3 OURNAL
Vol.
OF APPLIED 38, No. 3, March
PHYSIOLOGY
1975.
Maximal
2%&d
in U.S.A.
oxygen
exercise -reliability 0.
BAR-OR
Defartment
AND of Research.,
L. D. ZWIREN Wingate Institute for Physical Education
O., AND L. D. ZWIREN. Maximal oxygen consumption arm exercise --reliability and validity. J. Appl. Yhysiol. 38(3) : 424-426. 19X-The reliability and validity of a continuous progressive arm test, in which maximal 02 consumption arm) is determined, were analyzed. Forty-one men (ii02 m:kX (28.2 + 8.8 yr) performed the test twice. Eighteen additional men (22.6 + 5.6 yr) performed the arm test, as well as the treadmill run, in which maximal 02 consumption (VO, m:Lx leg) was determined. The validity of the voz m3X arm test was computed, using Voz 1n:ix leg as a criterion for the individual’s aerobic capacity. The reliability coefficients of voz max arm, ~~~~~~~ arm, arm were 0.94, 0.98, and 0.76, respectively, indicating and HR,,,,, a high reliability of the test. The validity coefficient of Voz In:lX arm was only 0.74. The regression equation of voz m:lX leg on These findings VO 2IniLX arm was y = 24.4 + 0.9 + 4.4 (&). indicate that, following the suggested protocol, the individual repeatedly uses the same muscles and does reach an all-out stage. However, different individuals apparently are aided by their trunk and leg muscles to different degrees, which lowers the validity of this test as a predictor of aerobic capacity. BAR-OR,
vs. leg exercise;
paraplegics;
arm
and validity
test during
arm
test during
consumption
prediction
of aerobic
capacity
TESTING OF CARDIOPULMONARY and metabolic reactions to rhythmic arm exercise is necessary whenever subjects cannot use their legs for exertion. Such is the case with paraplegics (10, 16), amputees (7), cerebral palsied (lo), or people with various leg traumata. Furthermore, arm exertion is used with able-bodied people in medical (3, 15) and physiological (e.g., 1, 2, 4-6, 8, 9, 11, 13, 14) research on the effects of exercising relatively small muscle groups. Among the major physiological differences between arm and leg exercise are the factors which limit the maxiin each case. Whereas maximal power ma1 performance output of the leg muscles is limited by one or more of the central cardiorespiratory stages of the oxygen transport chain (12), rhythmic arm exercise capacity is most probably dependent on the amount of active mass, so that “central” functions such as cardiac output, stroke volume, heart rate (HR), and pulmonary ventilation do not reach their maximal level in the latter mode of exercise (14). As a result, the highest oxygen consumption reached during arm exercise (Vo 2 II1s1Xarm) is lower than that achieved in running or cycling (VO2 lHflX leg). Some authors (1, 5, 14) have reported Voz rllnx arm to be some 65-70 alo of Vo:! lllflX leg. If this percentage were fairly consistent it would be possible to predict one’s
and $&A,
kVingate Post Q&e,
Israel
aerobic capacity (ime., VOZ max leg) by measuring Voz nzaX arm. Bouchard (personal communication) has calculated the correlation coefficients among ii02 Max arm, measured at the standing position, and ~OZ llZaX leg (treadmill run, step test, and upright bicycle test). To the best of our knowledge, there has been no systematic analysis of the validity of the sitting arm test against the more commonly used leg tests. Nor has there been any information available as to the reliability of the former. The purposes of this study were to determine the testretest reliability of a continuous progressive all-out arm test and to check its validity as an instrument for assessing maximal aerobic power capacity. SUBJECTS
Fifty-nine men participated in the study, of whom 41 were included in the test-retest evaluation, and 18 in the validity measurements. Some characteristics of all subjects are summarized in Table 1. More detailed background of the participants in the test-retest phase, 20 of whom were paraplegics, has been reported previously (16). The participants in the validity phase were healthy male volunteers, active participants in physical education programs but not in varsity competition. These programs included endurance training, ball games, and calisthenics, with no special emphasis on any muscle group. Accordingly, their fitness level was somewhat higher than in the general population. METHODS
Test-retest phase. A continuous progressive all-out arm test was performed, using a modified von Dijbeln (Monark) ergometer. The subjects sat on a wheelchair, the height of which was adjustable so that the axis connecting the pedals would bc at shoulder level. Pedaling cadence was 50 cycles/min. To keep the total time of exertion within 5-7 min, the initial load was decided upon according to the HR response of each individual to a submaximal test comprising three 2-min stages which preceded the all-out test by 20-30 min. Thus, initial load was 450, 600, or 750 kpm/min. Loads were subsequently increased every 2 min by 150 kpm/min, until subjects could no longer keep up the pace. HR was determined at the last 15 s of each minute during exercise and of the first 3 min of recovery, using a bipolar ECG chest lead. Expired air was collected into
Downloaded from www.physiology.org/journal/jappl by ${individualUser.givenNames} ${individualUser.surname} (163.015.154.053) on September 14, 2018. Copyright © 1975 American Physiological Society. All rights reserved.
