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Stuart percival

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 #16 
Ryan- I understand the 'cookbook' approach so no need to apologise ! Like Juerg I am super busy with testing and organising a womens race team so apologies for the delay in responding as I really have to think! I am also trying to read all the case studies and learnt the theory. I will answer Juerg tomorrow 

Ryan lets clear this part up first :0) baby steps 

Venous outflow blockage would increase the amount (ratio) of deoxygenated blood- lowering Sm02. Similarly 'flow' would be reduced (no exit). realising the occlusion would reverse this- tHB increase (more flow). Sm02 would increase on cessation of load as (lower) no demand for 02
ryinc

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 #17 
Stuart, for Sm02 you are thinking about it 100% correctly. For Thb, indicative for blood flow/volume, think about it some more. If its a venous occlusion only the exit of blood is blocked. So if you have blood coming in but not going out freely from the muscle what will happen to blood volume....
ryinc

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 #18 
I have lots of questions on the male athlete case:

Some of the observations (some already made, just including for completeness):
  • We generally see drops in tHb on recovery on both leg muscles (first left leg an exception). However, on the deltoid we see slight increases on recovery. This is the picture from early on in light loads right through to more difficult loads. Impact of compression shorts or blood pressure reaction seems to already have been ruled out - from what i could tell Juerg was suggesting it might be because both leg muscles still had some tension in? However, surely this residual tension would still be much lower than during the load itself and so we would still see at least some increase in tHB on at least one of the muscles?
  • As pointed out by Juerg Sm02 does not rebound higher than starting values for either of the leg muscles - possibly due to residual muscle tension suggested above?
  • The deltoid muscle shows saturation swings that are as high or even higher than the leg muscles
  • The deltoid muscle Sm02 resaturation looks "out of sync" with the leg muscle Sm02 recoveries in early part of the assessment, but then seems to come back into alignment later in the assessment (in early loads Sm02 recovery on deltoid seems to take place a bit later).
  • Although the trends of Sm02 are similar in the legs, the levels are different. The levels start off further apart in early loads and converge to very similar levels nearer the end of the assessment. Right leg has higher Sm02 in start. If this is indicative of imbalance, my guess is that the right leg is the stronger leg, as the loads get harder it has to compensate more and more for weaker leg
  • There is a marked reduction in peak recovery of Sm02 on deltoid from loads 2B and 3A. After that though Sm02 peak recoveries continue to increase on all muscles - often we actually see the opposite in later loads with peaks dipping.
  • On the left leg, on Sm02 recovery there is a v-shape - i.e. there is recovery, then slight desaturation and then recovery again. The right leg also shows this on the odd occasion, but less so. Deltoid does not show this at all.
I thought that perhaps this athlete might already have been warmed up, when the assessment began - however if you look at starting heart rate it is very low so this seems to rule this out.

Juerg you are going to need to help us understand what is going on here.[confused]

Here are the graphs again for ease of reference
HR.png  Sm02 comps.png  tHB comparisons.png    



juergfeldmann

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 #19 
Juerg you are going to need to help us understand what is going on here

Smile  same to me  we  will have  together some closer looks  here.
Perhaps  it may help  to show  the regular readers  that  even a 5/1/5 is a cook book as mentioned  and we have to  understand  that this is  a base line  with some base line cook book information's
 Below a base line idea of a 5/1/5 

col thb smo2 r leg.jpg 
 Now  as you can see all fits  well with  the  physiological reactions  and minimal discussion so  that's why Stuarts  datas  are so much more fun
now  when we look just  SmO2  below  from Allan
smo2  all three.jpg 
Now  SmO2 trends  look pretty cook book
Stop no  not  really look at the start resting SmO2( but only if Allan did not warmed up prior  to 5/1/5.

Than  look  at  tHb  left  and right leg again

r an left leg  thb.jpg 

So now  we are really of  cook book.
Same again look  at start  resting tHb  and  end  ?
Now   the  hard  part

Physiological assessments  are NOT  NOT performance tests .
Lab test or performance tests  are really just to find a maximal or peak performance  and than hope we can use  this  maximal performance result  to   create calculated zoning.
 A real performance test is a race   and that will give you the  real  current performance result.
VO2 max test  are  for what ?
 Now  physiological assessments  are here to find out  where it makes most sense  to work on  to improve  for the next race or  overall performance or what ever goal you may have.
That is hard  to  swallow   initially.
So  we argue  often. Well I am really tried or I am not in shape  or a I had a race yesterday or  I  was  not training  for a while  so I do not like to be tested.
 We  do NOT test  for performance. we asses  for   limiters  and weakness.
 So  an assessment after a race  may often give much more feedback than when recovered  and so on.

