of  HR in the   1 min rest.  What  can you see  and the  question is  why ?

Smile I  already  see some interesting mails  coming in, why I not simple  tell what happens ???
 Why would I . I only believe in  the  situation, that when people  get their own thoughts and logic into this interesting physiological field , that  they understand  why there is no  cook book.  But they will be real chefs  and  better a few  real chefs  , than a hole   big group of  franchise. 

bobbyjobling

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 #6 
Maybe extra blood pressure regulation is needed as blood flow resistance is reduced in the priority muscle esecialy during the rest period. If stroke volume is not adequate then HR need to increase. Please be kind to my answer[smile]
ryinc

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 #7 
Thanks Jeurg and Bobby for the comments.

Now  why is  this interesting. If  you   create a venous occlusion  or  an arterial occlusion  you will have a different   O2Hb  and HHb  trend.

So  venous occlusion  we have an inflow   but no outflow. How  will this be  visualized on a HHb and O2Hb graph.

For a venous occlusion we see, Sm02 reducing and tHb increasing. I think we would then see HHB rise sharply - combination of lower Sm02 and tHb. 02Hb would fall most likely, but not as drastically as the HHb rise. 

In the last load we see Sm02 reduce, tHb rise, 02Hb fall and HHb rise. On the rest straight after that load we see Sm02 rise, 02Hb rise, HHb fall. There is a hint that tHb stays flat just after the load is finished (although not very clear) and so venous occlusion trend is a possibility (highlighting that muscular strength at higher loads might be a limiter?).

Another thing i noticed in the higher loads is that tHb becomes less smooth and becomes more jagged - is this perhaps also highlighted that the quality of the muscle compression is decreasing in these higher loads? 

A non priority muscle ,  who may actually  shift blood  from  the arms into  the legs(  actually it is not the muscle  who  creates  the shift  it is  the central governor. ( brain )  as CO  can not delivery  the O2  demand anymore  will have  the same resting   metabolic  O2  use but now we have less  O2  delivery due to the  shift of blood but the  same O2  resting use. Can you see where we  go with this ?

Actually not sure i understand where you are going Jeurg. Are you saying that when there is a shift in blood we expect to see a drop in resting Sm02 because less is being delivered but it has the same utilisation? And are you trying to tie this into SpO2 - or is this just a separate point?

So  when we  test  SpO2  the  client has  to let go the  handle bar  so free  no pressure flow  and than we  compare  HR  and pulse rate  and it has to be the  same.

Thanks for this practical tip - i will apply it on data collection in future. One practical issue though is that on the hard loads, athletes would struggle to take their hands off the bars and put their index finger up in the air.

 Next  part you look . HR   after the first 5 min load   look the  drop  of the HR in the 1 min rest. Than  if properly done he loaded the  same wattage again  for  5 min. so  same load. Look  the " recovery " of  HR in the   1 min rest.  What  can you see  and the  question is  why ?

I assume what you are pointing out is the increases in the minimum heart rate reached on recovery, which starts right from the first load, and I assume that this is the question Bobby is responding to below as well.

You might need to give some hints at least Jeurg, I can see the link to stroke volume as highlighted by Bobby but not sure i can see the full picture clearly. [crazy]




juergfeldmann

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 #8 
Maybe extra blood pressure regulation is needed as blood flow resistance is reduced in the priority muscle especially during the rest period. If stroke volume is not adequate then HR need to increase.


That is a super great   and intriguing point  I and it will lead  in the future  many to  the  ability  to   create specific physiological  stimulation.

The point here  may as well be integrated in the  nice  Webinar   Andri  gave  over HIIT  and   how  starter  can use SmO2  for a  better individual feedback. I  may  come back on this Webinar  as I  would  challenge many points  in case we really just  go  there with SmO2  as the  guidelines NIRS offers  much more and    the point Andri makes here is , that we have to start somewhere. I lie to  show  you here based on Bobby's  interesting point  what really can be done in some practical examples.
  If  we  plan specific  stimulation  we have to take into account  thee  shift of blood volume  either  form  one  body area  like arm to  leg  as one options but as well the shift of blood  to the  skin as one of the biggest organs  if  we have  as a priority   a temperature  control ( Core temperature.)
 I like to keep it short here as it  can go   very deep into   training ideas  and I  simply just like to show  NIRS interpretations.

