Tuesday, December 6, 2011 at 10:56AM

By: Andrew N. Bosch, PhD

UCT/ MRC Research Unit for Exercise Science and Sports Medicine.

Department of Human Biology, University of Cape Town and Sports Science Institute of South Africa

From: International Journal of Sports Science & Coaching Volume 1 • Number 1 • 2006



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Many coaches who work with endurance athletes still believe in old concepts that can no longer be considered correct. Prime amongst these are the understanding, or misunderstanding, of the concepts of maximal oxygen uptake (VO2 max), lactate threshold, training heart rate, and dehydration and fluid requirements during prolonged exercise.

Knowing the VO2 max of an athlete is not particularly useful to the coach, and the exact VO2 max value of any particular athlete can vary considerably as fitness changes. Race performance is a more useful measure on which to base training schedules.

Lactic acid production, far from being an undesirable event, is of great importance and is actually beneficial to the athlete. The lactate concentration during exercise, and the lactate turnpoint, are both widely measured. The nature of the information that these measures can provide about training and training status, however, is still based on information from the 1980s, although more current information is available and many of the original concepts have been modified.

Heart rate is often used to prescribe training intensity, but it is important to understand the limitations inherent in its use. If used correctly, it is a useful tool for the coach.

Similarly, many athletes and coaches still believe that it is necessary to maintain a high fluid intake to avoid dehydration and prevent associated collapse. These beliefs are incorrect, but modern exercise science has been able to advance the knowledge in this area and provide more accurate information.

Exercise science continues to progress and can offer much to the coach willing to accept new and changing ideas.

Key words: Anaerobic threshold; Endurance training; hydration; lactic acid; maximal oxygen uptake; training heart rate

Introduction

Sports science knowledge has progressed tremendously in the last 20 years in terms of the understanding of many of the underlying concepts in exercise physiology and human performance. Many coaches, however, have failed to take cognisance of the new information and still believe in old and out-dated concepts, many of which frankly are wrong. And it is this incorrect understanding that is then applied to the coaching of athletes. In the following article, some of these misconceptions related to endurance performance are highlighted, specifically those around maximal oxygen uptake (VO2 max), lactate threshold, training heart rate, dehydration, and fluid requirements during prolonged exercise. Although runners are most often referred to in the discussion that follows, the principles are applicable to all genre of endurance athlete.

VO2 Max

Every so often a request is received from the coach of a runner or cyclist wanting to know ifit would be possible to measure the VO2 max of one of their athletes. I explain that it is, indeed, possible, but then go on to ask why they want to have the VO2 max of the athlete measured? There is usually one of two replies. Firstly, I am told, by knowing his or her VO2 max the runner will know the esoteric time that he or she is ultimately capable of running for some particular race distance, and therefore their ultimate potential as a runner. Secondly, once their VO2 max is known it will be possible to prescribe the ultimate personalised training schedule. Unfortunately, knowing the VO2 max of a runner does not answer either question.

It is widely believed by those involved in endurance sports that the VO2 max is genetically determined and never changes, and that an individual is born with either a high or low VO2 max. Generally, someone with a high VO2 max value is considered to have a cardiovascular system capable of delivering large amounts of oxygen to the working muscle and is able to exercise at a maximum aerobic work output that is determined by the exercise intensity that can be sustained by this supply of oxygen [1]. In this paradigm it does not appear to matter whether a runner or cyclist is unfit or superbly fit, the VO2 max value obtained in a test is theoretically the same. However, it is intuitively obvious that when fit, the athlete can run much faster on the treadmill than when unfit. Thus, since VO2 max is genetically determined and does not change, VO2 max would be reached at a relatively slow running speed when a runner is unfit compared to when very fit, when a much higher speed or workload can be reached. This means that in a totally unfit world class runner we would measure a high VO2 max (for example, 75 ml/kg/min or higher, a reasonable VO2 max value for an elite runner) at a speed of maybe 17 km/hr in a testing protocol in which the treadmill remains flat during the test. When very fit the same athlete will reach the same VO2 max, but now the speed reached on the treadmill will be around 24 km/hr (a reasonable speed for an elite athlete in such a test). The problem is that such a high VO2 max is never measured at a speed of just 17 km/hr, or thereabout. This would be almost impossibly inefficient [2]. The theory of a genetically set and unchanging VO2 max, regardless of work output therefore begins to appear a little shaky.