AKM
‘cioz Inax-
RELIABILITY
TABLE 1. hr~ ___---
;bhyska/ character&h
Group Test-retest (n = 41) Validity (n = 18) Values
AND
are means
425
VALIDITY
RESULTS
of subjects
Age, Y=
Ht,
28.2 zt8.8 22.6 +5.6
174.2 zt9.8 170.5 h8.1
cm
W-t, kg
O/GFat (Allen >
70.8 h13.2 67.9 zt8.8
17.4 zt5.4 12.0 zt5.3
LBM,
kg
58.8 3x9.4 59.6 zt6.7
#Z SD.
TABLE 2. Test-retest values obtained during and on recovery from maximal arm exercise +02
Test I (n = 41) Test II (n = 41) Test-retest
Values
max
ml/kg+ min
~W,tl
30.37 zt9.05 31.04 It9.01
174 ~12.6 174 zt14.3
& SD;
7
Recovery
VE I+X$
l/mm
76.5 Zt22.1 83.0 +22 .o
0.76
0.94
are means
X
= correlation
1 min
134 *l&l 135 &16.7
0.98
0.77
HR
2 min
117 zt15.5 114 hl5.8
3 min
107 +15.4 110 *14*5
0.78
0.86
Test-retest. Maximal values obtained during testing and retesting, as well as recovery HR of the first 3 min, are summarized in Table 2, together with the intertest reliability coefficients. Both ~oZ max arm and vEIlLaX arm seem to have a high reliability, while the consistency in results of HR,., arm is considerably lower. The high r value for ~~~~~~ arm was obtained despite the actual values being some 8 % higher in the second test. Individual results for vo2 lllnX in both tests are plotted in Fig. 1. Most subjects obtained very similar results in both tests (agreement within l-2 ml/kg. min). Five had higher second values by some 4-5 ml/kg -min, while three had lower second values by 3-5 ml/kg min. Validity testing. Maximal values, as achieved during arm and during leg exercise, are summarized in Table 3. AS expected from other studies, ~oZ max arm, vEII1aX arm and oxygen pulse max arm are about two-thirds of their respective leg values. However, the predictability of maximal leg values from arm data is merely fair, as can be judged from the correlation coefficients summarized in Table 3.
coefficient.
TABLE 3. comparison of maximal values obtained during arm and during running exercise (n = 18) --_ -~-.~-~ --~--902
HR max
max
-._-. Arm
Q 02/HR
*Emax -
Run
Arm
Run
56.01 zt6.49 62.5 zt6.3
173 &lo.2
195 1t7.5 88.7 A4.9
----ir Eli-02
max
-Arm
Arm
Run
Run
Arm
Ran
--._-----~ Mean + SD % *SD
r -_ SD
FIG.
cise
(V02
1. Test-retest of maximal 02 consumption Individual data, n = 41+ ma3 arm).
during
arm
34.59 zt5.32
86.2 zt20.4
120.6 zt14.5 73.4 xt13.9
13.5 19.5 zt2.8 h3.6 69.0 zt5.2
0.74 -0.25 0.65 -Values are means & 1 SD; rnean arm values as percentage of these percentages; T = correlation coefficient.