That means  you do NOT have to finish a protocol.
 So in Allan's  example I would have   changed  the assessment after  the  first  3 x 5 min when we had  this unusual but possible  tHb reaction  and SmO2 reaction.
 Here the   reason. We have an unusual result  very early on  so we  now  can play around with different interventions  by not changing the  watt level to keep this stable but change physiological  manipulations. Like what

The main reason  is to   check before we make many  possible interpretations.
 This  is true not just when we do  this   physiological  ideas but as well in classical ideas.

Sorry  Ruud   but I will use a lactate example. Below is a data  collection from one of   the MOXY webinar

lactate  info.jpg 
look at the resting BL before  the VO2 test.
 What looks interesting in this data's.. So I assume  by 2 subjects  the university in this case  did  for sure  what  before actually starting a VO2 max test. Unfortunately  we had no feedback on the   ability to see the raw datas  for  NIRS  and VO2  and  Lactate. Now  as we  would check in 2  of this objects  before  going further the  resting lactate we would in any physiological assessment after  the first 2  3  steps  make a  new decision  to  understand what is going in this case.

Now  next interesting  question.
  In Allans  case we have as well VO2  information. One feedback we often use in VO2  test is RER  and many  equipment actually  put instead of RER ,
 Now  RER  or better  RQ  of  o.7 means  what
 0.85  means what   and 1.0 means what
So  in a 5/1/5   in the rest  1 min what would we  expect  the RQ /RER  to be  s when we  do nothing  is it rather  closer  to 0.7  or closer  to 1.0  and than when we start the 5 min load  would RER  go up  or rather down  during the load

 More later after this  questions and answers.
RQ  as the  symbole



CraigMahony

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 #20 
I will have a bit of an attempt.

RQ of 0.7 indicates oxidation of fat
RQ of 0.85 indicates oxidation of a mix of fats and carbohydratres
RQ of 1.0 indicates oxidation of carbohydrates

I would expect as the workload increases that the RQ would increase. However, during the 1 minutes rest periods, I imagine that between the easier workloads RQ would still be low and may decrease slightly. During the 1 minutes recovery periods when the workload is high, I would think that RQ would stay high so as to increase the energy resupply. But I am not sure.

How quickly does the oxidative source change from carbohydrates to fat or vice versa? Is a minute enough time during recovery for RQ to change significantly?
ryinc

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 #21 
Juerg, i think most of the regular readers here would agree with what you were saying that it is an assessment not a performance test. I think there are a few problems though for some of us:

1. We have simply not seen a wide enough number of cases to know for sure when something is unusual (keep in mind these are some of the first assessments run by Stuart too). Here you also need to understand what might be causing the unusual trends to try to create a real-time protocol which will help to solve it.
2. Even if we can see it is unusual, sometimes we can only see this after studying it and thinking about it for some time post-assessment. Sometimes it requires us to first learn physiology that is already second nature to others. So difficult to see it "real-time" and make decisions right there and then to change protocol.
3. The real-time display options are limited if you are not using a computer. For example if you are using a garmin you only see the THb and Sm02 numbers - it can be quite hard to mentally "picture" the numbers. As more tablet applications come online to show this data, this will become more practical.
4. I am not a coach, but for those that are coaches and charging a client for the assessment - it becomes quite risky if you are not yet confident in your own interpretation abilities, ok change of plan we are doing something different - particularly where there may be time constraints. 

Example - it is a like an experienced mechanic vs an apprentice mechanic. The experienced mechanic can already identify 5 potential problems in the car just by listening, and then might try different things while the car is driving to establish the cause. The apprentice mechanic might not even be able to hear that something does not sound right on the car - he has to go small step at a time to work through what might be the cause.

On these cases, Stuart has perhaps been "unlucky" that all three do not look "cookbook".

To answer two of your questions
THb start vs end - its lower at the end vs the start.  Possibly hinting that there is an issue getting blood to the muscles (drops of thb on recovery might be further evidence).

