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Case report
The prediction of maximal oxygen uptake from
submaximal ratings of perceived exertion elicited
during the multistage fitness test
R C Davies, A V Rowlands, R G Eston
School of Sport and Health
Sciences, University of Exeter,
UK
Correspondence to:
Professor Roger Eston, School of
Sport and Health Sciences,
University of Exeter, St. Luke’s
Campus, Heavitree Road, Exeter
EX1 2LU, England, UK;
[email protected]
Accepted 22 January 2008
Published Online First
28 February 2008
ABSTRACT
The purpose of this study was to assess whether maximal
oxygen uptake (V̇O2max) could be predicted from
submaximal ratings of perceived exertion (RPE) elicited
during the multistage fitness test (MFT). Eleven female
volunteers completed three maximal exercise tests in
random order; the MFT, a simulated MFT on a motorised
treadmill and a graded exercise test to volitional
exhaustion (GXT), also on a motorised treadmill. RPE
values were recorded at the end of each 1 min stage in
all three tests. Oxygen consumption (VO2) was recorded
continuously during the treadmill tests. Measured V̇O2max
values from the GXT and simulated MFT were not
significantly different (48.2 and 47.5 ml/kg/min, respectively), but they were significantly higher than V̇O2max
values predicted by the MFT (41.2 ml/kg/min, p,0.05).
Regression of submaximal RPE values (7–17) elicited from
the MFT and VO2 values predicted by the MFT were
extrapolated to RPE 20 to predict V̇O2max. The RPEpredicted V̇O2max from the MFT (47.5 ml/kg/min) was
similar to measured V̇O2max. The findings suggest that
submaximal RPE values can be used to provide
acceptable estimates of V̇O2max which are more accurate
than the published table values for the MFT. Furthermore,
the use of RPE measures in conjunction with the MFT
enhances the accuracy of V̇O2max prediction by the MFT.
The need for expensive and sophisticated technical
equipment to measure maximal oxygen uptake
(V̇O2max) has encouraged exercise scientists to
develop a range of field tests that attempt to
predict V̇O2max. The multistage fitness test (MFT)1
is arguably the most widely used test of aerobic
fitness in the United Kingdom and is employed by
many agencies including schools, sports clubs and
the armed forces. The popularity of the MFT is due
in no small part to the fact that it requires no
specialist equipment or tester expertise and can be
used to test large numbers at one time. Modified
from the original Léger and Lambert2 20 m multistage shuttle run test, the MFT is a maximal
exercise test which requires subjects to run
between two markers which are 20 m apart in
time with a series of audio signals emitted from a
pre-recorded tape or CD. The prediction of V̇O2max
from the final level and shuttle achieved by the
subject is commercially available as a table of
predicted maximal oxygen uptake values and is
included in the multistage fitness test CD pack.1
The MFT prediction of V̇O2max correlates well
(eg,
with
laboratory-determined
V̇O2max
Ramsbottom et al,3 r = 0.92; Wilkinson et al,4
r = 0.91; McNaughton et al,5 r = 0.82). However,
1006
the reliance on the use of correlation coefficients,
which infer relationships but not necessarily
agreement, has been criticised.6 7 Using the 95%
Limits of Agreement analysis,7 Cooper et al8
concluded that the MFT routinely underestimated
laboratory-determined V̇O2max. Other assessments
of the agreement of MFT-predicted and laboratorydetermined V̇O2max have also shown a tendency
for the MFT to underpredict.9–12 Improvements to
the MFT’s ability to predict V̇O2max have been
proposed. These have included new sport-specific12
or gender-distinct11 regression equations. However,
an alternative to altering the widely used MFT
table may be to improve its validity by incorporating additional measures such as ratings of perceived
exertion (RPE).
The application of RPE in exercise testing and
prescription is recommended by the American
College of Sports Medicine (ACSM).13 The 6–20
RPE Scale14 is well established as the most widely
used scale to assess perceived exertion.15 The scale
is frequently utilised to complement the use of
objective physiological markers of the exercise
response and to aid the prescription of exercise
intensity in healthy populations16–19 and some
clinical groups.20–22 Several studies have extrapolated the submaximal heart rate or VO2 responses
to a theoretical maximal RPE of 20 to predict
maximal functional capacity23 and peak or maximal V̇O2max.24 25 More recently Eston et al 18 19 26
and Faulkner et al 27 have demonstrated the validity
of predicting V̇O2max from perceptually regulated
graded exercise tests (active production mode),
whereby participants exercised at intensities corresponding to RPE 9, 11, 13, 15 and 17 on the Borg
scale. Faulkner and Eston28 have also shown that
V̇O2max can be predicted from submaximal ranges
of RPE elicited during a graded exercise test to
volitional exhaustion. The findings from these
studies provide strong evidence that the relationship between RPE and VO2 can enable V̇O2max to
be predicted with acceptable accuracy, whether
this is guided by RPE or whether it is predicted
from RPE elicited during a graded exercise test.
