Maximal oxygen consumption or maximal aerobic power (V˙O2max) represents the highest rate at which oxygen can be used by an individual to perform muscular work. The measure reflects the optimal integration of oxygen uptake, transport, and delivery by the pulmonary and cardiovascular systems and the uptake and utilization of oxygen at the muscle level. Measurement of V˙O2max was originally used to determine the aerobic power of athletes, and although this remains a common application, it is increasingly used to quantify impairment in cardiorespiratory fitness in clinical populations and to monitor changes in response to interventions (pharmacological or "lifestyle" modifications).
The notion that there is an upper limit to the rate of oxygen consumption originates from the work of Hill and Lupton (18). Although this seminal work was conducted using a discontinuous exercise test, continuous incremental or graded exercise test (ramp) protocols in which work rate is increased continuously until an individual terminates the test at "volitional exhaustion" have been favored since the late 1960s/early 1970s (9,21-23). Such protocols have the potential to provide additional information (e.g., ventilatory threshold) and require less time than traditional discontinuous tests; tests may last between 5 and 26 min (24) and are commonly completed within 8-12 min (1).
The response to a graded exercise test is characterized by an initial linear increase in oxygen consumption as a function of work rate followed by a "plateau" or a point beyond which the increase in V˙O2 is considerably less than expected for a given increase in workload. Although the definition of a "plateau" is highly contentious (2,3,10,13,16), it remains the primary physiological marker to indicate that a "true" maximal has been achieved. However, as few as 17% (but up to 95%) of individuals may attain a V˙O2 plateau on completion of a graded exercise test despite a "good effort" (3,10,27). This suggests that a plateau in oxygen consumption is not obligatory to demonstrate a true V˙O2max and has led to the use of other markers to verify a maximal effort in the absence of a plateau in V˙O2. As with the definition of a plateau, the inclusion and application of these criteria vary widely between studies (19) but typically include the attainment of a percentage of age-predicted maximum HR (∼90%), an RER ≥ 1.15, a blood lactate concentration ≥ 8.0 mmol·L−1, and an RPE ≥ 18 (13,19).
Despite the widespread use of V˙O2max testing in clinical populations, few reports have detailed whether individuals from these populations are capable of attaining a true V˙O2max. As such, there is an obvious need to ensure that the test is valid in individuals who may be older, less fit, more sedentary, and have a different body composition (i.e., a greater fat mass) than leaner, healthier, and more active individuals. There is some evidence to suggest that the elderly, children, and low-fit individuals are less likely to reach a plateau in V˙O2 (19), although it has also been shown that neither age nor cardiorespiratory fitness was predictive of the tendency to exhibit a plateau in V˙O2 at the point of volitional fatigue (10). Whether adiposity affects the ability to attain a plateau in V˙O2 has not been specifically investigated.
Excess body fat increases the oxygen cost and, therefore, cardiorespiratory load at a given submaximal workload, particularly in weight-bearing exercise. However, excess body fat does not seem to impair the capacity of the cardiorespiratory system to deliver oxygen to active muscle during maximal exercise, at least in individuals with up to 34% body fat (8). Furthermore, in formerly overweight women who lost an average ∼16% of their initial body weight, V˙O2peak per kilogram of body weight was higher after weight loss, but V˙O2peak expressed per kilogram of fat-free mass (FFM) was similar in the overweight and weight-reduced states (15). Thus, although excess body fat may limit exercise tolerance (performance), there seems to be no physiological reason why individuals with higher levels of body fat would not be capable of exhibiting a plateau in V˙O2, given adequate motivation.
As such, the main aims of this study were 1) to determine whether overweight and obese individuals could achieve a plateau in oxygen consumption in response to a graded exercise test; 2) to determine whether these individuals could also attain other criteria (RER, lactate, HR, RPE); and 3) to identify and characterize individuals who attain, or fail to attain, a plateau.
