Muscle Oxygen Saturation to Determine Lactate Thresholds in Spinal
                    Cord Injury Population

Jose Luis Sánchez-Jiménez; Carlos Sendra-Pérez; Rosa M. Cibrian-Ortiz de Anda; Maria Vazquez-Fariñas; Jose Ignacio Priego-Quesada; Inmaculada Aparicio-Aparicio

doi:10.1055/a-2637-7212

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2025; 46(14): 1080-1086
DOI: 10.1055/a-2637-7212

Training & Testing

Muscle Oxygen Saturation to Determine Lactate Thresholds in Spinal Cord Injury Population

Authors

Jose Luis Sánchez-Jiménez

¹Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)
Carlos Sendra-Pérez

¹Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)

²Department of Education and Specific Didactics, Jaume I University, Castellon, Spain
Rosa M. Cibrian-Ortiz de Anda

³Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)
Maria Vazquez-Fariñas

⁴Toledo Physiotherapy Research Group (GIFTO), Nursing and Physiotherapy School, Castilla La Mancha University, Toledo, Spain (Ringgold ID: RIN16733)

⁵Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
Jose Ignacio Priego-Quesada

¹Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)

³Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)
Inmaculada Aparicio-Aparicio

¹Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain (Ringgold ID: RIN16781)

Abstract

This study aimed to compare the intensity when thresholds occur determined with muscle oxygen saturation and blood lactate concentration during a graded exercise test (GXT) in an arm-crank ergometer. Twenty-nine participants were included, divided into non-spinal cord injury (SCI) (N=12) and SCI (N=17) groups. Participants underwent a GXT with 3-minute steps and 1-minute rest intervals. Blood lactate concentration was measured at baseline and after each step, while muscle oxygen saturation was continuously registered in the biceps brachii. Agreement between methods was good at the first threshold [Non-SCI: intraclass correlation coefficient (ICC)=0.46; SCI: ICC=0.51] and excellent at the second threshold (Non-SCI: ICC=0.82; SCI: ICC=0.92). No significant differences were found between groups in bias for the first and second lactate thresholds (p > 0.05). In conclusion, muscle oxygen saturation is valid and reliable for the second lactate threshold determination, with stronger agreement than the first lactate threshold during GXTs using arm-cranking in biceps brachii in Non-SCI and SCI.

