Laboratory exercise testing:

1
Laboratory exercise testing
Exercise testing
W170and maximal tests
2
W170
Exercise test estimating theoretical physical
working capacity at hear rate of 170 beets/min.
The test is looking for a theoretical load (P)
W which should be produced by tested person at
his (her) HR 170 beets/min.
Physiological principle
A linear relation (positive correlation) between
HR and intensity of exercise (load) in a range
from 120 to 170 (180) beets/min.
Note There is no change in systolic volume from
120170 (180) beets/min and therefore cardiac
output depends only on heart rate. Systolic
volume rises till 120 beets/min, from 170180
beets/min slightly decreases (short diastole).

3
W170
Next characteristics
1) It is one of the oldest sub-maximal tests
evaluating fitness level, an effect of a training
or impact of a rehabilitation intervention.
2) There was a hypothesis of strong correlation
of the test with an aerobic power (VO2max).
However, current findings show, that the test is
valid only for common population (mainly for
men). It is not suitable for athletes.
3) HR 170 beets/min is approximately the value
when is a healthy young man reaching his
anaerobic threshold. For the elderly or ill (who
has reduced HRmax and HR at AnT) is sometimes
used modification of the test W150 ci W130.

4
W170
Equipment - cycle ergometer - HR monitor
Protocol
1) 2(sometimes 34) stages. There can be 1 min
long optional pause between stages.
2) duration of each stage 46 min (reaching of
steady state)
3) measurement of HR at the end of each stage
(during last 15 s)
4) load W should increase HR - at the end of
the 1. stage 120140 bpm - at the end of the 2.
stage 140160 bpm

5
W170
Determination of the load W per kg of weight
? ? and children trained
1. stage 1,5 W/kg 1 W/kg 2 W/kg
2. stage 2 W/kg 1,5 W/kg 2,5 W/kg
Final power depends on pedal rate as well. The
pedal rate should be kept in the range 5
revolution/min.
Optimal pedal rate for sedentary is 60 rev/min
(5565), for trained higher (even 8595). The
higher is load, the higher should be pedal rate.

6
W170
Protocol (? 60 kg)
Result of the test 1) 60 W 125 bpm 2) 90 W
145 bpm 3) x W 170 bpm
145 bpm
W
125 bpm
HR 2
90 W
HR 1
2. stage
60 W
1. stage
min
5 min
5 min

7
Calculation of W170 (extrapolation)


140


8
Calculation of W170 (extrapolation)
Result of the test 1) 60 W 125 bpm 2) 90 W
145 bpm 3) 140 W 170 bpm


Index W170 140 W weight (60) 2,33 W/kg
140

9
W170
Population norms
(Heller, 2005)

10
Comparison of a untrained (N) and a trained (T)
with use of three stages

11
W170
To create a line, two points are enough. It means
to realize W170, two exercise stages should be
enough too. There are some authors who recommend
at least three stages. More stages reduce the
risk of error.




12
W170
Note
If the HR at the end of the first stage is lower
than 120 bpm, there may be a risk of major error.
The reason is linearity from 120 to 170.. In
this case it is useful to add the third stage.

13
W170
W170 test can be use for evaluation of working
capacity at higher HR as well. However, by reason
of above mentioned problems of linear relation
there is at HR higher than 170-180 bpm increase
in error of the evaluation.
W170 test can be use for indirect determination o
aerobic power
1) Realization of standard test and determination
of load at HRmax which can be calculated from
formula 220-age
2) Determined load is used in formula (Bunc,
1989) VO2max (ml/min) 10.88 W 411 -
This formula can be used for load from 100 to 400
W, with considered error 10.

14
Indirect determination of VO2max for ? 60 kg, 20
year

• W at HRmax?
• 220-20 200 bpm
• 190 W 200 bpm

VO2max 10.88 W 411 VO2max 10.88 190
411 VO2max 2478 ml/min

2478 weight (60 kg)
VO2max 41,3 ml/kg/min
140
190


15
Maximal exercise test
Laboratory tests when the load is gradually
increasing till maximum.
The main aim is to measure maximum oxygen
consumption (aerobic power) - VO2max(peak). It
means to evaluate efficiency of cardiovascular
system and estimate working capacity or working
tolerance.
Sometimes is called spiroergometri.
A working capacity is a load reached immediately
before appearance of the signals of ischemia on
EKG record, which are the reasons to stop the
test. A working tolerance is the highest load at
the maximum, when the criteria for termination of
the test were reached.