Sixty-seven male and 68 female participants were recruited from the university staff and student population. For both genders, there were two groups: overweight (body mass index (BMI) = 25.0-29.9 kg·m−2) and obese (BMI ≥ 30.0 kg·m−2; Table 1). The obese group included 53 class I obese (BMI between 30.0 and 34.9 kg·m−2), 13 class II obese (BMI between 35.0 and 39.9 kg·m−2), and 3 class III obese (BMI ≥ 40.0 kg·m−2). All participants were sedentary and otherwise considered healthy. Ethical approval was obtained from Queensland University of Technology Human Research Ethics Committee, and participants gave their written informed consent to take part in the study.
Materials and Methods
Testing to assess maximal oxygen consumption (V˙O2max) consisted of two phases. Phase 1 was a graded exercise test performed to volitional exhaustion on a treadmill (Quinton Instrument, Co., Seattle, WA). Participants were fitted with a Hans-Rudolf headset (with two-way breathing valve and pneumotach), nose clip, and Polar Coded Transmitter and receiver (Polar Electro Oy, Kempele, Finland) before testing. Treadmill speed was set at 5.6 km·h−1 for the first 4 min at 0% grade, and thereafter, the velocity was increased to a speed consistent with a fast-paced walk/slow jog according to each individual's ability. This individualized speed was kept constant throughout the remainder of the test while the grade of the treadmill increased 2.5%·min−1 until volitional exhaustion. During a short rest (5-10 min), finger-prick blood samples were taken for blood lactate analysis, and the participant was given a small drink of water. Participants then resumed their position on the treadmill and began walking or running at, or within 0.5 km·h−1 of, the maximum workload achieved during the preceding continuous incremental test. As for phase 1, workload was increased each minute until volitional exhaustion. However, an individualized approach was taken with the protocol for phase 2 (the "booster" test) where increases in workload were achieved by increasing speed, grade, or a combination of speed and grade, depending on the tolerance and motor control of the individual participant.
Throughout both phases of the testing session, HR was recorded every 5 s, and HRmax was defined as the highest HR recorded for 30 s. Ventilation (V˙E), oxygen consumption (V˙O2), carbon dioxide production (V˙CO2), and RER were calculated from respiratory gases sampled every 15 s throughout phases 1 and 2 using a Q-PLEX Gas Analysis System (Quinton Instrument, Co.). The O2 and CO2 analyzers were calibrated before each test against known gas concentrations, and the flow meter was calibrated against a 3.0-L syringe. All data are reported as 30-s averages taken during the final 30 s of the last completed stage. Data are not reported for stages that were attempted but not completed. Before treadmill testing, participants were 1familiarized with the Borg 6-20 scale for the RPE (5,6), and RPE was assessed at the end of each stage of the treadmill test. Participants were instructed to walk or run to volitional exhaustion, at which point the test was terminated. Duplicate 0.5-mL samples of capillary blood obtained via the finger-prick method were collected immediately at the end of each phase of the testing. Blood samples were immediately deproteinized in chilled perchloric acid, then refrigerated. Blood lactate concentrations were subsequently analyzed via an ultraviolet end point method using the spectrophotometric assay procedure (7,14). Forty milliliters of clear supernatant was added to 2 mL of reagent (14), vortexed, and incubated for 45 min at 37°C. The absorbance of reduced nicotinamide adenine dinucleotide (NADH) for the sample was read off a spectrophotometer using a UV lamp set at a wavelength of 340 nm. The coefficient of variation for the repeated measures was 4.3%.
The continuous incremental exercise test (phase 1) was deemed to be a valid maximal test on the basis of achievement of at least three of the following criteria during the final 30 s of the last completed stage:
- Increase in V˙O2 < 50% of that expected for the change in mechanical work;
- HR within ±11 bpm of age-predicted maximum (13,19), calculated as 220 − age;
- RER ≥ 1.15;
- Peak blood lactate concentration ≥8 mmol·L−1; and
- RPE ≥ 18.