Keywords

incremental test - cycling - muscle oxygenation - breakpoint - exercise testing

Full Text

References

References
1 Peterson MD, Berri M, Lin P. et al. Cardiovascular and metabolic morbidity following spinal cord injury. Spine J 2021; 21: 1520-1527
2 Tweedy SM, Beckman EM, Geraghty TJ. et al. Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury. J Sci Med Sport 2017; 20: 108-115
3 Pebdani RN, Leon J, Won DS. et al. “It Helps Me With Everything”: A Qualitative Study of the Importance of Exercise for Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28: 176-184
4 Van Der Scheer JW, de Groot S, Tepper M. et al. Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels. J Rehabil Med 2016; 48: 33-42
5 Poole DC, Rossiter HB, Brooks GA, Gladden LB. The anaerobic threshold: 50+ years of controversy. J Physiol 2021; 599: 737-767
6 Iannetta D, Qahtani A, Mattioni Maturana F, Murias JM. The near-infrared spectroscopy-derived deoxygenated haemoglobin breaking-point is a repeatable measure that demarcates exercise intensity domains. J Sci Med Sport 2017; 20: 873-877
7 Mateo-March M, Moya-Ramón M, Javaloyes A, Sánchez-Muñoz C, Clemente-Suárez VJ. Validity of detrended fluctuation analysis of heart rate variability to determine intensity thresholds in elite cyclists. Eur J Sport Sci 2023; 23: 580-587
8 Sendra-Pérez C, Sanchez-Jimenez JL, Marzano-Felisatti JM, Encarnación-Martínez A, Salvador-Palmer R, Priego-Quesada JI. Reliability of threshold determination using portable muscle oxygenation monitors during exercise testing: a systematic review and meta-analysis. Sci Rep 2023; 13: 12649
9 Salas-Montoro J-A, Mateo-March M, Sánchez-Muñoz C, Zabala M. Determination of Second Lactate Threshold Using Near-infrared Spectroscopy in Elite Cyclists. Int J Sports Med 2022; 43: 721-728
10 Feldmann A, Ammann L, Gächter F, Zibung M, Erlacher D. Muscle Oxygen Saturation Breakpoints Reflect Ventilatory Thresholds in Both Cycling and Running. J Hum Kinet 2022; 83: 87-97
11 Cayot TE, Robinson SG, Davis LE. et al. Estimating the Lactate Threshold Using Wireless Near-Infrared Spectroscopy and Threshold Detection Analyses. Int J Exerc Sci 2021; 14: 284-294
12 Pogliaghi S, Casiello L, Bandera A. Validation of a continuous-wave, single-distance NIRS oxymeter for the determination of muscle oxygenation during cycling Medicine & Science in Sports & Exercise. 2009 41. 117
13 Nagasawa T. Slower recovery rate of muscle oxygenation after sprint exercise in long-distance runners compared with that in sprinters and healthy controls. J Strength Cond Res 2013; 27: 3360-3366
14 Yogev A, Arnold J, Nelson H, Clarke DC. et al. The effect of severe intensity bouts on muscle oxygen saturation responses in trained cyclists. Front Sports Act Living 2023; 5: 1086227
15 Kirby BS, Clark DA, Bradley EM, Wilkins BW. The balance of muscle oxygen supply and demand reveals critical metabolic rate and predicts time to exhaustion. J Appl Physiol 2021; 130: 1915-1927
16 Horiuchi M. Effects of arm cranking exercise on muscle oxygenation between active and inactive muscles in people with spinal cord injury. J Spinal Cord Med 2021; 44: 931-939
17 Horiuchi M, Fukuoka Y. Absence of cardiovascular drift during prolonged arm-crank exercise in individuals with spinal cord injury. Spinal Cord 2019; 57: 942-952
18 Qin W, Bauman WA, Cardozo C. Bone and muscle loss after spinal cord injury: organ interactions. Ann N Y Acad Sci 2010; 1211: 66-84
19 Lewis JE, Nash MS, Hamm LF, Martins SC, Groah SL. The Relationship Between Perceived Exertion and Physiologic Indicators of Stress During Graded Arm Exercise in Persons With Spinal Cord Injuries. Arch Phys Med Rehabil 2007; 88: 1205-1211
20 Burns P, Kressler J, Nash MS. Physiological Responses to Exergaming After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2012; 18: 331-339
21 Goosey-Tolfrey V, Lenton J, Goddard J, Oldfield V, Tolfrey K, Eston R. Regulating intensity using perceived exertion in spinal cord-injured participants. Med Sci Sports Exerc 2010; 42: 608-613
22 Lovell D, Shields D, Beck B, Cuneo R, McLellan C. The aerobic performance of trained and untrained handcyclists with spinal cord injury. Eur J Appl Physiol 2012; 112: 3431-3437
23 Al-Rahamneh HQ, Eston RG. Prediction of peak oxygen consumption from the ratings of perceived exertion during a graded exercise test and ramp exercise test in able-bodied participants and paraplegic persons. Arch Phys Med Rehabil 2011; 92: 277-283
24 Hooker SP, Wells CL. Aerobic power of competitive paraplegic road racers. Paraplegia 1992; 30: 428-436
25 Pelletier CA, Jones G, Latimer-Cheung AE, Warburton DE, Hicks AL. Aerobic capacity, orthostatic tolerance, and exercise perceptions at discharge from inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil 2013; 94: 2013-2019
26 Hjeltnes N, Wallberg-Henriksson H. Improved work capacity but unchanged peak oxygen uptake during primary rehabilitation in tetraplegic patients. Spinal Cord 1998; 36: 691-698
27 Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil 2018; 40: 497-521
28 Guilhem G, Rabita G, Brocherie F, Tsolakidis E, Ferrauti A, Helge JW, Piacentini MF. Book of Abstracts of the 28th Annual Congress of the European College of Sport Science, 4 – 7 July 2023 ISBN 978-3-9818414-6-6
