An Audio-Visual Discussion of Tests and Measures

Utilized in Assessing

Cardiopulmonary Function in a School Age Population

Conducted by

Paul Sholander

OR

What do we test in pediatrics?

• Functional mobility

▫ Walking around the school, over/around obstacles, climbing playground equipment, stairs

• Gross Motor

▫ Sit-stand, crawling, jumping, sit-ups, jumping jacks

• Balance

▫ Single Leg Stance, Yoga, balance beam, physioball

• Ball Skills

▫ Catch, throw, dribble, kick, juggle, cross ankles

Don’t Forget Cardio!

• Let kids be kids!• Off the IPad, out of the

chair, away from the desk

• Run around• Ride a bike• Play soccer• Go skating• Jazzercise• Spin class• Step class• Gymnastics

• Positives of Aerobic Exercise!▫ More energy, improved VO2,

improved sleep, improved heart function, improved blood sugar, improved digestion, HAPPIER!

• “I think that I cannot preserve my health and spirits unless I spend four hours a day at least — and it is commonly more than that — sauntering through the woods and over the hills and fields absolutely free from all worldly engagements.” –Ralph Waldo Emerson

Aerobic vs. Anaerobic

• Anaerobic: requires ATP, short bursts

▫ Sprints, jumping, pushing, pulling

• Aerobic: requires O2, extended activities

▫ Walk, run, bike, swim

• Hit VO2 max

▫ O2 supply not sufficient to continue activity

▫ Switch back to anaerobic

▫ An Aero An

Heart Rate1

• Max Heart Rate

▫ Use % for zones 50 - 80 = aerobic

80 - 100 = anaerobic

• Karvonen

▫ Target Heart Rate ((max HR − resting HR)

× %Intensity) + resting HR

▫ Rest = 70 if unknown

▫ 220 – age for MHR estimate

▫ Ex. If age = 10 ((210 – 70) x .5) + 70

(140 x .5) + 70

70 + 70 = 140

• Joe Friel

▫ Lactate Threshold Heart Rate 85% of MHR

Zone 1 = 85% of LTHR

• Zoladz1,2

▫ Target Heart Rates 1) MHR – 50 beats

2) MHR – 40 beats

3) MHR – 30 beats

4) MHR – 20 beats

5) MHR – 10 beats

▫ Zones Target Heart Rate +/- 5 beats

Ex. If age = 10

210 – (Age*.5) = 205 MHR

205 – 50 = 155 +/-5 = Zone 1

Digifit1 MaxHR Joe Friel Karvonen Zoladz

ZONE 5Speed

Anaerobic90-100% 100-106% LTHR 90-100%

MHR - 10 +/-5

ZONE 4EconomyAnaerobic

80-90% 95-99% LTHR 80-90%MHR - 20 +/-5

ZONE 3StaminaAerobic

70-80% 90-94% LTHR 70-80%MHR - 30 +/-5

ZONE 2EnduranceAerobic

60-70% 85-89% LTHR 60-70%MHR - 40 +/-5

ZONE 1RecoveryAerobic

50-60 %< 85% LTHR

LTHR = 85%MHR

50-60% HRR

HRR= MHR – RHRMHR - 50 +/-5

3

BORG Scale: self-selected rating ~ HR (Ex. RPE 12 ~ 120 bpm)

Modified RPE• Chen5 : 19 people with Down’s

Syndrome

• Avg age

▫ Chronologically = 22

▫ Mental = 6

• Modified progressive walking protocol on treadmill 24 min

• Modified pictorial RPE

▫ 1 = This task is easy for me

▫ 4 = This task is too hard and I want to stop

• Subjects able to accurately rate perceived exertion as HR and intensity increased

• Yelling4: 104 children, 12 and 15 y.o.

• Pictorial Children’s Effort Rating Table

• Phase 1: 5 rounds

▫ 3-minute incremental stepping

▫ 2 minute recovery

▫ HR during last 15 seconds of exercise

▫ Perceived exertion = HR increase

• Phase 2: 4 rounds

▫ 4 minute stepping

▫ Child asked to match intensity chosen at random

3, 5, 7, 9

▫ Significant differences in output corresponded with each intensity

DALHOUSIE

Dalhousie: Reliable and Valid?

