Submaximal Exercise Testing

Submaximal Exercise Testing:Clinical Application andInterpretation

Compared with maximal exercise testing, submaximal exercise testingappears to have greater applicability to physical therapists in their roleas clinical exercise specialists. This review contrasts maximal andsubmaximal exercise testing. Two major categories of submaximal tests(ie, predictive and performance tests) and their relative merits aredescribed. Predictive tests are submaximal tests that are used to predictmaximal aerobic capacity. Performance tests involve measuring theresponses to standardized physical activities that are typically encoun-tered in everyday life. To maximize the validity and reliability of dataobtained from submaximal tests, physical therapists are cautioned toapply the tests selectively based on their indications; to adhere tomethods, including the requisite number of practice sessions; and touse measurements such as heart rate, blood pressure, exertion, andpain to evaluate test performance and to safely monitor patients.[Noonan V, Dean E. Submaximal exercise testing: clinical applicationand interpretation. Phys Ther. 2000;80:782–807.]

Key Words: Functional limitation, Maximal exercise test, Outcome measures, Oxygen transport,

Performance, Prediction, Rehabilitation, Submaximal exercise test.

782 Physical Therapy . Volume 80 . Number 8 . August 2000

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Vanessa Noonan

Elizabeth Dean

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Although maximal exercise testing is consid-ered the gold standard for assessing maximalaerobic capacity, the role of such testing islimited in people whose performance may be

limited because of pain or fatigue rather than exertionand in cases where maximal exercise testing is contrain-dicated. Submaximal exercise testing overcomes many ofthe limitations of maximal exercise testing, and it is themethod of choice for the majority of individuals seen byphysical therapists in that these individuals are likely tobe limited physically by pain and fatigue or have abnor-mal gait or impaired balance. This article contrastsmaximal and submaximal exercise testing and describesthe clinical application of submaximal testing. Thestrengths and limitations of both predictive and perfor-mance submaximal tests and the means of maximizingvalidity and reliability of data are presented. Predictivetests are submaximal tests that are used to predictmaximal aerobic capacity. Typically, heart rate (HR) oroxygen consumption (V̇o2) at 2 or more workloads ismeasured.1,2 A predicted V̇o2 value is obtained by extrap-olating the relationship between HR and V̇o2 to age-predicted maximal heart rate (HRmax). Performancetests involve measuring the responses to standardizedphysical activities that are typically encountered in every-day life. Finally, we discuss the use of submaximalexercise testing in clinical decision making and theimplications for professional education and research.

Maximal Versus Submaximal Exercise TestsMaximal exercise tests either measure or predict maxi-mum oxygen consumption (V̇o2max) and have beenaccepted as the basis for determining fitness.3–7 They

have served as a stan-dard against which tocompare other mea-sures.8 Maximum oxy-gen consumption isdependent on the abil-ity of the oxygen trans-port system to deliverblood and the ability ofcells to take up and uti-

lize oxygen in energy production.9 Theoretically, a max-imal test is defined by the plateau of V̇o2 with furtherincreases in workload.10,11 Other indexes used to assessmaximal effort include obtaining HRmax within 15beats per minute (bpm) of age-predicted HRmax(ie, 2202age) and a respiratory exchange ratio .1.10(ratio of metabolic gas exchange calculated by carbondioxide production divided by V̇o2).12 Maximum oxygenconsumption is typically expressed relative to bodyweight (ie, mLzkg21zmin21),13 which enables individualsof different body masses to be compared. When amaximal test is performed but the criteria for V̇o2maxare not met, the maximal V̇o2 achieved is termed a“V̇o2peak.”14 Few individuals reach a true V̇o2max, andV̇o2peak values are often incorrectly reported as maxi-mal values.14 The intraindividual day-to-day variation inmeasuring V̇o2max is between 4% to 6% in individualswith no known cardiopulmonary pathology or impair-ment.15,16 In people with various diagnoses, such as thosewith chronic obstructive pulmonary disease (COPD),this variation is between 6% and 10%.17

V Noonan, PT, MSc, is Research Coordinator, Orthopaedic Spine Program, Vancouver Hospital, Vancouver, British Columbia, Canada.

E Dean, PT, PhD, is Professor, School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BritishColumbia, Canada V6T 1Z3 ([email protected]). Address all correspondence to Dr Dean.

Both authors provided concept/idea, writing, literature collection and analysis, project management, and consultation (including review ofmanuscript before submission). Dr Dean also provided clerical support.

Submaximal

exercise testing

overcomes many of

the limitations of

maximal exercise

testing.

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There are several limitations to assessing maximal per-formance with a V̇o2max test. Unless an individual isable to attain a V̇o2max without fatiguing first or beinglimited by musculoskeletal impairments or other prob-lems, the results of the test are invalid. In addition,higher levels of motivation are required by the individ-ual, and maximal tests require additional monitoringequipment (eg, electrocardiograph machine) andtrained staff and are labor intensive.1,13,18

In comparison with maximal tests, submaximal exercisetests and their applications have been less well devel-oped, which we find surprising given the large numberof patient types and individuals who should be able tobenefit from nonmaximal exercise tests. For the purposeof this review, submaximal tests are classified as eitherpredictive tests or performance tests.

Clinical Application of Submaximal ExerciseTesting

SafetyExercise constitutes a physiologic stress that may pose agreater risk to people with various diagnoses than topeople without pathology or impairment. The space fortesting must be sufficient to minimize injury should thepatient fall or have an arrest. All physical therapistsshould have current certification in cardiopulmonaryresuscitation. Emergency procedures and basic equip-ment need to be in place to ensure that the individualhas immediate care until paramedical or medical assis-tance arrives. There are other critical needs for exercisetesting. Basic emergency supplies, including a sugarsource for people with diabetes, should be on hand. Aportable oxygen source and suction device should beaccessible. People who are stable and who have a historyof angina should have their antianginal medication, andthe physical therapist should have access to this medica-tion. Monitoring equipment should be maintained andregularly calibrated.

Indications for testing and any contraindications fortesting should be determined before testing.19 In thepresence of relative contraindications, the person mayrequire additional monitoring (eg, 12-lead electrocardi-ography) or be cleared for such testing by an appropri-ate medical practitioner. A high proportion of peopleover the age of 65 years without known cardiac diseasehave a high incidence of cardiac dysrhythmias,20,21 whichmay necessitate greater attention to monitoring cardiacstatus during exercise. Individuals requiring additionalmonitoring or considered to be at hemodynamic riskshould be tested in a setting with medical personnelpresent.

IndicationsMaximal exercise testing has a role in the assessment ofmaximal aerobic capacity or functional work capacity.Because people are frequently limited by cardiopulmo-nary, musculoskeletal, and neuromuscular impairmentsand complaints such as exertion, dyspnea, fatigue, weak-ness, and pain during their activities of daily living,maximal testing is often contraindicated or of limitedvalue. In people without cardiopulmonary or musculo-skeletal impairments, the reserve capacity of the cardio-pulmonary and musculoskeletal systems is thought to bebarely tapped during daily activities.22 In people withpathology, this reserve can be greatly reduced, and agreater than usual proportion of a person’s maximalcapacity may be needed to perform routine activities.23

Exercise constitutes a major physiological stress that canlead to untoward responses in patients as well as inindividuals without known pathology. In addition, suchtesting is resource intensive and thus should be appliedand performed judiciously. The purposes of maximaltests include determination of V̇o2max and use as diag-nostic or treatment outcome tools. Submaximal exercisetests can be used to predict V̇o2max, to make diagnosesand assess functional limitations, to assess the outcomeof interventions such as exercise programs, to measurethe effects of pharmacological agents, and to examinethe effect of recovery strategies on exerciseperformance.13,19,23–25

Guidelines for Test SelectionThere are numerous submaximal tests from which tochoose. These tests have been developed to meet theneeds of people with various functional limitations anddisabilities and the needs of older adults. In our opinion,however, inappropriate selection may lead to eitherunderstressing or overstressing the individual. Suchunderstressing or overstressing of the person, in ourview, can lead to invalid conclusions because of ceilingor floor effects, and the testing may be hazardous. Thegoal of testing should be to produce a sufficient level ofexercise stress without physiologic or biomechanicalstrain. Factors that we believe should be considered inselecting the appropriate test include the person’s pri-mary and secondary pathologies and how these pathol-ogies physically affect the person’s daily life. Otherfactors include cognitive status, age, weight, nutritionalstatus, mobility, use of walking aids or orthotic orprosthetic devices, independence, work situation, homesituation, and the person’s needs and wants. People whomay be medically unstable and at risk for an arrest mayneed to be tested in the presence of a cardiologist orpulmonary specialist or by a physical therapist in aspecialized setting where emergency services are onhand. The population for which a given test was devel-oped, the degree of validity and reliability of measure-

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ments obtained with each test, and test sensitivity alsoshould be considered (Appendix). Reports in the liter-ature on the common submaximal tests described in thisarticle vary with respect to the adequacy of establishingvalidity, reliability, and sensitivity; thus, test interpreta-tion may be limited. These limitations should be consid-ered in the selection of each test. Physical therapistsshould determine what information will be added byperforming an exercise test and how that informationwill alter clinical decision making.