This concept of VO2 max evolved originally from misinterpretation of the data of early experimental work [1; 3-5]. It was believed that as an athlete ran faster and faster during a treadmill test, an increasing volume of oxygen was needed by the muscles, a process which continued until the supply of oxygen became limiting, or the ability of the muscle to utilise oxygen was exceeded. At this point there would be no further increase in oxygen uptake, despite further increases in running speed [1]. The plateau in oxygen utilisation was regarded as the VO2 max of the runner. If high, then the athlete had great genetic potential. This has been termed the cardiovascular/ anaerobic model by Noakes [1] and needs revision, although others adhere to the concept [6]. However, 30% of all runners and cyclists tested in exercise laboratories never show a plateau in their oxygen uptake [4; 7]. Instead, the oxygen uptake is still increasing when the athlete cannot continue the test. The conventional view of VO2 max now appears to be even more suspect.

Consider a different possibility. The muscles of a runner require a certain amount of oxygen to sustain contraction at a given speed. When the speed is increased, the muscles have to work harder and there is therefore a corresponding increase in the volume of oxygen needed to run at the higher speed. As the runner runs faster and faster, it follows that there is a concomitant increase in the oxygen required, until ultimately something other than oxygen supply to the muscle prevents the muscle from being able to work harder and to sustain a further increase in running speed.

The brain may be the ultimate subconscious controller, by sensing a pending limitation in the maximum capacity of the coronary blood flow to supply oxygen to the heart as exercise intensity increases, and then preventing a further increase in muscle contractility to prevent damage to the heart during maximal exercise [1].

The volume of oxygen being used by the muscle when maximum running speed has been reached is termed the VO2 max. With this theory, the increase in oxygen requirement merely tracks the increase in running speed, until a peak running speed and therefore peak oxygen requirement (VO2 max) is attained. It is easy to see why the VO2 max value will change (which it does) as a runner gets fitter and becomes capable of running faster. Within this framework, the genetically determined limit of VO2 max is actually determined by the highest running speed that the contractility of the muscles can sustain [8] before the brain limits performance to protect the heart, as described above [1]. Of practical importance, is that the exercise scientist and coach cannot use the VO2 max test as a predictor of future performance in someone who still has the capacity to improve their running by utilising a scientifically designed training programme. A great training-induced increase in running speed will result in a substantial change in VO2 max. Only when widely disparate groups of athletes are tested can a VO2 max value be used to distinguish between athletes (i.e. very fast and very slow [2; 9; 10]). In a group of athletes with similar ability, the VO2 max value cannot distinguish between the faster and slower runners i.e. their race performance. Neither is the knowledge of a VO2 max value going to assist in the construction of a training programme, other than by indirectly giving an indication of the time in which a race may currently be completed, by the use of various tables that are available [11]. Indeed, current race performance provides the most useful information for the coach on which to base training prescription [11].

There are, however, some potential uses of a VO2 max test for a coach. When constructing a training programme for someone who has not run any races and who therefore has no race times from which to determine current ability, a VO2 max test will help by giving an indication of the current capability of the athlete on which to base training schedules. If done at regular intervals, the test can provide information about the efficacy of a training programme [11] as laboratory conditions are very reproducible with regard to temperature and absence of wind. However, the peak speed attained in the test is probably the best indicator of current ability [1; 12-14] and not the actual VO2 max value. Race times remain the most useful measure on which to prescribe running speed in training schedules [11].

Lactic Acid

Most athletes and coaches still believe that lactic acid is released during hard or unaccustomed exercise and that this is what limits performance, as well as being the cause of stiffness. Neither is correct. Furthermore, the terminology “lactic acid,” is not correct.

