CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
COMPARISON OF ENDURANCE RUNNERS WITH FIELD ATHLETES
ON PERFORMANCE OF
SELECTED MAXIMAL TREADMILL STRESS TEST PROTOCOLS
A thesis submitted in partial satisfaction of the
requirements for the degree of Master of Arts in
Physical Education
by
Larry Lee David
May 1985
The Thesis of Larry L. David is approved:
Chairman
Dr.
California State University, Northridge
ii
TABLE OF CONTENTS
~age
LIST OF TABLES .
v
LIST OF FIGURES
vi
vii
ABSTRACT
I
CHAPTER 1 - INTRODUCTION •
1
Importance .
4
Statement of the Purpose
4
Statement of the Problem
5
Hypothesis .
5
Scope and Limitations
6
Assumptions
6
Definition of Terms
6
CHAPTER 2 - REVIEW OF THE LITERATURE •
8
Physiological Parameters
8
Protocol Comparisons . .
13
Comparisons of Exercise Test Modes • . . • • .
16
Treadmill Protocol Comparisons •
21
Summary and Conclusions . • •
23
CHAPTER 3 - RESEARCH METHODS AND DESIGN
....
26
Overview of the Research Design
26
Grouping and Randomization of Subjects
27
Instrumentation and Measurements • .
28
Analysis of the Data • . . • . •
28
iii
Page
CHAPTER 4 - ANALYSIS OF THE DATA . . .
30
Physical Characteristics .
32
Paired T-Test for Ratings of Perceived Exertion
32
.
Correlation of VE, HR, AT, RQ, and Total Time With
V0
Max . • • . • • . • . • . . . • • . • • . • •
33
Two-Way Analysis of Variance With Repeated Measures.
34
2
CHAPTER 5 - SUMMARY, DISCUSSION, CONCLUSIONS, RECOMMENDATIONS
45
Summary of Major Findings
45
Discussion •
47
Conclusions
50
Suggestions for Further Research .
51
BIBLIOGRAPHY
52
APPENDICES
A.
MAXIMUM EXERCISE TREADMILL PROTOCOLS . .
59
B.
INFORMED CONSENT FOR EXERCISE TESTING
62
C.
RAW DATA - PHYSIOLOGICAL PARAMETERS
64
D.
RAW DATA - PHYSICAL CHARACTERISTICS
67
E.
NON-INVASIVE DETERMINATION OF ANAEROBIC THRESHOLD
70
F.
DATA COLLECTION CHARTS • .
iv
b
............
72
LIST OF TABLES
Page
Table
1
Group A - Maximum Mean Scores for the Six Major Variables .
31
2
Group B - Maximum Mean Scores for the Six Major Variables .
31
3
Group A - Age and Physical Characteristics
32
4
Group B - Age and Physical Characteristics
32
5
Significant Difference and Correlation for Ratings of
Ferceived Exertion • • . • . • • • • . • . • • • • .
33
6
Correlation With
.
vo 2
.
Max For VE Max, Max HR, Max RQ, AT
and Time . . . . . . . . . . . . . . . . . . . . . .
33
7
Descriptive Data For Mean Maximum Minute Ventilation
34
8
Two-Way ANOVA For Mean Maximum Minute Ventilation
35
9
Descriptive Data For Mean Maximum Heart Rate
36
10
Descriptive Data For Mean Total Time
36
11
Two-Way ANOVA For Mean Maximum Heart Rate • .
37
12
Two-Way ANOVA For Mean Total Test Time
38
13
Descriptive Data for Mean Maximum Respiratory Quotient
39
14
Two-Way ANOVA For Respiratory Quotient
40
15
Descriptive Data For Mean Anaerobic Threshold
41
16
~7o-Way
17
Relationship o~ AT as a Percent of vo Max Versus AT as a
2
Percent of VE Max, Max HR, and Total Time
43
18
Descriptive Data For Mean Maximum Aerobic Capacity
43
19
Two-Way ANOVA For Mean Maximum Aerobic Capacity • • • .
44
ANOVA For Mean Anaerobic Threshold
v
42
LIST OF FIGURES
Figure
1
2
3
4
5
6
Page
Two-Way ANOVA With Repeated Measures For Maximum
Minute Ventilation • . • . • • • • • . • • • .
35
Two-Way ANOVA With Repeated Measures For Maximum Heart
Rate
......................
37
Two-Way ANOVA With Repeated Measures For Total Test
Time
38
......................
Two-Way ANOVA With Repeated Measures For Maximum
.
Respiratory Quotient~ •
. . . ... . . . . .
.
...
40
Two-Way ANOVA With Repeated Measures For Mean Anaerobic
Threshold
....................
42
Two-Way ANOVA With Repeated Measures For Mean Maximum
Aerobic Capacity
44
.................
vi
'ABSTRACT
COMPARISON OF ENDURANCE RUNNERS WITH FIELD ATHLETES
ON PERFORMANCE OF
SELECTED MAXIMAL TREADMILL STRESS TEST PROTOCOLS
by
Larry Lee David
Master of Arts.in Physical Education
The purpose of this study was to determine the appropriateness of
two maximum exercise treadmill stress test protocols for two athletic
populations with specific and different training backgrounds.
five competitive male athletes participated in the study.
Twenty-
Group A was
comprised of thirteen subjects who were predominantly aerobically
trained triathletes or cross-country runners.
Group B was comprised of
twelve subjects who were predominantly anaerobically trained field
event athletes.
The modified Balke protocol utilized had a starting speed and
grade of 3.4 mph and 2.0%.
increased 2.0% every minute.
Speed was held constant while grade was
The University of Michigan protocol had
vii
a starting speed and grade of 3.0 mph and 0%.
Variable speed and/or
grade adjustments were made every two or four minutes to a maximum of
7.0 mph and 15.5%.
Physiological parameters investigated to define
performance included
vo 2
.
max, VE max, maximum heart rate, AT, RQ, and
total test time.
Six two-way ANOVAS with repeated measures were conducted to
determine mean differences between groups and protocols.
A post hoc
modified t-test was used to evaluate interaction between groups
following a significant F.
Major findings with respect to the hypothesis were:
1.
.
Interaction between groups was not significant for VE
max, max heart rate, AT, RQ, or total time.
Training background did
not significantly influence performance as measured by these variables.
2.
at F
= 4.38 (P
Interaction between groups for V0
<
.05).
2
max was significant
The significant interaction indicates the
difference in performance for Group A, expressed in terms of
.
vo 2
max,
between the modified Balke and University of Michigan tests was
significantly greater than the difference in performance between
protocols for Group B's V0
2
max values.
Performance was significantly
influenced by training background when expressed in terms of aerobic
capacity.
viii
b
CHAPTER
1
INTRODUCTION
The origins of maximal exercise stress testing can be traced to the
early 20th Century and the empirical discoveries that coronary artery
disease produced S-T segmental changes in exercising subjects (Ellestad,
1981).
The foundation for modern stress testing was laid during the
1950's when investigators
such as Astrand and Rhyming (1954), Bruce
(1956), and Balke (1959) established progressive exercise test protocols
which were useful as determinants of physiological tolerance to exercise.
Since the 1960's stress testing has grown in popularity and use.
Most importantly, stress testing has developed into a valuable, noninvasive, diagnostic tool for determining the presence of coronary
artery disease (American Heart Association, 1972).
It has also become
a reliable evaluative technique for assessing maximal aerobic capacity
and fitness levels of athletes and other health conscious individuals
(American College of Sports Medicine, 1975).
The measurement of an athlete's physiological mechanisms under
stress conditions makes it possible to determine their functional
capacity.
Determinations can be made regarding exercise performance
capacity, limiting factors of exercise, symptomatic response, and
diagnosis (Jones, 1975).
The information obtained may be related to
occupational demands for use in prescribing a safe level of daily
activity and exercise, or utilized in designing athletic training
1
programs.
With increased awareness of fitness in recent years and the
emergence of the competitive weekend athlete, stress testing to determine fitness levels has become very common (ACSM, 1975).
The rise in
popularity of stress testing led the American Heart Association to
establish objectives and principles for exercise stress testing.
In
1972 the AHA published the following objectives:
1.
To establish a diagnosis of overt or latent heart disease.
2.
To evaluate cardiovascular functional capacity, particularly
as a means of clearing individuals for strenuous work or
exercise programs.
3.
To evaluate responses to conditioning and/or preventive
maintenance programs.
4.
To increase individual motivation for entering and adhering to
exercise programs.
These objectives were followed by a set of principles for graded
exercise testing (AHA, 1975).
1.
Multi-stage workload tests are preferable to single level
tests.
2.
A test should begin at a work level considerably below the
level of impairment.
3.
The workload should be maintained at each level for sufficient
time to ensure the individual's responses are stabilized.
4.
The increase in workloads to the point of limitation should
progress in stepwise fashion.
5.
Minimum monitoring of parameters should include blood pressure,
heart rate, and ECG.
All should be monitored before, during,
3
and after exercise.
6.
Informed consent should be obtained before testing.
7.
Criteria used for test termination should include;
a. attainment of maximum possible performance.
b. attainment of a symptom limited end-point indicative of
a disease process.
c. attainment of a predetermined end-point.
Nagle (1973) also published five standards for graded exercise
testing:
1.
The work must involve large muscle groups.
2.
The work must be measureable and reproducible.
3. 'Test results should be comparable and reproducible.
4.
The test must be tolerated by healthy individuals.
5.
Mechanical efficiency should be as uniform as possible in the
population tested.
It has long been established and accepted that physiologic adaptations occur as a result of exercise, and that these adaptations are
training specific, or uniquely related to the specific mode in which
the individual trains (Mathews and Fox, 1976).
Weight lifters develop
increased strength and hypertrophy by performing repeated muscle contractions against resistance in which major strength gains will be
primarily in that movement performed (Mathews and Fox, 1976).
Treadmill protocols are essentially variations of a basic format.
Variables include starting speed and percent grade, incremental
increase in speed and grade, and length of time at each incremental
level.
When training on a treadmill with a stipulated protocol, it
might be assumed the trainee would perform better when tested at the
specific protocol than when
te~ted
with a different protocol.
If this
4
is a valid assumption, then can the same be assumed of individuals who
train with an emphasis on either aerobic or anaerobic conditioning?
Today, athletes want to know their maximum aerobic capacity as well as
other fitness variables, and the best methods by which to improve their
performance.
It is essential to provide athletes with the most appro-
priate and valid test evaluation format.
This study will compare tread-
m:ill stress test protocols and their interaction with respect to
training background.
Importance
Use of a treadmill for administering exercise stress tests for
diagnostic purposes has become increasingly popular in recent years.
This increase in popularity has resulted in the development of a variety
of test protocols and technical procedures.
Often a protocol is chosen
on the basis of the investigator's personal preference rather than
clinical circumstances.
When testing a specific individual or group, it is appropriate to
use a protocol which was developed and tested on a similarly defined
population.
This is important to ensure maximum efficiency in physio-
logic adaptation and a true maximum test.
It is also an important
consideration when using stress testing as a diagnostic tool.
It is
necessary to know that test subjects are not limited in their performance bf:cause of an inappropriate test protocol.
Statement of the Purpose
The purpose of this study was to determine whether an individual's
training background would positively or negatively effect his performance on either of two treadmill stress test protocols.
Data collected
and analyzed may demonstrate if one protocol would be more appropriate
for use in testing a specifically defined population.
Statement of the Problem
The problem identified for this study was:
Will a primary athletic training background significantly influence
performance, expressed as
.
vo 2
.
max, VE max~ maximum heart rate, anaerobic
threshold, respiratory quotient, and total time, on either of two
commonly used maximum exercise treadmill stress test protocols?
Hypothesis
One general hypothesis consisting of six sub-hypotheses was formulated for this study:
1.
Primary training background will not significantly influence
performance on either of two commonly used maximum exercise treadmill
stress test protocols.
a.
Performance, expressed in terms of
vo 2
max, will not be
influenced by training background.
b.
Performance, expressed in terms of VE max, will not be
influenced by training background.
c.
Performance, expressed in terms of maximum heart rate,
will not be influenced by training background.
d.
Performance,expressed in terms of anaerobic threshold,
will not be influenced by training background.
e.
Performance, expressed in terms of respiratory quotient,
will not be influenced by training background.
f.
Performance, expressed in terms of total time, will not
be influenced by training background.
6
Scope and Limitations
Twenty-five competitive male athletes volunteered to be subjects
in this study.
Thirteen were intercollegiate distance runners or tri-
athletes with a predominantly aerobic training background.
Twelve were
intercollegiate field event athletes with a predominantly anaerobic
training background.