• Pianosi6: 100 children/adolescents cycling

▫ Borg CR-10 vs. Dalhousie

▫ Both showed excellent correlation between:

Exertion and intensity

Dyspnea and ventilation

▫ Respiratory diseases

No systematic difference with/out

▫ Alternative to Borg scale

• McGrath7 : 79 children 6-18 y.o.

▫ Asthma vs. CF vs. Healthy

▫ Given the Dalhousie pictures, rank in order on a VAS from least most

8+ : 75-98% correct

< 8 : 31-87% correct

Valid for 8-18 y.o.

▫ Chest tightness/throat narrowing

More correct responses vs. exertion

More experience?

More descriptive?

YES!

Pulmonary

• Vieira8: Backpacks with mono shoulder straps cause significantly lower:

▫ Forced vital capacity

▫ Forced expiratory capacity in 1 sec

▫ Maximal expiratory pressure

• Encourage use of double shoulder straps for better respiratory function

• Sperandio9: 27 adolescent idiopathic scoliosis patients 11-18 y.o.

• All patients had pulmonary restrictions

▫ Avg. FVC = 76.9% of predicted

▫ Avg. FEV1/FVC = .9

• Performed 2 beep tests at least 30 minutes apart

• Peak VO2 correlates with:

▫ Walking distance (highest)

▫ Maximal expiratory pressure

▫ Maximal inspiratory pressure

▫ Peak cough flow

Energy Expenditure Index10

• EEI (beats/m)

• (HRwalk – HRrest)/average velocity▫ HR = beats/min▫ Average velocity = m/min

• Rose: Most efficient at “comfortable walking speed”▫ Roughly 70m/min▫ Fastest speeds are less efficient

Velocity hits peak but HR ↑↑▫ Slower speeds least efficient

Initial HR spike from initiation of movement

• Correlates with SUBmax activity▫ Max activity anaerobic

____

____

Energy Expenditure Index• Rose10 : Assess for best mobility device

▫ Case: 7 yo boy spastic diplegia Compared canes with walker

1.53 canes vs. 1.83 walker

Canes were more efficient

▫ Case: 8 yo boy spastic diplegia Compared AFOs vs. not

No significant improvements

AFO’s not recommended

• Rose11: Children with CP▫ Follow similar pattern

▫ All values are higher, meaning less efficient movements

▫ Diplegia less efficient than hemiplegia

5

4

3

2

1

0

Energy Expenditure Index

InefficientHeart Rate increases more than Velocity

AnaerobicHeart rate continues

to increase as velocity hits peak

EfficientVelocity increases

more than heart rate

70m/min

EEI

Velocity

Autism• Pace12 : Eurofit comparison

▫ 20 children 9-11 y.o., 10 w/ASD

• HR responses for ASD

▫ Significantly lower pre/during/max

▫ HR mean ~ 20bpm lower

▫ Can’t push as hard/fast as TD children w/o training

• Tyler13 : Autism

▫ 29 children 9-18 y.o., 17 ASD

▫ Assessed for BMI, handgrip, sit-reach and beep test

▫ ASD had significantly:

Lower strength

More sedentary behavior

• Brand14 : Aerobics and Sleep

▫ 10 children mean age 10 y.o.

7 w/insomnia

ASD: 9.33x more likely than TD

▫ 3x/week for 3 weeks

30 min bicycle training

Easy to adapt, social aspect

30 min ball skills/balance

• Results for nights following aerobics

▫ Sleep efficiency increased

▫ Fall asleep faster

▫ More time in deep sleep

▫ Less time awake after sleep onset

▫ Improved morning mood

I Want To Ride My Bicycle• Jansen16 : RCT in DMD

▫ 30 boys 8-13 y.o.