However, investigations into the use of RPE in field
tests are sparse. No previous studies have
attempted to monitor RPE during performance of
the MFT.
The purpose of this study was to assess the
efficacy of predicting V̇O2max from RPE values
elicited during the MFT. On the basis of strong
individual linear relationships between RPE
and oxygen uptake, we hypothesised that acceptable estimates of V̇O2max could be made from
Br J Sports Med 2008;42:1006–1010. doi:10.1136/bjsm.2007.043810
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Case report
submaximal RPE values elicited during the MFT and that these
would enhance the accuracy of the test.
METHODS
Participants
Eleven physically active women (28.1 (SD 7.1) years, 65.8 (SD
5.4) kg, 1.68 (SD 0.05) m), asymptomatic of illness and preexisting injury, volunteered to take part in the study.
Participants were all active members of various local hockey,
rowing, football and cricket clubs. The study received institutional ethics approval and written informed consent was
obtained from all participants prior to testing.
Procedures
Participants completed three continuous incremental exercise
tests to volitional exhaustion in random order. These comprised
two laboratory-based sessions and one field assessment,
separated by a minimum period of 48 h.13 Prior to testing,
participants were familiarised with the equipment and the
exercise protocols. Participants were familiarised with Borg’s 6–
20 RPE Scale, provided with standardised instructions on how
to employ the scale and encouraged to focus on their overall
perception of exertion in their responses. Participants were
required to work to volitional exhaustion to determine V̇O2max
in all three tests. Standard criteria were used to corroborate the
attainment of V̇O2max.13
Field assessment
The 20 m Multistage Fitness Test (MFT)1 was performed in a
sports hall environment in accordance with the test procedure
instructions supplied with the CD package. Participants ran in
groups and were required to complete as many stages of a 20 m
shuttle run as possible until volitional exhaustion. Prior to
assessment, participants were asked to listen to a standardised
explanation of the test and perform a gentle warm up and
stretch. Subjects then ran continuously between 20 m markers,
turning in response to an auditory signal emitted from the
prerecorded CD. The pace for the first 1 minute level was set at
8 km/h, but accelerated progressively with each subsequent
1 minute level. On reporting an RPE of 15, participants were
verbally encouraged until they reached exhaustion and the test
was completed. However, if a participant failed to reach the
marker before the audio signal on three consecutive shuttles, she
was retired from the test.
Heart rate was monitored continuously using the Polar Team
System, which is an integrated heart rate monitoring system
comprising transmitter belts and an interface unit. The logged
heart rate data were subsequently downloaded using the Polar
Precision Performance Software (Polar Electro, Kempele, Finland).
The RPE scale was displayed on a large clipboard and held directly
in front of the participants at one end of the 20 m shuttle.
Participants reported an RPE at the end of each exercise level and
on completion of the test. No measured VO2 data were recorded
during the participants’ performance of the MFT.
signals of the prerecorded CD (level 1 = 8 km/h, level 2 = 9 km/
h with an increase of 0.5 km/h for each subsequent level). The
GXT also required the subjects to run continuously, but, rather
than increasing the running speed, exercise intensity was
adjusted by progressively increasing the gradient. The motorised
treadmill was set at 9 km/h throughout the test and the
gradient was manipulated by the investigator, starting at 0% for
the first 1 minute level and increasing by 1% at each subsequent
1 minute level.
The laboratory-based sessions were performed on a motorised
treadmill (Woodway, Weil am Rhein, Germany) and respiratory
gas analysis was carried out via an online system every 10 s
throughout the tests (Cortex MetaLyzer II, Biophysik, Leipzig,
Germany). The system was calibrated prior to every test in
accordance with manufacturer’s guidelines against known
concentrations of cylinder gases (5% oxygen, 15% carbon
dioxide) and a 3 l calibration syringe (for flow volume). Heart
rates were monitored using a wireless chest strap telemetry
system (Polar Electro T31, Kempele, Finland) and recorded
continuously via a link to the Cortex gas analysis system. The
RPE scale was fixed on the wall in full view of the participants
and participants were asked to report an RPE value at the end of
each exercise level and on completion of the test. All
physiological outputs were concealed from the participants
during the testing procedures.
