© McGraw-Hill Higher Education. All rights reserved. Chapter 11 Evaluating Aerobic Fitness

© McGraw-Hill Higher Education. All rights reserved. Chapter 11 Outline Essential Definitions Aerobic Fitness and Health Evaluation of Aerobic Fitness Risk Stratification for Exercise Laboratory-based Aerobic Fitness Tests Laboratory-based Maximal Tests of Aerobic Fitness Laboratory-based Submaximal Tests of Aerobic Fitness Field Tests of Aerobic Fitness Nonexercise Estimates of Aerobic Fitness

© McGraw-Hill Higher Education. All rights reserved. Aerobic Fitness – ability of the heart, lungs, and blood vessels to supply oxygen to working muscles and ability of the muscles to use the available oxygen to continue work or exercise

© McGraw-Hill Higher Education. All rights reserved. Importance of Aerobic Fitness Related to health outcomes Mortality risk Cardiovascular health Ability to meet demands of physical work

© McGraw-Hill Higher Education. All rights reserved. Definition of Aerobic Fitness Capacity to meet the energy demands of sustained, submaximal work Capacity to deliver oxygen to working muscles Capacity to extract oxygen at working muscles VO 2 max – maximal volume of oxygen one can consume during exhaustion exercise –best index of aerobic capacity

© McGraw-Hill Higher Education. All rights reserved. VO 2 max Delivery factors: –Blood supply (cardiac output, redistribution of blood flow) –Carrying capacity (Hb, RBC) Extraction factors: –Muscle mass –Capillary density

© McGraw-Hill Higher Education. All rights reserved. Aerobic Exercise Important for health promotion Efficient exercise mode for expending calories (large muscle groups) Examples: –Walking –Jogging –Cycling –Swimming –Group classes (Step, Spin)

© McGraw-Hill Higher Education. All rights reserved. VO 2 max Measured during maximal exercise Incremental test Components: –O 2, CO 2, VE Can be expressed in absolute or relative terms –Absolute – l·min -1 or ml·min -1 –Relative - ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. VO 2 max – Fit vs. Less fit (Fig 11.1)

© McGraw-Hill Higher Education. All rights reserved. VO 2 max - criteria Plateau in O 2 RER  1.15 RPE > 17 No increase in heart rate Use of age-predicted maximal heart rate is discouraged

© McGraw-Hill Higher Education. All rights reserved. VO 2 max – Average vs. Athlete

© McGraw-Hill Higher Education. All rights reserved. VO 2 max Quintile Norms - Women (ACSM, Jackson et al.) AgePoorFairAverageGood Excellent ≤ ≥ ≤ ≥ ≤ ≥ ≤ ≥ ≤ ≥31.3 (Table 11.1)

© McGraw-Hill Higher Education. All rights reserved. VO 2 max Quintile Norms - Men (ACSM, Jackson et al.) AgePoorFairAverageGood Excellent ≤ ≥ ≤ ≥ ≤ ≥ ≤ ≥ ≤ ≥38.2 (Table 11.1)

© McGraw-Hill Higher Education. All rights reserved. Age-adjusted VO 2 max Standards* Age GroupMenWomen   *Developed from data of Jackson et al. (1995; 1996) (Table 11.2)

© McGraw-Hill Higher Education. All rights reserved. Risk Stratification for Exercise Testing Exercise testing carries low risk Higher risk for maximal than submaximal testing, and for persons “at risk” ACSM Guidelines for stratifying risk

© McGraw-Hill Higher Education. All rights reserved. ACSM Risk Factors Positive Family history – MI or sudden death before age 55 in father, brother, or son; before age 65 in mother, sister, or daughter Smoking Hypertension (SBP  140 mm Hg or DBP  90 mm Hg) Dyslipidemia – Total (> 200 mg/dL), HDL ( 130 mg/dL) Fasting glucose – (> 100 mg/dL) Obesity (BMI > 30 kg/m 2 or waist girth > 102 cm for men and > 99 cm for women, or waist/hip ratio  0.95 for men and  0.86 for women) Sedentary Lifestyle - (Surgeon General’s recommendations) Negative High HDL cholesterol (HDL > 60 mg/dL)

© McGraw-Hill Higher Education. All rights reserved. Pre-Screening - PAR-Q Physical Activity Readiness Questionnaire Minimum for beginning moderate exercise program Series of Yes/No questions (see Fig 2-1 in text) If all “No” answers, can begin exercise program or fitness testing (with caveats regarding temporary illness, pregnancy, or change in status)

