Cardiovascular Assessment Form

Resting Values
Heart Rate Systolic Diastolic Max HR 75% HR

 

Seat Height

 

 

 

 

     

Cycle Ergometer Test
Watts Systolic Diastolic RPE Heart Rate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aerobic Fitness Test
Minutes Seconds Heart Rate RPE

 

 

 

 

O Rockport: 1 mile walk

O Balke: Speed 3.3 mph; 0%1st minute, 2% increase at start of minute 2, elevation increases 1% each minute

O Balke, Women: Speed 3.0 mph; 0% for 3 minutes, elevation increase 2.5% every 3 minute

O Bruce:

Stage 1 2 3 4 5 6 7
Speed (mph) 1.7 2.5 3.4 4.2 5 5.5 6
Grade (%) 10 12 14 16 18 20 22

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