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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;</span></p><p class="elsevierStylePara"> El consum m&#224;xim d&#8217;oxigen &#40;VO<span class="elsevierStyleInf">2max</span>&#41; &#233;s una mesura b&#224;sica de la condici&#243; f&#237;sica dels esportistes&#44; especialment en els casos en qu&#232; el rendiment est&#224; influ&#239;t per la pot&#232;ncia aer&#242;bica&#46; El mesurament directe es considera el patr&#243; de refer&#232;ncia per valorar-lo&#44; per&#242; &#233;s for&#231;a complex i cost&#243;s&#46; En conseq&#252;&#232;ncia&#44; s&#8217;han desenvolupat diversos tests indirectes per valorar el VO<span class="elsevierStyleInf">2max</span>&#44; com el test en cicloerg&#242;metre de 6 minuts d&#8217;Astrand-Rhyming<span class="elsevierStyleSup">1</span>&#44; el test Balke de 15 minuts de cursa<span class="elsevierStyleSup">2</span>&#44; el test de Cooper de 12 minuts de cursa<span class="elsevierStyleSup">3</span>&#44; el test de cinta de c&#243;rrer de Bruce<span class="elsevierStyleSup">4</span>&#44; el test de resist&#232;ncia de <span class="elsevierStyleItalic">course navette</span> de L&#233;ger i Lambert5 i L&#233;ger et al&#46;6&#44; el test de la milla<span class="elsevierStyleSup">7</span> i el test de resist&#232;ncia Yo-Yo<span class="elsevierStyleSup">8</span>&#46; El test de resist&#232;ncia Yo-Yo &#40;TYY&#41; &#233;s un test de camp de multiestaci&#243; cont&#237;nua que est&#224; a bastament implementat per valorar el VO<span class="elsevierStyleInf">2max</span> com una alternativa al mesurament directe del laboratori&#44; a causa de la seva especificitat&#44; la seva implementaci&#243; pr&#224;ctica i f&#224;cil&#44; i a l&#8217;entorn simple que requereix&#46; &#201;s un dels 3 tests Yo-Yo<span class="elsevierStyleSup">8</span>&#46; Els altres s&#243;n el test de resist&#232;ncia intermitent Yo-Yo &#40;TIYY&#41; i el test de recuperaci&#243; intermitent &#40;TRYY&#41;&#59; aquest darrer ofereix una valoraci&#243; del VO<span class="elsevierStyleInf">2max</span><span class="elsevierStyleSup">9</span>&#46;</p><p class="elsevierStylePara"> El m&#232;tode Bland-Altman<span class="elsevierStyleSup">10-12</span> ha estat aplicat a bastament per comparar m&#232;todes de mesurament en diferents &#224;rees de recerca&#46; Permet valorar el grau de concordan&#231;a entre dues t&#232;cniques de mesurament&#44; per determinar si poden emprar-se de manera intercanviable&#46; Tanmateix&#44; els estudis de comparaci&#243; de m&#232;todes algunes vegades s&#8217;han analitzat de forma inapropiada en comparar el significat de les respostes&#44; o usant coeficients de correlaci&#243; o comparant el gradient de regressi&#243; lineal entre m&#232;todes<span class="elsevierStyleSup">10</span>&#46;</p><p class="elsevierStylePara"> Diversos estudis han comparat el mesurament directe del VO<span class="elsevierStyleInf">2max</span> dels esportistes obtingut a partir de test d&#8217;esfor&#231; en la cinta de c&#243;rrer amb els resultats dels tests Yo-Yo<span class="elsevierStyleSup">13-26</span>&#46; En la majoria de casos la poblaci&#243; estudiada eren jugadors de futbol&#46; En aquests estudis&#44; la valoraci&#243; directa del VO<span class="elsevierStyleInf">2max</span> fou comparada amb el rendiment &#40;dist&#224;ncia recorreguda&#41; en els tests Yo-Yo&#44; o amb la valoraci&#243; indirecta del VO<span class="elsevierStyleInf">2max</span> obtinguda a partir del TYY o el TRYY&#46; S&#8217;examinaren correlacions lineals o es contrastaren les respostes&#46; Alguns estudis que comparaven la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> del test Yo-Yo &#40;TYY o TRYY&#41; amb el mesurament directe tamb&#233; reportaren els l&#237;mits de concordan&#231;a de Bland-Altman<span class="elsevierStyleSup">15&#44;21&#44;25</span>&#46; Tanmateix&#44; no s&#8217;inclo&#239;en els intervals de confian&#231;a d&#8217;aquests l&#237;mits&#46; A m&#233;s&#44; &#233;s &#242;ptim definir els l&#237;mits acceptables de concordan&#231;a <span class="elsevierStyleItalic">a priori</span>&#46; Tot i que pot resultar dif&#237;cil en les variables fisiol&#242;giques&#44; cal provar-ho&#59; s&#8217;ha de tenir en compte l&#8217;opini&#243; dels experts&#46; Sense establir el l&#237;mits de concordan&#231;a <span class="elsevierStyleItalic">a priori</span>&#44; es poden seleccionar l&#237;mits &#224;mpliament discrepants<span class="elsevierStyleSup">27</span>&#46;</p><p class="elsevierStylePara"> Cal tenir en compte l&#8217;ambig&#252;itat deguda a l&#8217;error de la mostra no sols en valorar les difer&#232;ncies entre m&#232;todes &#40;biaix&#41;&#44; sin&#243; tamb&#233; en valorar els l&#237;mits de concordan&#231;a<span class="elsevierStyleSup">12</span>&#46; Aquest aspecte t&#233; una import&#224;ncia cabdal quan la mesura de la mostra &#233;s petita&#46; El m&#232;tode Bland-Altman proporciona una metodologia estad&#237;stica per quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a estimats&#46; Tanmateix&#44; no es trob&#224; cap m&#232;tode de comparaci&#243; en els estudis entre el mesurament directe del VO<span class="elsevierStyleInf">2max</span> i la valoraci&#243; indirecta a trav&#233;s del test Yo-Yo &#40;TYY o TRYY&#41; que inclogu&#233;s intervals de confian&#231;a en els l&#237;mits de concordan&#231;a&#46; Aquest estudi tingu&#233; l&#8217;objectiu de revisar el grau de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> en esportistes entre el test de resist&#232;ncia Yo-Yo i el test incremental de mesurament directe realitzat a la cinta de c&#243;rrer&#44; i quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a valorats&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material i m&#232;todes</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants</span></p><p class="elsevierStylePara"> S&#8217;obtingueren les dades d&#8217;un grup d&#8217;11 jugadors competitius d&#8217;hoquei&#44; homes&#46; Tots els subjectes o els seus tutors firmaren el consentiment informat per participar a l&#8217;estudi&#44; despr&#233;s d&#8217;explicar-los els objectius i els procediments&#46; L&#8217;estudi es realitz&#224; basat en els principis &#232;tics de la Declaraci&#243; d&#8217;H&#232;lsinki de l&#8217;Associaci&#243; M&#232;dica Mundial&#46; Cada participant fou sotm&#232;s a una revisi&#243; m&#232;dica abans de les proves&#46; La taula 1 mostra una recopilaci&#243; estad&#237;stica dels trets cineantropom&#232;trics dels esportistes&#46; L&#8217;edat fou calculada en anys decimals&#44; restant la data de naixement de la data de valoraci&#243;&#46; Els percentatges de massa greixosa i massa muscular es calcularen amb el model de quatre compartiments basat en l&#8217;estrat&#232;gia de De Rose i Guimaraes<span class="elsevierStyleSup">28</span>&#46; Aquest model fou adaptat amb l&#8217;equaci&#243; de regressi&#243; simple per a esportistes homes desenvolupada per Withers et al&#46;&#44; citada per Norton<span class="elsevierStyleSup">29</span> per valorar la densitat del cos&#44; i la f&#243;rmula de Siri<span class="elsevierStyleSup">30</span> per calcular el percentatge de massa greixosa&#46;</p><p class="elsevierStylePara"><img alt="Taula 1&#46; Caracter&#237;stiques cineantropom&#232;triques dels esportistes" src="278v52n193-90460854fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Disseny de l&#8217;estudi</span></p><p class="elsevierStylePara"> Aquesta recerca &#233;s un estudi transversal de disseny simple&#44; per avaluar la concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max x en </span> ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span> entre el test de resist&#232;ncia Yo-Yo i el mesurament directe&#44; amb atenci&#243; especial a la valoraci&#243; de l&#8217;interval dels l&#237;mits de concordan&#231;a&#46; El mesurament directe del VO<span class="elsevierStyleInf">2max</span> &#40;MD&#41; fou dirigit pel <span class="elsevierStyleItalic">Laboratorio de Fisiolog&#237;a del Ejercicio</span> del <span class="elsevierStyleItalic">Centro Nacional de Alto Rendimiento Deportivo</span> &#40;CeNARD&#44; Buenos Aires&#44; Argentina&#41;&#44; mitjan&#231;ant un test incremental en una cinta de c&#243;rrer motoritzada &#40;Technogym Excite Run 700i&#59; Technogym SpA&#44; Gambettola&#44; It&#224;lia&#41;&#46; La recollida de dades s&#8217;obtingu&#233; mitjan&#231;ant un sistema d&#8217;an&#224;lisi de gasos respiraci&#243; a respiraci&#243; de circuit obert &#40;Medgraphics Cardiopulmonary Exercise System CPX&#47;D&#44; Breeze Ex v3&#46;06 software&#59; Medical Graphics Corporation&#44; St&#46; Paul&#44; MN&#44; EUA&#41;&#46; S&#8217;establiren increments de velocitat de la cinta d&#8217;1 km h<span class="elsevierStyleSup">&#8722;1</span> cada minut fins a l&#8217;esgotament &#40;velocitat inicial &#61; 9 km h<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; La freq&#252;&#232;ncia card&#237;aca es control&#224; amb un monitor de freq&#252;&#232;ncia card&#237;aca &#40;Polar 610i&#59; Polar Electro Oy&#44; Kempele&#44; Finl&#224;ndia&#41;&#46; El VO<span class="elsevierStyleInf">2</span> plateau &#40;un canvi en el VO<span class="elsevierStyleInf">2 </span> inferior a 2&#44;1 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span> a m&#233;s amb un increment de la c&#224;rrega de treball&#41; fou el criteri b&#224;sic per obtenir el VO<span class="elsevierStyleInf">2max</span>&#59; altres criteris secundaris foren&#58; &#237;ndex d&#8217;intercanvi respiratori m&#233;s gran d&#8217;1&#44;1 i freq&#252;&#232;ncia card&#237;aca dins els 10 batecs min<span class="elsevierStyleSup">&#8722;1</span> de l&#8217;edat prevista de freq&#252;&#232;ncia card&#237;aca m&#224;xima<span class="elsevierStyleSup">31&#44;32</span>&#46; El test de resist&#232;ncia Yo-Yo de nivell 1 fou realitzat dins el CeNARD&#44; en un pavell&#243; esportiu amb el paviment de fusta flotant&#46; Consist&#237; en una cursa llan&#231;adora de 20 m amb un increment progressiu de la velocitat &#40;velocitat inicial &#61; 8 km h<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; que fou controlada per xiulets d&#8217;&#224;udio des d&#8217;un reproductor port&#224;til&#46; El test es considerava acabat quan el participant era incapa&#231; de mantenir la velocitat indicada amb normalitat&#46; Es registr&#224; el nivell de velocitat final i el nombre de dist&#224;ncies de 20 m realitzat a aquest nivell&#46; La valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> s&#8217;obtingu&#233; amb el nomograma corresponent&#46; Ambd&#243;s&#44; TYY i MD&#44; tingueren lloc a la mateixa hora del dia &#40;&#177; 2 h&#41; per minimitzar els efectes de la variaci&#243; biol&#242;gica di&#252;rna en els resultats&#44; i per evitar restes de fatiga es realitzaren almenys amb un interval de 72 h entre l&#8217;un i l&#8217;altre&#46; L&#8217;ordre dels tests fou assignat als subjectes aleat&#242;riament&#46; Abans de l&#8217;avaluaci&#243; els participants realitzaren un escalfament apropiat de 20 min&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">An&#224;lisi estad&#237;stica</span></p><p class="elsevierStylePara"> Els trets cineantropom&#232;trics dels esportistes i els valors de la freq&#252;&#232;ncia card&#237;aca i quocient respiratori en assolir el VO<span class="elsevierStyleInf">2max</span> es mostren com a mitjana &#177; desviaci&#243; est&#224;ndard &#40;DE&#41;&#46; Es realitzaren resums estad&#237;stics per il&#183;lustrar els valors de VO<span class="elsevierStyleInf">2max</span> obtinguts mitjan&#231;ant TYY i MD&#46; L&#8217;an&#224;lisi de Bland-Altman s&#8217;empr&#224; per valorar la concordan&#231;a entre ambd&#243;s m&#232;todes de mesurament<span class="elsevierStyleSup">10-12</span>&#46; D&#8217;acord amb Bland<span class="elsevierStyleSup">33</span> i&#44; en base a l&#8217;experi&#232;ncia&#44; s&#8217;establiren els l&#237;mits de concordan&#231;a acceptables en un 95&#37;&#44; i es fixaren <span class="elsevierStyleItalic">a priori en</span> &#177;5ml&#44; kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Tamb&#233; es registraren els intervals de confian&#231;a del 95&#37; per als l&#237;mits de concordan&#231;a&#46; Degut a la petita dimensi&#243; de la mostra es van calcular usant l&#8217;expressi&#243; exacta de l&#8217;estimaci&#243; de la vari&#224;ncia dels l&#237;mits de concordan&#231;a&#44; per comptes d&#8217;una aproximaci&#243;<span class="elsevierStyleSup">12</span>&#58;</p><p class="elsevierStylePara"><img src="278v52n193-90460854fig2.jpg"></img></p><p class="elsevierStylePara"> en qu&#232; <img alt="F&#243;rmula" src="277v52n193-90460721figsi4.gif"></img> &#233;s la mitjana de la difer&#232;ncia entre els m&#232;todes i s<span class="elsevierStyleInf">d</span> &#233;s la desviaci&#243; est&#224;ndard de les difer&#232;ncies&#46; Els tests de correlaci&#243; de Pearson i Spearman s&#8217;implementaren per avaluar associacions possibles de la difer&#232;ncia entre TYY i MD amb la grand&#224;ria del mesurament&#46; El nivell de probabilitat de la significaci&#243; estad&#237;stica s&#8217;establ&#237; en 0&#44;05&#46; Totes les an&#224;lisis es realitzaren en l&#8217;entorn del programari R software&#44; versi&#243; 3&#46;2&#46;0 &#40;R Core Team&#44; Viena&#44; &#192;ustria&#41;<span class="elsevierStyleSup">34</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultats</span></p><p class="elsevierStylePara"> Els valors VO<span class="elsevierStyleInf">2max</span> obtinguts de cada individu&#44; amb els dos m&#232;todes de mesurament&#44; foren for&#231;a similars&#46; Els valors de VO<span class="elsevierStyleInf">2max</span> estimats per a TYY foren&#44; de mitjana&#44; sols un 0&#44;6&#37; inferiors als determinats mitjan&#231;ant MD&#46; La taula 2 presenta una recopilaci&#243; descriptiva dels resultats de TYY i MD i les difer&#232;ncies entre ambd&#243;s m&#232;todes&#46; Els valors de la freq&#252;&#232;ncia card&#237;aca i el quocient respiratori en assolir el VO<span class="elsevierStyleInf">2max es </span> resumeixen a la taula 3&#46;</p><p class="elsevierStylePara"><img alt="Taula 2&#46; Valoraci&#243; del V02max&#58; resum comparatiu d’ambd&#243;s m&#232;todes de mesurament" src="278v52n193-90460854fig3.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 3&#46; Valors de la freq&#252;&#232;ncia card&#237;aca i el quocient respiratori obtinguts en assolir el V02max" src="278v52n193-90460854fig4.jpg"></img></p><p class="elsevierStylePara"> Es trob&#224; un biaix no significatiu estad&#237;sticament entre TYY&#160; i&#160; MD&#160; &#40;&#8722;0&#44;31&#160; ml&#160; kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#59; interval de confian&#231;a del 95&#37;&#58;&#160;&#8722;1&#44;69&#160;a&#160;1&#44;07&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; L&#8217;estimaci&#243; dels l&#237;mits de concordan&#231;a&#160; inferior&#160; i&#160; superior&#160; al&#160; 95&#37;&#160; foren&#160; &#8722;4&#44;34&#160; i&#160; 3&#44;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Els intervals de confian&#231;a del 95&#37; d&#8217;aquests&#160; l&#237;mits&#160; foren&#44;&#160; respectivament&#44;&#160; de&#160; &#8722;6&#44;78&#160; a&#160; &#8722;1&#44;90&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i d&#8217;1&#44;29 a 6&#44;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Com s&#8217;ha dit anteriorment&#44; donada la petita dimensi&#243; de la mostra&#44; els intervals de confian&#231;a per als l&#237;mits de concordan&#231;a es van construir usant l&#8217;expressi&#243; exacta de l&#8217;estimaci&#243; de la vari&#224;ncia d&#8217;aquests l&#237;mits &#40;equaci&#243; 1&#41;&#46; La zona determinada per valorar els l&#237;mits de concordan&#231;a del 95&#37; fou m&#233;s redu&#239;da que l&#8217;acotada pels l&#237;mits d&#8217;acceptaci&#243; definits <span class="elsevierStyleItalic">a priori</span>&#46; Tanmateix&#44; la zona total coberta en considerar els intervals de confian&#231;a del 95&#37; pels l&#237;mits de concordan&#231;a del 95&#37; fou m&#233;s &#224;mplia que els l&#237;mits acceptats <span class="elsevierStyleItalic">a priori</span>&#46; A la figura 1 s&#8217;observa el diagrama t&#237;pic de Bland-Altman amb el biaix estimat i els l&#237;mits de concordan&#231;a del 95&#37; entre m&#232;todes&#44; mentre que els resultats esmentats anteriorment es presenten gr&#224;ficament a la figura 2&#46;</p><p class="elsevierStylePara"><img alt="Figura 1&#46; &#58; VO2max difer&#232;ncia entre m&#232;todes per a la mitjana de mesurament amb biaix i l&#237;mits de concordan&#231;a al 95&#37;&#46;" src="278v52n193-90460854fig5.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 1&#46; </span>VO<span class="elsevierStyleInf">2max</span>&#58; difer&#232;ncia entre m&#232;todes per a la mitjana de mesurament amb biaix i l&#237;mits de concordan&#231;a al 95&#37;&#46;</p><p class="elsevierStylePara"><img alt="Figura 2&#46; &#58; VO2max mediana i l&#237;mits de concordan&#231;a del 95&#37; de la difer&#232;ncia&#160;entre&#160;m&#232;todes&#160;amb&#160;intervals&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#46;" src="278v52n193-90460854fig6.