In the week before exercise testing, measurements of body height (stretch stature) to the nearest 0.1 cm using a wall-mounted Harpenden stadiometer and body weight to the nearest 5 g using a digital scale were recorded when subjects were in a fasted and voided state. Whole-body and regional (trunk, arm, and leg) lean and fat tissues were determined with the use of dual x-ray absorptiometry (DXA) (DPX-L; Lunar Radiation Corp., Madison, WI). All scans were analyzed with the use of ADULT software, version 3.6 (Lunar Radiation Corp.). The calculation of appendicular lean body mass and fat mass (FM) was made according to the approach described by Heymsfield et al. (17). Percent body fat (%BF) was determined as FM expressed relative to body weight.
Analyses were performed with SPSS 16 (SPSS, Chicago, IL). All data are expressed as mean (±SD) unless otherwise specified.
V˙O2peak and HR, blood lactate concentration, RER, and RPE at the termination of the maximal exercise test were compared between males and females and between overweight and obese participants using independent t-tests. Chi-square analysis was used to determine whether the proportion of participants who attained each of the criteria (V˙O2 plateau, RER ≥ 1.15, blood lactate ≥8 mmol·L−1, HR within 11 beats of age-predicted maximum (13,19), and RPE ≥ 18) differed between males and females and between overweight and obese participants. An independent t-test was used to determine whether the mean number of criteria attained differed between each group. Independent t-tests were used to compare age, body weight, BMI, maximal exercise responses, and attainment of the other criteria between those who did and did not exhibit a plateau in V˙O2.
Paired t-tests were used to compare workload, and peak values for V˙O2, RER, blood lactate concentration, HR, and RPE between phases 1 and 2 of the testing. For each individual, the expected change in V˙O2 was calculated from the American College of Sports Medicine (ACSM) metabolic equations for either walking or running (1). A plateau in V˙O2 between the penultimate and last completed stage is phase 1, and that between the last completed stages in phases 1 and 2 was defined as a measured change in V˙O2 of less than 50% of that expected on the basis of the change in workload. Repeated-measures ANOVA was used to determine whether the increase in V˙O2 between phases 1 and 2 was different between those who did and those who did not attain a plateau in phase 1.
Participant characteristics and peak response in phases 1 and 2.
The characteristics of the participants are shown in Table 1, and the peak exercise responses for phases 1 and 2 are shown in Tables 2 and 3. Peak HR and RPE at termination of the test in phase 1 were similar among all groups and maximum RER, and blood lactate concentrations were higher in males than in females (Table 2). Although V˙O2peak (L·min−1) was higher in males compared with that in females (4.03 vs 2.45 L·min−1, P < 0.001), this difference between genders was no longer evident after adjusting for FFM via covariance (3.30 vs 3.10 L·min−1, P = 0.22). Compared with overweight participants, the obese had lower blood lactate concentration at the termination of the test and a lower V˙O2peak when expressed relative to body weight and body composition (mL·min·kg−1 and mL·min·kg−1 FFM) but not when expressed in absolute terms (L·min−1; Table 2).
Attainment of V˙O2 plateau.
Figures 1 and 2 show the percentage of males and females and overweight and obese participants who attained each of the five criteria for V˙O2max in phase 1. At the end of phase 1, 46% of the participants reached a plateau in V˙O2, 83% increased HR to within 11 beats of age-predicted maximum, 89% reached an RER of ≥1.15, 70% reached a blood lactate concentration of ≥8 mmol·L−1, and 74% reached an RPE of ≥18. No significant differences between genders or between BMI groups were found with the exception of blood lactate, where males met the criterion for blood lactate concentration with a higher frequency than females (84% vs 56%, P < 0.05; Fig. 2). When considered as a group, participants achieved a mean ± SD criteria of 3.6 ± 1.2. Although the number of criteria met was lower in obese versus overweight individuals (P < 0.05), and tended to be lower in females compared with males (P = 0.07), on average, all groups met at least three of the criteria. There was a significant negative correlation between %BF and V˙O2peak (mL·min·kg−1) for the whole group (r = −0.53, P < 0.01; n = 131), and when males (r = −0.47, P < 0.01; n = 67) and females (r = −0.45, P < 0.01; n = 64) were considered separately.
