Cardiopulmonary exercise testing

Question 1

NOT CV Compromised

Answer 1

12 minute run

• Beep test
• Arm Ergometer
• YMCA
• Step Test

Question 2

CV Compromised

Answer 2

• 6 minute walk test (6MWT)
• Incremental shuttle walk test (ISWT)
• IUULEx

Question 3

EXERCISE CAPACITY TESTS

Answer 3

Require less expensive equipment, less skill and faster to administer
Dependent on an individuals motivation – not a VO2max ‘test’, but
requires maximal effort

Question 4

12 MINUTE RUN - procedure

Answer 4

• Explain the test requirements – objective is to cover as much distance in 12 mins as possible. Encourage patient to pace themselves.
• Dynamic warm up
• Record laps during the test 0 it is ok to walk, but running is preferable
• Monitor the patient for signs and symptoms that would stop the test
• Notify participant of elapsed time regularly – count down last minute
• At 12 minutes blow whistle – ask participant to stop and walk to nearest marker and then march on spot
• Record distance covered
• Allow 5 minutes walking around track/stretches

Question 5

12 min run

Answer 5

Use distance covered to calculate estimated VO2max (ml/kg/min) using the following equation:
Note: Cannot predict VO2max if distance covered is less than 1.71km
Use distance covered to compare to normative values:

Question 6

12 min run advantages

Answer 6

Able to test many people at once
• Limited equipment needed
• Can estimate VO2max

Question 7

12 min run disadvantages

Answer 7

Requires maximal effort – motivation may influence results
• Unable to monitor BP and HR individually
• May be unsuitable in sedentary individuals (minimal distance to cover)

Question 8

6 min walk

Answer 8

Test involves walking continuously around a 60m circuit with the aim to
cover as much distance as possible in 6 minutes.
If the patient stops during the test:
• Measure SpO2 and HR
• Ask patient why they stopped – eg breathlessness, tired, leg pain
• Give the following instruction “Begin walking as soon as you feel able” – repeat every 15 secs as needed.

Outcome measure: Distance walked. This can be expressed as absolute distance or percent predicted (%).

Question 9

6 min walk advantages

Answer 9

Easier to administer, more reflective of ADL activities than other tests
• Can be used for patients with respiratory and cardiac condition (self-paced)
• Familiar activity – walking
• Minimal clinically significant difference – 54 m
• A distance walked of <350m is associated with increased mortality in patients with COPD, chronic heart failure and pulmonary arterial hypertension (Rasekaba et al.)

Question 10

6 min walk dis.

Answer 10

Can be influenced by many factors – need to standardise testing protocol (tester instructions/encouragement, track set up, medications, other typical pre-test criteria)
• Learning effect – need to have at least 2 attempts.
• Does not calculate VO2max (other than in those awaiting lung transplant)

Question 11

MULTISTAGE SHUTTLE RUN TEST (MSRT)

Answer 11

Valid estimate of VO2max in children and youth, although less accurate in older individuals
• Can predict VO2max but equations need to be specific for gender and age – so will not be used in this practical.
• Run between markers in time with recorded beeps from a CD (or App)
• Starts 8.5km/hour – increases by 0.5 km/hr each minute

Question 12

MULTISTAGE SHUTTLE RUN TEST (MSRT) procedure

Answer 12

• Subjects must have one foot on or behind the starting lines before
the beep to complete a shuttle.
• If not, they are given one attempt to catch up with the pace.
• If the beep is missed on two consecutive shuttles, the test is stopped.
• Record the level/shuttle reached

Question 13

MULTISTAGE SHUTTLE RUN TEST (MSRT) advantages

Answer 13

• Externally paced
• Minimal equipment needed
• Suitable for very fit individuals
• Suitable for large groups

Question 14

MULTISTAGE SHUTTLE RUN TEST (MSRT) disadvantages

Answer 14

Need the recording
• Area
• Not suited for CV compromised individuals – test to exhaustion
• Requires self-motivated individuals

Question 15

INCREMENTAL SHUTTLE WALK TEST (ISWT)

Answer 15

When you hear 3 beeps, instruct the patient to “increase your speed now”
• Stop criteria are similiar to beep test – 2 consecutive shuttles missed