0,89 of running
36.9 h6.7
32.2 +5.4 116.1 zt26.0 0.62
values
&
exer-
Douglas bags during each of the final 3-4 min. Duplicated samples were analyzed for FECES and FEDS by a microVolume was determined by a Scholander apparatus. Tissot spirometer. The same protocol was repeated for each subject some 2 wk later. Validity phase. Esch subject performed the all-out arm test described above, as well as a progressive-continuous running test on the treadmill. The order of tests was aswith 7-10 days separating the tests. signed randomly, and the inclination was .Running speed was 10 km/h increased each 2 min by 2.5 %, till exhaustion. The initial load was again determined according to the HR response to a 6-min three-stage submaximal run, performed some 20-30 min earlier. Total time of the all-out run was thus kept at 5-7 min. The protocol for HR determination and for gas collection was as in the test-retest phase, with the exception that FELON and FEN, were analyzed by Beckman LB- 1 and E-2 analyzers, respectively.
/ 0
/ /
/
/
Y
=24.4*0.9x
~4.4 a,,)
/ r = 0.74
FIG. 2. Maximal 02 consumption during running (hz max leg) maximal 02 consumption during arm cranking $0 tted against line. Broken lines (Voz max arm) in 18 men. Solid line is regression denote 1 SE of estimate.
Downloaded from www.physiology.org/journal/jappl by ${individualUser.givenNames} ${individualUser.surname} (163.015.154.053) on September 14, 2018. Copyright © 1975 American Physiological Society. All rights reserved.
426
0.
DISCUSSION
Assuming that the capacity for 0, consumption during arm exercise is dependent on the amount of active muscle mass, the high reliability of the all-out arm test (Fig. 1) suggests that, with the described protocol, a given individual uses the same muscle groups in repeated exertions. Furthermore, it seems that this test does yield the peak of energy utilization through aerobic processes that the active muscles can reach. The lower r value for HR,,,,, arm does not necessarily indicate a low reliability of this measurement. Apparently, it merely reflects the fact that the dispersion of HR,,., is quite small among individuals (coeficient of variation being only 7-8 %, as compared to 29 % for VOW max arm in the same subjects), which automatically lowers the coefficient of correlation. On the other hand, the low r values for post exercise HR most probably do reflect a lower reliability of this measurement, as is also known for recovery HR from leg exercise. What is the predictive power of this test for ‘
Vol.
OF APPLIED 38, No. 3, March
PHYSIOLOGY
1975.
Maximal
2%&d
in U.S.A.
oxygen
exercise -reliability 0.
BAR-OR
Defartment
AND of Research.,
L. D. ZWIREN Wingate Institute for Physical Education
O., AND L. D. ZWIREN. Maximal oxygen consumption arm exercise --reliability and validity. J. Appl. Yhysiol. 38(3) : 424-426. 19X-The reliability and validity of a continuous progressive arm test, in which maximal 02 consumption arm) is determined, were analyzed. Forty-one men (ii02 m:kX (28.2 + 8.8 yr) performed the test twice. Eighteen additional men (22.6 + 5.6 yr) performed the arm test, as well as the treadmill run, in which maximal 02 consumption (VO, m:Lx leg) was determined. The validity of the voz m3X arm test was computed, using Voz 1n:ix leg as a criterion for the individual’s aerobic capacity. The reliability coefficients of voz max arm, ~~~~~~~ arm, arm were 0.94, 0.98, and 0.76, respectively, indicating and HR,,,,, a high reliability of the test. The validity coefficient of Voz In:lX arm was only 0.74. The regression equation of voz m:lX leg on These findings VO 2IniLX arm was y = 24.4 + 0.9 + 4.4 (&). indicate that, following the suggested protocol, the individual repeatedly uses the same muscles and does reach an all-out stage. However, different individuals apparently are aided by their trunk and leg muscles to different degrees, which lowers the validity of this test as a predictor of aerobic capacity. BAR-OR,
vs. leg exercise;
paraplegics;
arm
and validity
test during
arm
test during
consumption
prediction
of aerobic
capacity
