Following the test

• Subjects should continue to walk slowly round the course a further four times to avoid any syncopal attacks associated with abrupt cessation of exercise.

• Subjects are then seated and asked to confirm their limiting symptom.

• Record total distance walked, heart rate and perceived exertion for each level completed, peak heart rate and reason for termination.

• If subjects have fully recovered after 10 minutes then no further action is required. If they report continuing breathlessness or angina then a further rest period should follow during which they may receive sublingual nitrates, have an ECG or be seen by a doctor as appropriate.

Singh, et al, 1992. Reproduced with permission (SIGN, 2002).

Table 3.7. Estimated metabolic equivalents (METs) for each stage of a shuttle-walking assessment

Test stage

Walking speed (km/hr)

VO2 (ml-kg-1- min-1)

METS

1

1.8

6.5

1.9

2

2.41

7.5

2.1

3

3.03

8.6

2.4

4

3.63

9.6

2.7

5

4.25

10.6

3.0

6

4.86

11.6

3.3

7

5.47

12.6

3.6

8

6.08

13.7

3.9

9

6.69

14.7

4.2

*10

7.31

27.9

8.0

11

7.92

30.0

8.6

12

8.53

32.0

9.1

*Note the large increase in METs as the speed between 6.5 to 7.5kph is the threshold between walking and running.

(Adapted from Singh, et al. (1992) and Tobin and Thow (1999) applying equations from ACSM, 2000 p. 303.)

*Note the large increase in METs as the speed between 6.5 to 7.5kph is the threshold between walking and running.

(Adapted from Singh, et al. (1992) and Tobin and Thow (1999) applying equations from ACSM, 2000 p. 303.)

Table 3.8. Cycle ergometer estimated metabolic equivalents (METs)

Body

Body

25

50

75

100

125

150

175

200

Weight Weight

Watts

Watts

Watts

Watts

Watts

Watts

Watts

Watts

(kg)

(lbs)

50

110

3.0

5.1

6.6

8.2

9.7

11.3

12.8

14.3

60

132

2.3

4.6

5.9

7.1

8.4

9.7

11.0

12.3

70

154

2.1

4.2

5.3

6.4

7.5

8.6

9.7

10.8

80

176

2.0

3.9

4.9

5.9

6.8

7.8

8.8

9.7

90

198

2.0*

3.7

4.6

5.4

6.3

7.1

8.0

8.9

100

220

2.0*

3.5

4.3

5.1

5.9

6.6

7.4

8.2

* It is felt difficult to estimate the MET value when an activity is less than 2 METs. (Adapted from the ACSM, 2000 p. 304.)

* It is felt difficult to estimate the MET value when an activity is less than 2 METs. (Adapted from the ACSM, 2000 p. 304.)

The best way to set an initial intensity from this protocol is to take the peak MET value attained during the test and then determine what MET value represents 50-60% of this peak (Peak METs x 0.5 or Peak METs x 0.6). Then guide the patient's activities that equate to this MET value as outlined by Ainsworth, et al. (1993), ACSM (2000), AACVPR (2004) or BACR (1995, 2001). Table 3.7 summarises the MET values for the walking speeds in this protocol recommended by Tobin and Thow (1999) and SIGN (2002).

Similar principles for cycle ergometry can be applied as with the stepping and walking above. Cycle ergometers with accurate readings in Watts are required with MET values summarised in Table 3.8.

Rowing ergometry, especially the Concept II models, is now being used in rehabilitation settings (Buckley, et al., 1999a).The oxygen uptake of rowing on the Concept II ergometer can be determined using the regression equations developed by Lakomy and Lakomy (1993). Table 3.9 summarises the MET values for the Concept II rowing ergometer speeds, which can be determined from the machine's monitor read-out expressed as the 500-metre split time.

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