1. Cardiorespiratory Testing

2. Maximal Oxygen Uptake . AKA VO2 Max
Criterion measure of cardiorespiratory fitness
Product of maximal cardiac output and arterial-venous oxygen difference
Directly related to functional capacity of the heart

3. Maximal Oxygen Uptake Direct measurement Open-circuit spirometry
Pulmonary ventilation
Expired O2 and CO2 fractions

4. Maximal Oxygen Uptake . . Indirect methods Estimation techniques
VO2 values correlated with intensities reached
Similarities in fitness levels
Similarities in age and gender
Regression equations used to predict VO2 . .

5. Maximal Oxygen Uptake Indirect methods Estimation techniques
Step tests
Little equipment or skill needed
Short duration test – less than 5 minutes
Requires some balance
Difficult for extremely deconditioned

6. Maximal Oxygen Uptake Indirect methods Estimation techniques
Field tests – practical (mass testing)
Cooper 12 minute run
Requires maximal effort & motivation
Unmonitored – danger for at-risk?
Rockport 1 mile walk
Unmonitored but walking vs. running decreases danger

7. Maximal Oxygen Uptake Indirect methods Estimation techniques
Treadmill tests
Accommodates all fitness levels – speed changes
Requires skill and balance for some – practice?
Difficult to measure BP

8. Maximal Oxygen Uptake Indirect methods Estimation techniques
Cycle ergometer tests
Easy to take BP measurements
Non weight bearing – accommodates extremely weak
Small work rate adjustments can be made
Familiar skill – but not a common activity
Severe localized fatigue - motivation
Specific pedal cadence is required - motivation

9. Maximal Oxygen Uptake Maximal Exercise Tests Advantage Disadvantage
True maximal capacity can be measured
Increased sensitivity in Dx of CAD in asymptomatic
Disadvantage
Volitional fatigue
do they know maximum?
risk of injury
Physician supervision*
Emergency equipment*

10. Maximal Oxygen Uptake Maximal Exercise Tests Incremental workloads
Steady state not required
“Quick and dirty”
Just max is the goal
Prolonged – other measures along the way
Ventilatory threshold
Lactate threshold

11. Maximal Oxygen Uptake Submaximal Exercise Tests Assumptions
Steady is state reached at each work rate
Linear relationship between HR and work rate
Maximal HR is uniform for every age
Predict max from slope of line

12. Submaximal Testing Keys to success
2-3 min warm-up and equipment acquaintance
Monitor HR & BP near the end of each stage
Perceived exertion (6-20 or 1-10 scale)
Monitor subject’s/client’s appearance
Terminate at 85% of age-predicted max HR, or 70% of HR reserve, or if problems arise
Allow warm-down & monitor

13. Submaximal Testing
Test Termination Criteria in Low-risk adults (Box 4-5)
***Subject requests to stop***
**Failure of testing equipment**
Onset of angina – pain associated with ischemia
Significant rise or drop in BP
Signs of poor perfusion – pallor
Failure of HR to increase with workload increase
Noticeable change in heart rhythm
Severe fatigue

14. Submaximal Testing . . Cycle Ergometer Tests
Astrand-Rhyming Cycle Ergometer Test (page 70)
Single stage test – target HR from
Work Rate – 50 rpm)
Men – unfit 300 or 600, fit 600 or 900 kgm/min
Women – unfit 300 or 450, fit 450 or 600 kgm/min
Heart rate 5th & 6th min. – average them
Use of nomogram to estimate max VO2 (Figure 4-1)
Correct VO2 max by multiplying correction factor for age difference in max HR . .

15. Submaximal Testing . . Cycle Ergometer Tests
YMCA Cycle Ergometry Test (page 74)
2 - 4 stage continuous exercise
Branching – if ___ Hr, then ___ intensity
Heart rate 2nd & 3rd min. of each stage
HR must be within 6 beats to go to next stage
HR must be between 110 and 85% age predicted max
Plot HRs of last min. then extrapolate to max HR
Line to predicted work rate at max VO2
Calculate a predicted VO2 (Appendix D) . .

16. Prediction Line Max HR 220-age Submax 2 Submax 1 Max Work Rate

17. Evaluation of Results .
Compare predicted VO2 to norm table (table 4-8)

18. Example Male, Age = 45 1st stage yields HR of 98
2nd stage yields HR of 121
3rd stage yields HR of 143
Age predicted max HR = 175
85% of max HR = 149
Predicted max = ? Plot to find

19. Example . Use graph to plot predicted work rate at max HR
Used predicted max work rate for calculation of predicted max VO2 .