Pretest WorkupA detailed medical and surgical history is needed toidentify the indications for an exercise test and to alertthe physical therapist about any underlying conditions(eg, cardiovascular, pulmonary, musculoskeletal, or neu-rological dysfunction or the presence of diabetes, hyper-tension or heart block requiring a pacemaker, anemia,thyroid dysfunction, obesity, deformity, vertigo, orimpaired cognitive function). The therapist should beaware of medications (indications, response, and sideeffects) that can influence the test procedures and theresponse to the exercise. Laboratory tests and investiga-tions that may be relevant include electrocardiograms,echocardiograms, pulmonary function tests, investiga-tions of peripheral vascular function, blood chemistrytests, bone density measures, radiographs, scans, thyroidfunction tests, glucose tolerance tests, autonomic ner-vous system function tests, sleep studies, nutritionalassessment, and tests for level of hydration.

The effect of each medication on exercise response andthe medication’s side effects should be known to theperson administering the test. Beta blockers, for exam-ple, attenuate normal HR and blood pressure (BP)responses to exercise and contribute to fatigue in somepeople. The purpose of the test must be clear so that theperson can be appropriately premedicated (eg, withantidysrhythmic drugs, inotropic drugs, anticoagulants,antithrombolytics, bronchodilators, vasodilators, diuret-ics, and analgesics). For example, medications such asbronchodilators and analgesics have peak effect times;thus, it is important to ensure that these medications areat peak effect during the test and that this effect isreplicated on subsequent tests.

People with a history of angina should be screenedcarefully. The objective of submaximal testing is to testthe individual below the work rate that induces angina.The person’s anginal history will divulge the range ofactivities and the activities that are not associated withsymptoms. Labile angina, angina at rest, and frequentpremature ventricular contractions (PVCs) at rest are, inour opinion, absolute contraindications to exercise test-ing in the absence of a cardiologist unless in a special-ized setting where physical therapists are qualified to

perform such testing. Premature ventricular contrac-tions can be detected reliably only with electrocardio-grams and not by palpation or verbal report. A detailedanginal history, including what triggers episodes ofangina and the frequency of self-medication with anti-anginal medication and its effect, should be recorded.Any history of chest discomfort or pain from any causeshould be noted by the tester. We also believe that anymedication should be checked for its expiration dateand should be available in the event it is needed duringor after the test. A person with a history of angina and forwhom antianginal medication is prescribed, in our opin-ion, should be considered at risk even if the medicationhas not been required for a prolonged period. We advisethat a risk assessment should be conducted for everyindividual, regardless of whether a maximal exercise testor a submaximal exercise test is being performed. Thisassessment will help to determine which test is appropri-ate, predict an adverse response to testing, identify thelevel of monitoring needed, and whether there are anycontraindications to submaximal exercise testing.

Standardization of ProceduresA primary concern about submaximal exercise testing isthe lack of standardization of the procedures. We believethat general procedures should include informing theperson about the type and purpose of the test andinstructing the person to avoid any strenuous activity for24 hours prior to testing and to avoid a heavy meal,caffeine, or nicotine within 2 to 3 hours of testing.19

Medications taken prior to testing should be noted bythe examiner, and, if appropriate, their use should beconsistent from one test to the next. The individualshould become familiar with the equipment and testprocedures to minimize anxiety. Many tests require oneor more practice sessions. If time and resources do notpermit these practice sessions, we argue that the testshould not be performed because the results, in ourview, will not be valid. Appropriate rest periods, in ouropinion, need to be scheduled between practices andbetween the last practice and the actual test. We havepreviously shown that performance of a submaximaltreadmill walking test requires at least one practicesession, even in young subjects without functionalimpairments, in order for the measurements to bevalid.26 For some individuals, more practice sessions arejustified. The number of practice sessions required tomake the results valid, in our opinion, is dependent onthe test and on the experience and functional capacity ofthe person being tested. Verbal encouragement in sub-maximal testing should be standardized to ensure thatthis does not affect the person’s performance.27 Failureto calibrate both exercise devices and monitoring equip-ment can lead to erroneous results.


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MeasurementsBasic measures of exercise responses include HR, BP,respiratory rate (RR), rating of perceived exertion(RPE), and breathlessness. Depending on the person’shistory and other variables, the examiner may find othermeasures to be useful (eg, a 3-lead electrocardiogram,arterial saturation assessed using a pulse oximeter,cadence, ratings of fatigue and discomfort or pain).Because tests are performed over a wide area or circuit,monitoring equipment should be portable. Repeatedmeasurements of each variable of interest, in our opin-ion, should be taken prior to the exercise test to ensurea stable baseline, at various points during the test(depending on the type of test), and during the cool-down period, if applicable, and these measurementsshould be repeated during recovery to ensure that themeasures have returned to baseline levels. As a precau-tion, we recommend that the person should not leavethe testing area until all measures have returned towithin 10% of resting values.19 Based on the history ofthe person being tested, additional monitoring may beindicated to maximize the safety of the test.

Because the measurement of BP is an important part ofexercise testing, the validity of these measurementsshould be maximized with an appropriately sized cuff, itsposition on the midshaft of the humerus, its tightness,the cuff deflation rate, and the position of the stetho-scope over the brachial artery as it courses over theantecubital fossa.28 Skill in recording BP is essential,given that many people have undiagnosed or poorlycontrolled hypertension.

Measures of exertion, breathlessness, fatigue, discomfortor pain, and well being in response to physical activity orexercise are important exercise responses reported bythe person being examined. Many people, particularlyolder people, more readily and reliably monitor and acton their complaints, rather than using measures such asHR to guide their activities or exercise intensity.

InterpretationThe interpretation of the submaximal exercise testresults is based primarily on the type of test conducted,its indications (eg, assessment, diagnostic, exercise pre-scription), specified outcomes, and, in some instances,norms (Appendix). Submaximal exercise tests can beused to predict aerobic capacity or to assess the ability toperform a standardized exercise or task. In addition,measurements taken before, during (where applicable),and after the test can yield valuable information regard-ing the person’s exercise response. These values can becompared across subsequent tests. They can alert thephysical therapist to undue pretest arousal (a measure ofthe adequacy of the pretest standardization), exagger-ated exercise responses, and delayed recovery, which are

consistent with deconditioning or pathology, or both.Comparison of the responses with pretest and posttestmeasurements is particularly useful for assessing theeffect of an intervention such as an exercise program. Inthis case, a reduction in submaximal exercise responsessuch as HR, RR, and BP can be consistent with improvedaerobic conditioning or movement economy, or both.Movement economy refers to the efficient use of energyduring movement (ie, not excessive V̇o2 for a givenactivity or work rate).

Predictive Submaximal Exercise Tests

Modified Bruce Treadmill Test

Description. The Bruce Treadmill Test5 is a maximaltest that was designed to diagnose coronary heart dis-ease. Some preliminary stages have been added to theoriginal test, which has given rise to the use of theModified Bruce Treadmill Test in people with otherconditions.29,30 Compared with the original test, whichstarts at 1.7 mph at a grade of 10%, the modified test hasa zero stage (1.7 mph at 0% grade) and a one-half-stage(1.7 mph at 5% grade) (Tab. 1). Predictive equations forestimating V̇o2max have been developed and can beused with the original and modified tests. Bruce et al5developed the first predictive equations, which arepopulation-specific for active and sedentary adults withand without cardiac conditions. Individuals must becorrectly classified to determine which equation isappropriate. Foster et al30 later developed a regressionequation applicable to all men based on a sample of 230men of various ages with a variety of clinical conditions(symptomatic angina, n514; postmyocardial revascular-ization surgery, n536; outpatient cardiac rehabilitationsurgery, n563; preventative medicine program, n590,and athletes, n527) and activity levels. The details of the

Table 1.Modified Bruce Treadmill Test: Protocola

Stage Speed (mph) Grade (%) Duration (min)

0 1.7 0 30.5 1.7 5 31 1.7 10 32 2.5 12 33 3.4 14 34 4.2 16 35 5.0 18 36 5.5 20 37 6.0 22 3

a Adapted from Bruce RA. Exercise testing of patients with coronary arterydisease: principles and normal standards for evaluation. Ann Clin Res. 1971;3:323–332 and Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake andnomographic assessment of functional aerobic impairment in cardiovasculardisease. Am Heart J. 1973;85:564–562. The standard Bruce protocol begins atstage 1; stages 0 and 0.5 are used for individuals with reduced exercisecapacity.


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Modified Bruce Treadmill Test are provided in theAppendix.

Reliability and validity. Bruce et al5 reported Pearsonproduct moment correlation coefficients (r) betweenpredicted V̇o2max and measured V̇o2max of .94 forwithout cardiac conditions (n5292), .93 for womenwithout cardiac conditions (n5509), and .87 for menwith cardiac disease (n5153). Foster et al30 comparedpredicted V̇o2max and measured V̇o2max for the gen-eral equation and the population-specific equationsintroduced by Bruce et al.5 The average predicted errorwas 20.6 mLzkg21zmin21 for the general equation versus22.0 mLzkg21zmin21 for the population-specific equa-tions. The correlation between measured V̇o2max andpredicted V̇o2max for the general equation was high(r 5.96), with a multiple correlation coefficient (R)of .98 and a standard error of the estimate (SEE) of3.5 mLzkg21zmin21.30

Strengths and weaknesses. The Bruce Treadmill Testand the Modified Bruce Treadmill Test are widely used,especially for the diagnosis of coronary heart disease,and, as a result, normative data are available. Comparedwith the original protocol, which starts with a largeworkload, the modified protocol has a more gradualinitial workload. Thus, we contend that the modifiedprotocol is more applicable for individuals with lowfunctional capacity. The large increases in workload inthe original protocol, however, allowed the test to becompleted within 6 to 9 minutes.23

Single-Stage Submaximal Treadmill Walking Test

Description. Ebbeling et al12 developed the Single-Stage Submaximal Treadmill Walking Test (SSTWT),which can be used by individuals of various ages andfitness levels. The test was developed on a sample of 139volunteers with no health problems (67 men and 72women) aged 20 to 59 years. The subjects were randomlyassigned to either an estimation group (n5117) or across-validation group (n522). Subjects walked on atreadmill at a constant speed, ranging from 2.0 to 4.5mph at grades of 0%, 5%, and 10%, with each stagelasting 4 minutes. A maximal test was then performed.The regression equation used to estimate V̇o2max wasbased on data obtained from the estimation group fromthe 4-minute stage at a grade of 5%. The details of theSSTWT are given in the Appendix.