All subjects were variably trained, with elements
of each training design in their background.
Testing was conducted during the Fall semester, 1984, the earlymid competitive
se~qon
for the aerobic athletes, and the preseason
training period for the anaerobic athletes.
The Exercise Physiology
Laboratory at California State University, Northridge was the test
facility.
testing.
Subjects were instructed to eat no less than two hours before
Both treadmill tests were completed by each subject within a
one week period, with no less than forty-eight hours between tests.
Pulmonary function and body composition tests were conducted during the
week of treadmill testing.
Assumptions
Maximum performance on a treadmill requires the use of large muscle
mass and a significant increase in oxygen consumption.
The treadmill stress test is a commonly used procedure for evaluative and diagnostic purposes.
Definition of Terms
Maximum aerobic capacity
(V0 2 max)
The largest amount of oxygen consumed during performance of
increased workloads; when continued workload increases fail to produce
an increase in oxygen uptake.
7
Anaerobic threshold or ventilation breaking point
(AT)
That point at which aerobic metabolism no longer meets tissue
demands and the percent contribution of anaerobic metabolism increases
significantly.
Respiratory Quotient
(RQ)
co 2
Ratio of the volume of
expired to the vloume of 0
2
consumed.
Minute Ventilation (VE)
The volume of air ventilated by the lungs in one minute, expressed
in liters, BTPS.
Metabolic Equivalent
(MET)
One MET equals 3.5 ml 0 /kg/min, the oxygen required for sitting
2
at rest.
Ratings of Perceived Exertion
(RPE)
Subjective assessment of intensity of work performed; higher rating
indicates greater workload corresponding to higher heart rates.
Anaerobic threshold or ventilation breaking point
(AT)
That point at which aerobic metabolism no longer meets tissue
demands and the percent contribution of anaerobic metabolism increases
significantly.
Respiratory Quotient
(RQ)
Ratio of the volume of C0
2
expired to the vloume of 0
2
consumed.
Minute Ventilation (VE)
The volume of air ventilated by the lungs in one minute, expressed
in liters, BTPS.
Metabolic Equivalent
(MET)
One MET equals 3.5 ml 0 /kg/min, the oxygen required for sitting
2
at rest.
Ratings of Perceived Exertion
(RPE)
Subjective assessment of intensity of work performed; higher rating
indicates greater workload corresponding to higher heart rates.
CHAPTER
2
REVIEW OF THE LITERATURE
Physiological Parameters
Aerobic or functional capacity may be defined as "the greatest
difference between the rate at which inspired oxygen enters the lungs
and the rate that expired oxygen leaves the lungs" (Lamb, 1984).
The
difference in the volumes of the above measures is the amount of oxygen
utilized in the production of energy for working tissues.
The primary
parameters which affect oxygen uptake are cardiac output, circulation of
the blood to active tissues, and the extraction and utilization capabil±-·
ties of the tissues (Lamb, 1984; Cardus, 1978).
Cardus (1978) theorized
a fifteen to eighteen-fold increase in the blood 0
2
transport system as
a result of a five to six-fold increase in cardiac output and a threefold increase in 0
2
tissue extraction.
These increases result in V0
2
max values of approximately five to six liters, volumes observed in
competitive athletes (Lamb, 1984).
A direct correlation between oxygen uptake and cardiac output in a
normal population has been recorded (Taylor, Wang, Rowell, and Blomqvist,.
1963; Wasserman, Van Kessel, and Burton, 1967).
Taylor et al. (1963)
determined the greater the rate of workload increases, the faster the
rise in heart rate and oxygen uptake.
Wasserman et al. (1967) reported
the distribution of blood flow to working tissues is work rate dependent.
They showed the amount of oxygen removed from each heart stroke
volume (oxygen pulse) increases only with increases in work rate.
8
9
o2
At exhaustion,
slightly.
consumption peaks and either plateaus or declines
The decline is believed to be caused by a decrease in the
stroke volume and increased skin blood flow resulting in a smaller a-v
0 2 difference (Wasserman et al., 1967).
Minute ventilation has been shown to have a linear relationship
with 0
2
uptake, workload, and
co 2
output at submaximal workloads (Cardus,
1978; Jones, 1975; Nagle, 1973; Wasserman et al., 1967).
Jones (1975)
attributed the increase in VE at lower work levels to an increased tidal
volume, until about sixty percent of
.
vo 2
max is achieved.
Beyond that
level, increases in ventilation result from an increased breathing
frequency.
Linearity of minute ventilation has been shbwn to exist up to a
critical point in workload or oxygen consumption, beyond which ventilation increases at rates greater than increases in workload or oxygen
uptake (Lamb, 1984; Jones, 1975; Wasserman et al., 1967; McArdle et al.,
1981).
Traditionally this point of departure has been termed "anaerobic
threshold", or that point at which
o2
supply is no longer sufficient to
meet the needs of working tissues, resulting in the onset of anaerobic
metabolism (Wasserman, Whipp, Koyal, and Beaver, 1973).
Wasserman et
al. believe the anaerobic threshold concept invaluable in helping to
understand gas exchange modifications during exercise in normal subjects
and patients.
Anaerobic metabolism produces lactic acid which must be
buffered to maintain the proper acid-base balance in the tissues and
blood.
The
co 2
produced by the buffering of lactate with bicarbonate
ions must also be eliminated to prevent acidosis.
been shown to exist between increased production of
A relationship has
co 2
and the depar-
ture from linearity of the ventilation curve (Lamb, 1984; Jones, 1975;
10
Wasserman et al., 1973).
excess
co 2
An increase in ventilation acts to eliminate
and minimize arterial pH changes (Wasserman et al., 1967).
The exact mechanisms which tie ventilation and
completely known (McArdle, Katch, and Katch, 1981).
lated the excess
co 2
co 2
together are not
Lamb (1984) postu-
stimulates carotid body chemoreceptors which cause
a reflex increase in ventilation.
This contradicted the findings of
Hagberg, Coyle, Miller, Carroll, and Martin (1981).
These investigators
demonstrated the existence of the ventilation breaking point in patients
having a phosphorylase deficiency which results in the inability to
produce lactic acid.
Apparently there are other mechanisms acting to
keep ventilation in balance with the metabolic demands of working tissue
as well as maintaining a proper acid-base balance.
Assuming the existence of a breakaway point or anaerobic threshold,
several researchers have been concerned with its identification through
non-invasive techniques.
Wasserman et al., (1973) determined anaerobic
threshold may be identified by the ventilation break from linearity, a
corresponding non-linear increase in
partial pressure of
o2
partial pressure of
co 2 ,
quotient.
Davis,
vco2.
an increase in end-tidal
without a corresponding decrease in end-tidal
and a sharp increase in the respiratory
Frank~ Whipp~
and Wasserman (1979) and Davis, Vodak,
Wilmore, Vodak, and Kurtz, (1976) supported Wasserman et al. (1973) and
the validity of using ventilatory parameters as indicators of anaerobic
threshold.
Davis et al. (1979) included the use of ventilatory
equivalents in determining anaerobic threshold.
in
VE/vo 2
without an increase in
VE/Vco 2
A systematic increase
denotes AT.
A correlation of
.95 was found between ventilation measurements of AT and measures of
venous· lactate (Davis et al., 1976).
Limitations of ventilatory
11
parameters were noted when as much as thirty seconds inter-investigator
variability was found when determining anaerobic threshold from ventilation versus time-based plots (Davis, 1976).
The inter-researcher varia-
bility was confirmed by the work of Yeh, Gardner, Adams, Yanowitz, and
Crapo (1983).
Using independent physiologists analysis of gas data they
demonstrated an average variability range of sixteen percent in determining AT.
The authors also demonstrated the inaccuracy of using blood
lactate measures to pinpoint AT due to the differences between venous
and arterial blood values taken at the same time, as well as a nearlinear increase in arterial lactate concentration.
The lack of a thresh-
old point in arterial lactate results from the relationship between
lactate concentration and lactate production rate.
production results in an increased removal rate.
Increased lactate
Yeh et al. concluded
that neither the non-invasive estimates nor the invasive methods are
acceptable for clinical use.
Skinner and McLellan (1980) proposed a transition phase (Phase II)
between predominantly aerobic (Phase I) and predominantly anaerobic
(Phase III) periods during work bouts of increasing intensity to maximum
levels.
These authors believe a combination of aerobic and anaerobic
metabolism occurs during this transition.
Phase III is marked by a
sharp increase in blood lactate and the breakaway point of the ventilation curve.
The continuing controversy has led some researchers to
avoid the term "anaerobic threshold", preferring "ventilation breakaway
paine' or "ventilation threshold" (Lamb, 1984) •
Despite the debate concerning the validity of non-invasive anaerobic threshold measurement techniques, researchers have established
several other general principles about metabolic acidosis and the
respiratory changes which accompany its presence.
Whipp and Wasserman
(1973) demonstrated a delay in time to steady-state beyond AT.
For
measurements below AT, steady-state was reached in 2 - 3 minutes, but as
workloads increased and exceeded AT, time to steady-state became
increasingly greater.
-
Dwyer and Bybee (1983) suggested use of anaerobic
threshold may be a better parameter for exercise prescription than is
percent of max heart rate.
However, since subjects with similar aerobic
capacities may have different AT points, it would be necessary to determine heart rate at AT, as the correlation between heart rate and V0
AT was only .60 (Dwyer and Bybee, 1983).
was showii between
the higher the
vo 2
vo 2
max and
vo 2
2
at
A stronger correlation (r=.85)
at AT; the higher the aerobic capacity
at the point of metabolic acidosis (Weltman and Katch,
1979).
Another parameter studied while analyzing anaerobic threshold is
the respiratory quotient (RQ).
produced to
1964).
o2
RQ may be defined as the ratio of
co 2
consumed per unit time (Naimark, Wasserman, and Mcilroy,
Naimark et al. demonstrated RQ changes reliably reflect meta-
bolic acidosis induced by exercise.
Research has shown that RQ may
rise during exercise from resting values of approximately .75 to values
above 1.0, with 1.2 common and 2.1 reported (Issekutz and Rodahl, 1961).
Increases in RQ reflect a change in the relative contributions of
aerobic and anaerobic metabolism to total
al., 1964).
co 2
elimination (Naimark et
The rate of change was shown to be proportional to work
intensity (Issekutz, Birkhead, and Rodahl, 1962).
While RQ is consid-
ered the least sensitive non-invasive indicator of AT (Wasserman et al.,
1973), it may compli.ment the other non-invasive, methods of measuring
fitness levels.
Protocol Comparisons
There are a large number of test protocols which span a variety of
modes and philosophies.
All protocols are continuous or discontinuous
(interspersed with rest periods).
Cardus (1978) recognized four main
categories of treadmill protocols; constant level, staged, ramped, and
sinusoidal (a continuous sine curve).
more specific categories.
These were divided into nine
Variables, depending on the category of
protocol, include starting speed and grade, amount of increase at each
stage, time at each stage, and time of each rest period.
Using
combinations of these variables a large number of test protocols have
been developed.
No single protocol has been defined more appropriate
or advantageous than others.
During small step, staged protocols with
prolonged periods at each level, subjects may reach steady-state
physiological responses.
These protocols are more appropriate for
clinical diagnosis as hazardous physical stress may be avoided while the
subject achieves a target level of response.
For athletic populations,
protocols of larger stepped increments and greater total work intensity
appear to be more appropriate.
The variety of protocols has prompted some investigators to
propose the establishment of one or a few "standard" protocols (Redwood,
Rosing, Goldstein, Beiser, and Epstein, 1971).
Other investigators
believe a variety of protocols is necessary due to the variety of test
subjects and reasons for testing (Blomqvist, 1971; Kattus, Jorgansen,
Worden, and Alvaro, 1971; Shepard, 1966).
Continuous vs. discontinuous:
There is a lack of consensus on the
selection of a continuous or discontinuous protocol.
Ellestad, Allen,
Wan, arid Kemp (1969) prefer continuous with an inclination of ten
percent and variable speed.
Margaria, Olivia, diPrampero, and Ceretelli
(1969) used a discontinuous protocol with ten second workbouts of supramaximal exercise (18 km/hr and 15% grade) and rest periods of ten
seconds each.
Their investigation was primarily concerned with power
output and anaerobic metabolism.
A protocol based on the subject's -
physical condition is favored by Wessermil and Toor (1968).
continuous or discontinuous protocols as appropriate.
They use
Fletcher (1973)
used a continuous protocol with a constant belt speed of 2.0 mph and a
grade increase of 2.5% every 2.5 minutes until 85% of the age predicted
maximum heart rate was attained.