V˙O2 did not change between phases 1 and 2 despite a significant increase in workload (METs, calculated from the ACSM equations for walking or running; Table 3). RER was higher during phase 1, and lactate concentration was higher in phase 2 (Table 3). On the basis of the verification test (phase 2), 52 individuals who did not attain a plateau in V˙O2 in phase 1 could be classified as having reached a plateau in phase 2 on the basis of an increase of <50% of that expected on the basis of the change in workload from phase 1 to phase 2. When both phases 1 and 2 are considered, 85% of participants attained a plateau in V˙O2.
Plateau versus no plateau.
As shown in Table 4, neither were there differences in the age, BMI, and body weight of participants who did or did not attain a plateau in phase 1 nor were there differences in maximum HR, RER, blood lactate concentration, RPE, and V˙O2peak expressed in both absolute and relative terms. The number of other criteria attained was not different between those who did and did not attain a plateau (3.0 ± 1.2 vs 3.2 ± 0.9 criteria, P = 0.10). Furthermore, those individuals who did not attain a plateau in phase 1 of the testing had no greater increase in V˙O2peak in phase 2 than those who did plateau (0.10 vs 0.34 mL·min·kg−1, P = 0.57). The peak data for phases 1 and 2 (booster test) are shown in Table 3.
The primary aim of this study was to determine the frequency of a plateau in V˙O2 at the termination of a continuous incremental exercise test in overweight and obese individuals and to investigate whether attainment of other criteria was contingent on achieving a plateau in V˙O2. The main findings of this study were that: 1) 46% of participants achieved a plateau in V˙O2 at the point of terminating a continuous incremental exercise test (phase 1); 2) a large proportion of participants met the criteria for each of the other markers; 3) there were no differences in age, body weight, BMI, the maximal exercise responses, or attainment of the other criteria between those who did and did not achieve a plateau; and 4) the verification test (phase 2) revealed that 52 individuals (39%) who did not exhibit a plateau in V˙O2 in phase 1 had no further increase in V˙O2 in phase 2 despite an increase in workload. Therefore, when both phases 1 and 2 are considered, 85% of participants attained a plateau in V˙O2.
Attainment of a plateau in V˙O2 in overweight and obese individuals.
Of interest in the present study is the question of whether excessive body fat impedes the ability of an individual to attain a plateau in V˙O2; that is, are overweight and obese individuals less likely to attain a plateau in V˙O2 than leaner individuals? This question is of clinical interest in evaluating the effect of a weight loss intervention on cardiorespiratory function and functional capacity, where it is important that the comparison before and after weight loss is made on the basis of the same termination criteria. There seems to be no physiological reason why individuals with excessive body fat should be less likely than lean individuals to cease a maximal test because of an oxygen limitation and therefore exhibit a plateau in V˙O2. Astorino et al. (2) reported that body composition was not predictive of a plateau in V˙O2. However, all participants were very lean, and their %BF fell within a very narrow range (11%-18%). Although it is not surprising that body composition was unrelated to the likelihood of attaining a plateau in this group, similar findings have previously been reported in individuals with a wider range of %BF (up to 34% 8). In this early work, Buskirk and Taylor (8) reported no differences in V˙O2max expressed per kilogram of FFM between individuals grouped on the basis of their %BF (0%-10%, 10%-25%, and >25%), indicating that the presence of body fat, at least in this range, did not hinder the capacity of the cardiorespiratory system to deliver oxygen during maximal exercise. However, many obese individuals have levels of body fat far greater than the maximum of 34% reported by Buskirk and Taylor (8); in the present study, %BF ranged from 22% to 47% in males and from 26% to 57% in females.