▫ 18 ambulatory, 12 WC dependent

▫ 17 received intervention

15 minutes, 5 days/week, 24 weeks

65 rpm with arms/legs w/assisted bicycle trainer

▫ 13 received no intervention

▫ Motor Function Measure

Stable in intervention

Significant decrease in control (4.9)

▫ Assisted 6-Min Cycling Test

No significant endurance changes

• Pitchford15: 38 children 9-18 y.o. with autism

▫ Followed children for 12 weeks to promote skill

▫ Parents kept log for 12 weeks, 3 months post and 1 yr. post

▫ 33 children able to ride by 12 weeks

▫ 60% maintained riding at least 1x/week at 1 yr. post

▫ Most that maintained skill had 7+ weeks practice during study

ADHD• Hoza18: RCT for children with ADHD

▫ 94 at risk children vs. 108 typically developing

▫ 12 weeks, 31 minutes before school of either: Physical activities (PA)

Sedentary classroom activities (SD)

▫ PA > SD to reduce inattention and moodiness in home setting in at risk children

▫ Both interventions did have positive results

• Cerrillo-Urbina17: Meta-analysis▫ 8 RCTs on children with ADHD

and physical activity from ’02-’15

▫ Avg. protocol 5 weeks duration

50 minute sessions

2-3x/week

6 Running, 1 multi-sport, 1 yoga

Ages 8-11, 1 study had 16 y.o.

▫ Improvements found in (order) inattention, hyperactivity,

impulsivity, anxiety, executive function, social disorder

▫ Authors suggest 6-10 weeks enough for improvements

Yoga

• D’Souza19: Pulmonary RCT▫ 91 children 7-9 y.o.▫ 45 min yoga or PE sequence▫ 5 days/week for 3 months

• Results▫ Significant increase in lung

function for both groups FVC, FEV1, FVC/FEV1, MIP,

MEP, PEFR▫ MIP significantly higher in yoga

• 3 months follow-up (detraining)▫ FVC and FEV1 significantly

increased▫ All others went down, but not to

baseline

• Yoga effective at improving lung function in this population

• Ashwarthy20 : Harvard Step Test▫ 80 children 11-15 y.o.▫ 40 yoga trained

5 days/week, 6 month minimum▫ 40 untrained▫ Modified: 18” step

• Yoga trained had significantly lower HR/BP responses

• Telles21: RCT Yoga vs. PE▫ 98 children 8-13 y.o.▫ Protocol similar to D’Souza

• Improvements:▫ Both

Sit-ups, color-word task, total/general self-esteem

▫ Yoga SLS, plate tapping (coordination)

▫ PE Social self-esteem

Mental Muscles

• Schmidt22 : RCT look at physical activity and cognitive function

• 181 children 10-12 y.o.

• 6 wks. of either:

▫ Team games: ↑PA/↑Cogn

▫ Aerobic: ↑PA/↓Cogn

▫ Control: ↓PA/↓Cogn

• Team and Aerobic saw 4-5%↑ in estimated VO2max on beep test

• Only Team saw improvement in executive function

• Make aerobic interventions cognitively taxing as well

• Davis23 : RCT overweight children

• 171 overweight children 7-11 y.o.

• 13 weeks of daily:

▫ High dose: 2 20 minute PA bouts

▫ Low dose:

1 20 minute PA bout

1 20 minute sedentary activity

▫ Control: No intervention

▫ PA: running games, jump rope, basketball and soccer

• High dose significantly improved planning/math achievement vs. low dose

Mental Muscle II: Brawny and the Brain

• Chaddock-Heyman24 : 24 9-10 y.o. children assessed for white matter changes

• Children completed modified Balke protocol to determine aerobic fitness▫ Higher fit: > 70th percentile VO2 max▫ Lower fit: < 30th percentile VO2 max

• Higher fit had more fractional anisometry (white matter myelination) in:▫ Corpus Callosum▫ Corona Radiata▫ Superior Longitudinal Fasciculus

• Kamijo25 found “higher fit” children better at inhibiting task-irrelevant information during visual tasks

