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Brendan R. Scott, Olivier Girard, Nicholas Rolnick, James R. McKee, and Paul S.R. Goods

Background: Exercise with blood-flow restriction (BFR) is being increasingly used by practitioners working with athletic and clinical populations alike. Most early research combined BFR with low-load resistance training and consistently reported increased muscle size and strength without requiring the heavier loads that are traditionally used for unrestricted resistance training. However, this field has evolved with several different active and passive BFR methods emerging in recent research. Purpose: This commentary aims to synthesize the evolving BFR methods for cohorts ranging from healthy athletes to clinical or load-compromised populations. In addition, real-world considerations for practitioners are highlighted, along with areas requiring further research. Conclusions: The BFR literature now incorporates several active and passive methods, reflecting a growing implementation of BFR in sport and allied health fields. In addition to low-load resistance training, BFR is being combined with high-load resistance exercise, aerobic and anaerobic energy systems training of varying intensities, and sport-specific activities. BFR is also being applied passively in the absence of physical activity during periods of muscle disuse or rehabilitation or prior to exercise as a preconditioning or performance-enhancement technique. These various methods have been reported to improve muscular development; cardiorespiratory fitness; functional capacities; tendon, bone, and vascular adaptations; and physical and sport-specific performance and to reduce pain sensations. However, in emerging BFR fields, many unanswered questions remain to refine best practice.

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Grégoire P. Millet, Johannes Burtscher, Nicolas Bourdillon, Giorgio Manferdelli, Martin Burtscher, and Øyvind Sandbakk

Purpose: One hundred years ago, Hill and Lupton introduced the concept of maximal oxygen uptake ( V ˙ O 2 max ), which is regarded as “the principal progenitor of sports physiology.” We provide a succinct overview of the evolvement of research on V ˙ O 2 max , from Hill and Lupton‘s initial findings to current debates on limiting factors for V ˙ O 2 max and the associated role of convective and diffusive components. Furthermore, we update the current use of V ˙ O 2 max in elite endurance sport and clinical settings. Practical Applications and Conclusions: V ˙ O 2 max is a healthy and active centenarian that remains a very important measure in elite endurance sports and additionally contributes as an important vital sign of cardiovascular function and fitness in clinical settings. Over the past 100 years, guidelines for the test protocols and exhaustion criteria, as well as the understanding of limiting factors for V ˙ O 2 max , have improved dramatically. Presently, possibilities of accurate and noninvasive determination of the convective versus diffusive components of V ˙ O 2 max by wearable sensors represent an important future application. V ˙ O 2 max is not only an indicator of cardiorespiratory function, fitness, and endurance performance but also represents an important biomarker of cardiovascular function and health to be included in routine assessment in clinical practice.

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Thomas Losnegard, Magne Lund-Hansen, Erland Vedeler Stubbe, Even Dahlen Granrud, Harri Luchsinger, Øyvind Sandbakk, and Jan Kocbach

Purpose: In sprint biathlon, a J-shaped pacing pattern is commonly used. We investigated whether biathletes with a fast-start pacing pattern increase time-trial skiing and shooting performance by pacing more evenly. Methods: Thirty-eight highly trained biathletes (∼21 y, 27 men) performed an individual 7.5 (3 × 2.5 km for women) or 10-km (3 × 3.3 km for men) time trial on roller skis with a self-selected pacing strategy (day 1). Prone (after lap 1) and standing shooting (after lap 2) stages were performed using paper targets. Based on their pacing strategy in the first time trial (ratio between the initial ∼800-m segment pace on lap 1 and average ∼800-m segment pace on laps 1–3), participants were divided into an intervention group with the fastest starting pace (INT, n = 20) or a control group with a more conservative starting pace (CON, n = 18). On day 2, INT was instructed to reduce their starting pace, while CON was instructed to maintain their day 1 strategy. Results: INT increased their overall time-trial performance more than CON from day 1 to day 2  (mean ± 95% CI; 1.5% ± 0.7% vs 0.0% ± 0.9%, P = .02). From day 1 to day 2, INT reduced their starting pace (5.0% ± 1.5%, P < .01), with reduced ratings of perceived exertion during lap 1 (P < .05). For CON, no change was found for starting pace (−0.8% ± 1.2%) or ratings of perceived exertion between days. No differences were found for shooting performance for either group. Conclusion: Highly trained biathletes with a pronounced fast-start pattern improve skiing performance without any change in shooting performance by pacing more evenly.