DATA ANALYSIS
Comparison of maximum scores
Measured V̇O2max values from the two treadmill tests and the
table-predicted V̇O2max value1 for the MFT were compared via a
one-way repeated-measures analysis of variance (ANOVA).
Mauchly’s test was applied and the degrees of freedom corrected
using the Greenhouse-Geisser estimates where sphericity was
violated. Post-hoc analyses of significant effects were performed
with paired t tests where appropriate. The Bonferroni technique
was used to adjust the alpha value to offset the increased risk of
type 1 error that occurs when multiple ANOVA comparisons
are analysed.
Prediction of V̇O2max from submaximal MFT RPE
To investigate whether submaximal RPEs from the MFT could
be used to predict V̇O2max, submaximal oxygen uptake values
from the table of predicted V̇O2max values1 were regressed
against RPE. Linear regression analysis was performed for each
participant on four different submaximal RPE ranges (9–17, 7–
17, 9–15 and 11–17). In order to predict V̇O2max at RPE 20 from
the submaximal values, the following equation was employed:
V̇O2max = a + b (RPE 20) (fig 1).
RPE-predicted V̇O2max (RPE ranges 9–17, 7–17, 9–15 and 11–
17) and measured V̇O2max values from the GXT were then
compared via a one-way repeated-measures ANOVA. Mauchly’s
test of sphericity was applied and the Greenhouse-Geisser
correction factor was employed where necessary (p,0.05). Posthoc analysis was performed with paired t tests, with an
adjustment made to alpha via the Bonferroni technique.
Treadmill assessments
Two laboratory-based assessments of V̇O2max were performed:
one graded exercise test (GXT) and one simulation of the MFT.
The laboratory-based, treadmill simulation of the MFT
(Simulated MFT) replicated the pace and the auditory stimulus
of the MFT whilst facilitating online pulmonary gas analysis.
The treadmill was set at a gradient of 1%29 and the speed was
manipulated by the investigator in time with the auditory
Br J Sports Med 2008;42:1006–1010. doi:10.1136/bjsm.2007.043810
Reliability analysis
The consistency of the mean V̇O2max from test to test was
quantified in accordance with the recommendations of Lamb et
al30 and Bland and Altman.7 Intraclass correlation coefficients
(ICCs) were calculated via a two-way mixed-effect model to
assess the consistency of the V̇O2max scores (GXT, MFT and
simulated MFT). Similarly, the accuracy of V̇O2max predictions
1007
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Case report
Table 1 Maximal values for oxygen uptake (V̇O2max), ratings of
perceived exertion (RPEmax), heart rate (HRmax) and respiratory exchange
ratio (RERmax) recorded during each of the three maximal tests
Test
V̇O2max
(ml/kg/min)
RPEmax
HRmax
(beats/min)
RERmax
MFT
Simulated MFT
GXT
41.2 (7.7)
47.5 (10.0)
48.2 (9.7)
18.0 (1.2)
19.4 (0.9)
19.5 (0.5)
187 (7.4)
187 (8.1)
187 (10.1)
n/a
1.06 (0.1)
1.07 (0.1)
Values are mean (SD).
GXT, graded exercise test; MFT, multistage fitness test.
from submaximal RPE:VO2 relationships, compared with
V̇O2max measured in the GXT, was assessed by ICCs.
The agreement (difference and random error) between MFT
table-predicted V̇O2max and measured values from the GXT was
quantified using the 95% Limits of Agreement (LoA) technique.7
In addition, the LoA between the submaximal RPE-predicted
V̇O2max (RPE ranges 9–17, 7–17, 9–15 and 11–17) and measured
GXT values were quantified. All LoA statistics were calculated
on the basis of the tested assumption that the errors
(differences) were normally distributed and heteroscedastic.
All recorded data were analysed using the statistical software
package SPSS for Windows (version 13) and alpha was set at
0.05.
