Common Assessment of Cardiorespiratory Fitness

Question 1

VO2max Testing

Answer 1

Maximal oxygen uptake (VO2max) is gold standard for cardiorespiratory fitness measurements.
-mL/kg/min > mL/min
Not as functional to use for chronic conditions
-VO2peak test or submax VO2 will be used to estimate VO2max.

Question 2

Submaximal VO2 Testing

Answer 2

Normally used in clinics due to not having access to VO2max equipment (such as metabolic carts).
Used for most populations that maximal testing would be considered unsafe.
-may not be as accurate for athletes, but still good.
Goal for submax testing is to determine HR responses to exercise and predict VO2max
-does not give true VO2max, just an estimate but gives an idea.
-can show more than just VO2max estimation which makes it versatile.

Question 3

Benefits of Submax VO2 Testing

Answer 3

More clinically relevant.
Safer for most clinical populations.
Can be used on more clinical based equipment.
Opportunity to educate client on appropriate exercise intensities for them.
-easy to prescribe exercise related to the test.

Question 4

Limitations of Submax VO2 Testing

Answer 4

Equations used to estimate VO2max (can under or overestimate VO2max).
-typically overestimates VO2
Assumes adequate HR response to work rate to accurately estimate VO2max.
More potential for ceiling or floor effect.
Not accurate for populations that use medications that alter HR.

Question 5

General VO2 Testing Protocol

Answer 5

Discuss the test with the client and get informed consent.
Review pre-screening to determine if safe to complete.
Take resting measures (ie. HR, BP, O2%, RPE, ECG if possible).
Complete a 5 min warmup and get client comfortable with equipment.
Complete VO2 test based on specific test instructions (ie. take HR, O2%, and RPE each minute, take BP every 2 mins).
Complete 5-10 min active cool down (continue to measure vitals).
Complete 5-10 min passive cool down (continue to measure vitals).

Question 6

Rating of Perceived Exertion Scales

Answer 6

Used more for clinical populations.
-better for populations that use medications that alter HR.
Can help clients understand exercise intensity for independent exercise without the need for HR monitoring.
Two types of scales = modified or Borg RPE.

Question 7

Test Termination Criteria

Answer 7

Depends on test being used.
-predetermined end point
-volitional fatigue
-predicted Vo2max reached
-and more
Other criteria to stop test include…
-onset of angina or angina-like symptoms
-drop is SBP of >10 with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing
-excessive rise in BP: systolic BP >250 and/or diastolic pressure >115.
-shortness of breath, wheezing, leg cramps, or claudication.
-signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin.
-failure of HR to increase with increased exercise intensity.
-noticeable change in heart rhythm by palpation or auscultation
-subject requests to stop
-physical or verbal manifestations of severe fatigue
-failure of the testing equipment

Question 8

Estimated VO2

Answer 8

norms associated with age groups
look on slides for specifics

Question 9

Cardiovascular

Answer 9

Refers to the heart and blood vessels (whole circulatory system) and how well they work at rest and exercise to move blood around the body.

Question 10

Cardiorespiratory

Answer 10

Refers to the heart and respiratory pathways (lungs and tracheobronchial tree) and how well they work to move blood and oxygen around the body to working muscles.

Question 11

Cardiopulmonary

Answer 11

Refers to the heart and lungs together and how well they work to bring oxygen into the body and circulate it to working muscles

Question 12

Common Cardiorespiratory Tests

Answer 12

Field tests
Treadmill tests
Cycle ergometers
Step tests
*All of these are submax by nature

Question 13

Field Tests

Answer 13

Anything not using treadmill.
Some tests include rockport 1 mile walk test, 1.5mile walk test, 6 min walk test, beep test, Cooper 12 min test.

Question 14

Benefits of Field Tests

Answer 14

Easy to administer
Little equipment
Functional to population

Question 15

Limitations of Field Test

Answer 15

Can be near maximal or maximal for some people (low aerobic fitness).
Harder to monitor vitals (HR and BP).
Estimation of VO2max.
NOT always appropriate for chronic condition populations as unable to monitor for test termination criteria.

Question 16

Rockport 1 Mile Walk Test

Answer 16

Goal to get fastest time to walk 1 mile (1.6km).
Estimates VO2max for ages 20-60.
-equation associated with it
Not good to do on treadmill, must do outside or on track.