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Domingo Jesús Ramos-Campo, Francisco Javier López-Román, Silvia Pérez-Piñero, Raquel Ortolano, María Salud Abellán-Ruiz, Enrique Molina Pérez de los Cobos, Antonio Jesús Luque-Rubia, Dag Van Elslande, and Vicente Ávila-Gandía

The present randomized study investigated the effect of acute supplementation of 800 mg/kg of ketone monoester ingestion (KE) or placebo (PL) and 210 mg/kg of NaHCO3 co-ingestion on cycling performance of WorldTour cyclists during a road cycling stage simulation. Twenty-eight cyclists participated in the study (27.46 ± 4.32 years; 1.80 ± 0.06 m; 69.74 ± 6.36 kg). Performance, physiological, biochemical, and metabolism outcomes, gut discomfort, and effort perceived were assessed during a road cycling simulation composed of an 8-min time-trial (TT) performance + 30-s TT + 4.5 hr of outdoor cycling + a second 8-min TT + a second 30-s TT. Greater absolute and relative mean power during the first 8-min TT (F = 5.067, p = .033, η p 2 = .163 , F = 5.339, p = .029, η p 2 = .170 , respectively) was observed after KE than after PL (KE: 389 ± 34, PL: 378 ± 44 W, p = .002, d = 0.294 and KE: 5.60 ± 0.42, PL: 5.41 ± 0.44 W/kg, p = .001, d = 0.442). Additionally, greater concentration of β-hydroxybutyrate blood concentration (F = 42.195, p < .001, η p 2 = .619 ) was observed after KE than after PL during the first steps of the stage (e.g., after warm-up KE: 1.223 ± 0.642, PL: 0.044 ± 0.058 mM, p < .001, d = 2.589), although the concentrations returned to near baseline after 4.5 hr of outdoor cycling. Moreover, higher values of anion gap were observed (F = 2.333, p = .026, η p 2 = .080 ) after KE than after PL ingestion, after the warm-up and after the first 8-min and 30-s TT. Additionally, lower concentrations of HCO 3 were reported in the KE condition after warm-up and after the first 8-min and 30-s TT. During the initial phase of the stage simulation, acute supplementation with KE + NaHCO3 co-ingestion enhanced 8-min TT cycling performance (3.1%) in WorldTour cyclists with a concomitant hyperketonaemia.

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Patrick Cormier, Ming-Chang Tsai, Cesar Meylan, Victor H.T. Soares, David C. Clarke, and Marc Klimstra

Purpose: To determine the minimum number of events (training or matches) for producing valid acceleration–speed (AS) profiles from global navigation satellite system (GNSS) data. Methods: Nine elite female soccer players participated in a 4-week training camp consisting of 19 events. AS profile metrics calculated from different combinations of athlete events were compared to force–velocity (FV) profile metrics from 2 × 40-m stand-alone sprint effort trials, using the same GNSS 10-Hz technology. Force–velocity profiles were calculated, from which AS profiles were obtained. AS profiles from training and matches were generated by plotting acceleration and speed points and performing a regression through the maximal points to obtain the AS metrics (theoretical maximal speed, x-intercept [in meters per second], theoretical maximal acceleration, y-intercept [in meters per second squared], and the slope per second). A linear mixed model was performed with the AS metrics as the outcome variables, the number of events as a fixed effect, and the participant identifier as a mixed effect. Dunnett post hoc multiple comparisons were used to compare the means of each number of event grouping (1–19 events) to those estimated from the dedicated sprint test. Results: Theoretical maximal speed and theoretical maximal acceleration means were no longer significantly different from the isolated sprint reference with 9 to 19 (small to trivial differences = −0.31 to −0.04 m·s−1, P = .12–.99) and 6 to 19 (small differences = −0.4 to −0.28 m·s−2, P = .06–.79) events, and the slopes were no longer different with 1 to 19 events (trivial differences = 0.06–0.03 s−1, P = .35–.99). Conclusions: AS profiles can be estimated from a minimum of 9 days of tracking data. Future research should investigate methodology resulting in AS profiles estimated from fewer events.

