chapter 04 assessing cardiorespiratory fitness

Chapter 04Chapter 04

Assessing Cardiorespiratory FitnessAssessing Cardiorespiratory Fitness


• Cardiorespiratory Fitness Cardiorespiratory Fitness - - Ability to Ability to perform dynamic exercise involving large perform dynamic exercise involving large muscle groups at moderate-to-high intensity for muscle groups at moderate-to-high intensity for prolonged periods (ACSM 2000)prolonged periods (ACSM 2000)

• Criterion measure is VOCriterion measure is VO22max max - - The The

VO2max, or rate of oxygen uptake during VO2max, or rate of oxygen uptake during maximal exercise, reflects the capacity of the maximal exercise, reflects the capacity of the heart, lungs, and blood to deliver oxygen to the heart, lungs, and blood to deliver oxygen to the working muscles during dynamic exercise.working muscles during dynamic exercise.

– (VO(VO22 max) limited by max) limited by

• DeliveryDelivery

• UptakeUptake


• Criterion for VOCriterion for VO22 max: max:

– Traditional (historic) Traditional (historic) - - Traditionally, a plateau in Traditionally, a plateau in oxygen consumption despite an increase in oxygen consumption despite an increase in workload is the criterion used to determine the workload is the criterion used to determine the attainment of a true VOattainment of a true VO22 max. Recent studies have max. Recent studies have

established that a “plateau phenomenon” is highly established that a “plateau phenomenon” is highly variable and is not a prerequisite for identifying a variable and is not a prerequisite for identifying a true VO2max in the majority of individuals. true VO2max in the majority of individuals.


• Criterion for VOCriterion for VO22 max: ( max: (TraditionalTraditional))

• Because many individuals do not attain a VOBecause many individuals do not attain a VO22

plateau, (traditional VOplateau, (traditional VO22 max ) max ) other criteria other criteria

may be used to indicate the attainment of a may be used to indicate the attainment of a true VO2maxtrue VO2max : :

– Failure of the HR to increase with increases in Failure of the HR to increase with increases in exercise intensity. exercise intensity.

– Venous lactate concentration exceeding 8 mmol·L−1 −1

– Respiratory exchange ratio (Respiratory exchange ratio (RER) greater than 1.15 – Rating of perceived exertion greater than 17 using Rating of perceived exertion greater than 17 using

the original the original Borg scale (6-20)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769631/

http://en.wikipedia.org/wiki/Respiratory_exchange_ratio

http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.html


• VOVO22 peak peak (Easy with Ramp Protocols)(Easy with Ramp Protocols)

• VOVO22peak is the highest rate of oxygen peak is the highest rate of oxygen

consumption measured during the exercise test, consumption measured during the exercise test, regardless of whether or not a VOregardless of whether or not a VO22 plateau is plateau is

reached. reached.

• VOVO22 peak may be higher, lower, or equal to peak may be higher, lower, or equal to

VOVO22max.max.

• For many individuals who do not reach an actual For many individuals who do not reach an actual VOVO22 plateau, the VO plateau, the VO22peak attained during a peak attained during a

maximum-effort, incremental test to the limit of maximum-effort, incremental test to the limit of tolerance is a tolerance is a validvalid index of VO index of VO22max.max.


• Absolute VOAbsolute VO22 is measured in liters per minute is measured in liters per minute

(L·min(L·min−1−1) or milliliters per minute (ml·min) or milliliters per minute (ml·min−1−1) and ) and provides a measure of energy cost for provides a measure of energy cost for non-non-weight-bearingweight-bearing activities such as leg or arm activities such as leg or arm cycle ergometry. cycle ergometry.

• Absolute VOAbsolute VO22 is directly related to body size; is directly related to body size;

thus men typically have a larger absolute thus men typically have a larger absolute VOVO22max than women.max than women.

• Because absolute VOBecause absolute VO22 depends on body size, depends on body size,

VO2 is typically expressed VO2 is typically expressed relativerelative to body to body weight, that is, in ml·kgweight, that is, in ml·kg −1 −1 ·min·min −1 −1. .


