SUBMAXIMAL TESTING

• TREADMILL TEST
 Bruce Protocol
Modified Bruce Protocol
Balke and Ware treadmill test
• CYCLE ERGOMETRY TEST
The Astrand-Rhyming cycle
YMCA cycle ergometry
• Submaximal exercise testing is a way of estimating either VO2 max or “aerobic fitness” in sports medicine.
Acc. to ACSM submaximal testing should be kept at 40-60% of HRR.
• HRR= MHR-RHR (Maximal Heart Rate- Resting Heart Rate). MHR= 220-age.
• The test protocols do not reach the maximum of the respiratory and cardiovascular systems.
• Submaximal exercise tests require the client who is exercising on a particular mode is doing so at a known
work output that is less than their maximal effort.
• The individual’s HR for that particular workout is then used to predict CRF (cardio respiratory fitness).
 Bruce Protocol
THE BRUCE SUBMAXIMAL TREADMILL TEST IS PERHAPS THE MOST common test used to assess cardiorespiratory fitness, especially
in clinical settings.
The test is administered in three-minute stages until the client achieves 85% of his or her age-predicted maximum heart
rate(MHR).
In a clinical setting, the test is typically performed to maximal effort, to evaluate both fitness and cardiac function. Given the
degree of difficulty with this test, it is generally not appropriate for deconditioned individuals or the elderly.
Indications:
• In a clinical setting, the test is typically performed to maximal effort, to evaluate both fitness and cardiac function. Given the
degree of difficulty with this test, it is generally not appropriate for deconditioned individuals or the elderly.
• The length of time on the treadmill is the test score and can be used to estimate the VO2 max value. During the test, heart rate,
blood pressure and ratings of perceived exertion are often also collected.
• Contraindications
Visual or balance problems,or who cannot walk on a treadmill without using the handrails
• Orthopedic problems that create pain with prolonged walking. Lowback pain (LBP) can be aggravated at inclines exceeding 3 to
5%. As obese individuals may suffer from both balance and orthopedic issues, treadmill testing may not be an appropriate
modality for them. They may be better suited to a bicycle test if cardiorespiratory testing is considered appropriate.
• Foot neuropathy
Equipments

• Commercial treadmill
• Stopwatch
• Stethoscope and sphygmomanometer (with hand-held dial or with a
stand)
• Ratings of perceived exertion (RPE) scale
• Heart rate (HR) monitor (optional)
• Medical tape
 Technique

• The test is administered in three-minute stages until the client achieves 85% of his or her age-predicted
maximum heart rate (MHR).
• This is a maximal exercise tolerance test where the athlete works to complete exhaustion as the treadmill speed
and incline is increased every three minutes.
• The test should be performed until signs or symptoms develop that warrant test termination or until the
subject’s HR response exceeds 85% of MHR. To ensure test validity and accuracy, the client’s HR responses
should exceed 115 bpm for at least two stages.
• Upon completion of the test, the client should cool down on the treadmill, walking at a moderate speed until
breathing returns to normal and HR drops below 100 bpm. Three to five minutes should be sufficient.
• Calculate VO2max and metabolic equivalent (MET) level using the following conversion
formulas (Pollock et al., 1982; Foster et al., 1984).
Men: VO2max = 14.8 – (1.379 x time) +(0.451 x time²) – (0.012 x time³)
Women: VO2max = 4.38 (time) – 3.90
To calculate METs, divide the
VO2max by 3.5 mL/kg/min
• Record values on the testing form. Continue to observe the client after the test as negative symptoms can arise
immediately post-exercise.
Modification
• There is a commonly used Modified Bruce protocol, which starts at a
lower workload than the standard test, and is typically used for elderly or
sedentary patients.
• The first two stages of the Modified Bruce Test are performed at a 1.7
mph and 0% grade and 1.7 mph and 5% grade, and the third stage
corresponds to the first stage of the Standard Bruce Test protocol.
 BALKE & WARE TREADMILL EXERCISE TEST
• THE BALKE & WARE TREADMILL TEST IS ANOTHER COMMON TREADMILL test used in both clinical and fitness
settings to assess cardiorespiratory fitness.
• The test is administered in one- to three-minute stages until the desired HR is achieved or symptoms limit
test completion. In a clinical setting, the test is typically performed to maximal effort, to evaluate cardiac
function in addition to fitness.
• When performed in a fitness setting,this test should be terminated when the client achieves 85% of his or
her age-predicted MHR. Since speed is held constant, this test is more appropriate for deconditioned
individuals, the elderly, and those with a history of cardiovascular disease.