Question 16

INCREMENTAL SHUTTLE WALK TEST (ISWT) - advantages

Answer 16

• Externally paced
• Correlated with VO2max
• Can use in CV compromised patients, although this would be a level up from a 6MWT

Question 17

INCREMENTAL SHUTTLE WALK TEST (ISWT) - disadvantages

Answer 17

• Need 2 tests to allow for learning effect

* Equipment needed - CD

Question 18

Submaximal tests

Answer 18

• Treadmill
• Cycle ergometer
• Step test
• Arm tests

Question 19

Exercise capacity tests

Answer 19

12 Minute Run Test

• 6 Minute Walk Test
• Incremental Shuttle Walk Test
• Beep Test

Question 20

OUTCOME MEASURE

Answer 20

is the result of your exercise test.
• It is the value that you will compare between multiple tests to evaluate
whether change has occurred.
• It is the end-point value – i.e. after all equations have been used
It is NOT your pre- or post-test measures

Question 21

Bruce protocol

Answer 21

Protocol can be used for maximal or submaximal testing
• For submaximal testing – testing is stopped when 85% age predicted
HRmax is reached.
• Incremental exercise test with increasing workloads at pre-determined
speeds/treadmill inclination
Workload (speed and inclination) is increased every 3 minutes until 85% HRmax is reached. Record the time taken to reach target HR.
Outcome measure = estimated VO2 max

Question 22

treadmill benefits

Answer 22

Can be used with both maximal and submaximal tests

• Estimates VO2max

Question 23

treadmill negs

Answer 23

Cost/equipment required
• Requires participant to have sufficient dynamic balance to walk/run at pre-
determined speed
• Can only test one individual at a time
• Difficult to take physiological measures if required during test e.g. BP

Question 24

YMCA Cycle Ergometer Test

Answer 24

estimates VO2 max which is compared to normatives

Question 25

YMCA benefits

Answer 25

Can be used with both maximal and submaximal tests
• Predicts VO2max
• Easier to take physiological measures if required

Question 26

YMCA negs

Answer 26

Cost/equipment required
• Activity not necessarily matched to daily living
• Equipment requires regular calibration
• Can only test one individual at a time

Question 27

QUEEN’S COLLEGE STEP TEST

bens and lims

Answer 27

Benefits:
• Very cheap and portable
• Limited equipment needed
• Short duration of testing
• Can test many people at once
Limitations:
• Difficult to monitor physiological measures during the step (movement and large number of people typically)
• Requires moderate-high level dynamic balance

Question 28

UPPER LIMB TESTS: ARM ERGOMETRY TEST

Answer 28

Participant should be in a seated position in front of the ergometer
• Ergometer/participant should be positioned so that the fulcrum of the ergo is at
the participant’s shoulder height
• Instruct patient cycle at 50-60 rpm, starting at 0 W for 3 mins (warm up)
• Increase worked rate every 3 minutes by 10 W
• Test is stopped when patient reaches 85% HRmax

Question 29

UPPER LIMB TESTS: ARM ERGOMETRY TEST bens and negs

Answer 29

Able to be used with participants where lower limb tests cannot be used
• Cardiovascular assessment with upper limb effort
• Indication of performance during functional tasks (ADL’s)
Limitations:
• Difficult to monitor some physiological measures if required (movement and large number of people typically)
• UL CV tests typically result in lower estimations of VO2max
• This is due to higher HR, BP and O2 consumption with UL resisted exercise

Question 30

Incremental Unsupported Upper Limb Exercise Test IUULET

Answer 30

Used to assess upper limb exercise tolerance in a manner that resembles functional tasks, using an unsupported activity.
• Test specifically designed for patients with respiratory disease (Takahashi et al 2003)
Additional precautions:
• shoulder pain, shoulder impingement and/or surgery as test involves
repetitive, weighted and incremental increases in bilateral shoulder flexion
Outcome measure: Time (min) taken to reach 85% HRmax

Question 31

IUULET pros and cons

Answer 31

Benefits:
• Upper limb exercise tolerance
• Usually activities involving unsupported upper limbs cause dyspnea –
reproduces symptoms
• Highly repeatable, no practice test required
• More functional movement than arm ergometry
Limitations:
• Equipment required
• Lower VO2peak achieved compared to supported upper limb exercise testing