• Relative VORelative VO22max max is used to classify an individual’s is used to classify an individual’s

cardiorespiratory (CR) fitness level or to compare cardiorespiratory (CR) fitness level or to compare fitness levels of individuals differing in body size.fitness levels of individuals differing in body size.

• When VOWhen VO22max is expressed simply as a linear max is expressed simply as a linear

function of body mass, CR fitness levels of heavier function of body mass, CR fitness levels of heavier (>75.4 kg) and lighter (<67.7 kg) individuals may be (>75.4 kg) and lighter (<67.7 kg) individuals may be under- or overclassified, respectively.under- or overclassified, respectively.

• Thus, expressing VOThus, expressing VO22max relative to max relative to fat-free mass fat-free mass

(ml·kgFFM(ml·kgFFM−1−1·min·min−1−1), instead of body weight, provides ), instead of body weight, provides you with an estimate of cardiorespiratory endurance you with an estimate of cardiorespiratory endurance that is independent of changes in body weight.that is independent of changes in body weight.


• Gross VOGross VO22 is the total rate of oxygen is the total rate of oxygen

consumption and reflects the caloric costs of consumption and reflects the caloric costs of both rest and exercise (Gross VOboth rest and exercise (Gross VO22 = resting . = resting .

VO2 + exercise VOVO2 + exercise VO22).).

• Net VONet VO22 represents the rate of oxygen represents the rate of oxygen

consumption in consumption in excess of the resting excess of the resting VOVO2 2 and is and is

used to describe the caloric cost of the exercise.used to describe the caloric cost of the exercise.

• Both Gross and Net VOBoth Gross and Net VO2 2 can be expressed in can be expressed in

either absolute (e.g., L·mineither absolute (e.g., L·min−1−1) or relative ) or relative (ml·kg(ml·kg−1−1·min·min−1−1) terms. ) terms.


• Graded Exercise Testing Graded Exercise Testing – Educating participants about their present fitness Educating participants about their present fitness

status relative to health-related standards and age- status relative to health-related standards and age- and gender-matched normsand gender-matched norms

– Providing data that are helpful in development of Providing data that are helpful in development of exercise prescriptions to address all fitness exercise prescriptions to address all fitness componentscomponents

– Collecting baseline and follow-up data that allow Collecting baseline and follow-up data that allow evaluation of progress by exercise program evaluation of progress by exercise program participantsparticipants

– Motivating participants by establishing reasonable Motivating participants by establishing reasonable and attainable fitness goalsand attainable fitness goals

– Stratifying riskStratifying risk

Graded Exercise Testing: Guidelines and Procedures


• Who gets the Maximal, and who gets the Who gets the Maximal, and who gets the Submaximal exercise test?Submaximal exercise test?


See Table (Chart) 2.7, p. 26, Text


• BeforeBefore the start of a vigorous (> 60% VO the start of a vigorous (> 60% VO22max or max or

> 6 METs exercise program, ACSM (2010) > 6 METs exercise program, ACSM (2010) recommends a recommends a Graded Maximal Exercise Test Graded Maximal Exercise Test forfor::– older men (≥45 yr) and women (≥55 yr) ; older men (≥45 yr) and women (≥55 yr) ; – individuals of any age with moderate risk (two or more individuals of any age with moderate risk (two or more

coronary heart disease risk factors); coronary heart disease risk factors); – high-risk individuals with one or more signs or high-risk individuals with one or more signs or

symptoms of cardiovascular and pulmonary disease; symptoms of cardiovascular and pulmonary disease; and and

– high-risk individuals with known cardiovascular, high-risk individuals with known cardiovascular, pulmonary, or metabolic disease.pulmonary, or metabolic disease.



• Submaximal Exercise Test : Submaximal Exercise Test :

– for low-risk individuals, for low-risk individuals, – clients with moderate risk, if they are starting a clients with moderate risk, if they are starting a

moderate (40-60% VOmoderate (40-60% VO22max or 3-6 METs) exercise max or 3-6 METs) exercise

program (ACSM 2010). program (ACSM 2010). – For medical conditions that are absolute and relative For medical conditions that are absolute and relative

contraindications to exercise testing, contraindications to exercise testing, (see chapter 2, page (see chapter 2, page 22.)22.)



