Exercise Testing test 3
How to you truly find a max HR?
-Must do max GXT to find true HRmax on a treadmill!
Describe other ways to predict max HR
-Other equations have been developed to predict maximal HR, but remain controversial as no formula does a very good job
What are some examples of submaximal exercise test?
-YMCA cycle ergometer test -Astrand-Rhyming step test -3 minute step test -Cooper 12-min test -1.5 mile run -Rockport One-Mile Walk Test -6 minute walk test** **considered submaximal, this test may be somewhat maximal for the population it is used on (e.g., pulmonary rehab patients) •
What is baseline fitness level data used for?
-compare to later and evaluate if a plan is working. -help set exercise goals. -help develop their exercise prescription (Ex Rx).
What is kcal utilization over 20 minutes on a Monark cycle ergometer if a subject's VO2 = 1745 mL·min-1?
1)1745 mL · min-1 = 1.75 L · min-1 2) 1.75 L · min-1 x 5.05 kcals · L-1 = 8.84 kcals · min-1 3) 8.84 kcals · min-1 x 20 min = 176.8 ~ 177 kcals expended over 20 minutes
ACSM CALCULATION-BASED FORMULA Example Frank is 30 years old and weighs 75 kg. He completed 2 stages (not counting the 150 kg stage) at 450 and 600 kg/m/min. His HR's were 116 and 130 bpm at these stages, respectively. What is Frank's estimated VO2max?
1. VO21 (mL/kg/min) = [(1.8 x work rate)body weight in kg]+ 7 = [(1.8 x 450) / 75] + 7 = 17.8 2. VO22 (mL/kg/min) = [(1.8 x work rate)body weight in kg] + 7 = [(1.8 x 600) / 75] + 7 = 21.4 3. a = (21.4 - 17.8) / (130 bpm - 116 bpm ) = 0.257 4. VO2max (mL/kg/min) = (a) (HRmax - HR2) + VO22 5. VO2max (mL/kg/min) = [0.257 ((220 - 30) - 130)] + 21.4 = (0.257 x 60) + 21.4 = 15.42 + 21.4 = 36.8 mL/kg/min
Sophie (age 20 and 70 kg) has a HR of 100 bpm pedaling at 150 kg-m/min (stage I). She then increases her HR to 127 bpm pedaling at 450 kg/m/min during stage II of the YMCA cycle test and to a HR of 141 during stage III of the test at 600 kg/m/min. What is her estimated VO2max?
1.Line drawn down to x-axis bisects with 1200 kg/m/min or 2.8 Liters/min (from grid values) 2.VO2 (ml/kg/min) = VO2 (L/min) x 1000 Body Weight (kg) 3.VO2 (ml/kg/min) = 2.8 L/min x 1000 70 kg 4.VO2 = 40 ml/kg/min
Describe the summary of doing a bike test
1.Weigh the subject (no shoes) 2.Adjust the seat height 3.Set the metronome at 100 bpm (50 rpm) 4.Attach the BP cuff and Polar monitor (wet the strap) 5.Take the resting BP and HR—mark pulse site with pen 6.Set the 1st workload for 150 kg/m/min once the subject starts pedaling (0.5 Kp) 7.Start the stopwatch once the workload is achieved 8. Measure the subject's HR in the last 20 seconds of each minute (i.e., 0:40, 1:40 and 2:40) for a 10 second count and compare this to the Polar monitor—record both HRs 9. If the subject's HR's for minutes 2 and 3 are not within 5-6 BEATS of each other, steady state has not been achieved and a 4th minute must be performed at that workload. 10. Set the 3rd and 4th workloads (if needed) according to the workloads in the boxes below the second stage work rate. Once you choose a column, stay in that column! 11. The goal of this test is to have two stages (workloads) during which the HR is over 110 bpm. 12. Start to measure the BP at the start of minute two and complete your readings by minute 2:45 of each stage (we could listen behind you for your practical exam).
Calculate sophies mets Sophie (age 20 and 70 kg) has a HR of 100 bpm pedaling at 150 kg-m/min (stage I). She then increases her HR to 127 bpm pedaling at 450 kg/m/min during stage II of the YMCA cycle test and to a HR of 141 during stage III of the test at 600 kg/m/min.
5.METS = VO2 (ml/kg/min) 3.5 = 40 ml/kg/min 3.5 = 11.4 METS
WHAT IS THE DIFFERENCE BETWEEN DETERMINING IF A TEST IS VALID VS. DETERMINING IF A TEST IS RELIABLE?
A valid test refers to a test that measures what it is intended to measure, and reliable refers to the small variation in results if it is the same test.
