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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
I like to use a feedback  from a new and exited MOXY user, as he was ready  and open to sent me his first tryout and allowed me to use his information to discuss  with all of us here in the open.
 First step is to understand, that we understand not a lot  but try to get better.
 So any feedback and critical thoughts are welcome and needed.
 I like to start  this point here with an email I got this morning from Florida from a friend, who seems similar crazy like me but incredible success full in his field of expertise.
 He made a great summery to sort  things out in his head and it will help for many of us to sort it out   as good as possible in our heads.
 Here for you to start and enjoy.
 Than we will start with how most of you new MOXY users start . Strap the MOXY on and run and or bike and see, what is happening.
. This is  perhaps not a very scientific way  to approach it but it is the way  how all practical users  will and should start , go out and have fun  and than look what happens.
 Than   and  really than  comes the step, where we have to start looking outside the BOX   so we can make some sense out of the  data's. I will try as good as possible to follow step by step  with this  MOXY users through the  new challenges.:
Well put Juerg
It's difficult for me to sum things up quickly, but here's where I'm at now... maybe this will help?
As Juerg says, with any athlete you have the delivery and peripheral systems. Delivery systems being the heart and lungs, and their ability to deliver oxygen to the peripherals. Peripheral systems being the vascular and muscular system. When Juerg says utilization he's referring to the peripheral system and how it likes to use the oxygen being delivered.

With MOXY we're beginning to see and understand much more of whats happening inside our bodies during exercise. That along with Vo2 equipment, SEMG, PhysioFlow, Pulse oximetry, etc. its helping us understand how all of these systems relate to each other. They are all dependent on one another, and may limit or compensate as Juerg has said for years. The keystone piece of any test we run now is the NIRS device. Simply because what matters most in the end is how your muscles are performing, and how much oxygen is left over for a sprint, the brain, lungs, heart, etc. For example, if you have poor breathing, or a weak heart, your legs are going to pay for it while you're cycling. The muscles will no longer be able to push on further... but your heart doesn't stop, and your lungs don't quit either. The leg muscles will give out because the delivery systems are weak. With MOXY we can see exactly why this is happening live and real time. It gives us direct and instant feedback from the peripheral system like we've never seen before. In the past it's been reading Vo2 data and assuming, taking lactate samples and guessing, watching SEMG recruitment patterns or power meters to try and see what the muscles are doing.

Here are three major categories that most athletes will fall into:
1. If the legs use up all of the available oxygen (Smo2) and there is none left, they stop. It wasn't the legs fault though, it was one of the delivery systems who came up short and 'limited' their performance. In this case, you can continue training the legs harder and harder but they will never get any more oxygen from the heart or lungs unless you target those systems in training as well. With MOXY you can see this and target those systems then monitor their progress while making changes to the program along the way.

2. On the other hand, if Smo2 never really drops much at all, then obviously the delivery systems are doing their job, and this is most likely going to be a utilization issue as Juerg stated. For some reason the legs cannot use all of the oxygen that's being delivered. Maybe due to mitochondrial density, vascularization or something similar.

3. The other NIRS info we look for when testing an athlete is tHb, which can give us an indication of blood volume increasing or decreasing. This is a bit trickier in my mind since there are a few reasons why tHb can change.
a. Juerg mentioned one earlier, metaboreflex. Or the bodies protective response from the brain to defend itself from the legs robbing all of the oxygen. At some point the brain decides its going to shut the legs down and shunt blood flow to itself as a priority over anything else. No good for the legs as they have no say in the matter and receive less oxygen, and will ultimately have to slow down to a reasonable pace.
b. tHb may also drop as a result of decreasing cardiac output. For example, if an athlete becomes dehydrated or hot during the activity they can lose a significant amount of circulating blood volume through sweat, or the skin will vasodilate to bring blood to the surface for cooling. Both of these will result in less blood volume circulating though the vascular system, and will likely lower stroke volume (the amount of blood being pumped per beat) and reduce cardiac output. That will have an affect on tHb and available oxygen to the muscles.
c. Occlusions or the restriction of blood flow due to pressure changes inside the working muscles. I'll let Juerg give the technical explanation for this one, but long story short; if cardiac output is stable and the respiratory system seems to be working well.. then tHb dropping is likely a result of some type of occlusion.

