The V˙O2max Legacy of Hill and Lupton (1923)—100 Years On

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

doi:10.1123/ijspp.2023-0229

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The $\dot{V} O_{2} max$ Legacy of Hill and Lupton (1923)—100 Years On

in International Journal of Sports Physiology and Performance

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Grégoire P. Millet

Grégoire P. Millet Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland

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Johannes Burtscher

Johannes Burtscher Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland

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Nicolas Bourdillon

Nicolas Bourdillon Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland

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Giorgio Manferdelli

Giorgio Manferdelli Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland

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Martin Burtscher

Martin Burtscher Department of Sport Science, University of Innsbruck, Innsbruck, Austria

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Øyvind Sandbakk

Øyvind Sandbakk Department of Neuromedicine and Movement Science, Center for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway

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DOI:: https://doi.org/10.1123/ijspp.2023-0229

Keywords:: clinical applications; convection; diffusion; endurance performance; healthy aging; maximal oxygen consumption

First Published Online:: 28 Sep 2023

In Print:: Volume 18: Issue 11

Page Range:: 1362–1365

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Purpose: One hundred years ago, Hill and Lupton introduced the concept of maximal oxygen uptake ( $\dot{V} O_{2} max$ ), which is regarded as “the principal progenitor of sports physiology.” We provide a succinct overview of the evolvement of research on $\dot{V} O_{2} max$ , from Hill and Lupton‘s initial findings to current debates on limiting factors for $\dot{V} O_{2} max$ and the associated role of convective and diffusive components. Furthermore, we update the current use of $\dot{V} O_{2} max$ in elite endurance sport and clinical settings. Practical Applications and Conclusions: $\dot{V} O_{2} max$ 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 $\dot{V} O_{2} max$ , have improved dramatically. Presently, possibilities of accurate and noninvasive determination of the convective versus diffusive components of $\dot{V} O_{2} max$ by wearable sensors represent an important future application. $\dot{V} O_{2} max$ 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.

One hundred years ago, in 1923, Hill and Lupton¹ recognized “the observations. of maximum oxygen uptake in man” with a “plateau ... as an apparent steady state” and introduced the concept of maximal oxygen uptake ( $\dot{V} O_{2} max$ ) that has become a key factor in exercise physiology.² In the present commentary, we provide an overview of the evolvement of research on $\dot{V} O_{2} max$ , from the initial findings of Hill and Lupton to current debates on limiting factors for $\dot{V} O_{2} max$ and the associated role of convective and diffusive components. Furthermore, we update the current use of $\dot{V} O_{2} max$ in elite endurance sport and clinical settings.

Making History

Even as a centenarian, $\dot{V} O_{2} max$ remains in the spotlight. In 2021 and 2022 in PubMed, 74 and 69 articles, respectively, had either “ $\dot{V} O_{2} max$ ,” “maximal oxygen consumption,” or “maximal oxygen uptake” in the title.

In his original papers, Hill pointed out that a plateau in oxygen uptake ( $\dot{V} O_{2}$ ) occurs not because the runner “didn’t need oxygen but because he couldn’t get it.” Later, the protocol characteristics have been extensively investigated, and the current ACSM guidelines for testing $\dot{V} O_{2} max$ ³ are as follows: (1) protocol: incremental cardiopulmonary exercise, total exercise duration 6 to 12 minutes, and stage duration >3 minutes; and (2) exhaustion criteria: plateau in $\dot{V} O_{2}$ as $\dot{V} O_{2}$ increase <150 mL·min⁻¹, failure of heart rate to increase with increases in workload, lactate concentration >8.0 mmol·L⁻¹, rating of perceived exertion >17 on the 6 to 20 Borg scale, and a peak respiratory exchange ratio ≥1.10. Most of these criteria, such as the plateau at $\dot{V} O_{2} max$ , the total test duration and stage duration, and the need of an additional test to confirm $\dot{V} O_{2} max$ ,^4,5 have been highly debated.