Lactic acid does not exist as such in the body - it exists as lactate at physiological pH [15], and it is this that is actually measured in the blood when “lactic acid” concentration is measured, as is done when a “lactate threshold” is determined in an athlete. This distinction is important not only for the sake of correctness, but more importantly, because lactate and lactic acid would have different physiological effects.

The first misconception is that lactic acid is the cause of the stiffness felt after an event such as a marathon. Stiffness is due to damage to the muscle [1], and not an accumulation of lactic acid crystals in the muscle [1; 16], as is commonly believed.

The second misconception is that lactate is responsible for acidifying the blood, thereby causing fatigue. To the contrary, the production of lactate is actually important for two reasons. Firstly, when lactate is produced from pyruvate in the muscle, a hydrogen ion is “consumed” in the process [15]. Consequently the production of lactate actually reduces the acidity in the muscle cells and is thus a beneficial process. Secondly, lactate is an important fuel that is used by the muscles during prolonged exercise [17; 18]. It can be produced in one muscle cell and utilized as a fuel in another, or it can be released from the muscle and converted in the liver to glucose, which is then used as an energy source. So rather than cause fatigue, lactate production actually helps to delay fatigue [19].

Anaerobic Threshold

Closely allied to the thinking that lactate production is bad for performance, is the concept of measuring the blood lactate concentration to determine the so-called “anaerobic threshold” or “lactate threshold.”. The origin of this belief can probably be traced to the early studies of Fletcher and Hopkins [20]. Thus we see photographs of athletes at the track or at the side of the pool having a blood sample taken, with an accompanying caption indicating that the workout is being monitored by measuring “lactic acid.” The supposed rationale is that as speed is increased, a point is reached at which there is insufficient oxygen available to the muscle and energy sources that do not require oxygen (oxygen independent pathways, previously termed the anaerobic energy system) then contribute to the energy that is needed. This supposedly results in a disproportionate increase in the blood lactate concentration, a point identified as the “anaerobic” or “oxygen deficient” threshold. This is also known as the lactate threshold or lactate turnpoint.

There are two problems with this concept. First of all, the muscle never becomes anaerobic; there are other reasons for the increase that is measured in blood lactate concentration [21]. Secondly, the so-called disproportionate increase causing a turnpoint is not correct, in that the increase is actually exponential [22-24]. This is seen when many samples are taken, as in the exercise laboratory, where a blood sample can be drawn every 30 seconds as an athlete runs faster and faster.

Although a graph showing a “breakpoint” in lactate concentration as speed increases cannot be drawn as the breakpoint does not exist, a graph can nevertheless be drawn depicting the curvilinear increase in blood lactate concentration as running speed or exercise intensity increases. This curve changes in shape (shifts to the right) as fitness level changes. Particularly, the fitter a runner gets, the more the curve shifts to the right on the graph, meaning that at any given lactate concentration the running speed or work output is higher than before. A shift in the lactate curve to a higher workload or percentage VO2 max occurs due to a reduced rate of lactate production by the muscles and an increased ability of the body to clear the lactate produced [25; 26]. Often, the running speed at a lactate concentration of 4mmol/l is used as a standard for comparison. It is sometimes suggested that this can be used as a guide for training speed (i.e. a runner could do some runs each week at the speed corresponding to the 4mmol/l lactate concentration, some runs above this speed, and recovery runs at a lower speed). Of course, as fitness changes and the curve shifts, these speeds will change, and so a new curve will have to be determined. In concept this works well, but the problem is that neither exercise scientists nor coaches know how much running should be done below, at, and above the 4mmol/l concentration. The 4 mmol/l concentration referred to is a somewhat arbitrarily chosen concentration. It could just as well have been 3.5 mmol/l or 4.5 mmol/l, which would result in different training speeds for the athlete utilizing this system. Indeed, Borch et al [27] suggest 3 mmol/l as the lactate concentration representing an average steady state value. Measuring the maximal steady state lactate concentration may be useful, but requires 4-5 laboratory visits. Thus the real value in determining a ‘lactate curve’ is to monitor how it shifts with training. The desirable shift is one in which a faster running speed is achieved at the same lactate concentration. This regular testing can be done in the laboratory, with the athlete running on a treadmill or on a track, in which running speed can be carefully controlled, such as by means of pace lights.