• Preparation for TestingPreparation for Testing– At least 1 day before the exercise test, you should give At least 1 day before the exercise test, you should give

your client pretest instructions.your client pretest instructions.– Prior to graded exercise testing, the client should read Prior to graded exercise testing, the client should read

and sign the informed consent and complete the PAR-Q.and sign the informed consent and complete the PAR-Q.

Graded Exercise Testing: General Procedures


• Test AdministrationTest AdministrationMeasure the client’s resting HR and blood pressure (BP) in

the exercise posture.Begin the GXT with a 2 to 3 min warm-up to familiarize

clients with the exercise equipment and prepare them for the first stage of the exercise test.

During the test, monitor HR, BP, and ratings of perceived exertion (Borg Scale) at regular intervals. Measure HR at least two times during each stage, near the end of the second and third minutes of each stage. A steady-state HR (two HR measurements within ± 5 bpm) should be reached for each stage of the test. Do not increase the workload until a steady-state HR is reached.



Blood pressure should Blood pressure should be measured during the be measured during the last minute of each stage last minute of each stage of the test and repeated of the test and repeated if a hypotensive or hypertensive response is if a hypotensive or hypertensive response is observed. observed.

Rating of perceived exertion should be assessed Rating of perceived exertion should be assessed near the near the end of the last minute end of the last minute of each exercise of each exercise stage using either the Borg or OMNI scales (see stage using either the Borg or OMNI scales (see next slide). next slide).

ThroughoutThroughout the exercise test, continuously monitor the exercise test, continuously monitor the client’s physical appearance and symptoms.the client’s physical appearance and symptoms.



• Omni ScaleOmni Scale


The OMNI Scale of Perceived Exertion was developed foruse with children/adults of mixed ethnicity and gender.Directions : “Please use the numbers on this picture to tell us how your body feels when exercising. Please look at the person at the bottom of the hill who is just starting.

If you feel like this person when you are exercising you will be not tired at all. You should select a 0 (zero). Now look at the person who is barely able to jog to the top of the hill (point to the right pictorial). If you feel like this person when exercising you will be very, very tired. You should select number 10. If you feel somewhere in between not tired at all (0) and very, very tired (10), then point to a number between 0 and 10.“


Discontinue the GXT when the test termination Discontinue the GXT when the test termination criteria are reached, if the client requests stopping criteria are reached, if the client requests stopping the test, or if any of the indications for stopping an the test, or if any of the indications for stopping an exercise test are apparent exercise test are apparent (see p. 70). (see p. 70).

Have the client cool down by exercising at a low Have the client cool down by exercising at a low work rate that does not exceed the intensity of the work rate that does not exceed the intensity of the first stage of the exercise test . Active recovery first stage of the exercise test . Active recovery reduces the risk of hypotension from venous reduces the risk of hypotension from venous pooling in the extremities.pooling in the extremities.



During recovery, continue measuring post-During recovery, continue measuring post-exercise HR and BP for at least 5 min. If an exercise HR and BP for at least 5 min. If an abnormal response occurs, extend the recovery abnormal response occurs, extend the recovery period. The HR and BP during active recovery period. The HR and BP during active recovery should be stable but may be higher than pre-should be stable but may be higher than pre-exercise levels. Continue monitoring the client’s exercise levels. Continue monitoring the client’s physical appearance during recovery. physical appearance during recovery.

If your client has signs of discomfort or if an If your client has signs of discomfort or if an emergency occurs, use a passive cool-down with emergency occurs, use a passive cool-down with the client in a sitting or supine position.the client in a sitting or supine position.



