Sports Rehabilitation

VO₂max is the maximum amount of oxygen your body can take in, transport to working muscle and utilize during maximal intensity exercise. It’s considered one of the best indicators of cardiovascular fitness and aerobic endurance performance. The more oxygen a person can use during high levels of exercise, the more energy (ATP) they can generate, the greater their VO₂max will be and the greater their capacity for endurance performance.

How it works:

We’ll directly measure the volume and gas concentrations of inspired and expired air while you exercise on either a treadmill or stationary bicycle (your choice) while wearing a face mask. You’ll exercise at an intensity that increases every few minutes until you believe you can’t continue.

The test is designed to achieve a maximal effort and allow us to obtain a maximal heart rate and maximal aerobic capacity (VO₂max). The data will enable us to prescribe precise training zones based on speed, pace, heart rate and other variables. You’ll leave the lab with an abundance of personalized data, detailed knowledge of your current cardiovascular fitness level and how best to train and improve performance.

The iDXA scan is the most accurate method to practically assess body composition.

Body composition is the body’s amount of muscle mass, fat mass and bone mass. An optimal body composition is important for endurance as well as overall health. While a certain level of body fat is necessary to ensure proper physical and physiological functions, excess body fat has been shown to increase the risk of disease, such as cancer, diabetes and heart disease.

Measuring body weight alone can be misleading, because a scale doesn’t know the difference between one pound of muscle and one pound of fat. The iDXA uses dual energy x-ray absorptiometry to measure your muscle mass, fat mass and bone mass, as well as bone mineral density to screen for osteoporosis).

To maximize endurance performance, it is important to optimize body fat levels. Body fat is metabolically inactive tissue, meaning it requires oxygen but it doesn’t provide meaningful work. Muscle on the other hand, is metabolically active tissue. This means the oxygen muscles use can be turned into energy that helps us swim, bike or run. Having higher levels of body fat means you will carry extra weight that doesn’t help you swim, bike or run faster.

How it works:

The iDXA scan is a simple, pain-free process. To prepare for the test, wear loose clothing with no metal. You’ll lie on your back on a padded table and remain still for 15 minutes while the machine scans your entire body (excluding your head).

Following the iDXA scan, you’ll be provided with an exact blueprint of your muscle, fat and bone mass. By having a clear and extremely accurate measurement of your body composition, you can take the proper steps to improve your athletic performance and overall health. You’ll also be provided with a comprehensive and personalized list of exercises to help you achieve your goals.

Sweat composition refers to the amount of sodium and other electrolytes in your sweat. Sodium makes up 80 percent of the total electrolyte concentration of your sweat, making it an extremely important marker to pay attention to, especially when you’re exercising.

Every year, athletes succumb to hydration-related issues, including dehydration, cramping and hyponatremia (low blood sodium). The amount of sweat and sodium lost between people can vary as much as 15 times. This means “one-size-fits-all” does not apply to hydration. It’s important to measure your personal sweat composition to ensure you’re adequately replacing the proper amount of fluids and sodium.

How it works:

Our sweat test takes about 20 minutes and doesn’t require exercise. You’ll answer a few questions while we collect sweat from your forearm. Our lead exercise physiologist will attach two electrodes to your forearm that deliver an imperceptible electrical stimulation causing your sweat glands to activate. After the electrodes have been active for about five minutes, they’ll be removed and a sweat collector will be placed where the electrodes elicited the sweat. After about 10 minutes, we will have collected enough sweat to dispense into an analyzer that will read your sweat sodium concentration. This value is largely genetically predetermined and will change very little throughout your lifetime, so one test is all you’ll ever need.

Following the test, you’ll receive a comprehensive hydration plan that includes when, what and how much to drink before, during and after training and competitions to optimize your performance.

You also may purchase a variety of Precision Hydration products that contain up to 3.5 times more electrolytes than other brands you may have previously used (we apply a 25% discount on these products following testing sessions).

The lactate threshold is the point during incremental exercise when lactate is produced faster than it can be used. Your body always produces lactate, which is used as a fuel source at rest and during exercise by shuttling it to the mitochondria or liver, where it’s turned into energy. Even your heart and brain use lactate as a fuel source.

At lower intensities, the body can use lactate produced from metabolic pathways that give us energy. However, when exercise intensity reaches a certain point, lactate can’t be used as fast as it’s produced and begins to accumulate in the blood. The lactate threshold is a good indicator of submaximal endurance performance (anything that lasts longer than 12-15 minutes).

How it works:

We measure lactate threshold by drawing blood from your fingertip at intervals during an incremental exercise test. This can be performed on a treadmill or stationary bicycle (your choice), and you’ll exercise at an intensity that is increased every 3-4 minutes until you reach just beyond your lactate threshold.

Following the test, you will leave the lab with an abundance of personalized data, detailed knowledge of your current cardiovascular fitness level, and how best to train and improve performance.

The body’s metabolic processes require energy and are measured in calories per day. The total number of calories you burn in each day is known as Total Daily Energy Expenditure; it comes from several sources, including resting metabolic rate (RMR), the thermic effect of food and physical activity.