© McGraw-Hill Higher Education. All rights reserved. Laboratory-based Aerobic Fitness Tests Treadmill protocols Cycle ergometer protocols Arm ergometer protocols Maximal vs. Submaximal Data: –gas exchange; heart rate; RPE; BP

© McGraw-Hill Higher Education. All rights reserved. Test Selection Match intended/existing exercise mode Treadmill: Often yield higher maximal values More familiar mode for most people Running protocols may be unsuitable for some medical conditions (e.g., osteoarthritis, obese) Cycle ergometer: Often yield lower maximal values (local muscular fatigue) Some people may feel safer than on treadmill (balance/falling)

© McGraw-Hill Higher Education. All rights reserved. Test Selection Arm ergometer: Usually yields lowest maximal values (local muscular fatigue, smaller muscle mass) Suitable for people with medical conditions affecting the legs (paraplegia, amputation, severe osteoarthritis)

© McGraw-Hill Higher Education. All rights reserved. Cycle Protocols Power output – cadence, resistance, flywheel distance/revolution ACSM equations used to estimate O 2 cost Submaximal data used to estimate maximal work output or VO 2 max –Based on linear heart rate/workload relationship (beyond approximately 40% VO 2 max) Different prediction models (single-stage, multi-stage)

© McGraw-Hill Higher Education. All rights reserved. Cycle Ergometer Power Output kg. m. min -1 = kg x m. rev -1 x rev. min -1 watts = kg. m. min -1  6

© McGraw-Hill Higher Education. All rights reserved. ACSM Cycling Equation VO 2 (ml. kg -1. min -1 ) = 1.8 ml. kg -1. m -1 x kg. m. min -1  body weight in kg) + 7 ml. kg -1. min -1

© McGraw-Hill Higher Education. All rights reserved. Treadmill Protocols Power output – speed, grade ACSM equations used to estimate submaximal O 2 cost (walking, running) VO 2 max can be estimated from total time in maximal test protocols (different equations for different protocols) –Balke, Bruce

© McGraw-Hill Higher Education. All rights reserved. ACSM Walking Equation VO 2 (ml. kg -1. min -1 ) = 0.1 (speed) (speed)(fractional grade) speed in in m. min -1 (1 mph = 26.8 m. min -1 ) fractional grade is treadmill grade expressed as a fraction (e.g., 8% = 0.08)

© McGraw-Hill Higher Education. All rights reserved. ACSM Running Equation VO 2 (ml. kg -1. min -1 ) = 0.2 (speed) (speed)(fractional grade) speed in in m. min -1 (1 mph = 26.8 m. min -1 ) fractional grade is treadmill grade expressed as a fraction (e.g., 8% = 0.08)

© McGraw-Hill Higher Education. All rights reserved. Laboratory-based Maximal Tests of Aerobic Fitness Goal is to systematically increase exercise intensity until participant reaches exhaustion. VO 2 max can be measured by open-circuit spirometry. –expired gases are measured with metabolic measurement system. VO 2 max can be estimated from maximal treadmill time. –Bruce protocol –Balke protocol

© McGraw-Hill Higher Education. All rights reserved. The Bruce Protocol

© McGraw-Hill Higher Education. All rights reserved. Equation to Estimate VO 2 max from Bruce Protocol Maximal Treadmill Time VO 2 (ml. kg -1. min -1 ) = (0.30*TT) + (0.297*TT 2 ) - (0.0077*TT 3 ) where TT is maximal treadmill time in minutes, TT 2 is maximal treadmill time squared, TT 3 is maximal treadmill time cubed.

© McGraw-Hill Higher Education. All rights reserved. The Balke Protocol Time (min)Speed (mph)% Grade Speed is constant at 3.3 mph Elevation increases 1% each minute

© McGraw-Hill Higher Education. All rights reserved. Equation to Estimate VO 2 max from Balke Protocol Maximal Treadmill Time VO 2 (ml. kg -1. min -1 ) = (1.44*TT) where TT is maximal treadmill time in minutes.

© McGraw-Hill Higher Education. All rights reserved. Conversion Table to Estimate VO 2 max Time (min)BalkeBruce

© McGraw-Hill Higher Education. All rights reserved. Laboratory-based Submaximal Tests of Aerobic Fitness Less accurate, but more practical method to estimate aerobic capacity than maximal tests.

© McGraw-Hill Higher Education. All rights reserved. Submaximal Tests Principles Heart rate increases in proportion to VO 2 during aerobic exercise. VO 2 max is reached at maximal heart rate. A less fit person will have a higher heart rate at any given submaximal exercise intensity than a more fit individual.

