The Talk TestThe Talk TestThe Poor Man’s Way to Gauge Exercise Training Intensity

• Carl Foster, Ph.D., FACSM• Department of Exercise and

Sport Science• University of Wisconsin-La

Crosse

Every Story Starts SomeplaceSome Stories Start Twice

1970 1998

Exercise is MedicineOverwhelming Epidemiologic and Clinical Evidence

Risk of First Heart Attack

0102030405060708090

100

0 1000 2000 3000 4000 5000Physical Acitivity Index

Rel

ativ

e R

isk

Other ActivitiesStrenuous Sports

R.S. Paffenbarger et al Am J Epidemiology 108: 161, 1978

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0 3 6 9 12

Exerc isePTCA

Event Free Survival

Months

R Hambrecht et al.Circulation 109: 1371-1378, 2004

Exercise is MedicineOrder of Magnitude Effect

Effect of CR on Outcome

0

0.2

0.4

0.6

0.8

1

1.2

All Cause Death CV Mortality Non FatalRecurrence

N.B Oldridge et. al. JAMA 260: 945-950, 1988GT Oconnor et. al Circulation 80: 234-244, 1989

* *

Hakim AA; New Engl J Med 1998 338:94 - 99

Effect of Walking on 5 Year MortalityVs -1% with Rx for HTN & Cholesterol

=stopping smoking vs continuing to smokeafter first MI

-8%

Components of an Exercise Program

• Frequency– 5-7 x weekly

• Intensity– Hardest to define

• Time– 20-60 min

• Type

Prescription of Exercise Training Intensity

• Objective Markers– VO2 & METs

• 60-80% max• 45/50-85% reserve

– Heart Rate• 50/65-90% max• 40/50-85% reserve

• Limits of the “relative percent concept”– Individual response thresholds– Wide prescriptive window

• Metabolic markers– Ventilatory Threshold– Lactate Threshold

• Subjective Markers– RPE– Talk Test

Historical BackgroundLong standing belief that highest exercise intensity compatible with “just being able to speak” might be ‘just about right”Prof John Grayson (Oxford University) “Climb no faster than you can talk” (1939)

ACSM Guidelines (4th edition, 1991)Prof Robert Goode (University of Toronto) Hear your breathing test (1995)

Henry Ford Hospital, 1997 Abstracts

American Council on Exercise, 1997UW-La Crosse, 1998Common experience amongst exercisers ‘If we’re going to keep talking, you have to slow down’

Talk Test

What Does the Talk Test Look Like?

Speech Provoking Stimulus

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VO2 @ VT VO2 @ + VO2 @ +/- VO2 @ -

VO2

(ml

* kg

-1 *

min

-1)

Rainbow

Pledge

*

**

**

*

* p < 0.05 vs. VT

020406080100120140160180

HR @ VT HR @ + HR @ +/- HR @ -

HR

(bea

ts

* m

in-1)

Rainbow

Pledge

**

**

*

* p < 0.05 vs. VT

60

70

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90

Detroit LaCrosse

%M

ETs

50

60

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80

Detroit LaCrosse%

HR

R

N Shafer et al. JCRP 20: 289, 2000 JP Porcari et al. JCRP 22: 369, 2002(Amy Kelso-Amann)

Evidence that the Talk Test is a Marker of Appropriate Exercise Intensity

%HRmax & %METs

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%HR max %METs

PositiveEquivocalNegative

M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000N Shafer et al. JCRP 20: 289, 2000S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002P Recalde et al. S Afri J Sports Med 9: 5-8, 2002R Persinger et al. MSSE 36: 1716-1722, 2004

C Foster et al. J Str Cond Res 23: 2425-2429, 2009 (Neepa Talati)E Jeanes et al. J Str Cond Res 25: 590-596, 2011

VO2 @ VT vs + Talk Test

y = 0.9344x + 0.1287R2 = 0.9254

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60

0 10 20 30 40 50 60VO2 @ VT (ml/kg)

VO2

@ +

Tal

k Te

st (m

l/kg)

+Talk Test vs VT

M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000N Shafer et al. JCRP 20: 289, 2000S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002P Recalde et al. S Afri J Sports Med 9: 5-8, 2002R Persinger et al. MSSE 36: 1716-1722, 2004

M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000N Shafer et al. JCRP 20: 289, 2000S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002P Recalde et al. S Afri J Sports Med 9: 5-8, 2002R Persinger et al. MSSE 36: 1716-1722, 2004

+/-Talk Test vs VTVO2 @ VT vs +/- Talk Test

y = 0.9435x + 2.6613R2 = 0.9349

0

10

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30

40

50

60

0 10 20 30 40 50 60VO2 @ VT (ml/kg)

VO2

@ +

/- Ta

lke

Test

(ml/k

g)

-Talk Test vs VT

M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000N Shafer et al. JCRP 20: 289, 2000S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002P Recalde et al. S Afri J Sports Med 9: 5-8, 2002R Persinger et al. MSSE 36: 1716-1722, 2004

