Assessment of the Heart Rate Deflection Point in Athletes for a Non-Invasive Determination of the Anaerobic Threshold: A Systematic Review

Abstract

Objectives

This study analyzed the systematic bias, limits of agreement (LoA), and association between the anaerobic threshold (AT) and the heart rate deflection point (HRDP) in athletes.

Methods

A systematic search in EBSCOhost, PubMed, and Scopus was performed to identify studies analyzing AT (via blood lactate or gas exchange) and HRDP in athletes. Specific participant characteristics, exercise protocols, and analytical procedures were recorded. A random-effects meta-analysis evaluated agreement and bias between HRDP and AT. Systematic bias between AT and HRDP was assessed for heart rate (beats/min), running speed (km/h), and power output (W). Furthermore, meta-regression analysis was computed by considering the design of exercise protocols as well as methods applied to examine the AT (i.e., second lactate or ventilatory threshold), and the HRDP (i.e., mathematical detection or. visual analysis) as potential moderators.

Results

Twenty-five studies were selected, covering athletes such as runners, cyclists, mountain runners, and rowers. Significant systematic bias was found in heart rate (2.9 beats/min) and running speed (0.7 km/h), but not in power output (4.2 W). Wide limits of agreement were noted across all metrics, and the exercise protocol significantly influenced bias in speed. Methods applied to examine the AT and the HRDP did not influence the systematic bias between exercise thresholds.

Conclusion

Significant bias, wide LoA, and large estimation errors suggest HRDP is not reliable for non-invasive AT estimation in athletes. Standardized protocols and further exploration of population-specific moderators are necessary to enhance its utility as a practical tool for monitoring training adaptations.

Keywords

Anaerobic threshold / Heart rate / Deflection point

References

[1] Baiget E, Fernández-Fernández J, Iglesias X, Rodríguez FA. Heart rate Deflection point relates to second ventilatory threshold in a tennis test. J Strength Conditioning Res, 2015, 29(3): 765-71

[2] Bates D, Mächler M, Bolker B, Walker S. Fitting linear Mixed-Effects models Usinglme4. J Stat Softw. 2015;67(1). https://doi.org/10.18637/jss.v067.i01.

[3] Benítez-Muñoz JA, Cupeiro R, Rubio-Arias JÁ, Amigo T, González-Lamuño D. Exercise influence on monocarboxylate transporter 1 (MCT1) and 4 (MCT4) in the skeletal muscle: A systematic review. Acta Physiol (Oxf), 2024, 240(3): e14083

[4] Binder RK, Wonisch M, Corra U, Cohen-Solal A, Vanhees L, Saner H, Schmid J-P. Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. Eur J Cardiovasc Prev Rehabil. 2008;15(6):726–34. https://doi.org/10.1097/HJR.0b013e328304fed4.

[5] Birnbaumer P, Dostal T, Cipryan L, Hofmann P. Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18–65 years old men and women: the 4HAIE study. Front Physiol, 2023, 14: 1178913

[6] Birnbaumer P, Traninger H, Borenich A, Falgenhauer M, Modre-Osprian R, Harpf H, Hofmann P. Heart rate performance curve is dependent on age, sex, and performance. Front Public Health, 2020, 8: 98

[7] Bodner ME, Rhodes EC. A review of the concept of the heart rate Deflection point. Sports Med (Auckland N Z), 2000, 30(1): 31-46

[8] Bodner ME, Rhodes EC, Martin AD, Coutts KD. The relationship of the heart rate Deflection point to the ventilatory threshold in trained cyclists. J Strength Conditioning Res, 2002, 16(4): 573-80

[9] Bourgois J, Coorevits P, Danneels L, Witvrouw E, Cambier D, Vrijens J. Validity of the heart rate Deflection point as a predictor of lactate threshold concepts during cycling. J Strength Conditioning Res, 2004, 18(3): 498-503