The original recommendations regarding exercise prescription (ie, based on $% \dot{V} O_{2} \max$ ) have been replaced by intensities determined within intensity domains (ie, moderate, heavy, severe) delineated by ventilatory or lactic thresholds⁶ or determined by $\dot{V} O_{2}$ kinetics.⁷ The applied translation to the field was facilitated by the concepts of velocity associated with $\dot{V} O_{2} max$ and time to exhaustion at $\dot{V} O_{2} max$ .⁸

Since the 1960s, a large body of research has focused on developing and validating various training methods for improving $\dot{V} O_{2} max$ , leading to several—sometimes antagonistic; for example, “polarized” versus “pyramidal” training intensity distribution^9,10—proposals.

Focus on Convective Versus Diffusive Components

Even before Hill defined

\dot{V} O_{2} max

, oxygen (O₂) transport through the body has been modeled using the Fick principle:

{\dot{V} O}_{2} = \dot{Q} \times ({CaO}_{2} - C \bar{v} O_{2}),

with

\dot{Q}

indicating cardiac output, CaO₂ arterial O₂ content, and

C \bar{v} O_{2}

mixed venous O₂ content. Between 1923 and 1985, it was accepted that changes in

\dot{V} O_{2} max

were exclusively due to changes in convective O₂ transport by the blood, de facto considering an infinite muscle O₂ diffusion capacity (DM). Based on the data from Operation Everest II,¹¹ Wagner¹² combined the Fick principle with the Fick law of diffusion:

{\dot{V} O}_{2} = DM \times (P \bar{cap} O_{2} - {PmitO}_{2}),

with

P \bar{cap} O_{2}

indicating the mean O₂ pressure in the capillaries and the approximation PmitO₂ = 0. Wagner’s¹² model demonstrated a finite DM, which explained why the working muscles could not consume all the O₂ from the blood at

\dot{V} O_{2} max

. This model allowed to estimate that improvement in leg

\dot{V} O_{2} max

in response to training was associated with a 19% increase in leg blood flow and a 34% increase in DM in sedentary humans.¹¹ Accordingly, in 2003, di Prampero¹³ represented the O₂ transport system as a cascade of resistances and demonstrated that the importance of the “peripheral factors” (including DM) limiting

\dot{V} O_{2} max

was different between large or small exercising muscle masses or between normoxia and hypoxia.

Other models have been developed to specifically estimate O₂ diffusion within the muscle.¹⁴ These include August Krogh’s cylinder model (Nobel Prize in medicine, 1920), where the muscle capillaries are regarded closed at rest but opened during exercise, thereby supporting O₂ supply and increasing DM.¹⁵ This model was substituted by Hill’s Solid Cylinder Model in 1983,¹⁶ where the O₂ path is not limited to the space immediately around the capillary but to a muscle cell benefitting from all the capillaries around it, thereby having a far lower O₂ diffusion resistance.

A deeper understanding of the integrative mechanisms of convection and diffusion is fundamental to develop novel training interventions and/or to characterize the site of functional limitation to maximal endurance exercise capacity in elite, healthy, and diseased populations. However, due to the invasive nature of the current approaches (ie, arterial and venous catheters), only few studies were able to directly determine convective and diffusive O₂ mechanisms in humans at peak exercise intensity. The classic view from Hill and colleagues, which was further extended by later studies using blood transfusion,¹⁷ emphasizes the critical role of convective, rather than diffusive, O₂ transport to working skeletal muscle in limiting $\dot{V} O_{2} max$ . Indeed, the extremely high $\dot{V} O_{2} max$ measured in elite endurance athletes is primarily determined by a large and compliant heart, able to quickly accommodate a large amount of blood and, taking advantage of the Frank–Starling mechanism, can generate a large stroke volume.¹⁸ However, while convective O₂ mechanisms are clearly the primary limitation at $\dot{V} O_{2} max$ in elite endurance athletes¹⁸ and likely the main factor in individuals with cardiovascular diseases,¹⁹ diffusive O₂ mechanisms may also be important in exercise intolerance in several disease states, including muscle or pulmonary dysfunctions.²⁰ Therefore, the investigation of mechanisms maximizing (in elite endurance athletes) or impairing (in disease populations) exercise capacity remains crucial. For such purpose, it is possible to calculate convective versus diffusive components as well as the $\dot{V} O_{2} max$ value without gas exchanges by measuring $\dot{Q}$ by acetylene rebreathing or transthoracic impedance, arterial pressure in O₂ (P_aO₂), and hemoglobin concentration ([Hb]) by arterialized capillary blood microsamples and assuming that the muscle tissue saturating index measured by near-infrared spectroscopy is a reliable surrogate of muscle venous PO₂ (PvO₂).²¹ This approach enables the design of training protocols aiming at improving the site of functional limitation of $\dot{V} O_{2} max$ , thus exercise capacity.