About the questions as to what physiological manipulations could be used to try diagnose what he was seeing, i keen to understand this further. Off the top of my head the things that he could have tried at the same wattage:
 - Different cadence
 - Different foot positions at rest (particularly if only one moxy)
 - Different respiration patterns - e.g. fast shallow breathing vs deep slow breathing (perhaps more e.g. playing with length of expiration and inspiration)

Perhaps there are more, but what i would be keen to understand is which you would have used to help pinpoint the reason for the particular trend observed.



juergfeldmann

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 #22 
Craig   first. Thanks  and nothing to add which  would make more sense  or  look  smart.
 The  RER is the results  of CO2 / O2  and is measured  in he mask.
 The RQ is a blood  sampling  so it is measured  closer to the accrual source  of the CO2  production and O2 utilization  bit still in the  blood . NIRS  assess as close as it gets noninvasive  at the exchange area  of  O2.  So it is easy to  understand, that there may be difference  due to location and therefor  time lag  and dilution of   the testes  substances. So  to be relative  sure  RER = RQ  there is a  time   frame of  8  plus minutes   to be  at the same  intensity  so mostly at rest or  very  very low intensity.
 Resting metabolic rates  are tested  over a 15 minimal frame  and  are  very  close  to RER = RQ. That  there for is a big question and a critical question to all the interesting test we  can get  where we   believe  we have  an accurate  feedback in what energy sources  we suppose  to bun. The problem is the above. In short step test  with  change in intensities  and  high intensities    often  from very early  the RER is  tainted  with a lot  of respiratory  reactions like   location of  breathing  Apical  or  basal , the    TV  and RF ,  nose  or mouth  breathing and so on.
 VO2  max test done with a  mask  for mouth breathing only  or a  mask  for nose  breathing only    a mask for both  will give you different VO2 max  end results !!!!  So  I love  Stuart  VO2 integration as we have a confirmation n the same questions we had  along time back and it  reviews  this great  for many on here. It is a  nice  feedback on ho VO2   testing  and NIRS  can be used but what it reveals  concerning a time lag  and  other interface in  classical equipment.  I will try to work on this  this evening as it is important to understand as well when we look on priority  and non priority muscles and whether we have  shift of   Blood  due to cardiac limitation or an integration of  non priority    to the  performance level. So  time to work  here will be back later   and Craig thanks  for the  feedback
juergfeldmann

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 #23 
Ryan  perfect  and  the mechanic  and apprentice idea  is a great way  to explain what I try to  do here. The main difference to  an education or a certification  curse  t what I try to  do it, that   we learn together to think and  may have different  options and answer  but  all answers trigger a better discussion, versus an education, where you have to make the proper  cross in your exam with  they like to hear  no matter   whether it may  be true or not. Many regular readers on here  are already here  they just have to apply it now. Stuart  had some great emails  with me  and he is moving fast very fast  to be a  great  mechanic  including you  and more . Remember  this is a   process I had  very every long 30 + years  so you guys are  rockets  how you move  forward. So below I use your great  comment and add in   dark some additional thoughts   I hope  may help to stay motivated.
 Juerg, i think most of the regular readers here would agree with what you were saying that it is an assessment not a performance test. I think there are a few problems though for some of us:

1. We have simply not seen a wide enough number of cases to know for sure when something is unusual (keep in mind these are some of the first assessments run by Stuart too).Absolutely  and  it  is well accepted  how good you  do  and yes  it takes  some time and yes  you do  as an apprentice  5/1/5  this is just a hint  you start thinking about as it is the  key to physiological training  with a short daily assessment as the question we had a  while back how  do you now what is fatigued ?

Here you also need to understand what might be causing the unusual trends to try to create a real-time protocol which will help to solve it.
Again true  and  that's where we  try to work   on  all together and I try  to guide  this as good as possible. More  info on this in  later   thoughts

2. Even if we can see it is unusual, sometimes we can only see this after studying it and thinking about it for some time post-assessment.
True but avian a  question of  time involvement with this  new ideas.And   than  you will see  and  as an athlete  will feel it as you do it ( Physiological feedback  from your body and  some  bio feedback tools) Same happens  when we introduce  HR monitors  you watch  too much   but over time you can predict  the HR +- 2   with your feeling. Same happened  with lactate  and  my athletes  where  able and are still able  to tell the lactate e trend  and  actual numbers  very close to what it is . Same with diabetic  one  kids  they have this inner clock  if we trained  them to listen to the body and get feedback  from  equipment. Mots athletes  who to a LT  test  will feel when they reach the  LT  so no need to do it all he time. What is missing is  the feeling and feedback  what caused  today to reach the LT  earlier than usual or later  or in general what create  the LT  or  for us better the limiter  performance level. We all test  for a  great VO2 max number  but  that's  about it the rest is  calculation and speculation based on math and statistic . What we do here is  do look what happens and react accordingly.