[10] Bourgois J, Vrijens J. The conconi test: A controversial concept for the determination of the anaerobic threshold in young rowers. Int J Sports Med, 1998, 19(8): 553-9

[11] Cellini M, Vitiello P, Nagliati A, Ziglio PG, Martinelli S, Ballarin E, Conconi F. Noninvasive determination of the anaerobic threshold in swimming. Int J Sports Med, 1986, 7(6): 347-51

[12] Chávez-Guevara IA, Hernández-Torres RP, Trejo-Trejo M, Moreno-Brito V, González-Rodríguez E, Ramos-Jiménez A. Association among different aerobic threshold markers and fatmax in men with obesity. Res Q Exerc Sport, 2023, 94(3): 861-8

[13] Chavez-Guevara IA, Helge JW, Amaro-Gahete FJ. Stop the madness! An urgent call to standardize the assessment of exercise physiology thresholds. J Physiol, 2024, 602(17): 4089-92

[14] Conconi F, Ferrari M, Ziglio PG, Droghetti P, Codeca L. Determination of the anaerobic threshold by a noninvasive field test in runners. J Appl Physiology: Respiratory Environ Exerc Physiol, 1982, 52(4): 869-73

[15] Conconi F, Grazzi G, Casoni I, Guglielmini C, Borsetto C, Ballarin E, Mazzoni G, Patracchini M, Manfredini F. The C conconi test: methodology after 12 years of application. Int J Sports Med, 1996, 17(7): 509-19

[16] Denis C, Fouquet R, Poty P, Geyssant A, Lacour JR. Effect of 40 weeks of endurance training on the anaerobic threshold. Int J Sports Med, 1982, 3(4): 208-14

[17] Droghetti P, Borsetto C, Casoni I, Cellini M, Ferrari M, Paolini AR, Ziglio PG, Conconi F. Noninvasive determination of the anaerobic threshold in canoeing, cross-country skiing, cycling, roller, and ice-skating, rowing, and walking. Eur J Appl Physiol Occup Physiol, 1985, 53(4): 299-303

[18] Edwards AM, Clark N, Macfadyen AM. Lactate and ventilatory thresholds reflect the training status of professional soccer players where maximum aerobic power is unchanged. J Sports Sci Med, 2003, 2(1): 23-9

[19] Fabre N, Passelergue P, Bouvard M, Perrey S. Comparison of heart rate Deflection and ventilatory threshold during a field cross-country roller-skiing test. J Strength Conditioning Res, 2008, 22(6): 1977-84

[20] Faude O, Kindermann W, Meyer T. Lactate threshold concepts: how valid are they?. Sports Med (Auckland N Z), 2009, 39(6): 469-90

[21] Ferri Marini C, Sisti D, Leon AS, Skinner JS, Sarzynski MA, Bouchard C, Rocchi MBL, Piccoli G, Stocchi V, Federici A, Lucertini F. HRR and V˙O2R fractions are not equivalent: is it time to rethink aerobic exercise prescription methods??. Med Sci Sports Exerc, 2021, 53(1): 174-82

[22] Ferri Marini C, Tadger P, Chávez-Guevara IA, Tipton E, Meucci M, Nikolovski Z, Amaro-Gahete FJ, Peric R. Factors determining the agreement between aerobic threshold and point of maximal fat oxidation: Follow-Up on a systematic review and Meta-Analysis on association. Int J Environ Res Public Health, 2022, 20(1): 453

[23] Forsyth J, Burt D, Ridley F, Mann C. Using lactate threshold to predict 5-km treadmill running performance in veteran athletes. Biology Sport, 2017, 34(3): 233-7

[24] Gibbons RD, Hedeker DR, Davis JM. Estimation of effect size from a series of experiments involving paired comparisons. J Educational Stat, 1993, 18(3): 271

[25] Ghosh AK. Anaerobic threshold: its concept and role in endurance sport. Malaysian J Med Sciences: MJMS, 2004, 11(1): 24-36

[26] 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(2): e001899

[27] Henritze J, Weltman A, Schurrer RL, Barlow K. Effects of training at and above the lactate threshold on the lactate threshold and maximal oxygen uptake. Eur J Appl Physiol Occup Physiol, 1985, 54(1): 84-8

[28] Harrer M, Cuijpers P, Furukawa T, Ebert DD. dmetar: companion R package for the guide ‘doing meta-analysis in R’. R Package Version 0.0.9000. 2021. http://dmetar.protectlab.org/. Accessed 30 Jun 2021.