Low Fitness• Kjelsas26: Movement Assessment Battery for Children

▫ 11 y.o. children scoring below 13.5 on test had: Poorer performance on fitness tasks

Lower overall physical activity

Lower perception of athletic competence

• Rodrigues27: Fitness throughout school▫ 472 children from 1st-4th grade▫ 7 standard fitness tests each year

PACER, Sit-ups in 60 seconds, Flexed arm hang, Sit-Reach, Standing long jump, 50 meter dash, 10 meter shuttle run

• Children that regressed showed higher risk for overweight/obese

• Pacer test regression of 2.67 cycles = 6.31x risk

Obesity• Cooper28: High BMI (>95th

percentile) had lower than predicted values for:

▫ Heart rate, VO2 peak, work rate

▫ Changes in VO2 vs. work rate were highest

▫ Less efficient movements

• Hill29: Down’s Syndrome

▫ Significantly lower Resting Energy Expenditure compared to sibling controls, even when adjusted

▫ However, REE was NOT related to changes in fat mass

• Wee30: Down’s Syndrome

▫ 203 children, 59 w/DS

▫ Treadmill protocol for peak VO2/HR

• DS children:

▫ Significantly ↓ VO2/HR

compared to TD

▫ Obese vs. normal weight

Obese: Significantly ↓ VO2

only

• Down’s Syndrome affects cardiopulmonary more than obesity

Obesity• De Aruajo31 : RCT HIIT Training

▫ 30 obese children 8-12 y.o.

▫ 12 week intervention

▫ Endurance group: 30 min 80% peak HR

+10 min every 3 weeks

▫ HIIT group: 60 second sprint 100% velocity

3 min active recovery 50% velocity

3 sprints start, add 1 every 3 weeks

▫ Intensities re-calibrated at 6 weeks

• Results: BOTH improved▫ VO2 peak, Total exercise time,

Heart Rate Recovery at 2 minutes, Insulinemia

• Endurance OR HIIT effective

• Willis32 : Length of activity▫ 396 2nd/3rd graders

▫ Physical activity bouts of <5 min

5-10 min

> 10 min

▫ Significantly lower BMI with more >10 min bouts

▫ Significantly lower waist circumference with >5 min bouts

• Longer bouts of activity!

• “It is easier to build strong children than to repair broken men”▫ -Frederick Douglass

6 Minute Walk Test33

• Participants walk as far as they can in 6 minutes

• Self-selected pace

• Rectangular course to allow turns

▫ ~ 45 x 5 yards (Top End Sports)

▫ Dimensions can vary as long as consistent test/re-test

• Breaks are allowed, must be counted in scoring

• + Easy set up, can test multiple children at same time

• - Time to complete, motivation, possible exhaustion

6 Minute Walk Test

• Li34: 6MWT in children

▫ 1,469 children 7-16 y.o.

▫ Average distance (m)

All ages: 664 +/- 65.3

Males: 680.9

Females: 642.7

▫ Clinical markers between sexes

Heart rate pre/post: No difference

O2 saturation pre/post: No difference

Height: M > F, best correlation with distance

▫ Lower resting HR Greater distance covered

• Lammers35: 6MWT in children

▫ 328 children 4-11 y.o.

▫ Average distance

All ages: 470 +/- 59

4: 383 +/- 41

5: 420 +/- 39

6: 463 +/- 40

7: 488 +/- 35

Improvements past age 7 were not statistically significant

▫ Distance correlates with:

Age = ↑

Weight = ↓

Height = ↑

No difference between sex

6 Minute Walk Test: Valid and Reliable?• Thompson36: vs. 10m walk in CP

▫ 31 children, avg. age 9 yr. 5 m GMFCS I = 9

GMFCS II = 8

GMFCS III = 14

▫ Results 10m walk = 11.4 seconds

Re-test = 9.9 seconds

6MWT = 333.5 meters

Re-test = 340.8 meters

▫ 6MWT had excellent test-retest reliability while 10m walk did not

▫ GMFCS III had lowest scores and most within-participant variability

• Li37: Validity▫ 74 teens 13-15 y.o.