Other Other GeneralGeneral Procedures and Precautions Procedures and Precautions for for Exercise Testing (Exercise Testing ( see p.71, “General Principles of see p.71, “General Principles of

Exercise TestingExercise Testing))



• Test Termination Test Termination (low risk adults):(low risk adults):

1. Onset of angina or angina-like symptoms 1. Onset of angina or angina-like symptoms 2. Drop in systolic BP of >10 mmHg from baseline BP 2. Drop in systolic BP of >10 mmHg from baseline BP

despite an increase in workload despite an increase in workload 3. Excessive rise in BP: systolic pressure >250 mmHg or 3. Excessive rise in BP: systolic pressure >250 mmHg or

diastolic pressure >115 mmHg diastolic pressure >115 mmHg 4. Shortness of breath, wheezing, leg cramps, or 4. Shortness of breath, wheezing, leg cramps, or

claudication claudication 5. Signs of poor perfusion (e.g., 5. Signs of poor perfusion (e.g., ataxia, dizziness, , dizziness, pallor, ,

cyanosis, cold or clammy skin, or nausea), cold or clammy skin, or nausea)


http://en.wikipedia.org/wiki/Ataxia

http://en.wikipedia.org/wiki/Pallor

http://en.wikipedia.org/wiki/Cyanosis


• Test Termination Test Termination (low risk adults):(low risk adults):

6. Failure of HR to rise with increased exercise intensity 6. Failure of HR to rise with increased exercise intensity 7. Noticeable change in heart rhythm 7. Noticeable change in heart rhythm 8. Client’s request to stop 8. Client’s request to stop 9. Physical or verbal manifestations of severe fatigue 9. Physical or verbal manifestations of severe fatigue 10. Failure of the testing equipment10. Failure of the testing equipment



• The exercise test may be The exercise test may be continuouscontinuous or or discontinuousdiscontinuous. .

• A A continuouscontinuous test is performed with no rest between test is performed with no rest between work increments. Continuous exercise tests can work increments. Continuous exercise tests can vary in the duration of each exercise stage and the vary in the duration of each exercise stage and the magnitude of the increment in exercise intensity magnitude of the increment in exercise intensity between stages.between stages.

• For most continuous exercise test protocols, the For most continuous exercise test protocols, the exercise intensity is increased gradually (2 to 3 exercise intensity is increased gradually (2 to 3 METs for low-risk individuals) throughout the test, METs for low-risk individuals) throughout the test, and the duration of each stage is usually 2 or 3 min.and the duration of each stage is usually 2 or 3 min.

Graded Exercise Testing: Exercise Test Protocols


• Ramp protocols Ramp protocols provide provide continuouscontinuous and frequent and frequent increments in work rate throughout the test so that the VOincrements in work rate throughout the test so that the VO22

increases linearly; they are designed to bring individuals to increases linearly; they are designed to bring individuals to their limit of exercise tolerance in approximately 10 min. their limit of exercise tolerance in approximately 10 min.

• The VOThe VO2 2 peak from ramp-type protocols appears to be a peak from ramp-type protocols appears to be a

valid index of VOvalid index of VO2 2 max even without a plateau in VOmax even without a plateau in VO2. 2.

• To design an individualized ramp protocol, the maximum To design an individualized ramp protocol, the maximum work rate for each client must be work rate for each client must be predeterminedpredetermined or or accurately estimated accurately estimated from training records or from training records or questionnaires so that you can select a work rate that questionnaires so that you can select a work rate that allows the individual to reach his or her peak exercise allows the individual to reach his or her peak exercise tolerance in approximately 10 min.tolerance in approximately 10 min.



• For For discontinuousdiscontinuous exercise tests, the client rests 5 to 10 exercise tests, the client rests 5 to 10 min between workloads. The workload is progressively min between workloads. The workload is progressively increased until the client reaches maximum exercise increased until the client reaches maximum exercise tolerance (exhaustion). tolerance (exhaustion).

• Each stage of the discontinuous protocol lasts 5 or 6 min, Each stage of the discontinuous protocol lasts 5 or 6 min, allowing VOallowing VO22 to reach a steady state. to reach a steady state.

• On average, discontinuous tests take five times longer to On average, discontinuous tests take five times longer to administer than do continuous tests. administer than do continuous tests.

• May be easier for clients with other limitations rather than May be easier for clients with other limitations rather than cardiovascular.cardiovascular.


Maximal Test Protocols – FYI – pp. 73-84.