[29] Heck H, Wackerhage H. The origin of the maximal lactate steady state (MLSS). BMC sports science. Med Rehabilitation, 2024, 16(1): 36

[30] Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-60

[31] Higgins JPT, Thomas J, Chandler JCM, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions version 6.4 (updated August 2023). 2023. https://www.training.cochrane.org/handbook. Accessed 30 Aug 2023.

[32] Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A, 2009, 172(1): 137-59

[33] Heber S, Sallaberger-Lehner M, Hausharter M, Volf I, Ocenasek H, Gabriel H, Pokan R. Exercise-based cardiac rehabilitation is associated with a normalization of the heart rate performance curve Deflection. Scand J Med Sci Sports, 2019, 29(9): 1364-74

[34] Hofmann P, Jürimäe T, Jürimäe J, Purge P, Maestu J, Wonisch M, Pokan R, von Duvillard SP. HRTP, prolonged ergometer exercise, and single sculling. Int J Sports Med, 2007, 28(11): 964-9

[35] Hofmann P, Pokan R. Value of the application of the heart rate performance curve in sports. Int J Sports Physiol Perform, 2010, 5(4): 437-47

[36] Hopkins WG, Marshall SW, Batterham AM, Hanin J. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sport Exc, 2009, 41(1): 3-13

[37] Jamnick NA, Pettitt RW, Granata C, Pyne DB, Bishop DJ. An examination and critique of current methods to determine exercise intensity. Sports Med (Auckland N Z), 2020, 50(10): 1729-56

[38] Jeukendrup AE, Hesselink MK, Kuipers H, Keizer HA. The conconi test. Int J Sports Med, 1997, 18(5): 393-6

[39] Jones AM, Doust JH. Lack of reliability in Conconi’s heart rate Deflection point. Int J Sports Med, 1995, 16(8): 541-4

[40] Jones AM, Doust JH. The conconi test in not valid for Estimation of the lactate turnpoint in runners. J Sports Sci, 1997, 15(4): 385-94

[41] Keir DA, Iannetta D, Mattioni Maturana F, Kowalchuk JM, Murias JM. Identification of non-invasive exercise thresholds: methods, strategies, and an online app. Sports Med, 2022, 52(2): 237-55

[42] Kjertakov M, Dalip M, Hristovski R, Epstein Y. Prediction of lactate threshold using the modified conconi test in distance runners. Physiol Int, 2016, 103(2): 262-70

[43] Laursen PB, Knez WL, Shing CM, Langill RH, Rhodes EC, Jenkins DG. Relationship between laboratory-measured variables and heart rate during an ultra-endurance triathlon. J Sport Sci, 2005, 23(10): 1111-20

[44] Lucía A, Carvajal A, Boraita A, Serratosa L, Hoyos J, Chicharro JL. Heart dimensions May influence the occurrence of the heart rate Deflection point in highly trained cyclists. Br J Sports Med, 1999, 33(6): 387-92

[45] Lucía A, Hoyos J, Santalla A, Pérez M, Carvajal A, Chicharro JL. Lactic acidosis, potassium, and the heart rate Deflection point in professional road cyclists. Br J Sports Med, 2002, 36(2): 113-7

[46] Marques-Neto SR, Maior AS, Maranhão Neto GA, Santos EL. Analysis of heart rate Deflection points to predict the anaerobic threshold by a computerized method. J Strength Conditioning Res, 2012, 26(7): 1967-74

