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Exercise tolerance tests(ETT)
Stress testing

The efficiency of Cardiac performance can be
determined by :
(1) Subjective symptoms like pain and Dyspnoea
(2) Clinical examination of heart.
(3) Radiological examination of heart.
(4) Electrocardiography
(5) Echocardiography
(6) By performing CARDIAC EFFICIENCY TESTS
- Efficiency of circulation lies in giving a prompt
response to a sudden stress and returning back to the
resting condition as soon as the stress is removed.

The response of the CVS to standardized exercise is the
single best test for assessing the heart efficiency – physical
fitness
Any extra activity over the resting basal level like muscular
exercise, demands additional nutrition as well as faster
removal of metabolic end products.
To meet this demand, there is a progressive ↑ in the HR &
BP. These values return to the pre – exercise levels during
the next few minutes after the exercise is over.

The extent of increase in heart rate as well as time taken by the heart
to return to basal level will give an idea about the cardiac efficiency of
the subject.
The basis of ETT – Compared to a trained person (athlete), there is a
greater ↑ in the HR & BP in an untrained individual, and these values
take a longer time to return to basal levels.
The response depends on – cardiac reserve, muscle power, training,
motivation, nutritional state. Therefore, Cardiac efficiency can also be
used to test physical fitness of an individual.

Pro.:
Recording of basal pulse rate –
hopping on each foot 20 times
Response:
In healthy heart, little disturbance of breathing,
HR not ↑ by more than 10 – 20 bpm,
Return to pre – exercise level in about a minute

**** Only for physical fitness, not be used in patients
Pro.: After recording basal pulse rate,
subject should step up & down a 50 cm bench (40 cm for
females), at a frequency of 30 times/min for 5 minutes
Stop the test if the subject feels breathless and exhausted and
unable to continue the test.
Count the pulse rate 1 minute after the end of the exercise
The pulse rate is inversely proportional to the degree of cardiac
efficiency

Count the pulse rate at
Between 1 & 1.5 minutes = _____ / min (A)
Between 2 & 2.5 minutes = _____ / min (B)
Between 3 & 3.5 minutes = _____ / min (C)
Cardiac efficiency index =
Duration of exercise in seconds (300)
________________________________ x 100
A + B + C

In normal individuals, the index is nearly 100 %, but
is more in sport persons
Efficiency index:
Over 90 % : Excellent
81 – 90 % : Good
55 – 80 % : Average
Below 55 % : Poor

WHO grading of muscular exercise:
VO2 Max: Maximum amount of O2 that can be consumed
during a severe exercise.
Resting VO2 ( O2 consumption ) = 250 ml/min.
Grade HR (bpm) O2
consumption
(L/min)
RLI MET
i. Light (mild) < 100 0.4 – 0.8 < 25 < 3
ii. Moderate 100 - 125 0.8 – 1.6 25 - 50 3.1 – 4.5
iii. Heavy 125 - 150 1.6 – 2.4 51 - 75 4.6 - 7
iv. Severe > 150 > 2.4 > 75 > 7

It is the difference between the basal CO of an individual & the
maximum CO that can be achieved in that person.
Cardiac reserve % =
Maximum CO – Basal CO
______________________ x 100
Maximum CO
- Every Organ in the body, including heart, has a reserve
capacity which the body draws upon in case of emergencies.
- This reserve capacity diminishes in pathological situations and
this decreases the efficiency of the Organ.

Any factor that prevents the heart from
pumping blood satisfactorily decreases the
cardiac reserve.
(i) Ischemic Heart Disease.
(ii) Primary Myocardial Disease.
(iii) Vitamin Deficiency.
(iv) Valvular Heart Disease.
(v) Myocardial damage

(1) Increased sympathetic activity – anticipatory tachycardia.
(2) Decrease in Vagal tone.
(3) Increased activity of the limbic system and motor cortex due
to psychic stimuli directly acting on medulla – anticipatory
tachycardia.
(4) Increased Peripheral reflexes originating from
(i) Muscle spindle
(ii) Muscle tendon receptors
(iii) Joint receptors
(iv) Organ of Corti

(5) Liberation of hormones into circulation (Centrally acting)
(i) Catecholamines from Adrenal Medulla
(ii) Thyroxin (T4)from thyroid gland in response to stress
(6) Increase in body temperature.
(7) Chemical changes occurring in the blood
Hypoxia - arterial PO2
Hypercapnia - arterial PCO2
Academia
Lactic Acidosis - pH

(A) PHYSIOLOGIST has been interested in
(1)To Assess the work capacity of healthy
individuals.
(2)To determine the physical fitness of population
groups.
(3)To improve the performance of athletes,
sportsmen and military personnel.

(B) PHYSICIAN has been interested to use these tests as
(1) In Aiding the diagnosis of heart and lung disease.
(2)Pre and Post - operative assessment of cardio thoracic
surgical patients.
(3) Rehabilitation of Cardiac individuals.
(4) Screening workers for disability compensation.
- The exercise tolerance tests are the best tests for determining
the efficiency of the heart as a pumping organ.
- These tests take the place of cardiac output measurements
which cannot be made with ease in most clinical settings.

- A person is considered to be fit for a particular task or activity
if he accomplishes it with a reasonable degree of efficiency
without, being fatigued and with rapid recovery from the effects
of that exertion.
- Thus physical fitness is a relative term and it is impossible to
make an absolute distinction between fitness and unfitness.
COMPONENTS OF PHYSICAL FITNESS :
(A)Anatomical Fitness
(B)Physiological fitness
(C)PSYCHOLOGICAL FITNESS

i.e. Height, weight and other measurements
- When all the organ parts of the body which
are essential for the task are functionally
present, an individual can be considered as
anatomically fit.
- A man without a leg may not be a runner but
can do lot of other things.

- It means the capacity of an individual for the
skillful performance of the task along with
rapid recovery.
- It includes muscular strength, motor skill,
endurance etc.. A man with a weak masculine
lacks capacity for doing a work requiring
muscular strength but may acquire high
degree of motor skill.

- It depends upon the moral and religious
training of the individual and the impact
of the social and economic environment
upon his life.
- It implies the necessary emotional
stability, drive, motivation, intelligence
and desire to learn to perform a task.

1. Loco motor disturbances
2. Musculoskeletal dysfunctions
3. Anxiety
4. Ischemic Heart Disease
5. Unstable metabolic conditions
6. Threatening signs of Heart failure

(I)MASTER'S STEP TEST
(II)TREAD MILL TEST
(III) BICYCLE ERGOMETRY

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