1. BN closer look t1 t3 only thb.JPG 
What you see here  is a  tHb trend  ( Portamon ) The   thicker  Trace is  thee deeper  muscular  tHb trend  like we  would see  with MOXY.
 The   skinnier you can see show s up  by 900 time unit is  the trend in the   surface  region so mainly skin.
 As you can see the  skin blood flow   by 900 drops  as I had  the  goal  to see, whether we  actually can see a change in SV  if we have more blood in the circulatory system  ( muscles ) and less in the   skin, where we  have   still O2 in the blood but this now is NOT available  for actually performance. Some may recall the  studies  I showed  I did  and comparing  with  one  from Australia  on influence of  temperature  on FTP  but mainly on CO  and VE I showed in this forum.
 So  above  you see a successful manipulation of  blood flow   from the  skin into the more active  muscle tissue.  So  If we can do this  we simply  do  the opposite  stimulation or manipulation  and we should see the opposite reaction.

vascularisation and time lag.JPG


Now  here  you have again tHb  as  yellow trace Red is  O2Hb  and blue is  as usual HHb . Purple is  Hb difference  and would represent  for MOXY user  the tend in SmO2, You  can see  again by about 1140 the  shift  of  tHb but this time  to the skin  and less into the muscle, You can nicely see  that  with the shift of blood to the skin there is a big  amount of  O2  (  see skinny red  O2Hb ) moving into the  skin  and now  not available  for  performance. What you as well can see that the thick  HHb blue  is   not changing that much , as  the O2   utilization in the  working muscle is  basically the same  as we had  always the  same load.
 Now  both manipulation will create a very different  short term  functional stimulation ,but as well a  more   longer  term  functional respond. In very simple terms.
 If we move  blood  to the surface  with a very specific  stimulation than we reduce  pre load  due  to less  circulation of blood volume.
 On the pother side  we  create  an increase in   short term SV  if  we  move blood  form the  surface  to the   muscle.. Now  a reduction in  SV  due to a  reduction in blood volume  triggers a  plasma expansion  stimulation. If  I add  to this workout  a  proper  nutritional mix  of  certain proteins  and  other  substances  from the legal  area  than I  can increase this plasma volume  even more .
 If that is the case  and I have a client  with a cardiac limitation  so  in this case an actual cardiac   client but  in high performance sport   it is the same if the  athlete has a cardiac limitation as  his  weak link is a cardiac limitation today due to a   cardiac overload   workout. ( Remember )  I showed  a  south African  doctor   lo  ultra distance runners  and how we   see in a MOXY  calibration  warm up  whether his  cardiac system was recovered  or still   not. Hint. tHb reaction in  priority  and non priority muscle  and the trend  when we suddenly stop loads  after we  opened  up   the blood vessels in legs and arms. What  will tHb  do , if we  have a cardiac  weakness on this day   and what  doe s that mean. ?
So   that what I did  and to confirm  . , whether we  actually had a increase in SV  and  in sports   performance  we   hooked the client up to a Physio flow.
sv 2 different reations.jpg 


Now  this is the  SV  trend  before and after a  manipulation  of plasma expansion  . To  keep it simple   just look the SV  difference by the different loads. You can see on one section a AT  feedback  as we  had  at the same time as well a VO2  equipment running. This   was done many years back in Joshua  Tree  at the Training center  and  camp Mary Ann Kelly organized in California.

Now  this is  what   I  would call physiological  training stimulation. You set a  physiological goal  you prepare the body    and than  you  confirm  and workout. In this case we  had a much higher  CO  and therefor  where able to push very different  muscular  ideas. Now   here we planned it  and we did  it.  You as well can do any workout  you like  and than look the next day, what the  result   in physiological reaction was  due to yesterdays  workout  and now   accordingly  you adjust  the  today's workout  as you can use  the  benefits  or  reaction from yesterday  to    improve  the  workout  stimulation today.  For  example . The workout yesterday completely overloaded  your respiratory system. So  today  there is no way  you could  do anything  where you would need  a proper O2  intake  and a  great  CO2  out put.
 So  change the  plan  and use  the overloaded  system  to    improve  the idea of a better utilization   ability.  As  the respiration is overload   it will not be able to work as a compensator  as it is  today the limiter.
 So  you can benefit  form this  as you  do not need a very high load  but a  smart  way  of   using the fatigued   respiration to   increase  your   O2  utilization ability by  much easier  be able to shift the  O2  disscurve to the right.

So  HIIT  which are  based on  high  loads   change into MISS. ( Maximal Individual system stimulation's.)
  That's  why I   believe many HIIT ideas  are  really  MISSES in the real word  of MISS. They miss the  ability to individually stimulate  physiological reactions  as they  are  based on heavy load  and minimal option for the systems  to choose, whether they like to   be used or not. More  on that perhaps  later.

