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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Another interesting case study  with 2  MOxy's one on hamstrings  and one  on quadriceps.

Attached Files
pptx june_expl.pptx (668.06 KB, 28 views)

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Here   some additional thoughts  I  sent to thee  great group  who sent me this nice data  sets.

I was    looking  once more over the report  as  I often do  to see, what  I miss. The interesting part we often forget is :
 We  assume, that when tHb  drops as a  sign of reduced blood flow  due to a either mechanical compression  from muscle contraction or  as a systemic reaction as a vasoconstriction (  for example    form respiratory metaboreflex we than see with Physioflow a  drop in preload  respectively  the SV  drops  due to lower EDV  and often ad  rop in EF %.
  Now  this  is  most a  relative  easy to understand reaction.
 Now  in contrast to a  increase in tHb  where we  often think it will be  an advantage   and therefor a  higher preload  so SV  stable of increase.
 What is often missing is that a tHb increase lie in Peters  case is  actually a reduction in preload  due  to the occlusion ( outflow restriction. So many studies  miss this point as they not  create the  answer  as they do not stop suddenly. Only thanks  to the sudden stop  do we have a decent feedback on occlusion reactions. So the increase in HR  which coincides  with his  first time  trend of  occlusion in  both leg muscles  could indicate a  compensation over HR  due to a  drop in SV.
 If this is the case  that  his CO is  not able  to   overrule the musceel contraction than  you may see on a  limited  or  small involved muscle a  drop  in the rest period  with often a  slightly delay  as a BP  protection
. See picture of a  world  class  cyclist. frit att is  at the beginning  with  thb smo2  reactions  as soon we stop  followed  by a  rest at the end  stage of the assessment with the delayed vasoconstriction  see in tHb   for BP  protection.
 . If you have a combination of a weaker  CO  but as well a  limitation in vascularisation than  you may not see this clear drop  as  the risk  of  central BP  problem sis   smaller  due to lack of  capilarisation , which would drop the BP  easier
 Here a nice support off this idea

Are the arms and legs in competition for cardiac output?


Secher NH, Volianitis S.




The Copenhagen Muscle Research Center, Department of Anesthesia, Rigshospitalet, University of Copenhagen, Denmark.




Oxygen transport to working skeletal muscles is challenged during whole-body exercise. In general, arm-cranking exercise elicits a maximal oxygen uptake (VO2max) corresponding to approximately 70% of the value reached during leg exercise. However, in arm-trained subjects such as rowers, cross-country skiers, and swimmers, the arm VO2max approaches or surpasses the leg value. Despite this similarity between arm and leg VO2max, when arm exercise is added to leg exercise, VO2max is not markedly elevated, which suggests a central or cardiac limitation. In fact, when intense arm exercise is added to leg exercise, leg blood flow at a given work rate is approximately 10% less than during leg exercise alone. Similarly, when intense leg exercise is added to arm exercise, arm blood flow and muscle oxygenation are reduced by approximately 10%. Such reductions in regional blood flow are mainly attributed to peripheral vasoconstriction induced by the arterial baroreflex to support the prevailing blood pressure. This putative mechanism is also demonstrated when the ability to increase cardiac output is compromised; during exercise, the prevailing blood pressure is established primarily by an increase in cardiac output, but if the contribution of the cardiac output is not sufficient to maintain the preset blood pressure, the arterial baroreflex increases peripheral resistance by augmenting sympathetic activity and restricting blood flow to working skeletal muscles.

 Below  the pics

D rest strat thb smo2 symm.jpg  D rest end thb smo2.jpg 

These data's   where collected  thanks to Per Lundstrom  high performance director  Red Bull in Santa Monica. Thanks  so much.

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Here some additional insight view  in a discussion with a very  advanced  training   and coaching group. The case  is the one  we discuss above.   form the PP.

see in red below some additional thoughts

Subject: Re: P’s Moxy results

Date: Sun, 12 Jul 2015 10:00:08 -0700

Juerg and Andri,

I thought I was following your logic, and your descriptions, until you laid another level of complexity on top, so I just wanted to confirm the conclusions you have given, to ensure I am understanding your train of thought… 

I can see the difference in tHb reactions between first and last recovery period on your "world-class cyclist" example.

Summary…early in testing after lower loads, the tHb recovers quickly, almost exactly with the SmO2. However, after higher loads, the trend reverses, and we see a drop in tHb even though SmO2 recovers.

There are 2 common situations, where tHB drops when we make the one minute break or in general when we suddenly stop :

muscular activity stops so does the demand of O2 / Delivery meaning CO and VE still are high due to lag time so delivery of O2 is up and that gives us the increase in SmO2.