RESULTS
Comparison of maximum scores
Maximal values for all tests are shown in table 1. A comparison
of the mean measured V̇O2max values from the GXT and
simulated MFT and the mean table-predicted V̇O2max values for
the MFT revealed significant differences (F (2, 20) = 15.4, p,0 .01)
(fig 2). Post-hoc paired sample t tests showed no significant
differences between the mean measured V̇O2max values of the
GXT and simulated MFT (t(10) = 0.8, p.0.017). The tablepredicted mean V̇O2max of the MFT was significantly lower than
both the mean measured V̇O2max value of the GXT and the mean
measured V̇O2max value of the simulated MFT (t(10) = 4.9,
p,0.017 and t(10) = 3.8, p,0.017, respectively) (fig 2).
Table 2 Reliability analyses for the comparison of measured V̇O2max
from the GXT and predicted V̇O2max values from submaximal RPE in the
MFT and from the MFT table prediction of V̇O2max
Mean
difference*
(95% LoA)
ICC
RPE 9–17
RPE 7–17
RPE 9–15
RPE 11–17
MFT Table
21.7
(10.67)
20.6 (9.16)
21.4
(11.74)
22.2
(11.18)
26.4 (8.51)
0.92
0.95
0.91
0.91
0.93
*Mean difference (95% LoA) expressed in ml/kg/min (¡1.96?SDdiff).
GXT, graded exercise test; ICC, intraclass correlation coefficient; LoA, Limits of
Agreement; MFT, multistage fitness test; RPE, rating of perceived exertion.
Reliability analysis
Measures of the consistency of the mean V̇O2max of the GXT
and simulated MFT were high (ICC = 0.98, p,0.001) and
superior to the consistency of the GXT and MFT (ICC = 0.93,
p,0.001) and the consistency of the simulated MFT and MFT
(ICC = 0.92, p,0.001). The ICCs between all four of the RPE
range-predicted V̇O2max values and measured V̇O2max from the
GXT were significant (ICC .0.91, p,0.05) (table 2). RPE range
7–17 gave the most reliable prediction of V̇O2max (ICC 0.95,
p,0.05).
Limits of Agreement analysis revealed that the MFT showed
the greatest mean difference between predicted and measured
V̇O2max values (26.4 ml/kg/min). The RPE range 7–17 gave the
smallest mean difference (20.6 ml/kg/min). The 95% Limits of
Agreement were similar for all estimates of V̇O2max (¡8.5–
11.7 ml/kg/min) although narrowest for the table-predicted
values (¡8.5 ml/kg/min) (table 2).
DISCUSSION
The purpose of this study was to investigate the efficacy of
predicting V̇O2max from submaximal RPE values elicited during
the multistage fitness test (MFT).1 Comparison of the measured
V̇O2max values from two laboratory tests and the values
predicted by the MFT indicated that the MFT underestimated
V̇O2max in this group of healthy, physically active women.
These findings corroborate those of previous research8–12 in
reporting an underestimation of V̇O2max by the MFT. However,
it was established that submaximal RPE values elicited during
Prediction of V̇O2max from submaximal MFT RPE
There were no significant differences between submaximal RPEpredicted V̇O2max values elicited during the MFT and measured
V̇O2max from the GXT (F(1.3, 12.6) = 1.2, p.0.05) (fig 2).
Figure 1 An example of V̇O2max prediction using submaximal RPE 9–17
data obtained during the multistage fitness test.
1008
Figure 2 V̇O2max (mean (SEM)) values from the MFT, simulated MFT,
GXT and submaximal RPE prediction from the MFT. * Significant
difference between MFT table-predicted V̇O2max and all other V̇O2max
values. GXT, graded exercise test; MFT, multistage fitness test;
RPE, rating of perceived exertion.
Br J Sports Med 2008;42:1006–1010. doi:10.1136/bjsm.2007.043810
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Case report
the MFT could be used to improve the accuracy and reliability
of the predictions of V̇O2max.
The prediction of V̇O2max in this study was based on
individual submaximal RPE responses elicited during the MFT.