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 2&#46; </span>VO<span class="elsevierStyleInf">2max</span>&#58; mediana i l&#237;mits de concordan&#231;a del 95&#37; de la difer&#232;ncia&#160;entre&#160;m&#232;todes&#160;amb&#160;intervals&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#46;</p><p class="elsevierStylePara"> S&#8217;observ&#224; en les dades que ni la difer&#232;ncia ni els valors absoluts de la difer&#232;ncia semblava que estiguessin correlacionats amb la magnitud de la mesura&#46; En aquest ordre&#58; <span class="elsevierStyleItalic">r</span> de Pearson&#160;&#61;&#160;0&#44;02&#160;interval&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#58;&#160;&#8722;0&#44;59&#160;a&#160;0&#44;61&#41;&#59;&#160; <span class="elsevierStyleItalic">rho</span>&#160;d&#8217;Spearman&#160;&#61;&#160;&#8722;0&#44;06&#160;&#40;interval&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#58;&#160;&#8722;0&#44;64&#160; a 0&#44;56&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussi&#243;</span></p><p class="elsevierStylePara"> En la valoraci&#243; esportiva sovint s&#8217;usa el mesurament indirecte del VO<span class="elsevierStyleInf">2max</span>&#46; Per valorar la pot&#232;ncia aer&#242;bica m&#224;xima de l&#8217;individu s&#8217;han proposat protocols d&#8217;esfor&#231; m&#224;xim i subm&#224;xim<span class="elsevierStyleSup">1-9</span>&#46; El principal objectiu d&#8217;aquests tests ha de ser una bona concordan&#231;a&#46; El test de resist&#232;ncia Yo-Yo &#233;s un test de camp continu multiestaci&#243; a bastament emprat per valorar indirectament el VO<span class="elsevierStyleInf">2max</span><span class="elsevierStyleSup">15</span>&#46; Per les seves caracter&#237;stiques mec&#224;niques &#233;s adequat per als esportistes que practiquen esports que impliquen patrons de moviment d&#8217;aturada&#44; arrancada i canvi de direcci&#243;&#46;</p><p class="elsevierStylePara"> S&#8217;han dut a terme diferents estudis per comparar els resultats proporcionats pels tests Yo-Yo amb el VO<span class="elsevierStyleInf">2max</span> obtingut per mesurament directe en un test de cursa incremental en cinta de c&#243;rrer&#46; La comparaci&#243; implic&#224; contrastar els valors de VO<span class="elsevierStyleInf">2max</span> o el test de correlaci&#243; entre mesurament directe de valors del VO<span class="elsevierStyleInf">2max</span> i la dist&#224;ncia recorreguda en els tests Yo-Yo&#46; Alguns dels estudis que compararen els resultats del VO<span class="elsevierStyleInf">2max</span> en ambd&#243;s m&#232;todes tamb&#233; inclo&#239;en la valoraci&#243; de la concordan&#231;a&#46; Aix&#237;&#44; per exemple&#44; Metaxas et al&#46;<span class="elsevierStyleSup">22</span> trobaren difer&#232;ncies estad&#237;sticament significatives &#40;p &#60; 0&#44;05&#41; en jugadors de futbol homes &#40;n &#61; 35&#41; en comparar la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> proporcionada per TYY nivell 1 amb el valor de VO<span class="elsevierStyleInf">2max</span> obtingut per MD en ambd&#243;s protocols&#44; cursa cont&#237;nua o intermitent en cinta de c&#243;rrer &#40;valor TYY nivell 1 inferior als valors d&#8217;MD&#44; en 11&#44;4 i 13&#44;4&#37;&#44; respectivament&#41;&#46; Castagna et al&#46;<span class="elsevierStyleSup">15</span> contrastaren els resultats del VO<span class="elsevierStyleInf">2max</span> de TYY nivell 2 amb els d&#8217;MD en jugadors de futbol homes &#40;n &#61; 24&#41;&#44; i s&#8217;evidenci&#224; un biaix no significatiu estad&#237;sticament &#40;p &#61; 0&#44;10&#41; d&#8217;1&#44;17 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i uns l&#237;mits de concordan&#231;a&#160;del&#160;95&#37;&#160;de&#160;&#8722;5&#44;44&#160;i&#160;7&#44;79&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Nazarali et al&#46;<span class="elsevierStyleSup">23</span> descrigueren una mitjana m&#233;s elevada dels valors de VO<span class="elsevierStyleInf">2max</span> proporcionats per TRYY nivell 2 &#40;50&#44;8 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; en comparaci&#243; amb la mitjana de valors determinada per MD &#40;43&#44;6 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; en un estudi realitzat amb jugadores de futbol femen&#237; &#40;n &#61; 20&#41;&#46; En canvi&#44; Mart&#237;nez-Lagunas i Hartmann<span class="elsevierStyleSup">21</span> trobaren que el VO<span class="elsevierStyleInf">2max</span> de jugadores de futbol femen&#237; &#40;n &#61; 18&#41; estava significativament subestimat &#40;p &#60; 0&#44;001&#41; pel TRYY nivell 1 &#40;45&#44;2 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; comparat amb l&#8217;MD &#40;55&#44;0 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; i expressaren els l&#237;mits de concordan&#231;a&#160;del&#160;95&#37;&#160;en&#160;escala&#160;percentual&#160;&#40;&#8722;31&#44;8&#37;&#160;a&#160;&#8722;3&#44;8&#37;&#41;&#46;&#160; S&#225;nchez-Oliva et al&#46;<span class="elsevierStyleSup">25</span> revisaren la valoraci&#243; dels dos m&#232;todes en jugadors de futbol homes &#40;n &#61; 15&#41; i tamb&#233; trobaren una subestimaci&#243; estad&#237;sticament significativa del VO<span class="elsevierStyleInf">2max</span> amb el TRYY nivell 1 &#40;51&#44;00 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; en comparaci&#243; amb MD &#40;60&#44;85 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; amb l&#237;mits de concordan&#231;a del 95&#37; de 3&#44;37 i 16&#44;33 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p><p class="elsevierStylePara"> D&#8217;altra banda&#44; no s&#8217;han localitzat articles de recerca que descriguin estudis de comparaci&#243; de m&#232;todes que emprin l&#8217;an&#224;lisi de Bland-Altman entre mesurament directe del VO<span class="elsevierStyleInf">2max</span> i estimaci&#243; indirecta del test Yo-Yo &#40;TYY o TRYY&#41; que tinguessin en compte el c&#224;lcul dels intervals de confian&#231;a per als l&#237;mits de concordan&#231;a&#46; Aquest &#233;s un punt d&#8217;import&#224;ncia especial en el cas d&#8217;una mostra de mida redu&#239;da&#44; que &#233;s una situaci&#243; freq&#252;ent en estudis que impliquin test d&#8217;esfor&#231; m&#224;xim&#46; La vari&#224;ncia de la difer&#232;ncia de mitjanes i la dels l&#237;mits de concordan&#231;a s&#243;n inversament proporcionals a les dimensions de la mostra&#46; Per tant&#44; els intervals de confian&#231;a corresponents s&#243;n m&#233;s amplis quan la mida de la mostra &#233;s menor&#44; la qual cosa reflecteix una gran discrep&#224;ncia entre m&#232;todes&#46;</p><p class="elsevierStylePara"> Aquesta recerca presenta un estudi acurat de comparaci&#243; entre m&#232;todes de valoraci&#243; directa del VO<span class="elsevierStyleInf">2max</span> al laboratori i l&#8217;estimaci&#243; indirecta mitjan&#231;ant el test de resist&#232;ncia Yo-Yo&#44; que &#233;s un test de camp continu multiestaci&#243; especialment &#250;til per als esportistes de disciplines de resist&#232;ncia<span class="elsevierStyleSup">8</span>&#44; per&#242; tamb&#233; &#233;s apropiat per a esports d&#8217;equip<span class="elsevierStyleSup">35</span> com jugadors d&#8217;hoquei&#44; futbol i rugbi&#46; S&#8217;ha descrit l&#8217;estimaci&#243; del biaix i els l&#237;mits de concordan&#231;a del 95&#37; entre m&#232;todes&#46; A m&#233;s&#44; tamb&#233; s&#8217;ha reportat un interval de confian&#231;a prec&#237;s del 95&#37; del l&#237;mits de concordan&#231;a del 95&#37; per a la grand&#224;ria de la mostra actual&#46; S&#8217;observ&#224; un petit biaix entre ambdues t&#232;cniques&#44; que result&#224; que no era significatiu estad&#237;sticament &#40;p &#61; 0&#44;63&#41;&#46; L&#8217;estimaci&#243; dels l&#237;mits de concordan&#231;a del 95&#37; s&#8217;establ&#237; en &#177; 4&#44;03 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span> a partir de la mediana de la difer&#232;ncia entre ells&#46; En el model proposat&#44; per a la mitjana i desviaci&#243; est&#224;ndard de les difer&#232;ncies entre m&#232;todes de valoraci&#243; significatius&#44; que s&#243;n estimacions significatives&#44; cal suposar que s&#243;n constants al llarg de totes les s&#232;ries de mesurament<span class="elsevierStyleSup">12&#44;36&#44;37</span>&#46; Cal destacar que la difer&#232;ncia mitjana i la desviaci&#243; est&#224;ndard de les difer&#232;ncies sorgides no dep&#232;n de la magnitud de la mesura&#44; que compleix amb els sup&#242;sits fonamentals simples dels l&#237;mits de concordan&#231;a del 95&#37; del m&#232;tode aplicat&#46; La zona determinada pels l&#237;mits estimats de concordan&#231;a estigu&#233; dins els l&#237;mits acceptables definits <span class="elsevierStyleItalic">a priori</span>&#46; No obstant aix&#242;&#44; aquestes valoracions tenen gran vari&#224;ncia a causa de la petita grand&#224;ria de la mostra&#44; de manera que aquest &#250;ltim resultat ha de ser considerat amb precauci&#243;&#46; Tenint en compte els intervals de confian&#231;a del 95&#37; per els l&#237;mits de concordan&#231;a del 95&#37;&#44; la zona total ampliada s&#8217;est&#233;n m&#233;s enll&#224; de &#177; 6 ml kg<span class="elsevierStyleSup">-1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; superior als l&#237;mits de concordan&#231;a acceptables del 95&#37; establerts <span class="elsevierStyleItalic">a priori</span>&#46;</p><p class="elsevierStylePara"> Els intervals de confian&#231;a per a la difer&#232;ncia de mitjanes i per als l&#237;mits de concordan&#231;a proporcionen una mesura de la precisi&#243; dels aspectes valorats basada en l&#8217;error de mostreig&#46; Les vari&#224;ncies dels estimadors d&#8217;aquestes quantitats estan afectades decisivament per la grand&#224;ria de la mostra&#46; Com m&#233;s petit sigui el nombre d&#8217;observacions per a l&#8217;avaluaci&#243; de la difer&#232;ncia entre m&#232;todes&#44; m&#233;s amplis s&#243;n