Reliability and validity. The SSTWT was validated bycorrelating the estimated V̇o2max and the measuredV̇o2max in the cross-validation group. A correlation (r)of .96 was obtained, with a multiple correlation (R) of.86 (SEE54.85 mLzkg21zmin21).

Strengths and weaknesses. This test is suitable for test-ing people with various diagnoses in clinical andresearch settings. It consists of only a warm-up sessionand a single stage on the treadmill. This test, in our view,is useful for assessing people who are prone to fatigue.

Further research is needed to validate this test in peoplewith various diagnoses, in individuals over 60 years ofage, and in both unfit and highly trained individuals.Further studies are needed to establish its sensitivity todetect change. Finally, because this test is based on HR,factors that affect HR must be controlled; otherwise, thetest results will be invalidated.

Astrand and Ryhming Cycle Ergometer Test

Description. The Astrand and Ryhming (A-R) CycleErgometer Test, which is used to predict V̇o2max by useof a cycle ergometer, is based on the linear relationshipbetween V̇o2 and HR.31 Astrand and Ryhming31 notedthat, in subjects aged 18 to 30 years, the men had anaverage HR of 128 bpm at 50% of V̇o2max and anaverage HR of 154 bpm at 70% of V̇o2max, and thewomen had an average HR of 138 bpm at 50% ofV̇o2max and an average HR of 164 bpm at 70% ofV̇o2max. A nomogram was developed by Astrand andRyhming31 to estimate V̇o2max (Fig. 1), and later anage-correction factor was incorporated to account forthe decrease in HRmax with age (Tab. 2).32 Modificationof the A-R nomogram were proposed by Legge andBanister33 and by Hartung and colleagues9,34 to improvethe accuracy of the equation. A revision to the A-Rnomogram was also proposed by Siconolfi et al.35 Thedetails of the A-R Cycle Ergometer Test are presented inthe Appendix.

Reliability and validity. Astrand32 reported a correlation(r) of .71 between the measured V̇o2max and theestimated V̇o2max in the original A-R Cycle ErgometerTest and a correlation (r) of .78 between the measuredV̇o2max and the A-R Cycle Ergometer Test using theage-correction factor. Teraslinna et al36 reported a cor-relation (r) of .69 between the original A-R Cycle Ergome-ter Test and the measured V̇o2max and a correlation (r) of.92 using the age-correction factor in a sample of 31sedentary men. Kasch37 reported that the A-R CycleErgometer Test predicted a V̇o2max that was too low (by21%) in 83 men aged 30 to 66 years. Other research-ers38,39 have reported similar findings. Hartung et al,34 ina study of women aged 19 to 70 years, found that the A-Rmethod overestimated V̇o2max by 3% to 21%. In addi-tion, an overestimation of V̇o2max by the A-R methodhas been documented in women who were pregnant.40

Legge and Banister33 reported a correlation (r) betweentheir revised nomogram and the measured V̇o2max of


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.98. Hartung and colleagues9,34 reported a correlation(r) of .95 between the measured V̇o2max and theestimated V̇o2max using their revised nomogram. How-ever, the revised nomogram still predicted a V̇o2maxthat was too low (by 8.1 mLzkg21zmin21) in a sample ofsedentary and trained men.9 In a sample of women(n538) aged 19 to 47 years, the revised nomogramoverestimated V̇o2max by 18.5%.34

Strength and weaknesses. The A-R Cycle ErgometerTest is one of the most frequently used submaximal cycleergometer tests.41,42 This test has been a standard usedby fitness facilities as part of fitness evaluations and todevelop a training plan and evaluate the results.43 Theprotocol uses HR, which is easy to measure. Limitationsof the test include the margin of error in the predictedV̇o2max values. The protocol can elicit lower-extremitydiscomfort in some people, which may invalidate theresults.

Canadian Aerobic Fitness Test

Description. The Canadian Aerobic Fitness Test(CAFT), formerly known as the Canadian Home FitnessTest, is unique in that it was designed to promote fitnesstesting at home. The CAFT was developed on a sampleof 1,544 individuals (699 men and 845 women) aged 15to 69 years.44 The CAFT is a measure of fitness and isbased on the duration of the step test and a 10-secondrecovery of HR (Tabs. 3 and 4). Norms for the recoveryHR in men and women have been reported,44 and a“Physical Fitness Evaluation Chart” for various agegroups is available (Tab. 5). In addition, Jette et al45

developed a regression equation for the CAFT to predictV̇o2max. A sample of 59 individuals, aged 15 to 74 years,completed the CAFT and then underwent a progressivetreadmill test to evaluate V̇o2max.

The CAFT was modified (mCAFT)46,47 following reportsthat it predicted a V̇o2max that was too low in womenaged 20 to 30 years and in heavy, older, and well-trainedindividuals.48–50 Use of too few stages can produce aceiling effect, and, if the target HR is not attained, theV̇o2max prediction may be too low.46 The modificationallows an individual to complete the number of stagesnecessary to reach a target HR within 85% of theage-predicted maximum. Weller et al46 developed 2additional stages for the original CAFT for individualswho exceed stage 6. A new regression equation was alsodeveloped.51 The details of the CAFT52 are shown in theAppendix.

Reliability and validity. The reliability of measurementsof recovery time for HR for the CAFT was determinedusing a sample of 102 individuals (r 5.79).44 In terms ofvalidity, the regression equation developed by Jette

Figure 1.The Astrand and Ryhming nomogram. Estimated maximum oxygenconsumption (V̇O2max) can be determined by reading horizontally fromthe body weight scale (step test) or workload scale (cycle test) to theoxygen uptake (V̇O2) scale. The predicted V̇O2max value is obtained byconnecting the point on the V̇O2 scale (V̇O2 , liters per minute) with thecorresponding point on the pulse rate scale (in beats per minute). Thehorizontal line extends from the workload and V̇O2 scales to the pulserate scale. Where the line intersects the max V̇O2 scale (liters per minute)is the estimate of the individual’s V̇O2max. Reprinted with permissionfrom Astrand I. Aerobic capacity in men and women with specialreference to age. Acta Physiol Scand. 1960;49(suppl 169):2–92.


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et al45 had a multiple correlation (R) of .905(SEmeas54.08 mLzkg21zmin21). The regression equationfor the mCAFT demonstrated the same strengthbetween the predicted V̇o2max and the measuredV̇o2max as the original equation for the CAFT (mCAFT,r 5.88; CAFT, r 5.99), but there was a lower meansquare error (mCAFT537.0 and CAFT563.3).

Strengths and weaknesses. The CAFT is a step test and,therefore, is inexpensive to administer and requires noelectricity or calibration. A person’s power output can becalculated within 6% to 7% if the individual steps in timewith the beat, stands erect on the top step, and placesboth feet flat on the ground at the end of each steppingcycle.11

This test may not be suitable for people whose ability tobalance is diminished because no handrail is used. It isalso difficult to monitor individuals while they are step-ping. Because we believe there is a ceiling effect, wecontend that the original protocol appears to be moresuited for assessing individuals who are unfit. Furtherresearch is needed to validate both the CAFT and themCAFT with people with various diagnoses.

12-Minute Run Test

Description. The 12-Minute Run Test (12-MRT) wasdeveloped by Cooper53 in 1968. This test is based on thework of Balke,54 which indicated that various run-walktests could relate V̇o2 to either the distance covered in agiven period of time or the time taken to cover a givendistance. A sample of 115 men with no health problemsaged 17 to 52 years completed two 12-MRTs and aV̇o2max test on a treadmill, and a regression equation

was developed. The details of the 12-MRT are shown inthe Appendix.

Reliability and validity. Test-retest reliability (r) of mea-surements obtained with the 12-MRT was reported byCooper53 to be .90. In terms of validity, Cooper53

reported a correlation (r) of .90 between the 12-MRTdistance and V̇o2max. Jessup et al55 reported a lowercorrelation (r) of only .13 between the 12-MRT andV̇o2max in a sample of male subjects with no healthproblems aged 18 to 23 years. Safrit et al56 reportedfindings similar to those of Jessup et al.55

Strengths and weaknesses. The 12-MRT requires nospecialized equipment and allows more than one indi-vidual to be tested at a time. We suggest that this test isappropriate for assessing the cardiopulmonary fitness ofindividuals with high levels of function. The 12-MRT hasbeen modified as a 12-Minute Walk Test (12-MWT),which we believe is more appropriate for the rehabilita-tion setting.

This test was developed using a male population. Nocross-validation group was used to validate the equation.The 12-MRT requires a constant level of motivation, and

Table 2.Astrand and Ryhming Cycle Ergometer Test: Correction Factor forAge-Predicted Maximal Heart Ratea

Age (y) FactorMaximal HeartRate (bpm) Factor

15 1.10 210 1.1225 1.00 200 1.0035 0.87 190 0.9340 0.83 180 0.8345 0.78 170 0.7550 0.75 160 0.6955 0.71 150 0.6460 0.6865 0.65

a Use the correction factor if the individual is over 30 to 35 years of age or ifthe maximal heart rate is known. The actual factor should be multiplied bythe value in Table 2. Note: one correction factor is multiplied by age, and theother correction factor is multiplied by maximal heart rate. Reprinted withpermission from Astrand PO, Rodahl K. Textbook of Work Physiology. 2nd ed.New York, NY: McGraw-Hill Book Co; 1977:279.