Sometimes it requires us to first learn physiology that is already second nature to others.
Absolutely  and the coaches  you mention below  who  charge   should have this  as a  second nature  physiological  information and reactions as this is their  job  and they get paid  for  it in stead of running  protocols  for  LT or VO2 max  pre  fabriced  with little physiological feedback.And philological information changes  with advanced   equipment  so we may have to accept some  changes in out theories  if they  do not fit the facts  anymore, like  anaerob and aerob  and the immediate  use of  O2  and the   situation that O   is a  or the  main energy source  fro  activities  and cells. And all  what we often  discuss here and show studies  and still there is  some major resistance  to at least give it a more open look.

So difficult to see it "real-time" and make decisions right there and then to change protocol.
No  just hard  for the moment but will be soon second  nature  for many regular readers. Okay more later time to go back to work

3. The real-time display options are limited if you are not using a computer. For example if you are using a garmin you only see the THb and Sm02 numbers - it can be quite hard to mentally "picture" the numbers.
True but you  will get this as well  once  you know  what trends you look  for.
Example what we  talk in Stuarts  /Allan's case.
 The  sudden stop of a  decent high  activity  where we know the  HR is up   so CO is up  and we feel that VE is up   so higher RF  and bigger TV  and we know we push a decent  load , we  NORMALLY  expect  after  we stop a lag time of CO  and VE  so vasodilatation without  counterforce of  muscle compression so tHb  up. than as you start  tHb down.
 Now  you  know that is   what you  normally see. Now  you ride   you stop  and you see a  clear tHb  drop  and you   excluded  all other options we may try to exclude  with Allan's  assessment. than you an easy use  Garmin numbers. So we  will look at that thB options closer

As more tablet applications come online to show this data, this will become more practical.
Yes  and  again the majority of  MOXY users  use it inside a gym as personal trainers  or straighten and interval sports  like  ice hockey.

4. I am not a coach, but for those that are coaches and charging a client for the assessment - it becomes quite risky if you are not yet confident in your own interpretation abilities, ok change of plan we are doing something different - particularly where there may be time constraints. 
Absolutely if  you are  a coach  used  to have a cook book and  the VO2  equipment event  throws out the  zoning calculation. 
 BUT
If you  are a coach asking money  so you are a professional  you really shoudl  talk with your  client what the goal  of  the collaboration  and the   training  suppose to be . goal setting for the client  and how to achieve  with  working together ( The thinking client) In 40 years  of  rehabilitation and coaching  I never had  one single client  who was not interested in what I like to achieve and how I like to  achieve   his  goal. They  never  had a time  problem  to  actually accept  as I tell them when we do an assessment it is open time  so hey do not schedule a meeting 30 min after  we started. Most clients  are super happy  if  I  explain them  what we  can try together to achieve  the  goal and they have super fun to use  all this toys. They have even more  fun when they understand  that the assessments  we offer  are  far  above and beyond  what  many  top   world class athletes  ever get when they are getting tested . VO2 max  and LT  is  pretty much  most common as  we all know  and  rarely today we see   cardiac   hemodynamic test as a part of a Pro  Team. Jiri is  doing some  Pro  cyclist  with this but  that's  pretty much  it.
Example - it is a like an experienced mechanic vs an apprentice mechanic. The experienced mechanic can already identify 5 potential problems in the car just by listening, and then might try different things while the car is driving to establish the cause. The apprentice mechanic might not even be able to hear that something does not sound right on the car - he has to go small step at a time to work through what might be the cause.
YES  and  you as the main mechanic like to have an apprentice  at the end   and you woudl hire him if  he  is  able to  do  exactly what the BOSS  can do . 
On these cases, Stuart has perhaps been "unlucky" that all three do not look "cookbook".
NO Stuart is very lucky  as  we have a  unusual result and now we have the advantage  as we knwo what this  three  people did  before the  assessment   and what we may see due to this pre assessment loads. Now  Stuart can do a very  short  MOXY only  assessment as a part of a workout  for  him and the clients. They basically repeat the first 3  double loads but adjust if needed the  1 min break  or  do nothing different  and Stuart  can look    on the live trend and than we  may see  a difference or a repeat of the same pattern.
Remember the track and field girl from Craig and the orthostatic  reaction in between the 150 m runs?