[47] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71

[48] Pallarés JG, Morán-Navarro R, Ortega JF, Fernández-Elías VE, Mora-Rodriguez R. Validity and reliability of ventilatory and blood lactate thresholds in Well-Trained cyclists. PLoS ONE, 2016, 11(9): e0163389

[49] Peric R, Nikolovski Z, Meucci M, Tadger P, Ferri Marini C, Amaro-Gahete FJ. A systematic review and meta-analysis on the association and differences between aerobic threshold and point of optimal fat oxidation. Int J Environ Res Public Health, 2022, 19(11): 6479

[50] Petit MA, Nelson CM, Rhodes EC. Comparison of a mathematical model to predict 10-km performance from the conconi test and ventilatory threshold measurements. Can J Appl Physiol, 1997, 22(6): 562-72

[51] Pokan R, Hofmann P, Von Duvillard SP, Smekal G, Högler R, Tschan H, Baron R, Schmid P, Bachl N. The heart rate turn point reliability and methodological aspects. Med Sci Sports Exerc, 1999, 31(6): 903-7

[52] Poole DC, Rossiter HB, Brooks GA, Gladden LB. The anaerobic threshold: 50 + years of controversy. J Physiol, 2021, 599(3): 737-67

[53] Pustejovsky J. Clubsandwich. Cluster-robust (sandwich) variance estimators with small-sample corrections. R Package Version 0.5.8. 2022. https://CRAN.Rproject.org/package=clubSandwich. Accessed 29 May 2022.

[54] Schmid A, Huonker M, Aramendi JF, Klüppel E, Barturen JM, Grathwohl D, Schmidt-Trucksäss A, Berg A, Keul J. Heart rate Deflection compared to 4 mmol X l(-1) lactate threshold during incremental exercise and to lactate during steady-state exercise on an arm-cranking ergometer in paraplegic athletes. Eur J Appl Physiol Occup Physiol, 1998, 78(2): 177-82

[55] Sentija D, Vucetic V, Markovic G. Validity of the modified conconi running test. Int J Sports Med, 2007, 28(12): 1006-11

[56] Song F, Sheldon TA, Sutton AJ, Abrams KR, Jones DR. Methods for exploring heterogeneity in meta-analysis. Eval Health Prof, 2001, 24(2): 126-51

[57] Tipton E, Shuster J. A framework for the meta-analysis of Bland-Altman studies based on a limits of agreement approach. Stat Med, 2017, 36(23): 3621-35

[58] Tolfrey K, Jeukendrup AE, Batterham AM. Group- and individual-level coincidence of the ‘fatmax’ and lactate accumulation in adolescents. Eur J Appl Physiol, 2010, 109(6): 1145-53

[59] Vachon JA, Bassett DR, Clarke S. Validity of the heart rate D Deflection point as a predictor of lactate threshold during running. J Appl Physiol, 1999, 87(1): 452-9

[60] Van Hooren B, Souren T, Bongers BC. Accuracy of respiratory gas variables, substrate, and energy use from 15 CPET systems during simulated and human exercise. Scand J Med Sci Sports, 2024, 34(1): e14490

[61] Viechtbauer W. Conducting M meta-A analyses InRwith themetaforpackage. J Stat Softw, 2010, 36(3): 1-48

[62] Vucetić V, Sentija D, Sporis G, Trajković N, Milanović Z. Comparison of ventilation threshold and heart rate D Deflection point in fast and standard treadmill test protocols. Acta Clin Croatica, 2014, 53(2): 190-203

[63] Wackerhage H, Gehlert S, Schulz H, Weber S, Ring-Dimitriou S, Heine O. Lactate thresholds and the simulation of human energy metabolism: contributions by the Cologne sports medicine group in the 1970s and 1980s. Front Physiol, 2022, 13: 899670

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