els intervals de confian&#231;a&#44; i m&#233;s alt &#233;s el nivell d&#8217;incertesa&#46; A m&#233;s&#44; tot i que l&#8217;an&#224;lisi de Bland-Altman proporciona la metodologia per a la construcci&#243; dels l&#237;mits de concordan&#231;a&#44; no indica si s&#243;n o no acceptables&#46; Els l&#237;mits acceptables han de ser definits <span class="elsevierStyleItalic">a priori</span>&#44; basats en les necessitats espec&#237;fiques i els objectius&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Limitacions</span></p><p class="elsevierStylePara"> Una limitaci&#243; d&#8217;aquest estudi fou la petita grand&#224;ria de la mostra&#46; Els intervals de confian&#231;a del 95&#37; pels l&#237;mits de concordan&#231;a del 95&#37;&#44; atesa la mida de la mostra actual&#44; s&#243;n &#177; 1&#44;19 unitats de la desviaci&#243; est&#224;ndard de les difer&#232;ncies entre els mesuraments d&#8217;ambd&#243;s m&#232;todes&#46; Per tant&#44; caldria fer aquesta an&#224;lisi amb mostres m&#233;s grans per augmentar la precisi&#243; de les estimacions generades&#46; D&#8217;altra banda&#44; seria pertinent la realitzaci&#243; simult&#224;nia d&#8250;una comparaci&#243; de la repetibilitat de cada m&#232;tode mitjan&#231;ant la recopilaci&#243; de dades replicades&#44; perqu&#232; els &#237;ndexs de const&#224;ncia dels dos m&#232;todes de mesurament limiten la quantitat de concordan&#231;a possible<span class="elsevierStyleSup">12</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions</span></p><p class="elsevierStylePara"> La valoraci&#243; b&#224;sica dels l&#237;mits de concordan&#231;a del 95&#37; estigu&#233; dins de &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; satisfent <span class="elsevierStyleItalic">a priori</span> els requisits basats en l&#8217;experi&#232;ncia&#46; Per tant&#44; en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> d&#8217;esportistes es trob&#224; una concordan&#231;a correcta entre el test de resist&#232;ncia Yo-Yo i el mesurament directe al laboratori&#46; D&#8217;acord amb aquesta dada&#44; els dos m&#232;todes poden ser intercanviables&#46; Tanmateix&#44; la necessitat de precauci&#243; en la interpretaci&#243; d&#8217;aquest resultat encara s&#8217;emfatitza per la troballa que la zona coberta en considerar els intervals de confian&#231;a del 95&#37; per als l&#237;mits de concordan&#231;a del 95&#37; era m&#233;s ampla que la zona acceptable de concordan&#231;a definida <span class="elsevierStyleItalic">a priori</span> &#46; Per tant&#44; tot i que els l&#237;mits de concordan&#231;a estimats del 95&#37; no desacreditin el test de resist&#232;ncia Yo-Yo com un m&#232;tode alternatiu per mesurar el VO<span class="elsevierStyleInf">2max</span> dels esportistes&#44; el present estudi presenta una limitaci&#243; de precisi&#243;&#44; degut a la petita grand&#224;ria de la mostra&#44; i no permet conclusions definitives&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicte d&#8217;interessos</span></p><p class="elsevierStylePara"> Els autors declaren que no tenen cap conflicte d&#8217;interessos&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Agra&#239;ments</span></p><p class="elsevierStylePara"> Els autors desitgen agrair especialment a Mariela B&#46; Arangio&#44; Enrique D&#46; Balardini&#44; Claudio A&#46; Gillone&#44; Cristina P&#233;rez i Enrique O&#46; Prada pel seu suport t&#232;cnic&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleSup">&#9734;</span> Un resum preliminar d&#8217;aquest treball fou publicat en ocasi&#243; de la seva presentaci&#243; al &#171;57th Annual Meeting and Inaugural World Congress on Exercise in Medicine of the American College of Sports Medicine&#187;&#44; que tingu&#233; lloc al Baltimore Convention Center de Baltimore&#44; Maryland&#44; de l&#8217;1 al 5 de juny de 2010&#46; El resum fou publicat a la revista <span class="elsevierStyleItalic">Medicine and Science in Sports and Exercise</span>&#44; volum 42&#44; suplement 5&#46;</p><p class="elsevierStylePara"> Rebut el 12 d&#8217;abril de 2016&#59;<br></br> acceptat l&#8217;11 de juliol de 2016</p><p class="elsevierStylePara"> &#42; Autor per a correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58; </span><a href="mailto&#58;alongo&#64;deportes&#46;gob&#46;ar" class="elsevierStyleCrossRefs">alongo&#64;deportes&#46;gob&#46;ar</a> &#40;A&#46;F&#46; Longo&#41;&#46;</p>"
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            0 => "Consum m&#224;xim d’oxigen&#59; Mesurament directe i test de resist&#232;ncia Yo-Yo&#59; Precisi&#243; dels l&#237;mits de concordan&#231;a"
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        "resumen" => "<p class="elsevierStylePara"> Introducci&#243;&#58; Tot i que diversos estudis han reportat els l&#237;mits de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> entre el test Yo-Yo i el mesurament directe&#44; en general no s&#8217;ha reflexionat sobre la precisi&#243; d&#8217;aquests l&#237;mits&#46; L&#8217;objectiu d&#8217;aquest estudi fou examinar el grau de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> en esportistes entre el test de resist&#232;ncia Yo-Yo &#40;TYY&#41; i el mesurament directe &#40;MD&#41;&#44; i quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a estimats&#46;</p> <p class="elsevierStylePara"> Material i m&#232;todes&#58; S&#8217;obtingueren les dades d&#8217;un grup d&#8217;11 jugadors d&#8217;hoquei&#44; homes &#40;edat &#61; 22&#44;2 &#177; 3&#44;6 anys&#44; IMC &#61; 22&#44;1 &#177; 2&#44;4 kg m<span class="elsevierStyleSup">&#8722;2</span>&#41;&#46; L&#8217;MD es realitz&#224; amb un test de carrera incremental en cinta de c&#243;rrer&#46; Per valorar l&#8217;estimaci&#243; indirecta del VO<span class="elsevierStyleInf">2max</span> s&#8217;us&#224; el TYY nivell 1&#46; Per valorar la concordan&#231;a entre els dos m&#232;todes s&#8217;empr&#224; l&#8217;an&#224;lisi de Bland-Altman&#46; Els l&#237;mits acceptables de concordan&#231;a del 95&#37; foren fixats a priori en &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p> <p class="elsevierStylePara"> Resultats&#58; S&#8217;observ&#224; un biaix estad&#237;sticament no significatiu entre TYY i MD &#40;50&#44;78 vs&#46; 51&#44;09 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; p &#62;&#160;0&#44;05&#41;&#46;&#160;La&#160;valoraci&#243;&#160;dels&#160;l&#237;mits&#160;de&#160;concordan&#231;a&#160;del&#160;95&#37;&#160;fou&#160;&#8722;4&#44;34&#160; i 3&#44;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Els intervals de confian&#231;a del 95&#37; per a aquests l&#237;mits foren&#44; respectivament&#44;&#160;des&#160;de&#160;&#8722;6&#44;78&#160;fins&#160;a&#160;&#8722;1&#44;90&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i des d&#8217;1&#44;29 fins a 6&#44;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; La difer&#232;ncia entre m&#232;todes sembl&#224; que no estava correlacionada amb la magnitud del mesurament&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; Es trob&#224; una concordan&#231;a correcta entre TYY i MD&#46; Aix&#242; no obstant&#44; la gran difer&#232;ncia dels l&#237;mits de concordan&#231;a&#44; degut a la petita dimensi&#243; de la mostra&#44; fa que calgui considerar aquests resultats amb precauci&#243;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Introduction&#58; Although different studies have reported limits of agreement in assessing VO<span class="elsevierStyleInf">2max</span> between the Yo-Yo test and the direct measurement&#44; the precision of these limits in general has not been considered&#46; The aim of this study was to examine the extent of agreement in the assessment of VO<span class="elsevierStyleInf">2max</span> in athletes between the Yo-Yo endurance test &#40;YET&#41; and the direct measurement &#40;DM&#41;&#44; and to quantify the precision of the estimated limits of agreement&#46;</p> <p class="elsevierStylePara"> Material and methods&#58; Data were obtained from a group of 11 male field hockey players &#40;age &#61; 22&#46;2<span class="elsevierStyleBold"> &#177; </span>3&#46;6 yrs&#44; BMI &#61; 22&#46;1<span class="elsevierStyleBold"> &#177; </span>2&#46;4 kg m<span class="elsevierStyleSup">&#8722;2</span>&#41;&#46; DM was performed using an incremental tread-mill running test&#46; YET level 1 was used for indirect estimation of VO<span class="elsevierStyleInf">2max</span>&#46; Bland-Altman analysis was employed for assessing agreement between the two methods&#46; The acceptable 95&#37; limits of agreement were set a priori at &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p> <p class="elsevierStylePara"> Results&#58; A non-statistically significant bias was observed between YET and DM &#40;50&#46;78 vs&#46; 51&#46;09 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; P &#62; &#46;05&#41;&#46;&#160;The&#160;estimates&#160;of&#160;the&#160;95&#37;&#160;limits&#160;of&#160;agreement&#160;were&#160;&#8722;4&#46;34&#160; and 3&#46;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;&#160;And&#160;the&#160;95&#37;&#160;confidence&#160;intervals&#160;for&#160;these&#160;limits&#160;were&#160;from&#160;&#8722;6&#46;78&#160; to&#160;&#8722;1&#46;90 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; and from 1&#46;29 to 6&#46;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; respectively&#46; The difference between methods did not appear to be correlated to the magnitude of measurement&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; A reasonably good agreement was found between YET and DM&#46; However&#44; the large variance of the limits of agreement due to the small sample size means these results should be treated with caution&#46;</p>"
