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Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #1 
I   have the privilege  to get sent  more and more  moxy feed backs  to me  from around the world.
 From   Europe, China, Australia and  as well from south America  and  from the USA.
 This is great to see and I appreciate this very much, as we can gather in a very short time a  huge amount of data  and that saves a lot of  time  and will give  us  some much more critical ideas on how different great  brains  use NIRS in the field , but as well as  for their additional data collections , when combined  with traditional tools.
 I like to show  in this section here some of the great  feed backs  and  like to give  my ideas to  it not as a critic  but as  an additional  thought process and   more ground  for a constructive  discussion  with  an ongoing ability  to learn. So thanks  for all the  mails  and I am   a little bit behind as I really like to look each single one  as  close as possible.  So please  be patient.

 Let's start here  form a data set  sent to me  by  Jiri Dostal , one of the worlds  leading NIRS users and experts. The data is a  live feedback  from either him or somebody running a  10ikm race in Berlin last week. I will simply  plot the graph and tell loud  thinking what the MOXY feedback tells me  and   I may be wrong or  completely off, but that is the fun part to see, what  do we get  from physiological feedback  and where  do we need  additional info's  to  not make  wrong conclusions.

smo2  all.jpg 
Above the SmO2 Graph   from this event.
 Classical feedback:
 We have  an end  time possibly around 44 +0-  min and we   would have perhaps a HR   information which would be  most likely a relative  flat   high HR  level.
.
 Now  with MOXY  we may have some  better insight  view  and what happened  during and  before the race  and after.
For me it looks  as that the race started by 4800 time axis  and than finished by  mid 9600/10800 ?
So  MOXY  was  on  about  40 min  before the actual race. That would indicate,  that we  have the  full " warm up " section  info as well.
Now  metabolic preparation is one part in a  race preparation   besides   others. So alone a great  metabolic preparation does not automatically mean it is a perfect  preparation for this  event  or any activity as  coordination may be  as well very  important  and  much more.
 So  form a metabolic  point  one of the question could be: Do we increase delivery  and therefor  oxygenation to a higher level than  from the resting level. So  higher  CO   a higher VE  and higher   activation of blood flow  so better delivery of O2  to the  needed  areas.
 The  easiest  way  for me to see this is the biased  version of O2Hb  and HHb. Biased means  we assume  resting is  all zero  and  from the start one we see, whether we increase O2  saturation above resting  or whether it drops  below resting levels.

biasedall.jpg You can easy see  that it was a successful " warm  up " when  looking at improvement of  oxygenation    from the resting stage to the start  of the race.(  4800 ) As usual  when we start and when we start even  very slow we have a Delivery limiter. Lag time  for cardiac out put  as well as for the respiration to  get into the full swing of all.
 So we have an immediately need  for O2 , we have enough ready to  take  and in the mean  time, if the  intensity is properly adjusted   CO and VE  pick up as well as  blood  flow   and   from the initial drop we create  a great reactions in a now  higher delivery than utilization and we  can get ready  for the race. You can see that about  15 min are spent to just do that. Than  there where some   coordination loads most likely some sprints   and so on but very nicely done  and stopped early enough before the race  to have the optimal oxygenation  ready to  go.

 Now  for fun we  can  get a closer look  on the intensity  she  did the   few warm up sprints  and the duration.
 Here a closer look on  some of them.

spint 30  15 in warm up.jpg
I picked here 2  sprints in the warm up  phase. The first one about  30 seconds  and the second as you can see  about  15  +- seconds. The intensity was  metabolically different even if the speed  was perhaps the same or even faster the second  time.
Remember it is not  alone the performance ( watt  and speed)  who decides the stimulation but rather the physiological reaction needed  to supply   energy  for this demand.
The  first " sprint" was  long and intense  enough to create  an actual outflow limitation so you see tHb increase during the load  and than the outflow  reaction of tHb,  drop , before a back to  normal tHb  flow. The second   sprint  was either less intense or  simply to short to create the  outflow  stimulation or reaction. Now  let's see, whether the sprint in the warm up was  as intense  as the start of the race. ? SmO2  drop to about 57 +- in 30 seconds  and to about  65 +- in 15 seconds in both  sprints.