In examining the onset of angina
pectoris ·with exercise and the related importance of a test protocol,
Redwood et al. (1971) attempted to develop a "standard" diagnostic
protocol.
They utilized progressive work 'stages with fifteen minutes
rest between work bouts which were individually established.
It was
observed the level of oxygen consumption was'approximately the same at
the onset of angina for a given subject on repeated tests.
While a
discontinuous bicycle protocol may be safer than a continuous protocol
for a patient of unknown cardiovascular status, the same may not be
said for discontinuous treadmill protocols, as intermittency could
prove more hazardous during treadmill exercise.
Ramped vs. multiple-step:
In practice a ramped protocol (continu-
ous linear increases in workload vs. time) is difficult to administer
as most of the available test devices are not engineered to provide
continuous, linear workload increases.
are most often used and reviewed.
As a result, stepped protocols
A study by Karlsson and Wigertz
(1971) did use a ramped protocol to examine the time lag of physiological responses to linearly increased workloads.
They determined that
heart rate response time shortens with an increasing rate of ramp slope
while ventilatory response is basically independent of the rate of slope
increase.
They also found a negative correlation between the time lag
of heart rate response and the subject's working capacity.
Apparently,
cardiac output response is faster in more fit individuals.
Multiple-step vs. single-step:
The multiple-step protocols have
become the most popular of the various approaches.
Balke and Ware
(1959), Glesser and Vogel (1971), Cummings (1972), McHenry, Phillips,
and Knoebel (1972), and Patterson (1972), among others, used multiple
step protocols.
ence
(Car~us,
They cite four reasons in particular for their prefer-
1978).
Multiple steps allow for a first stage warm-up.
This permits an evaluation of the subject's physiological responses
before advancing to more stressful workloads.
Also, a steady-state
condition can be reached at lower workloads before advancing to more
intense workloads, where a steady-state response may not be possible.
Multiple step protocols make possible an accurate comparison of subjects
within a group.
A single-step format (one workload setting from
beginning to end of test) does not accommodate for a variety of test
subjects often encountered, nor does the single-step protocol allow
adjustments for the variety of reasons for administering stress tests.
Steady state vs. non-steady state:
Cardus (1978) identifies the
usual criterion for steady state response as either a stable heart rate
or a stable oxygen uptake plotted against time.
stress testing and
~xercise
These are parameters of
physiology which have received little
attention from clinical researchers (Cardus, 1978).
.
However, submaximal
tests to predict vo2 max have shown a steady state protocol will
provide a more accurate measurement of
vo2
max than will a non-steady
state protocol in which the workload is increased before heart rate or
oxygen uptake plateau (Davies, 1968).
Gilbert and Auchincloss (1971)
studied the relative merits of the two protocol styles, but no definite
statements have been made regarding the clinical importance of using
one method over the other.
Comparisons of Exercise Test Modes
To date, several general principles regarding exercise modes and
protocols and their effect on
.
vo 2
max have been suggested.
Astrand and
Saltin (1961) determined the greater the amount of muscle mass involved
in an activity, the higher the
vo2
max value obtained.
gation compared heart rate responses and
activities.
vo2
Their investi-
max for seven different
Cycling in a sitting and a supine position, arm cranking,
simultaneous arm and leg cranking on bicycle ergometers, uphill treadmill runing, skiing, and swimming were compared.
Supine cycling,
swimming, and arm cranking produced significantly lower
.
vo 2
max values
with arm cranking being about 70% of the values for sitting cycling and
uphill treadmill running.
Uphill runining gave values not significantly
higher than cycling (5%), cycling plus arm cranking (5%), and skiing
(4.5%), activities which produced similar results.
Astrand's findings do not support those of Taylor, Buskirk, and
Henschel (1955) who showed that combined maximal arm and leg work
produced higher
.
vo 2
max values than leg work alone.
Astrand (1961)
determined the ceiling for oxygen uptake to be independent of the mass
of muscle utilized, once a given mass is exceeded.
Taylor et al. (1955)
also concluded that in well-trained subjects, aerobic capacity and
maximum heart rates ere virtually the same in maximal running and
cycling.
Astrand and Saltin (1961) indicated some variations in
17
protocols would not be significant for obtaining significantly different
maximum
.
vo2
values.
Further research demonstrated that protocol variations may produce
significant differences in results depending on the type and extent of
manipulation of the variables.
vo2
conclusion when they compared
bicycle ergometer tests.
Hermansen and Saltin (1969) reached this
Maximum
max during maximum treadmill and
vo 2
values were seven percent higher
on the treadmill when compared to cycle ergometry at a pedal frequency
of 50 rpm.
Adjustments in treadmill speed and grade increases and
pedalling frequency produced varying differneces, some significant,
others not significant.
The authors concluded a protocol utilizing no
less than three degrees of inclination on the treadmill throughout the
test and a pedal frequency of sixty to seventy rpm would give the most
accurate
.
vo 2
max values.
No significant differences were found for the
total test time, ventilation, heart rate, and blood lactate levels for
the primary test settings of a constant three degress treadmill inclination and fifty rpm.
Hermansen and Saltin (1969) concluded use of work-
loads representing greater divergence between test modes could result
in significant differences for some physiological variables.
Faulkner, Roberts,
Elk~
and Conway (1971) investigated heart rate,
stroke volume, cardiac output, a-v
o2
difference, and
vo 2
responses on
sub-max and maximal treadmill and bicycle ergometer protocols.
vo 2
max
was significantly lower (11%) on the bike compared to running on the
treadmill.
Maximum a-v
o2
difference was the same for both activities,
as were maximum heart rates.
.
to be the reason for lower V0
A smaller stroke volume was determined
2
max values during the bike test.
Bio-
mechanical factors resulting in greater impairment to skeletal muscle
18
blood flowirrcycling than running were identified as causing the reduced
stroke volumes.
(1972).
These findings were contradicted by Miyamura and Honda
They found
vo 2
max and cardiac output values were greater on
the treadmill than the bike.
However, no significant differences were
found in stroke volume for the two modes.
observed in maximum heart rates and a-v
being greater for treadmill running.
lower
.
vo 2
Significant differences were
o2
differences, both variables
Miyamura and Honda suggest that
max values for cycle ergometry are a result of lower cardiac
output and a-v
o2
difference values achieved on the bike.
Unlike the
results of Faulkner et al. (1971), in this study lower cardiac output
was determined to be a result of lower heart rates during bike
ergometry.
Kaman and Pandolf (1972) also found lower maximal heart rates for
cycling at sixty rpm when compared to uphill treadmill running and
laddermill climbing at thirty degrees from the vertical.
heart rates helped contribute to lower
uphill running producing the highest
vo2
vo 2
The lower
max values for cycling, with
max value for male subjects
and laddermill climbing the highest value for females.
Mean VE max
values were not significantly different between the three modes.
VE/vo 2 and VE/HR ratios supported the findings for vo 2 max.
In a comparison of oxygen uptake for arm, leg, and simultaneous
arm-leg ergometry, Reybrouk, Heigenhauser, and Faulkner (1975), unlike
Astrand and Saltin (1961), found significnat differences for
values between the three modes.
Arm ergometry
.
vo 2
vo 2 max
max values averaged
68% of the values for leg ergometry and 60% of the maximum values for
combined arm and leg ergometry.
Cardiac output, minute ventilation,
and anaerobic threshold were also compared.
Anaerobic threshold as a
percent of
.
vo 2
max was reached at progressively higher workloads for
arm (65%), leg (70%), and arm-leg (95%) ergometry.
.
vo 2
Cardiac output at
max was significantly less in arm ergometry, being 71% of leg and
66% of arm-leg work.
These results were due to the fact that both heart
rate and stroke volume were significantly lower in arm ergometry.
Minute ventilation values were virtually the same as those for cardiac
.
output, VE for arm work being 71% of leg work and 64% of arm-leg work.
Because of inter-subject differences in
vo2
max values the authors
determined the attainment of a significantly higher
.
vo2
max value in
combined arm-leg ergometry may depend on the degree of specific conditioning for either arm or leg ergometry.
The greater and more specific
the conditioning program, the less the negative effects of adding a
second type of ergometry.
An investigation of minute ventilation responses to treadmill and
bicycle work showed VE to be lower with treadmill exercise than with
cycle ergometry for comparable oxygen uptakes (Koyal, Whipp, Huntsman,
Bray, and Wasserman, 1976).
Significantly higher arterial blood lactate
values were also achieved on the bike versus treadmill at comparable
o2
uptakes, while arterial pH and bicarbonate were lower for cycling.
Results indicate a greater metabolic acidosis for cycle ergometry at
equivalent
o2
uptakes.
This was accounted for by the greater mean
metabolic rate per unit of working muscle mass used on the bicycle to
generate the same power output as on the treadmill.
For subjects of
normal respiratory function, greater metabolic acidosis, leading to
increased
tion.
co 2
production, will result in an increased minute ventila-
The authors determined that higher
VE
values are independent of
the modes utilized, as equivalent levels of metabolic acidosis for the
20
treadmill and bike produced comparable minute ventilation values .
.
The continued discrepancies found in comparisons of vo
2
max for
treadmill, bike ergometer, and/or arm plus leg protocols led Bergh,
Kanstrup, and Ekblom (1976) to investigate V0 2 max when the relative
percent of arm work in arm plus leg work is varied.
Using the same
total work rate, the arms performed 10, 20, 30 or 40 percent of the
total work.
The same ten subjects were also tested on treadmill run-
ning, cycling, and arm cranking.
Maximum aerobic capacity for running
was the same as for arm plus leg work except when arm work was 10 or 40
percent of the total workload, where aerobic capacity was significantly
greater in running.
arm cranking.
Treadmill running was also greater than cycling or
Bergh et al. (1976) determined V0
2
max is dependent on
the amount of working muscle, the ratio of arm work to total workload,
and the ability of the test subjects to perform a specific exercise.
Buchfurer, Robinson, Whipp, Hansen, and Wasserman (1982) demonstrated test modes should be carefully selected when examining selected
.
physiological parameters, including heart rate max, vo2 max, and
anaerobic threshold.
Various work intensities were used for treadmill
walking and cycle ergometry for repeated tests of 4.5 minutes to 31
minutes in duration.
between
vo2
Consistent linear relationships were found
max and heart rate or time, as well as a reproducible
response of ventilation to vco •
2
.
A very reproducible vo 2 max for each
subject on tests of 7 to 17 minutes duration was found on both exercise
modes.
Tests on either mode of less than seven or greater than seven-
.
teen minutes resulted in significantly lower vo2 max values than the 7
to 17 minute tests.
Test durations of 7 to 17 minutes were therefore
considered optimal for vo2 max determinations.
.
Maximal values for VE
heart rate, AT, and V0
2
were then determined for treadmill and bicycle
tests of optimal duration.
.
Heart rate max and vo
2
max were slightly
greater on the treadmill (3 and 6 percent respectively).
threshold was twenty percent higher on the treadmill.
Anaerobic
Buchfurer et al.
(1982) concluded test modality preferences should depend in part on the
parameters to be investigated.
The findings of Buchfurer et al. (1982) were contradicted somewhat
by results from similar studies conducted by Whipp, Davis, Torres, and
Wasserman (1981), and Fairshter, Walters, Salness, Fox, Minh, and Wilson
(1983).
Whippet al. (1981) used cycle ergometry to compare protocols
of constant load, five minute incremental and one minute incremental
work bouts and a continuous ramp load.
.
in no significant differences for vo
.
well as work efficiency and vo
2
2
Use of these protocols resulted
max or anaerobic threshold, as
uptake versus time.
Fairshter et al. (1983) compared treadmill and cycle ergometry and/
or protocols of either one minute or 15 seconds incremental loading.
Results showed no significant differences for
vo2
max,
VE max,
or
maximum heart rate for 15 second and one minute protocols on either the
treadmill or cycle ergometer.
Fairshtet 1 s data also showed tests of
.
less than 7 and greater than 17 minutes duration produced vo2 max values
similar to tests of 7 to 17 minutes.
Fairshter et al. (1983) concluded
incremental tests of short duration can be as reliable and perhaps more
practical than longer duration tests in determining physiological
responses to exercise.
Treadmill Protocol Comparisons
Maksud and Coutts (1971) compared the multi-session, discontinuous,
graded treadmill protocol developed by Taylor et al. (1955) with a
22
continuous, graded, running treadmill protocol.
ences were found for the mean
vo 2
max values.
No significant differThe reliability of using
a continuous protocol for group studies was also investigated.
Their
findings supported the hypothesis that a continuous protocol gives
accurate and reproducible measurements of
vo 2
max.