Training Heart Rate

In recent years the concept of using heart rate while training as an indicator of the correct training intensity, has gained in popularity. Specifically, various heart rate “training zones” have been suggested, and ways to calculate these proposed. This approach has been described in many articles written for coaches and runners [27-29] and does have potential for being a precise way to regulate running intensity in training, particularly for novice runners. However, at present there are no scientific data to support an ideal specific heart rate for different types of training, and much of what is written is based on anecdotal experiences. There is no doubt that future studies will refine this area, making the prescription of training heart rate a more exact science.

Probably the greatest value in heart rate in training is for the coach to use it as a way of ensuring that an athlete does not train too hard on those days when nothing more than an easy training session is prescribed. The use of heart rate for more absolute prescription has the risk of the athlete training at the wrong intensity as a result of the large daily variability in heart rate due to influence of diurnal variation, temperature differences, sleep patterns, and stress [30]. All these can result in the prescribed training heart rate being either too high or too low on a given day. Thus the athlete may train too easily on one day, but on another day when more recovery is needed from a prior hard training session, the training intensity may be too high. The coach is probably better able to assess the most suitable intensity for the athlete. Nevertheless, training intensity based on heart rate may have some value [28].

The use of heart rate as a monitoring tool during training, as opposed to being used to dictate training intensity is a useful aid that coaches can use to assess the training response of an athlete. A progressive decline (over weeks) in heart rate for a given training session would indicate appropriate adaptive response by the athlete; a progressive increase in normal training heart rate would indicate a failure in the adaptive process and that the training load should be adjusted. Similarly, an abnormally high heart rate for a given training session may indicate approaching illness or failure to adapt to the training load and impending overtraining. The athlete would then be well-advised to train only lightly, or to rest [30].

Post-Run Stiffness

In the section on lactic acid, it was stated that the stiffness and muscle pain felt after a marathon or hard workout is not caused by lactic acid. While this was believed to be the case some decades ago, it is now known that lactic acid is not the cause of muscle stiffness, but is the result of damage to the muscle cells, connective tissue and contractile proteins [31-33].

Although the precise cause of delayed onset muscle soreness remains unknown, all runners and coaches are aware that the degree of pain depends on the intensity, duration and type of workout. For example, there is more muscle pain after a long or hard downhill run than after running over flat terrain (i.e. if eccentric muscle actions are emphasised [34]). In fact, it is this phenomenon that begins to exclude a build-up of lactic acid as a cause of the pain. In downhill running, the concentration of lactate in the blood and muscle will be low compared to running at the same speed on the flat. Thus, the most painful post-race stiffness can occur when the lactate concentration is lowest.

If a blood sample is taken from a runner the day after a marathon, especially an ultra- marathon, the concentration of an enzyme, creatine kinase, will be high [35-37]. This is an indication that muscle damage has occurred, as this particular enzyme “leaks” from damaged muscle. The “damage” referred to is minute tears or ruptures of the muscle fibres [38; 39]. This trauma to the muscle can be visualised if a sample of the muscle is examined microscopically. However, it is not just the muscle that is damaged. By measuring the amino acid hydroxyproline, it is possible to show that the connective tissue in and around the muscles is also disrupted [40]. What this shows is that stiffness results from muscle damage and breakdown of connective tissue.

Running fast or running downhill places greater strain on the muscle fibres and connective tissue compared with running on the flat. Downhill running is particularly damaging because of the greater eccentric muscle actions that occur. It is this simultaneous contracting of the muscle while being forced biomechanically to lengthen that is most damaging to muscle fibres.