Now below the start of the race  with some comments.

start pahse  race.jpg

Hard  to know where the race  started but  the runner started to  get exited or  slow  walk depending on how many people  by 4920
By  4950  all started to break loose and  by 4965  the delivery limitation started  out
Interesting is that by 4900  where   blood flow started to  be reduced  due to muscle compression    and by  30 seconds in this we have a very  similar reaction of a start of  a  outflow limitation like in the warm up 30 seconds sprint. After the  30 seconds either from feeling or planned the athlete   found a  pace or  settled into a better   step  pattern so compression eased a little bit off.
 What did not  changed is the problem of  Delivery  and an ongoing drop in SmO2.
 This is  not sustainable in a   race of this duration and earlier than later this runner  either  felt  that  so he or she had  to easy off  or the body  will force them to easy off. So lets  see the race  closer.


race smooth.jpg

You can nicely see the either planned or forced   " slow  down " in race  speed  starting by 5400 / 6000 The   muscle compression east off allowing   better blood flow  due to now  CO overrules  muscle tension  as well as possible  balance of CO2   slightly high  here so vasodilatation effect  from that as well.. Than  drop in tHb  due   most likely combination of feeling better so  slightly  increase in pace  plus   balanced  respiration now.   So  by 7200 settled in  and by 7800  slightly pick up  of pace again. The pace  was pushing limits  as we have  now steady higher utilization than delivery. The delivery tries  to compensate  most likely  with  increase in CO  ( need  Hr  curve to see that) but  as well we may  have a slightly increase in muscle tension so  it could be a  slightly  outflow  limitation. This would create a   CO2 increase  ( H + ) increase in working muscle and  allow  for a better O2  release ( O2  diss curve shift to the right).
 To see, what  it  may have been  we look at the end.
 What we  see is that the last km  was  an all out  push  for optimal time as she or  he really moved into  utilization mode  with no Chance to upkeep over delivery.
 Now  to be sure  we would have to have a situation, where the runner  goes though the finish line  to a  sudden stop. Often that can happen but in a   big race  with many people you have to move  first before  coming to a complete  stop ,so  not  optimal feedback.
 Lets  see it anyway.
end sdpitn  thb smo2.jpg 
We  have  the   very common  30 +- SECOND  UP And down AS A  SIGN OF  bp  CONTROL  SITUATION  AND WE HAVE A   Potential  SMALL HINT OF A  DROP IN Thb  AT The END  DUE TO Either    Occlusion OUTFLOW OR  bp  CONTROL . The runner  may have gone  through the finish  line  exhausted  ,came to a  complete  stop, but than had  to move again ( see that small spike..)
To rule  BP  or  occlusion  a  MOXY on a  less involved  muscle would have given  some additional answers. For me it is more  a BP  reaction so  the runner may have felt  somewhat dizzy  at the end. The  hesitation of SmO2   going up ( recovery) can be two reasons. Respiratory limitation so  slowly balancing of CO2  and H +  or    the runner had  to move, stopped a little bit  moved  again a little bit  due to the way it is in races  like that with many people.
This was fun and  a nice  example how classical feedback after a race like speed  and HR   are interesting but this is fun and it feels  as   you are in there in the runners body.
 Any feedback is appreciated.

 Next up a  fun discussion on an intriguing test . Wingate reactions  and what  do we  have to look at it  whne integrating the lates in physiological informations on    energy substrate use .
 Key word : Is it really a great test  for anaerobic  power  information???