22. Maximal Testing Purpose Physician Supervised? Diagnosis of CAD
Prognosis of client regarding disease
Finding functional capacity for prescription (CRF – Cardiorespiratory Function)
Physician Supervised?
Low risk & men < 45 yr / women < 55 yr
Moderate & High risk

23. Maximal Testing Personnel “Experienced paramedical personnel”
ACSM Exercise Specialist Certified? KSA’s
Exercise Physiology and Related Exercise Science
Pathophysiology and Risk Factors
Health Appraisal, Fitness and Clinical Exercise Testing
Electrocardiography and Diagnostic Techniques
Patient Management and Medications
Medical and Surgical Management
Exercise Prescription and Programming
Nutrition and Weight Management
Human Behavior and Counseling
Safety, injury Prevention, and Emergency Procedures
Program Administration, Quality Assurance, and Outcome Assessment

24. Maximal Testing Work Rate Changes Incremental Format Ramp Format
1 minute – 3 minutes
Large intensity changes
Time to reach steady state
Ramp Format
~ 20 sec stages
Small intensity changes
Smoother – non-steady state

25. Maximal Testing Clinical Treadmill Bruce Protocol most common
large metabolic demand increments
best for more fit subjects
3 min stages
increases in speed & grade

26. Maximal Testing Clinical Treadmill Balke-Ware small work increments
best for less fit subjects
1 min stages
speed remains at 3.3 mph
increases in grade only by 1% each stage

27. Maximal Testing Sequence of Measures
HR (ECG), BP, RPE, Familiarization, Termination
Box 4-4
Pre
Exercise
Posttest

28. Maximal Testing Indications for Terminating Test Absolute Relative
Decreased medical status
Equipment Failure
Request to stop
Relative
Change in hemodynamic function
Change in ECG
Fatigue / Chest Pain

29. Maximal Testing Symptomatic Angina Scale
1+ Light, barely noticeable
2+ Moderate, bothersome
3+ Moderately severe, very uncomfortable
4+ Most severe or intense pain ever experienced
A 3+ would indicate stopping a test

30. Maximal Testing . . . Functional Aerobic Impairment
%FAI = (Predicted VO2 – Observed VO2) x 100
Predicted VO2 . . .

31. Maximal Testing . . Metabolic Equivalents – METs
Multiples of VO2 at rest ml/kg/min
Predicted average max VO2 in METs
Men= ( x age) / 3.5
Women= ( x age) / 3.5 . .

32. Maximal Testing Performance Determine functional capacity
Velocity at max for prescription and program assessment
HR at max for prescription and program assessment
Power at max for prescription and program assessment

33. Maximal Testing Performance Methods Max only
“Quick & dirty” – rapid rise in intensity until max
minutes of testing
No need for steady state
max is goal without fatigue from time

34. Maximal Testing Treadmill Protocol Ramp or incremental stages
Alternate speed and / or grade
Limitation should be physiological not psychological

35. Maximal Testing Cycle Ergometer Protocol Ramp or incremental stages
Maintain pedal cadence
Increase tension
Seated & legs only – no standing or arm assistance
Limitation should be physiological not psychological

36. Maximal Testing . . Max VO2 Determination Criteria
Caveat 1. Use of large muscle groups
Caveat 2. Activity specific to “athlete’s” sport
No increase in VO2 with increase in work rate
RER > 1.15
HR during final stage beats of predicted HR
* Blood lactate concentration > 8 mmoles/liter .

37. Max VO2
VO2 (ml/kg/min) .
Work Rate

38. Maximal Testing . . . PEAK VO2
Highest VO2 reached without meeting caveats
Highest VO2 reached without meeting 2 of 3 criteria . .

39. Maximal Testing Threshold Determination
OBLA – rapid blood lactate accumulation
T-vent - non-linear ventilation increase
Protocol
Smaller intensity increments – not too small!
Even intensity increments
Minute by minute measures – “catch” the inflection point
May last too long to achieve max (fatigue)

40. Ventilatory Threshold
Ventilation (ml/min)
T-vent
Work Rate

41. Supra-maximal Testing
Wingate Anaerobic Power Test
Energy supply beyond aerobic metabolism
Protocol
Cycle ergometer
30 second ride at maximal cadence
Load = 7.5% to 10% of body mass (kg)
Determines peak power (watts)
Determines average power
Determines %Power Decline

42. Supra-maximal Testing
Wingate Anaerobic Power Test
Indices
Phosphagen stores
Glycolytic system
Buffering capacity
Motivation & capacity to tolerate discomfort
“Kick” at the end of a race or surge during the race
Power to weight ratio (relative power)

43. Questions?

44. End