The findings revealed no significant differences in the perceptual
ranges’ (RPE 9–17, 7–17, 9–15, 11–17) ability to predict maximal
values. Narrowing the perceptual range by excluding markers of
‘‘extremely light’’ and ‘‘very hard’’ (RPE 9–15) did not impact
significantly on the accuracy of the prediction. Deciding which
perceptual range should be used for predicting V̇O2max may best
be determined by the characteristics of the subjects being tested
and the need for accuracy in the test.18 19 26 27 Whilst this study
used healthy, active women, a more sedentary or clinical
population might benefit from a protocol that avoids the use of
RPE 17, particularly as working to an exertion level equivalent
to RPE 17 may be associated with a negative effect in a more
sedentary population.31
The strong relationship between RPE and VO2 which enabled
V̇O2max to be predicted from submaximal exercise in the MFT
may be the result of a direct or an indirect association. Oxygen
uptake is one of many cardiopulmonary variables that increase
with rises in exercise intensity. It has been suggested that
afferent feedback from these and other peripheral factors, such
as the sensation of muscle soreness resulting from exerciseinduced muscle damage,32 33 antecedent fatigue,34 carbohydrate
availability,17 and blood lactate levels,35–37 is integrated to
generate perception of exertion during physical activity.38
However, the cluster of cardiopulmonary and peripheral cues
may simply serve to enhance a feedforward mechanism which
ensures the body does not exceed its physical limits. It has been
proposed that perceived exertion may be set in an anticipatory
manner from the start of exercise according to the perceived
distance or duration of the task in a process known as
teleoanticipation.38–41 The majority of participants in this study
had prior knowledge of the MFT. They were aware of the
temporal and incremental nature of the tests and that they
would exercise to volitional exhaustion. Several studies have
investigated the scalar relationship between RPE and exercise
duration.42–44 More recently Noakes40 and Eston et al 34 based
their work on the premise that RPE is reported as a proportion
of the time to volitional exhaustion. Hence individual RPE
responses for these subjects could have been regulated as the
test progressed within an anticipated personal time-frame.
Individual awareness of the potential time to end task would
have enabled a protective reserve capacity to be held.
Familiarity with the MFT or with the RPE scale may have
influenced the RPE reported. The reliability of RPE improves
with protocol familiarity.18 19 21 26 27 45 In the present study the
95% LoA for the V̇O2max values predicted from submaximal RPE
ranged from ¡9.2 ml/kg/min to ¡11.7 ml/kg/min. These
values are similar to those reported by Eston et al18 when
V̇O2max was predicted from submaximal perceptually regulated
exercise bouts (¡7.3 ml/kg/min to ¡11.3 ml/kg/min), which
were observed to improve with practice (¡5.8 ml/kg/min to
¡8.4 ml/kg/min). Familiarity with the use of RPE in the MFT
might provide estimates of V̇O2max with LoA that could be as
narrow as or better than those provided by the MFT table in
this study (¡8.5 ml/kg/min).
In conclusion, the data revealed that the MFT significantly
underpredicted V̇O2max in this group of healthy, active women.
However, submaximal RPE values elicited during the MFT
provided accurate and reliable estimates of V̇O2max. These
findings demonstrate that the accuracy of the MFT can be
enhanced by the simple incorporation of measures of RPE
Br J Sports Med 2008;42:1006–1010. doi:10.1136/bjsm.2007.043810
What is already known on this topic
c
c
c
Prediction of maximal oxygen uptake from the multistage
fitness test (MFT) has been shown to correlate well with
laboratory-determined measures.
The MFT shows a tendency to underestimate laboratorydetermined maximal oxygen uptake.
The strong individual relationship between oxygen uptake and
ratings of perceived exertion (RPE) enables maximal oxygen
uptake to be predicted from RPE during graded exercise tests
on a cycle ergometer.
What this study adds
c
c
The study demonstrates that submaximal RPE values elicited
during the MFT can provide accurate and reliable estimates of
maximal oxygen uptake.
The accuracy of the MFT can be enhanced by including
measures of RPE during testing procedures.
during testing procedures. The findings may also have implications where using the MFT in its current maximal form is
inappropriate. Further investigations are justified to explore the
potential of this method whilst accounting for the effects of
familiarisation, gender, age, exercise experience and fitness
along with the influence of psychological factors. In addition,
the efficacy of submaximal RPE estimation procedures to
predict maximal functional capacity in sedentary and clinical
populations should also be considered.
Competing interests: None.
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Br J Sports Med 2008;42:1006–1010. doi:10.1136/bjsm.2007.043810
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The prediction of maximal oxygen uptake
from submaximal ratings of perceived
exertion elicited during the multistage
fitness test
R C Davies, A V Rowlands and R G Eston
Br J Sports Med 2008 42: 1006-1010 originally published online
February 28, 2008
doi: 10.1136/bjsm.2007.043810
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