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Valoració del VO 2max en esportistes: un rigorós estudi comparatiu entre el test Yo-Yo i el mesurament directe
VO 2max assessment in athletes: A thorough method comparison study between Yo-Yo test and direct measurement
Aldo F. Longoa, Gustavo D. Aquilinoa, Marcelo L. Cardeya, Néstor A. Lentinia
a Laboratorio de Fisiología del Ejercicio, Centro Nacional de Alto Rendimiento Deportivo (CeNARD), Buenos Aires, Argentina
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el test de cinta de c&#243;rrer de Bruce<span class="elsevierStyleSup">4</span>&#44; el test de resist&#232;ncia de <span class="elsevierStyleItalic">course navette</span> de L&#233;ger i Lambert5 i L&#233;ger et al&#46;6&#44; el test de la milla<span class="elsevierStyleSup">7</span> i el test de resist&#232;ncia Yo-Yo<span class="elsevierStyleSup">8</span>&#46; El test de resist&#232;ncia Yo-Yo &#40;TYY&#41; &#233;s un test de camp de multiestaci&#243; cont&#237;nua que est&#224; a bastament implementat per valorar el VO<span class="elsevierStyleInf">2max</span> com una alternativa al mesurament directe del laboratori&#44; a causa de la seva especificitat&#44; la seva implementaci&#243; pr&#224;ctica i f&#224;cil&#44; i a l&#8217;entorn simple que requereix&#46; &#201;s un dels 3 tests Yo-Yo<span class="elsevierStyleSup">8</span>&#46; Els altres s&#243;n el test de resist&#232;ncia intermitent Yo-Yo &#40;TIYY&#41; i el test de recuperaci&#243; intermitent &#40;TRYY&#41;&#59; aquest darrer ofereix una valoraci&#243; del VO<span class="elsevierStyleInf">2max</span><span class="elsevierStyleSup">9</span>&#46;</p><p class="elsevierStylePara"> El m&#232;tode Bland-Altman<span class="elsevierStyleSup">10-12</span> ha estat aplicat a bastament per comparar m&#232;todes de mesurament en diferents &#224;rees de recerca&#46; Permet valorar el grau de concordan&#231;a entre dues t&#232;cniques de mesurament&#44; per determinar si poden emprar-se de manera intercanviable&#46; Tanmateix&#44; els estudis de comparaci&#243; de m&#232;todes algunes vegades s&#8217;han analitzat de forma inapropiada en comparar el significat de les respostes&#44; o usant coeficients de correlaci&#243; o comparant el gradient de regressi&#243; lineal entre m&#232;todes<span class="elsevierStyleSup">10</span>&#46;</p><p class="elsevierStylePara"> Diversos estudis han comparat el mesurament directe del VO<span class="elsevierStyleInf">2max</span> dels esportistes obtingut a partir de test d&#8217;esfor&#231; en la cinta de c&#243;rrer amb els resultats dels tests Yo-Yo<span class="elsevierStyleSup">13-26</span>&#46; En la majoria de casos la poblaci&#243; estudiada eren jugadors de futbol&#46; En aquests estudis&#44; la valoraci&#243; directa del VO<span class="elsevierStyleInf">2max</span> fou comparada amb el rendiment &#40;dist&#224;ncia recorreguda&#41; en els tests Yo-Yo&#44; o amb la valoraci&#243; indirecta del VO<span class="elsevierStyleInf">2max</span> obtinguda a partir del TYY o el TRYY&#46; S&#8217;examinaren correlacions lineals o es contrastaren les respostes&#46; Alguns estudis que comparaven la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> del test Yo-Yo &#40;TYY o TRYY&#41; amb el mesurament directe tamb&#233; reportaren els l&#237;mits de concordan&#231;a de Bland-Altman<span class="elsevierStyleSup">15&#44;21&#44;25</span>&#46; Tanmateix&#44; no s&#8217;inclo&#239;en els intervals de confian&#231;a d&#8217;aquests l&#237;mits&#46; A m&#233;s&#44; &#233;s &#242;ptim definir els l&#237;mits acceptables de concordan&#231;a <span class="elsevierStyleItalic">a priori</span>&#46; Tot i que pot resultar dif&#237;cil en les variables fisiol&#242;giques&#44; cal provar-ho&#59; s&#8217;ha de tenir en compte l&#8217;opini&#243; dels experts&#46; Sense establir el l&#237;mits de concordan&#231;a <span class="elsevierStyleItalic">a priori</span>&#44; es poden seleccionar l&#237;mits &#224;mpliament discrepants<span class="elsevierStyleSup">27</span>&#46;</p><p class="elsevierStylePara"> Cal tenir en compte l&#8217;ambig&#252;itat deguda a l&#8217;error de la mostra no sols en valorar les difer&#232;ncies entre m&#232;todes &#40;biaix&#41;&#44; sin&#243; tamb&#233; en valorar els l&#237;mits de concordan&#231;a<span class="elsevierStyleSup">12</span>&#46; Aquest aspecte t&#233; una import&#224;ncia cabdal quan la mesura de la mostra &#233;s petita&#46; El m&#232;tode Bland-Altman proporciona una metodologia estad&#237;stica per quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a estimats&#46; Tanmateix&#44; no es trob&#224; cap m&#232;tode de comparaci&#243; en els estudis entre el mesurament directe del VO<span class="elsevierStyleInf">2max</span> i la valoraci&#243; indirecta a trav&#233;s del test Yo-Yo &#40;TYY o TRYY&#41; que inclogu&#233;s intervals de confian&#231;a en els l&#237;mits de concordan&#231;a&#46; Aquest estudi tingu&#233; l&#8217;objectiu de revisar el grau de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> en esportistes entre el test de resist&#232;ncia Yo-Yo i el test incremental de mesurament directe realitzat a la cinta de c&#243;rrer&#44; i quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a valorats&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material i m&#232;todes</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants</span></p><p class="elsevierStylePara"> S&#8217;obtingueren les dades d&#8217;un grup d&#8217;11 jugadors competitius d&#8217;hoquei&#44; homes&#46; Tots els subjectes o els seus tutors firmaren el consentiment informat per participar a l&#8217;estudi&#44; despr&#233;s d&#8217;explicar-los els objectius i els procediments&#46; L&#8217;estudi es realitz&#224; basat en els principis &#232;tics de la Declaraci&#243; d&#8217;H&#232;lsinki de l&#8217;Associaci&#243; M&#232;dica Mundial&#46; Cada participant fou sotm&#232;s a una revisi&#243; m&#232;dica abans de les proves&#46; La taula 1 mostra una recopilaci&#243; estad&#237;stica dels trets cineantropom&#232;trics dels esportistes&#46; L&#8217;edat fou calculada en anys decimals&#44; restant la data de naixement de la data de valoraci&#243;&#46; Els percentatges de massa greixosa i massa muscular es calcularen amb el model de quatre compartiments basat en l&#8217;estrat&#232;gia de De Rose i Guimaraes<span class="elsevierStyleSup">28</span>&#46; Aquest model fou adaptat amb l&#8217;equaci&#243; de regressi&#243; simple per a esportistes homes desenvolupada per Withers et al&#46;&#44; citada per Norton<span class="elsevierStyleSup">29</span> per valorar la densitat del cos&#44; i la f&#243;rmula de Siri<span class="elsevierStyleSup">30</span> per calcular el percentatge de massa greixosa&#46;</p><p class="elsevierStylePara"><img alt="Taula 1&#46; 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Argentina&#41;&#44; mitjan&#231;ant un test incremental en una cinta de c&#243;rrer motoritzada &#40;Technogym Excite Run 700i&#59; Technogym SpA&#44; Gambettola&#44; It&#224;lia&#41;&#46; La recollida de dades s&#8217;obtingu&#233; mitjan&#231;ant un sistema d&#8217;an&#224;lisi de gasos respiraci&#243; a respiraci&#243; de circuit obert &#40;Medgraphics Cardiopulmonary Exercise System CPX&#47;D&#44; Breeze Ex v3&#46;06 software&#59; Medical Graphics Corporation&#44; St&#46; Paul&#44; MN&#44; EUA&#41;&#46; S&#8217;establiren increments de velocitat de la cinta d&#8217;1 km h<span class="elsevierStyleSup">&#8722;1</span> cada minut fins a l&#8217;esgotament &#40;velocitat inicial &#61; 9 km h<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; La freq&#252;&#232;ncia card&#237;aca es control&#224; amb un monitor de freq&#252;&#232;ncia card&#237;aca &#40;Polar 610i&#59; Polar Electro Oy&#44; Kempele&#44; Finl&#224;ndia&#41;&#46; El VO<span class="elsevierStyleInf">2</span> plateau &#40;un canvi en el VO<span class="elsevierStyleInf">2 </span> inferior a 2&#44;1 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span> a m&#233;s amb un increment de la c&#224;rrega de treball&#41; fou el criteri b&#224;sic per obtenir el VO<span class="elsevierStyleInf">2max</span>&#59; altres criteris secundaris foren&#58; &#237;ndex d&#8217;intercanvi respiratori m&#233;s gran d&#8217;1&#44;1 i freq&#252;&#232;ncia card&#237;aca dins els 10 batecs min<span class="elsevierStyleSup">&#8722;1</span> de l&#8217;edat prevista de freq&#252;&#232;ncia