• It is difficult and expensive to measure the oxygen It is difficult and expensive to measure the oxygen consumption during exercise. Therefore, ACSM (2010) has consumption during exercise. Therefore, ACSM (2010) has developed equations (table 4.3, p. 73) to estimate the developed equations (table 4.3, p. 73) to estimate the metabolic cost of exercise (VOmetabolic cost of exercise (VO22). ).

• These equations provide a valid estimate of VOThese equations provide a valid estimate of VO2 2 for for steady-steady-

state exercise state exercise only. only.

• When used to estimate the maximum rate of energy When used to estimate the maximum rate of energy expenditure (VOexpenditure (VO2 2 max), the measured VOmax), the measured VO2 2 will be less will be less than the than the

estimated VOestimated VO2 2 if steady state is not reached. if steady state is not reached.

• Also, because maximal exercise involves both aerobic and Also, because maximal exercise involves both aerobic and anaerobic components, the VOanaerobic components, the VO2 2 max will be max will be overestimatedoverestimated

since the contribution of the anaerobic component is not since the contribution of the anaerobic component is not known.known.

Graded Exercise Testing: Metabolic Calculations


• Before using any of the ACSM metabolic equations to Before using any of the ACSM metabolic equations to estimate VOestimate VO22, make certain that all units of measure match , make certain that all units of measure match

those in the equation (see “Converting Units of Measure”, those in the equation (see “Converting Units of Measure”, p. 73).p. 73).

• Metabolic equations are available in Table 4.3. You ill need Metabolic equations are available in Table 4.3. You ill need to be able to calculate a walking and running equation. to be able to calculate a walking and running equation.

• Example slides followExample slides follow….….



• Calculating VOCalculating VO2 – Walking, no grade.2 – Walking, no grade.


• 70 kg woman walks at 3.5 mph at no grade70 kg woman walks at 3.5 mph at no grade

• VOVO22 = = Horizontal Horizontal + + Vertical Vertical + + RestRest

• VOVO22 = = (speed x 0.1)(speed x 0.1) + + 00 + + 3.5 ml/kg/min3.5 ml/kg/min

• VOVO22 = = [(3.5mph x 26.8m/mi) x 0.1][(3.5mph x 26.8m/mi) x 0.1] + + 00 + + 3.53.5

• VOVO22 = = (93.8 m/min x 0.1)(93.8 m/min x 0.1) + + 00 + + 3.5 ml/kg/min3.5 ml/kg/min

• VOVO22 = = 9.389.38 + + 00 + + 3.5 ml/kg/min3.5 ml/kg/min

• VOVO22 = 12.88 ml/kg/min = 12.88 ml/kg/min


• Calculating VOCalculating VO2 – Running, with grade2 – Running, with grade


• 90 kg man walks at 3.4 mph at 14% grade90 kg man walks at 3.4 mph at 14% grade


• VOVO22 = = (speed x 0.1)(speed x 0.1) + + (speed x grade x 1.8)(speed x grade x 1.8) + + 3.53.5

• VOVO22 = = [(3.4mph x 26.8m/mi) x 0.1][(3.4mph x 26.8m/mi) x 0.1]

+ + (speed x grade x 1.8)(speed x grade x 1.8) + + 3.53.5

• VOVO22 = = (91.12 m/min x 0.1)(91.12 m/min x 0.1) + + (91.12 x .14 x 1.8)(91.12 x .14 x 1.8) + + 3.53.5

• VOVO22 = = 9.119.11 + + 22.9622.96 + + 3.5 ml/kg/min3.5 ml/kg/min



• Calculating VOCalculating VO2 – Running, with grade2 – Running, with grade


• 60 kg man running at 7 mph at 14% grade60 kg man running at 7 mph at 14% grade


• VOVO22 = = (speed x 0.2)(speed x 0.2) + + (speed x grade x 0.9)(speed x grade x 0.9) + + 3.53.5

• VOVO22 = = [(7mph x 26.8m/mi) x 0.2][(7mph x 26.8m/mi) x 0.2] + + (speed x (speed x gradegrade

x 0.9)x 0.9) + + 3.53.5

• VOVO22 = = (187.60 m/min x 0.2)(187.60 m/min x 0.2) + + (187.6 x .14 x 0.9)(187.6 x .14 x 0.9) + + 3.53.5

• VOVO22 = = 37.5237.52 + + 23.6423.64 + + 3.5 ml/kg/min3.5 ml/kg/min



• Many of these tests are similar to the maximal exercise Many of these tests are similar to the maximal exercise tests described previously but differ in that they are tests described previously but differ in that they are terminated at some predetermined HR intensity. terminated at some predetermined HR intensity.