Table 3.Canadian Aerobic Fitness Test: Starting Tempo of the SteppingExercise Based on Age and Sexa

Age (y)

Starting Exerciseb

Males Females

60 and over 1 (66) 1 (66)50–59 2 (84) 1 (66)40–49 3 (102) 2 (84)30–39 4 (114) 3 (102)20–29 5 (132) 3 (102)15–19 5 (132) 4 (114)

a Reprinted with permission from Operations Manual: Canadian Home FitnessTest, 2nd ed, Health Canada. © Minister of Public Works and GovernmentServices Canada, 2000.b Stepping tempo (in parentheses) in steps per minute.

Table 4.Canadian Aerobic Fitness Test: Ceiling Postexercise Heart Ratesa

Age (y)

Heart Rate

10 s After1st Stage

10 s After2nd Stage

60 and over 24 2350–59 25 2340–49 26 2430–39 28 2520–29 29 2615–19 30 27

a Reprinted with permission from Operations Manual: Canadian Home FitnessTest, 2nd ed, Health Canada. © Minister of Public Works and GovernmentServices Canada, 2000.


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Table 5.Canadian Aerobic Fitness Test: Physical Fitness Evaluation Charta

AgeGroup

Start at SteppingExercise No.

Your pulse rate after first exerciseMales Females

60s 1 1 Stop if 24 or more If 24 or more, you have anundesirable (below average)personal fitness level

Go only if 23 or less Everybody stop

50s 2 1 Stop if 25 or more If 25 or more, you have anundesirable personal fitnesslevel

Go only if 24 or less Stop if 23 or more







15–19 5 4 Stop if 30 or more If 30 or more, you have anundesirable personal fitnesslevel


Your pulse rate after second exercise Your pulse rate after third exercise* Caution: The advanced version of the Canadian Home Fitness Test is

intended for use only by those individuals who have attained therecommended fitness level.

If 23 or more, you havethe minimum personalfitness level

If 22 or less, you havethe recommendedpersonal fitnesslevel

Advanced ONLY


Go only if 22 or less Everybodystop

If 23 or more, you havethe recommendedpersonal fitness level

GOOD

If 21–22, you havethe recommendedpersonal fitnesslevel

VERY GOOD


EXCELLENT




GOOD


VERY GOOD


EXCELLENT




GOOD

If 23–24, you haveto recommendedpersonal fitnesslevel

VERY GOOD


EXCELLENT




GOOD


VERY GOOD


EXCELLENT




GOOD


VERY GOOD


EXCELLENTa Reprinted with permission from Operations Manual: Canadian Home Fitness Test, 2nd ed, Health Canada. © Minister of Public Works and Government ServicesCanada, 2000.


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the individual must pace herself or himself. The wordingof the instructions makes this a potentially maximalexercise test, so well-defined testing criteria are neededto ensure that it is a submaximal exercise test. Finally,this test fails to account for age or body weight, whichcan influence exercise responses.18

20-Meter Shuttle Test

Description. The 20-Meter Shuttle Test (20-MST)57,58

assesses maximal aerobic power. This test was designedfor children, adults attending fitness classes, and athletesparticipating in sports requiring constant stopping andstarting. The test requires subjects to run between 2 linesspaced 20 m apart at a pace set by signals on a pre-recorded cassette tape (Fig. 2). Starting speed is8.5 kmzh21, and the frequency of the signals is increased0.5 kmzh21 each minute. When the subject can nolonger maintain the set pace, the last completed speed(ie, stage) is used to predict V̇o2max. Leger and Lam-bert59 found that maximal speed, subsequently termed“maximal aerobic speed” (MAS), for 2-minute stages inthe 20-MST, could predict V̇o2max, with a correlation (r)of .84 (SEE510.5%). A regression equation was devel-oped on a sample of 188 boys and girls aged 8 to19 years.58 Another regression equation was developedfor adults based on a sample of 77 adults (53 men and24 women) aged 18 to 50 years, in which age is heldconstant at 18 years.58 Norms have been established forchildren aged 6 to 17 years.57 Berthoin et al60 modifiedthe 20-MST by incorporating 1-minute stages rather than2-minute stages because they reported that faster speedscould be achieved when the work stages were shorter.The details of the 20-MST are presented in the Appen-dix.

Reliability and validity. In terms of reliability, the test-retest correlation (r) for the 20-MST was reported to be.89 for children (n5139) aged 8 to 19 years and .95 foradults (n581) aged 20 to 45 years.58 Leger et al58

reported a correlation (r) of .71 (SEE55.9mLzkg21zmin21) between the 20-MST and measuredV̇o2max in children and a correlation of .90 in adults.Paliczka et al61 confirmed the validity of measurementsobtained with the 20-MST by demonstrating a highcorrelation between 20-MST and V̇o2max (r 5.93), aswell as with a 10-km race time (r 52.93). The test hasbeen further validated on active women.62 The 20-MSTwas reported to yield valid and sufficiently sensitivemeasurements such that the intensity of exercise couldbe modified for children with asthma.63

Strength and weaknesses. The 20-MST is based on anindividual’s MAS. This test has multiple stages, enablinga wide range of fitness levels to be tested. It requires littleequipment, and more than one individual can be testedat a time. The 20-MST is unique because it paces theindividual with the use of sound signals on a pre-recorded cassette tape.

Due to the frequent stopping and starting of this test, webelieve that it is important to screen the individual priorto testing to ensure that she or he is suitable. The testmay not be suitable for some individuals due to theprogressive increments of speed each minute and therequirement to pivot when they run between 2 lines. Forexample, this test may not be suitable for elderly peopleor those with musculoskeletal impairments. Some indi-viduals may find it difficult to pace themselves with thesignals. Finally, testing criteria are needed to ensure thatthe test is submaximal.

1-Mile Track Walk Test (Rockport Fitness Test)

Description. The 1-Mile Track Walk Test (1-MTW), alsoknown as the Rockport Fitness Test, estimates V̇o2maxacross a range of age groups and fitness levels. Theprediction equations were developed based on a sampleof 390 volunteers with no health problems (183 men and207 women, aged 30 to 69 years).64 Each individualperformed a minimum of two 1-MWTs on separate days.The walk times in the 2 tests had to be within 30 seconds.All individuals also performed a V̇o2max test on atreadmill. This test has also been validated on individualswith mental retardation.65,66 Variations in the distanceused with this test have been reported (eg, 1-milerun/walk,67,68 1.5-mile run,68 2-mile run69). The detailsof the 1-MWT are given in the Appendix.

Reliability and validity. Kline et al64 reported the reli-ability (r) of measurements obtained for the last quarter-mile HRs to be .93 (SEE57.6 bpm) and the reliability (r)

Figure 2.The setup and protocol for the 20-Meter Shuttle Test. Reprinted withpermission from Leger LA, Mercier D, Gadoury C, Lambert J. Themultistage 20-meter shuttle run test for aerobic fitness. J Sports Sci.1988;6:93–101.


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of measurements obtained for the total time for the 2trials of the track walk to be .93 (SEE50.26 minute). Thevalidity of the regression equation was established byhaving a validation group (n5174) and a cross-validation group (n5169). The sample of 390 volunteerswere assigned to the validation and cross-validationgroups based on alternate case assignment (ie, odd-evencase selection). Descriptive statistics revealed no differ-ence between the 2 groups. The correlation (r) betweenthe predicted V̇o2max and the actual V̇o2max was .93(SEE50.325 Lzmin21) for the validation group and .92(SEE50.355 Lzmin21) for the cross-validation group.

Strengths and weaknesses. This test, in our view, isapplicable to a wide range of individuals. It requires littlespecialized equipment and uses the familiar activity offast walking. Thus, we contend that it is suitable for usein the rehabilitation setting. The test was cross-validated,which confirms the accuracy of prediction.

The test and regression equations need to be validatedin patient groups. Finally, research is needed to deter-mine whether a practice test improves the prediction.

Performance Submaximal Tests

Self-Paced Walking Test

Description. The Self-Paced Walking Test (SPWT)70 isan exercise test developed for elderly and frail individu-als. It consists of free walking at 3 speeds down an indoorcorridor (ie, 250 m). Various exercise responses can beassessed such as speed, time, stride frequency, stridelength, HR, and predicted V̇o2max. The test was devel-oped on 24 individuals aged 64 to 66 years. Ten activestudents aged 19 to 21 years served as a comparisongroup. Each subject performed the SPWT and a progres-sive cycle ergometer test. Only 17 elderly individualscould complete the cycle ergometery test, whereas all ofthem completed the SPWT.

Performance of the SPWT is correlated with V̇o2max andis independent of age.71 Following an exercise program,the speed of walking was reported to increase, whereasHR remained unchanged.72 A predicted V̇o2max can beobtained from estimating V̇o2 from an aerobic demandcurve and then extrapolating a predicted V̇o2max fromV̇o2 and HR. To date, this test has been used primarilywith older individuals.71–73 The details of the SPWT arepresented in the Appendix.