card&#237;aca m&#224;xima<span class="elsevierStyleSup">31&#44;32</span>&#46; El test de resist&#232;ncia Yo-Yo de nivell 1 fou realitzat dins el CeNARD&#44; en un pavell&#243; esportiu amb el paviment de fusta flotant&#46; Consist&#237; en una cursa llan&#231;adora de 20 m amb un increment progressiu de la velocitat &#40;velocitat inicial &#61; 8 km h<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; que fou controlada per xiulets d&#8217;&#224;udio des d&#8217;un reproductor port&#224;til&#46; El test es considerava acabat quan el participant era incapa&#231; de mantenir la velocitat indicada amb normalitat&#46; Es registr&#224; el nivell de velocitat final i el nombre de dist&#224;ncies de 20 m realitzat a aquest nivell&#46; La valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> s&#8217;obtingu&#233; amb el nomograma corresponent&#46; Ambd&#243;s&#44; TYY i MD&#44; tingueren lloc a la mateixa hora del dia &#40;&#177; 2 h&#41; per minimitzar els efectes de la variaci&#243; biol&#242;gica di&#252;rna en els resultats&#44; i per evitar restes de fatiga es realitzaren almenys amb un interval de 72 h entre l&#8217;un i l&#8217;altre&#46; L&#8217;ordre dels tests fou assignat als subjectes aleat&#242;riament&#46; Abans de l&#8217;avaluaci&#243; els participants realitzaren un escalfament apropiat de 20 min&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">An&#224;lisi estad&#237;stica</span></p><p class="elsevierStylePara"> Els trets cineantropom&#232;trics dels esportistes i els valors de la freq&#252;&#232;ncia card&#237;aca i quocient respiratori en assolir el VO<span class="elsevierStyleInf">2max</span> es mostren com a mitjana &#177; desviaci&#243; est&#224;ndard &#40;DE&#41;&#46; Es realitzaren resums estad&#237;stics per il&#183;lustrar els valors de VO<span class="elsevierStyleInf">2max</span> obtinguts mitjan&#231;ant TYY i MD&#46; L&#8217;an&#224;lisi de Bland-Altman s&#8217;empr&#224; per valorar la concordan&#231;a entre ambd&#243;s m&#232;todes de mesurament<span class="elsevierStyleSup">10-12</span>&#46; D&#8217;acord amb Bland<span class="elsevierStyleSup">33</span> i&#44; en base a l&#8217;experi&#232;ncia&#44; s&#8217;establiren els l&#237;mits de concordan&#231;a acceptables en un 95&#37;&#44; i es fixaren <span class="elsevierStyleItalic">a priori en</span> &#177;5ml&#44; kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Tamb&#233; es registraren els intervals de confian&#231;a del 95&#37; per als l&#237;mits de concordan&#231;a&#46; Degut a la petita dimensi&#243; de la mostra es van calcular usant l&#8217;expressi&#243; exacta de l&#8217;estimaci&#243; de la vari&#224;ncia dels l&#237;mits de concordan&#231;a&#44; per comptes d&#8217;una aproximaci&#243;<span class="elsevierStyleSup">12</span>&#58;</p><p class="elsevierStylePara"><img src="278v52n193-90460854fig2.jpg"></img></p><p class="elsevierStylePara"> en qu&#232; <img alt="F&#243;rmula" src="277v52n193-90460721figsi4.gif"></img> &#233;s la mitjana de la difer&#232;ncia entre els m&#232;todes i s<span class="elsevierStyleInf">d</span> &#233;s la desviaci&#243; est&#224;ndard de les difer&#232;ncies&#46; Els tests de correlaci&#243; de Pearson i Spearman s&#8217;implementaren per avaluar associacions possibles de la difer&#232;ncia entre TYY i MD amb la grand&#224;ria del mesurament&#46; El nivell de probabilitat de la significaci&#243; estad&#237;stica s&#8217;establ&#237; en 0&#44;05&#46; Totes les an&#224;lisis es realitzaren en l&#8217;entorn del programari R software&#44; versi&#243; 3&#46;2&#46;0 &#40;R Core Team&#44; Viena&#44; &#192;ustria&#41;<span class="elsevierStyleSup">34</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultats</span></p><p class="elsevierStylePara"> Els valors VO<span class="elsevierStyleInf">2max</span> obtinguts de cada individu&#44; amb els dos m&#232;todes de mesurament&#44; foren for&#231;a similars&#46; Els valors de VO<span class="elsevierStyleInf">2max</span> estimats per a TYY foren&#44; de mitjana&#44; sols un 0&#44;6&#37; inferiors als determinats mitjan&#231;ant MD&#46; La taula 2 presenta una recopilaci&#243; descriptiva dels resultats de TYY i MD i les difer&#232;ncies entre ambd&#243;s m&#232;todes&#46; Els valors de la freq&#252;&#232;ncia card&#237;aca i el quocient respiratori en assolir el VO<span class="elsevierStyleInf">2max es </span> resumeixen a la taula 3&#46;</p><p class="elsevierStylePara"><img alt="Taula 2&#46; Valoraci&#243; del V02max&#58; resum comparatiu d’ambd&#243;s m&#232;todes de mesurament" src="278v52n193-90460854fig3.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 3&#46; Valors de la freq&#252;&#232;ncia card&#237;aca i el quocient respiratori obtinguts en assolir el V02max" src="278v52n193-90460854fig4.jpg"></img></p><p class="elsevierStylePara"> Es trob&#224; un biaix no significatiu estad&#237;sticament entre TYY&#160; i&#160; MD&#160; &#40;&#8722;0&#44;31&#160; ml&#160; kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#59; interval de confian&#231;a del 95&#37;&#58;&#160;&#8722;1&#44;69&#160;a&#160;1&#44;07&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; L&#8217;estimaci&#243; dels l&#237;mits de concordan&#231;a&#160; inferior&#160; i&#160; superior&#160; al&#160; 95&#37;&#160; foren&#160; &#8722;4&#44;34&#160; i&#160; 3&#44;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Els intervals de confian&#231;a del 95&#37; d&#8217;aquests&#160; l&#237;mits&#160; foren&#44;&#160; respectivament&#44;&#160; de&#160; &#8722;6&#44;78&#160; a&#160; &#8722;1&#44;90&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i d&#8217;1&#44;29 a 6&#44;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Com s&#8217;ha dit anteriorment&#44; donada la petita dimensi&#243; de la mostra&#44; els intervals de confian&#231;a per als l&#237;mits de concordan&#231;a es van construir usant l&#8217;expressi&#243; exacta de l&#8217;estimaci&#243; de la vari&#224;ncia d&#8217;aquests l&#237;mits &#40;equaci&#243; 1&#41;&#46; La zona determinada per valorar els l&#237;mits de concordan&#231;a del 95&#37; fou m&#233;s redu&#239;da que l&#8217;acotada pels l&#237;mits d&#8217;acceptaci&#243; definits <span class="elsevierStyleItalic">a priori</span>&#46; Tanmateix&#44; la zona total coberta en considerar els intervals de confian&#231;a del 95&#37; pels l&#237;mits de concordan&#231;a del 95&#37; fou m&#233;s &#224;mplia que els l&#237;mits acceptats <span class="elsevierStyleItalic">a priori</span>&#46; A la figura 1 s&#8217;observa el diagrama t&#237;pic de Bland-Altman amb el biaix estimat i els l&#237;mits de concordan&#231;a del 95&#37; entre m&#232;todes&#44; mentre que els resultats esmentats anteriorment es presenten gr&#224;ficament a la figura 2&#46;</p><p class="elsevierStylePara"><img alt="Figura 1&#46; &#58; VO2max difer&#232;ncia entre m&#232;todes per a la mitjana de mesurament amb biaix i l&#237;mits de concordan&#231;a al 95&#37;&#46;" src="278v52n193-90460854fig5.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 1&#46; </span>VO<span class="elsevierStyleInf">2max</span>&#58; difer&#232;ncia entre m&#232;todes per a la mitjana de mesurament amb biaix i l&#237;mits de concordan&#231;a al 95&#37;&#46;</p><p class="elsevierStylePara"><img alt="Figura 2&#46; &#58; VO2max mediana i l&#237;mits de concordan&#231;a del 95&#37; de la difer&#232;ncia&#160;entre&#160;m&#232;todes&#160;amb&#160;intervals&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#46;" src="278v52n193-90460854fig6.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 2&#46; </span>VO<span class="elsevierStyleInf">2max</span>&#58; mediana i l&#237;mits de concordan&#231;a del 95&#37; de la difer&#232;ncia&#160;entre&#160;m&#232;todes&#160;amb&#160;intervals&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#46;</p><p class="elsevierStylePara"> S&#8217;observ&#224; en les dades que ni la difer&#232;ncia ni els valors absoluts de la difer&#232;ncia semblava que estiguessin correlacionats amb la magnitud de la mesura&#46; En aquest ordre&#58; <span class="elsevierStyleItalic">r</span> de Pearson&#160;&#61;&#160;0&#44;02&#160;interval&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#58;&#160;&#8722;0&#44;59&#160;a&#160;0&#44;61&#41;&#59;&#160; <span class="elsevierStyleItalic">rho</span>&#160;d&#8217;Spearman&#160;&#61;&#160;&#8722;0&#44;06&#160;&#40;interval&#160;de&#160;confian&#231;a&#160;del&#160;95&#37;&#58;&#160;&#8722;0&#44;64&#160; a 0&#44;56&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussi&#243;</span></p><p class="elsevierStylePara"> En la valoraci&#243; esportiva sovint s&#8217;usa el mesurament indirecte del VO<span class="elsevierStyleInf">2max</span>&#46; Per valorar la pot&#232;ncia aer&#242;bica m&#224;xima de l&#8217;individu s&#8217;han proposat protocols d&#8217;esfor&#231; m&#224;xim i subm&#224;xim<span class="elsevierStyleSup">1-9</span>&#46; El principal objectiu d&#8217;aquests tests ha de ser una bona concordan&#231;a&#46; El test de resist&#232;ncia Yo-Yo &#233;s un test de camp continu multiestaci&#243; a