Cardiorespiratory Fitness Testing Guidelines Learning Objectives Describe factors that affect exercise test selection assessments State the recommended sequencing of fitness Explain the proper procedures to follow in conducting cardiorespiratory fitness CRF assessments Identify the test termination criteria Purpose of Testing Collect baseline data educate individuals about present status Provide data to inform the development of exercise Rx Collect follow up data to evaluate track progress Motivation Test Selectio n Purpose goals Injury history Risk vs benefit Length of test Intensity of test Expense of administration Personnel facilities equipment Required accuracy of results Willingness motivation of participant Source ACSM s Guidelines for Exercise Testing Prescription 11th ed Procedures Before Testing Informed consent preparticipation screening Explain test procedures Ensure forms are organized available Calibrate equipment monthly cycle treadmill metronome BP cuff skinfold calipers Control environment room temp 68 72 degrees F humidity 60 Take resting measures HR BP body comp anthropometrics Medications Emergency response plan Source ACSM s Guidelines for Exercise Testing Prescription 11th ed Pre Test Instructions Wear loose fitting comfortable clothes sneakers Avoid food alcohol and caffeine for at least 3 hours before test Drink plenty of fluids in 24 hours preceding test Sleep at least 6 8 hours night before Take routine meds w small amount of water functional tests No strenuous exercise 24 hrs prior to test test Test Sequence Ensures validity reliability Avoid testing same muscle group repeatedly Resting measurements HR BP anthropometrics body comp CRF Muscular fitness Flexibility HR BP Measurement Resting measures taken in same position as test will be HR measures palpate HR monitor auscultate with performed in stethoscope 80 of BP cuff should encircle the arm Rate of releasing pressure 2 5 mm Hg per second Count pulse min of 15 sec 30 60 preferable Measure HR twice during last 2 min of each stage determine steady state BP measured during the final minute of each stage Monitor HR BP at least 5 min post test Rating of Perceived Exertion RPE Correlates with exercise HRs and work rates Interindividual variability Subjective rating Can be influenced by Psychological factors mood states Exercise modes Age Thirst Environmental conditions Borg scale 6 20 Category ratio 0 10 Test Termination Criteria Angina Drop in SBP 10 mm Hg with an increase in workload or decrease in SBP SBP 250 mm Hg or DBP 115 mm Hg SOB wheezing leg cramps claudication Light headedness confusion pallor ataxia cyanosis nausea cold clammy skin Failure of HR to increase with increase in workload Individual requests to stop Physical or verbal signs of severe fatigue Equipment malfunction Maximal Submaxim al Exercise Testing Learning Objectives State the criteria for determining VO2max Describe how to estimate VO2max from submaximal test results Describe how to interpret the results of CRF tests Identify VO2max norms Maximal Exercise Testing Measures VO2max Require expensive equipment trained technicians Subject must exercise max intensity Indicates true physiologic max reached VO2peak used when leveling off of VO2 or HR plateau is not observed Criteria for VO2max Plateau of HR in final min 2 beats min VO2 plateau 1 15 ml min inc in VO2 w inc workload RER 1 15 Venous lactate concentration 8 mmol L Submaximal Exercise Testing Can estimate VO2max from HR response field test performance time to volitional fatigue Require precise HR measurement by technician Can be over or underestimated Accuracy of estimating VO2 max influence by various factors Interpreting Results of CRF Tests Criterion referenced standards classify individuals into categories or groups i e excellent needs improvement based on external criteria Normative standards provide percentiles from data collected within a specific population Based on sex recorded at birth along with age other discriminating factors VO2 max Changes to Indicate Improvement in CRF HR at submax workload HR recovery Distance covered or time to cover same distance VO2max Norms Typical college aged male Typical college aged female Trained college aged male Trained college aged female 45 49 ml kg min 35 39 ml kg min 66 ml kg min 56 ml kg min Effects of Common Medications on Exercise Learning Objective Recognize the effects of common medications substances on heart rate blood pressure and exercise response Effects of Common Medicatio ns Substanc es on Exercise Testing Exercise may impact the pharmacokinetic and pharmacodynamic properties Can impact dose dosing interval length of time the individual takes the med and or exercise prescription Cardiovascul ar Medications Beta Blockers Blunts HR response to exercise Decreases resting exercise HR BP May block symptoms of hypoglycemia Calcium channel Blockers ACE Inhibitors Decrease resting exercise BP May cause excessive post exercise hypotension Digitalis Antiarrhythmic dec RHR in patients w a fib can cause ST segment depression during exercise Diuretics may inc RHR dec resting exercise BP may cause PVCs caution when taken w ACE inhibitors hypotension monitor weight Statins no sig effect on exercise capacity HR or BP muscle soreness may indicate rhabdomyolysis Nitrates inc resting HR may inc exercise HR dec resting BP may dec exercise BP inc exercise capacity in patients w angina Other Medications Substances Oral Hypoglycemics inc hepatic insulin output dec insulin resistance dec absorption of CHO minimal effect on exercise capacity monitor blood glucose before during after exercise Caffeine inc RHR inc exercise BP may inc exercise HR inc endurance OTC Cold Flu Medications ephedrine inc SBP may affect exercise HR BP depend on med type Human Growth Hormone inc performance VO2max Alcohol inc BP may provoke arrhythmias dec performance VO2max Nicotine NRT inc HR BP may dec exercise capacity Marijuana May dec exercise capacity Cannabis THC have been shown to alter CV function at rest and during submax exercise typically by inc HR Diet Pills inc resting HR BP Antidepressan ts Antianxiety May cause increase in resting or exercise HR May cause decrease in resting or exercise BP Variable changes in resting ECG Modes of Exercise Testing Learning Objectives State the strengths and limitations of various test modalities Select appropriate CRF testing protocols based on screening info Field Tests Based on how far a person can walk run in a set