$\dot{V} O_{2} max$ in Elite Endurance Athletes: An Update

The best endurance athletes have exceptionally high $\dot{V} O_{2} max$ values. However, the body sizes and compositions of athletes must also match the specific constraints of their disciplines, and different biomechanical constraints contribute to explain why different scaling components of body mass are used when expressing $\dot{V} O_{2} max$ in different sports.²² This means that athletes in some sports have high absolute $\dot{V} O_{2} max$ values, while other sports require high body mass–normalized (relative) values. The sex difference in $\dot{V} O_{2} max$ appears to be 40% to 50% (absolute) and 15% to 20% (relative) in equally trained men and women²³ and is explained by a lower body mass, a higher percentage of body fat, and lower [Hb] in women.

Male heavyweight rowers, who are typically large and heavy, exhibit some of the highest $\dot{V} O_{2} max$ values in absolute units, often exceeding 7 L·min⁻¹, although their values expressed relative to body mass might be more modest. In women, the highest absolute $\dot{V} O_{2} max$ values observed are slightly below 5.0 L·min⁻¹ in cross-country skiers and rowers.²³ In cross-country skiing, high relative $\dot{V} O_{2} max$ (>85 and >70 mL·kg⁻¹·min⁻¹ in male and female athletes, respectively) have been shown in world-leading athletes over many decades.²³ Here, the highest relative values reported so far are 96 mL·kg⁻¹·min⁻¹ in men²⁴ and 80 mL·kg⁻¹·min⁻¹ in women.²² However, while extensive data on $\dot{V} O_{2} max$ values in the world’s best male endurance athletes exist, corresponding data for women remain sparse, despite early reports in the 1960s.²⁵ From examinations of other animals with markedly higher $\dot{V} O_{2} max$ than the best trained humans,²⁶ we know that functional capacities at each step in the O₂ transport and utilization systems are matched to each other, and an upregulation of functional capacities seems to occur at virtually all steps.²⁷

If values exceeding 8 L·min⁻¹ or 100 mL·kg⁻¹·min⁻¹ in men or above 5 L·min⁻¹ or 85 mL·kg⁻¹·min⁻¹ in women are possible, is not known. Haugen et al²² used the Fick principle to estimate the requirements for this. In a large male endurance athlete with a body mass of 100 kg, achieving 8 L·min⁻¹ would require a heart rate of 200 beats·min⁻¹, an arteriovenous O₂ difference of 200 mL O₂·dL⁻¹, and a stroke volume of 200 mL·beat⁻¹, necessitating a [Hb] of 17 g·dL⁻¹. In women, a $\dot{V} O_{2} max$ of >5.0 L·min⁻¹ would require a maximal heart rate of 200 beats·min⁻¹, combined with a maximal stroke volume of 150 mL·beat⁻¹ and an arteriovenous O₂ difference of 170 mL O₂·dL⁻¹, assuming a [Hb] of 15 g·dL⁻¹.²²