juergfeldmann

Development Team Member
Registered:
Posts: 1,501
 #2 
After this  great  example of a practical application  during a race   , we now  have the opportunity to show  some data's  from a triathlon coach.
 I  could move this to the triathlon section but it is  simply a  cycling 5/1/5   from a triathlete  so I like to  keep it here.
  Now  what we  have more and more   is  different "levels " of interested  MOXY users.
 I  make it very simple here  and than there is anything  either in between  or  you can look at the levels as an  individual personal  progress,  as  you get  familiar  and more involved in MOXY data  interpretations.
 If you use any of the classical ideas please  do not throw them out but rather start to  integrate MOXY  so you can see, where you can get a  perfect  symbiosis  between direct feedback  of NIRS  combined  with indirect feedback  like using VO2  or lactate  or   any other tools you may have  lot's of experiences  with.
 This  way  you can support  findings  you see in NIRS trends.
 Example:
 VO2  information  are great as we have a lot of  feed backs  on VE  and in most even lower priced  VO2  equipment  we have RF ( respiratory frequency )  So  you therefor  can get  TV ( tidal volume)  as well. Now  you can often see how respiration  and cardiac  work  and   loco motor  reactions  go  hand in hand as a team approach
 Simple  example  just to end this idea.
 Respiration  or better  TV  can be a great support  for  venous  back flow. Venous back flow is a big  helper in cardiac  pre load . so you can see how respiration together  with tHb  trends  can therefor give some feedback on  preload.
 Example in performance. You  do a workout  and you find a  great balanced intensity. So  relative stable HR  level ,  by a  fixed performance . Now  you as well have a stable SmO2  trace  and a  stable tHb  trace as well as you feel great  and have a  very controlled  relaxed  respiration.
 Now  you can do a change in just respiration like increase TV  but keep  stable VE. Therefor  you will breathe slower. We did many  case studies,  where we had for example 35  RF  as  basic   individual,  comfortable RF. So  we either dropped it down  by 15 RF  to 20  or  we increased  it  by 15 to 50. No  real physiological  reason  why  15. just a number.
 The interesting part is , that  when  we reduce  the RF  we often see   an increase in TV   but as well an increase in tHb.
 When we  increase  RF  we often see a  drop in SV  but as well a  drop in tHb.
 Now  as better an athlete is  trained    in his respiratory system , as  easier  he or she  can manipulate this reactions.
 So  we have players  who start out  with Brian Kozak  and they have a  VE in an all out  what ever test  of 130 - 150 L / min  so  for example RF  of  50  and therefor  TV  of 3 L.
 He now  has  kids they can move a  7.5  L  TV  or  a  6 L  Spiro  bag  with a  RF  of  50 plus  so  you can calculate the VE  of  350 - 400 L VE.
 Easy to imagine  that when they  do a  workout they have a  huge   space to  play with the respiration  and as  such can influence many  physiological reactions.
 .
  Now  back to our  different "levels "  of MOXY users  or  MOXY interpretations.

 LEVEL  1.
 Mainly  fitness centers  or groups  who  work  with a huge  group of people  and  simply like to have something more individual than  what they offered before.
 So instead of  220 - age  or   any  calculations  or VO2  max  % they use  the simple 5 min step idea without a break  to  find the individual " zoning"  and than use  HR  or performance  for their client  , which than  can be reassessed  after a  while. Some centers  rent  MOXY's  for workouts  or  simply use this  as a  feature  to compete  against the incredible amount  of centers  all over the place.

LEVELl 1. SmO2  and HR  data collection. Than look  for GAS  and you find the different individual levels ( Zoning)
. a) look  for SmO2 increase
,b) look  for  SmO2  Plateau and
c) look for SmO2  decrease.
 If you do a 5 min step test  and  somebody  can, as often is seen, finish the  last 5 min you most likely  do not have a HII  ( High intensity  performance  as  nobody  can maintain a HII  over 5 min. So the beauty is   you do not need this  " zoning"  as HR is  most often irrelevant  in Intervals.

LEVEL 2. This  are often personal coaches  who like to go one step further.
 They like the " zoning " idea  as they easy  can  show  progress but they like to have a   basic trend information, whether the limitation in performance  comes  form the delivery system  or rather  from the utilization.

So you keep  SmO2  and HR  but you add a minimal involved  muscle to the assessment.
 In many cases  a drop in the  less or minimal involved  SmO2 trend  before   the SmO2  drop in the  involved muscles  indicate a  delivery limitation  from the cardiac  or respiratory  systems  limitation.

 Better,  as you have the data  anyway,y is to add tHb trend  to it, as  we see as well a drop in tHb  due to vasoconstriction.
 Now we have   many coaches they sent us the  data  and we  explain  how they find  the zoning  and after  5- 10 assessments  they are often as good as we  and now they  can  go  along  and just sent  very interesting cases  to us , when there are special  questions arising.
  LEVEL  3.
 This are  Professional coaches making good money  and   think outside the BOX. They often keep  for a  while their   experienced  system going but interesting enough is, that they sent us the  very intriguing  information  and after a  while they often start to simply use  MOXY only. Easy , fast , cheap,noninvasive . no  blood,  no  masks contamination  and  can be do it in the field , easy to move  from camp to camp, or center to center and the beauty , you can test as many as you like  at the same time. So 16  athletes  at the same time if you  have the treadmill or  bike capacity , but in camps  everybody  has a bike and often as well trainers or  simply  do it  on the road or a 400 m track in a rowing boat,  on stair climbers, steppers, cross country  indoor trainers or  what ever you like to use.
1 Hour, 16 athletes is  great  and fast  for teams  to do. Than  discussion all together so they  learn  from different assessments  and the beauty  is that you can deliver much much more feedback than just a %  number  of  some hopefully  100 % test result.
 The other beauty is, that  you can than use the information and MOXY  during workouts  to correct  and see, how you can  influence  the  physiological reactions  to have  an individual stimulation  for your  goal  or LIMITER. stimulation.