© McGraw-Hill Higher Education. All rights reserved. HR/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. HR/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. HR/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. HR/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. SV/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. SV/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. SV/VO 2 Relationship

© McGraw-Hill Higher Education. All rights reserved. Submaximal Models to Estimate VO 2 max Single-Stage Model Astrand-Ryhming Single-Stage Test Multi-Stage Model

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Model VO 2 (ml. kg -1. min -1 ) = SMVO 2 * (220-age-k)  * (SMHR – K) where SMVO 2 is VO 2 in ml. kg -1. min -1 at the submaximal exercise intensity, 220-age is the estimate of maximal heart rate, SMHR is the submaximal heart rate at SMVO 2, and k is a constant of 63 for men and 73 for women.

© McGraw-Hill Higher Education. All rights reserved. Submaximal VO 2 When using Submaximal Models, submaximal VO 2 (SMVO 2 ) is estimated from ACSM cycling, walking, or running models.

© McGraw-Hill Higher Education. All rights reserved. Astrand-Ryhming Single-Stage Test Can be administered on a cycle ergometer, treadmill, or step. Cycle protocol last 6 minutes. Pedal rate is 50 rpm. Heart rates between 125 and 170 bpm are used for prediction.

© McGraw-Hill Higher Education. All rights reserved. Multi-Stage Model Heart rate and power output must be measured at two or more submaximal levels. YMCA is best known multi-stage test. –Heart rates between 100 and 150 bpm are used. –3-minute exercise stages are used. –VO 2 max is estimated by plotting heart rate – power output relationship.

© McGraw-Hill Higher Education. All rights reserved. Estimating Maximal Workload - for a 40-yr-old client If client weighs 50 kg: 2.0 L/min = 40 ml/kg/min; 2.2 L/min = 44 ml/kg/min; 2.4 L/min = 48 ml/kg/min;

© McGraw-Hill Higher Education. All rights reserved. YMCA Protocol 750 kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min kp. m. min -1 HR <80 HR HR HR >100 1 st Power Output 2 nd Power Output 3 rd Power Output 4 th Power Output 3 Minute Stages

© McGraw-Hill Higher Education. All rights reserved. Multi-Stage Model VO 2 (ml. kg -1. min -1 ) = VO b(220 – age - HR 2 ) b = (VO VO 2.1 )  (HR 2 – HR 1 ) where VO 2.1 is VO 2 at stage I, VO 2.2 is VO 2 at stage II, HR 1 is heart rate at stage I and HR 2 is heart rate at stage II.

© McGraw-Hill Higher Education. All rights reserved. Submaximal Treadmill Models Both single-stage and double-stage models can be used to estimate VO 2 max from treadmill tests.

© McGraw-Hill Higher Education. All rights reserved. Single-Stage 4-minute Treadmill Walking Test Participant walks for 4 minutes at at treadmill speed of either 2, 3, 4, or 4.5 mph at 5% grade. Speed should be a brisk, but comfortable pace.

© McGraw-Hill Higher Education. All rights reserved. Single-Stage 4-minute Treadmill Walking Test VO 2 (ml. kg -1. min -1 ) = (speed) – 0.327(submaximal HR) – 0.263(speed * age) (submaximal HR * age) (gender) where speed is mph, submaximal HR is submaximal heart rate at the submaximal exercise level used in the test, age is in years, and gender is coded as 1 = male and 0 = female. (R =.93, SEE = 4.85 ml. kg -1. min -1 )

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Treadmill Walking Test Two prediction models were developed. –Percent fat model –BMI model

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Treadmill Walking Test – Percent Fat Model for Men VO 2 (ml. kg -1. min -1 ) = (age) +1.08(PAR) (submaximal HR) (submaximal VO 2 ) (% fat) (R =.87, SEE = 4.0 ml. kg -1. min -1 )

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Treadmill Walking Test – BMI Model for Men VO 2 (ml. kg -1. min -1 ) = (age) (PAR) (submaximal HR) (submaximal VO 2 ) (BMI) (R =.86, SEE = 4.1 ml. kg -1. min -1 )

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Treadmill Walking Test – Percent Fat Model for Women VO 2 (ml. kg -1. min -1 ) = (age) (PAR) (submaximal HR) (submaximal VO 2 ) (% fat) (R =.85, SEE = 4.2 ml. kg -1. min -1 )

© McGraw-Hill Higher Education. All rights reserved. Single-Stage Treadmill Walking Test – BMI Model for Women VO 2 (ml. kg -1. min -1 ) = (age) (PAR) (submaximal HR) (submaximal VO 2 ) (BMI) (R =.84, SEE = 4.4 ml. kg -1. min -1 )

© McGraw-Hill Higher Education. All rights reserved. Steady State Exercise Subjects need to be at steady state for submaximal estimates to be accurate. Steady state heart rate is defined as two successive heart rates within 5 beats. min -1.