Reliability and validity. The test-retest reliability formeasurements obtained with the SPWT when it wasrepeated a few days later for the older group was 65.2%,64.7%, and 611% for the fast, normal, and slow paces,respectively.70 The younger group varied by 67%, but

no difference was found between the 2 tests on separatedays. In terms of validity, the assessments (ie, standard-ized HR from the SPWT and a progressive cycle test)were correlated (r 5.79).70

Strengths and weaknesses. The SPWT assesses cardio-pulmonary fitness as well as walking efficiency, both ofwhich are beneficial in daily activities.70 This test issuitable for individuals requiring mobility devices orwhen a treadmill or cycle ergometer is not indicated.This test may also be suitable for monitoring an olderperson’s mobility status over time, including the effectsof aging and the effect of using mobility aids anddevices.70 The information obtained from this test canprovide safety guidelines (eg, for crossing an intersec-tion safely requires a speed of 3.5 ft/s).24 Individuals whoare at risk for injury while crossing an intersection maybe identified. Individuals who are not able to walk at thisspeed should be identified as being not safe, and alter-native means of mobility or mobility aids need to berecommended.

This test is limited because it does not provide a measureof endurance and may not be sufficiently sensitive to testindividuals with higher levels of function. For someindividuals with diminished function, it may be toodifficult to complete the 3 selected walks with only 5minutes of rest.

Modified Shuttle Walking Test

Description. The Modified Shuttle Walking Test(MSWT) was modified from the 20-MST to provide astandardized progressive test for obtaining a symptom-limited maximum performance in individuals withchronic airway obstruction (CAO).74,75 The individualwalks up and down a 10-m course at incremental speeds

Table 6.Modified Shuttle Walking Test: Protocola

LevelSpeed(m/s)

Speed(mph)

No. ofShuttles

1 0.50 1.12 32 0.67 1.50 43 0.84 1.88 54 1.01 2.26 65 1.18 2.64 76 1.35 3.02 87 1.52 3.40 98 1.69 3.78 109 1.86 4.16 11

10 2.03 4.54 1211 2.20 4.92 1312 2.37 5.30 14

a Reprinted with permission of the BMJ Publishing Group from Payne GE,Skehan JD. Shuttle walking test: a new approach for evaluating patients withpacemakers. Heart. 1996;75:414–418.


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of 0.17 m/s each minute dictated by a prerecordedaudio signal on a cassette deck74 (Tab. 6), whereas theoriginal 20-MST required the individual to run a 20-mdistance at a starting speed of 8.5 km/h with incrementsof 0.5 km/h each minute.58

A sample of 35 individuals with CAO aged 45 to 74 yearswas used to develop the test.74 This test has been furthervalidated on individuals with pacemakers.76 Singh andcolleagues74,75 have recommended the MSWT for use asan assessment tool for individuals with a wide range ofcardiac and respiratory disabilities. The details of theMSWT are shown in the Appendix.

Reliability and validity. The measurements obtainedwith this test were replicable in a sample of 10 individu-als after one practice trial.74 The mean differencebetween trials 2 and 3 was 22.0 m (95% confidenceinterval of 221.9 to 17.9 m). The validity of measure-ments obtained with the test, which was established bycomparing the distance completed during the MSWTwith the distance completed during the 6-Minute WalkTest (6-MWT), was moderate (rho5.68).74 The HRs,however, were higher on the MSWT, indicating a greatercardiovascular response. A strong relationship (r 5.81and r 5.88) was observed on comparing the V̇o2maxrecorded in 2 tests using treadmill walking with theV̇o2max recorded during the MSWT.75

Strengths and weaknesses. The MSWT requires littleequipment and is easy to administer. The audio signalstandardizes the increments in walking speed and moti-vates the individual. We believe that the initial speed issufficiently slow to be used with most types of patients.No individual in the studies attained the highest level(ie, level 12).74,75 This test can be used to prescribe anappropriate walking speed for an exercise program byevaluating the individual’s HR and RPE responses at thevarious stages.74

This test, however, requires a near-maximal effort byhaving the speeds continue to increase. We believe,therefore, that it is essential to monitor the individualduring the test to ensure that she or he is respondingappropriately. Familiarizing the individual with the pac-ing required for the test may require some time.

Bag and Carry Test

Description. The Bag and Carry Test (BCT)77 is used toassess a task that evaluates both endurance and muscleforce. The BCT involves walking a circuit carrying a0.9-kg package for 7.5 m, up and down a 4-step flight ofstairs, and back 7.5 m. On the completion of eachcircuit, 0.9 kg is added to the package until the individ-ual can no longer complete the circuit. It requires 10

minutes to complete. A sample of 61 women aged 48 to93 years was recruited from the community and aresidential home. Fifty-six subjects completed the test.The maximal weight they could carry up and down thestairs ranged between 3 and 26 kg. The test developersconcluded that this test was easy to administer andsuitable for testing individuals with higher levels offunction. The details of the BCT are presented in theAppendix.

Reliability and validity. The test-retest reliability of mea-surements obtained with the BCT was established byadministering the BCT 3 days later (r 5.89). MaximalHR was 90%610% of the HR achieved during theV̇o2peak test on a cycle ergometer. The BCT correlatedwith force of the quadriceps femoris muscle (r 5.43),hamstring muscle (r 5.54), gastrocnemius muscle(r 5.52), and soleus muscle (r 5.62).77

Strength and weaknesses. The BCT is designed to inte-grate endurance, muscle force, and balance capabilityand is based on an everyday activity. This test, in ourview, is easy to administer and can be used in researchand clinical settings. However, it may be difficult toreplicate the test with 4 steps. A platform or landingshould be at the top of the stairs to allow the individualto turn around safely.

The guidelines for administering this test are not welldescribed in the literature. There are no specificationsregarding the height of the steps, whether the individualis allowed to use a handrail for support, or whether apractice trial is required. In the absence of criteria foradministering the test, this test could become a maximaltest if the individual is not properly monitored duringthe test. We argue that this test has the potential to be avery useful submaximal exercise test if the individual istimed as opposed to being scored by only the weight heor she carried. The number of circuits completed in aspecified time could be measured, or the time to com-plete the circuit while carrying a specified weight andwalking at a safe and comfortable pace could be scored.

Timed Up & Go Test

Description. The Timed Up & Go Test (TUGT)78 wasmodified from the Get-up & Go Test.79 Both tests arebased on a functional task of rising from a standardarmchair, walking 3 m, turning, and returning to thechair. Podsiadlo and Richardson,78 however, changedthe scoring system from an observer rating of 1 to 5 to atimed version. The test was modified using a sample of60 frail, community-dwelling, elderly individuals (23men and 37 women, aged 60 to 90 years) and 10volunteers with no health problems (6 men and 4women, aged 70 to 84 years). Medical diagnoses of thestudy population included cerebrovascular accident


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(n523), Parkinson disease (n510), rheumatoid arthritisor osteoarthritis (n59), and miscellaneous conditions(eg, postsurgical hip fractures, general deconditioning)(n58).78 The TUGT has been used as a test of mobilityto assess change following an exercise program forelderly individuals aged 79 to 86 years80 and aged 75 to96 years.81 No improvement in mobility based on this testfollowing an exercise programs was reported.80,81 Thedetails of the TUGT are given in the Appendix.

Reliability and validity. The interrater reliability fortimes obtained on the same day and the intraraterreliability tested 3 days to 5 weeks apart were good(intraclass correlation coefficient5.99 for both).78 Valid-ity was assessed by correlating the time (in seconds) onthe TUGT with the log-transformed scores on the BergBalance Scale (r 52.72), gait speed (r 52.55), andBarthel Index of Activities of Daily Living (r 52.51). Thecorrelations were negative, indicating that those individ-uals who took longer with the TUGT had lower scores onthe Berg Balance Scale, with gait speed, and on theBarthel Index.

Strengths and weaknesses. The TUGT is easy to admin-ister, and no training is required. This test is easy toperform in research and clinical settings. The resultsfrom this test provide information related to mobility.Based on the time taken to complete the test, the level ofassistance required in mobility tasks can bedetermined.78

A limitation of this test is that it may not detect a changefollowing an exercise program because of the lack ofsensitivity of the measure.81 Further studies are war-ranted to examine its sensitivity, using a larger sample,and to investigate its predictive capacity. Sensitivity couldpossibly be improved by increasing the distance walkedor having subjects sit down and get up again at each endof the 3-m walkway, but research is needed to determinewhether this is true.

12- and 6-Minute Walk Tests

Description. The 12-MWT was introduced by McGavinand colleagues82,83 to assess the distance covered in 12minutes in individuals with chronic bronchitis. The totaldistance covered in 12 minutes is recorded, and theindividual is allowed to stop and rest. This test wasmodified from the 12-MRT described by Cooper53 forindividuals without health problems. The 12-MWT hasbeen used primarily for people with COPD,82–91 but ithas also been used with college-aged students.92

Butland et al93 reported that similar results could beobtained in 6 minutes. Guyatt et al94 applied the 6-MWTin individuals with heart failure. The 6-MWT has been

used with individuals with end-stage lung disease,95 peo-ple with chronic heart failure,96,97 people with COPD,98–100

children who are severely ill,101 people with chronicrenal failure,102 and older adults between the ages of 65and 89 years.103 Two practice tests appear to be requiredto obtain reproducible results,93,94 the walking circuitneeds to be identical,92 and encouragement needs to bestandardized.27 Walk tests with durations of 4 minutes104

and 2 minutes93 have also been reported. The details ofthe 6-MWT and the 12-MWT are presented in theAppendix.

Reliability and validity. Reliability has been assessed formeasurements obtained with the 12-MWT. Mungall andHainsworth89 reported a coefficient of variation of68.2% over 6 tests. This statistic, however, is not aprobabilistic measure, which is normally used to assessreliability. If the results of the first 2 tests were elimi-nated, however, the coefficient of variation was reducedto 64.2%. Guyatt et al94 also reported that 2 practicetests are required. Other researchers95,96 have reportedintraclass correlation coefficients of .96 to .99 betweenthe second and third administrations of the 6-MWT,suggesting that only one practice test is required.