bastament emprat per valorar indirectament el VO<span class="elsevierStyleInf">2max</span><span class="elsevierStyleSup">15</span>&#46; Per les seves caracter&#237;stiques mec&#224;niques &#233;s adequat per als esportistes que practiquen esports que impliquen patrons de moviment d&#8217;aturada&#44; arrancada i canvi de direcci&#243;&#46;</p><p class="elsevierStylePara"> S&#8217;han dut a terme diferents estudis per comparar els resultats proporcionats pels tests Yo-Yo amb el VO<span class="elsevierStyleInf">2max</span> obtingut per mesurament directe en un test de cursa incremental en cinta de c&#243;rrer&#46; La comparaci&#243; implic&#224; contrastar els valors de VO<span class="elsevierStyleInf">2max</span> o el test de correlaci&#243; entre mesurament directe de valors del VO<span class="elsevierStyleInf">2max</span> i la dist&#224;ncia recorreguda en els tests Yo-Yo&#46; Alguns dels estudis que compararen els resultats del VO<span class="elsevierStyleInf">2max</span> en ambd&#243;s m&#232;todes tamb&#233; inclo&#239;en la valoraci&#243; de la concordan&#231;a&#46; Aix&#237;&#44; per exemple&#44; Metaxas et al&#46;<span class="elsevierStyleSup">22</span> trobaren difer&#232;ncies estad&#237;sticament significatives &#40;p &#60; 0&#44;05&#41; en jugadors de futbol homes &#40;n &#61; 35&#41; en comparar la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> proporcionada per TYY nivell 1 amb el valor de VO<span class="elsevierStyleInf">2max</span> obtingut per MD en ambd&#243;s protocols&#44; cursa cont&#237;nua o intermitent en cinta de c&#243;rrer &#40;valor TYY nivell 1 inferior als valors d&#8217;MD&#44; en 11&#44;4 i 13&#44;4&#37;&#44; respectivament&#41;&#46; Castagna et al&#46;<span class="elsevierStyleSup">15</span> contrastaren els resultats del VO<span class="elsevierStyleInf">2max</span> de TYY nivell 2 amb els d&#8217;MD en jugadors de futbol homes &#40;n &#61; 24&#41;&#44; i s&#8217;evidenci&#224; un biaix no significatiu estad&#237;sticament &#40;p &#61; 0&#44;10&#41; d&#8217;1&#44;17 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i uns l&#237;mits de concordan&#231;a&#160;del&#160;95&#37;&#160;de&#160;&#8722;5&#44;44&#160;i&#160;7&#44;79&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Nazarali et al&#46;<span class="elsevierStyleSup">23</span> descrigueren una mitjana m&#233;s elevada dels valors de VO<span class="elsevierStyleInf">2max</span> proporcionats per TRYY nivell 2 &#40;50&#44;8 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; en comparaci&#243; amb la mitjana de valors determinada per MD &#40;43&#44;6 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; en un estudi realitzat amb jugadores de futbol femen&#237; &#40;n &#61; 20&#41;&#46; En canvi&#44; Mart&#237;nez-Lagunas i Hartmann<span class="elsevierStyleSup">21</span> trobaren que el VO<span class="elsevierStyleInf">2max</span> de jugadores de futbol femen&#237; &#40;n &#61; 18&#41; estava significativament subestimat &#40;p &#60; 0&#44;001&#41; pel TRYY nivell 1 &#40;45&#44;2 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; comparat amb l&#8217;MD &#40;55&#44;0 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; i expressaren els l&#237;mits de concordan&#231;a&#160;del&#160;95&#37;&#160;en&#160;escala&#160;percentual&#160;&#40;&#8722;31&#44;8&#37;&#160;a&#160;&#8722;3&#44;8&#37;&#41;&#46;&#160; S&#225;nchez-Oliva et al&#46;<span class="elsevierStyleSup">25</span> revisaren la valoraci&#243; dels dos m&#232;todes en jugadors de futbol homes &#40;n &#61; 15&#41; i tamb&#233; trobaren una subestimaci&#243; estad&#237;sticament significativa del VO<span class="elsevierStyleInf">2max</span> amb el TRYY nivell 1 &#40;51&#44;00 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41; en comparaci&#243; amb MD &#40;60&#44;85 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#41;&#44; amb l&#237;mits de concordan&#231;a del 95&#37; de 3&#44;37 i 16&#44;33 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p><p class="elsevierStylePara"> D&#8217;altra banda&#44; no s&#8217;han localitzat articles de recerca que descriguin estudis de comparaci&#243; de m&#232;todes que emprin l&#8217;an&#224;lisi de Bland-Altman entre mesurament directe del VO<span class="elsevierStyleInf">2max</span> i estimaci&#243; indirecta del test Yo-Yo &#40;TYY o TRYY&#41; que tinguessin en compte el c&#224;lcul dels intervals de confian&#231;a per als l&#237;mits de concordan&#231;a&#46; Aquest &#233;s un punt d&#8217;import&#224;ncia especial en el cas d&#8217;una mostra de mida redu&#239;da&#44; que &#233;s una situaci&#243; freq&#252;ent en estudis que impliquin test d&#8217;esfor&#231; m&#224;xim&#46; La vari&#224;ncia de la difer&#232;ncia de mitjanes i la dels l&#237;mits de concordan&#231;a s&#243;n inversament proporcionals a les dimensions de la mostra&#46; Per tant&#44; els intervals de confian&#231;a corresponents s&#243;n m&#233;s amplis quan la mida de la mostra &#233;s menor&#44; la qual cosa reflecteix una gran discrep&#224;ncia entre m&#232;todes&#46;</p><p class="elsevierStylePara"> Aquesta recerca presenta un estudi acurat de comparaci&#243; entre m&#232;todes de valoraci&#243; directa del VO<span class="elsevierStyleInf">2max</span> al laboratori i l&#8217;estimaci&#243; indirecta mitjan&#231;ant el test de resist&#232;ncia Yo-Yo&#44; que &#233;s un test de camp continu multiestaci&#243; especialment &#250;til per als esportistes de disciplines de resist&#232;ncia<span class="elsevierStyleSup">8</span>&#44; per&#242; tamb&#233; &#233;s apropiat per a esports d&#8217;equip<span class="elsevierStyleSup">35</span> com jugadors d&#8217;hoquei&#44; futbol i rugbi&#46; S&#8217;ha descrit l&#8217;estimaci&#243; del biaix i els l&#237;mits de concordan&#231;a del 95&#37; entre m&#232;todes&#46; A m&#233;s&#44; tamb&#233; s&#8217;ha reportat un interval de confian&#231;a prec&#237;s del 95&#37; del l&#237;mits de concordan&#231;a del 95&#37; per a la grand&#224;ria de la mostra actual&#46; S&#8217;observ&#224; un petit biaix entre ambdues t&#232;cniques&#44; que result&#224; que no era significatiu estad&#237;sticament &#40;p &#61; 0&#44;63&#41;&#46; L&#8217;estimaci&#243; dels l&#237;mits de concordan&#231;a del 95&#37; s&#8217;establ&#237; en &#177; 4&#44;03 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span> a partir de la mediana de la difer&#232;ncia entre ells&#46; En el model proposat&#44; per a la mitjana i desviaci&#243; est&#224;ndard de les difer&#232;ncies entre m&#232;todes de valoraci&#243; significatius&#44; que s&#243;n estimacions significatives&#44; cal suposar que s&#243;n constants al llarg de totes les s&#232;ries de mesurament<span class="elsevierStyleSup">12&#44;36&#44;37</span>&#46; Cal destacar que la difer&#232;ncia mitjana i la desviaci&#243; est&#224;ndard de les difer&#232;ncies sorgides no dep&#232;n de la magnitud de la mesura&#44; que compleix amb els sup&#242;sits fonamentals simples dels l&#237;mits de concordan&#231;a del 95&#37; del m&#232;tode aplicat&#46; La zona determinada pels l&#237;mits estimats de concordan&#231;a estigu&#233; dins els l&#237;mits acceptables definits <span class="elsevierStyleItalic">a priori</span>&#46; No obstant aix&#242;&#44; aquestes valoracions tenen gran vari&#224;ncia a causa de la petita grand&#224;ria de la mostra&#44; de manera que aquest &#250;ltim resultat ha de ser considerat amb precauci&#243;&#46; Tenint en compte els intervals de confian&#231;a del 95&#37; per els l&#237;mits de concordan&#231;a del 95&#37;&#44; la zona total ampliada s&#8217;est&#233;n m&#233;s enll&#224; de &#177; 6 ml kg<span class="elsevierStyleSup">-1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; superior als l&#237;mits de concordan&#231;a acceptables del 95&#37; establerts <span class="elsevierStyleItalic">a priori</span>&#46;</p><p class="elsevierStylePara"> Els intervals de confian&#231;a per a la difer&#232;ncia de mitjanes i per als l&#237;mits de concordan&#231;a proporcionen una mesura de la precisi&#243; dels aspectes valorats basada en l&#8217;error de mostreig&#46; Les vari&#224;ncies dels estimadors d&#8217;aquestes quantitats estan afectades decisivament per la grand&#224;ria de la mostra&#46; Com m&#233;s petit sigui el nombre d&#8217;observacions per a l&#8217;avaluaci&#243; de la difer&#232;ncia entre m&#232;todes&#44; m&#233;s amplis s&#243;n els intervals de confian&#231;a&#44; i m&#233;s alt &#233;s el nivell d&#8217;incertesa&#46; A m&#233;s&#44; tot i que l&#8217;an&#224;lisi de Bland-Altman proporciona la metodologia per a la construcci&#243; dels l&#237;mits de concordan&#231;a&#44; no indica si s&#243;n o no acceptables&#46; Els l&#237;mits acceptables han de ser definits <span class="elsevierStyleItalic">a priori</span>&#44; basats en les necessitats espec&#237;fiques i els objectius&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Limitacions</span></p><p class="elsevierStylePara"> Una limitaci&#243; d&#8217;aquest estudi fou la petita grand&#224;ria de la mostra&#46; Els intervals de