The authors are aware of only two studies conducted with the specific purpose of evaluating the attainment of V˙O2max in overweight and obese individuals. These studies, from Donnelly et al. (12) and Misquita et al. (25), reported that as few as 15% and 18% of obese individuals attained a plateau in V˙O2, respectively; this is considerably lower than the 49% of overweight and obese individuals who attained a plateau in the present study. There are several postulates for the markedly higher occurrence of a plateau in the present study. Donnelly et al. (12) and Misquita et al. (25) studied only obese females, and it is therefore possible that the larger proportion of individuals attaining a plateau in the present study may be attributable to the greater heterogeneity of our sample, specifically the inclusion of both males and females, and those classified as overweight in addition to only obese individuals. However, similar proportions of overweight and obese males and females achieved a plateau in oxygen consumption. Furthermore, although not significant, the plateau criterion was attained with a greater frequency in obese females (63%) than in the other subgroups (overweight and obese males and overweight females). It therefore seems unlikely that the attainment of a plateau can be explained by the inclusion of a more heterogeneous population.
It seems more likely that the low incidence of a plateau in the studies of Donnelly et al. (12) and Misquita et al. (25) is attributable to the premature termination of the exercise test and thus failure to reach a true physiological maximum, rather than being indicative of the fact that individuals in this population were less able to attain a plateau. If we consider only the obese females in the present study for ease of comparison, although the women in our study were younger than those in the studies by Donnelly et al. (12) and Misquita et al. (25), they were similar in BMI and %BF. Unfortunately, Donnelly et al. (12) did not report the actual V˙O2peak values, but the obese females in the present study achieved higher V˙O2peak values (expressed in absolute terms as well as relative to body weight) than the women in the Misquita et al. study (25) (27 vs 19 mL·min·kg−1). Although the postmenopausal women in the cohort of Misquita et al. (25) were older than the women in the present study, this factor alone does not account for the lower V˙O2peak, given that it remains lower when adjusted for age (10th vs 30th percentile for gender-specific, age-adjusted maximal aerobic power) (1). That the low incidence of a plateau may be attributed to the premature termination of the exercise test seems even more plausible given that only 57% of the women in the study by Misquita et al. (25) reached an RER of ≥ 1.10 and only 60% of those in the study by Donnelly et al. (12) met the criterion for RER that was only set at >0.95. In contrast, 74% of the obese females in the present study achieved an RER ≥ 1.15. Furthermore, only 54% of the participants in the study by Donnelly et al. (12) attained a peak HR within 10 bpm of age-predicted maximum HR compared with 83% of participants in the present study, and only 44% of participants in the study by Donnelly et al. (12) had an RPE of at least 19, whereas 74% of those in the present study met this criterion.
It is also important to consider the results of the present study in the context of previously reported data in nonobese individuals. It has been suggested that motivation, high pain tolerance, muscle strength, high anaerobic capacity, and greater ability to buffer hydrogen ions during maximal work could collectively, or independently, differentiate between those individuals who do, and those who do not, exhibit a plateau in V˙O2 (2,20,29). According to Wagner (29), only those able or willing to tolerate the pain associated with a maximal effort may exhibit a plateau in oxygen consumption, which implies that attaining a plateau is dependent largely on motivation. This opinion is supported more recently by Shephard (28), who noted regarding the testing of athletes that, "the power of the observer is important to the reaching of an oxygen 'plateau,' and laboratories that have difficulty in demonstrating this phenomenon probably need to upgrade their motivational skills."
Whereas certain populations, for example, children, the elderly, and low-fit individuals (19), may have greater difficulty achieving a plateau, the frequency with which even young, healthy, active, individuals exhibit a plateau has been reported to be as low as 17% (26). This is the case even among the most highly motivated individuals and those presumably well accustomed to the pain and discomfort associated with producing and sustaining a maximal effort. Indeed, it has been reported that only 25%-39% of elite male and female middle- and long-distance runners (11) and 47% of elite male road cyclists (20) exhibited a plateau in oxygen consumption at the completion of continuous incremental tests. When considered in this context, the occurrence of a plateau is unlikely to be explained by motivation alone because the individuals in the present study, possibly one of the least motivated groups (on the basis of long-term sedentary lifestyles), were no less likely, and in fact were more likely, to attain a plateau in V˙O2 than arguably some of the most highly motivated individuals (i.e., athletes). This is not to undervalue the importance of creating a highly motivating testing environment but rather to note that motivation is unlikely to be the primary determinant of a plateau in V˙O2.