The concurrent validity of measurements obtained withthe 6-MWT and the 12-MWT based on measurements ofV̇o2max or V̇o2peak is not clear. Some investigators havereported a correlation between the distance covered inthe 6-MWT and V̇o2peak (r 5.6496 and r 5.70101) as wellas between the distance covered in the 12-MWT andV̇o2max (r 5.4985 and r 5.5282). Other researchers havereported no correlation between V̇o2max and either thedistance covered in the 6-MWT94 or the distance coveredin the 12-MWT.82 The physiologic demand of the walktest appears to be distinct from that of cycle ergometertests and, therefore, may be a better indicator of func-tion in normal daily activities.102,105 The correlationbetween lung function and the distance covered in the6-MWT and the 12-MWT has also shown conflictingresults.85,99,100

Strengths and weaknesses. The 6-MWT and the12-MWT are simple tests that are inexpensive to admin-ister. Walking for a given time seems, in our opinion, tocorrespond to functional activities used in daily activities.These tests, therefore, can be administered to individu-als without health problems and to patients with a varietyof diagnoses. The use of a standard time rather than apredetermined distance provides a better test of endur-ance.82 The tests allow the individual to set her or hisown pace and stop if necessary. The 12-MWT can beused to detect a change following an exercise program.86

In the literature in which these tests are described, thenumber of practice trials varies. Often only one practice


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test was given,99–102 and there was considerable variationin the rest periods between tests. Some investiga-tors95,96,100,102 reported having the subjects perform thetest on the same day as the practice, whereas otherinvestigators94,99,105 reported having the test and practiceon separate days. In addition, different versions of theinstructions have been used for both the 6-MWT and the12-MWT. Some investigators101 stated in their instruc-tions that the individual was allowed to stop if necessary,whereas other investigators85 instructed the individual topace herself or himself so that she or he would not haveto stop. The scoring of the test has also varied. Mostinvestigators83,94,105 used the final distance (ie, that ofthe last test trial), whereas some investigators99 reportedthe longest distance of all test trials. We believe thatother limitations of the timed walk tests include lack ofmonitoring of physiological variables while the individ-ual is completing the test and the lack of specificperformance criteria to ensure that a maximal effort isnot performed.

Other Performance TestsPerformance tests are frequently incorporated as a mea-sure of mobility in global physical assessments used forelderly people. The most common performance test is ameasure of walking speed, which is similar to the 3walking speeds (ie, slow, normal, and fast) used with theSPWT. Typically, a 10-ft walk106–108 is used for assessingindividuals who are confined indoors and a 50-ftwalk107,109–111 is used for all others. A 30-m walk has alsobeen used, as this is the usual distance for pedestriancrossings.112 The instructions are for the individual towalk from a standing start at his or her regular pace andto use any mobility devices that he or she normally uses.106

The individual is timed, and the walking speed (in metersper second or feet per second) is calculated. Reports ofaverage walking speed range from 0.7460.29 mzs21 forindividuals aged 60 to 99 years113 to 1.1 and 1.2 mzs21 for70-year-old women and men with no health problems,respectively.112

The assessment of walking speed is very important forassessing independent mobility in the community.Pedestrian intersection crossing times are calculatedbased on a walking speed of 1.22 mzs21.114 A walkingspeed of 11.5 mzmin21 is a threshold value for predictingnursing home status,107 with a normal walking speedbeing 70 mzmin21.107 Two factors, quadriceps femorismuscle weakness and joint impairment, are thought tobe critical variables in determining walking speed,which, in turn, determines some aspect of dependencyin elderly people. Variations in walking speed are due toa change in stride length rather than an alteration infrequency or cadence.113 The onset of pathology short-ens the stride length and influences speed of walking.113

Chronologic age is not thought to be a primary factor indetermining gait speed.113

Researchers have assessed a maximum walking speed fora given distance (eg, 30 m). In a sample of 70-year-oldsubjects (n5602), the maximum walking speed was themost reliable predictor of dependence in activities ofdaily living.112 The critical levels for the threshold ofbeing dependent in activities of daily living was found tobe a maximum walking speed of 1.7 mzs21 in men and1.5 mzs21 in women. It is not entirely clear whether adecline in cardiopulmonary fitness affects walkingspeeds for short distances; it is more likely to be acontributing rather than a primary factor.112

Other performance tests cited in the literature include astep test. This test requires 3 boxes combined to formsteps of 10, 20, 30, 40, and 50 cm in height and ahandrail on the wall.112 The highest possible step heightthat the individual is able to climb up and down witheither leg and without a rail is recorded. There are alsovariations of this step test.115,116 Correlations have beenreported between the maximum step height up anddown with a comfortable walking speed in 70-year-oldmen (r 5.39) and women (r 5.37).112

An obstacle course described by Imms and Edholm113 isused in a test that is similar to the BCT. In this test, theindividual rises from a chair, walks across the room,climbs 3 stairs (rails on either side), turns around,descends the stairs, and returns to the chair. The indi-vidual is allowed to go at her or his own speed and to usea mobility aid. Two practice trials are given, and the time(in seconds) taken to complete the course is recorded.In a sample of 71 subjects (28 men and 43 women) aged60 to 99 years, the time to complete the course was notcorrelated with age but was correlated with walkingspeed (r 52.80).113

Examples of Test Selection

1. The patient is a 65-year-old man with severe chronicairflow limitation and right atrial enlargement. He hasno history of angina but does have hypertension, whichis controlled with medication. He is 18.1 kg (40 lb)overweight and is unaccustomed to physical activity. Hisactivity is normally terminated by shortness of breath.

Indications: to establish an exercise profile to ensure thathe is safe to undertake an exercise program and todefine the parameters for such a program.

Test: 6-MWT or SPWT.

Clinical Decision-Making Process: The 6-MWT and theSPWT are both suited for older patients with chroniclung disease. This patient is deconditioned, overweight,and hypertensive. These tests enable him to perform an


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activity (ie, walking) that is useful to him on a daily basis.In addition, with portable equipment, including HRmonitor, BP measurement apparatus, and pulse oxime-ter, he can be readily monitored. Furthermore, the scaleof breathlessness can be used to assess his symptoms.The physical therapist can correlate the rating of breath-lessness and physiologic parameters to prescribe theparameters of an exercise program, including type ofexercise, intensity, frequency, duration, continuous ver-sus discontinuous program, and its course. These testscan be repeated at various intervals to evaluate theoutcome of the training program.

2. The patient is a 52-year-old man who had bypasssurgery 10 years ago. He had one recurrence of angina.He has intermittent claudication in the left calf at amoderate walking speed.

Indications: to establish safe exercise intensity (no angi-nal symptoms) and a training program for his peripheralvascular disease as well as heart disease.

Test: Modified Bruce Treadmill Test, SPWT, or 6-MWT.

Clinical Decision-Making Process: This patient is showingsigns and symptoms of reocclusion of his coronaryarteries and stenosis of a lower-extremity artery, whichresults in claudication. He could be a candidate formaximal exercise testing; however, if he stops because ofleg pain, the test results will be limited. Alternatively, hecould undergo submaximal exercise testing (eg, Modi-fied Bruce Treadmill Test, SPWT, 6-MWT). Because ofhis cardiac history, precautions must be taken. Having acardiologist present is recommended, and the treadmilltest is preferable for monitoring electrocardiographicactivity. If the electrocardiogram is normal, the SPWT orthe 6-MWT can be performed, and one of these tests canbe used to assess training response, if preferred. Theparameters of the training program are set to keep thepatient below his anginal threshold and his leg paintolerable.

Summary and ConclusionsPhysical therapists are clinical exercise specialists whoapply exercise as an assessment and diagnostic tool andin treatment. We believe that they should have a thor-ough knowledge of exercise testing, including submaxi-mal exercise testing. Physical therapists, in our opinion,need to assume a role in refining existing exercise testsand measures and to assume a leadership role in devel-oping new tests and measures. Refinement of submaxi-mal exercise tests is needed to increase their sensitivity asassessment, diagnostic, and treatment outcome toolsand to provide valid indexes of a person’s capacity toassume a given type of employment, homemaking activ-ities, and activities of daily living. They also need to serveas a basis for exercise prescription.

We believe that there is a need for standardized submaxi-mal ergometer tests for people with musculoskeletallimitations, people who have impaired balance, peoplewho are overweight, people who are unable to walk on atreadmill for other reasons, and for people who requireclose monitoring during exercise. There is also, in ouropinion, a need for the development of upper-extremitysubmaximal exercise tests for people with lower-extremity paresis or severe deformity.

We contend that stringent monitoring of exerciseresponses is essential both for test validity and for safety.When testing people with a wide range of conditions,including cardiovascular and cardiopulmonary condi-tions that can be life threatening, even people withoutknown health problems can exhibit unexpectedresponses. People without known health problems, forexample, can have cardiac dysrhythmias; and this inci-dence increases with advancing age.20 Safety and mini-mizing undue strain, in our view, are essential in plan-ning and implementing submaximal exercise testing.

Research is also needed for the development and re-finement of scales used to assess exercise response(eg, exertion, breathlessness, fatigue, discomfort orpain, and even well being associated with physical activ-ity). Given that people are limited by their symptomsthat correlate to physiologic measures, assessment oftheir symptoms can provide critical information abouttheir exercise responses as well as a basis for setting theintensity of tolerable physical activity or an exerciseprogram.