 So  got lost as usual  so will start a new thread  for the case 5/1/5  discussion.
 I will add there some basic ideas on how you can get a better and better  data collection by following some simple basic handling  skills.


juergfeldmann

Development Team Member
Registered:
Posts: 1,501
 #3 
Triathlon case  data collection of a 5/1/5. The following ideas  are not  at all a critic  to  who ever did this great 5/1/5  but simply loud  thinking on  what  we can  perhaps change or what  can't  be changed  as this  are  actual physiological reactions.

LEVEL 1   ZONING ?

Overall view  of the full assessment looking at SmO2 trends  and HR trends.

hr  smo2 all.jpg

To keep it simple:
2 options:
a) Try to  force a  zoning on it
b)  repeat the assessment again  and compare  , whether this is really this persons  physiological reactions.
 For me:  too much speculation  on  where we have a clear  SmO2 increase, where we  may have a  plateau  and  for sure where we  may have   drop in SmO2.
 Here some pointer, which  perhaps  where done in this assessment or  perhaps not.
1. I miss a  clear "calibration"  meaning  always  what ever you use a MOXY  for  have a  at least 1 min calibration in the sport specific position   so we have  resting  actual HR  and resting actual SmO2  and tHb traces.
2. The SmO2 trends  but as well the HR  trends  are very interesting.. It  could be the physiological reactions of this athletes  or something  went  not optimal. Juts  short hint  and we  can  get back later if  there are questions.
 Already in the third double load  we  loose a  HR  homeostasis  and have a steady increase in HR during the load. Question: Indication of using CO   as a compensator.
 Now look carefully:  SmO2  is very stable  indicating a balanced  O2  delivery  and utilization  and if that true the increase HR  as a part of  CO = HR  x SV  is very successful.  Now interesting is that  step 5  and 6  = equal loads  and 8 are similar  SmO2  levels   with a  slightly  drop in 8, But than 7  and 9  which suppose to be very different loads  again have a similar  SmO22 level. This indicates  either a utilization limitation  and or a great  compensation    by the delivery systems  despite a much higher  load. Now  HR  are +-  the same so  CO  could not have  been increasing anymore e over  HR but only over  SV. So you see  we need tHb  to  get some answers. Now before we go there the  critical questions  are:
- Why do we have this interesting pattern in the 1 min rest with a  high SmO2  recovery  followed by a low  and followed  by a high  and so on
- very little  utilization trend  in SmO2 trace  already  from the third double step.?
 Summary > I  would not use this  for ZONING  but would dig deeper in this interesting  reactions  so let's  add  tHb  to it.

thb smo2  all  loads.jpg 
Now that is  fun First  what you see immediately is the pattern  in tHb  as we have in SmO2  on  1 min rest  alternate  with   tHb  up  and tHb  down  and this  from the beginning.
 At  the end of a test that could be   for sure in a  minimal involved  muscle a sign of a cardiac limitation  as the BP  has to be maintained  and we see a vasoconstriction in the less involved muscles.
We  showed some cases  from world  class Tour  de France  cyclist  and  some readers may remember.
 In  many cases  . Identical drop in tHb  and SmO2 indicates a  physical  reaction like for example  muscle compression release  or   occlusion outflow. Systemic reactions have a lag  time of  15 +  seconds  and therefor  SmO2  and tHb  do not react  at the same time.
 So let's look closer  what this up and downs  may mean.