• Protocol▫ Bruce treadmill test

▫ 6MWT 2 weeks later

▫ 6MWT re-test 2-4 weeks later

• 6MWT significant correlation with:▫ Height

▫ FEV1

▫ HR at end of test

▫ HR change during test

▫ Max HR

▫ VO2 max

• Valid: No significant difference between test/re-test distances

YES!

6MWT in DMD

• McDonald38: 6MWT has:

▫ High test/re-test reliability

▫ High validity

▫ Lowest MCID

Minimal Clinically Important Difference

Necessitates a change in patient management

Roughly 8% change

• 2 Minute Walk Test can be used39,40

▫ High reliability and correlation to 6MWT results

▫ Can be substituted if client has:

Poor focus

Low motivation

Safety concerns

• Alfano41: Want better 6MWT scores in this population?

▫ Children offered $50 to beat distance on re-test

▫ Re-test:

$50: 44m improvement

No $: 5.1m improvement

▫ Most net gain occurred if child could walk 350+meters

BRIBE!

Step Tests• Harvard Step Test42

▫ 20 inch step at 30 step/min pace for 5 minutes

▫ Ends at 5 minutes or lose pace for 15 seconds

▫ Sit down immediately, HR counted between 60-90 seconds of recovery

• Fitness Index (Short Form)

▫ (100 x test duration in seconds)

(5.5 x pulse 60-90 seconds)

▫ Only count beats during recovery period, not bpm

• Queens College Step Test43

▫ 16.25 inch step for 3 minutes

▫ 22 step/min female, 24 male

• Post test

▫ Heart rate counted at 5-20 seconds

▫ Rate x 4 = bpm

• VO2 max

▫ Male

111.33 – (0.42 x bpm)

▫ Female

65.81 – (0.1847 x bpm)

Step tests

• Jankowski45: Kasch Pulse Recovery

▫ 14,501 children 6-12 y.o.

3,210 overweight/obese

• Protocol

▫ 0.305 m step

▫ 3 min at 24 steps/min

▫ 1 min 5 sec seated recovery

▫ Test stopped if HR > 180 for 15 seconds

• Determined HRpost for different fitness levels

• Brooke44: DMD & stairs

▫ Time student while walking up 4 standard steps

▫ 5-12 sec = child has avg. 2.4 years of unassisted walking

▫ >12 sec = child has avg. 1.5 years of unassisted walking

▫ Important for proper patient management

Cardiorespiratoryfitness45

Boys (6–9 years)

Boys (10-12 years)

Girls (6–9 years)

Girls (10–12 years)

Excellent (HRmean

post-ex < 5th %tile)<95 <93 <100 <102

Very good (HRmean

post-ex ≤ 25th %tile)95–106 93–105 100–113 102–116

Good (HRmean

post-ex ≤ 50th %tile)107–115 106–116 114–123 117–128

Sufficient (HRmean

post-ex ≤ 75th %tile)116–126 117–128 124–134 129–141

Poor (HRmean

post-ex ≤ 95th %tile)127–142 129–147 135–152 142–157

Very poor (HRmean

post-ex > 95th %tile)>142 >147 >152 >157

Upper body endurance• Flexed Arm Hang46

• Hold pull up position, palms away from body, chin level with bar

• Can be placed in position to limit excess exertion

• Stops when:▫ chin dips below bar

▫ head tilts back to maintain chin position

• FitnessGram47

▫ 5 y.o. = 2 sec 11 y.o. = 6 sec

▫ 7 y.o. = 3 sec 12 y.o. = 10M/7F

▫ 9 y.o. = 4 sec 14 y.o. = 15M/8F

• Push-up Test48

• Back and knees straight, bend elbows to 90° and return

• Continue until exhaustion/out of rhythm/hit target number

• Presidential Fitness Challenge49

▫ 20 push-ups/minute cadence

▫ Ends w/3 consecutive misses

• FitnessGram50

▫ Females 5 y.o. = 3, 10+ y.o. = 7

▫ Males 5 y.o. = 3, 10 y.o. = 7, 16 y.o. = 18

TUG51

• Williams52: Reliability

▫ 176 healthy children 3-9 y.o.

