Procedures for the Administration of a Graded Exercise Test

Prior to Test Date

• Advise subject
  • proper clothing and shoes
  • food consumption before test
  • time allotment for the test
• Verify with subject
  • time, date, and location
• Request subject to bring
  • medical records
  • medications (if subject is taking medications)
• Make certain equipment is working and is calibrated

Health Appraisal

• Subject completes Medical History / Health Risk Analysis
• Determine reason for testing subject
• Review medical history with subject
• Identify if testing is contraindicated and if physician should be present
• Determine modality and protocol stress test; based upon medical review
• Answer all subject's questions
• Subject reads and signs informed consent

Before Test

• Perform other tests
  • pulmonary, flexibility, body composition, etc.
• Invite subject to use the restroom
• Determine age predicted maximum heart rate
• Prepare subject for graded exercise test
  • prep in position of test modality
  • shave hair (if necessary) for electrode sites
  • clean off dead skin with alcohol, let dry
  • apply electrodes over appropriate sites
  • hook up leads to electrodes
• Subject supine
  • EKG strip, identify irregularities
  • record resting heart rate
  • take and record blood pressure, identify irregularities
• Subject seated
  • EKG strip, identify irregularities
  • record resting heart rate
  • take and record blood pressure, identify irregularities
• Subject standing
  • EKG strip, identify irregularities
  • record resting heart rate
  • take and record blood pressure, identify irregularities
• Administer hyperventilation test for 30 seconds
  • EKG strip, identify irregularities
  • record resting heart rate
  • take and record blood pressure, identify irregularities
• Inform subject of test procedures
  • demonstrate proper positioning
  • review Rate of Perceived Exertion (RPE) scale
  • treadmill will progressively increase in speed and incline throughout the test
  • blood pressure and EKG will be taken throughout the test
  • assure subject they are in control of termination of test
    • They will be encouraged to continue as long as they can, although they will be very tired at the end
    • instruct subject to signal 30 to 60 seconds before they need to stop
    • instruct the subject to signal, or let the tester know if they experience and chest discomfort, dizziness, nausea, severe shortness of breath, extreme leg fatigue and the test will terminate
    • instruct the subject upon termination of the test, the treadmill will slow down for a codeine and they are to continue to walk
  • Ask the subject if they have any questions

Graded Exercise Test

• Begin test
  • instruct subject during initial stages of test
  • warm up (if in protocol)
  • note EKG rhythm on monitor
• Every stage
  • ask subject RPE and record
  • take and record blood pressure: 30 seconds before end of stage
  • EKG strip: 15 seconds before end of stage
• Before progressing to next stage
  • assess RPE and blood pressure
  • note any EKG abnormalities
  • record signs and symptoms of fatigue, dyspnea, or pain
  • ask subject if they can do more work
  • tell subject when workload is going to change

Terminating the Test

• Termination point of testing
  • subject requests to stop
  • doctor's orders
  • symptom-limited guidelines
  • observed maximal limit reached
  • ACSM Guidelines for test termination
• Record heart rate, blood pressure, RPE, and take EKG strip

Recovery

• Cool down
  • 3 to 5 minutes or when heart rate and blood pressure has returned to recommended levels
  • keep subject moving and monitor condition
  • Be cautious, problems often occur during recovery
• Take rhythm strip at the end of each recovery minute
• Take blood pressure at 1, 3, 5 minutes into recovery
• Note the condition of the patient and abnormalities on EKG monitor
• Verbally ensure the subject is doing well and has recovered from the test
• Disconnect the subject
• Advise subject
  • showering, daily activity, avoiding extreme temperatures, appointment for consultation, etc.

Interpretation and Exercise Prescription

• Calculate VO2 max and METs
• Determine exercise training intensity: heart rate, RPE, or METs
• Have physician interpret EKG recordings
• Consult subject
  • review test results
  • exercise prescription
  • monitor outcome and behavioral changes