Question 17

Procedure of Rockport Walk Test

Answer 17

Record weight (lbs) and explain procedure.
Ask client to walk light-mod pace for 3 min as warm up, then direct to walk 1 Mile as fast as possible.
-they can stop and rest in between but the timer will keep going (not how many stops they take).
Record HR during final minute of walking with HR monitor or immediately after test is completed.
-peak HR
Use HR and time to determine VO2max with given calculation.

Question 18

6 Minute Walk Test

Answer 18

Used to evaluate cardiorespiratory fitness as well as predicting morbidity and mortality rates.
Looking at walking/gait speed.
-slower gait speed = higher morbidity and mortality rates.
Can predict VO2peak but equation is not as valid or useful.
Clients completing <300m in 6min demonstrate poorer short-term survival vs those who complete >300m.
Useful for older populations or those with chronic conditions (ie. CVD, CHF, COPD, etc.).
-just need 30m distance

Question 19

Procedure for 6Min Walk Test

Answer 19

Take resting vitals and explain test.
Client walks along predetermined track (ideally 30m or more in length) at their own pace.
-client can stop and rest when needed (timer will continue).
Record distance walked in 6 minutes.

Question 20

Cooper’s 12 Min Walk/Run Test

Answer 20

Goal to complete furtherest distance in 12 mins.
-do on track or relatively flat area.
Estimate VO2max.
-VO2max (mL/kg/min) = (distance in m - 504.9)/44.73
-missing client body weight in equation.
-can be seen in a couple equations for submax VO2 test
-says its relative, but it is actually absolute.

Question 21

Procedure for Cooper’s 12 Min Walk/Run Test

Answer 21

Take resting vitals and explain test to client.
Have client complete a 3-5 min warm up of light-mod activity.
At the end of the warmup, start the 12 min timer.
Record the distance completed in 12 min.
-clients can stop and rest if needed but keep the timer running.
Use the final distance to determine estimated VO2max.

Question 22

Treadmill Tests

Answer 22

Used for submax and maximal VO2 tests.
Includes treadmill walk test, Bruce and Modified Bruce Treadmill Test, Graded Exercise Test (can be used with other equipment too).

Question 23

Benefits of Treadmill Tests

Answer 23

Can be adjusted easily to any fitness level.
Can be used with running or walking with or without incline.
Functional to walking.

Question 24

Limitations of Treadmill Tests

Answer 24

Some individuals may not be comfortable on a treadmill due to balance issues.
Expensive and not portable.
Difficult to measure BP and ECG.

Question 25

Bruce Protocol Treadmill Test

Answer 25

Is a maximal stress test, commonly used with ECH stress testing. Limitation is that it is not very clinically relevant because need a specific treadmill.

Question 26

Procedure for Bruce Treadmill Test

Answer 26

Explain procedure and collect resting vitals, height, weight, age, etc. Complete 3-5 min warm up of light-mod exercise on treadmill. Follow the stages outline (on slide 41), each stage is completed for 3 mins. Test is stopped when client can no longer continue or other predetermined termination criteria. Use duration of test to determine VO2max via give calculations (on slide 41).

Question 27

Modified Bruce Protocol Treadmill Test

Answer 27

Starts with a lower workload so more useful for older populations or sedentary clients. Same procedure as Bruce Treadmill Test but starting stages are lower. Idea is still to get to maximal level for client or volitional fatigue occurs.

Question 28

Graded Exercise Treadmill Test

Answer 28

Could be used for maximal or submax VO2 testing. If used for submax testing, must determine clients 85% HRmax or 70% HRR prior to test (ie. determine end point). BUT certain calculations are needed based on speed, incline grades, activity, and extrapolated HRmax so not always the most accurate, straightforward or useful. Recommend to use this type of test to determine exercise capacity using RPE scales, HR zones, and client feedback.

Question 29

Procedure for Graded Exercise Treadmill Test

Answer 29

Complete warm up 3-5 min of light-mod exercise. Increase either incline or speed (or both) every 3 minutes (or longer). -steady state heart rate should be achieved before increasing workload (aim for 3 min stages and if heart rate differs between 2nd and 3rd minutes by >5bpm then add additional minutes as needed. Continue stages until 85% of HRmax achieved (or another pre-determined termination criteria is met. -use this test to help determine general aerobic capacity. Chart on slide 44 with other machines you can do this test on.

Question 30

Cycle Ergometer

Answer 30

Used for submax and maximal VO2 tests. Include YMCA cycle ergometer test, wingate (measures anaerobic fitness), astrand-rhyming cycle test.