In addition to high $\dot{V} O_{2} max$ values, many sports require high peak $\dot{V} O_{2}$ using the specific locomotion employed in competitions. Normally, this figure is markedly lower during modes of exercise, where the muscle mass involvement is constrained. For instance, kayakers demonstrate the highest peak $\dot{V} O_{2}$ values in upper-body exercise, exceeding 85% of their $\dot{V} O_{2} max$ .²⁸

From Elite Sports to Clinical Applications

The cardiorespiratory system orchestrates O₂ transport from ambient air to working skeletal muscles. Consequently, impairment of any component of this system can reduce $\dot{V} O_{2} max$ and aerobic exercise performance. While in patients suffering from heart disease (eg, heart failure) the pumping function of the heart may represent the major limiting factor, ventilatory function is likely limiting in respiratory diseases (eg, chronic pulmonary obstructive disease).²⁹ These diseases initiate a circulus vitiosus as impaired cardiorespiratory function deteriorates skeletal muscle performance and locomotion, further worsening cardiorespiratory parameters and $\dot{V} O_{2} max$ . $\dot{V} O_{2} max$ in heart failure patients can be lower than 14 mL·kg⁻¹·min⁻¹, but will improve after exercise training, contributing to improved survival rates and a better quality of life.²² Especially, individuals suffering from chronic diseases with very low cardiorespiratory fitness in combination with normal body mass index (compared with high body mass index—the “obesity paradox”) have a poor prognosis.^30,31 $\dot{V} O_{2} max$ in heart failure patients can be lower than 20 mL·kg⁻¹·min⁻¹, but will improve after exercise training, contributing to a better quality of life.³² Such low $\dot{V} O_{2} max$ values are also characteristic for patients with chronic pulmonary obstructive disease and were found to be negatively correlated with mortality.³³ Diminished load on the skeletal muscles, as a consequence of cardiorespiratory diseases and/or aging, provokes reductions of muscle capillarization, mitochondrial density, and functioning³⁴ since large amounts of O₂ delivery to muscles are no longer required to satisfy energy demands of working muscles. This promotes the circulus vitiosus. Similarly, immobility and training cessation due to injury or illness, peripheral vascular disease, musculoskeletal diseases, and/or mitochondrial myopathies affect $\dot{V} O_{2} max$ at the muscular level, retroacting (due to lack of sufficient stimuli) on the cardiorespiratory system.²⁹

These interactions emphasize the importance of appropriate exercise (training) interventions to maintain or improve skeletal muscle performance and cardiorespiratory function. Although the effects of exercise vary considerably depending on the type and severity of disease, comorbidities, and life-style factors, appropriate interventions improve $\dot{V} O_{2} max$ , exercise tolerance, quality of life, and life expectancy. Thus, it is not surprising that high $\dot{V} O_{2} max$ values, largely relying on the capacity of the cardiorespiratory system, determine health and well-being and are associated (independently of age, sex, ethnicity, and comorbidities) with reduced mortality risk and longevity.³⁵ One promising perspective may consist in establishing a range of values for healthy aging, calculated from the known highest $\dot{V} O_{2} max$ values at the different ages ( $\dot{V} O_{2} maxra$ – record age).³⁴ In young adults, the 30% (lower limit) to 50% (recommended value) $\dot{V} O_{2} maxra$ ^22,24 range would be 29 to 48 and 24 to 40 for males and females, respectively. Using the same method, the recommended range would be 20 to 33 for males aged 60 years ( $\dot{V} O_{2} maxra = 65$ ) and 13 to 21 for females aged 80 years ( $\dot{V} O_{2} maxra = 42$ ).³⁴

Practical Applications and Conclusions

$\dot{V} O_{2} max$ is a healthy and active centenarian who remains a very important measure in elite endurance sports and, additionally, contributes as an important biomarker for 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 $\dot{V} O_{2} max$ , have improved dramatically. Presently, possibilities of accurate and noninvasive determination of the convective versus diffusive components of $\dot{V} O_{2} max$ by wearable sensors represent an important future application. Such tools would allow regular monitoring in athletes as well as improved diagnosis of cardiovascular dysfunction in patients.

