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
  • 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

Also see: Proper Technique in Administering a Stress Test DVD


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