16
Maximal exercise test
The sources of the load

• cycle ergometer
• treadmill
• arm ergometer

Next equipment

• HR monitors

• unit for pulmonary gas exchange (PGE)
  measurement

• analyzers for measurement of O2 a CO2 in
  inspired and expired air (importance of
  calibration one time per day- mixture of gases
  e.g. CO2 5 , O2 15 , rest N2)

• flow sensor measuring volume of inspired and
  expired air (importance of calibration before
  every measurement)

Every devises are controlled from one PC
spiroergometrics unit
17
Spiroergometrics unit
Mixture of calibration gases
Calibration pump
Suction pump for EKG
Suction electrodes EKG
PC
HR receiver
Unit for PGE measurement
EKG
18
Unite for pulmonary gas exchange measurement
Measurement of O2 consumption and CO2
production - from difference in concentration in
inspired and expired air
Measurement of ventilation - calculation from
breathing frequency and tidal volume
Tested person wears mask or mouthpiece with clamp
Mouthpiece discomfort, but lower death space
Maska comfortable (breathing via nose), but
bigger death space (accumulation of CO2)
leaking.

19

20
Air sampling for CO2 a O2 analysis
Information about volume of inspired and expired
air
Mast fit.
21
Flow sensor working on principle different
pressure in the front of and behind of membrane.
Disinfection and calibration prior to each
measurement.
22
Maximal exercise test
Increase in the load

• continual (ramp) test

There is steples increase in the load W till
maxima.
O2
W W/kg
Problem delay in O2 consumption VO2 does not
correspond with the load.
min

23
Maximal exercise test
Increase in the load

• gradual (step) test

W W/kg
There is gradual increase in load W with use of
steps from low values to maxima
0,5 1 25 min.
O2 consumption corresponds to the load at the end
of each step (reaching steady state)
min

24
Maximal exercise test
Increase in the load
Every minute (step) increase about o 1/3 W/kg of
waight. VO2 should not increase between steps
more than 3 METs.

• ? 75 kg 25 W/min
• ? 60 kg 20 W/min

Total duration of the test should be from 812
min.
If the test is shorter or longer, VO2max values
are lower.
Generally for sedentary, obese and elderly,
tests should e longer with lower increase in
load)

25
Maximal exercise test
Increase in the load
Sedentary male
Wmax 175 (around). If increase about 25W/min,
duration will be 7 minutes.
Trained cyclist
Wmax 550 (or more). If increase about 25W/min,
duration will be 22 minutes. Solution higher
increase (30 W) change in exercise protocol

1. 45 min warming-up at constant low intensity
2. test starts at the load corresponding with load
   at individual anaerobic threshold

26
Maximal exercise test
Sedentary 7 steps x 25 W 175 W

27
Maximal exercise test
Trained would need by 22 steps x 25 W 550 W
Problem
1) Long duration
ACCORDINGLY
2) Low (boring) intensity at the beginning
550 W

28
Maximal exercise test
Trained would need by 22 steps x 25 W 550 W
Problem
1) Long duration
ACCORDINGLY
2) Low (boring) intensity at the beginning
550 W
Minute long brake, not necessary
W at AnT
Test 38 min
45 min

29
Maximal exercise test
How to estimate AnT?
THAN
1) Based on population norms...
2) By using W70 test, which could serve as a
warming-up at the same time
550 W
W at AnT
test 38 min
45 min

30
Maximal exercise test
How to estimate AnT?
Using W170 test as a warming-up before test to
maximum
550 W
W 170
Test 38 min
2. step
1. step

31
Maximal exercise test
Chosen monitored parameters
1) Heart rate (HRmax, HR at AnT) and saturation
A saturation means percentage of saturation of
blood bye O2 from maximum possible amount. It is
at the rest about 98 and decreases during
exercise. It can be lower than 90 at maximum
exercise.
Saturation
HR
Digital pulse oxymetere

32
Maximal exercise test
Chosen monitored parameters
1) Heart rate (HRmax, HR at AnT) and saturation
2) Power P (Wmax, W at AnT)
Work force acting upon a distance
N m J
power work for time
Nm/s W
force
speed
Or
P F v
W Nm/s

33
Maximal exercise test
Chosen monitored parameters
1) Heart rate (HRmax, HR at AnT) and saturation
2) Power P (Wmax, W at AnT)
The values of Wmax/kg
? ? trained KVS illnesses
3,5 2,8 69 od 0,5
See next table

34

35
Maximal exercise test
Chosen monitored parameters
1) Heart rate (HRmax, HR at AnT) and saturation
2) Power P (Wmax, W at AnT)
3) Lactate for estimation of so called
metabolic AnT