Question 31

Benefits of Cycle Ergometer Tests

Answer 31

Can be adjusted easily to any fitness level. Easier for older populations or those with balance issues (non-weight bearing). Easier to take BP and ECG readings.

Question 32

Limitations of Cycle Ergometer Tests

Answer 32

Needs regular calibrations. Need cycle ergometer that measures power output. Less familiar movement compared to walking. More localized work to legs resulting in underestimation of VO2. Specific RPM needed for most tests. Less reliable for relative VO2 calculations (non-weight bearing mode).

Question 33

YMCA Cycle Ergometer Test

Answer 33

Estimates VO2 max for ages 15-69. -quite accurate for estimating VO2. Uses 3 or more consecutive 3 min workloads. -goal to get HR between 110bpm and 85% of HRmax for 2 consecutive workloads. -not as useful for some clinical populations such as those with CVD, better for general population. Need a cycle ergometer that can give workload and RPM.

Question 34

Procedure for YMCA Test

Answer 34

Explain test and calculate 85% of HRmax. Have client complete first workload at 150kpm/min at a pedalling rate of 50rpm for 3 minutes. -record final HR in final 15s of each min, -steady state HR is the average HR of the 2nd and 3rd min (if these mins differ by >5bpm then add an additional min). HR of workload 1 determines load sequence for subsequent workloads (chart on slides). Continue through workloads until client's steady state HR is within 110bpm and 85% of HRmax. Use given equation to determine VO2max. Worksheet comes with the test (on slides)

Question 35

Astrand-Rhyming Cycle Test

Answer 35

Single stage 6 min test at 50rpm. Goal to obtain HR between 125-170bpm. HR is taken in 5th and 6th min of work. -average of these is used for VO2max with a nomogram. -steady stage heart rate needed, add minutes until achieved. Workloads chart on slides, Nomogram used to determine absolute VO2 (L/min). -on slides. -where line intersects in middle of the two dots when line drawn between them is clients absolute VO2 then go to correction factor based on age. -to get relative, times absolute by 1000 and then divide by weight. Due to decreasing HRmax with age, VO2 needs to be corrected. -correction factor table on slides.

Question 36

Step Tests Benefits

Answer 36

Inexpensive, portable, and functional. Easy for most populations. Short duration and easy to follow protocols. Use of post-exercise HR recovery results.

Question 37

Step Tests Limitations

Answer 37

Estimation of VO2max May have balance issue for older adults or those with lower limb joint issues. Specific step cadence needed which may lead to maximal exertion or quick fatigue. no BP or HR monitoring while stepping (only after).

Question 38

Step Tests

Answer 38

Include mCAFT step test, YMCA 3min step test, AStrand and Rhyming Step test, Harvard Step test, and Queen's College Step test. Some tests look at heart rate recovery rather than HRmax. -good to show how quickly heart is adapting to changes in activity.

Question 39

mCAFT Step Test

Answer 39

Multistage step test that estimates VO2max for ages 15-69. 3 min stages (stage 1-8). -starting stage differs on sex and age. 2 step sequence (1 step for stage 7 for men/stage 8 for women) on a 2 step platofrm (each step is 20.3cm tall). HR is taken after each stage. Continued until >85% HRmax is achieved. Ending staged has related O2 cost which used in VO2max calculation. -equation on slides. Have them listen to recording -different recording for men and women indicates cadence for step.

Question 40

Procedure for mCAFT Step Test

Answer 40

Take weight and calculate 85 HRmax. Determine starting stage. Explain test and allow client to practice stepping sequence if needed. -client may lead with any foot, do not run up steps, place both feet on top step and floor. Have client complete first 3min stage with mCAFT music recording. Take HR immediately after stage. Continue to next stage until >85% HRmax is achieved, last stage is complete, or other termination criteria met. Complete active and passive cool down in mode of choice. Use final stage to determine O2 cost. Use given calculation to estimate VO2max.

Question 41

YMCA 3 min Step Test

Answer 41

Utilizes HR recovery to determine cardiorespiratory fitness. -does not estimate VO2max. Single step test using 30.5cm high step. Step for 3 minutes at a rate of 24 steps per minute. -use metronome to help with cadence (96bpm). At end of 3 minutes, have client sit down and record HR immediately for 1 minute. -use HR recorded at end of 1 min of rest and compare to norms tables to determine fitness level. -can record with manual pulse counting or HR monitoring. Take recovery HR and compare to normative tables (on slides).