Your RMR represents the number of calories you need to maintain essential functions at rest, such as heartbeat and breathing. It constitutes the largest percentage of TDEE (60-75 percent) in most people. RMR is relatively constant but can fluctuate with changes in muscle mass, conditioning and diet. Pinpointing the precise number of calories you burn at rest is crucial if you’re trying to lose weight or build muscle mass. Therefore, testing your RMR directly is important.

How it works:

Diligent preparation is important, because your RMR is very sensitive. It’s affected by many factors, including environment, hormones, stress, movement and digestion. To ensure accurate results, please follow these steps prior to your test:

1. Avoid exercising for 12 hours; no food, tobacco or alcohol
2. Avoid coffee or other caffeine sources for at least 6 hours
3. Continue taking any prescription medications as recommended by your doctor
4. Drink water as needed
5. Come to the test well rested and in comfortable clothing

During the test:

1. Relax comfortably while breathing into a mask for 20-30 minutes. The mask will cover your mouth and nose but will not provide you with extra air. You will breathe air from the environment.
2. We measure the amount of oxygen you consume.

Following the test:

1. We analyze your data, review it with you and answer any questions
2. You will be provided with the following information:
3. Your personalized resting metabolic rate (how many calories your burn throughout the day) and how that compares to others your age, height, weight and sex
4. Your body mass index (BMI)
5. How many grams of carbohydrates, fat and protein you burn
6. Recommendations for nutrient consumption and timing
7. Your resting breathing frequency
8. Your resting heart rate.

Metabolic efficiency refers to the amount of fat utilized as the primary fuel source at a given intensity during exercise. The fat stores in our body are nearly unlimited (100,000 calories are enough to run roughly 1,000 miles on fat alone). By comparison, our bodies store much less carbohydrates — 2,000 calories worth of energy (or roughly 20 miles of running).

At lower intensity exercises, fat is the body’s preferred fuel source. That’s because fat provides the body with more energy (per gram) than carbohydrates (9 calories for fat vs. 4 calories for carbohydrates).

At higher intensities, fat takes too long to break down and cannot provide energy quickly enough for our body to perform the work it needs to. This is when carbohydrates take over as the preferred fuel source.

To burn fat, it’s necessary for the body to have an adequate amount of carbohydrates, because the metabolic processes involved in fat breakdown require a product derived from the breakdown of carbohydrates (oxaloacetate). If you don’t have this product, the fat metabolism process becomes a “metabolic traffic jam,” so to speak. So, if you choose to go on a low- or no-carbohydrate diet, you’ll deplete your carbohydrate stores and your ability to create this byproduct of carbohydrate metabolism also used in fat metabolism. Yes, you’ll be better at burning fat at a given intensity, but having the best fat metabolism does not on its own help you go faster or win races.

How it works:

You’ll visit the Performance Lab after fasting. It’s important to arrive fasted to enable us to obtain an accurate assessment of your metabolic status and allow for a clear “picture” of your substrate oxidation rates without the influence of food. It’s also important to stay hydrated and drink water, but NOT coffee or other caffeinated drinks as these will influence your substrate oxidation rates.

We will directly measure the volume and gas concentrations of your inspired and expired air while you wear a face mask. The test can be performed on a treadmill or stationary bicycle (your choice), and you’ll exercise at an intensity that increases every four to five minutes until you believe you can’t continue. The test is designed this way to elicit a steady-state condition during each exercise stage so we can get an accurate measurement of how much fat and carbohydrate you use at each intensity. The test usually lasts 20-45 minutes, depending on your fitness level, but your appointment is scheduled for one hour.

Within one week following your test, you will have the option to come back to the lab and discuss your results or discuss the results over the phone. We’ll interpret the data and formulate a metabolic plan based on your metabolism:

1. Your personalized Metabolic Efficiency Point.
2. This will tell you when your body begins to favor carbohydrates as its primary fuel source over fat.
3. The amount of fats and carbohydrates you burn at various intensity levels per hour of exercise.
4. Intensity is measured by speed, heart rate, pace/power and rating of perceived exertion.
5. The amount of total carbohydrate and fat calories per hour your body burns at each intensity level.
6. Your personalized value of the amount of carbohydrate calories needed per hour of exercise.
7. This will provide you a range of carbohydrate calories to consume during exercise based on the intensity of exercise, your current fitness level, gender, age and physiology.

Anaerobic capacity refers to the most energy your body can produce using anaerobic (without oxygen) energy systems during short-duration, maximal exercise. Energy is produced extremely fast through anaerobic systems. However, this rate of energy production can only be sustained for two to three minutes. This makes anaerobic capacity particularly important for athletes whose efforts last less than this amount of time, such as those who compete in sprint events.

That said, anaerobic capacity also is important for endurance athletes whose events last longer than three minutes. Even though the aerobic energy system is the primary system used for endurance events, the anaerobic system can contribute up to 10 percent of the total energy used for long-distance events.