McArdle, Katch, and Pechar (1973) compared continuous and discontinuous treadmill and bicycle ergometer protocols.
No significant
.
differences in vo max were observed for three treadmill running proto2
..
cols. Mean V0 max values were significantly lower for the Balke walking
2
protocol of 3.4 mph with a 1% grade increase each minute, when compared
to the three running protocols.
Continuous treadmill running protocols
studied gave higher RQ values than either of the two discontinuous running or Balke protocols.
Minute ventilation was not significantly
different for the four treadmill protocols.
These investigators
determined the continuous running treadmill to be most appropriate for
group testing of
.
vo 2
max, a finding which supported Maksud and Coutts
(1971).
Three commonly used treadmill test protocols were compared for
maximum physiologic responses and reproducibility (Froelicher, Brammel,
Davis, Noguera, Alderus, and Lancaster, 1974).
modified Taylor and
Balke
each minute) were studied.
Standard Bruce and
protocols (3.3 mph and 1% grade increases
A higher mean
vo 2
max was achieved with the
modified Taylor test than either the Bruce (6.5% less) or Balke (9.7%
less) protocols.
The investigators concluded this difference was due
to an increased skin blood flow in the Bruce and Balke protocols which
resulted in a decrease in the a-v
maximum
ox~gen
o2
difference, and thus lowered the
consumption attainable.
There were no significant
";;,
differences in mean maximal heart rates for subjects performing the
three tests.
Statistical analysis did not show reliability differences
for V0 2 max between the three protocols.
.
vo 2
The measurement of
max
was apparently reproducible with any of the three protocols.
Mean maximum treadmill time increased with test experience in
Froelicher's study (1974) without a matching increase in
.
vo 2
max.
This
was not consistent with the findings of other investigators (Pollock,
Bohannon~ Cooper~
Ayers, Ward, White, and Linnerud, 1976).
Froelicher's
results question the validity of utilizing established nomograms for
vo 2
max or functional aerobic impairment based on maximum test time.
A comparative analysis of four maximal treadmill protocols was
conducted by Pollock et al. (1976).
Protocols compared were the
standard Balke, Bruc-e, Ellestad, and modified Astrand.
No significant
differences were found for maximum values of heart rate, blood pressure,
or
vo 2 ,
except when
vo 2
to Astrand (39 vs 41 ml
max values for the Balke protocol were compared
o2 /kg/min).
.
However, the Balke protocol had
lower maximum values for VE and RQ than the other three protocols.
The
Balke test also had the lowest rate of progression in terms of METS.
When screening sedentary or at risk populations, a protocol with a
relatively low progression rate is the preferred type (American Heart
Association, 1975).
The rapid initial increase (9 METS for the first
two or three minutes) of the Astrand protocol makes it inappropriate
for use as a diagnostic tool, but more expedient in screening healthy
populations because of its rapid application.
Summary and Conclusions
Maximum exercise stress testing has grown in popularity since the
2.
treadmill running protocols appear to produce the most consistent, most
reproducible, and highest maximum values.
In studies comparing treadmill protocols, there is as yet no
consensus with respect to significant differences based on maximum
values attained.
differences in
vo 2
Maksud and Coutts (1971) found no significant
McArdle, Katch, and Pechar (1973) found the
max.
.
Balke protocol produced significantly lower V0
three running protocols.
max values than did
2
This finding was confirmed by Froelicher et al.
(1974) and Pollock et al. (1976).
.
The Balke protocol also produced
significantly lower values for VE and RQ max (McArdle et al., 1973;
Pollock et al., 1976).
Neither McArdle, Froelicher, or Pollock found
significant differences for maximum heart rates.
While significant differences may be found between protocols for
certain parameters, nothing to date suggests training background
produces significant performance differences during various protocols.
CHAPTER
3
RESEARCH METHODS AND DESIGN
Overview of the Research Design
Two maximum exercise treadmill stress test protocols were selected
for comparison in this study.
(Appendix A)
The modified Balke test
represents a walking speed, increasing grade approach.
and grade for the Balke test were 3.4 mph and 2.0%.
Starting speed
The speed was held
constant while grade was increased 2.0% every minute.
The University
of Michigan protocol was begun at a speed of 3.0 mph and grade of 0%.
Variable speed and/or grade increases were made every two or four
minutes to a maximum workload of 7.0 mph and 15.5% grade.
Subjects
were given a warm-up period of five minutes, including moderate stretching and two or three minutes walking on the treadmill.
All subjects
received instructions for proper technique and procedures to be
followed at termination time for each test.
Use of side rails for
upper extremity support was prohibited during test sessions until the
cool-down period following data collection.
Borg's fifteen point scale
(Borg, 1973) for rating perceived exertion was utilized to establish
the protocols as comparable and sufficiently intense to elicit
maximum physiological responses.
nc{n~
The scale was posted in front of the
treadmill to be observed by every subject during each test.
A body composition analysis using hydrostatic weighing was conducted on each subject during the week of treadmill testing.
26
Pulmonary
function tests, including vital capacity and helium rebreathing for
residual volume determinations, were conducted prior to underwater
weighing.
Data collected and analyzed for this study included: body weight,
percent body fat, fat free mass, vital capacity, residual volume, heart
rate, blood pressure, ECG, VE,
threshold, and total test time.
vo 2 ,
VC0 , FE0 , FEC0 , RQ, anaerobic
2
2
2
Anaerobic threshold was determined
non-invasively, utilizing the break from linearity of the ventilation
versus time curve, FE0 2 , RQ, and ventilatory equivalents
fo~
o2
and
co 2
(Wasserman 'et al., 1973).
Data collection took place in the Fall semester, 1984.
Each
subject completed testing on the two protocols within a one week period
to eliminate conditioning effects.
Order of protocol sequence was
randomized for each subject.
Grouping and Randomization of Subjects
Twenty-five college age male volunteers were involved in this
study.
All were competitive athletes, either independent triathletes
or participants in intercollegiate cross-country or track and field at
CSU, Northridge.
ally.
Test times were scheduled for each subject individu-
They were advised of the tests they would perform and the effort
required of them.
Subjects were instructed to refrain from eating at
least two hours before testing.
A written informed consent was' read
and signed by all subjects prior to testing. -(Appendix B)
There were two subgroups, with 13 subjects in Group A and 12
1
subjects in Group B.
!
and Group B was predominantly anaerobically trained.
L
Group A consisted of aerobically trained subjects
That is, their
training time was devoted to a minimum of ninety percent aerobic (Group
A), or ninety to ninety-five percent anaerobic (Group B), conditionin8.
Members of each group were randomly assigned a number.
The oroer of
testing for each subject was then assigned with the use of a table of
random numbers (Borg and Gall, 1983).
Initial test times were con--
firmed and. subjects were instructed what to wear and when to arrive at
the Exercise Physiology Lab.
Instrumentation and Measurements
A Quinton motorized treadmill, model number 24-72 was used
throughout the study.
Treadmill speed arfd grade adjustments were
calibrated prior to the start of testing and rechecked at random
intervals during the semester of data collection.
Other equipment used
during actual testing for data collection included: 1) Beckman Metabolic Measurement Cart, with OM-11 and LB-2 oxygen and
co 2
analyzers,
2) Rudolph 2-way valve and rubber mouthpiece for expired gas collection,
3) noseclip, 4) Hewlett-Packard 1500-B Electrocardiograph recorder
(CM lead), and 5) stethescope and Tycos anaeroid sphygmomanometer.
5
Pulmonary function tests were conducted on a Collins 13.5 Liter
Respirometer Helium Analyzer.
Underwater weighings were conducted and
body density determinations made from an average of the final three
trials.
Percent bodyfat and fat free mass were then calculated from
body density results using values obtained from the equations of Brozek
and Keys (1963).
Analysis of the Data
Initially, an intercorrelation matrix
·~.Jas
conducted among the six
dependent variables for eacb group (aerobic and anaerobic) by protocol
I
l
29
to identify common factors.
In the absence of common factors, the
following two-way ANOVAS with repeated measures were performed:
o2 /kg
1)
Mean maximum aerobic capacity (V0
2)
Mean maximum minute ventilation (VE max, liters/min, BTPS).
3)
Mean maximum heart rate (beats/min).
4)
Mean anaerobic threshold (percent
5)
Mean maximum respiratory quotient.
6)
Mean total test time (minutes).
2
max, ml
vo 2
ffm/min).
max).
A post-hoc modified t-test (Dixon and Brown, 1979) was used to evaluate
group differences following a significanl F.
A confidence level of
P <.05 was used to determine significant differences for mean maximum
responses between groups and protocols.
Anaerobic threshold data was expressed four ways:
vo 2 max
1)
As a percent of
(ml 0 /kg ffm/min).
2
2)
As a percent of VE max (BTPS).
3)
As a percent of heart rate max.
4)
As a percent of total test time.
An intercorrelation matrix was conducted to examine the degree of
relationship between anaerobic threshold as a percent of
vo2
max and
the other three variables.
Pearson's correlation and a paired t-test were conducted on the
ratings of perceived exertion data to determine the relationship
between protocols with respect to perceived intensity.
31
TABLE 1
GROUP A - MEAN MAXIMUM SCORES
FOR THE SIX MAJOR VARIABLES
.
vo 2
.
VE
BTPS
HR
RQ
AT
%V0 2
TIME
141.40
190.20
1.21
72.82
16.51
S.D.
63.45
4.46
18.56
8.93
.07
7.10
1.01
Range
12.70
58.30
31.00
.26
24.80
3.09
1.19
77.41
11.64
ml
o2 /kg
ffm/min
MOD. BALKE
(N = 13)
Mean
U. MICH
(N = 13)
/
Mean
67.69
140.39
"
190.30
S.D.
4.03
15.36
8.23
.07
5.05
1.33
Range
11.30
57.40
25.00
.26
17.00
5.17
RQ
AT
%V0
TABLE 2
GROUP B - MEAN MAXIMUM SCORES
FOR THE SIX MAJOR VARIABLES
.
ml
o2 /kg
vo 2
ffm/min
.
VE
BTPS
HR
TIME
2
MOD. BALKE
(N = 12)
Mean
52.62
1.37.18
186.50
1.27
66.69
13.88
S.D.
5.62
13.72
7.32
.05
9.50
1.88
Range
15.60
47.00
23.00
.15
27.70
5.17
Mean
54.37
137.85
186.50
1.29
73.54
8.56
S.D.
6.43
13.40
8.59
.06
7.73
1.62
Range
21.10
40.80
28.00
.23
22.10
4.67
U. MICH
(N = 12)
32
Physical Characteristics
Tables 3 and 4 list means, standard deviations, and ranges for age
and relevant physical data of Groups A and B respectively.
Group A was 22.85 years, and 21.25 years for Group B.
fat was 9.53% for Group A and 11.75% for Group B.
1.078 for Group A and 1.072 for Group B.
Mean age for
Mean percent body
Mean body density was
Raw data can be found in
Appendix D.
TABLE 3
GROUP A - AGE AND PHYSICAL
CHARA~ERISTICS
AGE
HT
em
WT
kg
WT
kg/ffm
% FAT
VC L
BTPS
DENSITY
Mean
22.85
177.25
69.95
62.56
9.53
5.14
1.078
S.D.
3.36
5.64
9.93
6.24
1.87
.97
.009
Range
13.00
22.90
27.68
25.98
5.90
3.25
.015
TABLE 4
GROUP B - AGE AND PHYSICAL CHARACTERISTICS
VC L
BTPS
AGE
HT
em
WT
kg
kg/ffm
Mean
21.25
183.28
87.35
76.66
11.75
4.94
1.072
S.D.
2.28
2.92
13.67
8.77
4.20
.38
.009
Range
8.00
9.30
49.45
29.49
18.00
1.08
.038
WT
% FAT
DENSITY
Paired T-Test for Ratings of Perceived Exertion
Paired t-test data illustrated a statistically significant difference (P<.05) between means for maximum exertion ratings on each test
(Table 5).
Subjects were asked to quantify their ratings to the nearest
whole number.
In practice the fractional difference did not appear to
be as significant as statistical data suggests.
Both tests required
33
maximum efforts from all subjects, but the modified Balke protocol was
perceived to be less intense.
The exertion ratings were also signifi-
cantly correlated (P <.01).
TABLE 5
SIGNIFICANT DIFFERENCE AND CORRELATION FOR
RATINGS OF PERCEIVED EXERTION
N
MEAN
S.D.
MOD. BALKE
25
16.920
.795
u.
25
17.760
.723
MICH
S.E.
r
.160
.4009
/
p
t
5.25
.05
.
