title: Methodological aspects of crossover and maximum fat-oxidation rate point determination.
abstract: OBJECTIVE
  Indirect calorimetry during exercise provides two metabolic indices of substrate oxidation balance: the crossover point (COP) and maximum fat oxidation rate (LIPOXmax). We aimed to study the effects of the analytical device, protocol type and ventilatory response on variability of these indices, and the relationship with lactate and ventilation thresholds.
  
  
  METHODS
  After maximum exercise testing, 14 relatively fit subjects (aged 32+/-10 years; nine men, five women) performed three submaximum graded tests: one was based on a theoretical maximum power (tMAP) reference; and two were based on the true maximum aerobic power (MAP). Gas exchange was measured concomitantly using a Douglas bag (D) and an ergospirometer (E).
  
  
  RESULTS
  All metabolic indices were interpretable only when obtained by the D reference method and MAP protocol. Bland and Altman analysis showed overestimation of both indices with E versus D. Despite no mean differences between COP and LIPOXmax whether tMAP or MAP was used, the individual data clearly showed disagreement between the two protocols. Ventilation explained 10-16% of the metabolic index variations. COP was correlated with ventilation (r=0.96, P<0.01) and the rate of increase in blood lactate (r=0.79, P<0.01), and LIPOXmax correlated with the ventilation threshold (r=0.95, P<0.01).
  
  
  CONCLUSIONS
  This study shows that, in fit healthy subjects, the analytical device, reference used to build the protocol and ventilation responses affect metabolic indices. In this population, and particularly to obtain interpretable metabolic indices, we recommend a protocol based on the true MAP or one adapted to include the transition from fat to carbohydrate. The correlation between metabolic indices and lactate/ventilation thresholds suggests that shorter, classical maximum progressive exercise testing may be an alternative means of estimating these indices in relatively fit subjects. However, this needs to be confirmed in patients who have metabolic defects.
authors.affiliation: Laboratoire de recherche-exercice, santé REX-S, IFR 1, hôpital Sud, université Joseph-Fourier Grenoble-1, BP 338, 38043 Echirolles cedex, France; Inserm, ERI17, laboratoire HP2, université Joseph-Fourier Grenoble-1, 38042 Grenoble, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Michallet
authors.forename: J
authors.initials: J
authors.lastname: Tonini
authors.forename: J
authors.initials: J
authors.lastname: Regnier
authors.forename: M
authors.initials: M
authors.lastname: Guinot
authors.forename: A
authors.initials: A
authors.lastname: Favre-Juvin
authors.forename: V
authors.initials: V
authors.lastname: Bricout
authors.forename: S
authors.initials: S
authors.lastname: Halimi
authors.forename: B
authors.initials: B
authors.lastname: Wuyam
authors.forename: P
authors.initials: P
authors.lastname: Flore
mesh_terms: D000328:Adult; D015308:Anaerobic Threshold / Q000502:physiology; D002153:Calorimetry, Indirect / Q000379:methods; D002245:Carbon Dioxide / Q000032:analysis; D004041:Dietary Fats / Q000378:metabolism*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D010084:Oxidation-Reduction; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology; D012016:Reference Values; D015656:Respiratory Mechanics; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D002245:Carbon Dioxide