If at that moment the respiratory muscular system is in trouble, so we may have a lot of CO2 remaining in the system and lungs, than we have a systemic reaction still. This means in the in minute rest the tHb will go higher than usual. ( No muscle compression still high CO and now additional vasodilatation due to CO2 still high.

As soon we are normocapnic again the tHb in the rest will actually drop a little bit due to now less vasodilatation as CO2 is normal. In this case we as well have a delayed systemic SmO2 reaction. What you will see is that when you stop tHb will go up immediately as explained above lack of compression CO up and CO2 up.

But due to the O2 disscurve on the right you will still see a low SpO2 ( EIAH) and a ongoing drop in SmO2 due to still optimal deloading of O2 but lack of loading and then with a lag time as soon normocapnic an increase in SmO2 at the rest period. See picture of a workout where we triggered this situation. att 1

squat smo2 thb  3 loads  with unloaded  desat.jpg   This study  was  done  by Mary Ann Kelly  PS  2015

Muscular contraction stops so there goes the compression. This is an example of a systemic reaction on O2. Now the example

I sent you is an example of Marshal's sleeping giant idea 1967.

And later picked up by Holmgren in his work on cross country skiers. att 2 and 3 arm blood flow alone or leg blood flow alone but arm plus leg cannot be covered so there is a vasoconstriction somewhere with less priorities. That’s when MOXY in a non-involved section will give feedback.

So when we have an occlusion trend and CO is good enough and we stop we have a mechanical release of compression and an immediate drop in tHb as an occlusion outflow., or an immediate increase in tHB as a relaxation of compression and CO takes over.

If we have a BP reflex reaction than as we stop we have a short delay of the reflex so we have a flat tHb so same level but no additional inflow but a start of BP reflex reaction with than if successful vasoconstriction than with lag time of 10 - 15 seconds we see a drop in tHb

Question: Are you (and the attached article) suggesting this is a result of the body trying to support BP, through vasonconstriction, because there is a limitation of CO? In the case of PW, we think this is a reflection of limitation in SV, because we see a rising HR.

Yes see above Holmberg

In PW situation we do not have a lag time so we see a mechanical tHb reaction. So not a limitation of CO for the whole systemic reaction as he still seem to be able to maintain BP. (would be confirmed or not with a non-involved muscle reaction. See att cross country triceps reactions. This is at the end of a cross-country assessment the reaction in the one minute rest in the triceps as a systemic delayed tHb reaction for BP protection. In PW's case he has a muscular occlusion trend which reduces pre load and therefore to maintain CO he has to increase HR as SV will drop.

 See  tricpes  reflex   vasoconstriction in a cross country skiier .

tri close look BP systemic reaction.jpg  This   datas  are form Roger  form a assessment he  did  with a crosscountry skier  and a  ski erg

sleeping giant.jpg 

 This  is    from  Holmberg as well as the next  one .


 The " fight "  for blood volume  is  lost  as CO is  too low  . so BP is priority.

increase CO with more muscles.jpg 

This is  where  MOXY  on  a  less   involevd  muscle or in rowing  orCrosscountry  skiing  comes in  at the upper body area.

Question: With a 6 day stage race coming up in two weeks, and a long career ahead of him, we could suggest…

Short Term:

1) Adding a few sessions of SV work to try to help overcome this perceived weakness in the short term.

To maintain or even improve SV and use the 6 days race as a SV workout the best is over plasma volume reqctions in the daily post race nutrition. Talk with your nutritional specilist on how to do that.

2) Do some specific maximal strength work to help reduce the muscle tension on capillary beds.

Yes intramuscular strength sets every 3 rd or 4 th day and you should load till you see an arterial occlusion on the screen.

Long Term:

1) Continue to focus on both capillarization and SV as the two main structural elements in his training program.

Yes as in structural development you will need first always capillarsiation before we see an increase as well in mitochondria density. Density. Key word angiogenesis and the different options which are discussed.

Question: Is there any way to use Moxy and HR data in combination to assess the best means of increasing SV through training?

We have played with the ideas a few times, looking for maximal tHb at varying intensities and different cadences, and it seems to be possible when using Peripedal software. Are there any other recommendations you can suggest for in the field work on SV?

Yes besides seeing live reactions over Physio flow the next best option is to look at tHb reactions in combination with HR and respiratory interventions.

see last att. an experiment we did to see how we can influence SV during a step test.

  martina first.jpg 

Have a great season Juerg


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