References1 Montoye HJ, Ayen T, Washburn RA. The estimation of V̇o2max frommaximal and submaximal measurements in males, age 10–39. Res Q.1986;57:250–253.

2 Wyndham CH. Submaximal tests for estimating maximum oxygenintake. Can Med Assoc J. 1967;96:736–745.

3 Balke B, Ware R. An experimental study of Air Force personnel. USArmed Forces Med J. 1959;10:675–688.

4 Brouha L, Fradd NW, Savage BM. Studies in physical efficiency ofcollege students. Res Q. 1944;15:211–224.

5 Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake andnomographic assessment of functional aerobic impairment in cardio-vascular disease. Am Heart J. 1973;85:546–562.

6 Ellestad MH. Stress Testing. 2nd ed. Philadelphia, Pa: FA Davis Co;1980.

7 Patterson JA, Naughton J, Pietras RJ, Gunnar RM. Treadmill exercisein assessment of patients with cardiac disease. Am J Cardiol. 1972;30:757–762.

8 Shephard RJ, Allen C, Benade AJS, et al. The maximum oxygenintake: an international reference standard of cardiorespiratory fitness.Bull World Health Org. 1968;38:757–764.

9 Hartung GH, Krock LP, Crandall CG, et al. Prediction of maximaloxygen uptake from submaximal exercise testing in aerobically fit andnonfit men. Aviat Space Environ Med. 1993;64:735–740.


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rere

quire

dfo

rth

eno

mog

ram

(Fig

.1);

mul

tiply

the

deriv

edV̇O

2m

axva

lue

(Lzm

in2

1)b

yth

eag

e-co

rrec

tion

fact

or(T

ab.2

)

●M

enan

dw

omen

ingo

odhe

alth

aged

18–3

0y3

1

●M

enin

good

heal

thag

ed19

.96

2.39

y;m

odifi

edpr

otoc

ol4

1

●M

enin

good

heal

thag

ed19

.76

2.2

y42

●Pr

egna

ntw

omen

aged

30.9

60.

7y

(SE)

attim

eof

deliv

ery4

0

●M

enin

good

heal

thag

ed18

–24

y(c

ondi

tione

dan

dse

dent

ary)

39

●M

enin

good

heal

thag

ed17

–33

y38

●M

enin

good

heal

thag

ed47

.76

7.3

y37

●M

enan

dw

omen

ingo

odhe

alth

20–7

0y3

5

●M

enin

good

heal

th23

–49

y36

●M

enin

good

heal

th(tr

aine

dan

dun

train

ed)a

ged

20–2

9y3

3


IIIIII

IIIIII

IIIIII

IIIIII

IIII

Dow



Appen

dix

.C

ontin

ued

Pre

dic

tive

Subm

ax

imalE

xer

cise

test

s

Test

Set-

up

and

Supplie

sPra

ctic

ePro

toco

lO

utc

om

eReg

ress

ion

Equations

Popula

tion

Studie

d

Can

adia

nA

erob

icFi

tnes

sTe

st(C

AFT

)44,4

5,5

2

and

mod

ified

CA

FT(m

CA

FT)4

6,4

7,5

1

Ath

ome

orcl

inic

/la

bora

tory

●A

doub

le8-

in(2

0.3-

cm)s

tep

●H

Rm

onito

r●

Prer

ecor

ded

audi

otap

e●

Cas

sette

reco

rder

●Sp

hygm

oman

omet

er●

Stet

hosc

ope

●St

opw

atch

Dem

onstr

ate

the

stepp

ing

cycl

ean

dal

low

the

indi

vidu

alto

prac

tice

●C

AFT

44

,52

●M

easu

res

ofre

sting

BPan

dH

Rar

eop

tiona

l●

Follo

win

ga

war

ning

sign

alon

anau

diot

ape,

the

indi

vidu

alis

instr

ucte

dto

clim

ba

doub

le8-

inste

pfo

ra

3-m

in“w

arm

-up

”at

aste

ppin

gte

mpo

base

don

his

orhe

rage

(see

Tab.

3)52;t

heSt

anda

rdiz

edTe

stof

Fitn

ess

pack

age5

2co

ntai

nsth

eca

sset

tes

with

the

vario

uste

mpo

s;fo

llow

ing

the

first

stage

,th

ein

struc

tions

onth

eca

sset

tein

dica

tew

hen

toob

tain

a10

-sm

easu

rem

ento

fHR

●C

onsu

ltth

eta

ble

“Cei

ling

Poste

xerc

iseH

eart

Rate

s”(se

eTa

b.4)

52

tode

term

ine

whe

ther

the

indi

vidu

alco

ntin

ues

fora

seco

ndsta

geor

whe

ther

the

test

iste

rmin

ated

●If

the

indi

vidu

alha

san

HR

belo

wth

ece

iling

HR

indi

cate

din

the

tabl

e,he

orsh

epr

ocee

dsto

the

seco

ndsta

ge;H

Ris

mea

sure

dag

ain

follo

win

gth

ese

cond

stage

tode

term

ine

whe

ther

heor

she

proc

eeds

toth

eth

irdan

dfin

alsta

ge;a

mea

sure

ofH

Ris

take

nfo

r10

sfo

llow

ing

the

third

stage

●In

the

poste

xerc

isepe

riod,

mea

sure

men

tsof

BPca

nbe

take

nin

the

first

2m

inan

dm

easu

rem

ents

ofre

sting

HR

can

beta

ken

inth

eth

irdm

inut

e●

Follo

win

gth

ete

st,th

ein

divi

dual

shou

ldco

ntin

ueste

ppin

gor

wal

king

slow

lyto

cool

dow

n●

Fort

hepr

otoc

olof

the

CA

FT,

see

Wel

lera

ndco

lleag

ues4

6,4

7

Con

sult

the

“Phy

sica

lFi

tnes

sEv

alua

tion

Cha

rt”(s

eeTa

b.5)

tode

term

ine

leve

lof

fitne

ssba

sed

onth

efin

alex

erci

seH

Rre

adin

g52;a

pred

icte

dV̇O

2m

axva

lue

(mLzk

g21zm

in2

1)

isob

tain

edus

ing

the

regr

essi

oneq

uatio

n

1.C

AFT

(Jette

etal

45)

estim

ated

V̇O2m

ax(m

Lzkg2

1zm

in2

1)5

42.5

116

.63

V̇O2

(Lzm

in2

1)*

20.

123

body

wei

ght(

kg)2

0.12

3H

Rfo

llow

ing

last

stage

(bpm

)20.

243

age

(y)

*V̇O

2is

the

aver

age

oxyg

enco

stof

the

last

com

plet

edsta

ge(L

zmin

21);

obta

inva

lue

from

the

tabl

e“E

nerg

yRe

quire

men

tsfo

rth

eVa

rious

Stag

esof

the

CA

FT”4

5

2.m

CA

FT(W

elle

ret

al5

1)

estim

ated

V̇O2m

ax(m

Lzkg2

1zm

in2

1)5

32.0

116

.03

V̇O2

for

final

stage

(Lzm

in2

1)2

0.17

3bo

dyw

eigh

t(kg

)20.

243

age

(y)

●M

enan

dw

omen

ingo

odhe

alth

aged

15–6

9y4

4,4

5

●M

enan

dw

omen

ingo

odhe

alth

aged

15–7

4y,

mod

ified

prot

ocol

47

●M

enan

dw

omen

ingo

odhe

alth

aged

15–6

9y4

6,4

7

●M

enan

dw

omen

ingo

odhe

alth

aged

15–6

9y5

1


Dow



12-M

inut

eRu

nTe

st(1

2-M

RT)5

3M

easu

red

track

●St

opw

atch

●Ta

pem

easu

re

Fam

iliar

ize

the

indi

vidu

alw

ithth

etra

ckan

dth

eco

ncep

tof

paci

ng

●Th

ein

divi

dual

isin

struc

ted

to“c

over

the

long

est

poss

ible

dista

nce

in12

min

,ru

nnin

gpr

efer

ably

but

wal

king

whe

neve

rne

cess

ary

topr

even

tbec

omin

gex

cess

ivel

yex

haus

ted”

53

●Re

cord

the

dista

nce

inm

iles

com

plet

edin

12m

in●

On

com

plet

ion

ofth

ete

st,th

ein

divi

dual

shou

ldco

ntin

uew

alki

ngto

cool

dow

n

Apr

edic

ted

V̇O2m

axva

lue

(mLzk

g21zm

in2

1)i

sob

tain

edus

ing

the

regr

essi

oneq

uatio

ns

1.C

oope

r53

wal

k/ru

ndi

stanc

e50.

3138

10.

0278

3V̇O

2(m

Lzkg2

1zm

in2

1)

2.W

ard

etal

18

estim

ated

V̇O2m

ax(m

Lzkg2

1zm

in2

1)5

35.9

73di

stanc

e(m

ile)

211

.29

●M

enin

good

heal

thag

ed17

–52

y53

●M

enin

good

heal

thag

ed18

–235

5

20-M

eter

Shut

tleTe

st(2

0-M

ST)5

7–5

9

Mea

sure

dco

rrid

or

●H

Rm

onito

r●

Prer

ecor

ded

audi

otap

e●

Cas

sette

reco

rder

●Py

lons

●Ta

pem

easu

re

Fam

iliar

ize

the

indi

vidu

alw

ithth

eco

urse

●Th

ein

divi

dual

runs

betw

een

2lin

es20

map

art;

whe

nth

ein

divi

dual

hear

sa

shor

tso

und,

heor

she

has

tobe

on1

ofth

ese

2lin

es,a

ndw

hen

alo

ngso

und

ishe

ard,

itin

dica

tes

ach

ange

insta

ge●

The

first

stage

is8.

