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Editorials

thinks about the balance of sedentary adults in industrialised and developing sufficient public health approach to prevent obesity—
a focus on China. Obes Rev 2008;9:119–26.
behaviour and activity in all aspects of countries spend sitting in their 15.5 ‘‘non- 4. Healy GN, Dunstan DW, Salmon J, et al. Objectively
daily life, including transport, occupa- exercise’’ waking hours. A particular con- measured light-intensity physical activity is
tional settings, domestic work and leisure, cern for this new research agenda is how independently associated with 2-h plasma glucose.
especially around obesity management to approach reducing or breaking-up Diabetes Care 2007;30:1384–9.
5. Anderssen SA, Engeland A, Sogaard AJ, et al.
and the role of total physical activity in prolonged sitting time, and how this Changes in physical activity behavior and the
the prevention of further weight gain. might relate to increasing light intensity development of body mass index during the last 30
This involves some re-orienting of the and moderate to vigorous intensity phy- years in Norway. Scand J Med Sci Sports
physical activity and health field from its 2008;18:309–17.
sical activities. Other research opportu-
6. Levine JA. Nonexercise activity thermogenesis—
well-established focus on LTPA to a nities include carrying out studies on how liberating the life-force. J Intern Med
comprehensive programme of research to best to promote higher volumes of overall 2007;262:273–87.
understand the determinants of sedentary physical activity (light intensity activities 7. Bell AC, Ge K, Popkin BM. The road to obesity or the
behaviour and both LIPA and MVPA. It path to prevention: motorized transportation and
in addition to moderate to vigorous obesity in China. Obes Res 2002;10:277–83.
will also involve studying the effects on intensity activities), in the context of the 8. Brown W, Ringuet C, Trost S. How active
health outcomes of shifting the balance of ubiquitous environmental and social dri- are young adult women? Health Promot J Austr
these behaviours towards more activity in vers of sitting time in occupational, 2002;13:23–38.
all domains of daily life. 9. Ainsworth BE, Haskell WL, Whitt MC, et al.
transportation, recreational and domestic Compendium of physical activities: an update of
settings. activity codes and MET intensities. Med Sci Sports
CLINICAL IMPLICATIONS Particular concerns for exercise science Exerc 2000;32:S498–504.
10. Gunn SM, Brooks AG, Withers RT, et al. Determining
Given the recent recognition of this research agenda include identifying why
energy expenditure during some household and
phenomenon of too much sitting, there sedentary behaviour and the associated garden tasks. Med Sci Sports Exerc
are not yet any recommended clinical health relationships seem to be particu- 2002;34:895–902.
guidelines. Commonsense might suggest larly strong for women and examining the 11. Brown WJ, Williams L, Ford JH, et al. Identifying the
energy gap: magnitude and determinants of 5-year
that it may be prudent to try to minimise effects of interventions for reducing or weight gain in midage women. Obes Res
prolonged sitting with 5 minute breaks breaking-up sitting time. The issue of too 2005;13:1431–41.
every hour. However, more specific advice much sitting has challenging implications 12. Healy GN, Dunstan DW, Salmon J, et al. Breaks in
will require dose-response relationships for future healthcare practice and will sedentary time: beneficial associations with metabolic
risk. Diabetes Care 2008;31:661–6.
between sitting and health outcomes to require development of new kinds of 13. Booth ML, Chey T, Wake M, et al. Change in the
be defined using controlled studies. Many clinical and public health guidelines.18 prevalence of overweight and obesity among young
of the possible interventions that encou- Australians, 1969–1997. Am J Clin Nutr 2003;77:29–
rage movement may well be undertaken Funding: NO, AB WB are supported by NHMRC 36.
Program Grant funding (#301200); NO is also supported 14. Australian Institute for Health and Welfare. Are
in settings in which prolonged periods of by a Queensland Health Core Research Infrastructure all Australians gaining weight? Differentials in
sedentary behaviours are the norm. grant. overweight and obesity among adults, 1989–90 to
2001. Bulletin No. 11. AIHW Cat. No. AUS 39.
Competing interests: None. Canberra: AIHW, 2003.
CONCLUSIONS 15. Venn AJ, Thomson RJ, Schmidt MD, et al.
Accepted 24 October 2008
Research, policy and practice on physical Published Online First 28 November 2008 Overweight and obesity from childhood to adulthood:
activity and population health has a follow-up of participants in the 1985 Australian
Br J Sports Med 2009;43:81–83. Schools Health and Fitness Survey. Med J Aust
focussed largely on increasing the time
doi:10.1136/bjsm.2008.055269 2007;186:458–60.
that adults spend doing moderate to 16. Hu FB, Willett WC, Li T, et al. Adiposity as compared
vigorous intensity activities; 30 minutes with physical activity in predicting mortality among
a day is generally the target. However, REFERENCES women. N Engl J Med 2004;351:2694–703.
recent evidence from biomarker studies 1. Daar AS, Singer PA, Persad DL, et al. Grand 17. Brown WJ, Hockey R, Dobson A. Rose revisited: a
challenges in chronic non-communicable diseases. ‘‘middle road’’ prevention strategy to reduce
and objective-measurement studies (and Nature 2007;450:494–6. noncommunicable chronic disease risk. Bull World
also from some prospective epidemiologi- 2. Bauman A, Bellew B, Vita P, et al. Getting Australia Health Organ 2007;85:886–7.
cal studies) highlights the importance of active: Best practice for the promotion of physical 18. Hamilton M, Healy G, Dunstan D, et al. Too little
activity. Melbourne: National Public Health exercise and too much sitting: Inactivity physiology
focusing on the balance of light-intensity Partnership, 2002. and the need for new recommendations on sedentary
activities and sedentary behaviours—par- 3. Bauman A, Allman-Farinelli M, Huxley R, et al. behaviour. Current Cardiovascular Risk Reports
ticularly the high volumes of time that Leisure-time physical activity alone may not be a 2008;2:292–8.