Here to  end BOBBYs  great  points. This is not just in theory or in the lab. This reactions of  Blood shift  from surface to muscles  for " survival" points  is real.

Below is a  data collection  done  by the university of Trois Riviere ( Claude  Lavoie  and his  crew)  when  many years back  we  lent them   Physio flow and  NIRS for some data collection  during the MSA ( mount saint Ann Quebec) MTB  world  cup  with a world  class cyclist.
 The traces  show  2 loops   in the   world cup  trail .  one is a  controlled speed   and one is  race pace  speed.
Have  fun  to think through that.

GK MSA t1 t3 cross over.jpg

ryinc

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 #9 
Jeurg thanks for the fascinating information

Can you explain what a plasma expansion workout is (i am not asking how to do a plasma expansion workout - rather what it aims to achieve?)

Hint. tHb reaction in  priority  and non priority muscle  and the trend  when we suddenly stop loads  after we  opened  up   the blood vessels in legs and arms. What  will tHb  do , if we  have a cardiac  weakness on this day   and what  doe s that mean. ?

I assume if you had cardiac weakness, you would see that cardiac output is not sufficient to maintain pressure on the rest period if the CO system is overloaded, so might actually see drops in tHb particularly on the non-priority muscle during rest?
bobbyjobling

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 #10 
On the last image, I assume the thin line is again surface THb. The red line show two distinct phases in the lap, in the first phase of the lap surface THb appears higher then muscular THb. Is this due to body or ambient heat? On the second phase of the lap surface and muscular THb swap now muscular THb appears higher than surface THb. Maybe by the second phase the body has reached race mode.
Or maybe the red lap was used to prime the system for race lap blue.
Juerg please help [smile]
bobbyjobling

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 #11 
Ryinc that would be my conclusion too. Fingers crossed[smile]
juergfeldmann

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 #12 
Come back if  I forget  some possible  thought s to   all the great feedback.

1. So  venous occlusion  we have an inflow   but no outflow. How  will this be  visualized on a HHb and O2Hb graph.

 Yes  to your  answer.
 Small addition.
  The  occlusion  can be created over  actual msucel tension as  showed many times  and the   Study  by Rhomert. So in some  activities is  easy to create a venous  occlusion, in some it is very hard  to get the  muscle  tension that hard.
 That's  why  we   sometimes can not use  our generic  sport activity if  we like to  stimulate  some  venous occlusion   ideas.

2. A non priority muscle ,  who may actually  shift blood......
Think in the  same terms  as you did in the  venous occlusion  HHb  and O2Hb trend  and you will have the  answer.

3.One practical issue though is that on the hard loads, athletes would struggle to

 
Yes  and  no. If  he  can not lety go his handle bar  he  uses  the arm  very hard  and  the  chance to have a non priority muscle in his arm  actually getting involved in the work is  pretty high.
 . I  never had a problem  to actually   assess SpO2 in cycling even   in an all out  loads in a 5/1/5 . Possibly  in a Wingate  or  short  steps  as they push  anyway far above  what  the information  we gather is needed  as they already have all limiters reached  and push now  all compensators  to the   limit.

 The  real problem is  in sports like rowing or  cross country skiing. There we use an earlobe  SpO2  sensor or a  capno meter.

4. I assume what you are pointing out is the increases in the minimum heart rate reached on recovery

Yes it is    the  point  I was looking  and it is interesting , that after the  first  5 min  load  the recovery HR  is not the  same +-  than after the  same  load  and  than recovery again.
 We  may think , that after the first  5 min  it may be   the same as  after the  same load  and if  higher  you would perhaps  assume it is after the first as  the cardiac system  and  the repsiratroy system may be not yet  fully engaged  due to the  time lag of this systems  to react. But it seems  the opposite  . Why ?


5.Can you explain what a plasma expansion

The goal  of the workout is  to increase the   blood volume over  expansion of the  blood plasma.
 In the short term we only can  naturally  increase blood volume over  plasma expansion.  We  needed  some time to  actually increase the  blood volume by increasing  red blood cells.
The idea is  to create a  better   pre load of the   heart and as  such a better CO.. This  only makes sense , when we have  what  kind of a limiter.?
 This  is a reason  why  when plasma  expansion  was  done as a drug in the big story of the Finnish  cross country ski team a few  years  back   not all athletes  actually had a  performance improvement.  That's  because  you need a  specific limiter   that  this  works.

Same holds  true  with Beet juice  or  vasodilatator  or by EPO    and so on.
 You need  to  know the limiter to successfully  " cheat " or   successfully stimulate this  reactions  naturally.