Correlation of VE, HR, AT, RQ, and Total Time With vo Max
2
Common factors were found as shown in table 6.
and
.
mean vo
protocol.
2
Mean total time
max were significantly related for both groups on each
For the aerobic athletes, mean max RQ was significantly
.
related with mean vo
2
max on both protocols.
.
significantly with mean vo2
Mean HR max correlated
max for the anaerobic athletes on the
Michigan test only.
TABLE 6
CORRELATION WITH vo 2 MAX
VE
GROUP A
Mod. Balke
r = -.0909
p = .384
U. Mich
GROUP B
Mod. Balke
U. Mich
r
MAX, MAX HR, MAX RQ, AT, AND TIME
HR
RQ
AT
TIME
.1343
.331
-.7033
.004
-.0506
.435
.8154
.001
.2106
.245
-.7376
.002
.2880
.170
.6504
.008
r = -.2968
p = ~174
.3893
.105
-.1051
.373
-.1557
.314
.9098
.001
.1422
.330
.5202
.041
-.4095
.093
.4264
.083
.8376
.001
-.0341
.3137
.4889
.1270
.8033
r
p
= .1093
r =
p =
MEAN
FOR~E
.361
34
Two-way Analysis of Variance With Repeated Measures
Intercorrelation matrices produced only one variable (mean Total
Time) significantly related to mean
protocols.
vo 2 max for
each group on both
The range of correlation for time to
.6504 to .9098, with a mean correlation of r
=
.
vo 2
max was from r =
.8033 (Table 6).
It was
subjectively determined this correlation was not high enough to eliminate any of the variables from ANOVA on the bases that two or more
were measuring the same parameter.
All six two-way ANOVAS were
conducted.
Mean Maximum Minute Ventilation:
.
for VE max.
.
Table 7 lists descriptive data
VE max (BTPS) was greater for Group A, the aerobically
trained athletes, than Group B, the anaerobically trained athletes, on
both tests.
1).
The difference was not significant on. either test (Figure
Interaction between groups from the modified Balke to the
University of Michigan test was also not significant (Table 8).
TABLE 7
DESCRIPTIVE DATA FOR MEAN MAXIMUM MINUTE VENTILATION
MEAJ'.1
S.D.
RANGE
Mod. Balke
141.40
18.558
58.3
U. Mich
140.392
15.360
57.4
Mod. Balke
137.183
13.715
47.0
U. Mich
137.850
13.399
40.8
GROUP A
GROUP B
Mean maximum Heart Rate:
Figure 2 demonstrates both groups
achieved virtually identical means for maximum heart rates on each
protocol.
Maximal mean rates for Group A were not significantly higher
35
TABLE
8
TWO-WAY ANOVA FOR MAXIMUM MINUTE VENTILATION
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
p
Groups
142.533
1
142.533
.37
.5487
8846.608
23
384.635
.36285
1
.36285
.00
.9510
8.74685
1
8.74685
0.9
.7630
2161.388
23
93.9734
Error
Protocols
Interaction
Error
I
J
142
141.40
x- -
-
-
N.S.
141
X
140
VE
139.38
N.S.
X---
------
139.17
- - -x
139
N.S.
(L, BTPS)
138
137.85
o--~-::-:-_...---:-:--:::-:-:::~~-- o}
N. S.
137.18
137
136
x - Group A
o - Group B
MOD. BALKE
U. MICH
Figure 1. Two-way ANOVA with repeated measures for Maximum Minute
Ventilation. Mean between groups for each protocol
denoted by
x.
36
than those for Group B on either protocol.
Mean maximum HR values for
Group B were identical at 186.5 beats/min (Table 9).
There was no sig-
nificant interaction between groups for the two protocols (Table 11)
TABLE 9
DESCRIPTIVE DATA FOR MEAN MAXIMUM HEART RATE
MEAN
S.D.
RANGE
Mod. Balke
190.2
8.93
31.0
U. Mich
190.3
8.23
25.0
GROUP A
/
GROUP B
Mod. Balke
U. Mich .,
186.5
7.32
23.0
186.5
8.51
28.0
Mean Total Time:
Both groups performed on the modified Balke
protocol significantly longer than on the Michigan test (P <.01).
(Figure 3)
Group A performed significantly longer than Group B on
both protocols.
Descriptive data can be found in Table 10.
was not significant.
Interaction
ANOVA indicated relative differences between
Groups A and B were the same foT the Balke and Michigan protocols.
values are recorded in Table 12.
TABLE 10
DESCRIPTIVE Vi
FOR MEAN TOTAL TIME
MEAN
S.D.
RANGE
Mod. Balke
16.51
1.006
3.09
U. Mich
11.64
1.326
5.17
13.88
1.882
5.17
8.56
1.260
4.67
GROUP A
GROUP B
Mod. Balke
D. Mich
F
37
TABLE
11
TWO-WAY ANOVA FOR MAXIMUM HEART RATE
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
Groups
177.305
1
177.305
1.39
.2498
2925.615
23
127.201
Protocols
.01846
1
.01846
.00
.9670
Interaction
.01846
1
.01846
.00
.9670
243.462
23
10.5853
Error
Error
p
/
Figure 2.
Two-way ANOVA with repeated measures for Maximum
Heart Rate. Mean between groups for each protocol
denoted by
x.
38
12
TABLE
TWO-WAY ANOVA FOR TOTAL TEST TIME
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
p
Groups
101.809
1
101.809
25.26
.0000
Error
92.619
23
4.0300
323.500
1
323.500
885.01
.0000
Interaction
.61980
1
.61980
1. 70
.2058
Error
8. 4072
23
·)6533
Protocols
17.0
16.51
x- -
16.0
15.0
p <.01
t =3.279
14.0
Total
""''
-
-
-
''
0 13.88
'
13.0
-
-
-
-
p < .01
t=20.130
'
''
12.0
11.0
-
x~·25
Test
Time
-
,,
11.64
p < .01
t=21.979
X
p <
.01
t=3.835
10.0
9.0
-
8.0
-
x - Group A
o - Group B
MOD. BALKE
-
-
-
-
-
-
-
-
-o
8.56
U.
MICH
Figure 3. Two-way ANOVA with repeated measures for Total Test
Time. Mean between groups for each protocol denoted
by x.
39
Mean Maximum Respiratory Quotient:
Group B achieved significantly
higher mean RQ values on both test than Group A (Figure 4).
The
differences were significant at P<.05 on the Balke test and P <.01 on
the Michigan protocol (Table 13).
Interaction between groups from one
test to the other was not significant (Table 14).
TABLE 13
DESCRIPTIVE DATA FOR MEAN MAXIMUM RESPIRATORY QUOTIENT
MEAN
S.D.
RANGE
Mod. Balke
1.208
.0707
.26
U. Mich ._
1.188
.0723
.26
Mod. Balke
1.270
.0476
.15
U. Mich
1.292
.0553
.23
GROUP A
GROUP B
Anaerobic Threshold as a Percent of V0
2
Max:
Figure 5 demonstrates
both groups achieved significantly higher anaerobic thresholds on the
Michigan protocol than on the Balke test (P <.05 for Group A, P <.01
for Group B). Descriptive data can be found in Table 15.
Group A, the
aerobically trained athletes, achieved a significantly higher anaerobic
threshold than Group B, the anaerobically trained athletes, on the
modified Balke protocol (P <.05).
The difference between groups was
not significant for AT on the Michigan test.
Interaction was not
significant between groups (Table 16).
Anaerobic threshold data was calculated and expressed four ways;
as a percent of
.
vo 2
.
max, VE max, maximum heart rate, and total time.
Correlation matrices were computed on AT data for both groups on each
protocol to analyze the relationship between AT expressed as a percent
40
TABLE
14
TWO-WAY ANOVA FOR RESPIRATORY QUOTIENT
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
Groups
.09436
1
.09436
14.33
.0010
Error
.14148
23
.00659
Protocols
• 00011
1
.00011
.08
• 7774
Interaction
.00364
1
2.81
.1074
Error
.02985
23
·q9364
J
.00130
1.3
-p
1.29
N.S.
{0____- -_--_--_--------------0
1.27
1.25
------
p <. 05
t=2.149
X-----------
P< .01
t=3.203
1.21
Respiratory
Quotient
--x
1.238
1.2
N.S.
X
1.19
1.15
x - Group A
o - Group B
MOD. BALKE
U. MICH
Figure 4. Two-way ANOVA with repeated measures for mean Maximum
Respiratory Quotient. Mean between groups for each
protocol denoted by x.
41
.
of VG 2 max versus AT expressed as a percent of the other three variables
(Table 17).
AT as a percent of VE max demonstrated the most significant
correlation (mean r
=
significantly (mean r
.7074).
=
AT as a percent of max HR correlated least
.5871).
nificantly related (mean r
=
AT as a percent of total time was sig-
.6360) but this value was skewed by the
very low relationship between AT as a percent of total time and AT as a
vo 2 max
percent of
17).
(r
=
.0902) for Group A on the Michigan test (Table
The low correlation may be explained by the fact that three
subjects in Group A continued to perform for
achieving
vo 2 max.
if
least 1.67 minutes after
Several other subjects demonstrated a similar but
less significant ability to continue running without increasing 0
uptake.
2
This factor, combined with a low range for total time on the
Michigan test, altered total time tendencies for Group A as a whole.
For predictive purposes, the aerobic athletes performing the
Michigan protocol demonstrated the lowest relationships for AT as a
percent of V0
2
max versus the other three variables (Table 17).
The
modified Balke protocol produced the most significant correlations for
both groups.
TABLE 15
DESCRIPTIVE DATA FOR MEAN ANAEROBIC THRESHOLD
EXPRESSED AS A PERCENT OF V0 2 MAX
MEAN
S.D.
RANGE
Mod. Balke
77.823
7.099
24.8
U. Mich
77.408
5.047
17.0
Mod. Balke
66.692
9.505
27.7
U. Mich
73.542
7.736
22.1
GROUP A
GROUP B
42
TABLE
16
TWO-WAY ANOVA FOR MEAN ANAEROBIC THRESHOLD
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
Groups
311.840
1
311.840
4.66
.0416
Error
1539.667
23
66.942
Protocols
407.941
1
407.941
9.17
.0060
Interaction
16.0117
1
16.0117
.36
.5544
1023.103
Error
p
l
"44. 4828
23
80.0
77.41
-
75.0
N. S.
p < .05
t=l.718
Threshold. 70 ·0-
(%
vo2
max)
p < .05
t=1.87
73.54
0
X
Anaerobic
X
72.82
......
......
...... ......
p < .01
t=2.568
:x-
69.8~
0~-----
66.69
65.0-
x - Group A
o - Group B
MOD. BALKE
U. MICH
Figure 5. Two-way ANOVA with repeated measures for mean
Anaerobic Threshold expressed as a percent of
2_max.
Mean between groups for each protocol denoted by x.
vo
43
TABLE 17
RELATIONSHIP OF AT AS A PERCENT OF V0 2 MAX VERSUS
AT AS A PERCENT OF VE MAX, MAX HR, AND TOTAL TIME
.
HR
VE
TIME
GROUP A
Mod. Balke
.8301 (P < .001)
.6297 (P < .011)
.9246 (P < .001)
U. Mich
.5150 (P < .036)
.5027 (P
.040)
.0902 (P<.385)
GROUP B
Mod. Balke
.7980 (P < .001)
.6736 (P < .008)
.7861 (P < .001)
U. Mich
.6864 (P<.007)
.5422 (P
.7431 (P < .003)
MEAN r
.7074
.5871
Mean Maximum Aerobic Capacity:
vo 2
ranges for
cantly higher
(Figure 6).
<
<
.
.6360
Means, standard deviations, and
max data is shown in Table 18.
vo 2
.034)
Group A achieved signifi-
max values on both test (P <.05) than did Group B
Significantly higher values were achieved by both groups on
the University of Michigan protocol (P < • 01 for Group A, P <. 05 for
Group B).
Table 19 lists the significant level of interaction between
groups from the Balke to the Michigan test, F
= 4.38
(P <.05).
The sig-
nificant interaction indicates the difference in performance, expressed
in terms of
vo 2 max,
between the Balke and University of Michigan values
for Group A was significantly greater than the difference in performance
between protocols for Group B's
.
vo 2
max values (Figure 6).
TABLE 18
DESCRIPTIVE DATA FOR MEAN MAXIMUM AEROBIC CAPACITY
MEAN
S.D.
