Pre-test Health Screening
It is imperative that there are no medical contraindications to the subject undertaking any of the above tests.
Most people don’t require a medical check-up before taking this test or starting regular, moderate exercise. However, if there are any doubts about the individual’s suitability to partake in moderately vigorous physical activity, then please advise them to consult a doctor – and do not conduct the Fitness Test.
Pre-participation health screening questionnaire
There are several questionnaires that have been developed for pre-screening participants with a view to identifying and excluding individuals with medical contraindications to exercise. The following PAR-Q Test was developed in Canada by the British Colombian Department of Health in 1975 and modified by ACSM (2000).
It has been widely used as a pre-participation screening test for apparently healthy individuals of any age for moderate exercise.
For further information on pre-participation health screening, see American College of Sports Medicine (ACSM 2008).
PAR-Q physical activity readiness questionnaire
For most people, physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable.
1. Has your doctor ever said you have heart trouble?
2. Do you frequently suffer from pains in your chest?
3. Do you feel faint or have spells of severe dizziness?
4. Has a doctor ever told you that your blood pressure is high?
5. Has a doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?
6. Is there a good reason not mentioned here why you should not follow an activity programme even if you wanted to?
7. Are you over 65 and not accustomed to vigorous exercise?
If a person answers ‘Yes’ to any question, vigorous exercise testing should be postponed. Medical clearance may be necessary.
There is always the slight risk that taking any form of exercise may reveal a health defect or weakness that may lead to injury, illness or even fatality. If you have any doubts at all about the subject’s ability to safely undertake the Chester Step Test, the Chester Treadmill Test or the Chester Cycle Test – or to participate in a programme of regular exercise, then do not conduct the test and refer them to their GP for appropriate advice.
Beta blocker drugs and cardio-respiratory fitness
Beta blocker drugs
Beta Blocker drugs are adrenergic receptor blocking drugs which prevent the actions of catecholamine’s (adrenaline and noradrenaline) on the beta-receptors of the heart. The actions of these catecholamines is to increase heart rate and force of contraction of the heart muscle. Beta blockers will, therefore, decrease cardiac output, slow the heart rate, reduce the force of concentration and lower blood pressure. Consequently, their main use is in the control of hypertension, angina pectoris and certain cardiac dysrhythmias.
Patient response to exercise training
Beta blockers will decrease the oxygen requirements of the heart muscle both at rest and in exercise, with a resultant decrease in angina pectoris and an improvement in exercise tolerance. This enables a patient receiving beta blocker drugs to exercise at an increased intensity and for a longer duration before achieving the same heart rate and blood pressure responses. If the patient is monitored during several months of exercise training, the usual haemodynamic adaptations are seen – including a reduction in exercise heart rate in response to a standard workout – together with an increase in maximal oxygen uptake. However, the prescription of exercise should be carefully handled and should be medically supervised to ensure safety.
Testing cardio-respiratory fitness in patients taking beta blocker drugs
While patients can normally participate in controlled exercise training and receive the benefits of regular physical activity; it poses problems for testing cardio-respiratory fitness when heart rate response to a sub-maximal workout is being used as the criterion for predicting aerobic capacity. The results are extremely difficult to interpret, and as a general rule, such tests cannot give valid results. While there are adjustments that can be made to the scores, the results are extremely difficult to interpret, and as a general rule, such tests cannot give valid aerobic capacity results. However, in some clinical situations, performance monitoring is more appropriate, and heart rate and RPE score at each stage of CST or CCT may provide valuable information on patient progression.
Please note: The Chester Treadmill Test is not recommended for patients with medical contraindications for whom brisk walking on an inclined treadmill would be too strenuous.
Pre – test conditions
- Ensure the subject has not eaten, smoked, exercised or drunk tea or coffee for at least 2 hours before the fitness test.
- Ensure the subject is not recovering from illness or has a cold, or is taking beta-blocker drugs which will depress heart rate scores or influence test performance.
- The subject should be wearing loose-fitting, comfortable clothing.
- The room should be quiet, well ventilated and between 18-20 degrees Celsius.
- The subject should not have undertaken any heavy physical exercise for at least 24 hours before the fitness test.
Monitoring Exercise Heart Rate
Heart rate is monitored continuously throughout the fitness tests for a number of reasons:
- for safety purposes, ensuring that the cardiac stress remains within acceptable limits
- for measurement accuracy, rather than post-exercise palpation
- to monitor the increasing heart rate with increasing workload and perceived exertion
- to enable a comparison of heart rate responses in subsequent test occasions to monitor improvements
- to enable aerobic capacity to be predicted from exercise heart rate responses to increasing workloads and oxygen demand.