title: Graded Exercise Testing Versus Simulated Competition Exercise in Trained Older Males.
abstract: OBJECTIVE
  Exercise-based rehabilitation is a standard therapy for patients with heart disease. Despite examples of patients who have extended normal rehabilitation exercise into competitive participation, there are no clear-cut guidelines for patients whether they should participate in competitive-level exercise. This study investigated the occurrence of complications, physiologic responses, and exercise patterns during simulated competitive exercise in active, older nonathletes (most with a history of cardiovascular disease) and compared these with responses during maximal incremental exercise.
  
  
  METHODS
  Fourteen trained older males, 7 with stable cardiovascular disease, performed an incremental exercise test and time trial of 55 kJ (equivalent to running ∼1 mile) on a semirecumbent stepping ergometer. Variables of gas exchange, hemodynamics, perception, and power output were measured in both tests.
  
  
  RESULTS
  Subjects attained a remarkably high physiologic and psychologic strain (respiratory exchange ratio >1.0; average peak rating of perceived exertion >8) in both tests, with no evidence of symptomatic, hemodynamic, or electrocardiographic abnormalities. Peak physiologic responses were not significantly different between simulated competition and incremental exercise. The fixed-work time trial was finished in 8.97 ± 1.85 minutes, mean power output of 100 ± 26 W. Results showed a distinct pacing pattern in the relative power output, consisting of a conservative start, an even-paced middle portion, and an end spurt.
  
  
  CONCLUSIONS
  Results suggest that in trained individuals with normal incremental exercise test results, competitive-level efforts may be undertaken with no apparent side effects. This may provide a strategy whereby physicians can advise patients concerning their decision to perform in competitive events.
authors.affiliation: MOVE Research Institute Amsterdam (Mr van der Zwaard, Mr Rougoor, Mr van Kasteel, Dr de Koning, and Dr Foster), Department of Human Movement Sciences, VU University Amsterdam, the Netherlands; and Department of Exercise and Sport Sciences (Dr de Koning, Mr Hill, Dr Porcari, and Dr Foster), Department of Physical Therapy (Dr Greany), and Student Health Services (Dr Allen), University of Wisconsin-La Crosse, La Crosse, Wisconsin.
authors.forename: Stephan
authors.initials: S
authors.lastname: van der Zwaard
authors.forename: Guus
authors.initials: G
authors.lastname: Rougoor
authors.forename: Paul Y
authors.initials: PY
authors.lastname: van Kasteel
authors.forename: John
authors.initials: J
authors.lastname: Greany
authors.forename: Jos J
authors.initials: JJ
authors.lastname: de Koning
authors.forename: Ethan
authors.initials: E
authors.lastname: Hill
authors.forename: John P
authors.initials: JP
authors.lastname: Porcari
authors.forename: Brian
authors.initials: B
authors.lastname: Allen
authors.forename: Carl
authors.initials: C
authors.lastname: Foster
mesh_terms: D000368:Aged; D003163:Competitive Behavior; D015444:Exercise; D005080:Exercise Test / Q000706:statistics & numerical data*; D005081:Exercise Therapy / Q000379:methods*; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D016896:Treatment Outcome