Describe the cadence of a YMCA bike test
Cadence—revolutions per minute (usually 50-60)
What needs to happen to the cycle ergometer before it is used? (YMCA BIKE)
Cycle callibbration •MUST be performed on each cycle used to assure that the subject is pedaling at an accurate workload
Describe these workload guidelines
Dont memorize •< 80 bpm, set the second workload at 750 kg-m/min (2.5 kp) •80-89 bpm, set the second workload at 600 kg-m/min (2.0 kp) •90-100 bpm, set the second workload at 450 kg-m/min (1.5 kp) •>100 bpm, set the second workload at 300 kg-m/min (1.0 kp)
Look at this example of steady state
Example: Frank is in Stage II of his YMCA test. His heart rates (bpm) for each minute are as follows: Minute 1: 112 Minute 2: 118 Minute 3: 123 Frank has NOT reached a steady state level of exercise during Stage II of the test because there is > than 5-6 bpm between the HRs of minute 2 and minute 3. How do you proceed? •Frank must pedal an additional minute and attempt to achieve a HR that is within 5-6 beats of 122 bpm (e.g., 127 bpm). •If he does, you would plot his HR for the 4th minute on the YMCA grid as your 2nd HR (127 bpm). •If he does not (e.g., his HR = 130 bpm) you cannot plot a 4th minute HR and the test is in•Frank must pedal an additional minute and attempt to achieve a HR that is within 5-6 beats of 122 bpm (e.g., 127 bpm). •If he does not (e.g., his HR = 130 bpm) you cannot plot a 4th minute HR and the test is invalid.
How do field test and submaximal tests relate?
Field fitness tests are also submaximal tests.
Describe the flywheel distance of a bike test
Flywheel distance—Distance the circumference of the flywheel travels per complete pedal revolution -Dependent on brand of cycle -Monark (most popular) = 6 m . rev-1 ratio -Monark Arm Ergometer = 3 m . rev-1 ratio
Describe the ACSM calculator based formula
Goal: To calculate the slope of the HR and VO2 relationship to estimate VO2max Slope (a) = (VO22 - VO21) / (HR2 - HR1) VO2 1 = Predicted VO2 from Stage 1 (NOT 150 kg/m/min) in bpm VO2 2 = Predicted VO2 from Stage 2 (NOT 150 kg/m/min) in bpm HR 1 = HR from stage 1 (NOT 150 kg/m/min) in bpm HR 2 = HR from Stage 2 in bpm
What are cycle test all about
HR at sub max!
What two units of measure are essentially the same?
Kilogram meter and kilopond meter
Why Measure Cardiorespiratory Fitness (CRF)?
Low CRF is an independent risk factor for cardiovascular mortality—gigantic research finding Individualization of exercise prescription Tracking exercise progress (pre- and post-tests for outcomes assessment) Clinical purposes with patients with chronic diseases Motivation for the client or patient To determine an estimated VO2max To compare individual CRF values to normative values and percentiles
How do you calculate Mets?
METS = VO2 (ml/kg/min) 3.5
What do you plot for cycle test? (method 1)
Method #1: Graphing •Plot the TWO HR's on the corresponding work output data points (x-axis) on your YMCA grid that are > 110 bpm. •Draw a horizontal line at the age-predicted maximal HR level across the top of the graph paper. •Connect the two data points (HR's) and extend this straight line to the horizontal age-predicted max HR line at the top. •Extend a perpendicular line down from this intersection point to the x-axis to determine the the estimated (predicted) maximal workload and VO2 level (in liters/minute).
What is the VO2 and METS for a 72 kg woman pedaling on a Schwinn Airdyne cycle ergometer at 2 "Airdyne units"? (For air resistant bikes)
NOTE: One Airdyne unit = 300 kg · m · min-1 or 50 w VO2 (mL · kg-1 · min-1) = 1.8 (work rate / body mass) + 3.5 mL · kg-1 · min-1 + 3.5 mL · kg-1 · min-1 (resting VO2) (unloaded cycling VO2) VO2 = 1.8 x (600 kg · m · min-1 / 72 kg) + 7 mL · kg-1 · min-1 VO2 = 15.0 mL · kg-1 · min-1 + 7 mL · kg-1 · min-1 VO2 = 22.0 mL · kg-1 · min-1 METS = 22.0 mL · kg-1 · min-1 / 3.5 = 6.3 METS
What are other reasons to measure CRF?