© McGraw-Hill Higher Education. All rights reserved. Field Tests of Aerobic Fitness Can be conducted “in the field” on large numbers of people. Extensive technical equipment or expertise not required. Generally less accurate than laboratory tests. Most involve maximal or strenuous effort. –Risks involved Suitable for young people in good physical condition, without significant CVD risk factors.

© McGraw-Hill Higher Education. All rights reserved. Field Tests of Aerobic Fitness Distance run/walk –12-minute run/walk for distance Timed run/walk –1.5-mile run –1-mile run/walk 20-meter shuttle run (e.g., PACER) Rockport 1-mile walk test BYU Jog test

© McGraw-Hill Higher Education. All rights reserved. 12-Minute Run/Walk Test Developed on 115 men, years. High correlation with VO 2 max (r =.90). Practice required, need to learn pacing. Run/walk for 12 minutes. Measure distance traveled in miles. VO 2 max (ml·kg -1 ·min -1 ) = (Distance – ) 

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 42-year old man ran 1870 meters in 12 minutes. Estimate his VO 2 max (1 mile  1609 meters). VO 2 max (ml·kg -1 ·min -1 ) = (Distance )  VO 2 max = ( – )  VO 2 max = (.8484)  VO 2 max = 30.5 ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. 1.5-mile Run Test Everyone runs same distance. Same start and finish point. Performance time in minutes and fractions of a minute (not seconds) is outcome score. VO 2 max (ml·kg -1 ·min -1 ) = (483  time)

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 29-year old woman ran 1.5 miles in 12 minutes, 27 seconds. Estimate her VO 2 max. VO 2 max = (483  time) VO 2 max = (483  12.45) VO 2 max = (38.80) VO 2 max = ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. Generalized 1-mile Run/Walk Test Participants cover the 1 mile distance as fast as possible. Developed on 8- to 25-year-old (n = 750), males and females.

© McGraw-Hill Higher Education. All rights reserved. Generalized 1-mile Run/Walk Test VO 2 max (ml·kg -1 ·min -1 ) = (time) (time 2 ) (age*gender) (BMI) (Gender: male = 1; female = 0) (R =.72; SEE = 4.8 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 12-year-old boy with BMI = 27.8 walked a mile in 17 minutes, 24 seconds. Estimate his VO 2 max. VO 2 max (ml·kg -1 ·min -1 ) = – 8.41(time) (time 2 ) (age*gender) – 0.84(BMI) VO 2 max = – 8.41(17.4) ( ) (12*1) – 0.84 (27.8) VO 2 max = – – VO 2 max = ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. PACER (20-meter Shuttle Run) Progressive Aerobic Cardiovascular Endurance Run. Participants run together (same pace). Paced by audio tape. Pace increases with time. Less fit finish first, fittest finish last. Record individual’s fastest speed (km·hr -1 ).

© McGraw-Hill Higher Education. All rights reserved. PACER (20-meter Shuttle Run) VO 2 max (ml·kg -1 ·min -1 ) = (max speed) (R =.90; SEE = 4.4 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 25-year old woman stopped running the PACER at a speed of 10.5 km·hr -1. Estimate her VO 2 max. VO 2 max (ml·kg -1 ·min -1 ) = (max speed) VO 2 max = (10.5) VO 2 max = VO 2 max = ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. Distance Runs – Important Considerations Select appropriate test. Be sure participant is motivated – accurate score depends on maximal exertion. Provide practice. Discuss pacing.

© McGraw-Hill Higher Education. All rights reserved. Walking and Jogging Tests Do not require maximal exertion. Pace is self-determined. Post-test heart rate response is measured.

© McGraw-Hill Higher Education. All rights reserved. Rockport 1-Mile Walk Test Developed on 343 males and females years of age. Requires accurate measurement of heart rate. Participants walk as fast as possible for 1 mile. Heart rate monitor was used in original study. Pace should be brisk (> 120 beats·min -1 ), and constant.

© McGraw-Hill Higher Education. All rights reserved. Rockport 1-Mile Walk Test Not suitable for highly fit or people on HR- altering medications (anti-hypertensives, beta- blockers). Measure time (minutes), post-walk HR, weight (lb).

