Procedures for the Administration of a Graded Exercise Test

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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 doctors 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 the EKG monitor Verbally insure the subject in 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 Also see: Proper Technique in Administering a Stress Test DVD