Overall health risk assessment Determine MET levels for ADLs, vocational and recreational activities (e.g., snow shoveling, carrying groceries, swimming, golf) Return to work assessment (occupational disability assessment—MET standards are in place) Can provide diagnostic and prognostic information (e.g., orthopedic limitations, ECG changes for some tests, exercise oxygen saturation levels)
Describe proper seat high for cycle ergometer test
Proper Seat Height •Knee flexed ~ 25 degrees with full leg extension or... •Seat should align with the hip (greater trochanter) if standing beside the cycle and... •Client should maintain comfortable, upright posture without gripping the handlebars too tightly
Describe the resitance of a YMCA bike test
Resistance—the force that the pendulum weight applies to the friction belt
What is steady state during a bike test?
To assure that you have reached a "steady-state workload, the heart rate values must be within 5-6 beats of each other for each minute during the stage.
What is the VO2 and METS of a 50 kg woman pedaling a Monark cycle at 60 rpm with a resistance of 1.0 kg?
VO2 (mL · kg-1· min-1) = 1.8 (work rate / body mass) + 3.5 mL·kg-1 · min-1 + 3.5 mL·kg-1 · min-1 (resting VO2) (unloaded cycling VO2) Work rate (WR) = 1.0 kg x 6 m x 60 rpm WR = 360 kg · m · min-1 VO2 (mL · kg-1 · min-1) = 1.8 (360 / 50 kg) + 3.5 + 3.5 VO2 = 12.96 + 7 VO2 = 19.96 mL · kg-1 · min-1 METS = 19.96 mL · kg-1 · min-1 / 3.5 = 5.7 METS
How do you calculate relative VO2?
VO2 (ml/kg/min) = VO2 (L/min) x 1000 Body Weight (kg)
What is the energy cost (Kcal) of this 50 kg woman pedaling the bike for 30 minutes (think back to kcal lab in KNES 3281)?
VO2 = 19.96 mL · kg-1 · min-1 (from previous equation) VO2 in L · min-1 = (VO2 in mL · kg-1 · min-1) (body mass) / 1000 VO2 in L · min-1 = (19.96 mL · kg-1 · min-1) (50 kg) / 1000 VO2 = 0.998 or 1.0 L · min-1 Net caloric expenditure in Kcal · min-1 = 1.0 L · min-1 x 5.05 kcal/L ~ 5.1 Kcal · min-1 Net caloric expenditure for 30 minutes = 5.1 Kcal · min-1 x 30 minutes = 153 Kcal
describe Vo2 max estimation error
VO2max estimation may range from ~ 10% to 15% for trained and untrained individuals, respectively.
What environmental concern has become super important? Especially with Covid
Ventilation
Describe cycle ergometry
WORK (kg/m or kp/m) = FORCE (cycle braking resistance in kilograms or Newtons) x DISTANCE (distance in m traveled by the flywheel rim per revolution)
What is External work?
Work performed in the environment against a resistance to create energy
Describe determining exercise work rate
dont memorize, is given
What is one kilogram meter?
•1 kilogram-meter = work in which the product of force (kg) acts against a kg weight through a distance = 1 kg-m = 1 kp-m (at sea level)
What is one kilopond meter?
•1 kilopond-meter = work in which the product of force (kp) acts against a kg mass through a distance = 1 kp-m = 9.81 joules = 0.00234 kilocalories (kcal) Note: Do not use this kcal equivalent in your lab calculations.
What is one watt?
•1 watt = 6.12 kg-m/minute = 1 Joule/second
Describe what a subject does in terms of performance during a submaximal exercise test
•A client performs a fixed amount of work per unit of time that can be a single-stage or multi-stage test. -Examples: meters/min, miles/hour, etc.
Describe the metronome of a cycle ergometer
•A metronome is typically set at 100 beats/minute to produce 50 rpm (100 downstrokes of pedal). •This assures that the workload is constant and the amount of work being performed is constant.
Describe what should be instructed in terms of a pre test
•A minimal recommendation is that individuals complete a questionnaire such as the Physical Activity Readiness Questionnaire (PAR-Q or the ACSM/AHA form). •A listing of preliminary instructions for all clients can be found in Chapter 3 ("Participant Instructions"). These instructions may be modified to meet specific needs and circumstances.
What is a submaximal exercise test hoping to accomplish
•A test to measure the HR response and predict VO2max, which is a measure of functional capacity.
How should test procedures be explained to a test subject?
•All test procedures must be explained clearly prior to initiating the testing process.
What is the stardard workrate on a monarch cycle ergometer
•As this rate is standardized for the Monark cycle, the subject will always be covering 300 meters/minute or 50 rpm x 6 meters/revolution.
What should you do in terms of forming an informed consent document
•Be sure to provide an informed consent form. (Note: you may have to check with the legal department of your hospital or clinic for proper wording of the informed consent form to meeting hospital/clinic legal guidelines.
