Systemic Acid Load from the Diet Affects Maximal-Exercise RER


Medicine & Science in Sports & Exercise: April 2012 - Volume 44 - Issue 4 - p 709–715
doi: 10.1249/MSS.0b013e3182366f6c
Applied Sciences

A maximal-exercise RER (RERmax) ≥ 1.10 is commonly used as a criterion to determine whether a “true” maximal oxygen uptake (V˙O2max) has been attained during maximal-effort exercise testing. Because RERmax is heavily influenced by CO2 production from acid buffering during maximal exercise, we postulated that dietary acid load, which affects acid–base regulation, might contribute to variability in RERmax.

Purpose: The study’s purpose was to determine whether a habitual dietary intake that promotes systemic alkalinity results in higher RERmax during V˙O2max testing.

Methods: Sedentary men and women (47–63 yr, n = 57) with no evidence of cardiovascular disease underwent maximal graded treadmill exercise tests. V˙O2max and RERmax were measured with indirect calorimetry. Habitual diet was assessed for its long-term effect on systemic acid–base status by performing nutrient analysis of food diaries and using this information to calculate the potential renal acid load (PRAL). Participants were grouped into tertiles on the basis of PRAL.

Results: The lowest PRAL tertile (alkaline PRAL) had higher RERmax values (1.21 ± 0.01, P ≤ 0.05) than the middle PRAL tertile (1.17 ± 0.01) and highest PRAL tertile (1.15 ± 0.01). There were no significant differences (all P ≥ 0.30) among PRAL tertiles for RER at submaximal exercise intensities of 70%, 80%, or 90% V˙O2max. After controlling for age, sex, V˙O2max, and HRmax, regression analysis demonstrated that 19% of the variability in RERmax was attributed to PRAL (r = −0.43, P = 0.001). Unexpectedly, HRmax was lower (P ≤ 0.05) in the low PRAL tertile (164 ± 3 beats·min−1) versus the highest PRAL tertile (173 ± 3 beats·min−1).

Conclusions: These results suggest that individuals on a diet that promotes systemic alkalinity may more easily achieve the RERmax criterion of ≥1.10, which might lead to false-positive conclusions about achieving maximal effort and V˙O2max during graded exercise testing.

1Department of Nutrition and Dietetics, Doisy College of Health Sciences, Saint Louis University, St. Louis, MO; 2Human Physiology Laboratory, Marywood University, Scranton, PA; 3The Commonwealth Medical College, Scranton, PA; 4Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, MO; and 5Division of Nutrition and Aging, Istituto Superiore di Sanita, Rome, ITALY

Address for correspondence: Edward P. Weiss, Ph.D., 3437 Caroline St., Room 3076, Saint Louis University, St. Louis, MO 63104; E-mail:

Submitted for publication April 2011.

Accepted for publication September 2011.

©2012The American College of Sports Medicine