RANGE
GROUP A
Mod. Balke
63.446
4.460
12.7
U. Mich
67.692
4.025
11.3
GROUP B
Mod. Balke
52.625
5.616
15.6
U. Mich
54.367
6.428
21.1
44
TABLE
19
TWO-WAY ANOVA FOR MEAN MAXIMUM AEROBIC CAPACITY
(ml 0 /kg ffm/min)
2
Source
Sum of
Squares
Degrees of
Freedom
Mean
Square
F
Groups
1819.171
1
1819.171
36.96
.0000
Error
1132.080
23
49.221
111.864
1
111.864
25.06
.0000
19.570
1
19.570
4.38
.0475
102.671
23
Protocols
Interaction
Error
Group A
0 - Group B
I
-p
4.464
X -
68.0
67.69
66.0
·x }P<.01
t=5.024
64.0
X
62.0
- - - -
61.29 -
.
vo 2
p < .01
t=4.749
-X
60.0
max
58.0
p
< .01
t=3.85u
x58.25
56.0
54.370
54.0
52.0
o-52.62
MOD. BALKE
}
p <.05
t=2.061
U. MICH
Figure 6. Two-way ANOVA with repeated measures for mean Maximum
Aerobic Capacity (ml o /kg ffm/min). Mean between
2 denoted by x.
groups for each protocol
CHAPTER
5
SUMMARY, DISCUSSION, CONCLUSIONS, RECOMMENDATIONS
The purpose of this study was to determine the effects of two
different types of training background on performance of two maximum
exercise treadmill stress test protocols.
D'ta collection was conducted
"
during the Fall semester, 1984, in the Exercise Physiology Lab at
California State University, Northridge.
Twenty-five competitive male
athletes volunteered to participate in the study.
Thirteen were pre-
dominantly aerobically trained competitive triathletes or cross-country
runners.
Twelve were predominantly anaerobically trained competitive
field event athletes.
The order of protocol testing was randomized.
between tests was one week.
Maximum elapsed time
Hydrostatic weighing to determine body
composition was conducted during the week of testing for each subject.
Summary of Major Findings
1.
There was a significant level of interaction (F
between groups when performance was expressed in terms of
The difference in mean
.
vo 2
= 4.38,
vo2
P <.05)
max •
max for Group A from the modified Balke test
to the University of Michigan protocol was significantly greater than
the difference from the Balke to the Michigan test demonstrated by
Group B (Figure 6).
2.
Both groups achieved significantly higher
45
.
vo 2
max scores on
46
the Michigan protocol than on the Balke protocol.
The difference
between tests for Group A was significant at P<.01 (67.69 to 63.45
ml
o2 /kg
ffm/min).
(54.37 to 52.62 ml
3.
The difference for Group B was significant at P <.05
o2 /kg
ffm/min).
.
vo 2
Anaerobic threshold as a percent of
max was significantly
higher (P <.05) for Group A than Group Bon the modified Balke test,
72.82% versus 66.69%.
Both groups achieved significantly higher
anaerobic thresholds (Group A, P <.05; Group B, P <.01) on the Michigan
protocol (Figure 5).
4.
/
Group B achieved significantly higher RQ values on both tests
than did Group A (P < .05 on the Balke test, P <.01 on the Michigan test).
Mean maximum RQ values were 1.27 and 1.29 for Group B and 1.21 and 1.19
for Group A on the modified Balke and University of Michigan protocols
respectively.
5.
Mean total time was significantly longer on the Balke test
(P <.01) for both Group A (16.51 minutes) and Group B (13.88 minutes)
than on the Michigan test (11.64 and 8.56 minutes for Groups A and B
respectively).
6.
In terms of mean maximal heart rate, both protocols elicited
maximum results from both groups.
Group B's maximal means were identi-
cal for both tests (186.5 beats/min).
Group A's maximal means differed
by 0.1 beats (190.2 and 190.3 beats/min).
7.
Mean maximum minute ventilation values were not significantly
different between groups or tests.
Both protocols produced maximum
performances from both groups in terms of mean maximum minute ventilation.
8.
The difference between means for the ratings of perceived
47
exertion data was statistically significant (P<.05), but in practice
the ratings indicated a perception of near maximum performance on both
tests.
The University of Michigan protocol was considered the more
difficult of the two tests (17.76 to 16.92 for the Balke test).
Discussion
A review of the literature disclosed several studies which examined
various treadmill stress test protocols for the purpose of comparing
maximum physiological responses (Maksud and Coutts, 1971; McArdle, Katch,
/
and ?cchar, 1973; Froelicher et al., 1974; Pollock et al., 1976).
a f<
While
studies have compared trained versus non-trained subjects (Pollock
et al., 1976; Miyamura et al., 1978) investigations comparing groups of
specifically and differentially trained athletes have not been published.
Research to date indicates continuous, multi-stage treadmill
running protocols produce the highest maximum physiological response
values (McArdle et al., 1973; Froelicher et al., 1974; Pollock et al.,
1976).
Maksud and Coutts (1971) compared two running protocols and
found no significant differences in
vo 2 max.
In comparing walking and
running protocols, the investigations cited above found the Standard
or a modified version of the Balke protocol produced significantly
lower
.
vo 2
max values than any of several running protocols.
findings of the present investigation were consistent with
results (Figure 6).
The
~hose
The University of Michigan running protocol pro-
duced significantly higher
vo 2
max values than the modified Balke
protocol for both Groups A (P <.01) and B (P <.05).
trained athletes achieved significantly higher mean
The aerobically
.
vo 2
the anaerobically trained athletes on both protocols.
max values than
The early, low-
level stages of both protocols, and their rates of progression to
48
maximum levels prevented them from being anaerobic or power oriented
tests, the type of protocol which might have favored Group B's athletes.
Anaerobic threshold data were not collected or investigated in any
of the studies concerning treadmill protocol comparisons.
comparing test modes, AT as a percent of V0
2
In studies
max was found to be higher
on the treadmill or on those modes which elicited the highest
values (Buchfurer et al., 1982).
AT as a percent of
.
vo 2
vo 2
max
max was sig-
nificantly higher for both groups on the Michigan test, the protocol
which also produced the higher
.
vo 2
max values.
In terms of anaerobic
threshold, the Michigan protocol did not distirfguish between training
as the difference between groups A and B was not signifi-
backgrou~ds,
cant.
The significant difference between groups on the modified Balke
protocol (P <.05) agreed with the findings of Weltman and Katch (1979)
who determined that the higher the aerobic capacity, the higher the
anaerobic threshold.
When comparing walking versus running treadmill protocols, McArdle
et al. (1974) and Pollock et al. (1976) found the Balke protocol
produced significantly lower RQ values than :my of several running
protocols.
The present study found no significant differences for mean
maximum RQ values between the Balke and Michigan tests for either group.
The discrepancy between studies may be explained by the relatively high
workloads achieved on the modified Balke test in this study.
Both
McArdle and Pollock were limited by treadmills which could achieve a
maximum incline of only 22%.
minute.
Both authors increased the grade 1% each
McArdle et al. used a speed of 3.4 mph, and Pollock et al.
used 3.3 mph.
The present investigation utilized a speed of 3.4 mph on
a treadmill capable of achieving a 40% incline.
The minimum inclination
49
reached by any subject in the present study was 24%.
It is reasonable
to assume the higher levels of inclination required a greater power
output by the subjects, leading to greater percentages of anaerobic work
being accomplished, resulting in the higher mean RQ values for the Balke
protocol.
In the McArdle and Pollock studies, mean maximum RQ values
were identical at 1.09.
The modified Balke test used in this study
produced a mean RQ value for all subjects of 1.24.
Group B's significantly higher mean RQ values indicate a lower
level of aerobic efficiency relative to Group
Michigan protocol.
~
especially on the
This finding was consistent with the findings from
the anaertibic threshold data (Figure 5).
Mean maximum minute ventilation data demonstrated results similar
to and supportive of the RQ data.
between groups or protocols for
VE
There were no significant differences
max (Figure 1).
These results
differ from the findings of McArdle et al. (1974) and Pollock et al.
(1976), who found significantly lower VE max values on the Balke
protocols
versus the running protocols.
The reason for the discrepancy
may again be the higher workloads achieved on the modified Balke test in
this study.
.
Combining the VE max data with the AT and
vo 2
demonstrates the greater aerobic efficiency of Group A.
ventilated similar volumes, but the
vo 2
max data
Both groups
max data (Figure 6) shows Group
A utilized more oxygen per unit volume of air ventilated.
In terms of maximum heart rate the Balke protocols used by McArdle
et al. (1974), Froelicher et al. (1974), and Pollock et al. (1976)
elicited maximum responses, as no significant differences were found
between the Balke and various running protocols.
There were no signifi-
differences between groups or protocols for mean maximum heart rates in
50
the present study.
The anaerobically trained athletes achieved identical
mean max HR scores, 186.5 beats/min, on both protocols.
The aerobically
trained athletes differed between tests by 0.1 beats, the Balke mean
max HR being 190.2 and the Michigan HR being 190.3 beats/min.
Conclusions
Twenty-five college age, competitive male athletes volunteered to
be tested on two maximum exercise treadmill stress tests.
A modified
Balke and the University of Michigan protocols were used (Appendix A).
/
A hypothesis was established to determine whether training background
would significantly influence performance on either of the two protocols •
.
The physiological parameters investigated included V0
2
max, VE max,
anaerobic threshold, maximum heart rate, max RQ, and total test time.
Considering the limitations of the study the following conclusions were
reached:
1.
The modified Balke and Unive.rsity of Michigan protocols were
sufficiently intense to elicit maximum physiological responses.
Mean
maximum heart rate, minute ventilation, and respiratory quotient values
were not significantly different for the two protocols.
2.
Training background did not significantly influence performance
on the two protocols in terms of the following physiological parameters:
a.
.
VE max; the hypothesis for maximum minute ventilation is
accepted.
b.
Maximum heart rate; the hypothesis for HR max is accepted.
c.
Anaerobic threshold; the hypothesis for AT is accepted.
d.
Respiratory quotient; the hypothesis for max RQ is
accepted.
e.
Test time; the hypothesis for total test time is accepted.
51
3.
Significant interaction between groups on the mean
vo 2
max
data indicates performance was significantly influenced by training
background.
Data indicates the University of Michigan protocol is a
more appropriate maximum exercise test for Group A than Group B.
hypothesis for maximum aerobic capacity is rejected.
B's significantly higher mean
vo 2 max value
The
However, Group
on the Michigan test, as
compared to the modified Balke, demonstrates its appropriateness for
anaerobically trained athletes as well.
Suggestions for Further Research
/
1.
The research design used in the present study should be
applied to elderly and female populations for a comparison of results
and conclusions.
2.
The research design should be applied to sample populations
with greater disparity in their physical characteristics and/or
training background (i.e., a more objective method of determining
precise aerobic and anaerobic backgrounds).
3.
Sample populations similar to those used in this study should
be tested on protocols and modes providing greater diversity between
tests.
4.
Physiological parameters investigated should be examined
further to determine the degree of relationship between various
measures of fitness.
53
American College of Sports Medicine (1975). Guidelines for Graded
Exercise Testing and Exercise Prescription. (2nd ed.). Philadelphia:
Lea and Febiger.
American Heart Association (1972). Exercise Testing and Training of
Apparently Healthy Individuals: A Handbook for Physicians. Dallas:
American Heart Association.
American Heart Association (1975). Exercise Testing and Training of
Individuals with Heart Disease or at Risk for its Development: A
Handbook for Physicians. Dallas: American Heart Association.
Astrand, P.O. and Rhyming, I. (1954). Nomogram jor calculation of
aerobic capacity (physical fitness) from pulse rate during submaximal work. Journal of Applied Physiology, I• 218.
Astrand, P.O. and Saltin, B. (1961). Maximal oxygen uptake and heart
rate in various types of muscular activity. Journal of Applied
Physiology, ~(6), 977-981.
Balke, B. and Ware, R. (1959). An experimental study of "physical
fitness" of Air Force personnel. U.S. Armed Forces Medical Journal,
10, 675-688.
Bergh, U., Kanstrup, I-L., and Ekblom, B. (1976). Maximal oxygen uptake
during exercise with various combinations of arm and leg work.
Journal of Applied Physiology, ~(2), 191-196.
Blomqvist, G. (1971). Use of exercise testing for diagnostic and
functional evaluation of patients with arteriosclerotic heart
disease. Circulation, 44, 1120.
Borg, W. and Gall, M. (1983). Educational Research: An Introduction.
New York: Longman lnc.
Brozek, J., Grande, F., Anderson, J., and Keys, A. (1963). Densitometric
analysis of body composition: revision of some quantitative assumptions. Annals of the New York Academy of Science, ~· 113-140.
Bruce, R. (1956). Evaluation of functional capacity and exercise
tolerance of cardiac patients. Modern Concepts in Cardiovascular
Disease, 12_, 321.