With the capability MOXY has given us, we're now able to see the changes in the vascular system that were impossible for us to see before. For example, if the body is needing to cool itself, then it will shunt blood flow to the surface tissue and allow the skin to cool as it does like a radiator. The result is a reduced stroke volume, and that means less blood/oxygen going to the muscles. Another great example is if cerebral oximetry (aka TSI% or oxygen levels in the brain) begin to drop to a critical level, then the brain decides to protect itself by shunting blood flow again, but this time towards the brain to deliver the oxygen it needs to protect the most vital organ in the body. (The brain uses predominately carbohydrates for fuel, but also uses oxygen in the process of metabolizing those carbs for energy) Another common trend we see with MOXY is the initial drop in o2 Juerg referred to as the alarm phase. Then as he said, the response of the body to regain homeostasis by vasodilating blood vessels to the working muscles, and therefore increasing the amount of available o2 they receive.

All of this is new to us, and possible because of MOXY. Without it we would still be taking lactate samples or reading Vo2 data and trying to make a whole heck of a lot of assumptions on whats happening in there?? With it, we can use the other equipment to validate what we see on the MOXY device. If it looks like o2 levels are low in the legs and tHb is stable, we check the vo2 info and sure enough the athlete has terrible breathing. Then we will most likely see the finger pulse oximeter dropping from 98 to 97.. then lower and lower. Meanwhile, cardiac output is stable the whole time so no problems there, it's just cruising along (maintaining as Juerg likes to say) but never really being challenged at all. After some time getting comfortable with MOXY you don't even need the other data systems in some cases. If Smo2 is dropping but tHb is stable, the athlete is running low on oxygen. Cardiac output isn't dropping off, and there's no problems with occlusions because tHb is steady. If you look at the athlete and see that they're breathing poorly, then common sense would tell you there's a respiratory problem going on.

The interesting part for me currently, is how much blood flow can change and affect performance. Before using NIRS I never even thought about how much blood can shift from one area of the body to another. I knew it did, because after a biceps workout I could feel the volume increased dramatically in my arms (not that I was looking or checking it out in the mirror or anything). However, I never would have imagined that our brain could control blood flow as drastically as it does to regulate things like temperature, o2 delivery, metabolic demands or whatever else it deems a priority.

Our latest study which integrated cerebral oximetry into the mix has given us a wide variety of results we never could have imagined. Cerebral Spo2% never seems to drop, except in extreme cases, but opposite of what we see with pulse oximetry on a finger monitor. (In my mind this is suggesting the brain prioritizing blood flow to itself first and foremost) At the same time cerebral oxygenation (TSI%) drops down below 30% sometimes (the critical level where most doctors say you're on the floor, but where we know now some athletes spend the whole race below this level). Other athletes may not see a drop at all and will remain dead even at 80%, while some cerebral tissue saturation values actually mimic tHb readings of MOXY while they're both on the legs and cranium during exercise (Maybe this is related to blood pressure and/or inter-cranial pressure). It should be fun taking that one apart, and if anybody wants to take a shot.. please be my guest. Really it's not that I don't know the answer, it's just that I'm 'currently struggling' to remember it right now. So if one of you guys can remind me real quick, I'd appreciate it.

Human physiology can be really tough and complicated, but it can also be very simple. I love to use the example of wheels on a suitcase. 15 years ago we we're all lugging our baggage around, but some genius thought to put a set of wheels on there and BAM!! Next thing you know, Juerg can pack a Goat in his suitcase and not even strain his back. That means old Betty's coming with him on that trip to Florida this winter hahahahahaa I'm sure Therese will be thrilled. My point is, when we try to extrapolate information from the Vo2 machine and figure out how much o2 or carbs were being used by the muscles per heart rate, beat for beat... or start to take lactate samples and assume that we're anaerobic or something, things can get a little messy. Instead, now we just throw a sensor on the muscle and look to see live how much is actually there. No more guessing...

Oxygen is the most important energy source for all humans, athletes in particular. Most of the mass of living organisms is oxygen as it is a part of water, the major constituent of lifeforms (about two-thirds of human body mass). The ability to take a peek inside ourselves to read these levels in an athletic environment is a real breakthrough. It's simple and sweet, all you have to do is place it on the skin and push the power button. The real key is what you decide to do with that knowledge, and how you learn to apply it to your particular sport that will change the game.
Hope this helps

Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
I like to  start  some information here   and will use   some of the now  many MOXY users info I get  daily.  But first  some thoughts before you sent your cvs  files for interpretation .

a) give it some thoughts  whether you like to follow a  current protocol and sent the info paired with your classical data collection.
 VO2 . HR, Lac, Cardiac hemodynamic   and so on combined with MOXY.
b) follow one of our here shown protocols for endurance  or  "interval"  and combine with your  classical data collection.
c)  simply follow one of our protocols and MOXY only but add performance and perhaps HR.

or    simply   strap the moxy on a muscle. tell us where and tell us what  you did. There would be and advantage  if we have  the  relative accurate time you change ideas or loads.

or  simply  sent us cvs files and tell nothing and we   can try to say something 2hich can be accurate  or stupid  but that's how we learn to see, how far  we can push already our  information just simply based on  MOXY.
 Feed backs would be nice, as I get this last version very very often and I take the time to  try to  speculate or  try to explain  what I think on what I see and than I do not get any feedback how far off I was or how correct I was. So how can I learn without feedback. ?  I will take  some time   and go into depth with  the  12 files I got today from different  coaches and new MOXY users. Remember we will give you a feedback on the first cvs file you sent us  as a new user. but than you   can use our services  for deeper interpretation. I make an exception here  as I  have fun to see, that some coaches really   look outside the box and sent me this information. Thanks to all of you.