$\dot{V} O_{2} max$ is not only an indicator of cardiorespiratory function, fitness, and endurance performance, but it can also be readily modulated by physical activity levels and exercise.³⁵ As a consequence, similarly to other analyses of pulmonary gas exchange (eg, ventilatory threshold³⁶), $\dot{V} O_{2} max$ assessment is no longer restricted to sport performance evaluations but represents an important biomarker of cardiovascular function and health to be included in routine assessment in clinical practice. Similarly, $\dot{V} O_{2} max$ thus represents an exquisite example for a mainstay tool initially developed for elite sport research that has subsequently shown a massive clinical potential.³⁷

Acknowledgments

Sandbakk is the Editor of the International Journal of Sports Physiology and Performance, and Millet is a member of the journal’s editorial board. The possibility of publication bias was discussed critically among editors, and it was ensured that none of the authors, including those with editorial roles, had the opportunity to influence the independent review process.

References

1.↑
Hill AV, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. Q J Med. 1923;16:135–171. doi:10.1093/qjmed/os-16.62.135
- Search Google Scholar
- Export Citation
2.↑
Hale T. History of developments in sport and exercise physiology: A. V. Hill, maximal oxygen uptake, and oxygen debt. J Sports Sci. 2008;26(4):365–400. doi:10.1080/02640410701701016
- Search Google Scholar
- Export Citation
3.↑
Liguori G. ACSM’s Guidelines for Exercise Testing and Prescription. 11th ed. Wolters Kluwer; 2021.
- Search Google Scholar
- Export Citation
4.↑
Poole DC, Jones AM. Measurement of the maximum oxygen uptake VO2max: VO2peak is no longer acceptable. J Appl Physiol. 2017;122(4):997–1002. doi:10.1152/japplphysiol.01063.2016
- Search Google Scholar
- Export Citation
5.↑
Howley ET, Bassett DR Jr, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc. 1995;27(9):1292–1301. PubMed ID: 8531628
- Search Google Scholar
- Export Citation
6.↑
Bosquet L, Leger L, Legros P. Methods to determine aerobic endurance. Sports Med. 2002;32(11):675–700. doi:10.2165/00007256-200232110-00002
- Search Google Scholar
- Export Citation
7.↑
Poole DC, Jones AM. Oxygen uptake kinetics. Compr Physiol. 2012;2(2):933–996. doi:10.1002/cphy.c100072
- Search Google Scholar
- Export Citation
8.↑
Billat LV, Koralsztein JP. Significance of the velocity at VO2max and time to exhaustion at this velocity. Sports Med. 1996;22(2):90–108. doi:10.2165/00007256-199622020-00004
- Search Google Scholar
- Export Citation
9.↑
Burnley M, Bearden SE, Jones AM. Polarized training is not optimal for endurance athletes. Med Sci Sports Exerc. 2022;54(6):1032–1034. doi:10.1249/MSS.0000000000002869
- Search Google Scholar
- Export Citation
10.↑
Foster C, Casado A, Esteve-Lanao J, Haugen T, Seiler S. Polarized training is optimal for endurance athletes. Med Sci Sports Exerc. 2022;54(6):1028–1031. doi:10.1249/MSS.0000000000002869
- Search Google Scholar
- Export Citation
11.↑
Roca J, Agusti AG, Alonso A, et al. Effects of training on muscle O2 transport at VO2max. J Appl Physiol. 1992;73(3):1067–1076. doi:10.1152/jappl.1992.73.3.1067
- Search Google Scholar
- Export Citation
12.↑
Wagner PD. Determinants of maximal oxygen consumption. J Muscle Res Cell Motil. 2023;44:73–88. doi:10.1007/s10974-022-09636-y
- Search Google Scholar
- Export Citation
13.↑
di Prampero PE. Factors limiting maximal performance in humans. Eur J Appl Physiol. 2003;90(3–4):420–429. doi:10.1007/s00421-003-0926-z