Buchfurer, M., Robinson, T., Whipp, B., Hansen, J., and Wasserman, K.
(1982). Optimizing the work rate protocol for clinical exercise
tests. American Review of Respiratory Diseases, 125, 259. (Abstract)
54
Cardus, D. (1978). Exercise testing: methods and uses. Exercise and
Sport Sciences Reviews, 6, 59-103.
Cummings, G. (1972). Yield of ischemic exercise electrocardiogram in
relation to exercise intensity in a normal population. British
Heart Journal, 34, 919.
Davies, P. (1968). Limitations to the prediction of maximum oxygen
intake from cardiac frequency measurements, Journal of Applied
Physiology, 24, 700.
Davis, J., Frank, M., Whipp, B., and Wasserman, K. (1979). Anaerobic
threshold alterations caused by endurance training in middle-aged
men. Journal of Applied Physiology: Respiration, Environment,
Exercise Physiology, 46(6), 1039-1046.
Davis, J., Vodak, P., Wilmore, J., and Kurtz, P. (1976). Anaerobic
threshold and maximal aerobic power for thfee modes of exercise.
Journal of Applied Physiology, ~(4), 544-550.
Dixon, W. and Brown, M. (Eds.). (1979) BMDP Biomedical Computer
Programs. Berkeley: U.C. Press.
Dwyer, J. and Bybee, R. (1983). Heart rate indices of the anaerobic
threshold. Medicine and Science in Sports and Exercise, 15(1),
72-76.
Ellestad, M. (1980). Stress Testing: Principles and Practice (2nd ed.).
Philadelphia: F.A. Davis Co.
Ellestad, M., Allen, W., Wan, M., and Kemp, G. (1969). Maxit:<3.l treadmill
stress testing for cardiovascular evaluation. Circulation. 39, 517.
Fairshter, R., Walters, J., Salness, K., Fox, M. Minh, V-D., and
Wilson, A. (1983). Acomparison of incremental exercise test during
cycle and treadmill ergometry. Medicine and Science in Sports and
Exercise, 15,(6), 549~554.
Faulkner, J., Roberts, D., Elk, R., and Conway, J. (1971). Cardiovascular responses to submaximum and maximum effort cycling and
running. Journal of Applied Physiology, 30(4), 457-461.
Fletcher, G. (1973). Submaximal treadmill exercise evaluation in
patients with symptoms of cardiovascular disease; an aid to
rehabilitation and reemployment. Chest, .§l. 153.
Froelicher, V. Jr., Brammel, H., Davis, G., Noguera, I., Alderus, S.,
and Lancaster, M. (1974). A comparison of the reproducibility and
physiologic response to three maximal treadmill exercise protocols.
Chest, 65(5), 512-517.
Gilbert, R. and Auchincloss, J. (1971). Comparison of cardiovascular
responses to steady-state and unsteady-state exercise. Journal of
Applied Physiology, 30, 388.
55
Gleser, M. and Vogel, J. (1971). Endurance exercise: effect of workrest schedules and repeated testing. Journal of Applied Physiology,
l.!_, 735.
Hagberg, J., Coyle, E., Miller, J., Carroll, J., and Martin, W. (1981).
Ventilatory threshold without increasing blood lactic acid levels
in Mcardle's disease patients - anaerobic threshold? Medicine and
Science in Sports and Exercise, ..!]_, 115. (Abstract)
Hermansen, L. and Saltin, B. (1969). Oxygen uptake during maximal
treadmill and bicycle exercise. Journal of Applied Physiology, 26,
(1), 31-37.
Issekutz, B. Jr., Birkhead, N., and Rodahl, K. (1962). Use of respiratory quotients in assessment of aerobic work capacity. Journal of
Applied Physiology, 12(1), 47-50.
Issekutz, B. Jr. and Rodahl, K. (1961). Resp1fatory qoutient during
exercise. Journal of Applied Physiology, ~(4), 606-610.
Jones, N~ (1975). Exercise testing in pulmonary evaluation: rationale,
methods adn the normal respiratory response to exercise. The New
England Journal of Medicine, 293(11), 541-544.
Jones, N. (1975). Exercise testing in pulmonary evaluation: clinical
applications. The New England Journal of Medicine, 293(13), 647-650.
Kamon, E. and Pandolf, K. (1972). Maximal aerobic power durring laddermill climbing, uphill running, and cycling. Journal of Applied
Physiology, ~(4), 467-473.
Karlsson, H. and Wigertz, 0. (1971). Ventilation and heart rate responses
to ramp-function changes in work load. Acta Physiologica Scandinavica , ~. 215.
Kattus, A., Jorgansen, C., Worden, R., and Alvaro, A. (1971). STsegment depression with near maximal exercise in the detection of
preclinical coronary artery disease. Circulation, 44, 585.
Koyal, S., Whipp, B., Huntsman, D., Bray, G., and Wasserman, K. (1976).
Ventilatory responses to the metabolic acidosis of treadmill and
cycle ergometry. Journal of Applied Physiology, 40(6), 864-867.
Lamb, D. (1984). Physiology of Exercise: Responses and Adaptations.
New York: MacMillan Publishing Co.
Maksud, M. and Coutts, K. (1971). Comparison of a continuous and
discontinuous graded treadmill test for maximum oxygen uptake.
Medicine and Science in Sports, 1(2), 63-65.
56
Margaria, R., Olivia, R., diPrampero, P., and Cerretelli, P. (1969).
Energy utilization in intermittent exercise of supramaximal
intensity. Journal of Applied Physiology, ~· 752-756.
Mathews, D. and Fox, E. (1976). The Physiological Basis of Physical
Education and Athletics (2nd ed.). Philadelphia: W.B. Saunders Co.
McArdle, W., Katch, F., and Katch, V. (1981). Exercise Physiology:
Energy, Nutrition, and Human Performance. Philadelphia: Lea and
Febiger.
McArdle, W., Katch, F., and Pechar, G. (1973). Comparison.of continuous
and discontinuous treadmill an(1 bicycle tests for max vo2.
Medicine and Science in Sport<:: 20), 156-160.
McHenry, P., Phillips, J., and Kn ::~bel, S. (1972). Correlation of
computer-quantitated treadmill exercise electrocardiogram with
arteriographic location of cor:mary artery lis ease. American Journal
of Cardiology, 30, 747.
Miyamura, M. and Honda, V. (1972). Oxygen intake and cardiac output
during maximal treadmill and bicycle exercise. Journal of Applied
Physiology, 32(2), 185-188.
Miyamura, M., Kitamura, K., Yamada, A., and Matsui, H. (1978). Cardiorespiratory responses to maximal treadmill and bicycle exercise
in trained and untrained subjects. Journal of Sports Medicine, ~.
25-32.
Nagle, F. (1973). Physiological assessment of maximal performance.
Exercise and Sport Sciences Reviews, l• 313-338.
Naimark, A., Wasserman, K., and Mcilroy, M. (1964). Continuous
measurement of ventilatory exchange ratio during exercise. Journal
of Applied Physiology, ~(4), 644-652.
Patterson, J., Naughton, J., Pietros, R., and Gunnar, R. (1972).
Treadmill exercise in assessment of the functional capacity of
patients with cardiac disease. American Journal of Cardiology, 30,
757.
Pollock, M., Bohannon, R., Cooper, K., Ayers, J., Ward, A., White, S.,
and Linnerud, A. (1976). A comparative analysis of four protocols
for maximal treadmill stress testing. American Heart Journal, 92(1),
39-46.
Redwood, D. and Epstein, S. (1972). Uses and limitations of stress
testing in evaluation of ischemic heart disease. Circulation, 46,
1115.
57
Redwood, D., Rosing, D., Goldstein, R., Beiser, G., and Epstein, S.
(1971). Importance of the design of an experimental protocol in an
evaluation of patients with angina pectoris. Circulation, 43, 618628.
Reybrouk, T., Heigenhauser, G., and Faulkner, J. (1975). Limitations to
maximum oxygen uptake in arm, leg, and combined arm-leg ergometry.
Journal of Applied Physiology, 38(5), 774-779.
Skinner, J. and McLellan, T. (1980). The transition from aerobic to
anaerobic metabolism. Research Quarterly for Exercise and Sport,
~(1), 234-248.
Taylor, H., Buskirk, E., and Henschel, A. (1955). Maximal oxygen intake
as an objective measure of the cardio-respiratory performance.
Journal of Applied Physiology, ~. 73-80.
/
Taylor, H., Wang, Y., Rowell, L., and Blomqvist, G. (1963). The
standardization and interpretation of submaximal and maximal tests
of working capacity. Pediatrics, ~(2), 703-722.
Wasserman, K., Van Kessel, A., and Burton, G. (1967). Interaction of
physiological mechanisms during exercise. Journal of Applied
physiology, ~(1), 71-85.
Wasserman, K., Whipp, B., Koyal, S., and Beaver, W. (1973). Anaerobic
threshold and respiratory gas exchange during exercise. Journal of
Applied Physiology, ~~(2), 236-243.
Weltman, A. and Katch, V. (1979). Relationship between the onset of
metabolic acidosis (anaerobic threshold) and maximal oxygen uptake.
Journal of Sports Medicine,~. 135-141.
Wessermil, M. and Toor, M. (1968). Clinical and electrocardiographic
observation of patients with ischemic heart disease during multistage submaximal exercise. Cardiology, 53, 158.
Whipp, B., Davis, J., Torres, F., and Wasserman, K. (1981). A test to
determine parameters of aerobic function during exercise. Journal of
Applied Physiology: Respiration, Environment, and Exercise Physiology ' 50 (1 ) ' 21 7-2 2 1.
Whipp, B. and Wasserman, K. (1972). Oxygen uptake kinetics for various
i': ensities of constant-load work. Journal of Applied Physiology,
-~~ (3)' 351-356.
Yeh, M., Gardner, R., Adams, T., Yanowitz,F., and Crapo, R. (1983).
"Anaerobic threshold": problems of determination and validation.
Journal of Applied Physiology: Respiration., Environment, and
Exercise Physiology, 55(4), 1178-1186.
-··
/
APPENDICES
APPENDIX A
MODIFIED BALKE PROTOCOL
UNIVERSITY OF MICHIGAN PROTOCOL
60
MODIFIED BALKE
Stage
Speed
mph
Grade
%
Duration
min.
Predicted
V0 2
ml/kg/min
METS
-
I
3.4
2
1
15.9
4.5
II
3.4
4
1
19.2
5.5
III
3.4
6
1
22.4
6.4
IV
3.4
8
1
25.7
7.4
v
3.4
10
1
29.0
8.3
VI
3.4
12
1
32.3
9.2
35.6
10.2
I
VII
3.4
14
1
VIII
IX.
3.4
16
1
38.9
11.1
3.4
18
1
42.1
12.0
X
3 .l~
20
1
45.5
13.0
XI
3.4
22
1
48.7
13.9
XII
3.4
24
1
52.0
14.8
XIII
3.4
26
1
55.3
15.8
XIV
3.4
28
1
58.6
16.7
XV
3.4
30
1
61.8
17.7
"
30
26
22
18
% Grade 14
10
6
2
0
3.4 mph
~1~2~~3--4~-5~~.~6~~7~8~~9--~10~~17
1~1~2~~13~~17
4~1~5~
Minutes
61
UNIVERSITY OF MICHIGAN
Stage
Speed
mph
Grade
I
3.0
0.0
II
5.0
III
Duration
min.
Predicted
V0 2
ml/kg/min
METS
2
10.5
3.0
5.5
2
37.5
10.7
7.0
7.5
2
53.5
15.3
IV
7.0
9.5
2
56.7
16.2
v
7.0
13.5
4
65.5
18.7
VI
7.0
15.5
2
70.0
20.0
%
I
'
15.57 mph
13.5 7 mph
l1.5 -
% Grade
9.5-
7mph
7.5 -
7 mph
5.5 0
5 mph
3 mph
2
4
6
·.-< ...
8
Minutes
10
12
14
APPENDIX B
INFORMED CONSENT
63
INFORMED CONSENT FOR MAXIMAL EXERCISE TESTING
I,
, voluntarily consent to undergo two maximal
exercise stress tests for the purpose of assisting Larry David in completing the requirements for a Master's Degree. I also consent to an
underwater weighing for the purpose of determining my body composition.
The statistical data collected will be analyzed and utilized only in the
thesis.
The two tests I perform will be conducted on a motor driven treadmill, beginning with a low intensity and progressing to maximal effort.
Maximum performance will be determined by my heart rate, minute ventilation, oxygen uptake, and/or a combination of these factors. The underwater weighing and accompanying pulmonary function test will be conducted during the one week period in which the stress tests are completed.