 Now first of all I like to show you  how  we  get challenged  and I like  to throw  a question out to you for  your thoughts  and ideas.

 Here we go:
 Picture one is a classical step test with HR and  lactate. Be fair and tell yourself   what you would make on zoning , if you would not take  any % calculation or  a  specific  absolute number like 2 and 4 mmol or a tangent against the lactate curve.
  Where do you see real physiological clear changes  you could  use and 5 people would   take the same  points ?

Picture 2  same challenge on this one.

 Picture three same challenge on this one.
 Which of the three  ideas   do you think we would agree most likely for  " zoning " or  trends. ?

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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Okay  enough talk , let's  plunge into the  challenge.
 Here a cvs file from a  out of the box thinking coach.
 I show you the print  of SmO2  and  tryout  from his tHb as he went out for a run to try different information's.
 Now  think. I give you a lactate analyzer and you would pull nonstop blood as you run ?????
 I give you a VO2 mask   and equipment on your back and you would look nonstop on the VO2 trend ?????
 I give you   wattage trainer or  speed sensor and you  look nonstop on the speed ?????
 or what ever we  used to do.
  Now lets  see what we can do when looking non stop on  the window to your  working muscles using MOXY in this case  case the leg muscle.
 Here what we see  followed by the interpretation.
 We can get   back later even closer to this   example.
 1.  Green is SmO2   > if increasing we add more O2  to the system than we  currently use.
 Flat we  found a kind of a balance , where O2 intake and utilization are in a balance. ( But as well  it is possible  we see a flat    area, when we have a problem to utilize O2    and we  have perfect system , who delivers , but nobody can use it properly.
 Just keep that in mind.
  If SmO2  drops we have  a delivery problem  where O2 use is  bigger than delivery is able to   do.
. Brown is tHb  . Increase in tHb   means normal an increase in blood volume  ( flow ) in that area.
 Flat means  stable blood flow  or no   blood flow  in some specific cases (  arterial occlusion. ( we can discuss this later how we rule this out .)
  dropping tHb   is a indication of reduced blood flow due to different reasons we will discuss again as we go along.
 For the moment just use ts basic idea.

 So as  he starts out he drops  blood volume . meaning he creates a kind of an activity , where at the start the blood due to an increase in muscle activity is getting pumped out  and the  delivery systems like heart and respiration are not yet fully working  and we do not yet have  the increase in available blood volume.
 What we see is that the SmO2  is stable   so relative to the lower blood volume  it actually is an indication, that we deliver  more O2  than we use.
 This is  a  too short warm up phase  and  tHb  would go up if optimal intensity and SmO2  would go up  more as well.
Than he increases not explosive but relative  fast intensity . It takes him 2 1/2 min to actually be able to  deliver the needed O2  so his SmO2 drops  due to a too low delivery efficiency. Meaning again that the warm up phase  did not  created the needed optimal  increase in  blood flow  nor in  respiratory activity. The short  warm up as well did not relaxed  the muscles enough to have an optimal  blood flow and tHb drops further. After 2 1/2 min   into this new intensity he start  to " recover"  HR  will be up  and possible stable and respiration is working now optimal  with optimal RF and TV  and he starts to re oxygenate, as his speed seems to be a speed he can sustain for a longer period of time and   the O2  need and deliver start to fall into balance.
  Old idea would be LBP or MAX Lass. The reasons why this is not an extreme increase sign, is the  speed how SmO2 drops , but as well  he  keeps the same speed, as the recovery to   balance is relative slow over 5 min duration.  Than somewhere  short after 1200  he must have changed something  like  step frequency or   slightly higher speed  so tHb drops, but the change was not  extreme enough to actually change SmO2  as now HR and respiration maintain delivery  and there was no  problem to keep that in balance despite a short change in  activity. By 1500 there is an abrupt change. Now this next phase  over about  2 +- minute looks , when isolated  observed ,like a very strong increase in activity and an immediate  delivery problem so SmO2  drops due  to the fast change, Than a: " collapse" of that intensity due to different options, but we can see the sudden change in SmO2  and the fast  increase due to a clear change to a  slower  or lower activity. SmO2 goes back to " balanced" level but if we would have  HR and  respiration the HR and respiration now   will be higher than in the balanced situation prior to this all out,t but the speed may be the same as in the   stage  before this drop.
. Than a  relaxation of the muscle tension ,see tHb,  and an increase of Smo2  as delivery is higher than demand but the relaxation tHb indicates a much slower  activity level  and the lag of respiration ( VO2)_) and HR  as a part of CO  and some other reasons  show that delivery is much higher than  actual utilization so SmO2  goes up.
 What is interesting is, that SmO2  drops much lower  in the first  increase in load than in the second increase in load. Reason ??? Think delivery systems  situation at this two stages.( Level of CO, VE and capillarisation reaction / see   pic 2 and 3 )
. Summary.
 This person has a very strong delivery system ( Cardiac and respiratory  situation  and a very great vascularisation. He or she is weak is the ability on utilization.
 There are 2 main  areas, who  hinder utilization. a) a peripheral  limitation   and a  central limitation.
 To have the answer here:
 1  Make an IPAHD  and than make an IPAHR  so we see, why  there is in an endurance situation perhaps a very limited utilization or whether even in an IPAHR the  utilization may be  not optimal  as of yet.