TESTING OF CARDIOPULMONARY and metabolic reactions to rhythmic arm exercise is necessary whenever subjects cannot use their legs for exertion. Such is the case with paraplegics (10, 16), amputees (7), cerebral palsied (lo), or people with various leg traumata. Furthermore, arm exertion is used with able-bodied people in medical (3, 15) and physiological (e.g., 1, 2, 4-6, 8, 9, 11, 13, 14) research on the effects of exercising relatively small muscle groups. Among the major physiological differences between arm and leg exercise are the factors which limit the maxiin each case. Whereas maximal power ma1 performance output of the leg muscles is limited by one or more of the central cardiorespiratory stages of the oxygen transport chain (12), rhythmic arm exercise capacity is most probably dependent on the amount of active mass, so that “central” functions such as cardiac output, stroke volume, heart rate (HR), and pulmonary ventilation do not reach their maximal level in the latter mode of exercise (14). As a result, the highest oxygen consumption reached during arm exercise (Vo 2 II1s1Xarm) is lower than that achieved in running or cycling (VO2 lHflX leg). Some authors (1, 5, 14) have reported Voz rllnx arm to be some 65-70 alo of Vo:! lllflX leg. If this percentage were fairly consistent it would be possible to predict one’s
and $&A,
kVingate Post Q&e,
Israel
aerobic capacity (ime., VOZ max leg) by measuring Voz nzaX arm. Bouchard (personal communication) has calculated the correlation coefficients among ii02 Max arm, measured at the standing position, and ~OZ llZaX leg (treadmill run, step test, and upright bicycle test). To the best of our knowledge, there has been no systematic analysis of the validity of the sitting arm test against the more commonly used leg tests. Nor has there been any information available as to the reliability of the former. The purposes of this study were to determine the testretest reliability of a continuous progressive all-out arm test and to check its validity as an instrument for assessing maximal aerobic power capacity. SUBJECTS
Fifty-nine men participated in the study, of whom 41 were included in the test-retest evaluation, and 18 in the validity measurements. Some characteristics of all subjects are summarized in Table 1. More detailed background of the participants in the test-retest phase, 20 of whom were paraplegics, has been reported previously (16). The participants in the validity phase were healthy male volunteers, active participants in physical education programs but not in varsity competition. These programs included endurance training, ball games, and calisthenics, with no special emphasis on any muscle group. Accordingly, their fitness level was somewhat higher than in the general population. METHODS
Test-retest phase. A continuous progressive all-out arm test was performed, using a modified von Dijbeln (Monark) ergometer. The subjects sat on a wheelchair, the height of which was adjustable so that the axis connecting the pedals would bc at shoulder level. Pedaling cadence was 50 cycles/min. To keep the total time of exertion within 5-7 min, the initial load was decided upon according to the HR response of each individual to a submaximal test comprising three 2-min stages which preceded the all-out test by 20-30 min. Thus, initial load was 450, 600, or 750 kpm/min. Loads were subsequently increased every 2 min by 150 kpm/min, until subjects could no longer keep up the pace. HR was determined at the last 15 s of each minute during exercise and of the first 3 min of recovery, using a bipolar ECG chest lead. Expired air was collected into
Downloaded from www.physiology.org/journal/jappl by ${individualUser.givenNames} ${individualUser.surname} (163.015.154.053) on September 14, 2018. Copyright © 1975 American Physiological Society. All rights reserved.
AKM
‘cioz Inax-
RELIABILITY
TABLE 1. hr~ ___---
;bhyska/ character&h
Group Test-retest (n = 41) Validity (n = 18) Values
AND
are means
425
VALIDITY
RESULTS
of subjects
Age, Y=
Ht,
28.2 zt8.8 22.6 +5.6
174.2 zt9.8 170.5 h8.1
cm
W-t, kg
O/GFat (Allen >
70.8 h13.2 67.9 zt8.8
17.4 zt5.4 12.0 zt5.3
LBM,
kg
58.8 3x9.4 59.6 zt6.7
#Z SD.
