WEARABLE LACTATE THRESHOLD PREDICTING DEVICE
IS VALID AND RELIABLE IN RUNNERS
NATTAI R. BORGES1 AND MATTHEW W. DRILLER2
1
School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia; and 2University of
Waikato, Hamilton, New Zealand
ABSTRACT
Borges, NR and Driller, MW. Wearable lactate threshold
predicting device is valid and reliable in runners. J Strength
Cond Res 30(8): 2212–2218, 2016—A commercially avail-
able device claiming to be the world’s first wearable lactate
threshold predicting device (WLT), using near-infrared LED
technology, has entered the market. The aim of this study
was to determine the levels of agreement between the
WLT-derived lactate threshold workload and traditional
methods of lactate threshold (LT) calculation and the
interdevice and intradevice reliability of the WLT. Fourteen
(7 male, 7 female; mean 6 SD; age: 18–45 years, height:
169 6 9 cm, mass: 67 6 13 kg, V_ O2 max: 53 6 9
ml$kg21 $min 21 ) subjects ranging from recreationally active
to highly trained athletes completed an incremental exercise
test to exhaustion on a treadmill. Blood lactate samples
were taken at the end of each 3-minute stage during the
test to determine lactate threshold using 5 traditional meth-
ods from blood lactate analysis which were then compared
against the WLT predicted value. In a subset of the popu-
lation (n = 12), repeat trials were performed to determine
both inter-reliability and intrareliability of the WLT device.
Intraclass correlation coefficient (ICC) found high to very
high agreement between the WLT and traditional methods
(ICC . 0.80), with TEMs and mean differences ranging
between 3.9–10.2% and 1.3–9.4%. Both interdevice and
intradevice reliability resulted in highly reproducible and
comparable results (CV , 1.2%, TEM ,0.2 km$h21,
ICC . 0.97). This study suggests that the WLT is a practi-
cal, reliable, and noninvasive tool for use in predicting LT in
runners.
KEY WORDS lactate threshold, endurance performance,
performance testing, reliability, validity
Address correspondence to Nattai R. Borges, n.borges@cqu.edu.au.
30(8)/2212–2218
Journal of Strength and Conditioning Research
Ó 2015 National Strength and Conditioning Association
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2212 Journal of Strength and Conditioning Research
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INTRODUCTION
F
or decades, lactate threshold (LT) has been utilized
by endurance athletes as a key performance pre-
dictor and to dictate training practices (29).
Alongside a high V_ O2max and efficiency, a high
LT is essential for endurance performance as it allows an
athlete to perform at a higher work-rate for an extended
duration (19). Historically, to determine LT, invasive blood
measures and costly laboratory equipment are required to
sample whole blood during incremental exercise tests. Fur-
thermore, skilled technicians are required to measure blood
lactate concentration values and to interpret lactate profile
data. Over the past 20 years, monitoring of blood lactate
concentration has become less invasive and easier to acquire
because of advances in technology that require smaller
amounts of whole blood and capillary blood sampling tech-
niques. However, new alternatives to quantify exercise
threshold workloads via noninvasive and cost-effective
methods are constantly being introduced.
To circumvent the invasive nature of calculating exercise
threshold workloads from blood lactate concentration,
researchers have investigated the use of expired gas (8),
and to a lesser extent heart rate (7) inflection points and
rating of perceived exertion scores (10) as means for deter-
mining exercise thresholds. Although no invasive measures
are required, there are still high costs related to the labo-
ratory equipment and skilled technicians needed to collect
and interpret the expired gas and heart rate data. More
recently, near infrared spectroscopy (NIRS) systems have
been used to continuously monitor muscle tissue oxygen-
ation via the absorption of the near infrared light by hemo-
globin and myoglobin as the near infrared light passes
through the muscle tissue. Recent studies have been test-
ing the use of the muscle tissue oxygenation values derived
from NIRS to gain exercise threshold information via
inflection points of muscle oxygenation parameters during
incremental exercise (2,3,13,27). Although the use of NIRS
is relatively new to sports science, it has proven to be
a viable noninvasive tool to determine peripheral muscle
oxygenation during exercise (4,22).
With further technological advancements, the use of
portable NIRS systems to monitor peripheral muscle oxy-
genation in field testing has become more common (6). A