Let's look mid load  , when the athlete  has  some  good feeling not too easy  and not overload.
thb smo2  mid   loads.jpg  Now great picture and you see tHb  and SmO2 react  at the same time. So there is a mechanical reasoning  for the reduction  and increase in tHb  ( blood flow ) in the one min rest.
This athlete  somehow  relaxes  the   muscle ( first  load on the graph  so we  have immediately no muscle contraction tension  and we  have   still high CO  so tHb  goes up  as   better flow in a non restricted  capillary  net work.
 But than in the next 21 min break  he  seems to  reduce blood flow  and tHb  drops ???
 Most common reason is pedal position during the one  min rest. 6  or  12 o clock position.
 No  where is his leg ?
. Now  more interesting  on what we  see:
 If  it is a simple  blood flow restriction   than we should see only a change in tHb but as  he does not use  O2  anymore the SmO2  should go  back to the same level  as  in the first rest  1 min period In fact we  even could argue, that if  we have the  same amount of loaded  Hb  but in less tHb  the %   may be  equal or even higher ? At least we  could expect   same.
 But  you can see  as we  discussed this in the  SmO2 HR graph  SmO2  is less high, when ever we see a  drop in tHb  in the 1 min rest period.
This indicates, that it is not just the position but in fact he  does not relax  his muscle  very good  so he  still has some  muscular activity ( so compression reduces  CO  overrule  so less high in fact even drop in tHb  and  the fact that SmO2  does not increase  shows  that he still uses  O2  to hold the resting 1 min  suppose to be  relaxed  position.

result.
 Check  with this athlete in  a training or  even a race, whether he  actually  can't relax  his  legs or  one leg  when just for example cruising down a hill. ( Key  places )  bike fit ,  flexibility , Clothing  to name some easy to adjust    options.

Now next interesting  situation is  than  from step 6/7/8/9 tHb does not really  change dramatically.
 When we argued  that the lack of HR increase could be  because he increases  SM instead, than we  would expect an increase in tHb  do have a better  preload, but we do not see that.
 So we have  despite a   must be big change in performance a minimal change in HR  and  minimal change in tHb  and a  minimal increase in deoxygenation ???
When we look to make  it nicer   on the biased O2Hb  red  and  HHb  blue  graph  than it looks like this.

bias  all.jpg 


You can see red  above  0  or blue during recovery  and again the pattern of not relaxation every second  1 min rest  due  to possibly pedal position  and  not the ability to relax.
Second  we  miss  in the easiest  1  or  22  steps   the ability  to actually increase  O2  form a  baseline  of  around 50  to a higher level. The  rest  periods  proofs, that he  can increase  SmO2 up to 85  %.
 This indicates, that the  assessment started  with a far too high intensity. In most cases this start intensity  was  most likely already  50 %  or more of  classical VO2  max performance or    of FTP  60 min wattage  result
 This is far to high to allow  the  different system  to get properly activated  and as  such we miss the SmO2 increase  or what we  term ARI The minimal  change in O2 Hb  over the last  few  steps  despite a  step increase  does not make  sense.
 Stop  . There are  some specific  situation we  actually can see that. A  situation, where  we  for example change  cycling technique  so we maintain a  stable power out put  with this muscles  but  the increase in wattage will be carried  by  a different muscle group  for example, more  hip extension in the down stroke  situation or a  better  up  pull in the up stroke  situation. In other words a better inter muscular  action in the higher intensity. What  does not make sense than is , that we  not see a  linear increase in HR.

 So you know  when the facts  we see here do not fit the theory  you start thinking all different strange ideas.
 So after going over and over through all of the options there was that one  stupid  thought>
 What IF  he  did not increased  performance in the steps  but was basically  from step  5  to thee end  more or  less +- the same  wattage  with some small fluctuations.
 Wowww impossible  as they would have  corrected this. So I did what I hate  looking at  actual performance trends  together with tHb . below the result.

watt thb.jpg 
You are  the judge. Out of  what ever reason planned or not the steps  where very irregular  and as you can see very little  change in the last 5 steps with a  very " restless"  last step  and you can see that as well in the tHb reaction.
Below  " triathlon 5/1?5   from the same day  we got  sent to us  from another center. and I  took as well watt and tHb.

watt HR all.jpg 
As you can see  some  clear hick ups  and  we  will discuss this case later and see, whether this watt hocks  up  where big  and long enough to be visualized  with SmO2    and tHb reactions


Now  when we compare  the erratic  wattage  graph  and tHb    from this two triathletes  than it looks like this.
 Below our  case discussion with the interesting  low change in steps  in the assessment.

thb smo2  all  loads.jpg 
and  now below the second  graph  with the relative smooth  wattage  graph.

smo2  thb all disc.jpg 
Now  even more interesting is , when we look the wattage  trainer data's  from planned  or target  Wattage  to what  they actually pushed. Our  case  first  followed by the second  " smooth " case.
list target watt  and  actual watt. 3.jpg 
Target watt 198 actual watt fluctuation between 198 to 321 watt.  This  looks about like this
watt flcutuation in  8  th step.jpg

Now below the other example in numbers.

good  tbelle  example.jpg 


Target watt 174.6 actual wattage  fluctuation ???

