Chapter 7 - Assessment of Cardiorespiratory Fitness

Type

*______ of treadmill test influences VO2max: Graded running > running at 0% grade > walking *Cool down lasts until a heart rate is 100 or less (low level of exercise to keep the blood circulating *If an older person immediately sits down after the GXT, the blood can pool in the legs and cause a mild heart attack *Bruce treadmill protocol = every 3 minutes it increases in speed and incline

Cons of Field testing

-Difficult to monitor physiological responses -Other factors can affect outcome (e.g., motivation, environment) -Lack of graded or sub maximal testing protocols

Cons for bench stepping GXT

-Difficult to take measurements (BP) -Limited number of stages for a step height for a given fitness level

Pros for cycle ergometer

-HR and BP measurements relatively easy to take -Safe for those with balance problems -Instruments are moderately priced

1 mile walk test

-Heart rate end -Time it took them to walk

Cons for cycle ergometer

-Leg fatigue may force a client to stop before reaching VO2max -Pacing may be difficult to regulate -Each increment in intensity places greater relative load on smaller person

Pros for bench stepping GXT

-Low cost of equipment -Portability

Pros of Field testing

-Moderate to high correlation of VO2max -Use of natural activities -Ability to test large numbers in a short time

Pros of Treadmill gxt

-Reproducible: the treadmill maintains the speed -Natural activity -Accommodates all fitness levels

Cons of treadmill gxt

-Some clients may want to use handrail -Lack of portability -Difficult to take measurements (BP, blood) -Expense of equipment

Sequence of administering a gxt

1. Calibrate the exercise equipment 2. Make sure all equipment needed is available 3. Check supplies and data forms 4. Select appropriate test protocol 5. Check testing room 6. Verify pretest instructions were followed by participant 7. Obtain informed consent 8. Record age and measure height and weight 9. Obtain resting HR and BP 10. Demonstrate how to do the GXT and ask if there are any questions

Estimated maximum heart rate

220 - age

Maximal

A __________ sign- and symptom-limited exercise test is generally recommended for finding ischemic heart disease in asymptomatic individuals. Maximal GXTs are usually performed by participants with a minimal fitness level because they usually require too much exertion for people who have been inactive (p. 147). Submaximal exercise tests are not as effective in identifying disease, but they are appropriate for making activity recommendations, adjusting the medical regimen, and identifying the need for additional diagnostic tests (p. 147).

large

If it were possible, it would allow investigators to easily classify ________ numbers of people into CRF categories and determine if CRF is linked to various chronic diseases. Doing exercise testing on such large populations would be impossible due to time, cost, personnel, and so on (p. 154).

Liters per minute

Liters of O2 used by the body each minute

VO2max

Maximal oxygen consumption; how much oxygen you an get to your working muscles

Field tests

Measure all-out performance in an endurance test (e.g., time on 1 mile run)

Lab tests

Measure physiological responses (e.g., HR, BP) to increasing workloads

Ml per kg per min

Milliliters of O2 used by each kilogram of body weight each minute

METs

Multiples of resting metabolic rate

heart rate and duration

My two measurable objectives would be ________ _______ and ___________ (time made). Over time, the patient should improve, and should walk the mile faster than they did the first time. Each time the mile walk is performed, it is expected that it will take the patient less and less time. The healthier/better in shape the patient gets, the lower their resting heart rate will be. They will also have a lower recovery heart rate following the exercise period. It is said that a healthy heart will recover quickly in the first three minutes after stopping exercise.

test

The results of the ______ are still useful in evaluating changes in cardiorespiratory fitness due to the exercise program. Submaximal tests are reliable in measuring changes in heart rate, blood pressure, and rating of perceived exertion (RPE)

1 MET

What is equal to 3.5 ml per kg per min?

