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