 Why  do we see so  many drugs  targeting in  high performance athletes cardiac out put. ?
 Because  many of this   great trained athlete  have a great  mitochondria  volumina  and  an incredible capillarisation now  due to the type of  workouts  the majority  do, but thy  never actually target  CO  or  VE  as many may not   actually know   how to  do it. So  they lack  delivery  and  there for  needs  substances  who in the short  term  improve  delivery  for  a specific  event.

Plasma expansion is  one of this short term  improvements , but if it is integrated in a long term plan it is a help  for structural changes in the heart in combination with respiration.
 A successful  short term plasma  expansion  will shwo up in some  simple  feedback   including a reaction when using NIRS/ MOXY in a calibration wr arm up  for the next days  workout.
How  Think  CO  = HR  x  SV
 Think  muscle compression due to contraction versus vasodilatation and  now  combine  HR  performance  and tHb  together in a priority or in a non priority muscle  and you have the feedback .


6.I assume if you had cardiac weakness, you would see that cardiac output is not sufficient to maintain pressure on the rest period if the CO system is overloaded, so might actually see drops in tHb particularly on the non-priority muscle during rest?

You are well underway  to being a  "chef" There  is  some ideas   in the madness of a 5/1/5  assessment  and   you do not need a 5/1/5  assessment during a ride  but simply  once in a  while the 1  and  the non priority muscle  can give you instant  feedback depending what your goal of the workout is.  The idea  we  have, that in a  VO2 max test or wingate  test  we can get any meaning full feedback of  any involved  physiological systems is  strange. We get a  performance feedback  without any meaningful ideas, why  the performance  peak  where it did. But we can use  afterwards a calculator and find  %  of a non meaning full all out idea. Does  that make sense. Why  do we never  have  the same  interesting  questions when we see this test results but I have  this   great  and very smart questions  when we look at physiological ideas ?
 I had yesterday  an over  1 hour  great   phone with a great coach who starts  to integrate Spiro Tiger in his workouts   and   I hope  he  got  the  information how  respiration and cardiac  reactions are  uniquely  linked  to each other  and we never ever  think on this. call where we   just  started  with one  regular reader to put  some ideas together  for his   clients.


7.Maybe by the second phase the body has reached race mode.
Or maybe the red lap was used to prime the system for race lap blue.
Juerg please help [smile]

You do not need help  you are very close.
 One part we have to  keep in   mind.
 This is the feedback of  one single muscle area VL.
 So  in this case  they should m have used a   upper body   non priority  muscle  as well.
 Now  Portamon is great but you can buy 10 + MOXYs   for the same price  as you but a portamon  so  was too expensive  to have more than one there.
 But we did  some Physio flow live as well  so there is the answer   form that  case study , which  than helped  use  to  move to  2 MOXY/s  or NIRS  to have a  same feedback  just  easier to  attach  and use in a  race or workout.
 Your observations are  very correct.  Now  remember  Portamon uses  something called TSI %  so  all three  depth  feedback  are used in that.
 This than sometimes can give  some "confusing" feedback. where TSI  %  actually increases as harder  we  go or decreases  when we  sue  compression cloth   and  otehr ideas.
 How  would it look in SmO2  MOXY  see in forum  explained  already.
  If we compare  Portamon results  with MOXY  we use  in portamon Hb difference   to compare  trends  with MOXY's  SmO2

8.Ryinc that would be my conclusion too. Fingers crossed[smile]

Uncross  your fingers  and give  a  thumb up . Great  questions great discussions  great  brain power. No  cook book therefor needed.
Ryinc. I am still behind  with your  mail sorry  will   try to catch up.


ryinc

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Posts: 369
 #13 
Jeurg thanks for the time taken to respond to all the points, it's really appreciated that you are willing to take the time to share your knowledge and experience.
juergfeldmann

Development Team Member
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Posts: 1,501
 #14 
You are more  than welcome , as  it si people like you  and otehr on here  to keep me honest  here in the bush  with what   I try to  do here and  how I  try  to evolve  and improve   patient service in a   small community  with limited resources.
. The great open and critical  questions and feedback  help  me  to stay  daily motivated  to  get   more   feedback  and  improvements on what we  can do. The  internet  allows  us now  to have  a  discussion  world wide   with open minded  people   and without  the fear  of  stepping on my  teacher  or  Profs  feet  and therefor   we  can  improve.
 Education as  a part  of the ability to repeat  what I have to repeat  to pass the exam is  for  sure  a part of a  past  system but it is still very  indoctrinated in our   ideas and believes. This is a  super small   window  here to   think together with  people  and  have the  courage  to ask  what we   can improve  from what we  do or  did.
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