title: Identification and agreement of first turn point by mathematical analysis applied to heart rate, carbon dioxide output and electromyography.
abstract: BACKGROUND
  The second heart rate (HR) turn point has been extensively studied, however there are few studies determining the first HR turn point. Also, the use of mathematical and statistical models for determining changes in dynamic characteristics of physiological variables during an incremental cardiopulmonary test has been suggested.
  
  
  OBJECTIVE
  To determine the first turn point by analysis of HR, surface electromyography (sEMG), and carbon dioxide output (VCO2) using two mathematical models and to compare the results to those of the visual method.
  
  
  METHODS
  Ten sedentary middle-aged men (53.9 ± 3.2 years old) were submitted to cardiopulmonary exercise testing on an electromagnetic cycle ergometer until exhaustion. Ventilatory variables, HR, and sEMG of the vastus lateralis were obtained in real time. Three methods were used to determine the first turn point: 1) visual analysis based on loss of parallelism between VCO2 and oxygen uptake (VO2); 2) the linear-linear model, based on fitting the curves to the set of VCO2 data (Lin-LinVCO2); 3) a bi-segmental linear regression of Hinkley's algorithm applied to HR (HMM-HR), VCO2 (HMM-VCO2), and sEMG data (HMM-RMS).
  
  
  RESULTS
  There were no differences between workload, HR, and ventilatory variable values at the first ventilatory turn point as determined by the five studied parameters (p>0.05). The Bland-Altman plot showed an even distribution of the visual analysis method with Lin-LinVCO2, HMM-HR, HMM-VCO2, and HMM-RMS.
  
  
  CONCLUSIONS
  The proposed mathematical models were effective in determining the first turn point since they detected the linear pattern change and the deflection point of VCO2, HR responses, and sEMG.
authors.affiliation: Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Zamunér
authors.affiliation: Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil.
authors.forename: Aparecida M
authors.initials: AM
authors.lastname: Catai
authors.affiliation: Universidade Estadual de Campinas, Physical Education College, CampinasSP, Brazil.
authors.forename: Luiz E B
authors.initials: LE
authors.lastname: Martins
authors.affiliation: Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sakabe
authors.affiliation: Universidade Federal de São Carlos, Physical Therapy Department, São CarlosSP, Brazil.
authors.forename: Ester
authors.initials: E
authors.lastname: Da Silva
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism*; D003430:Cross-Sectional Studies; D004576:Electromyography; D005080:Exercise Test; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical
chemical_list: D002245:Carbon Dioxide