5km

zh2

1

for

wom

enan

d10

kmzh

21

for

men

;the

spee

dis

incr

ease

dby

0.5

kmzh

21

per

1-m

insta

ges

(see

Fig.

2)●

The

indi

vidu

alco

ntin

ues

until

she

orhe

isun

able

tom

aint

ain

the

rhyt

hmof

runn

ing

●Th

esp

eed

atth

ela

stco

mpl

eted

runn

ing

stage

iste

rmed

the

“max

imal

aero

bic

spee

d”(M

AS)

●O

nco

mpl

etio

nof

the

test,

the

indi

vidu

alsh

ould

cont

inue

wal

king

toco

oldo

wn

Apr

edic

ted

V̇O2m

axva

lue

(mLzk

g21zm

in2

1)i

sob

tain

edus

ing

the

regr

essi

oneq

uatio

ns

1.G

ener

aleq

uatio

n(L

eger

etal

58)e

stim

ated

V̇O2m

ax(m

Lzkg2

1zm

in2

1)5

31.0

251

3.23

83sp

eed

(km

zh2

1)

23.

2483

age

(y)

10.

1536

3(a

ge3

spee

d)

2.A

dults

(Leg

eret

al5

8)

estim

ated

V̇O2m

ax(m

Lzkg2

1zm

in2

1)5

224

.41

6.03

spee

d(k

mzh

21)

●M

enan

dw

omen

ingo

odhe

alth

aged

20–4

5y5

8

●Bo

ysan

dgi

rlsin

good

heal

thag

ed6

–19

y58

,62

●Bo

ysan

dgi

rlsin

good

heal

thag

ed8

–19

y58

●A

ctiv

em

enin

good

heal

thag

ed18

–42

y(m

odifi

edpr

otoc

ol)6

0

●M

enan

dw

omen

with

asth

ma

aged

12–1

7y6

3


IIIIII

IIIIII

IIIIII

IIIIII

IIII

Dow



Per

form

ance

Subm

ax

imalE

xer

cise

Test

s

Test

Set-

up

and

Supplie

sPra

ctic

ePro

toco

lO

utc

om

ePopula

tion

Studie

d

Self-

Pace

dW

alki

ngTe

st(S

PWT)

70

Mea

sure

dco

rrid

or

●H

Rm

onito

r●

Stop

wat

ch●

Tape

mea

sure

●Py

lons

Fam

iliar

ize

the

indi

vidu

alw

ithth

eco

urse

●Th

ein

divi

dual

isin

struc

ted

tow

alk

am

easu

red

dista

nce

(ie,2

50m

)at3

diffe

rent

spee

ds,w

itha

5-m

inre

stbe

twee

ntri

als:

(a)r

athe

rslo

wly

(ie,s

low

pace

),(b

)ata

norm

alpa

ce,n

eith

erfa

stno

rslo

w,a

nd(c

)ra

ther

fast,

butw

ithou

tove

rexe

rting

your

self

(ie,f

astp

ace)

●Re

cord

the

time

inse

cond

sfo

rea

chof

the

3tri

als

●Fo

llow

ing

the

3tri

als,

the

indi

vidu

alsh

ould

cont

inue

wal

king

slow

lyto

cool

dow

n

For

each

wal

king

trial

,the

spee

d,tim

eto

com

plet

eth

edi

stanc

e,an

dstr

ide

frequ

ency

are

calc

ulat

ed;i

nad

ditio

n,av

erag

eH

R,str

ide

leng

th,a

nda

pred

icte

dV̇O

2m

axva

lue

can

bede

term

ined

●M

enin

good

heal

thag

ed64

–66

y●

Act

ive

men

ingo

odhe

alth

aged

19–2

1y7

0

●M

enin

good

heal

thag

ed19

–66

y71

,72

Appen

dix

.C

ontin

ued

Pre

dic

tive

Subm

ax

imalE

xer

cise

test

s

Test

Set-

up

and

Supplie

sPra

ctic

ePro

toco

lO

utc

om

eReg

ress

ion

Equations

Popula

tion

Studie

d

1-M

ileTr

ack

Wal

kTe

st(R

ockp

ort

Fitn

ess

Test)

(1-M

TW)6

4

Mea

sure

dtra

ck

●St

opw

atch

●H

Rm

onito

r●

Tape

mea

sure

●A

min

imum

of2

tests

are

requ

ired;

the

times

ofbo

thte

stssh

ould

bew

ithin

30s

ofea

chot

her;

othe

rwis

e,su

bseq

uent

tests

are

perfo

rmed

until

this

isac

hiev

ed

●Th

ein

divi

dual

isin

struc

ted

“to

wal

kas

fast

aspo

ssib

lear

ound

the

cour

se”6

4

●Re

cord

HR

atth

een

dof

ever

yqu

arte

rm

ile●

Reco

rdth

etim

eto

com

plet

eth

ete

st(in

min

utes

)●

On

com

plet

ion

ofth

ete

st,th

ein

divi

dual

shou

ldco

ntin

uew

alki

ngto

cool

dow

n

The

HR

atth

een

dof

the

four

thqu

arte

rof

the

test

isus

edfo

rth

ere

gres

sion

equa

tion;

apr

edic

ted

V̇O2m

axva

lue

(Lzm

in2

1)i

sob

tain

edus

ing

the

regr

essi

oneq

uatio

n

Klin

eet

al6

4es

timat

edV̇O

2m

ax(L

zmin

21)5

6.96

521

0.00

913

body

wei

ght(

lb)

20.

0257

3ag

e(y

)1

0.59

553

sex

(men

51,

wom

en5

0)2

0.22

403

T 1(tr

ack

wal

ktim

e)2

0.01

153

HR 1

–4

(four

thqu

arte

rH

Rfo

rtra

ckw

alk)

●M

enan

dw

omen

ingo

odhe

alth

aged

30–6

9y6

4

●M

enan

dw

omen

with

men

talr

etar

datio

nag

ed26

–40

y65


Dow



Mod

ified

Shut

tleW

alki

ngTe

st(M

SWT)

74

,75

Mea

sure

dco

rrid

or10

min

leng

thw

ith2

pylo

nspl

aced

0.5

mfro

mea

chen

d

One

prac

tice

trial

isre

quire

d

●Th

ete

ststa

rtsw

itha

tripl

ebe

ep;

afte

rth

at,a

sing

lebe

epin

dica

tes

whe

nth

ein

divi

dual

shou

ldbe

wal

king

arou

ndth

eco

ne;a

tripl

ebe

epal

sosi

gnifi

esa

chan

gein

stage

Tota

lnum

ber

ofsh

uttle

sat

each

leve

l;re

port

tota

ldis

tanc

e(in

met

ers)

●M

enan

dw

omen

with

chro

nic

airw

ayob

struc

tion

aged

45–7

4y7

4,7

5

●M

enan

dw

omen

with

pace

mak

ers

aged

27–7

4y7

6

●H

Rm

onito

r●

Prer

ecor

ded

audi

otap

e●

Cas

sette

reco

rder

●Py

lons

●Ta

pem

easu

re

●Th

ein

divi

dual

isin

struc

ted:

“Wal

kat

aste

ady

pace

,aim

ing

totu

rnar

ound

whe

nyo

uhe

arth

esi

gnal

,yo

ush

ould

cont

inue

tow

alk

until

you

feel

that

you

are

unab

leto

mai

ntai

nth

ere

quire

dsp

eed

with

out

beco

min

gun

duly

brea

thle

ss”7

4

●RP

Esc

ale

●Th

eM

SWT

starts

at0.

50m

zs21

(1.1

2m

ph)f

orle

vel1

;eac

hle

vel

lasts

1m

in,a

ndth

esp

eed

isin

crea

sed

by0.

17m

zs21

for

12m

in;t

hefin

alsp

eed

is2.

37m

zs21

(see

Tab.

6)●

The

indi

vidu

alco

ntin

ues

until

:(a)

heor

she

isto

obr

eath

less

tom

aint

ain

the

requ

ired

spee

d,(b

)he

orsh

eis

mor

eth

an0.

5m

away

from

the

cone

whe

nth

ebe

epis

soun

ded,

or(c

)atta

inm

ento

f85%

ofag

e-pr

edic

ted

HRm

ax●

The

tota

lnum

ber

ofco

mpl

eted

shut

tles

(10-

mle

ngth

s)at

each

leve

lis

reco

rded

(inm

eter

s)●

On

com

plet

ion

ofth

ete

st,th

ein

divi

dual

shou

ldco

ntin

uew

alki

ngslo

wly

toco

oldo

wn

Bag

and

Car

ryTe

st(B

CT)

77

Mea

sure

dco

urse

7.5

min

leng

th,

inad

ditio

nto

a4-

step

fligh

tof

stairs

●H

Rm

onito

r●

Pack

age

toca

rry

wei

ghts

●W

eigh

tsof

0.9

kgea

ch●

Stop

wat

ch●

Tape

mea

sure

●Th

ein

divi

dual

isin

struc

ted

tow

alk

the

circ

uitc

arry

ing

apa

ckag

ew

eigh

ing

0.9

kg,w

ithbo

thar

ms,

7.5

m,u

pan

ddo

wn

a4-

step

fligh

tof

stairs

,and

back

7.5

m●

On

com

plet

ion

ofea

chci

rcui

t,0.

9kg

ofw

eigh

tis

adde

dto

the

pack

age,

the

indi

vidu

alco

ntin

ues

until

heor

she

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IIIIII

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Dow



Submaximal Exercise Testing

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