The Maximal Oxygen Uptake Verification Phase: a Light at the End of the Tunnel?

Gustavo Z Schaun, Gustavo Z Schaun

Abstract

Commonly performed during an incremental test to exhaustion, maximal oxygen uptake (V̇O2max) assessment has become a recurring practice in clinical and experimental settings. To validate the test, several criteria were proposed. In this context, the plateau in oxygen uptake (V̇O2) is inconsistent in its frequency, reducing its usefulness as a robust method to determine "true" V̇O2max. Moreover, secondary criteria previously suggested, such as expiratory exchange ratios or percentages of maximal heart rate, are highly dependent on protocol design and often are achieved at V̇O2 percentages well below V̇O2max. Thus, an alternative method termed verification phase was proposed. Currently, it is clear that the verification phase can be a practical and sensitive method to confirm V̇O2max; however, procedures to conduct it are not standardized across the literature and no previous research tried to summarize how it has been employed. Therefore, in this review the knowledge on the verification phase was updated, while suggestions on how it can be performed (e.g. intensity, duration, recovery) were provided according to population and protocol design. Future studies should focus to identify a verification protocol feasible for different populations and to compare square-wave and multistage verification phases. Additionally, studies assessing verification phases in different patient populations are still warranted.

Keywords: Cardiopulmonary exercise testing; Criteria; Exercise; Graded exercise test; Incremental exercise; Oxygen consumption; Plateau.

Conflict of interest statement

Ethics Approval and Consent to Participate

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Not applicable.

Competing Interests

Gustavo Schaun declares that he has no conflicts of interest relevant to the content of this review.

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Figures

Fig. 1
Fig. 1
Schematic illustration of an incremental test followed by either a square-wave (a) or a multistage (b) verification phase. Incremental protocol consists of a 5-min warm-up followed by 1 km h−1 increments every minute until exhaustion (i.e. 19 km h−1). After 10 min of passive recovery, an effort at one stage higher (20 km h−1) than the last stage completed during the incremental phase is performed directly (a) or preceded by a “warm-up” corresponding to 2 min at 50% and 1 min at 70% of the maximal velocity reached during the incremental phase (b)
Fig. 2
Fig. 2
Oxygen uptake (V̇O2) responses to an incremental test followed by a multistage verification phase for two representative subjects. a represents a valid test, while b represents a test were verification phase maximal oxygen uptake (V̇O2max) was higher than that reached during incremental phase, consequently, an invalid test. Note: differences between phases were considered as V̇O2 differences > 2%; > 3%; > 2.2 or 2.0 ml kg−1 min−1 and V̇O2 values presented as 15-s averages

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