CRF

Why Test ____? · Determine physiological responses at rest and with exercise. · Provide a basis for exercise programming · Evaluate the effectiveness of current training program · Screen for coronary heart disease (CHD) · Determine ability to perform specific work tasks · *When exercising BP response is higher; Systolic rises with increases in stages o Have to increase blood output to the muscles because of the increasing intensity · *Diastolic stays the same, may drop 2 or 3 points o Diastolic is the venous return of blood

Cycle ergometers

________ __________ are portable, moderately priced work instruments that allow easy measurement of HR and BP because the participant's upper body is essentially stationary. Their disadvantages are that the exercise load is self-paced and that fatigued leg muscle may be a limiting factor (p. 142). The treadmill protocols are very reproducible because they set the pace for the subject. This means that the treadmill has an advantage because of the set pace. On the bench step or cycle ergometer, the individual may go too slow or too fast (p. 143). Treadmills can also accommodate people of any fitness level and use the natural activities of walking and running. Some disadvantages of treadmills are they are expensive, not portable, and make some measurements (e.g., BP and blood sampling) difficult (p. 143).

Clients

________ are asked not to eat, drink, or smoke before a submaximal GXT because they do not want an increased heart rate from caffeine, fatigue from food, or a decreased lung capacity due to smoking.

Running

__________ tests for adults are usually performed for 12 minutes or longer so the contribution of anaerobic sources of energy to the average velocity are diminished. Anaerobic energy is the immediate and short-term source of energy (p. 136). If an all-out 3-minute run test was performed, their VO2 max would be overestimated because the anaerobic energy sources contribute substantially to total energy production. On the other hand, if a run lasts too long, the person is not able to run close to 100% of VO2 max and the estimate is too low (p. 139).

Cardiorespiratory fitness

_____________ _________ testing is used to indicate positive or negative changes in CRF from physical conditioning, aging, illness, or activity. CRF is a good measure of the heart's ability to pump oxygen-rich blood to the muscles (p. 132). Individuals with a low CRF are at a much higher risk of developing heart disease, which could lead to death (p. 132). Health professionals should emphasize that the overall CHD risk is greater for those who remain sedentary than for those who take an exercise test and then embark on a regular exercise program (p. 132). Having a low CRF, puts an individual at a much higher risk of developing a chronic disease. Having a high CRF, puts an individual at a lower risk of developing chronic diseases.

Heart rate

o Fitness indicator at rest and at submaximal levels o Obtaining true maximal HR can improve accuracy of prescribing optimal training heart rate o Take for 30 seconds at rest or during steady-state activity; convert to 1 minute for bpm o Take for 10 to 15 seconds postexercise

Rating of perceived exertion

o Gives subjective information regarding intensity of activity (scale from 6 to 20)

Blood pressure

o Systolic blood pressure should rise with increasing workloads o Diastolic blood pressure remains the same or may decrease slightly o Proper cuff size is imperative for accurate readings

70-100 rpm

rpm for highly fit or competitive cyclists

50-60 rpm

rpm for low to average fitness

PACER

· 20-meter progressive shuttle run · Beginning pace of 5.3 mph and increasing 0.3 mph at each level · CRF based on number of 20 m laps completed · Part of the Fitness gram testing battery for children

Mile walk test

· Accommodates different ages and fitness levels · Walk as fast as possible · Measure HR at the end of the mile · Use formulate to calculate an estimated VO2 max (ml · kg-1 · min-1) with SEE of about 5 ml · kg-1 · min-1 · VO2 max = 132.853 - 0.0769 (weight) - 0.3877 (age) + 6.315 (sex) - 3.2649 (time) - 0.1565 (HR)

Choosing and appropriate CRF test

· Age · Fitness level · Current health status · Risk of CHD · Financial cost (supervision of physician versus fitness professional)

General indications for stopping an exercise test

· Angina · SBP · BP · Shortness of breath, wheezing, leg cramps, claudication · Severe fatigue · Poor perfusion (blood flow), light-headedness, confusion, ataxia, pallor, cyanosis, cold or clammy skin · HR and heart rhythm · Subject communication · Failure of testing equipment

