Underused fitness measurements could be the key to training results

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January 6, 2022 – In recent years there has been a push to encourage doctors to prescribe exercise as medicine and tell their patients how often, how long and how hard they need to exercise to improve health.

A new study from Brigham Young University suggests that physicians could take this initiative to the next level and prescribe exercise regimens that lead to a specific health outcome; Let’s say lowering your blood pressure or losing weight.

“The results of this and other studies suggest that we should be able to more consistently and accurately prescribe exercise like medicine,” says lead study author Jayson Gifford, PhD, professor of exercise science at BYU.

These exercise regimens would be patient-tailored based on a largely ignored fitness measure called critical power, or maximum steady state — the fastest speed you can achieve while maintaining a pace you can sustain for a long time.

By designing workouts around critical power instead of the more commonly used VO2 max (maximum effort), we could more accurately predict health outcomes, just like we can with drugs, the researchers say Journal of Applied Physiology.

“We have known for centuries that exercise is part of the path to a healthy and long life,” says Dr. Jordan Metzl, an exercise medicine physician at the Hospital for Special Surgery in New York and author of The exercise course. “But it’s only in the last 70 years that we’ve realized the medicinal value of exercise.”

Metzl, who was not involved in the study, helped develop an annual seminar at Cornell Medical School that taught medical students ways to prescribe exercise that went beyond the cookie-cutter advice of “30 minutes a day.” . Nevertheless, doctors and other health professionals often have difficulty prescribing exercises to prevent or treat disease. And a recent study from Oxford found that when doctors give weight loss advice, it is often vague and difficult for patients to handle.

“The drug of movement is one of the safest and most effective forms of health care,” says Metzl. “We need to get the medical community fully committed to prescribing exercise for their patients.”

This study suggests that a focus on critical power may be key to achieving this.

What the research found

In the study, 22 adults completed 8 weeks of either moderate-intensity exercise or high-intensity interval training or HIIT. The intensity levels given in both plans were based on VO2 max, so people in the study exercised at specific percentages of their VO2 max.

Both groups saw improvements in endurance, but results varied greatly from person to person. These mixed results could be explained by individual differences in critical performance.

“The improvement was much more closely correlated with the percentage of critical forces people were working on than the percentage of their VO2max exercise physiologists assumed for years,” says study lead author Jessica Collins, a researcher at Brigham Young University.

Not only that, but several subjects who did not improve their VO2max did see an increase in critical power and endurance.

“People tend to just focus on VO2max,” says Gifford. “Many may see the lack of increase in VO2max in some people and conclude that the training was ineffective. Personally, I believe many potentially useful therapies have been ruled out due to an almost exclusive focus on VO2max.”

It turns out that critical performance varies greatly from person to person, even for people with similar VO2 max values.

“Let’s say you and Jessica had the same VO2max,” explains Gifford. “If we let you both go at 70% [your VO2 max]it could be Above Your maximum steady state, which would give you a really hard time. And it could be under her maximum state of equilibrium, which would make it easy for her.”

That means you’re putting different stresses on your body, and it’s that stress that drives improvements in fitness and endurance.

“Below critical performance, metabolic stressors are well controlled and maintained at elevated but constant levels,” says Gifford. “Above critical performance, the metabolic stressors are produced so rapidly that they cannot be controlled and continually accumulate until they reach very high levels leading to failure.”

By knowing your critical power, you can predict how those stressors will build up and tailor a training program that provides just the right stressor “dose” for you, says Gifford.

Such programs could be used for rehab patients recovering from a heart attack or lung disease, Gifford suggests. Or they could help older adults improve their endurance and physical function, Collins notes.

But first, researchers need to confirm these findings by programming workouts based on people’s critical power and seeing how much different measures improve.

How to find your critical power

Critical strength isn’t new, but exercise physiologists and medical professionals have largely ignored it because it’s not easily measured.

“People generally train at VO2max, or max heart rate, which is even less accurate,” says Gifford.

Finding the critical power of subjects in the study required multiple timed trials and calculating the speed/power versus time relationship, explains Gifford.

But for a rough measure of your critical power, you could use an app that measures functional threshold power (FTP), something Gifford calls the “Walmart version” of critical power. “It’s not exactly the same, but it’s close,” he says. (The app Strava has FTP as well as pretty sophisticated performance analysis.)

Or skip the technique and go by feel. When you’re below your critical power, “it’ll be challenging, but you’ll feel in control,” says Gifford. Above your critical effort, “your breathing and heart rate will steadily increase until you hit rock bottom in about 2 to 15 minutes, depending on how far above you are.”

Still, you don’t need to know your critical strength to start training, Collins notes.

“The beauty of training is that it’s such a powerful drug that you can see benefits without refining your training in that way,” he says. “I would hate if this became an obstacle to training. The important thing is to do something.”

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Underused fitness measurements could be the key to training results
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