What does this mean for the runner and coach? From a training and racing point of view, after the muscles have recovered from the damage that caused the stiffness and the adaptive process is complete, the muscle is more resistant to damage from subsequent exercise for up to six weeks [41]. From a coaching point of view, hard training sessions should be withheld when there is muscle pain, as further damage could result. It would be better to allow the appropriate physiological adaptations to take place before resuming hard training sessions. Weight training to increase the strength of the muscle [1] may be beneficial. It has been suggested that vitamin E may help to reduce muscle soreness, but there is little evidence to support this idea [42]. Vitamin E is thought to act as an antioxidant that may blunt the damaging action of free radicals, which attack the cell membrane of the muscle fibre.

It has also been suggested that stretching the painful muscle or muscles may be beneficial, but this has not consistently been shown to alleviate delayed onset muscle soreness. Neither is there any evidence that massage or ultrasound speed up recovery [43]. Similarly, an easy “loosening up” run “to flush out the lactic acid” is unlikely to speed up recovery, although it is also unlikely to result in further damage.

The real cause of muscle stiffness after a hard run is clearly not due to lactic acid in the muscle. Coaches will be in a better position to manage the return to normal training of their athletes after training or racing that has induced muscle soreness, if they understand the effects of type, intensity, and volume of training on muscle stiffness after exercise.

Dehydration, Heat Exhaustion and Heat Stroke

Historically, the understanding has been that runners collapse (most often at the end of races) due to dehydration. This is popularly thought to be more likely when the environmental temperature is high and dehydration more severe. “Heat exhaustion” has been incorrectly thought to be associated with dehydration, yet there is no evidence to support this [1]. “Heat stroke” is an entirely different condition, associated with an increase in body temperature.

There are a number of critical errors in the traditional thinking on the issue of dehydration. Firstly, and possibly most importantly, rectal temperatures are not abnormally elevated in collapsed runners suffering from “dehydration” [44; 45]. Secondly, there is no published evidence that runners with dehydration/ heat exhaustion will develop heat stroke if left untreated [46; 47]. And thirdly, the question must be asked why these runners nearly always collapse at the finish of the race and not during the race. Thus we must look for another explanation as to why the runners collapse.

The explanation is found in a condition called postural hypotension [44; 47-50]. While running, the high heart rate and rhythmic contraction of the leg muscles maintain blood pressure and aids in the return of blood from the legs. When running ceases, the pump action of the leg muscles stops and the heart rate drops rapidly. This results in pooling of the blood in the veins of the lower limb, which in turn causes blood pressure to decrease. It is the lowered blood pressure that results in collapse. Secondly, there is an increase in peripheral blood flow to regulate body temperature. This is more pronounced in hot conditions, and results in a reduction in the pressure of blood filling the heart [51]. Treatment is therefore very simple: If the runner lies down with the legs elevated, the return of blood from the legs is aided, blood pressure is restored and after a short while the runner will have recovered. Cooling the legs may be beneficial. As a preventive measure, it is a good idea to continue to walk after the finish line has been crossed. A second possibility is to lie down as soon as possible and elevate the legs slightly, with cooling of the legs as an additional option.

Heat exhaustion as a result of dehydration does not, therefore, exist and is not a condition that coaches need to be concerned about. This contrasts with heat stroke, in which the body temperature becomes very high (rectal temperature above 41°C) and is a potentially dangerous condition. Even after the athlete has stopped, either voluntarily or because of collapse, the temperature remains elevated because of physiological and biochemical abnormalities in the muscles. Thus the athlete must be cooled as quickly as possible, using methods such as fans, to bring the body temperature down to below 38 degrees Celsius.

Heat stroke develops as a result of a combination of a number of factors. Particularly, a high environmental temperature (>28°C) is more likely to result in the problem than when conditions are cooler. If the humidity is also high, there is an additional heat load on the runner because the sweating mechanism of the body is rendered ineffective. Sweat running off the body, as it does when the humidity is high, does not result in cooling. To cool the surface temperature of the skin, the sweat must evaporate. In addition, and also very importantly, the metabolic heat produced by the runner must be high. Thus, it is the faster athletes who are at risk, who are exercising at a high intensity. It is also, therefore, in races shorter than the marathon in which there is a high likelihood of heat stroke because of the much higher running intensity in shorter races such as cross country (on a hot day) or a 10 km race [46; 47; 52]. Thirdly, it appears that some runners are more susceptible to the development of heat stroke than others [53].