confian&#231;a del 95&#37; pels l&#237;mits de concordan&#231;a del 95&#37;&#44; atesa la mida de la mostra actual&#44; s&#243;n &#177; 1&#44;19 unitats de la desviaci&#243; est&#224;ndard de les difer&#232;ncies entre els mesuraments d&#8217;ambd&#243;s m&#232;todes&#46; Per tant&#44; caldria fer aquesta an&#224;lisi amb mostres m&#233;s grans per augmentar la precisi&#243; de les estimacions generades&#46; D&#8217;altra banda&#44; seria pertinent la realitzaci&#243; simult&#224;nia d&#8250;una comparaci&#243; de la repetibilitat de cada m&#232;tode mitjan&#231;ant la recopilaci&#243; de dades replicades&#44; perqu&#232; els &#237;ndexs de const&#224;ncia dels dos m&#232;todes de mesurament limiten la quantitat de concordan&#231;a possible<span class="elsevierStyleSup">12</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions</span></p><p class="elsevierStylePara"> La valoraci&#243; b&#224;sica dels l&#237;mits de concordan&#231;a del 95&#37; estigu&#233; dins de &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; satisfent <span class="elsevierStyleItalic">a priori</span> els requisits basats en l&#8217;experi&#232;ncia&#46; Per tant&#44; en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> d&#8217;esportistes es trob&#224; una concordan&#231;a correcta entre el test de resist&#232;ncia Yo-Yo i el mesurament directe al laboratori&#46; D&#8217;acord amb aquesta dada&#44; els dos m&#232;todes poden ser intercanviables&#46; Tanmateix&#44; la necessitat de precauci&#243; en la interpretaci&#243; d&#8217;aquest resultat encara s&#8217;emfatitza per la troballa que la zona coberta en considerar els intervals de confian&#231;a del 95&#37; per als l&#237;mits de concordan&#231;a del 95&#37; era m&#233;s ampla que la zona acceptable de concordan&#231;a definida <span class="elsevierStyleItalic">a priori</span> &#46; Per tant&#44; tot i que els l&#237;mits de concordan&#231;a estimats del 95&#37; no desacreditin el test de resist&#232;ncia Yo-Yo com un m&#232;tode alternatiu per mesurar el VO<span class="elsevierStyleInf">2max</span> dels esportistes&#44; el present estudi presenta una limitaci&#243; de precisi&#243;&#44; degut a la petita grand&#224;ria de la mostra&#44; i no permet conclusions definitives&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicte d&#8217;interessos</span></p><p class="elsevierStylePara"> Els autors declaren que no tenen cap conflicte d&#8217;interessos&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Agra&#239;ments</span></p><p class="elsevierStylePara"> Els autors desitgen agrair especialment a Mariela B&#46; Arangio&#44; Enrique D&#46; Balardini&#44; Claudio A&#46; Gillone&#44; Cristina P&#233;rez i Enrique O&#46; Prada pel seu suport t&#232;cnic&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleSup">&#9734;</span> Un resum preliminar d&#8217;aquest treball fou publicat en ocasi&#243; de la seva presentaci&#243; al &#171;57th Annual Meeting and Inaugural World Congress on Exercise in Medicine of the American College of Sports Medicine&#187;&#44; que tingu&#233; lloc al Baltimore Convention Center de Baltimore&#44; Maryland&#44; de l&#8217;1 al 5 de juny de 2010&#46; El resum fou publicat a la revista <span class="elsevierStyleItalic">Medicine and Science in Sports and Exercise</span>&#44; volum 42&#44; suplement 5&#46;</p><p class="elsevierStylePara"> Rebut el 12 d&#8217;abril de 2016&#59;<br></br> acceptat l&#8217;11 de juliol de 2016</p><p class="elsevierStylePara"> &#42; Autor per a correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58; </span><a href="mailto&#58;alongo&#64;deportes&#46;gob&#46;ar" class="elsevierStyleCrossRefs">alongo&#64;deportes&#46;gob&#46;ar</a> &#40;A&#46;F&#46; Longo&#41;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Introducci&#243;&#58; Tot i que diversos estudis han reportat els l&#237;mits de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> entre el test Yo-Yo i el mesurament directe&#44; en general no s&#8217;ha reflexionat sobre la precisi&#243; d&#8217;aquests l&#237;mits&#46; L&#8217;objectiu d&#8217;aquest estudi fou examinar el grau de concordan&#231;a en la valoraci&#243; del VO<span class="elsevierStyleInf">2max</span> en esportistes entre el test de resist&#232;ncia Yo-Yo &#40;TYY&#41; i el mesurament directe &#40;MD&#41;&#44; i quantificar la precisi&#243; dels l&#237;mits de concordan&#231;a estimats&#46;</p> <p class="elsevierStylePara"> Material i m&#232;todes&#58; S&#8217;obtingueren les dades d&#8217;un grup d&#8217;11 jugadors d&#8217;hoquei&#44; homes &#40;edat &#61; 22&#44;2 &#177; 3&#44;6 anys&#44; IMC &#61; 22&#44;1 &#177; 2&#44;4 kg m<span class="elsevierStyleSup">&#8722;2</span>&#41;&#46; L&#8217;MD es realitz&#224; amb un test de carrera incremental en cinta de c&#243;rrer&#46; Per valorar l&#8217;estimaci&#243; indirecta del VO<span class="elsevierStyleInf">2max</span> s&#8217;us&#224; el TYY nivell 1&#46; Per valorar la concordan&#231;a entre els dos m&#232;todes s&#8217;empr&#224; l&#8217;an&#224;lisi de Bland-Altman&#46; Els l&#237;mits acceptables de concordan&#231;a del 95&#37; foren fixats a priori en &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p> <p class="elsevierStylePara"> Resultats&#58; S&#8217;observ&#224; un biaix estad&#237;sticament no significatiu entre TYY i MD &#40;50&#44;78 vs&#46; 51&#44;09 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; p &#62;&#160;0&#44;05&#41;&#46;&#160;La&#160;valoraci&#243;&#160;dels&#160;l&#237;mits&#160;de&#160;concordan&#231;a&#160;del&#160;95&#37;&#160;fou&#160;&#8722;4&#44;34&#160; i 3&#44;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; Els intervals de confian&#231;a del 95&#37; per a aquests l&#237;mits foren&#44; respectivament&#44;&#160;des&#160;de&#160;&#8722;6&#44;78&#160;fins&#160;a&#160;&#8722;1&#44;90&#160;ml&#160;kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; i des d&#8217;1&#44;29 fins a 6&#44;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46; La difer&#232;ncia entre m&#232;todes sembl&#224; que no estava correlacionada amb la magnitud del mesurament&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; Es trob&#224; una concordan&#231;a correcta entre TYY i MD&#46; Aix&#242; no obstant&#44; la gran difer&#232;ncia dels l&#237;mits de concordan&#231;a&#44; degut a la petita dimensi&#243; de la mostra&#44; fa que calgui considerar aquests resultats amb precauci&#243;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Introduction&#58; Although different studies have reported limits of agreement in assessing VO<span class="elsevierStyleInf">2max</span> between the Yo-Yo test and the direct measurement&#44; the precision of these limits in general has not been considered&#46; The aim of this study was to examine the extent of agreement in the assessment of VO<span class="elsevierStyleInf">2max</span> in athletes between the Yo-Yo endurance test &#40;YET&#41; and the direct measurement &#40;DM&#41;&#44; and to quantify the precision of the estimated limits of agreement&#46;</p> <p class="elsevierStylePara"> Material and methods&#58; Data were obtained from a group of 11 male field hockey players &#40;age &#61; 22&#46;2<span class="elsevierStyleBold"> &#177; </span>3&#46;6 yrs&#44; BMI &#61; 22&#46;1<span class="elsevierStyleBold"> &#177; </span>2&#46;4 kg m<span class="elsevierStyleSup">&#8722;2</span>&#41;&#46; DM was performed using an incremental tread-mill running test&#46; YET level 1 was used for indirect estimation of VO<span class="elsevierStyleInf">2max</span>&#46; Bland-Altman analysis was employed for assessing agreement between the two methods&#46; The acceptable 95&#37; limits of agreement were set a priori at &#177; 5 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;</p> <p class="elsevierStylePara"> Results&#58; A non-statistically significant bias was observed between YET and DM &#40;50&#46;78 vs&#46; 51&#46;09 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; P &#62; &#46;05&#41;&#46;&#160;The&#160;estimates&#160;of&#160;the&#160;95&#37;&#160;limits&#160;of&#160;agreement&#160;were&#160;&#8722;4&#46;34&#160; and 3&#46;72 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#46;&#160;And&#160;the&#160;95&#37;&#160;confidence&#160;intervals&#160;for&#160;these&#160;limits&#160;were&#160;from&#160;&#8722;6&#46;78&#160; to&#160;&#8722;1&#46;90 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; and from 1&#46;29 to 6&#46;16 ml kg<span class="elsevierStyleSup">&#8722;1</span> min<span class="elsevierStyleSup">&#8722;1</span>&#44; respectively&#46; The difference between methods did not appear to be correlated to the magnitude of measurement&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; A reasonably good agreement was found between YET and DM&#46; However&#44; the large variance of the limits of agreement due to the small sample size means these results should be treated with caution&#46;</p>"
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ISSN: X8866581
Original language: Català
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