commercially available wearable lactate threshold predicting
device (WLT) (BSXinsight multisport edition; BSX Athletics,
Austin, TX, USA) is a portable NIRS LED device, which is
marketed as the first wearable lactate threshold predictor
claiming to have the ability to determine the workload at
LT during self-administered maximal cycling or running
exercise tests (5). The noninvasive and portable nature of
the device allows athletes and coaches to easily monitor
their LT, prescribe exercise-training zones based on LT val-
ues, and monitor training adaptations in a cost-effective
manner. Because of the patented design and algorithm of
the device, it is difficult to evaluate the exact methodology
used to predict LT workload by the WLT. However, no
studies have investigated the validity nor the reliability of
the WLT devices’ ability to predict workload at LT. There-
fore, the aims of this investigation were twofold: (a) to
determine the levels of agreement between the WLT and
a number of traditional blood lactate methods including the
linear spline fitting method, Dmax method, modified Dmax
method, fixed blood lactate concentration of 4 mmol$L21
method, and first rise of blood lactate greater than 1
mmol$L21 method to determine workload (km$h21) at
LT, and (b) to establish the reliability of the WLT device
during a repeated trial (intradevice reliability) and when
using 2 devices during a single test (interdevice reliability).
METHODS
Experimental Approach to the Problem
The LT workloads calculated by the WLT were compared
with traditional LT workloads after an incremental exercise
test to exhaustion (GXT) on a treadmill (HP Cosmos,
Traunstein, Germany). All testing was performed in con-
trolled laboratory conditions (21 6 18 C and 60% relative
humidity). Subjects were asked to refrain from strenuous
exercise (,12 hours) and to arrive at each session in a fully
rested and hydrated state. For the test–retest reliability trials,
subjects were to report for testing at the same time of day
(61 hour), separated by 24 hours.
Subjects
Seven male (mean 6 SD; age: 19–45 years, height: 172.2 6
8.5 cm, mass: 74.5 6 12.7 kg, V_ O2max: 58.6 6 7.0
ml$kg21$min21) and 7 female (age: 18–41 years, height:
164.4 6 7.1 cm, mass: 59.8 6 7.6 kg, V_ O2max: 47.1 6 6.5
ml$kg21$min21) subjects from a range of recreationally
active to highly trained athletes (V_ O2max range = 39.7–
67.0 ml$kg21$min21) volunteered to participate in the cur-
rent study. Both male and female runners from a range of
abilities and demographics were recruited to test the WLT
across a large span of lactate threshold speeds (10.9–16.2
km$h21). To be eligible for the study, all participants were
required to be free from injury and medication that may have
affected their ability to perform maximal exercise. Before
inclusion, all participants were informed about the study
including potential risks and benefits and were required to
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give written consent. This study was given ethical clearance
by the University of Waikato Human Research Ethics Com-
mittee in accordance with the Helsinki declaration.
Procedures
The GXT consisted of 3-minute stages at increasing work-
loads (km$h21) determined by the WLT software. The WLT
software predetermined the protocol stage workloads via
information about the subjects’ current fitness levels. The soft-
ware required information on current “conversational pace”
explained to participants as the maximal pace that subjects
would still be able to comfortably maintain a conversation
and “10 km pace” explained as the maximal pace subjects
would be able to maintain over a 10-km distance. The GXT
protocols started with a “warm up” walking stage at 4.8
km$h21 followed by a sharp increase in workload for the
second stage (9.3–11.7 km$h21). Further stage increments
ranged from 0.3 to 1.1 km$h21 until the subject was unable
to maintain the stage workload. The exercise protocol and
workload increments set by the WLT had to be followed and
a minimum of 4 stages had to be completed for a successful
prediction of LT workload by the WLT. Expired gas variables
were collected and analyzed at 15 seconds intervals through-
out the GXT with an indirect calorimetry system (TrueOne
2400; Parvo Medics, Inc.; Sandy, UT, USA), which was cali-
brated as per the manufacturer’s instructions. V_ O2max was
taken as the highest V_ O2 value (ml$kg21$min21) recorded
over a 1-minute period during the GXT.
BSX Insight
The WLT (BSXinsight multi-sport edition; BSX Athletics) is
a commercially available portable NIRS LED device that is
housed in a compression sleeve and fitted over the gastroc-
nemius muscle of the user (Figure 1). Compression sleeves of
different sizes were utilized to ensure that the compression
sleeve fit firmly and comfortably on all subjects regardless of
body size. During inter-reliability trials, 2 devices were used,
with 1 device attached to each leg. The WLT monitors
change in muscle oxygenation (total oxygenation index
[TOI]) and has been suggested by the manufacturers to be
able to predict LT at 97% accuracy via their patented algo-
rithm that detects inflection points in the muscle oxygena-
tion curve at increasing workloads (5). The WLT was aligned
with the thickest section of the gastrocnemius as per the
manufacturer’s instructions and LT workload was calculated
in pace (min$km21), which was converted to speed
(km$h21) for further analysis.
Blood Lactate Sampling and Analysis
Blood lactate concentration was collected and analyzed
(Lactate Pro 2; Arkray Global Business Inc., Shiga, Japan) in
the final 10 seconds of each stage and 1-minute postexercise via
finger-prick capillary blood samples using universal procedures.
Traditional method LTs were calculated using a previously
validated Excel spreadsheet (14,23). Traditional LT workloads
were determined using a range of methods including:
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 Wearable Lactate Threshold Predictor