VO2 @ VT vs - Talk Test

y = 0.9869x + 6.463R2 = 0.9152

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10

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30

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0 10 20 30 40 50 60VO2 @ VT (ml/kg)

VO2

@ -

Talk

Tes

t (m

l/kg)

VO2 @ VT vs Talk Test

20

25

30

35

40

1

VO2

(ml/k

g)

VTPositiveEquivocalNegative

VO2 @ VT vs Talk Test

*

*

-Talk Test vs RCT

y = 1.0417x - 0.1001R2 = 0.993

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1

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3

4

5

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Respiratory Compensation Threshold (L/min)

Talk

Tes

t (N

egat

ive)

P Recalde et al. S Afri J Sports Med 9: 5-8, 2002

Percent of VT vs Talk Test

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140

Positive Equivocal NegativeStage of Talk Test

VO2

as %

VT

StudentsAthletesPatients

Ok, the Talk Test Matches VO2, HR and VT Markers of Exercise Capacity……Does it Work in Real Life?

Does the Talk Test Reflect Changes in Exercise Intensity?

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0 5 10 15 20 25 30Time (minutes)

% V

O2

@ V

T

Protocol

Mean % VT

Observed +

Observed -

Expected +Expected -

59 147

24 4

% Right = 73.1%% Wrong = 26.9%

Stage duration in relation to % VT

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2

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6

105% VT 110% VT 115% VT 120% VT 125% VT

Intensity (% of VT)

Tim

e (m

in)

“If we’re going to keep talking, you have to slow down”

Can the Talk Test Prevent Exertional Myocardial Ischemia?

• Exertional ischemia is the one substantial danger in ExRx• K Meyer (Eur Heart J 16: 623, 1995) has shown that the VT often

precedes ST segment changes in patients with CAD

y = 0.4254x + 0.8629R2 = 0.2962

02468

10

0 2 4 6 8 10First Evidence of Ischemia

Last

+ T

T

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140

1

Hear

t Rat

e

IschemiaPositive TTEquivocal TTNegative TTIschemia -10

CA Cannon et al. Am J Med Sport 6: 52-57, 2004

Can the Talk Test Track Permutations in Exercise Capacity? C.FosterC.Foster et al: et al: J J CardiopulmCardiopulmRehabilRehabil

28: 2428: 24--30, 2008 (J Anderson, M 30, 2008 (J Anderson, M Paulson)Paulson)

Experiments with Experiments with venesectionvenesection ExerimentsExerimentswith short term trainingwith short term training

Effect of Training and Blood Loss

-15

-10

-5

0

5

10

15

-15 -10 -5 0 5 10 15

VO2 @ VT (ml*min-1*kg-1)

VO2

@ L

PTT

(ml*m

in-1

*kg-

1)

TrainingBlood Loss

Can You “Translate” From Exercise Testing to Exercise Training with the Talk Test?

• C Foster et al. • J Str Cond Res 23: 2425-2429,

2009– Neepa Talati

• Sedentary individuals• Incremental exercise test to

identify + +/- - stages of Talk Test

• 20 min exercise bouts at LP-1, LP, EQ

Translating GXT to Training

Talk Test Score

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0 2 4 6 8 10 12 14 16 18 20Time (min)

EqTTLPTTLP-1TT

RPE

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EqTTLPTTLP-1TT

% HRmax

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0 2 4 6 8 10 12 14 16 18 20Time (min)

EqTTLPTTLP-1TT

Does “Translating” Exercise Intensity Work for Fitter Individuals?

• EA Jeanes et al.• J Str Cond Res 25: 590-

596, 2011• Well-trained non athletes

including several “t-shirt runners”

• Incremental exercise to identify stages of TT

• 40 min stead state exercise sessions at – LP-1, LP, EQ

% HR max

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0 10 20 30 40Time (min)

%H

R m

ax

%HR LP-1%HR LP%HR EQ

RPE

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RPE

xRPE LP-1xRPE LPxRPE EQ

Talk Test Score

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0 10 20 30 40Time (minutes)

Talk

Tes

t Sco

re

TT score LP-1TT score LPTT score EQ

Newest Data on Translating Exercise Training Intensity

• C Foster et al. J Str Cond Res 23: 2425-2429, 2009 (N Talati)

• EA Jeanes et al. J Str Cond Res 25: 590-596, 2011

• + L Walraven• + J Lueck

RPE

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0 10 20 30Time (min)

trLP1trLPtrEQsedLP1sedLPsedEQ

%HRmax

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0 10 20 30Time (min)

trLP1trLPtrEQsedLP1sedLPsedEQ

So, Where Does this Leave Us?

Summary • Talk Test---a good ‘old idea’• Easy to perform• eliminates need for maximal exercise• forgiving of variations in speech producing stimulus• Accurately places exercisers in exercise intensity defined

by conventional criteria– %HRmax– %VO2max– VT– RPE

• Apparently useful as tool for avoiding exertonal ischemia• Responsive to permutations in exercise capacity• Easy to translate into exercise training intensity

One Hippopotomus, Two Hippopotomus, Three Hippopotomus, Four