29 Hol AT, Eng JJ, Miller WC, Sproule S, Krassioukov AV. Reliability and Validity of the Six-Minute Arm Test for the Evaluation of Cardiovascular Fitness in People With Spinal Cord Injury. Arch Phys Med Rehabil 2007; 88: 489-495
30 Theisen D, Vanlandewijck Y, Sturbois X, Francaux M. Cutaneous vascular response and thermoregulation in individuals with paraplegia during sustained arm-cranking exercise. Int J Sports Med 2001; 22: 97-102
31 Goosey-Tolfrey VL, Alfano H, Fowler N. The influence of crank length and cadence on mechanical efficiency in hand cycling. Eur J Appl Physiol 2008; 102: 189-194
32 Hart S, Drevets K, Alford M, Salacinski A, Hunt BE. A method-comparison study regarding the validity and reliability of the Lactate Plus analyzer. BMJ Open 2013; 3: e001899
33 McManus CJ, Collison J, Cooper CE. Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise. J Biomed Opt 2018; 23: 1-14
34 Hasnan N, Mohamad Saadon NS, Hamzaid NA, Teoh MX, Ahmadi S, Davis GM. Muscle oxygenation during hybrid arm and functional electrical stimulation–evoked leg cycling after spinal cord injury. Medicine (Baltimore) 2018; 97: 12922
35 Sanchez-Jimenez JL, Cibrian-Ortiz de Anda RM, Vazquez-Fariñas M, Martin-Manjarres S, Priego-Quesada JI, Aparicio-Aparicio I. Effect of spinal cord injury on the skin temperature of different regions of interest during a graded exercise test in a moderate temperature environment. J Therm Biol 2024; 125: 103969
36 Sendra-Pérez C, Encarnación-Martínez A, Oficial-Casado F, Salvador-Palmer R, Priego-Quesada JI. A comparative analysis of mathematical methods for detecting lactate thresholds using muscle oxygenation data during a graded cycling test. Physiol Meas 2023; 44: 125013
37 Batterson PM, Kirby BS, Hasselmann G, Feldmann A. Muscle oxygen saturation rates coincide with lactate-based exercise thresholds. Eur J Appl Physiol 2023; 123: 2249-2258
38 Hofmann P, Tschakert G. Special Needs to Prescribe Exercise Intensity for Scientific Studies. Cardiol Res Pract 2010; 2011: 209302
39 Cohen J. Statistical Power Analysis for the Behavioral Sciences, Second edn. New York: Lawrance Eribaum Associates; 1988
40 Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005; 19: 231-240
41 Martin Bland J, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet 1986; 327: 307-310
42 Turnes T, Penteado Dos Santos R, de Aguiar RA, Loch T, Possamai LT, Caputo F. Association Between Deoxygenated Hemoglobin Breaking Point, Anaerobic Threshold, and Rowing Performance. Int J Sports Physiol Perform 2019; 14: 1103-1109
43 Sendra-Pérez C, Encarnacion-Martinez A, Salvador-Palmer R, Murias JM, Priego-Quesada JI. Profiles of muscle-specific oxygenation responses and thresholds during graded cycling incremental test. Eur J Appl Physiol 2025; 125: 237-245
44 Driller M, Borges N, Plews D. Evaluating a new wearable lactate threshold sensor in recreational to highly trained cyclists. Sports Eng 2016; 19: 229-235
45 Raleigh C, Donne B, Fleming N. Association between different Non-Invasively Derived Thresholds with Lactate Threshold during graded incremental exercise. Int J Exerc Sci 2018; 11: 391-403
46 Osmani F, Lago-Fuentes C, Alemany-Iturriaga J, Barcala-Furelos M. The relationship of muscle oxygen saturation analyzer with other monitoring and quantification tools in a maximal incremental treadmill test. Front Physiol 2023; 14: 1155037
47 van der Zwaard S, Jaspers RT, Blokland IJ. et al. Oxygenation Threshold Derived from Near-Infrared Spectroscopy: Reliability and Its Relationship with the First Ventilatory Threshold. PLoS One 2016; 11: e0162914
48 Kraaijenbrink C, Vegter R, de Groot S. et al. Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review. Disabil Rehabil 2021; 43: 3461-3475
49 Krassioukov A, West C. The role of autonomic function on sport performance in athletes with spinal cord injury. PM&R 2014; 6: 58-65
50 Martín-Manjarrés S, Rodríguez-López C, Martín-García M. et al. Increased Fat Oxidation During Arm Cycling Exercise in Adult Men With Spinal Cord Injury Compared With Noninjured Controls. Int J Sport Nutr Exerc Metab 2022; 32: 30-40
51 Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol 2009; 169: 157-164
52 Rud B, Foss O, Krustrup P, Secher NH, Hallén J. One-legged endurance training: leg blood flow and oxygen extraction during cycling exercise. Acta Phys (Oxford, England) 2012; 205: 177-185
53 Roca J, Agusti AG, Alonso A. et al. Effects of training on muscle O2 transport at VO2max. Journal of App Phy (Bethesda, Md 1985) 1992; 73: 1067-1076
54 Niemeijer VM, Jansen JP, van Dijk T. et al. The influence of adipose tissue on spatially resolved near-infrared spectroscopy derived skeletal muscle oxygenation: the extent of the problem. Physiol Meas 2017; 38: 539-554
55 Gandia-Soriano A, Salas-Montoro J-A, Javaloyes A. et al. Validity and Reliability of Two Near-infrared Spectroscopy Devices to Measure Resting Hemoglobin in Elite Cyclists. Int J Sports Med 2022; 43: 875-880
56 Sendra-Pérez C, Priego-Quesada JI, Salvador-Palmer R, Murias JM, Encarnacion-Martinez A. Sex-related differences in profiles of muscle oxygen saturation of different muscles in trained cyclists during graded cycling exercise. J Appl Physiol 2023; 135: 1092-1101