Now I do not know , whether this  case  we  discussed here  was planned to  bike like that or whether it just is the way this  athletes  bikes.
 So  no zoning possible  , Limiter  is  strength. No  not too weak  far  to much   strength so he seems to just " hammer  to  maintain  or hopes to maintain a performance. Restless cycling technique  with a   incredible acceleration  on the  most likely  down push phase. This pictures  we see I ice hockey players  and soccer players , when they do VO2  max test  and we add MOXY. Not  Greta  cycling technique  but will power  and  actual power. This kills the muscle  and  just for  fun I was looking his  after load reaction, when either planned  or not they did a short load increase. See below.

thb smo2  end  loads.jpg 

The steep tHb drop is a MOXY  drop out  at the end of the assessment but regained  connection  and the last  peak  and  drop tHb/Smo2  was a  end load after the assessment a short  burst   not  always  high wattage needed  and in this case he  " killed " his muscles  that  even in this most likely  low wattage he create  what ??? 
Summary: Great data collection. As a 5/1/5  not optimal due to the discussed points. As  an assessment it shows a  technical  problem in cycling in this athlete   most likely due to too strong muscle power  and a lack of  optimal efficient inter muscular  coordination.
   The   too strong  muscle contraction   can't be off set  by  CO  so  training, Efficiency technical  workouts  on low intensity . RPM  drills  with integrated respiratory work and increase of vascularisation  with  different options over low intensity )  For  example  over  hypoxia  hypercapnic  interval in  low intensity to maintain  great technique but stimulate  physiological reactions  the same  way  was when you would have to push very high interval loads. So  150 watts  workouts with integration of  deoxygenation hypercapnic and therefor  maintain  and  often even improve the great utilization he has  but as well  stimulate vascularisation.
 



Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #4 
I like to show  some   other details   from another " triathlon group   sent to us  with a great data collection. I used the power data  and Hr  as well as  SmO2  and tHb  trend in the discussion above to show the  two very different pictures of this two  very different  reactions  from a bike assessment. So here  more details  of interest in our  second triathlon case.
  Here again as a start AmO2 and HR  as Level 1  idea.

hr smo2  trend lines.jpg

I made  some line s by the HR  trends  and you can  do the same  by adding the same idea at the SmO2 trends
 You can see  a  " homeostasis " reach in HR  at the first  two  double loads. After that  despite  same loads the HR  never  balanced  out  anymore  during the 5  min load. This is unfortunately  a nice example that   by a stable  load the HR not always  will be   stable as well  and for sure not  once we reach intensities, where   we may have already reached a limiter  and HR  or  CO  can be a part of  a  compensatory reaction. So we have  what some would call HR  drift  and  one of the reason  why power believer  have a good point, when they argue   that HR is  not  stable. ( remember  Ruuds point ) We than  from the HR  side  could argue, that   the problem is not the unstable HR  but rather the unstable  performance  or better the unstable physiological demand  by a  certain performance, where  limiter and compensator kick in  so that we  can't  maintain  the same wattage    and have the same physiological stimulation. So HR  believers  will now argue, that  we have to maintain a stable HR  to maintain a stable  physiological stimulation and therefor have to let  the performance drift downwards > A good point as well.
Now interesting here is in comparison with the previous  case the  high SmO2  start level  and as well   as  before a  relative high starting  HR.
 We miss the 1 min calibration as well  so do not forget this as it reveals a lot on the capillarisation  question.
 Now  here we have the initial drop   of the Alarm phase  when he starts but we miss as  well the increase in SmO2  during the  load. This  as well indicates often a  far too hard  initial  start wattage.
 Remember  it is NOT a test it is an assessment  and the " warm up"  section is an important  part of the data collection.
  Many argue the Test  is going too long.
 Again it is NOT a  test  it is a work out  with some  forced ideas  on the  workout , similar as you do a   60 min workout  with  for example 5  x 5 min XY  %  of FTP. The difference here is that we  create a relative planned  overload  and we    basically have in the most extreme situation a 5 min relative  heavy hard load  that's it.
 wee  can   integrate in the rest  many different tasks  and ideas  to learn how the body works.
 So  I believe in this case again, the start wattage  was  for sure    at least, if not more than 50 %  of his  or her FTP  load or VO2  max.
 Too hard   to allow  all the  systems  to have enough time  to  try to optimize their  part so they can deliver  for  the overall performance.  If you do a  20 min FTP  as  a short version you   often  will warm up  before that load . How long will you warm up , 15 min or longer ??? If you do a VO2  max test    most often  they let  you warm up. For  how long.???
 Why would we not be interested to see, whether we  really   benefit  metabolically from the  warm up section. Do we increase blood flow  and or do we increase  oxygenation  and where and which body  part. Any  VO2  max test  any  LT  test  and for sure  an MAXLASS lactate test will take you  easy up to an hour   all included  so no difference here. The difference here  is that we  assess all the time how we react in the different intensities levels.
 One more business  difference. What  is the cost of a VO2  equipment. ? So  for this  cost you can get 8 - 10 MOXY's  and can therefor  test 8 - 10  athletes  at the same time  no  masks cleaning, no  contamination no blood  sampling  just fix  and go and see live. in 1 hour  you test  8 - 10  athletes  with the same  price per test  than you charge  for a VO2  max test  but much more feedback. So a no brainer  from that side isn't it.?
 Here to go back to physiology.
 Warm up effectiveness    from a metabolic point of view  can best be reviewed  on biased HHb  O2Hb    graphs or  make it really visual  so here the Assessment in a biased graph.
 you will see again we never really ave  a higher O2  situation over the whole time  even   in the very lower  loads.
Bias all.jpg 