36
Invasive estimation of AnT from level of a blood
lactate

(Placheta et al, 2001)
37
Maximal exercise test
Chosen monitored parameters
1) Heart rate (HRmax, HR at AnT) and saturation
2) Power P (Wmax, W at AnT)
3) Lactate for estimation of so called
metabolic AnT
4) Gas exchange (O2 a CO2) and ventilation
CO2
RQ
RQ of fats 0,7. RQ of carbohydrates 1
O2
However during maximal exercise test RQ overlap
level of 1. The reason is reduction of acidity
with help of bicarbonates
H HCO-3 ? H2CO3 ? H2O CO2
Note H2CO3 - carbonic acid

38
Maximal exercise test
However during maximal exercise test RQ overlap
level of 1. The reason is reduction of acidity
with help of bicarbonates
H HCO-3 ? H2CO3 ? H2O CO2
CO2
l
O2
Deflection point from linear trend between CO2
output and exercise intensity.
W
AnP

39
Maximal exercise test
This deflection point represent anaerobic
threshold, which is called as a respiration or
ventilation AnT.
Similar increase (deflection point) can be seen
on the curve of ventilation - because increase of
pCO2 in blood stimulates ventilation (due to
chemoreceptors).
V
l
So called talking test can be used for
estimation.
W

Ventilation AnT
40
Determination of ventilation AnT (Tvent)

(Heller, 2005)
41
V-slope method for determination of AnT
Linear relation is disturbed for the benefit of
CO2 output.

42
O2 consumption during maximal test

(Heller, 2005)
43
O2 consumption during maximal test
Plateau in O2 consumption
1) It is situation when VO2max is reached and
next increase in exercise intensity does not
cause father increase of it.
2) It is possible to sustain for seconds (trained
longer).
3) It is evident among less then 50 tested. The
most of the tested finish early from reason of
uncomfortable filings.
4) It is one criteria for reaching maximum
exercise intensity.

44
Maximal exercise test is ended when the tested
feels inability to continue - reaching volitional
maximum
Maximum at lest 18.

(Borg, 1982)
45
Criteria of reaching maximum
1) Plateau in VO2.
2) RQ higher than 1.
3) Lactate is 1,5 min after cessation of exercise
gt8mmol/l
4) HRmax gt85 from predicted maximum
VO2max x VO2peak.

46
Maximum test on treadmill
The example of the set used in our laboratory
than increase every 30 s
4 min
1 min
km/hour
8 5
10 5
11 5
12 5
13 5
14 5
15 5
15 7
8 0
Tr. ?
Than increase in inclination about 2
7 0
km/hour
7 5
8 5
9 5
10 5
11 5
12 7
12 9
12 11
Tr. ?

47
Receiver of HR.
Safety belt.
48
Maximum test on treadmill
Example of next protocols

49
Some parameters during maximal test
VCO2 volume of expired CO2, RER respiration
quotient, V ventilation, FIO2FEO2
utilization of O2 from ventilated air

50
Some parameters during maximal test
VE ventilation VCO2 volume of expired CO2
VO2 volume of inspired O2 PETO2 partial
pressure of O2 at the end of expiration PETCO2
partial pressure of CO2 the end of expiration LA
level of lactate HCO3- bicarbonate R
respiration quotient pH pH W load

51
Results of maximal exercise test
52
Results of maximal exercise test
53
Results of maximal exercise test
54
Results of maximal exercise test
VO2l/min
55
Measurement of VO2 in the field conditions
A
B

56
Determination of VO2max from regression equation
(Jurca el al.)
1. Evaluation of physical activity

57
Determination of VO2max from regression eguetion
(Jurca el al.)
2. Filing of different parameters

58
Výpocet VO2max dle regresní rovnice (Jurca el
al.)
3. Final evaluation of results

59
Literature
Heller, J. (2005). Laboratory Manual forHuman
and Exercise Physiology. Charales Univeristy in
Prague The Karolinum Press. Maud, ? C. Foster
(Eds.). Psychological assessment of human
fitness. Champaign, IL Human Kinetics. Placheta,
Z., Siegelová, J., Štejfa, M., Jancík, J.,
Homolka, P., Dobšák, P. (2001). Zátežové
vyšetrení a pohybová lécba ve vnitrním lékarství.
Brno Masarykova Univerzita. Silbernagl, S.,
Despopoulos, A. (1988/1993). Atlas fyziologie
cloveka (E. Trávnicková et al., Trans.). Praha
Grada.