• Equipment:
Commercial treadmill
• Stopwatch
• Stethoscope and sphygmomanometer (with hand-held dial or with
a stand)
• RPE scale
• HR monitor (optional)
 Pre-test procedures:
• Measure pre-exercise HR, sitting and standing, and record the values on a testing form or
data sheet.
• Estimate the submaximal target exercise HR and record the value on the testing form.
• Discuss RPE and remind the client that he or she will be asked for perceived exertion
levels throughout the test.
• Describe the purpose of the treadmill test. The protocols for men and women are
different, as illustrated in the table at right:
For men, the treadmill speed is set at 3.3 mph, with the gradient starting at 0%. After one
minute, the grade is raised to a 2% incline and increased by 1% each minute thereafter
until any test termination criteria is achieved (i.e., signs,symptoms, or 85% of MHR).
For women, the treadmill speed is set at 3.0 mph, with the gradient starting at 0%. After
three minutes, the grade is raised to a 2.5% incline and increased by 2.5% every three
minutes thereafter until any test termination criteria is achieved (i.e., signs, symptoms, or
85% MHR).
Test administration:
This treadmill test begins at 3.0 mph for a female client or 3.3 mph for a male client with a 0% grade.
• Assess and record exercise HR and RPE at each minute; assess and record exercise BP with 30 seconds to
go in each stage. (Since men are only in each stage for 1 minute, BP assessment may be appropriate at
every other stage.)
• The test should be performed until 85% maximal effort is achieved or until symptoms develop that
warrant test termination.
• Upon completion of the test, allow the client to cool down on the treadmill by walking at a moderate
speed until breathing returns to
normal and HR drops below 100 bpm.
• Calculate VO2max and MET level using the following conversion
formulas (Pollock et al., 1976; 1982).
Men: VO2max = 1.444 (time) + 14.99
Women: VO2max = 1.38 (time) + 5.22
• To calculate METs, divide the VO2max by 3.5 mL/kg/min
• Record all values on the testing form.
• Continue to observe the client as he or she cools down, as
negative symptoms can arise immediately post-exercise.
• Cycle ergometry
• Bicycle ergometers have distinct advantages over the other exercise device. In
contrast to treadmills, power output is easily calculated and regulated on the
ergometer independent of body mass.
• Most ergometers are safe, potable, relatively inexpensive.
• The same general guidelines for treadmill testing is applied to bicycle
ergometer. Power output on a bicycle ergometer is expressed in kg. m/min or
watts. Bicycle ergometer tests generally use 2 to 4 min stages of graded
exercise. Initial resistance ranges from 0-30 W, power output generally
increases 15-30W per stage. Pedalling at 50-60 revolutions per min (rpm)
represents the typical rpm for weight-loaded ergometers.
 Astrand-Rhyming cycle ergometer test
• Per olaf Astrand ( a famous exercise physiologist from sweden ), along with
his wife , Irma Ryhming , developed a simpler protocol in the 1950s to be
used for prediction of CRF(cardior-respiratory fitness) from laboratory
submaximal cycle exercise results.
• This protocol uses a single stage approach for prediction of CRF.
• In this test subject performs a 6 minutes submaximal exercise session on the
cycle ergometer .Thus this is typically a single stage test.
• The HR response to this session will be determine the maximal aerobic
capacity by plotting HR response to this one stage on a nomogram.
 Procedure
1) Explain the test to your subject.
2)Pre-test instruction given to the subject.
3)Explain inform consent
4)Take the baseline or resting measuresof HR and BP
5) Adjust the seat height
6)START THE TEST-have your subject freewheel, without any resistance (0kg), at the pedal cadence of
50 rpm(no. of pedal revolutions per minute). Maintainaing 50 rpm throughout the test is essential.
7)Set the first stage’s workout according to the protocol table
8) Start the timer.
9)Measure heart rate after each minute starting at minute 2. count HR for 10-15 sec.
10)Measure and record the BP after 3 minutes HR.
11)The 5th and 6th minute HR will be used in the VO2 max as long as there is not more than 6 beat
difference between the two HRs.(if there is diff. less than or equal to 6 bpm then considered the test
is finished but diff. is more than 6 bpm then continue the test for another 1 minute and check HR
again.
12) You need to obtain HRs from the test with 5th and 6th minute HR(within 6 bpm)
13)For best prediction of vo2 max, the HR should be between 125-170bpm.
14)Allow your subject to cool down after the protocol is complete. Have your subject continue to
pedal at 50 rpm and adjust resistance down to 0.5 to 1 kp for 3 minutes of cool down or recovery.
Take HR and BP at the end of 3 minute.
Prediction of maximal aerobic capacity (VO2 max)
1)calculation based formula
2) Nomogram technique.
• Numerical calculation-
Vo2 max(mL.kg-1.min-1)=SM(220-age-73-(sex.10)÷(HR-73-(SEX.10).
SM=submaximal workload
SEX=represent 0 for women and 1 for men.
HR=steady state HR, in bpm.
• Eg.33 year old condition female (63kg) rides at 600 kg.m.min
(ml.kg.min=24.1) and has HR=124bpm
• Vo2 max=sm.(220-age-73-(sex.10)÷(HR-73-(sex.10)
24.1(220-33-73-(0.10)÷(124-73-(0.10)÷(124-73-(0.10)=53.8 ml.kg.min
 Nomogram technique
Estimated maximum oxygen
consumption (VO2max) can be determined by
reading horizontally from the body weight scale
(step test) or workload scale (cycle test) to the
oxygen uptake (VO2) scale.