If motivation was the main factor in determining whether an individual attained a plateau in V˙O2, we would have expected to find differences in the maximal responses and a higher incidence of the other criteria in those who exhibited a plateau compared with those who did not. However, in the present study, there were no differences in age, body weight, BMI, V˙O2peak, and maximal exercise responses between those individuals who did and did not exhibit a plateau (Table 4). As noted by Bassett and Howley (4), if a subject fatigues just as V˙O2max is reached, there may be too few data points for a plateau to be evident. To have enough data points to provide evidence of a plateau, a participant must be able or be prepared to continue exercising for a sufficient duration at an increasing level of anaerobic energy metabolism (i.e., once V˙O2max has been achieved). The blood lactate responses in the present study, and those reported by Lucia et al. (20) in elite cyclists, support this notion. In the present study, the peak blood lactate tended to be lower (not statistically significant) in the group that did not attain a plateau (Table 4). This is consistent with the findings in elite cyclists (20) where, although peak blood lactate concentration was lower and pH was higher in cyclists who did not plateau compared with those who did, there were no differences in maximal HR, V˙O2peak, ventilation, and RER. Thus, although the absence of a plateau makes it difficult to determine whether a maximal oxygen consumption has been achieved, it is not necessarily indicative of a failure to attain a "true" maximal oxygen consumption.
Attainment of other criteria in overweight and obese individuals.
In the absence of a plateau, other criteria may be used to provide evidence that a maximal oxygen consumption has been achieved. In phase 1, the frequency with which individuals met each of the other criteria was greater than the frequency with which they attained a plateau in V˙O2 (Figs. 1 and 2). The number of other criteria attained was not different between those who did and did not attain a plateau in phase 1, and there were no differences in V˙O2peak or the number of the other criteria attained in phase 1 of testing in the 85% who attained a plateau in V˙O2 (phases 1 and 2) versus those who did not plateau (data not shown). Furthermore, neither gender nor fatness predicted the number of V˙O2 markers attained, and attainment of the other criteria did not differentiate whether a V˙O2 plateau was achieved (Figs. 1 and 2).
Given the questionable usefulness of the other criteria, it has been suggested that a verification or "booster" test may be used to determine whether a V˙O2peak is indicative of a true maximal V˙O2 (27). Although protocols vary between studies, the verification test typically involves participants undertaking a standard incremental exercise test, having a short rest, and then undertaking an additional verification test at a workload higher than that achieved at the end of the incremental exercise test (27). This two-phase test can be conducted within a single session and thus may provide a time-efficient means of verifying whether a V˙O2peak reflects a true V˙O2max without relying on other ill-defined and controversial criteria.
All participants in the present study undertook a verification test after the standard incremental exercise test. When analyzed as a group, there was a small, but significant, increase in work rate between phases 1 and 2 of the testing (0.48 METs, P < 0.0001; Table 3). Despite the higher workload, there were no differences in the peak HR attained during each phase of testing, and although peak RER, lactate concentration, and RPE differed between phases 1 and 2 (Table 3), these differences were likely related to the duration of the exercise and were unlikely to be clinically meaningful. In addition, the measured change in V˙O2 between phases 1 and 2 for the whole group (0.13 mL·min·kg−1, P = 0.55) was far less than the 1.68 mL·min·kg−1 that would be predicted for a 0.48-MET increase in mechanical work. Importantly, the change in V˙O2 between phases 1 and 2 was not different between those who did and did not attain a plateau in phase 1.