Fixed blood lactate concentration of 4 mmol$L21

(4mmoL): Calculated using an inverse prediction by finding
the work rate/intensity corresponding to a lactate value
equal to a fixed blood lactate concentration of 4 mmol$L21.
First rise of blood lactate greater than 1 mmol$L21
(1mmoL): Defined as the workload preceding an increase
in lactate concentration of a fixed rise of 1 mmol$L21 after
baseline.
All LT workload calculations have also been previously
described (23).

Figure 1. A) The wearable lactate threshold predicting device (WLT)
and (B) the compression calf sleeve that the WLT it is housed in,
positioned over the gastrocnemius calf muscle. 1 = 3 near infrared
LED’s; 2 = charging connector pins.
Reliability Testing
In a subset of the sample used in the current study, further
trials were performed to evaluate the interdevice and
intradevice reliability of the WLT (n = 12). Subjects per-
formed 2 GXT tests separated by 24 6 1 hour to measure
the intradevice reliability of a single WLT. Given the aim
was to test the reliability of the measurement device (not
the test itself ), the test was discontinued at exactly the
same point of the GXT in the second trial. The same in-
dividuals also wore 2 WLT devices (one on each leg) dur-
ing a single GXT to determine the interdevice reliability of
2 WLTs.

Linear spline fitting (LSP): The point of intersection Statistical Analyses

between 2 linear splines on a lactate curve. The location of
this intersection is estimated by minimizing the sum of the
squared differences between the observed lactate values and
the fitted values.
Dmax: Defined as the point that yields the maximal
distance from the lactate curve (using a third-order poly-
nomial) to the line formed by the lowest and highest lactate
values of the curve.
Modified Dmax (mDmax): Defined as the point that
yields the maximal distance from the lactate curve (using
a third order polynomial) to the line formed between 0.4
mmol$L21 above the lowest lactate value and the highest
lactate value on the curve.
Descriptive statistics (mean 6 SD) were calculated for all
data. A 1-way ANOVA was implemented to measure differ-
ences between LT workload values derived from the WLT
and traditional methods. Between-method agreements for
LT were examined using intraclass correlation coefficients
(ICC) with 95% confidence intervals and interpreted as
0.90–1.00 = very high correlation, 0.70–0.89 = high correla-
tion, 0.50–0.69 = moderate correlation, 0.26–0.49 = low cor-
relation and 0.00–0.25 = little, if any correlation (18,21). The
mean differences and upper and lower levels of agreement (2
standard deviations or 95% of a normally distributed popu-
lation) between methods were determined in absolute values
(km$h21) and as a percentage (%). Between-method typical

TABLE 1. Intraclass correlation coefficients, typical error of measurement, and levels of agreement for lactate
threshold workload (km$h21) predicted by the WLT and traditional methods.*

WLT
compared ICC TEM (95% CI) TEM Mean difference Mean
with (95% CI) (km$h21) (95% CI) (%) (62 SD) (km$h21) difference (%)