To answer two of your questions 
THb start vs end - its lower at the end vs the start.  Possibly hinting that there is an issue getting blood to the muscles (drops of thb on recovery might be further evidence).
Yes
About the questions as to what physiological manipulations could be used to try diagnose what he was seeing, i keen to understand this further. Off the top of my head the things that he could have tried at the same wattage:
 - Different cadence
 - Different foot positions at rest (particularly if only one moxy)
 - Different respiration patterns - e.g. fast shallow breathing vs deep slow breathing (perhaps more e.g. playing with length of expiration and inspiration)
Perfect ; Always start  when manipulating  with mechanical   reasons  like gravity , compression position  and so on. This are local  mechanical reactions  who, when they  are the reason will react  immediately  and  even without a big load ( like  the gravity idea) 
 If  they do not show  any change than you go towards  more  systemic reactions like  respiration  manipulation.


Perhaps there are more, but what i would be keen to understand is which you would have used to help pinpoint the reason for the particular trend observed.
There are always more  but you nailed  the initial most important  and easy to  try out  once. 

Stuart percival

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 #24 
Thanks Ryan , Craig and Juerg

Ryan agree with you....real time analysis and intervention is some way off. I have a good understanding of physiology and modern testing but this is really making me have to think hard!!! Exciting stuff but equally frustrating as Im getting my athletes to ride and test with kit but they want feedback the minute they take it off!!!!

Anyway Craig was right with RQ values. I have included breath by breath RER and V02 data so you could play about making graphs but during the 1 min rest of a 5-1-5 when they stop you will see a rise in RER which would suggest a large usage (increase) of carbohydrate yet the MOXY shows actually no oxygen usage above resting - counter intuitive as the Sm02 pings back up- 

We usually get closer to RER 1 in standard V02 max test as C02 production increases exponentially whereas oxygen uptake follows a linear increase..approx 10ml per watt.

It goes closer to 1 and over in 5-1-5 during 1 min rest as V02 levels drop more than VC02 
juergfeldmann

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 #25 
Will be back n the RQ  and RER one  later   hopefully.
 Exciting stuff but equally frustrating as I m getting my athletes to ride and test with kit but they want feedback the minute they take it off!!!!

I  do not see the frustrating part   it is  real professional  information based n individual reactions. If  an athlete  pays  for  a n assessment than he  should understand  that  Stuart is a professional coach  and offering a  professional optimal individual advice  and this is not possible with a  calculator  and cookbook but with a  real discussion and  understanding or individual  abilities and reactions. If  I work  with Pro  athletes  I very very rarely have an answer  and need  lots  of time  to look through all the options  and  call the   athlete back in  and sit down  and we  do a lot of  talking and   discussing  the  different options  and how we  will approach it.
 In patients  it may be different as it is a one  step  at a time  so  shorter but even there  I never  give a feedback immediately I like to review  it for  mys elf  and than  we discuss.

I have included breath by breath RER and V02 data so you could play about making graphs but during the 1 min rest of a 5-1-5 when they stop you will see a rise in RER which would suggest a large usage (increase) of carbohydrate yet the MOXY shows actually no oxygen usage above resting - counter intuitive as the Sm02 pings back up- 

First   do not look the MOXY look at the "theoretical " classic la logic   as most do not have a MOXY. So  you have a 1 min break   and do nothing and  the equipment RER  suggests  that you actually use   carbs  entirely actually  RER  is  above 1.0  despite the fact you do nothing  and than as  you do something  so much more  than nothing  you acutely move down  with RER  towards   more mixed  energy supply.
Or in  simple words.
 The VO2  equipment suggest  that when you  push ZERO wattage  you will burn a  lot  or entirely   carbs  as your  RER  is  1.0  and above. where as  when you actually push all out  you will see that you burn less carbs and move towards using Fat.So you burn less carbs by going hard versus doing nothing. ???  Remember  each  research using VO2  is very proud  to write   breath by breath so it  as to be  super accurate  in what we  see  ??

