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A Combined Analysis of Peak and Submaximal Exercise Parameters in Delineating Underlying Mechanisms of Sex Differences in Healthy Adolescents

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Abstract

Peak exercise parameters are considered the gold standard to quantify cardiac reserve in cardiopulmonary exercise testing (CPET). We studied whether submaximal parameters would add additional values in analyzing sex differences in CPET. We reviewed CPET of age-matched healthy male and female adolescents by cycle ergometer. Besides peak parameters, submaximal CPET parameters, including ventilatory anaerobic threshold (VAT), oxygen uptake efficiency slope (OUES), and submaximal slopes of Δoxygen consumption (ΔVO2)/Δwork rate (ΔWR), Δheart rate (ΔHR)/ΔWR, ΔVO2/ΔHR, and Δminute ventilation (ΔVE)/ΔCO2 production (ΔVCO2), were obtained. We studied 35 male and 40 female healthy adolescents. Peak VO2 (pVO2), peak oxygen pulse (pOP), and VAT were significantly lower in females than males (1.9 ± 0.4 vs. 2.5 ± 0.6 L/min; 10 ± 2.0 vs. 13.2 ± 3.5 ml/beat; 1.23 ± 0.3 vs. 1.52 ± 0.5 L/min, respectively, all p < 0.005). Females showed significantly lower pVO2, VAT, and OUES with the same body weight than males, implying higher skeletal muscle mass in males. When simultaneously examining ΔHR/ΔWR and pOP, females showed higher dependency on increases in HR than in stroke volume. Females demonstrated significantly lower pOP with the same levels of ΔVO2/ΔHR, suggesting more limited exercise persistence than males under an anaerobic condition at peak exercise. Oxygen uptake efficiency in relation to peak VE was significantly higher in males. There was no sex difference in either ΔVO2/ΔWR or ΔVE/ΔVCO2. Combinational assessment of peak and submaximal CPET parameters delineates the multiple mechanisms that contribute to the sex differences in exercise performance.

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Abbreviations

BMI:

Body mass index

CPET:

Cardiopulmonary exercise testing

OP:

Oxygen pulse

OUES:

Oxygen uptake efficiency slope

RAMP:

Raise, activate, mobilize, potentiate/performance

VO2:

Oxygen consumption

VCO2:

Carbon dioxide production

VAT:

Ventilatory anaerobic threshold

VE:

Minute ventilation

WR:

Work rate

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Acknowledgements

Authors thank Ms. Kimberley Eissmann and Ms. Michelle Stofa for editing this manuscript.

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Authors declare no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

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Authors and Affiliations

  1. Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Daphney Kernizan, Austin Glass, Gina D’Aloisio & Takeshi Tsuda

  2. Department of Biostatistics, Nemours Children’s Hospital, Delaware, Wilmington, DE, 19803, USA

    Jobayer Hossain

  3. Department of Biomedical Engineering, Saint Louis University, St. Louis, MO, 63103, USA

    Austin Glass

  4. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Takeshi Tsuda

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  1. Daphney Kernizan
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  2. Austin Glass
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Correspondence to Takeshi Tsuda.

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246_2022_2832_MOESM1_ESM.pptx

Supplementary file1 (PPTX 58 kb). Supplemental Figure 1 Submaximal slope parameters of CPET in 9-year-old male. ΔVO2/ΔWR (exercise efficiency), ΔHR/ΔWR (heart rate dependency), ΔVO2*/ΔHR (stroke volume indexed by weight), OUES (oxygen uptake efficiency slope), and ΔVE/ΔVCO2 (ventilatory efficiency). An excellent correlation was seen in each graph

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Kernizan, D., Glass, A., D’Aloisio, G. et al. A Combined Analysis of Peak and Submaximal Exercise Parameters in Delineating Underlying Mechanisms of Sex Differences in Healthy Adolescents. Pediatr Cardiol 43, 1122–1130 (2022). https://doi.org/10.1007/s00246-022-02832-0

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