LSF 0.91 (0.22–0.98) 0.74 (0.53–1.23) 6.1 (4.3–10.2) 0.86 (20.61 to 2.32) 6.6
Dmax 0.80 (20.17 to 0.92) 0.98 (0.74–1.48) 8.6 (6.4–13.3) 1.21 (20.82 to 3.23) 9.4
mDmax 0.89 (20.10 to 0.95) 1.21 (0.92–1.84) 10.2 (7.6–15.8) 0.59 (21.75 to 2.93) 4.5
4mmoL 0.98 (0.94–0.99) 0.48 (0.36–0.72) 3.9 (2.9–6.0) 0.18 (20.82 to 1.18) 1.3
1mmoL 0.92 (0.41–0.98) 0.72 (0.54–1.09) 6.3 (4.8–9.8) 0.84 (20.84 to 2.52) 6.4

*WLT = wearable lactate threshold predicting device; LSF = linear spline fitting; mDmax = Modified Dmax; 4mmoL = fixed blood
lactate concentration of 4 mmol$L21; 1mmoL = first rise of blood lactate greater than 1 mmol$L21; ICC = intraclass correlation
coefficient; TEM = typical error of measurement.

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2214 Journal of Strength and Conditioning Research

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Figure 2. Bland Altman plots depicting levels of agreement of workload (km$h21) at lactate threshold for (A) linear spline fitting (LSF) and the wearable lactate
threshold predicting device (WLT) (B) Dmax and the WLT (C) mDmax and the WLT (D) fixed blood lactate of 4 mmoL21 (4mmoL) and the WLT (E) first increase
in blood lactate greater than 1 mmoL21 (1mmoL) and the WLT during incremental exercise tests to exhaustion on a treadmill.

error of measurement (TEM) was determined in absolute RESULTS

values (km$h21) and as a percentage (%) using an excel
spreadsheet (15,17). Bland Altman plots were also con-
structed to visualize levels of agreements. Interdevice and
intradevice reliability data were log-transformed and ana-
lyzed using an Excel spreadsheet for reliability (16). Typical
error of measurement and overall reliability of the WLT is
presented as a coefficient of variation percentage (CV%) and
as an absolute value (km$h21) along with ICCs and upper
and lower 95% CI. All statistical analyses were performed in
SPSS V22.2 (IBM Corporation, Armonk, NY, USA) unless
stated otherwise. Statistical significance was accepted at the
p # 0.05 level.
One-way ANOVA showed no statistically significant differ-
ences between the LT workloads determined by the different
methods (p = 0.60). Intraclass correlation coefficients with
95% CI ranged from 0.80 to 0.98 (20.10 to 0.99) for work-
load at LT calculated by the WLT and traditional methods,
and are shown in Table 1.
Table 1 also shows the TEM and levels of agreement
between the workloads at LT calculated by the WLT and
traditional methods in absolute values and as percentages.
TEM and levels of agreement and 95% CI ranged from 0.48
to 1.21 km$h21 (3.9–10.2) and 0.18 to 0.86 km$h21 (1.3–9.4),

TABLE 2. The inter-reliability and intrareliability of the wearable lactate threshold predicting device (WLT) including
intraclass correlation coefficients, typical error of measurement (km$h21), and coefficient of variation for each
comparison.*†

Trial 1 Trial 2 ICC TEM (95% CI) CV

(km$h21) (km$h21) (95% CI) (km$h21) (95% CI) (%)

Inter-reliabilityz 12.99 6 0.84 13.05 6 0.81 0.97 (0.90–0.99) 0.16 (0.12–0.28) 1.2 (0.9–2.1)
(n = 12)
Intrareliability§ 13.02 6 0.78 13.03 6 0.87 0.97 (0.90–0.99) 0.16 (0.11–0.27) 1.2 (0.9–2.1)
(n = 12)

*ICC = intraclass correlation coefficient; TEM = typical error of measurement; CV = coefficient of variation.
†Data are shown as means 6 SD unless stated otherwise.
zInter-reliability of the WLT device as determined during a single test where subjects wore a device on each leg.
§Intrareliability of WLT determined using the same device in a repeated trial separated by ,24 hours.