Is  that true ? Is  what we seethe  unreal seen or  the unseen real is missing.


juergfeldmann

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 #26 
Okay lets  look as promised  somewhat closer into  the exercise physiology  we learned  and we may have to review or readjust.
 Below a  graph. do not overthink just look at it  and give it some  thoughts. It is  a one of many graphs  I have  from Allan. We  have a lot of feedback  from Allan thanks  to Stuart.

We have  lactate  information  and we  have  performance information Wattage  and  we know FTP  and much more.We  have  all VO2  collectible  and calculated  data's  and we have  a lot of NIRS feedback.
Now  the red line  could be any baseline like FTP if this is a wattage feedback  from a workout.
 Or it  could be a VO2 feedback or it could be a SEMG   graph  or it could be a  tHb graph or a SmO22  graph.
 No matter what it is  what  would the graph  explain  when  we  assume:.
RER CLOSE OR   WHAT IF  IT WOUDDL EB A WATTAGE  CURVE.jpg

1. it is a wattage graph. So direct feedback  what is the workout look like
2. Now  if this is a HR feedback   how  would the wattage look like
3. If it is the feedback of  VO2 /kg body weight
4. If it is RQ or RER
5. If it is lactate
6. If  it is  tHb
7.If it is  SmO2 Now   when we look at live feedback and we like to have an instant  fast  idea on what is going on  that is  what we train  with our  students  and coaches.
 There is no  right o r  wrong there is just the fats idea on  wow if I see that  than it could mean  that than go and  confirm  with additional fast feedbacks. Again forget that it is  the graph of datas  from a 5/1/5 assessment. You simply see the physiological  feedback  any  possible equipment will give you and you  make the explanation or interpretation based on  what you se  and  not what you think  you may see. This is what we  all  did   and or many still really do    with  VO2  and lactate and many tests we sell and the  client  as Stuart points out, likes to have immediately a feedback of his results.  Now  to make it easier to start. 
a) assume this graph would be a  wattage graph  so  what  many cyclist  look for is  the instant  performance feedback and wattage is a direct feedback  as you go and  do it.
 b) now assume this is  RER ( RQ ) feedback )  and you know  we have 0.7 /0.85 and 1.0  as a metabolic feedback on what energy source we  actually use   BREATH  by BREATH

Now
1.if it is a wattage graph  how  would VO2 look like.
2. If it is a RER graph how would VO2 look like. 
Simple  exercise  physiology we  all learned  from  our  education.


bobbyjobling

Development Team Member
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Posts: 211
 #27 
Hopefully I understood the question is related to what we would see on the equipment and not in the muscle:
1)Vo2 will look similar to a CO trend ( delayed response due to HRxSV)
2)RER will have peak as the start of a load then reduce as CO delivery increases. (information still delayed due to HRxSV)

Theoretical Live feedback; on the muscles all energy systems are used at the start of each load (we have an internal buffer capacity) and I believe O2 is used to replenish this system

I have no experience using VO2 equipment so I may be completely wrong.
juergfeldmann

Development Team Member
Registered:
Posts: 1,501
 #28 
Hopefully I understood the question is related to what we would see on the equipment and not in the muscle

Yes  perfect , as we use the results of  equipment readings like VO2  feedback and  lactate feedback as it relates to what we  see on results there. Same is  true when we use a power meter in cycling  or a weight in  a  weight training.
 We all as well know  when we have a HR monitor , that in some workouts  the   number we see on HR on the  watch does not  reflect  the  unseen real the actual  need  CO  and we often have a  higher HR  after   a certain interval or  workout  as we  will often see in respiration as well.
 So  some  equipment are  live  immediate feedback  like SEMG  or  NIRS  and some  are live feedback  with a physiologic delay. And some  are  feedback's  with a physiological delay  and a  lag time  due  to the location we  get results  from. Finger  ear   mask  mouth  and so on.

2)RER will have peak as the start of a load then reduce as CO delivery increases. (information still delayed due to HRxSV) 

Good options  but  let's  wait  for VO2  equipment users out there  with some experience  and feedback but as well on all theoretical thinkers  and  thoughts. The thoughts  woudl make sense. a high RER  close  to 1  as  an indication o  carb or glycolyses  involvement  and than  reduction in RER as we go along as we may deliver  more O2  so  Gehrig  option  to possible involve  some FAT.
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