At baseline and 3 months, a submaximal exercise test is performed on a cycle ergometer (Corival, Lode B.V. Groningen, The Netherlands), and submaximal cardiorespiratory fitness is measured by breath-by-breath indirect calorimetry using a Vmax Encore metabolic cart (Carefusion, San Diego, CA, USA). Procedures are adjusted from standard fitness testing protocols [45 ] to suit participant clinical presentation. Total and relative (kg BM) oxygen consumption ( O2 per min) are determined and will be reported. The height of the seat is individually adjusted for participant leg length and participants are asked to keep a cadence of 60–70 pedal rounds per minute. Heart rate is measured by a pulse belt (Polar Electro, Kempele, Finland) and RPE by Borg Scale [28 (link)] during the ~ 16-min assessment. Participants begin the test with an 8–10 min light warm up and start at 1 W/kg FFM and increase 0.5 W/kg FFM every 3 min until they cannot maintain the watt output at ≥60 rpm, or they reach a rating of perceived exertion (RPE) of 15–17. Data are used to establish aerobic economy as previously reported [46 (link), 47 (link)].
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