Predicting VO2max from sub maximal test data

· Based on the linear response of HR of 110 bpm to 85% of HRmax · SEE = 5 ml x kg-1 x min-1 · Very reliable for tracking progress over time, regardless of accuracy of estimated VO2max · Because estimation is based on submaximal HR responses, conditions that affect HR should be noted · Plot of HR responses (>110 beats · min−1) to a GXT on a treadmill, cycle ergometer, or bench step · A line is drawn through the HR values and is extrapolated to the subject's age-predicted estimate of maximal HR · A vertical line is drawn to the x-axis to estimate the work rate and VO2 the person would have achieved if it were a maximal test *KP = Kilopond meters *Multiply the RPM by 2 and set the Metrinome at that number *Don't grip the rail b/c it increases systolic blood pressure *Steady state heart rate is less than 5 beats per minute *Results of the 2nd workload are based on the 1st workload *Plot 2 heart rates greater than 110 on the Y's Way to Physical Fitness

Sequence of testing

· Introducing themselves to one another · Informed consent - contains risks and responsibilities · Health history (assigning risk category) · Screening o Is referral to a health professional needed before maximal or submaximal testing? o Review history for absolute and relative contraindications · Resting CV tests (BP, HR, ECG) and body composition · Submaximal CRF tests o Estimate VO2 max via extrapolation · Tests for low-back function and flexibility · Begin moderate-intensity activity · Test for muscular strength and endurance · Maximal CRF tests · Activity program revision (including games and sports) · Periodic retest and activity revision

Jog or run test

· Jog or run as fast as possible for 12 minutes or 1.5-mile · One of the most common CRF tests (easy to administer repeatedly and low expense) · Run time for VO2 max test is 12 to 15 min to diminish the anaerobic contribution · Underestimates VO2max in children · Overestimates VO2max in competitive runners and those who walk · *have to go at least 12 minutes so it is aerobic instead of anaerobic

GXT protocols

· Submaximal and maximal tests can use the same GXT protocol, but the criteria for test termination differ · Maximal tests effectively identify ischemic heart disease · Submaximal tests are useful in assessing fitness and less expensive to administer · VO2mas estimated from a submaximal test is not as accurate as that obtained from a maximal test

Modified Canadian aerobic fitness test

· Submaximal field test § Can be done in the home on stair steps § 3-minute stages of stepping § Reach 85% of age-predicted max HR (220-age) § Modifications for more fit individuals: additional stages and higher step (16 inches vs. 8 inches) § Stage progression based on HR response to previous stage

Factors that affect sub maximal, HR, BP, and RPE response of a GXT

· Temperature and humidity · Amount of sleep before testing · Emotional state · Hydration state · Medications · Time of day · Time since last meal, nicotine, caffeine intake, and exercise · Psychological environment (participants comfort level)

Estimating functional capacity

· The highest work rate (oxygen uptake) during which HR, BP, and ECG responses are still normal · VO2max usually is estimated from the final stage achieved during the GXT · Stage length may affect the accuracy of determining functional capacity

Posttest protocol

· Use an active cool-down procedure to help the participant transition back to rest o Decrease intensity (e.g., grade on treadmill, load on cycle ergometer) and have participant do an active recovery for 3 min- Monitor HR and BP during recovery and transition to sitting rest when the subject feels comfortable- Monitor HR and BP at the end of 1 and 3 min of sitting rest- Remove BP cuff and HR monitor when BP and HR are close to pretest values · Provide instructions for showering o The participant should wait about 30 min before showering o The participant should move around in the shower and use warm (not hot) water o Wait for the participant to return from the shower · Have the participant make an appointment to discuss the results of all the fitness tests (e.g., body composition, muscular strength and endurance, CRF)

Graded exercise test (GXT)

· Workload increases incrementally § Maximal GXT (client stops because of exhaustion) § Submaximal GXT (client stops at 85% of maximal heart rate) § Symptom limited GXT (client stops due to discomfort or abnormal physiological responses)