 So  next up  you can see in the second  double load a  flat HR  but a drop in SmO2 . Indicating , that  the  compensation to deliver  O2   over  CO is  at least not working over  HR  but perhaps  he  may try it over  tHb  ( SV,). To see that we will need to look later on the tHb reaction.
 In the third  double load something happened  in the 1 min rest  with a  kind of  a double start but in any case again a delivery limitation  at first and  now a  reaction to try  to compensate over  HR  as he  does not reach a  homeostasis  anymore. Interesting is that his  SmO2  recovery  peaks are more or less always the same level in contrast to the  previous  case, where we had   most likely from the pedal position a  change in relaxation in the rest period. Here we see  always the same SmO2  so perhaps  same pedal position ,but not  sure as we have to look at tHb  first. he  for sure   " relaxes"  always the same  even if he changes  pedal position.
 The interesting part is, that despite a  for sure higher CO   towards  higher loads  we do not see an overshoot  of SmO2   compared to the start SmO2  ( true it is  already high but can go higher  . What causes  this   missed overshoot. one initial thought could be  respiration   limitation  but   for that we need additional feedback on tHb  as well. Remember. High CO2  will reduce  recovery of  SmO2  due to the right shift  of the O2  diss curve  but on the other side  it will increase tHb  at  the rest as we  accumulate  CO  without  fighting  muscle compression plus  vasodilatation   from  CO2. So   no overshoot  or even  lower SmO2  recovery values   dropping SmO2  during load but overshoot in the rest  or even during  load  due to additional vasodilatation reaction of higher CO2 ? So let's    push the tHb  and SmO2  graph on here before we  have to go back to work and you can start  to do your won   thinking  till I am back.
smo2  thb all disc.jpg 

I added some lines  to  show where I look for trends. Give it a  try  as  we all learn together. What would you  look closer in this graph and why would  we look closer?

Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #5 
Here we  are back  and I like to start  with a  nice  comparison we  have  from the  above discussion.
 Here the first one  tHb  and SmO2   overall view.
thb smo2  all  loads.jpg

You can see  tHb  for sure  a  pattern of every second  rest tHb  drops or  is increasing.
 Indicating a clear  different blood flow reaction.
 SmO2  has  some  reactions as well . Now  I unfortunately  have  very rarely  feed backs  from many of the top coaches sending us  results. I  do not mind being very  wrong  with my assumption  like in here where I tried  to argue, that this is most likely mechanical  compression due to  lack of relaxation.
 The only way  we all can get more confident  by using  just MOXY in the field is  to have this feed backs and   looking , whether the interpretation fits  to the facts  to avoid  building a theory which can not be  backed  up with facts  as we so often have in  exercise physiology.
 History of  lactic  acid  as one  example  or  history  of VO2  max  as the other one , where we  all use  education to repeat  what we    got  indoctrinated into our  ideas but   we  have little to no back up  of  one of this current  classical ideas, in fact we  try to defend     for all cost the VO2  max plateau  which seem   to get more on more  additional   points    to try to be defended.
 So  please   get back with feedback  so we see  whether    it is  close  to what we see in the NIRS reactions or  far off so we can go back  and try at least to understand  why  we see what we see and whether we  can back it up or not.
  So the next  tHb  SmO2  reaction is below  and look the big difference.