The predicted VO2 max value is obtained by

connecting the point on the VO2 scale (VO2, liters
per minute) with the corresponding point on the
pulse rate scale (in beats per minute). The horizontal
line extends from the workload and
VO2 scales to the pulse
rate scale.

Where the line intersects the max VO2

scale (liters per minute)
is the estimate of the individual’s VO2 max.
 Ymca cycle ergometer
• Explain the test to the subject and his screened with the health history questionnaire and
risks.
• Clothing should be comfortable , should have plenty of fluids , avoiding alcohol and caffeine
within 3 hours of test, avoiding strenous exercise on the day of test.
• Explain informed consent and complications with the patient.
• Take the baseline HR and BP when the subject is seated. If necessary these measurements
can be performed on the ergometer.
• Adjust the seat, the knees should be flexed at approximately 5 to 10 degrees in the pedal
down position with toes on pedals. Also the alignment of the seat can be made by the seat
height with greater trochanter , or hip or with the subject standing next to the ergometer.
• While pedaling the subject should be comfortable and there should be no rocking of hips ,
the subject should maintain upright position and should not grip the handle bars too tight.
Procedure:
• Start clock or timer at each stage for eg:3mins rather than entire test time.
• Measure heart rate after 2 mins into first work rate or stage.
• 0:00-0:45 monitor subjects workoutput (cadence or resistance)
• 0:45-1:00 pulse count for 15 secs
• 1:00-1:45 monitor subjects work output
• 1:45-2:00 pulse count for 15 seconds
• 2:00-2:30 stage bp check
• 2:30-2:45 stage rpe check
• 2:45-3:00 pulse count for 15 seconds ( 3min HR).
• Stage I requires participants to pedal against 0.5kg of resistance
(25W,150kgm.min)

• The workload for stage II is based on the steady state hr maintained at the
last minute of the initial stage:
 HR<80 bpm – change the resistance to 2.5 kg
 HR 80-89 bpm – change the resistance to 2.0 kg
 HR 90-100 bpm-change the resistance to 1.5 kg
 HR > 100bpm – change the resistance to 1.0 kg