- Search Google Scholar
- Export Citation
14.↑
Poole DC, Musch TI. Capillary-mitochondrial oxygen transport in muscle: paradigm shifts. Function. 2023;4(3):zqad013. doi:10.1093/function/zqad013
- Search Google Scholar
- Export Citation
15.↑
Krogh A. The supply of oxygen to the tissues and the regulation of the capillary circulation. J Physiol. 1919;52(6):457–474. doi:10.1113/jphysiol.1919.sp001844
- Search Google Scholar
- Export Citation
16.↑
Ellis CG, Potter RF, Groom AC. The Krogh cylinder geometry is not appropriate for modelling O2 transport in contracted skeletal muscle. Adv Exp Med Biol. 1983;159:253–268. doi:10.1007/978-1-4684-7790-0_23
- Search Google Scholar
- Export Citation
17.↑
Ekblom B, Wilson G, Astrand PO. Central circulation during exercise after venesection and reinfusion of red blood cells. J Appl Physiol. 1976;40(3):379–383. doi:10.1152/jappl.1976.40.3.379
- Search Google Scholar
- Export Citation
18.↑
Levine BD. VO2max: what do we know, and what do we still need to know? J Physiol. 2008;586(1):25–34. doi:10.1113/jphysiol.2007.147629
- Search Google Scholar
- Export Citation
19.↑
Esposito F, Reese V, Shabetai R, Wagner PD, Richardson RS. Isolated quadriceps training increases maximal exercise capacity in chronic heart failure: the role of skeletal muscle convective and diffusive oxygen transport. J Am Coll Cardiol. 2011;58(13):1353–1362. doi:10.1016/j.jacc.2011.06.025
- Search Google Scholar
- Export Citation
20.↑
Grassi B, Porcelli S, Marzorati M. Translational medicine: exercise physiology applied to metabolic myopathies. Med Sci Sports Exerc. 2019;51(11):2183–2192. doi:10.1249/MSS.0000000000002056
- Search Google Scholar
- Export Citation
21.↑
Manferdelli G, Barstow TJ, Millet GP. NIRS-based muscle oxygenation is suitable for computation of the convective and diffusive components of O2 transport at V ˙ O 2 max. Med Sci Sports Exerc. Published online June 19, 2023. doi:10.1249/MSS.0000000000003238
- Search Google Scholar
- Export Citation
22.↑
Haugen T, Paulsen G, Seiler S, Sandbakk O. New records in human power. Int J Sports Physiol Perform. 2018;13(6):678–686. doi:10.1123/ijspp.2017-0441
- Search Google Scholar
- Export Citation
23.↑
Sandbakk O, Solli GS, Holmberg HC. Sex differences in world-record performance: the influence of sport discipline and competition duration. Int J Sports Physiol Perform. 2018;13:2–8. doi:10.1123/ijspp.2017-0196
- Search Google Scholar
- Export Citation
24.↑
Ronnestad BR, Hansen J, Stenslokken L, Joyner MJ, Lundby C. Case Studies in Physiology: temporal changes in determinants of aerobic performance in individual going from alpine skier to world junior champion time trial cyclist. J Appl Physiol. 2019;127(2):306–311. doi:10.1152/japplphysiol.00798.2018
- Search Google Scholar
- Export Citation
25.↑
Saltin B, Astrand PO. Maximal oxygen uptake in athletes. J Appl Physiol. 1967;23(3):353–358.
- Search Google Scholar
- Export Citation
26.↑
Suarez RK. Oxygen and the upper limits to animal design and performance. J Exp Biol. 1998;201(pt 8):1065–1072. doi:10.1242/jeb.201.8.1065
- Search Google Scholar
- Export Citation
27.↑
Weibel ER, Hoppeler H. Exercise-induced maximal metabolic rate scales with muscle aerobic capacity. J Exp Biol. 2005;208(pt 9):1635–1644. doi:10.1242/jeb.01548
- Search Google Scholar
- Export Citation
28.↑
Michael JS, Smith R, Rooney KB. Determinants of kayak paddling performance. Sports Biomech. 2009;8(2):167–179. doi:10.1080/14763140902745019
- Search Google Scholar
- Export Citation
29.↑