What should be done for medications that a patient takes?
•Because certain medications (e.g., β-blockers) which lower HR will affect some physical fitness test results, use of these medications should be noted.
Describe the cadence of a cycle test
•Cadence is always kept at 50 rpm for this particular test
What should you do before the patient arrives at the test site?
•Ensure that all forms, score sheets, tables, graphs, and other testing documents are organized and available for test administration. •Calibrate all equipment (e.g., metronome, cycle ergometer, treadmill, sphygmomanometer, skinfold calipers) at least monthly, or more frequently based on use. Certain equipment such as ventilatory expired gas analysis systems should be calibrated prior to each test according to manufacturers' specifications. Be sure to document equipment calibration in a designated folder.
What is Ergo?
•Ergo = Work
What is ergometry?
•Ergometry = The study of measuring work
What is important for finding steady state?
•Establish a relationship between HR and work rate
What data can be achieved from submaximal exercise tests?
•Estimated VO2max •What type of exercise your client likes •Normative data—How your client compares to people of their age and gender Baseline fitness level data
Look at this example of work output determination
•Example: 2 kp x 50 rpm x 6 meters (1.62 x 3.7) = -600 kg/m/min-1
Are field tests safe?
•Generally safe (partially due to young, low-risk groups in PE)
What are the 3 health related components of physical fitness?
•Have a strong relationship with good health •Are characterized by an ability to perform daily activities with vigor •Are associated with a lower prevalence of chronic disease and health conditions and their risk factors
For a bike test, what do you begin instructing the patient to do? (CRF assessment)
•Have plenty of fluids for the previous 24 hours •Avoid strenuous exercise for the previous 24 hours •Obtain an adequate amount of sleep the night before the test •Avoid alcohol, tobacco, and caffeine with 3 hours of the test •Refrain from eating a large meal 1 hour prior to the test •Wear comfortable exercise-type clothing •Wear proper exercise shoes! •Sign the Informed Consent form •Take the PAR-Q (Canvas ACSM 2018 version) with screening
What are the resting measurements that should be taken first?
•Heart rate (HR) •Blood pressure (BP) •Height (HT) •Weight (WT) •Simple spirometric analysis (FVC, FEV1.0) •Body composition (e.g., % fat, girths, BMI) •SpO2 (blood oxygen saturation level)
Describe some of the benefits of field test
•Low cost, minimal equipment, lower level of training necessary (e.g., BS vs. MS)
What is one thing that is important in terms of the testing cite temperature?
•Maintain a testing room temperature between 68°F and 72°F (20°C and 22°C) and a humidity of <60%.
What are the best alternative approach categories that fall under the gold standard tests
•Many alternative approaches, falling into two categories: -Field tests: Take place in a variety of non-laboratory settings, typically by a group of people -Submaximal exercise tests: Tests with the level of effort limited to submaximal exertion, typically performed by an individual in a laboratory setting
Describe the gold standard CRF test
•Maximal exercise test with collection of expired gases and ECG analysis using a treadmill •Highly involved regarding both time and expense
What is meter?
•Meter = Measure
What are the two most common predicted max heart rate formulas?
•Most commonly used age based equations: 1.Age-predicted HRmax = 220 - age (years) (Fox et. al.) 2.Age-predicted HRmax = 208 - 0.7 (age) (Tanaka et. al.) (N = 18,712)
In terms of test organization, what is one thing you should keep in mind in terms of muscle group fatigue?
•Organize all equipment so that each test can follow in sequence without stressing the same muscle group repeatedly.
Where does the field test curriculum originate?
•Origins in physical education (PE) curricula
What is the power formula?
•POWER = WORK (Kg/m) / TIME (min.)
For predicted maximal heart rate formulas, what is the common error range?
•Predicted by equations with standard error ranges between ±10 and 15 bpm
What are disadvantages to cycle ergometers
•Premature muscle fatigue from the workload on the quadriceps (local muscle fatigue) can result in submaximal performance before VO2max is achieved. •The measured functional capacity is usually 10-15% lower than that achieved on a treadmill. •Many find the seat uncomfortable, particularly older and thin populations. •The belt can come off the flywheel easily! •Cycling is not a common mode of exercise, particularly for older adults in the U.S. •The client must maintain a constant pedaling rate for accurate workload assessment.
Is there a specific order of testing protocol that should be followed?
•Research has not established an optimal testing order for multiple health-related components of fitness (i.e., cardiorespiratory [CR] endurance, muscular fitness, body composition, and flexibility). However, sufficient time should be allowed for HR and BP to return to baseline between tests conducted serially.