/
I understand that I may discontinue either of the two treadmill
tests at any time if I am unable to continue. Before, during and after
each test my heart rate, blood pressure and electrocardiogram will be
monitored by a trained exercise physiologist. During each test, specific respiratory measurements will be taken. I realize that certain
abnormal physiologic changes may occur during the course of a test.
These changes include abnormal blood pressure responses, fainting,
multiple arrhythmias, and rare occurrences of heart attack.
The data collected during the tests will be considered confidential
and will not be used or released for reasons other than the completion
of the thesis project without my expressed written consent. The information obtained will be used for statistical analysis and my right of
privacy will be retained.
To the best of my knowledge I have no medical or physiological
abnormalities which would endanger me or prevent my maximum performance.
My last medical-physical examination was
, and I was cleared
for unlimited physical activity.
I have read and understand this form and the tests I shall perform.
I agree to participate freely in this study.
SUBJECT
--------------------------------·
WITNESS
------------------------------------
TECHNICIAN
--------------------------------Larry David
DATE
----------------
.......................------------------
;
I
APPENDIX C
GROUP A - PHYSIOLOGIC PARAMETERS
GROUP B - PHYSIOLOGIC PARAMETERS
LL
65
Subject
vo
L
2
GROUP A
vo
2
ml/kg ffm/
min
VE
BTPS
VE
STPD
HR
RQ
AT
%V0 2
TOTAL
TIME
1. MB
4.599
59.9
136.7
108.9
188
1.29
UM
63.6
4.860
63.3
15.58
147.2
118.2
195
1.33
76.3
10.58
2. MB
3.767
67.8
119.2
95.7
196
1.10
UM
4.017
69.5
72.3
18.00
137.9
110.7
200
1.16
73.1
12.00
3. MB
4.614
62.8
123.7
99.3
189
1.18
UM
4.820
73.8
65.6
17.00
130.6
104.9
180
1.21
71.8
16.25
4. MB
4.794
57.6
162.0
130.1
184
1.27
UM
5.527
83.8
66.4
15.50
165.8
133.1
uf8
1.28
81.5
11.50
5. MB
4.331
57.4
177.5
142.5
176
1.36
UM
-4.670
68.1
15.75
61.9
156.8
125.9
180
1.22
76.8
12.17
6. MB
4.731
65.0
147.1
118.1
188
1.15
UM
5.270
68.2
17.00
72.4
149.2
119.8
190
1.07
84.0
12.25
7. MB
4.521
70.1
136.7
109.8
171
1.19
UM
4.721
77.5
18.17
73.2
139.3
111.9
175
1.17
79.6
13.17
8. MB
4.916
67.0
154.0
123.7
202
1.21
UM
5.033
75.7
16.75
68.6
150.3
120.7
200
1.16
82.8
12.50
9. MB
4.339
64.2
143.8
115.5
198
1.19
UM
4.332
59.0
15.50
64.1
138.4
111.1
186
1.24
74.1
10.17
10. MB
4.302
64.1
131.1
105.3
195
1.19
UM
4.819
70.7
17.30
71.8
139.8
112.3
198
1.14
83.0
11.58
11. MB
3.647
60.1
121.1
97.2
195
1.15
UM
78.2
4.053
16.00
66.8
117.0
93.9
198
1.14
67.0
11.00
12. MB
3.654
58.8
122.2
98.1
196
1.27
80.9
UM
3.915
15.08
63.0
108.4
87.1
190
1.23
77.7
9.00
13. MB
5.366
70.0
163.1
130.9
195
UM
1.16
77.7
5.412
17.00
70.6
144.4
115.9
194
1.10
76.1
14.17
66
GROUP B
vo 2
vo
VE
BTPS
VE
STPD
HR
L
2
ml/kg ffm/
min
1. MB
4.171
58.2
130.4
104.7
185
UM
3.892
54.3
124.8
100.2
2. MB
3.999
58.0
124.0
UM
4.385
63.6
3. MB
4.446
UM
4. MB
Subject
RQ
AT
%V0
2
TOTAL
TIME
1.26
77.6
15.25
188
1.31
63.7
9.25
99.6
186
1.26
58.1
15.50
134.2
107.8
190
1.31
79.5
10.17
49.5
150.2
120.6
194
1.35
70.9
12.00
4.697
52.3
120.1
96.4 / 192
1.31
81.5
6.50
5.149
60.1
126.1
101.2
192
1.20
59.1
16.00
. 5.594 .
65.3
129.0
103.6
190
1.15
81.7
9.75
5. MB
5.399
45.6
162.4
130.4
176
1.30
78.7
11.08
UM
5.233
44.2
}';7. 9
110.7
175
1.31
80.9
5.58
6. MB
4.249
44.5
115.4
92.7
175
1.21
71.1
11.17
UM
4.402
46.1
121.0
97.2
174
1.27
65.9
6.50
7. MB
4.899
55.2
150.5
120.8
180
1.31
61.1
15.67
UM
5.041
56.8
160.9
129.2
180
1.27
71.5
9.83
8. MB
3.869
48.6
131.2
105.3
184
1.23
68.3
13.93
UM
4.323
54.3
137.4
110.3
180
1.26
74.4
9.58
9. MB
5.246
57.5
131.9
105.9
185
1.31
75.6
16.25
UM
5.173
56.7
139.4
111.9
184
1.38
72.5
10.25
10. MB
4.646
56.2
144.0
115.6
195
1.32
54.6
14.00
UM
4.514
54.6
147.5
118.4
198
1.30
69.2
8.67
11. MB
3.938
52.3
131.6
105.7
198
1.27
74.2
13.17
UM
4.307
57.2
159.4
128.0
202
1.30
81.9
9.17
12. MB
4.612
45.8
148.5
119.2
188
1.32
51.0
12.50
UM
4.733
47.0
142.6
114.5
185
1.34
59.8
7.50
UM
-
/
APPENDIX D
GROUP A - PHYSICAL CHARACTERISTICS
GROUP B - PHYSICAL CHARACTERISTICS
68
GROUP A - PHYSICAL CHARACTERISTICS
vc
HT
WT
em
kg
23
176.5
76.78
63.69
10.9
4.64
1.075
2
18
178.0
55.56
49.93
10.1
4.95
1.077
3
25
180.0
73.48
68.06
7.4
5.24
1.084
4
26
190.5
83.24
75.91
8.8
6.52
1.080
ID
AGE
1
WT
kg/ffm
% FAT
/
BTPS
DENSITY
5
31
181.0
75.45
67.11
8.9
7.05
1.080
6
23
175.0
72.79
65.36
10.5
4.88
1.076
7
22
178.0
64.50
57.71
10.5
5.11
1.076
8
19
177.8
73.37
65.07
11.3
5.95
1.074
9
23
174.0
67.59
59.94
11.3
4.29
1.074
10
23
168.9
67.72
61.48
6.2
4.38
1.087
11
22
167.6
60.68
56.64
6.6
3.80
1.086
12
19
179.1
62.14
54.02
12.1
4.12
1.072
13
23
177.8
76.66
68.16
9.3
5.89
1.079
Mean
23.85
177.25
69.95
62.56
9.53
5.14
1.078
S.D.
3.363
5.638
9.929
6.237
1.87
.968
.0091
Range
13
22.9
27.68
25.98
5.9
3.25
.015
69
GROUP B - PHYSICAL CHARACTERISTICS
vc
WT
kg/ffm
% FAT
71.76
63.21
11.8
4.93
1.071
178.0
68.95
62.54
9.3
4.54
1.079
21
182.8
89.81
79.65
11.3
4.60
1.074
4
22
179.4
85.67
78.05
8.9
4.86
1.076
5
26
187.3
118.40
92.03
22.3
5.18
1.047
6
21
185.4
95.48
80.88
15.3
5.07
1.064
7
20
184.5
88.75
77.74
12.4
4.78
1. 071
8
21
184.1
79.61
74.60
6.3
4.55
1.082
9
23
181.3
91.24
79.01
13.4
5.57
1.068
10
19
182.8
82.67
73.65
10.9
4.95
1.070
11
19
183.0
75.30
70.03
7.0
4.64
1.085
12
24
H35.4
100.70
88.51
12.1
5.62
1.072
Mean
21.25
183.28
87.35
76.66
11.75
4.94
1.072
S.D.
2.276
2.921
13.667
8. 772
.377
.0095
49.45
29.49
1.08
.038
HT
em
ID
AGE
1
21
185.4
2
18
3
Range
8.0
9.3
WT
kg
I
"
18.0
BTPS
DENSITY
APPENDIX E
NON-INVASIVE DETERMINATION OF ANAEROBIC THRESHOLD
71
Subject #6: Group A - University of Michigan
140
130
120
.
AT
110
I
100
I
/I
VE
90
(L)
80
70
60
50
40
17
FE
0
16
2
(%)
15
1.1
1.0
RQ
.9
.8
--4
VE/C0
(x)
VE/0
2
(o)
2
X
X
X
X
3
0
0
0
0
X
0
0
X
X
X
6
7
8
9
X
0
0
4
5
0
2
1
2
3
Minutes
APPENDIX F
DATA COLLECTION CHARTS
Body Composition
Exercise Test Data
7')
73
BODY COMPOSITION DATA
Name
-------------------------------- Group---------- Date-------------
Age
----------
Residual Volume
2.54
Ht--------- in
x
Wt---------lbs
. 2.2046
-------------
liters
Water Temperature ____________ °C
_______em
=
______kg
(helium equilibration)
DbH 0 ---------- Tare Wt____________
2
Hydrostatic Weighings: 1. _________
2.
=
5.
------------
----------- 6. --------
3. ________
7. ________
4 ·---------
8.
-------
Average of final 3 trials: ________ - Tare Wt = _________kg
MA
% Fat
100
X
=
(4.57 - 4.142)
Fat Mass = MA
X
% Fat
100
Db
=-------%
Fat Free Mass
MA - bodyfat mass
_______kg
=_ _ _ _ _ _kg
EXERCISE TEST DATA
Subject
Minute
Group
Wkload
mph/%Grd
HR
Date
VE BTPS
Age
vo 2
VE STPD
Wt
1
%Fat
FFM
vo
ml/kglmin
vo 2
ml/kg ffm/
min
THR
vco 2
1
VE
MB
0
2
VECO
UM
RQ
2
1
2
I
3
4
5
6
7
,,
8
9
10
11
12
13
14
-----
---~---------·
L _ _ _____________
~--
--
-----
--
.......
~
---------••••••••••••1'1·1-•·
iliiillll•lllillill•••••-
1
·l"'l;""l""l""'l·-1'?1'"i'J0'i·'"'ii''·'ii.""I.''I'.''Bi>'l<····..l·l·
24
1960's, both
a diagnostic and evaluative tool.
It serves as a method
by which clim.ci;ms may evaluate the physiological responses to stress,
determine a subject's functional capacity, and diagnose the possible
presence of coronary artery disease.
The physiological parameters most
often investigated include aerobic or functional capacity
.
(vo 2
max),
minute ventilation (VE), anaerobic threshold (AT), respiratory quotient
(RQ), maximum heart rate, attd total test time.
Their effects on and
interaction with each other may be influenced by the manipulation of
exercise test variables.
The treadmill and bicycle ergometers have become the' most popular
of the st::veral test modes used.
Test variables include starting work-
loads, amount of workload increases on succesive work stages, time at
each stage, and time o± rest periods on discontinuous protocols.
number of protocols can be and have been developed.
A
The evolution of
protocol variety has prompted investigators to compare protocols and
modes to determine possible significant differences in results
obtained.
In conducting an investigation to compare modes or protocols, many
factors must be controlled or accounted for.
Some necessary controls
include; 1) subject population, motivation, age, and sex; 2) modes
utilized; 3) subject fitness levels; 4) specific protocols compared;
5) interactive effects of physiological pe;Tameters; and 6) overall
research design.
The research to date al:inws for acceptance of several
general principles.
Manipulation of key test variables may or may not
produce significant physiological response differences.
values, particularly
.
vo 2 ,
Higher maximum
will be obtained by protocols which require
the involvement of greater muscle mass.
Continuous, multi-stage
BIBLIOGRAPHY
52
APPENDIX A
MODIFIED BALKE PROTOCOL
UNIVERSITY OF MICHIGAN PROTOCOL
59
..
APPENDIX D
GROUP A - PHYSICAL CHARACTERISTICS
GROUP B - PHYSICAL CHARACTERISTICS
67
APPENDIX E
NON-INVASIVE DETERMINATION OF ANAEROBIC THRESHOLD
70