Is the measurement of maximal similar athletic ability and of the changes in


performance that occur with continued train-
ing should encourage both basic and applied
oxygen intake passé? sports scientists to reconsider the real value of
this iconic test.’’
A number of the arguments that are
Roy J Shephard advanced in this review seem to need
correction or refutation. Specifically, this
A recent and controversial review1 sug- oxygen intake is passé. The author con- riposte will examine whether a maximal
gests that the measurement of maximal cludes (p. 554) ‘‘It is now time to develop treadmill test is an unrealistic procedure for
novel testing methods....That the measured athletes, whether a unimodal approach to
Correspondence to: Roy J Shephard, PO Box 521, VO2max is a relatively poor predictor of both testing is appropriate in sports medicine,
Brackendale, Canada BC V0N 1H0; royjshep@shaw.ca the performance potential of athletes with and whether an alternative laboratory test

Br J Sports Med February 2009 Vol 43 No 2 83


Editorials

will be developed to categorise the perfor- tactical skills. The motivating power of be determined to a small fraction of a
mance of individual athletes. Comments the observer is important to the reaching second. This compares very favourably
will also be made on the place of maximal of an oxygen consumption ‘‘plateau’’, and with the laboratory treadmill, since even
oxygen intake assessment in various areas laboratories that have difficulty in careful determinations of maximal oxy-
of science, sports medicine and clinical demonstrating this phenomenon6 prob- gen intake have an experimental error of
medicine. ably need to upgrade their motivational 2–4 per cent, and superimposed upon this
skills. Mechanical efficiency can be esti- is an intraindividual biological variation of
IS THE MAXIMAL TREADMILL TEST AN mated roughly from treadmill data, 10–20 per cent.15
UNREALISTIC PROCEDURE FOR although other forms of ergometer pro-
ATHLETES? vide more precise values.7
WHAT ARE APPROPRIATE USES OF
Noakes argues1 that the treadmill test is MAXIMAL OXYGEN INTAKE
an unrealistic approach to the testing of IS A UNIMODAL APPROACH TO TESTING DETERMINATION?
athletes for three reasons: the duration of APPROPRIATE? Maximal oxygen intake tests are of little
the exercise is not known to the subject, Another puzzling feature of the recent help in ranking athletes of similar ability.
there is a steep and progressive increase in review1 is the apparent assumption that However, this does not imply that such
the intensity of exercise, and the person everyone will be tested on a treadmill. The measurements are passé. On the contrary,
who is tested has no control over the International Working Party that standar- the testing of maximal oxygen intake has
ultimate intensity of effort. All of these dised procedures for the measurement of many appropriate and important applica-
criticisms may be true of the test protocol maximal oxygen intake suggested that tions. This concluding section highlights
used in some laboratories. However, the three possible modes of testing were suita- just a few such applications, in integrative
standard recommendation is for a tread- ble for ordinary, non-athletic individuals, biology, sports medicine, doping control,
mill test lasting 9–11 minutes, and this based on a treadmill, a double step and a epidemiology and clinical medicine.
should be explained to the subject. The cycle ergometer.8 In non-athletic indivi-
appropriate treadmill slope and speed duals, the largest values were obtained on Integrative biology
should be ascertained by preliminary the treadmill; step test readings were on Analysis of the oxygen conductance equa-
submaximal testing; this allows the defi- average 4 per cent smaller, and cycle tion under conditions of maximal aerobic
nitive test to commence close to maximal ergometer values 7 per cent smaller. effort16 provides helpful insights into the
steady-state effort, thereby avoiding a Intermodal differences in maximal oxy- factors limiting various types of physical
steep ramp of intensity. Moreover, the gen intake are thought to reflect the performance.9 In activities that involve
maximal value can be determined by differing proportions of the total muscle large muscle groups, oxygen transport is
carrying out a series of tests on successive mass that are used in the different determined almost entirely by maximal
days, although the values obtained in this protocols9; intermodal differences are cardiac output, and, taken together with
manner do not differ materially from those much larger in athletes who have trained determinations of heart rate, the measure-
seen with an appropriately conducted one particular group of muscles. For ment of maximal oxygen intake offers a
continuous test protocol.2 Finally, proto- athletes, it is thus critical to select a test useful method of examining cardiac
cols are available that allow the subject to modality that allows use of the muscles stroke volume during maximal aerobic
regulate the speed of the treadmill himself engaged in their chosen sport; for a exercise. If the external work is measured,
or herself as the test proceeds. cyclist, the natural choice would be a the mechanical efficiency of various types
There are thus ways of dealing with the cycle ergometer or a racing bicycle of activity can also be determined.7
problems cited by Noakes. However, there mounted on rollers,10 for the oarsperson
remain some important differences a rowing ergometer or the collection of
between a laboratory treadmill test and Sports medicine
gas samples during actual rowing,11 for the Grouped data on the maximal oxygen
athletic performance that Noakes does cross-country skier a skiing ergometer or
not discuss. Most treadmills cannot intake of top competitors provide insights
uphill skiing,12 and for the swimmer a into the extent of aerobic demands in
match the speed of short-distance run- flume or the collection of gas samples
ners. While on a treadmill, an athlete does various forms of sport.17 Comparisons of
during swimming in a pool.13 14 Plainly, for the grouped physiological profile with the
not encounter wind resistance3 and can- many categories of athlete, the treadmill
not profit from ‘‘drafting’’.4 Few labora- individual’s personal data may suggest
is an inappropriate test modality. how large an emphasis the individual
tories simulate radiant heating or cooling
by cross-winds, and the running surface should place upon enhancing his or her
of the treadmill differs substantially from CAN LABORATORY TESTS OFFER A aerobic power. Careful records of an
the usual track. However, these various USEFUL PREDICTION OF ATHLETIC individual’s maximal oxygen intake are
limitations apply only to laboratory mea- ABILITY? also helpful in evaluating the extent of
surements, and do not negate the value of Given the various constraints noted any deterioration in aerobic function
maximal oxygen intake testing, since it is above, it seems unlikely that any labora- following injury or overtraining, and in
quite practicable to measure oxygen con- tory test can be devised that will categor- monitoring the recovery of aerobic func-
sumption when an athlete is running on a ise athletes of similar ability with useful tion following such episodes.18
standard track.5 accuracy. Rather, athletes should be
Other factors affecting athletic perfor- ranked based on the actual performances Doping control
mance include an appropriate choice of achieved over several recent competitions. A variety of drugs19 and manipulations such
tactics (including selection of clothing), Here, tactics, motivation and mechanical as blood transfusions20 can induce small
motivation of the individual, and the efficiency all come into play, and the increments of maximal oxygen intake
mechanical efficiency of movement. No mode of exercise is entirely natural. that have an important influence on the
laboratory test seems likely to evaluate Moreover, individual performances can outcome of endurance competitions.

