Validity of criteria for establishing maximal O2 uptake during ramp exercise tests

The incremental or ramp exercise test to the limit of tolerance has become a popular test for determination of maximal O(2) uptake (VO(2max)). However, many subjects do not evidence a definitive plateau of the VO(2) -work rate relationship on this test and secondary criteria based upon respiratory exchange ratio (RER), maximal heart rate (HR(max)) or blood [lactate] have been adopted to provide confidence in the measured VO(2max). We hypothesized that verification of VO(2max) using these variables is fundamentally flawed in that their use could either allow underestimation of VO(2max) (if, for any reason, a test were ended at a sub-maximal [Formula: see text]), or alternatively preclude subjects from recording a valid VO(2max). Eight healthy male subjects completed a ramp exercise test (at 20 W/min) to the limit of tolerance on an electrically braked cycle ergometer during which pulmonary gas exchange was measured breath-by-breath and blood [lactate] was determined every 90 s. Using the most widely used criterion values of RER (1.10 and 1.15), VO(2max) as determined during the ramp test (4.03 +/- 0.10 l/min) could be undermeasured by 27% (2.97 +/- 0.24 l/min) and 16% (3.41 +/- 0.15 l/min), respectively (both P < 0.05). The criteria of HR(max) (age predicted HR(max) +/- 10 b/min) and blood [lactate] (> or = 8 mM) were untenable because they resulted in rejection of 3/8 and 6/8 of the subjects, most of whom (5/8) had demonstrated a plateau of VO(2max) at VO(2max). These findings provide a clear mandate for rejecting these secondary criteria as a means of validating VO(2max) on ramp exercise tests.