smo2  thb all disc.jpg 
 we do Not have  a  drop in tHb  every second load  but we  as well have a pattern  that  in very second load the blood flow  was somewhat different. Again the question  of  the   pedal position and it seems he may as well have  changed  6  and 12 o clock position. Difference he  was   much more relaxed  so  just mechanical position pressure  or  additional  some pressure  from the cycling shorts. which reduces  blood flow.
 The later  most likely not the case, as when we tested   compression clothing with NIRS  and used  two different NIRS  equipment the reaction would be different.  ( one  nice  case study done by Clint  Friesen in Florida)That is another topic  for another time.

What I like to show is the individual difference in    metabolic reactions depending on Limiter and compensator.
 This is  why I  hate   cook boocks  and   why I believe coaches  who take  their cleints  serious , charge a  fair but  good price  should able to look at this inidividual  and not just pushing a  soft ware button to spit out  some statistical  hopefully   usable  results  based on  what?. You are you  and we  take  care  of each individuals  ability , yes we make  mistakes,  yes we are not perfect, but  at least we  could try to improve ?

Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #6 
Now  to end  of the last  case.
 Let's look  first close  at a 1 min rest reaction.
one  reacovery  section close.jpg  Identical reaction tHb  and SmO2  so   most likely mechanical release of  compression  due to muscle contraction and  when we start again compression increase  so tHb  drops as  a  compression outflow feedback. Let's look  a  few  in a  row.

last 2 loads.jpg  Decompression at the  start of the 1 min tHb  up , less O2  utilization but still delivery  so SmO2  up. Than sudden start so  compression outflow due to again muscle contraction and  immediate  need  of  O2  so SmO2  drop as  higher demand / utilization than delivery. Finally delivery   picks  up (see HR  )and we have a  stabilization of SmO2     and  subsequent  drop in SmO2  as an indication for more  utilization than can be delivered. tHb  increase  due to increase in CO  ( HR  x SV )  and  as well   possible  support of CO2  accumulation due to respiratory CO2  release limitation  due to a limited VE  ability.
 Now   here  some  option.
 1. This  client  has  most likely a respiratory  release limitation of CO2  . Too small VE  in higher intensities.
. The assessment started  somewhat too fast too higher wattage In first step  so we have  a  CO2 problem  from the beginning see biased  graph  as we never have a situation, where d delivery is  higher than utilization. even in the rest    not.

Bias all.jpg 

 Now   for me to back this findings  up I  would repeat the assessment, start slower  and would add  different additional  data.
 a)   you can use a capno meter  and see how CO2  develops   at the end of each  load.  ( remember  it is  an indirect feedback,so  take into account the possible  time lag  of the EtCO2  reading on the capnometer.
b) you can use an SpO2  pulse oxymeter  and see  how SpO2  changes . If you use an SpO2  sensor, they are very tricky under motion, but the one  minute rest is perfect to get a decent reading. Now  to be  more sure of the reading check the HR  and the puls rate . The HR  with a belt, the pulse rate with the sensor . Pulse rate and HR  have to be equal  to   be relative sure that you have a free flow in the finger  pulse oxymeter of blood and therefor  a relative  save  SpO2  %  reading.
 Best is  if you have a  VO2  equipment so we  can see how RF  and VE change over time including FeO2  %  and EtCO2  readings. Than we  can go back and   now, that the result in the MOXY  can be backed up  with some more specific   information  from the respiration we  can be  more  confident , that MOXY alone  can give in many cases a lot  of feedback we  otherwise would need big  and expensive  equipment  and we would not be able to do it in the field. Please come  back  for more discussion n MOXY interpretation.
 Next up will be  the promised  interesting discussion on Wingate  and than I  hope to show you some live current feed backs on a rehabilitation case of a professional  hockey player after a hip surgery.
.
  Result;t . This  athlete    may need some  time investment to increase his  respiratory  VE ability . So  check VT start working on his  VE improvement  and than retest  and    you have some feedback  whether it was the limiter  and  what is  potentially the new limitation. Good luck  with this interesting case.

By the way. The coach  from this case study  came to the conclusion that his client has a respiratory limitation. Congrats  and yes  once you get into it it is  fun  and great  to think through  the  options.

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