Contrary to popular belief, dehydration is not a major cause of the development of heat stroke. Although adequate fluid replacement during racing in the heat may reduce the risk of heat injury, it is not the only factor and may not even be the most important factor [46; 47; 54; 55]. Arunner can develop heat stroke without being dehydrated. Conversely, a runner can be dehydrated, but not develop heat stroke. If the recommended guidelines for fluid ingestion are followed (~600 ml/ hour), it is very unlikely that fluid deficit will play a role in the development of heat stroke.

Fluid Intake During Exercise

During events such as marathon running, one often reads recommendations suggesting that more than 1L of fluid should be ingested every hour. Ingestion of such a high volume is unnecessary, however, and probably impossible for faster runners to adhere to.

The rate at which fluid ingested during exercise empties from the stomach before being absorbed in the small intestine is influenced by a number of factors. These include the temperature of the fluid, the volume of fluid ingested, and the concentration of any carbohydrate such as glucose, fructose, sucrose or glucose polymer in the water. Thus it is important that athletes follow the correct regimen to ensure optimal fluid and carbohydrate replacement. This consists of ingesting 500-600 ml per hour of a fluid containing 7-10% carbohydrate [56]. This serves two purposes. It supplies a source of carbohydrate to maintain blood glucose concentration, as well as all the fluid replacement that is necessary during prolonged exercise, except possibly under extreme environmental conditions.

Ingestion of too much water during prolonged exercise is not only unnecessary, but can be harmful. In some susceptible people, ingesting large volumes of water can result in a condition called “water intoxication” or hyponatraemia. This occurs when the body’s normal sodium concentration becomes significantly diluted, because the amount of water or sports drink ingested is far in excess of what is needed during exercise to maintain hydration [46; 54; 57; 58]. As with heat stroke, in extreme cases this condition can be life threatening, in this case due to cerebral oedema.

Conclusions

VO2 max testing can be of some limited use to a coach when constructing a training programme for someone who has not run any races. If done regularly, the test can provide information about the efficacy of a training programme. However, the peak speed attained in the test is probably the best indicator of current ability, but race times are the most useful measure on which to prescribe running speed in training schedules.

Rather than cause fatigue, the process of lactate production helps to delay fatigue. In addition, it is important as a fuel substrate. The real value in determining a ‘lactate curve’ is to monitor how it shifts with training, the desirable shift being one in which a faster running speed is achieved at the same lactate concentration.

Heart rate during training is a useful monitoring tool, but should not be used to dictate training intensity. Rather, training heart rate information, together with knowledge of current race speeds and training-induced fatigue, should be used by the coach to determine training intensity. Ultimately, the influence of various parameters that effect heart rate response will be well researched and the coach will then be able to prescribe a specific heart rate for different types of training.

Muscle stiffness after a hard run is not due to lactic acid in the muscle. Return to normal training should be prescribed based on the knowledge that soreness is due to muscle damage.

Dehydration is not a major cause of the development of heat stroke. Heat stroke can occur without dehydration, and conversely, dehydration can occur without heat stroke. If the recommended guidelines for fluid ingestion are followed, it is very unlikely that fluid deficit will play a role in the development of heat stroke.

Ingestion of too much water during prolonged exercise is not only unnecessary, but can be harmful. In some susceptible people, ingesting large volumes of water can result in a condition called “water intoxication” or hyponatraemia.

Despite the exponential increase in knowledge in exercise physiology in the last two decades, the process of exercise physiologists and coaches changing old ideas and concepts and accepting new ones has been slow. Both should examine the new information available and use it to proceed with the next series of research studies and coaching concepts, respectively.

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