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 Wearable Lactate Threshold Predictor
Figure 3. Comparison of lactate threshold workloads (km$h21) for the WLT (wearable lactate threshold predicting device), linear spline fitting (LSF), Dmax,
modified Dmax (mDmax), fixed blood lactate accumulation of 4 mmol$L21 (4mmoL), and first rise of blood lactate greater than 1 mmol$L21 (1mmoL).
respectively, with the highest level of agreement between the
WLT and 4mmoL method. Bland Altman plots showing the
mean difference and limits of agreement for the WLT and
traditional methods are shown in Figure 2.
Both interdevice and intradevice reliability resulted in
highly reproducible and comparable results (Table 2). When
comparing the interdevice reliability during a single test in 12
separate trials, the WLT resulted in a CV and 95% CI of 1.2%
(0.9–2.1), a TEM of 0.16 km$h21 (0.12–0.28) and an ICC of
0.97 (0.90–0.99). Similarly, the intradevice reliability deter-
mined by the same device during 2 tests separated by ;24
hours, resulted in a CV and 95% CI of 1.2% (0.9–2.1), a TEM
of 0.16 km$h21 (0.11–0.27), and an ICC of 0.97 (0.90–0.99).
DISCUSSION
The results for the current study support both the validity
and reliability of the WLT during an incremental exercise test
to exhaustion on a treadmill. This study showed no
significant differences in the workloads at LT determined
by the WLT when compared with 5 traditional methods of
measuring LT. Correlation analysis of LT speeds showed
high to very high levels of agreement (ICC = 0.80–0.98)
between the WLT and traditional methods, with 4mmoL
threshold resulting in the highest correlation (ICC = 0.98).
The typical error of measurement and levels of agreement
(absolute and %) were also lowest between WLT and
the
2216 Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
4mmoL at 0.48 km$h21 and 3.9%, and 0.18 km$h21 and
1.3%, respectively. Additionally, the current study found high
reliability when comparing 2 WLT devices during the same
test (inter-reliability; CV% = 1.2, TEM = 0.16 km$h21,
ICC = 0.97), which was almost identical to the comparison
between the same device during a repeated test (intrareli-
ability; CV% = 1.2, TEM = 0.16 km$h21, ICC = 0.97). These
results suggest that the WLT is both valid and reliable in
determining workload at LT through the threshold range
of 10.9–16.2 km$h21 and promote the suitability of the
WLT in a practical setting.
As this is the first study to compare the WLT and
traditional methods, it is difficult to make direct comparisons
with existing research. However, previous studies investigat-
ing the suitability of muscle oxygenation breakpoints using
other NIRS systems to determine exercise thresholds have
shown similar results to those of the present study (2,3,27). It
is important to note, however, that when comparing the
results of the present study to existing research, the hetero-
geneous methodology such as the NIRS device used, site of
measurement (vastus lateralis, gastrocnemius) and which
parameter was used in determining the NIRS breakpoint
(TOI, change in oxyhemoglobin concentration, change in
deoxyhemoglobin concentration) may have an effect on
the compatibility of the results. Furthermore, the majority
of existing literature has compared NIRS inflection points to
TM