How it works:

There are a variety of testing options to measure anaerobic capacity. However, one of the most popular is the Wingate test. Performed on a stationary bicycle in the Performance Lab, you’ll pedal as hard as you can for 30 seconds.

Following the testing session, you will be provided with the following information:

• Peak power – highest power seen during the test
• Mean power – average power during the test
• Anaerobic capacity – mean power divided by body weight (W/kg)
• Anaerobic power – peak power divided by body weight (W/kg)
• Fatigue index – peak watts minus the minimum watts divided by the test duration (W/s)
• Total work – average watts time test duration (J)
• Submaximal exercise to estimate VO2max
• Cardiorespiratory fitness, skinfold testing, flexibility, and muscular strength and endurance

Body composition is the body’s amount of muscle and fat mass. It’s well established that excess body fat is associated with many diseases (hypertension, type 2 diabetes, heart disease, etc.). More than 66 percent of American adults are classified as overweight and over 33 percent are classified as obese. To optimize athletic performance and maintain a healthy lifestyle, it’s important to assess your body fat percentage.

How it works:

Your body composition will be assessed using skinfold calipers that measure the subcutaneous fat at seven locations on your body. The measurements will be used to give us a value of your body fat percentage. From there, we’ll compare your results to those of other individuals your age and sex to determine your body composition ranking.

Obtaining a measurement of your body composition will enable you to take the proper training and nutritional steps to improve your athletic performance and overall health.

Pulmonary function tests are a noninvasive way to show how well your lungs work. The tests can measure a variety of volumes and capacities, rates of flow and gas exchange. These can be used to diagnose and/or treat lung disorders.

The ventilatory muscles can be a limiting factor in endurance performance. By reducing inspiratory muscle work, we can reduce blood flow to the respiratory muscles, increase blood flow to the locomotor muscles, decrease locomotor muscle fatigue and increase exercise time to exhaustion.

How it works:

We use a handheld device that you will breathe through. You’ll perform a series of breathing tests that will provide useful information about your lung function. You’ll learn:

• Forced vital capacity (maximum amount of air exhaled from your lungs after taking the deepest possible breath)
• Forced expiratory volume (how much air you can exhale during a forced breath).
• Forced expiratory flow (speed of air coming out of the lungs during the middle portion of a forced expiration)
• Maximal voluntary ventilation (maximum amount of air inhaled and exhaled in one minute).
• Breaths per minute (maximum amount of breaths you take per minute)
• Tidal volume (amount of air inhaled and exhaled with a normal breath)

Chances are, you already know the benefits of being physically fit, but what does being “physically fit” mean and how do you achieve it? That’s where the five components of physical fitness come in:

1. Cardiorespiratory fitness
2. Body composition
3. Muscular strength
4. Muscular endurance
5. Flexibility

Developed by the American College of Sports Medicine, the components of fitness serve as a tool for assessing, organizing and implementing a well-structured exercise routine.

Cardiorespiratory fitness

Cardiorespiratory fitness (CRF) is your body’s ability to perform large-muscle, dynamic, moderate-to-high intensity exercise for prolonged periods of time. The goal of the cardiorespiratory system is to turn oxygen into energy for your muscles to use during sustained physical activity. Activities such as swimming, cycling, running and anything else that challenges your cardiorespiratory system (your heart, lungs and blood vessels) are beneficial ways to improve your CRF.

One reason CRF is important is because low levels are related to a substantially higher risk of premature death from all causes, but especially heart disease. This is particularly important because heart disease is the leading cause of death for both men and women.

Your CRF will be assessed while you walk on a treadmill. We’ll compare your results to people the same age and sex to determine your CRF ranking.

Muscular fitness

Muscular fitness is an integral part of total health-related fitness and is comprised of muscular strength and muscular endurance. Muscular strength refers to the force that can be generated by a specific muscle or group of muscles and can be assessed statically or dynamically. Muscular endurance refers to a muscle or group of muscles’ abilities to execute repeated contractions over a period sufficient to cause muscular fatigue.

Muscular strength and endurance may improve or maintain bone mass (related to osteoporosis), glucose tolerance (related to type 2 diabetes), musculotendinous integrity (related to a lower risk of injury, including low back pain), the ability to carry out activities of daily living (related to self-esteem) and resting metabolic rate (related to weight management).

Performing muscular fitness tests before starting a training program can provide valuable information regarding your current training status.

To assess your muscular strength, you’ll perform a standardized one-repetition maximum test (this can be modified up to 10-repetition maximum). Muscular endurance will be assessed by having you perform a push-up and partial curl-up. From there, we’ll compare you to other individuals your age and sex to determine your body composition ranking.

Flexibility

Flexibility, the ability to move a joint through its complete range of motion, is important for athletic performance as well as activities of daily living. Maintaining flexibility of your joints helps to facilitate movement. On the other hand, if you perform an activity that moves the joint beyond its range of motion, tissue damage can occur. Ensuring appropriate flexibility enables you to avoid injury and improve efficiency while swimming, cycling and/or running.

See our Running form analysis page here.