For each individual who completed both phases of testing, we also compared the measured change in V˙O2 with the expected change in V˙O2 on the basis of the change in workload. This individualized approach provides further evidence that a large number of participants had reached a "true" maximal oxygen consumption at the end of the incremental exercise test. Of the 132 participants who have complete V˙O2 data for both tests, 60 (46%) attained a plateau in V˙O2 at the end of the incremental treadmill test. The phase 2 test provided verification that an additional 52 participants (39%) had indeed attained maximum on the basis of an increase in V˙O2 of less than 50% of that expected on the basis of the change in workload between the final stage of the incremental exercise test (phase 1) and the final stage of the verification test (phase 2). This is consistent with previous research using a verification test in lean males where all participants failed to attain a plateau in V˙O2 at the end of a continuous incremental exercise test but had no further increase in V˙O2 at the end of a verification test performed 5 min later at either 95% or 105% of the previously attained maximal workload (27).
For both phases of testing, a plateau was defined as an increase in of less than 50% of that expected on the basis of the increase in mechanical work. In phase 1 (incremental treadmill test), the change in workload was a uniform increase in grade of 2.5% between the penultimate and ultimate stages of the test. For phase 2 (the verification test), the increase in workload was individualized for each participant and was achieved via increases in either speed or grade or a combination of speed and grade. For both phases, the expected change in V˙O2 was predicted from the appropriate ACSM walking or running equation (1), depending on speed. It is possible that this method may overestimate the incidence of a plateau, given that the equations are valid only for steady-state conditions and the workload in this study was increased each minute during exercise. A preferable way of determining the expected increase in V˙O2 would have been to establish the relationship between V˙O2 and workload from individual regression equations for submaximal workloads completed during the incremental test. However, because the test protocol was designed to avoid participants undertaking unduly long tests, there were too few data points to establish regression equations with any predictive power.
V˙O2max is commonly used to measure changes in cardiorespiratory capacity in overweight and obese individuals during exercise (or other) interventions. If successful, these interventions may result in considerable weight loss such that individuals who entered the intervention as obese may be classified as overweight or even "normal weight" by the end of the intervention period. Implicit in the use of a V˙O2max test to measure changes in cardiorespiratory capacity is that the test is limited by the same variable, cardiorespiratory power, at each time point. If the ability to reach V˙O2max (as defined by a plateau in V˙O2) is affected by excess body fat, then apparent changes in V˙O2max in response to an exercise intervention (with accompanying weight loss) may be attributable, at least in part, to a reduced fat mass. The findings of the present study, in combination with the limited existing evidence (15), suggest that this is not the case.
In the present study, 85% of participants attained a plateau in despite having %BF levels ranging from 22% to 47% in males and from 26% to 57% in females. Furthermore, although there was a moderate negative correlation between %BF and V˙O2peak (mL·min·kg−1) in both males and females in the present study, neither BMI nor %BF was different between those who did and did not achieve a plateau in V˙O2 (Table 4). This suggests that even a very high level of body fat does not prevent an individual from attaining a plateau in V˙O2. This is in agreement with the only longitudinal study addressing this question in which Goran et al. (15) reported no differences in V˙O2max when expressed relative to FFM in formerly obese women who had lost an average of ∼13 kg (16%) of their body weight and reduced their fat mass by 31%. Although this warrants further investigation, the available evidence suggests that a high level of body fat does not impede the maximum capacity of the cardiorespiratory system and does not preclude the use of V˙O2max testing in longitudinal studies in which individuals experience large changes in body composition.
There are two important findings from the present research. Firstly, 46% of overweight and obese individuals attained a plateau in V˙O2 at the end of a continuous incremental exercise test, and there were no differences in any of the measured variables between those who did and did not attain a plateau. Secondly, in an additional 39% of individuals who did not attain a plateau in V˙O2 in the continuous incremental test, the verification test failed to induce further increases in V˙O2 despite a significant increase in workload. Together, these findings suggest that the absence of a plateau in V˙O2 alone is not indicative of a failure to reach a true maximal oxygen consumption and that individuals with excessive body fat are no less likely than "normal-weight" individuals to exhibit a plateau in V˙O2 at the end of a continuous incremental exercise test, provided that the protocol is appropriate to the population and encouragement to exercise to maximal exertion is provided.
This research received financial support from Polar Electro Oy and HUR Oy. The results of this study do not constitute endorsement by ACSM.
1. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription
. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2006. 368 p.
2. Astorino TA, Willey J, Kinnahan J, et al. Elucidating determinants of the plateau in oxygen consumption at V˙O2max
[commentary]. Br J Sports Med
3. Bassett DR, Howley ET. Maximal oxygen uptake: "classical" versus "contemporary" viewpoints. Med Sci Sports Exerc
4. Bassett DR, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc
5. Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc
6. Borg G. An Introduction to Borg's RPE-scale
. Ithaca (NY): Mouvement Publications; 1985. 26 p.
7. Burtis CA, Ashwood ER. Tietz Textbook of Clinical Chemistry
. 2nd ed. Philadelphia (PA): WB Saunders Company; 1994. 2326 p.
8. Buskirk E, Taylor HL. Maximal oxygen intake and its relation to body composition, with special reference to chronic physical activity and obesity
. J Appl Physiol
9. Davies CT, Tuxworth W, Young JM. Physiological effects of repeated exercise. Clin Sci
10. Day JR, Rossiter HB, Coats EM, Skasick A, Whipp BJ. The maximally attainable V˙O2
during exercise in humans: the peak vs. maximum issue. J Appl Physiol
11. Doherty M, Nobbs L, Noakes TD. Low frequency of the "plateau phenomenon" during maximal exercise in elite British athletes. Eur J Appl Physiol
12. Donnelly JE, Jakicic J, Roscoe M, Jacobsen DJ, Israel RG. Criteria to verify attainment of maximal exercise tolerance test with obese females. Diabetes Res Clin Pract
. 1990;10(1 suppl):S283-6.
13. Duncan GE, Howley ET, Johnson BN. Applicability of V˙O2max
criteria: discontinuous versus continuous protocols. Med Sci Sports Exerc
14. Fink WJ, Costill DL. Analytical Methods for the Measurement of Human Performance
. Muncie (IN): Human Performance Laboratory, Ball State University; 1990. p. 38-43.
15. Goran M, Fields DA, Hunter GR, Herd SL, Weinsier RL. Total body fat does not influence maximal aerobic capacity. Int J Obes Relat Metab Disord
16. Hale T. History of developments in sport and exercise physiology: A. V. Hill, maximal oxygen uptake, and oxygen debt. J Sports Sci
17. Heymsfield SB, Smith R, Aulet M, et al. Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr
18. Hill A, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. Q J Med
19. Howley ET, Bassett DR, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc
20. Lucia A, Rabadan M, Hoyos J, et al. Frequency of the V˙O2max
plateau phenomenon in world-class cyclists. Int J Sports Med
21. Maksud MG. Coutts Comparison of a continuous and discontinuous graded treadmill test for maximal oxygen uptake. Med Sci Sports
22. McArdle WD, Magel JR. Physical work capacity and maximum oxygen uptake in treadmill and bicycle exercise. Med Sci Sports
23. Michael ED Jr, Horvath SM. Physical work capacity of college women. J Appl Physiol
24. Midgley AW, Bentley DJ, Luttikholt H, McNaughton LR, Millet GP. Challenging a dogma of exercise physiology: does an incremental exercise test for valid V˙O2max
determination really need to last between 8 and 12 minutes? Sports Med
25. Misquita NA, Davis DC, Dobrovolny CL, Ryan AS, Dennis KE, Nicklas BJ. Applicability of maximal oxygen consumption criteria in obese, postmenopausal women. J Womens Health Gend Based Med
26. Niemela K, Palatsi I, Linnaluoto M, Takkunen J. Criteria for maximum oxygen uptake in progressive bicycle tests. Eur J Appl Physiol Occup Physiol
27. Rossiter HB, Kowalchuk JM, Whipp BJ. A test to establish maximum O2
uptake despite no plateau in the O2 uptake response to ramp incremental exercise. J Appl Physiol
28. Shephard RJ. Is the measurement of maximal oxygen intake passe? Br J Sports Med
29. Wagner PD. New ideas on limitations to V˙O2max
. Exerc Sport Sci Rev