▫ 41 CP/Spina bifida 3-19 y.o.

• Mean times (seconds)

▫ 3-5 y.o. = 6.7

5.7 at 5 month follow-up

▫ > 5 y.o. = 5.1

▫ GMFCS

I = 8.3 sec

II = 10.8

III = 28.1

• Reliability

▫ ICC = 0.89 within session

10 min between tests

▫ ICC = 0.83 test/re-test

1 week apart

• Patient sits back in chair

• Patient rises, walks 3 meters, turns and walks back

• Time between “Go” and sit back down

▫ Initiation of movement lag

• One practice trial

• If using assistive device, consistency with re-test

• If vestibular, test turning to both sides

TUG II: TUG HARDER• Hassani53: Minimal Clinically

Important Difference in CP

▫ 219 children 8-18 y.o.

Surgical: Procedure within 12 months of baseline

Non-Surg: > 12 months

▫ Baseline and 1 yr. follow-up

• Modified 3m TUG (sec)

▫ GMFCS I = 1.1 – 1.7

▫ GMFCS II = 0.7 – 1.2

▫ GMFCS III = 1.2 – 1.9

• 1 Minute Walk Test w/supports (m)

▫ I = 5.6 – 9.0

▫ II = 5.1 – 8.3

▫ III = 3.8 – 6.2

• Nicolini-Panisson54: Down’s Syndrome

▫ 459 TD children (mean 10.6 y.o)

▫ 40 children DS (mean 10.8 y.o.)

• Typically Developing

▫ Mean time : 5.61 seconds

▫ Age/weight best predictors

• Down’s Syndrome

▫ ↑ GMFM = faster TUG scores

Dimension E: highest correlation

▫ Avg.: 2-3.5 seconds longer when matched up for sex/age/weight

Beep Test/Pacer/ISWT55

• Two variations▫ Standard: 20 meters▫ 2nd/3rd grade: 15 meters▫ spatial limitations: 15 meters

• Test comes with CD with recorded cadence of beeps

• Participants move from one end of course to other between beeps

• As test goes on, intervals between beeps decreases▫ Pace increases, making it more difficult to keep up▫ 21 total levels▫ 21 total minutes to finish if complete entire test

• Test ends for each participant when they fail to reach end of course on 2 consecutive beeps

20 MeterPACER/Beep/ISWT

PREFITAndersen

Yo-Yo 10 MeterShuttle Beep Test for CPWheelchair Propulsion

Pros55/56 Cons55

• Exertion test for max aerobic capacity

▫ VO2peak56 =31.025 + (3.238*speed in km/h) – (3.248*age) + (0.1536*speed*age)

▫ FitnessGram50

Females 10+ y.o. = 38.6

Males 10+ y.o. = 40.2

• Test multiple children at once

• Other children can motivate each other

• Easy to administer

• Space necessary to complete tests

• Careful regarding exhaustion since this tests max capacity

• Requires CD or not valid

• Different variations use different norms

PREFIT57

• Cadenas-Sanchez et al.

• 20m shuttle run reliability for preschool children

• 130 students 3-5 y.o.

• 6.5 km/h start, .5 km/h ↑/min▫ Test ends on when late 2 consecutive times

▫ Test ends when child stops due to exhaustion

• Test/re-test 2 weeks apart

• 2 laps found to be mean systemic error

▫ Differences in sex and age were not significant

• Improvements > 2 laps = Progress

10 meter shuttle beep test58

• For children with CP

• GMFCS Level I or II

▫ I = start at 5 km/hr

▫ II = start at 2 km/hr

▫ .25 km/hr increase/minute

• Shorter distance more appropriate

• Vs. treadmill testing

▫ Coordination easier at self-selected pace

▫ Posture of legs/feet confined on treadmill

▫ Changes in treadmill speed/grade may be too difficult and give inaccurate reading of capacity

• Vershuren59: Reliability/Validity

▫ 25 children mean age 12 y.o.