TABLE 2. Test-retest values obtained during and on recovery from maximal arm exercise +02
Test I (n = 41) Test II (n = 41) Test-retest
Values
max
ml/kg+ min
~W,tl
30.37 zt9.05 31.04 It9.01
174 ~12.6 174 zt14.3
& SD;
7
Recovery
VE I+X$
l/mm
76.5 Zt22.1 83.0 +22 .o
0.76
0.94
are means
X
= correlation
1 min
134 *l&l 135 &16.7
0.98
0.77
HR
2 min
117 zt15.5 114 hl5.8
3 min
107 +15.4 110 *14*5
0.78
0.86
Test-retest. Maximal values obtained during testing and retesting, as well as recovery HR of the first 3 min, are summarized in Table 2, together with the intertest reliability coefficients. Both ~oZ max arm and vEIlLaX arm seem to have a high reliability, while the consistency in results of HR,., arm is considerably lower. The high r value for ~~~~~~ arm was obtained despite the actual values being some 8 % higher in the second test. Individual results for vo2 lllnX in both tests are plotted in Fig. 1. Most subjects obtained very similar results in both tests (agreement within l-2 ml/kg. min). Five had higher second values by some 4-5 ml/kg -min, while three had lower second values by 3-5 ml/kg min. Validity testing. Maximal values, as achieved during arm and during leg exercise, are summarized in Table 3. AS expected from other studies, ~oZ max arm, vEII1aX arm and oxygen pulse max arm are about two-thirds of their respective leg values. However, the predictability of maximal leg values from arm data is merely fair, as can be judged from the correlation coefficients summarized in Table 3.
coefficient.
TABLE 3. comparison of maximal values obtained during arm and during running exercise (n = 18) --_ -~-.~-~ --~--902
HR max
max
-._-. Arm
Q 02/HR
*Emax -
Run
Arm
Run
56.01 zt6.49 62.5 zt6.3
173 &lo.2
195 1t7.5 88.7 A4.9
----ir Eli-02
max
-Arm
Arm
Run
Run
Arm
Ran
--._-----~ Mean + SD % *SD
r -_ SD
FIG.
cise
(V02
1. Test-retest of maximal 02 consumption Individual data, n = 41+ ma3 arm).
during
arm
34.59 zt5.32
86.2 zt20.4
120.6 zt14.5 73.4 xt13.9
13.5 19.5 zt2.8 h3.6 69.0 zt5.2
0.74 -0.25 0.65 -Values are means & 1 SD; rnean arm values as percentage of these percentages; T = correlation coefficient.
0,89 of running
36.9 h6.7
32.2 +5.4 116.1 zt26.0 0.62
values
&
exer-
Douglas bags during each of the final 3-4 min. Duplicated samples were analyzed for FECES and FEDS by a microVolume was determined by a Scholander apparatus. Tissot spirometer. The same protocol was repeated for each subject some 2 wk later. Validity phase. Esch subject performed the all-out arm test described above, as well as a progressive-continuous running test on the treadmill. The order of tests was aswith 7-10 days separating the tests. signed randomly, and the inclination was .Running speed was 10 km/h increased each 2 min by 2.5 %, till exhaustion. The initial load was again determined according to the HR response to a 6-min three-stage submaximal run, performed some 20-30 min earlier. Total time of the all-out run was thus kept at 5-7 min. The protocol for HR determination and for gas collection was as in the test-retest phase, with the exception that FELON and FEN, were analyzed by Beckman LB- 1 and E-2 analyzers, respectively.
/ 0
/ /
/
/
Y
=24.4*0.9x
~4.4 a,,)
/ r = 0.74
FIG. 2. Maximal 02 consumption during running (hz max leg) maximal 02 consumption during arm cranking $0 tted against line. Broken lines (Voz max arm) in 18 men. Solid line is regression denote 1 SE of estimate.
Downloaded from www.physiology.org/journal/jappl by ${individualUser.givenNames} ${individualUser.surname} (163.015.154.053) on September 14, 2018. Copyright © 1975 American Physiological Society. All rights reserved.
426
0.
DISCUSSION
Assuming that the capacity for 0, consumption during arm exercise is dependent on the amount of active muscle mass, the high reliability of the all-out arm test (Fig. 1) suggests that, with the described protocol, a given individual uses the same muscle groups in repeated exertions. Furthermore, it seems that this test does yield the peak of energy utilization through aerobic processes that the active muscles can reach. The lower r value for HR,,,,, arm does not necessarily indicate a low reliability of this measurement. Apparently, it merely reflects the fact that the dispersion of HR,,., is quite small among individuals (coeficient of variation being only 7-8 %, as compared to 29 % for VOW max arm in the same subjects), which automatically lowers the coefficient of correlation. On the other hand, the low r values for post exercise HR most probably do reflect a lower reliability of this measurement, as is also known for recovery HR from leg exercise. What is the predictive power of this test for ‘