Burtscher M. Exercise limitations by the oxygen delivery and utilization systems in aging and disease: coordinated adaptation and deadaptation of the lung-heart muscle axis—a mini-review. Gerontology. 2013;59(4):289–296. doi:10.1159/000343990
- Search Google Scholar
- Export Citation
30.↑
Lavie CJ, Cahalin LP, Chase P, et al. Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure. Mayo Clin Proc. 2013;88(3):251–258. doi:10.1016/j.mayocp.2012.11.020
- Search Google Scholar
- Export Citation
31.↑
Myers J, McAuley P, Lavie CJ, Despres JP, Arena R, Kokkinos P. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis. 2015;57(4):306–314. doi:10.1016/j.pcad.2014.09.011
- Search Google Scholar
- Export Citation
32.↑
Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev. 2019;24(4):535–547. doi:10.1007/s10741-019-09774-5
- Search Google Scholar
- Export Citation
33.↑
Ewert R, Obst A, Muhle A, et al. Value of cardiopulmonary exercise testing in the prognosis assessment of chronic obstructive pulmonary disease patients: a retrospective, multicentre cohort study. Respiration. 2022;101(4):353–366. doi:10.1159/000519750
- Search Google Scholar
- Export Citation
34.↑
Valenzuela PL, Maffiuletti NA, Joyner MJ, Lucia A, Lepers R. Lifelong endurance exercise as a countermeasure against age-related VO2max decline: physiological overview and insights from masters athletes. Sports Med. 2020;50(4):703–716. doi:10.1007/s40279-019-01252-0
- Search Google Scholar
- Export Citation
35.↑
Burtscher J, Strasser B, Burtscher M, Millet GP. The impact of training on the loss of cardiorespiratory fitness in aging masters endurance athletes. Int J Environ Res Public Health. 2022;19(17):50. doi:10.3390/ijerph191711050
- Search Google Scholar
- Export Citation
36.↑
Wasserman DH, Whipp BJ. Coupling of ventilation to pulmonary gas exchange during nonsteady- state work in men. J Appl Physiol. 1983;54(2):587–593. doi:10.1152/jappl.1983.54.2.587
- Search Google Scholar
- Export Citation
37.↑
Millet GP, Chamari K. Look to the stars—Is there anything that public health and rehabilitation can learn from elite sports? Front Sports Act Living. 2022;4:1072154. doi:10.3389/fspor.2022.1072154
- Search Google Scholar
- Export Citation

J. Burtscher https://orcid.org/0000-0002-2889-0151

Bourdillon https://orcid.org/0000-0001-6791-2002

Manferdelli https://orcid.org/0000-0001-9529-4977

M. Burtscher https://orcid.org/0000-0002-5232-3632

Sandbakk https://orcid.org/0000-0002-9014-5152

^*Millet (gregoire.millet@unil.ch) is corresponding author, https://orcid.org/0000-0001-8081-4423

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International Journal of Sports Physiology and Performance

Making History
Focus on Convective Versus Diffusive Components
V˙O2max in Elite Endurance Athletes: An Update
From Elite Sports to Clinical Applications
Practical Applications and Conclusions
Acknowledgments
References

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The V˙O2max Legacy of Hill and Lupton (1923)—100 Years On

Making History

Focus on Convective Versus Diffusive Components

V˙O2max in Elite Endurance Athletes: An Update

From Elite Sports to Clinical Applications

Practical Applications and Conclusions

Acknowledgments

References

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International Journal of Sports Physiology and Performance

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The $\dot{V} O_{2} max$ Legacy of Hill and Lupton (1923)—100 Years On

$\dot{V} O_{2} max$ in Elite Endurance Athletes: An Update