Does someone need to be screened for a field test?
•Screening procedures are necessary as different populations may perform differing levels of exertion to complete the activities (e.g., PAR-Q, overall health history, ACSM screening tools)
Describe stage one during a cycle test
•Stage I has a set work rate (150 kg/m/min)with the subsequent stages being based on the stage I HR
What is the premise for a YMCA bike test?
•THE PREMISE FOR THIS TEST IS THAT ONCE YOU ACHIEVE A STEADY-STATE HEART RATE, YOU CAN PREDICT VO2max FROM THE SUBJECT'S STEADY-STATE HEART RATES AT THE GIVEN WORKLOADS.
What are types of things that should be controlled during a test?
•Test anxiety/emotional issues, food in the stomach, bladder distention, room temperature, noise, lighting and ventilation should be controlled as much as possible.
Should testing procedures be rushed?
•Testing procedures should not be rushed.
Describe the testing staff optimal demeanor
•The demeanor of personnel should be one of relaxed confidence to put the subject at ease.
What is the flywheel distance on the cycle ergometer?
•The flywheel distance varies by the brand, but is constant for each cycle ergometer of that brand. • The Monark cycle has a 6 meter per revolution ratio. •The flywheel travels 6 meters for a complete revolution of the pedal (down--up--down).
Describe the flywheel itself
•The flywheel itself is 1.62 meters in circumference and thus travels 3.7 circuits per pedal revolution. -3.7 X 1.62 meters = 5.994 ~ 6.0 meters
What are the advantages of the monarch bike?
•The resistance is independent of body weight. •Upper body movement is minimal—other physiological measures such as heart rate, blood pressure and blood sampling can be taken more easily. •Power output can be measured directly. •Compared to a treadmill, cycle ergometers are relatively less expensive and there are no electrical requirements. •Cycle ergometers can be easily moved around on 2 rollers under the flywheel.
What should the lab be equipped with?
•The room should be equipped with a comfortable seat and/or examination table to be used for resting BP, HR and/or ECG recordings.
What are some other advantages to cycle ergometers?
•These type of ergometers are easily calibrated. •This is a "non-weight bearing" modality, making it a good choice for those with orthopedic injury, obesity, or chronic disease. •Cycles are relatively safe—less chance of falling off (as with the treadmill). •There is less extraneous noise and better stabilization for BP measurements on the arms. •Cycle ergometers require little space.
What should the bikes force be set to?
•This is a setting of 0.5 kp on the bike's force scale
How do you calculate watts?
•To calculate Watts: kg . m . min-1 / 6.12 •Example: 900 kg . m . min-1 / 6.12 = 147.05 W ~ 150 W •Used to estimate VO2, VO2peak, + VO2max
For test and anxiety, what should be done?
•To minimize subject anxiety, the test procedures should be explained adequately, and the test environment should be quiet and private.
How many stages do you use during a cycle test?
•Two to four 3-4 minute exercise stages -Total test time ranges from 6-16 minutes
How is cycle calibration usually performed? (YMCA bike)
•Usually performed with 2-4 kg weights that hang from the suspension hook at the front of the flywheel. •The kg weight will move the pendulum to the proper marker on the scale at the side of the cycle ergometer. •The cycle is then adjusted with a screw device if the pendulum is off and the cycle is out of calibration
What is the work formula?
•WORK = FORCE (Kg or Newton) x DISTANCE (meter or ft.)
what is work output dependent on during cycle test?
•Work output is dependent on the cycle ergometer resistance settings
Describe work output determination
•Work performed per unit of time •Work output (kp . m . min-1) = -Resistance (kg) × Revolutions per minute (rpm) × Flywheel distance traveled in 1 down-up-down pedal revolution (flywheel is 1.62 meters in circumference and travels 3.7 circuits per pedal revolution (m . rev-1)
What is internal work?
•Work performed within the body to overcome inertia
How many workloads do you use during a cycle test?
•You must obtain two separate workloads resulting in HR values between 110 and 150 bpm
Describe what should ideal fitness test be?
•is 1) reliable, 2) valid, 3) relatively inexpensive, and 4) easy to administer.
Describe what the desired the results or data of an ideal fitness test
•should 1) yield results that are indicative of the current state of fitness, 2) reflect positive changes in health status from participation in a physical activity or exercise intervention, and 3) be directly comparable to normative data.
Describe the error of cycle test
•variation in age-predicted HRmax. •mechanical efficiency. •one's physical condition (e.g., cyclist vs. runner). •one's physiologic status (e.g., effects of smoking, fatigue, caffeine, meds). poor extrapolation techniques (must use grid on Canvas)