ventilatory thresholds (VT) (3,20,24,30) with only a handful
of studies comparing NIRS inflection points to blood LTs
(2,13,28). Additionally, there is a high prevalence of cycle
ergometer studies in existing research which is most likely
a result of the possible increase in signal noise owing to
movement artifact of the NIRS leads while running (25).
The levels of agreement in our study are supported by
existing literature showing high correlations between NIRS
breakpoints and LTs (2,12). Similar to the results of this study,
Belloti et al. (2) reported no significant differences, high cor-
relations (r = 0.81; r = 0.76), and mean differences of 0.26
L$min21 and 8 bpm for V_ O2 and heart rate values derived
from change in deoxyhemoglobin concentration from the
vastus lateralis muscle and from maximal lactate steady state
during cycle ergometry. Wang et al. (28) compared threshold
workload (W), V_ O2 and heart rate values from multiple NIRS
parameters (TOI, change in oxyhemoglobin concentration,
change in deoxyhemoglobin concentration) also from the
vastus lateralis muscle with those derived from VT and LT
during incremental cycling exercise. Threshold for all param-
eters was determined as the inflection point of 2 regression
lines. The authors report the NIRS parameter with the stron-
gest correlations to be between change in deoxyhemoglobin
concentration with VT and LT (28). However, contrasting
the results from our study, the authors reported a significant
correlation between TOI measures and VT (r = 0.95) but not
LT (r = 0.68) (28). The contrasting results between the pres-
ent study and that of Wang et al. (28) could be attributed to
heterogeneous methodology.
Although showing high levels of agreement through
ICCs, mean difference values reveal a tendency of the
WLT to overestimate LT workload when compared with
traditional methods (Figure 3). However, higher workloads
at NIRS inflection points compared with VT and LT has
been previously reported in existing literature (11) and there
is also evidence to suggest that NIRS inflection points at the
gastrocnemius muscle occur at higher workloads compared
with those at the vastus lateralis muscle (27). Taken together,
these past findings may explain why the WLT showed
a small overestimation of LT workload in our study. The
WLT showed the highest levels of agreement with the
4mmoL method (ICC = 0.98; TEM = 0.48 km$h21, 3.9%;
mean difference = 0.18 km$h21, 1.3%) with narrow 95%
limits of agreement (20.82 to 1.18 km$h21). However, this
magnitude of agreement was not apparent with all tradi-
tional methods. Visual inspection of Bland Altman plots
demonstrates that outliers in are evident when comparing
the WLT to Dmax and mDmax (Figures 1B,C) with data
points falling outside the 95% limits of agreement. Further-
more, inspection of the scatter points for the WLT and
1mmoL (Figure 2E) also shows a downward trend with
increasing workload, suggesting greater agreement between
the 2 measures at higher threshold workloads. Therefore,
although no significant statistical differences between the
WLT and traditional methods were found, overall means
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and 95% limits of agreement with visual inspection of Bland
Altman plots suggest that magnitude of agreements can
occasionally show variation between the WLT and LT tra-
ditional methods.
Given the range of LT values that were produced in this
study (12.3–13.3 km$h21) by the different traditional meth-
ods, it makes it difficult to conclude whether the WLT pro-
vides a valid prediction of LT. Therefore, it could be argued
that the reliability of the WLT is perhaps the most important
factor when it comes to using the device to monitor running
performance. Owing to the logistics associated with testing
multiple athletes at 1 time, scientists commonly interchange
multiple units of the same brand device between repeat tests.
As such, it is important that the brand of device employed
demonstrates good intradevice and interdevice reliability.
This way, measurement errors are minimized, and a greater
level of confidence is achieved when comparing and inter-
preting repeat tests on the same athlete. Both the intradevice
and interdevice reliability of the WLT device resulted in
a CV% of ,1.2 (TEM , 0.16 km$h21, ICC . 0.97), suggest-
ing that the WLT can produce reliable and reproducible
results both when using the same device and 2 separate
devices. Given, it has been suggested that a CV of ,10% is
acceptable for reliability in other sport science measurement
tools (1), such as metabolic analyzers (9), and the intradevice
and interdevice CV of the one of the most commonly used
blood lactate analyzers (Lactate Pro; Arkray Global Business
Inc.) has been reported as 5.7 and 5.2% (26), an intradevice
and interdevice CV of ;1.2% suggests that the WLT appears
to be highly reliable.
PRACTICAL APPLICATIONS
This study provides the first data on the validity and
reliability of the WLT’s ability to predict lactate threshold
in runners. The results highlight that the WLT is a reliable
tool that shows marginal variance in predicting workload at
LT when compared with some of the common LT methods
derived through blood-sampling techniques. These observa-
tions suggest that coaches and athletes could use this device
to monitor workload at LT and prescribe training parameters
based on the LT workload predictions through the noninva-
sive and self-administered exercise test. The nature of the
exercise test prescribed by the WLT would allow coaches
to remotely monitor their athletes and could allow coaches
and athletes to monitor training adaptations through
changes in LT workload.
CONCLUSIONS
The findings of our study suggest that the WLT is a practical
tool for estimating lactate threshold workloads for runners.
We found acceptable levels of agreement between the WLT
and traditional blood lactate threshold methods and also
that the device was highly reliable in both a test–retest set-
ting and when comparing 2 devices during the same test.
The WLT could be implemented by coaches and athletes as
VOLUME 30 | NUMBER 8 | AUGUST 2016 | 2217
 Wearable Lactate Threshold Predictor
a portable and noninvasive method to monitor lactate
threshold workload changes in runners.
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