© McGraw-Hill Higher Education. All rights reserved. Rockport 1-Mile Walk Test VO 2 max (ml·kg -1 ·min -1 ) = (age) (weight) (time) (heart rate) (gender) gender (male = 1; female = 0) (R =.88; SEE = 5.0 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 61-year old man walked a mile in 15 minutes, 53 seconds. His weight was 217 lb, and post-walk HR was 137 b·min -1. Estimate his VO 2 max. VO 2 max (ml·kg -1 ·min -1 ) = – (age) – (weight) – (time) – (HR) (gender)

© McGraw-Hill Higher Education. All rights reserved. Knowledge check VO 2 max = – (61) – (217) – (15.88) – (137) (1) VO 2 max = – – – – VO 2 max = ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. BYU Jog Test Similar to the 1-Mile Walk Test, but participant jogs instead of walks. To ensure a submaximal pace, run times of  8 minutes per mile for males and  9 minutes per mile for females. –Heart rates should be  180 bpm. Developed on 54 males and females 18 to 29 years of age.

© McGraw-Hill Higher Education. All rights reserved. BYU Jog Test VO 2 max (ml·kg -1 ·min -1 ) = (weight) (jog time) (heart rate) (gender) gender (male = 1; female = 0) (R =.87; SEE = 3.0 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Knowledge check A 23-year old woman jogged one mile in 9 minutes, 30 seconds. Her weight was 130 lb, and post-jog HR was 168 b·min -1. Estimate her VO 2 max. VO 2 max (ml·kg -1 ·min -1 ) = – (130) – 1.438(9.5) – (168) (0) VO 2 max = – – – VO 2 max = 33.2 ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. Non-Exercise Estimates of Aerobic Fitness Can accurately estimate VO 2 max without exercise testing. Include age, sex, body composition (BMI or % fat), and self-reported physical activity (SRPA). –30-day physical activity recall (7-point scale) Suitable for people on HR-altering medication. Accuracy is similar to many exercise tests. Less accurate for highly fit (top 5%).

© McGraw-Hill Higher Education. All rights reserved. 30-day Physical Activity Recall

© McGraw-Hill Higher Education. All rights reserved. University of Houston Non-exercise Percent Fat Model Men: VO 2 max (ml·kg -1 ·min -1 ) = (age) (%fat) (SRPA) (%fat*SRPA) (R =.79; SEE = 4.9 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. University of Houston Non-exercise Percent Fat Model Women: VO 2 max (ml·kg -1 ·min -1 ) = (age) (%fat) (SRPA) (%fat*SRPA) (R =.85; SEE = 4.4 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Knowledge Check A 37-year-old woman has 27.5% fat, and reports a score of 3 on the 30-day SRPA. Estimate her VO 2 max. VO 2 max (ml·kg -1 ·min -1 ) = – 0.265(age) – 0.309(% fat) (SRPA) – 0.044(%fat*SRPA) VO 2 max = – 0.265(37) – 0.309(27.5) (3) – 0.044(27.5*3) VO 2 max = – – – 3.63 VO 2 max = 30.2 ml·kg -1 ·min -1

© McGraw-Hill Higher Education. All rights reserved. University of Houston Non-exercise BMI Model Men: VO 2 max (ml·kg -1 ·min -1 ) = (age) (BMI) (SRPA) (BMI*SRPA) (R =.74; SEE = 5.4 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. University of Houston Non-exercise BMI Model Women: VO 2 max (ml·kg -1 ·min -1 ) = (age) (BMI) (SRPA) (BMI*SRPA) (R =.82; SEE = 4.7 ml·kg -1 ·min -1 )

© McGraw-Hill Higher Education. All rights reserved. Summary Aerobic fitness is important for health. Aerobic fitness can be tested in the lab or in the field. Lab tests are generally more accurate than field tests. Maximal effort tests are generally more accurate than submaximal effort tests. Non-exercise models are as accurate as many submaximal exercise tests.

© McGraw-Hill Higher Education. All rights reserved. Formative Evaluation of Chapter Objectives Define aerobic fitness. Explain the relationship between aerobic fitness and health. Explain the idea of risk stratification prior to exercise testing. Define the methods used to determine power output from cycle ergometer and treadmill tests. Identify laboratory-based methods used to assess VO 2 max during maximal exercise testing. Identify laboratory-based methods used to assess VO 2 max during submaximal exercise testing.

© McGraw-Hill Higher Education. All rights reserved. Chapter 11 Evaluating Aerobic Fitness