▫ GMFCS I = 14

▫ Test/re-test at 2 weeks

• Results

▫ Excellent reliability for:

Levels completed

Peak HR at last level

▫ High correlation w/treadmill test

▫ GMFCS Levels

II more reliable than I

Less variability

Wheelchair Propulsion• Verschuren60: 23 early teens with

spastic CP & manual WC▫ 10m shuttle run vs. graded arm test

Arm: 8W/min until can’t maintain 40-60 rpm

Shuttle: similar to PACER, 10m at 2km/h, metronome ↑ .25km, ends with 2 consecutive misses

▫ Shuttle Avg: 2.4 minutes longer/trial Avg: 10.5 higher HR peak/trial ICC=.99 reliability within 1 week

▫ Validity HR peak: r=0.80 VO2 peak: r=0.84 RER: r=0.63

• Shuttle > Crank▫ Arms fatigue before aerobic

system fatigues

• Bloemen61: 6-18 y.o. children with spina bifida▫ Propulsion vs. Arm Cranking▫ Both protocols:

Increase resistance fatigue based on cadence

5 min rest 5 min at 110% resistance

▫ Propulsion had higher peak HR and VO2 vs. arm cranking Avg: 15 bpm, 3.6 ml/kg/min Trunk and arms vs. arms Better at determining capabilities

• Test children at their maximum capabilities for best picture of cardiopulmonary function

Wheelchair: Multistage Field/Beep test

• Vanderthommen et al.62 developed test in 2002

• 37 participants 18-60

• Reliable for▫ Score/Stages reached

▫ Peak HR

▫ Peak VO2

• Based on HR, blood lactate and RER, MFT = max aerobic test

• Change of +/- 1.6 levels = significant

• Protocol (Top End Sports)63

▫ 11m x 11m square course

▫ 2.83m turning zones at each corner for 90° turns

▫ Test starts at 6km/h velocity

▫ .37km/h ↑/minute

▫ Subject chooses counter/clockwise

▫ Test ends when subject doesn’t make it within turning zone 3 consecutive times

▫ Possible to test 4 at one time

• Pro: Easy/Fast to perform

• Con: Safety, Requires CD

Intermittent Tests• Yo-Yo Intermittent Test64

• 20 meter track w/3rd cone behind start

• After every bout, participant has to get around 3rd cone and back to start

▫ Endurance: 2.5 meters, 5 seconds

▫ Recovery: 5 meters, 10 seconds

• Allows short recovery period between bouts

• Level I: starts at 10 km/hr, up to 19

• Score

▫ VO2max (mL/min/kg) = distance (m) × 0.0084 + 36.4

• Anderson Test65

• 20 meter track

• Walk/run length of track and touch ground at each end

• 2 intervals

▫ 15 second walk/run

▫ 15 second pause

• 10 minute total time

• Score

▫ 18.38 + (0.03301 x running distance in meters) minus (5.92 x gender)

▫ Male = 0, Female = 1

Yo! Andersen• Bendiksen66: Yo-Yo/Andersen

▫ 82 children 6-10 y.o.▫ Older children = better performance

Yo-Yo: 84% Andersen: 10%▫ Submax HR

Inverse correlation with Yo-Yo score 6 week re-test Submax HR ↑ = Yo-Yo ↑

• Bendiksen67: Modified Yo-Yo/Andersen▫ 34 children 6-9 y.o.▫ Modified Yo-Yo: 16m

• Results▫ No sign. difference with test/re-test▫ Correlated with VO2 Max▫ Both tests correlated with each

other

• Andersen68: Test for children

• 57 children 10-11 y.o. compared against▫ 27 University students▫ 14 elite teen soccer players

• Performed Andersen test, rest few days, VO2 max test for validity▫ Children: correlation = 0.68▫ VO2 range: 30-74 ml/min/kg

• Age not significant factor▫ See equation on previous slide

• Distance highly reliable (r=0.84)

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