• You will monitor the HR, BP, and RPE during the You will monitor the HR, BP, and RPE during the submaximal exercise test. submaximal exercise test.

• The treadmill, cycle ergometer, and bench stepping The treadmill, cycle ergometer, and bench stepping exercises are commonly used for submaximal exercise exercises are commonly used for submaximal exercise testing.testing.

Graded Exercise Testing: Submaximal Test Protocols


• Not direct assessments of cardiorespiratory capacityNot direct assessments of cardiorespiratory capacity

• May be more practical than maximal exertion protocolsMay be more practical than maximal exertion protocols

• Can be performed on many modalitiesCan be performed on many modalities

• Can involve multiple stages or just oneCan involve multiple stages or just one

• Can determine VOCan determine VO22 via calculations or nomograms via calculations or nomograms

• Rely on underlying assumptionsRely on underlying assumptions



• Assumptions of submaximal exercise tests:Assumptions of submaximal exercise tests:


1.1. Steady-state HR is achieved and is consistent Steady-state HR is achieved and is consistent for work rate. for work rate. (Steady-state HR usually is achieved in 3 to (Steady-state HR usually is achieved in 3 to 4 min at a constant, submaximal work rate.)4 min at a constant, submaximal work rate.)

2.2. Relationship between HR and VORelationship between HR and VO22 is linear for is linear for HRs between 110 and 150 bpm. HRs between 110 and 150 bpm. ( Although the ( Although the linear relationship between HR and VOlinear relationship between HR and VO2 2 holds for light-to-holds for light-to-moderate workloads, the relationship between oxygen uptake moderate workloads, the relationship between oxygen uptake and work rate becomes curvilinear at heavier workloads)and work rate becomes curvilinear at heavier workloads)

3.3. Mechanical efficiency is the same for all tested. Mechanical efficiency is the same for all tested. . . (VO(VO22max predicted by submaximal exercise tests tends to be max predicted by submaximal exercise tests tends to be overestimated for highly trained individuals and overestimated for highly trained individuals and underestimated for untrained, sedentary individuals.)underestimated for untrained, sedentary individuals.)

4.4. HRmax is similar for all of same age. HRmax is similar for all of same age. (Because of (Because of inter-individual variability in HRmax and the potential inter-individual variability in HRmax and the potential inaccuracy with use of age-predicted HRmax, there may be inaccuracy with use of age-predicted HRmax, there may be considerable error (±10% to 15%) considerable error (±10% to 15%) continued…continued…


• Assumptions of submaximal exercise tests:Assumptions of submaximal exercise tests:


4. 4. An accurate HRmax is particularly important in An accurate HRmax is particularly important in situations in which :situations in which :the exercise test is terminated at a the exercise test is terminated at a predetermined percentage of either HRmax predetermined percentage of either HRmax (%HRmax method) or heart rate reserve [HRR = % (%HRmax method) or heart rate reserve [HRR = % (HRmax − HRrest) + HRrest], (HRmax − HRrest) + HRrest], the client’s VOthe client’s VO22max is estimated from max is estimated from submaximal exercise test data that are submaximal exercise test data that are extrapolated to an age-predicted HRmax, orextrapolated to an age-predicted HRmax, orHRmax is used to determine target exercise HRs HRmax is used to determine target exercise HRs for aerobic exercise prescriptions for aerobic exercise prescriptions See alternate equations, p. 85, text., single and See alternate equations, p. 85, text., single and multistage models. Review (FYI) Field Tests, multistage models. Review (FYI) Field Tests, Exercise For children and older adultsExercise For children and older adults


End of Presentation

chapter 04 assessing cardiorespiratory fitness

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