84 Br J Sports Med February 2009 Vol 43 No 2


Editorials

Measurements of maximal oxygen intake observations also provide an optimal basis 10. Hagberg J, McCole S. Energy expenditure during
cycling. In: Burke ER, ed. High Tech Cycling.
under carefully controlled double-blind for the setting of a safe and effective Champaign, IL: Human Kinetics, 1996:167–84.
trials are thus important in distinguishing intensity of training in programmes of 11. Jackson RC, Secher NH. The aerobic demands of
medications that are acceptable (for cardiac rehabilitation.24 Clinical informa- rowing in two Olympic rowers. Med Sci Sports Exerc
instance, certain drugs used in the treat- tion can be derived from the extent of ST 1976;8:168–70.
12. Strömme SB, Inger F, Meen HD. Assessment of
ment of bronchospasm induced by exercise depression at various fractions of an maximal aerobic power in specifically trained athletes.
or cold) from those which would give individual’s maximal oxygen intake.25 J Appl Physiol 1977;42:833–7.
athletes an unfair advantage. Finally, determinations of maximal oxy- 13. Holmér I. Physiology of swimming man. Ex Sport Sci
gen intake are helpful in gauging recovery Rev 1979;7:87–123.
14. Pendergast DR, Di Prampero PE, Craig AB, et al. The
Epidemiology following bed rest, injury, and exposure to influence of biomechanical factors on the energy cost
It is widely agreed that the majority of zero gravity environments. of swimming. In: Eriksson B, Fürberg B, eds.
the population in developed countries Swimming Medicine IV. Baltimore, MD: University
Competing interests: None. Park Press, 1978.
currently takes insufficient physical activ- 15. Wright GR, Sidney KH, Shephard RJ. Variance of
ity, with adverse consequences for many Accepted 7 August 2008
direct and indirect measurements of aerobic power.
Published Online First 21 August 2008
facets of health.21 Nevertheless, the deter- J Sports Med Phys Fitness 1978;18:33–42.
mination of the physical activity of a Br J Sports Med 2009;43:83–85. 16. Shephard RJ. The oxygen conductance equation. In:
doi:10.1136/bjsm.2008.052506 Shephard RJ, ed. Frontiers of fitness. Springfield, IL:
population, whether by questionnaire or C.C. Thomas, 1971:129–164.
by use of accelerometers, is unreliable, and 17. Shephard RJ, Åstrand P-O. Endurance in Sport. 2nd
the mass testing of maximal oxygen REFERENCES ed. Oxford, UK: Blackwell Science, 2000.
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