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Lachlan P. James, Jonathon Weakley, Paul Comfort, and Minh Huynh

Background: Maximal lower-body strength can be assessed both dynamically and isometrically; however, the relationship between the changes in these 2 forms of strength following resistance training is not well understood. Purpose: To systematically review and analyze the effects of resistance training on changes in maximal dynamic (1-repetition-maximum back squat, deadlift, and power clean) and position-matched isometric strength (isometric midthigh pull and the isometric squat). In addition, individual-level data were used to quantify the agreement and relationship between changes in dynamic and isometric strength. Methods : Databases were systematically searched to identify eligible articles, and meta-analysis procedures were performed on the extracted data. The raw results from 4 studies were acquired, enabling bias and absolute reliability measures to be calculated using Bland–Altman test of agreement. Results: Eleven studies met the inclusion criteria, which resulted in 29 isometric–dynamic change comparisons. The overall pooled effect was 0.13 in favor of dynamic testing; however, the prediction interval ranged from g = −0.49 to 0.75. There was no evidence of bias (P = .825) between isometric and dynamic tests; however, the reliability coefficient was estimated to be 16%, and the coefficient of variation (%) was 109.27. Conclusions: As a range of future effects can be expected when comparing isometric to dynamic strength changes following resistance training, and limited proportionality exists between changes in these 2 strength qualities, there is strong evidence that isometric and dynamic strength represent separate neuromuscular domains. These findings can be used to inform strength-assessment models in athlete populations.

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Mary C. Geneau, Ming-Chang Tsai, Dana Agar-Newman, Daniel J. Geneau, Marc Klimstra, and Lachlan P. James

Purpose: Ice hockey is a team invasion sport characterized by repeated high-intensity skating efforts, technical and tactical skill, physical contact, and collisions requiring considerable levels of muscular strength. The purpose of this study was to evaluate the relationships between lower-body vertical force–time metrics and skating qualities in subelite female ice hockey players. Methods: A cross-sectional cohort design was employed utilizing 14 athletes (body mass = 66.7 [1.8] kg; height = 171.6 [6.2] cm; age = 21.1 [1.7] y). The relationships between metrics of lower-body strength collected from a drop jump, squat jump, countermovement jump, loaded countermovement jump, and an isometric squat and 4 skating qualities collected from a linear sprint, repeated sprint test, and a multistage aerobic test were evaluated. Results: The regression models revealed a positive relationship between relative peak force in the isometric squat and skating multistage aerobic test performance (r 2 = .388; P = .017) and a positive relationship between repeated-sprint ability and eccentric mean force during the loaded countermovement jump (r 2 = .595; P = .001). No significant relationships were observed between strength metrics and skating acceleration or maximal velocity. Conclusions: These data suggest that skating ability is most affected by relative isometric strength in female ice hockey players. It is recommended that practitioners focus training on tasks that improve relative force output. It is also recommended that isometric relative peak force be used as a monitoring metric for this cohort.

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Michel Marina, Priscila Torrado, Blai Ferrer-Uris, and Albert Busquets

Purpose: To verify whether training the iron cross (IC) with assistive devices (herdos; HIC) and added external load (LHIC) to equate the moments of force developed on the rings could be considered an intermediate step between the nonoverloaded herdos situation (HIC) and the IC performed on the rings. Methods: Relative levels of surface electromyography (sEMG) activity were normalized with respect to a standing IC before comparing gymnasts who can perform the IC on the rings (achievers) and gymnast who cannot (nonachievers) in the 2 herdos conditions (HIC and LHIC). Seven muscles were chosen for sEMG analysis, namely, pectoralis major (PM), latissimus dorsi, teres major, lower trapezius, serratus anterior, biceps brachii (BB), and triceps brachii. Additionally, 3 indices were calculated to measure levels of coactivation: Elbowidx, Scapulaidx, and Shoulderidx. Results: The bigger magnitude of differences in sEMG activity among situations was found for the PM and BB (F ≥ 30.7; P < .001). When comparing the global and the PM, teres major, BB, and triceps brachii activity across groups, nonachievers activated their musculature to a greater extent than the achievers independently of the herdos situation (P ≤ .046). Achievers’ Elbowidx was the only index that was significantly higher (P ≤ .005) in the IC in comparison to LHIC and HIC. Conclusion: sEMG activity of PM and BB was particularly sensitive between situations, independently of the level of achievement. We recommend training the IC by adding external load in the herdos situation to increase muscle activity to levels closer to the rings situation but avoiding the potential factor of injuries.