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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530
Okay here the next step , meaning we try to make a summary from what we described yesterday above in one picture.
 Warm up : too short .
 reaction:  Alarm phase  and  not sufficient delivery  so delivery problem ( low  CO low VE  and compensation with a better utilization of O2  . ( Think what shifts the O2 Diss curve ).
 than "  reoxygenation to balance followed by  a sudden overload with delivery problem  and than  reduction of load but interesting enough    a very high O2 level  with an indication of great delivery but limited  utilization.
 Dangerous conclusion but still fun the play the game.
 This person is an athlete with potentially a long history of endurance sport activity. Great  secularization and great cardiac  ability ( delivery.
 Where there looks like a limitation is  utilization..
 If the first part is true  ( great vascularisation and great cardiac  hemodynamic than the utilization is unlikely due to  low mitochondria density ( numbers ) but more likely  due to  a limitation of   O2 Diss curve  motion. This would indicate a  limitation in the respiratory system with the problem   of inability after long runs to  actually extract O2.
 Easy test for this person.  Go for a longer run  in the  intensity we had in this test  Zone 3  and   as you get somewhat  an increase In SmO2  start  changing your breathing by  breathing much deeper and hold your breath a little bit before breathing out. 3 steps   breath in  3 steps hold breath 3 steps out for example  and adjust the speed accordingly. Loo what happens to the SmO2  and sent cvs file to see what we created here. Keep stable speed so easiest on a treadmill.  Here the above  workout in color  and some thoughts.

 What do we mean with Alarm Phase :
 See simple pictures.  and look where in this basic  idea the NIRS MOXY comes in as an immediate bio feedback information in combination with what other simple bio markers. ?

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Juerg Feldmann

Fortiori Design LLC
Posts: 1,530

I own an answer  to this coach  from a MOXY files  I got.
 It was  a first  try out  to see, what  you can "

 This is a fun part   when you get your MOXY but as well a confusing part.
 Pretty much the same , when we got the first Polar 250  over 30 years back and could see live HR. We where  just going for a run  and had a nice   graph with no idea what to do with it.
 Similar if you have a wattage   sensor and you go for a bike ride  or a GPS and you look at the speed or a lactate pro and you test once in a while during a run the blood lactate.
. Nevertheless , when you go with an open mind  and some  thoughts you will get many great interesting feed backs.
 For example today I had a test  with a client and he has a severe  bad  left side knee joint so we did the test on the bike.
 He  on his own was  watching SmO2 on his right ( good leg ) and could see, that when he bike as usual he  would drop relative low and when he tried to bike symmetrically pressure SmO2  would go nicely up on the good side.
 Conclusion ????
So I show you a print from the above mentioned tryout.
 They  tried the MOXY first and than  went out  for a run  and id not clear the initial try out data's  so I took that part out of the cvs file  and just show you the run.
 The first few colors  are  relative clear  explained time elements  and than the last 2  somewhat less clear  how long as they states a few minutes  .
 See the difference between walk and   warm up and the reaction in Z1  after a longer warm up period.
 What we can see is an extremely high SmO2  value and a  relative stable  tHb   if you take the average.
 and some great clear indication what  the  different elements of this run  did at the beginning.
 Think delivery limitation or problem versus  utilization problem m or limitation.
 Great delivery here but relative  "poor " utilization.
 Think 2 main reason why we can't  get the O2  which is available  but it is  just stuck there.
 Is it stuck or  can we not use it  because ????
 Here you thanks giving thoughts.

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