The Talk Test The Poor Man’s Way to Gauge Exercise Training Intensity

1. The Talk TestThe Poor Man’s Way to Gauge Exercise Training Intensity John P. Porcari, Ph.D., RCEP, FACSM, FAACVPR Department of Exercise and Sport Science University of Wisconsin-La Crosse

2. Talk Test • The recommendation is often made that people should exercise at an intensity where they can still carry on a normal conversation. • Been around since at least 1939 • Professor John Grayson at Oxford University advised English mountaineers to “climb no faster than you can talk” • First appeared in ACSM Guidelines in 1991

3. Every Story Starts Someplace 1998

4. Components of an Exercise Program • Frequency • 5-7 x weekly • Intensity • Hardest to define • Time • 20-60 min • Type

5. Prescription of Exercise Training Intensity • Objective markers • VO2 & METs • 40-85% VO2max or maximal METs • 30/40-85% VO2 reserve • Heart Rate • 64-94% HRmax • 40/50-85% HR reserve • Limits of the “relative percent concept” • Wide prescriptive windows • Individual differences in anaerobic threshold • Metabolic markers • Ventilatory threshold • Lactate threshold • Subjective markers • RPE • Talk Test

6. ATP

7. Anaerobic Aerobic

8. (LAH+ + H2CO3-  H2CO3  CO2 and H2O) Anaerobic (LAH) Aerobic (CO2 and H20)

9. What does this have to do with anything? • 2 studies: Katch et al., 1978 • Dwyer et al., 1994 • At 55% of HR reserve, 50% of cardiac • patients were above their anaerobic • threshold and 50% were below

10. HR Training Zone

11. HR Training Zone

12. What about Resting HR + 20 bpm? • Wake Forest Group • 11 cardiac rehab patients • 4 were < 40% of VO2max • 6 were within 40-60% of VO2max • 1 was > 60% VO2max • range was 25-65% of VO2max

13. BOTTOM LINE Even though you may prescribe the same prescription (target HRs) for two people, it may be more (or less) physiologically taxing for some people, and may be perceived to be more (or less) difficult for that individual. Thus, we need a way to individualize exercise prescription based on individual physiology.

14. Our research sought to: • Determine the relationship between the Talk Test and other physiological measures (e.g., VT, HR, VO2, RPE, etc.). • Determine how we could translate this information into a useful exercise prescription in the clinic.

15. Terminology • Last Positive Stage (+ TT) – the last stage where the person can speak comfortably • Equivocal Stage (+/- TT) – the stage where speech begins to become difficult • Negative Stage (- TT) – where the person can no longer speak comfortably

16. What Does the Talk Test Look Like?

17. Last + Stage vs VT M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000 N Shafer et al. JCRP 20: 289, 2000 S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002 P Recalde et al. S Afri J Sports Med 9: 5-8, 2002 R Persinger et al. MSSE 36: 1716-1722, 2004

18. Equivocal Stage vs VT M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000 N Shafer et al. JCRP 20: 289, 2000 S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002 P Recalde et al. S Afri J Sports Med 9: 5-8, 2002 R Persinger et al. MSSE 36: 1716-1722, 2004

19. Negative Stage vs VT M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000 N Shafer et al. JCRP 20: 289, 2000 S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002 P Recalde et al. S Afri J Sports Med 9: 5-8, 2002 R Persinger et al. MSSE 36: 1716-1722, 2004

21. A subsequent study in cardiac patients found that the last stage where subjects could pass the Talk Test corresponded to 64% of VO2max, 70% of HRmax, and an RPE of 13.

22. OK, the Talk Test Matches VO2, HR and VT Markers of Exercise Capacity……Does it Work in Real Life?

23. How to develop an exercise prescription using the Talk Test • Perform a Talk Test (speech evaluation): • Treadmill • Walk at comfortable speed • Start and 0% grade and increase 2% every 2 minutes • Go up to Equivocal Stage (+/- TT) • To set workload for training, go one stage below the last positive stage (LP-1) • Example: Person walks at 2.2 mph; the equivocal stage occurs at 8% grade; 2.2 mph/6% grade was the last + stage; you would begin workouts at 2.2 mph and 4% grade; adjust workload based on RPE • If working in METs, start workouts at .5-1 MET below METs at last + TT • Bike • Start at ~ 20 watts and go up by 20 watts every 2 minutes

24. Translating GXT to Training

25. Does the Talk Test Reflect Changes in Exercise Intensity?

26. Can the Talk Test Prevent Exertional Myocardial Ischemia? • Exertional ischemia is the one substantial danger in ExRx • K Meyer (Eur Heart J 16: 623, 1995) has shown that the VT often precedes ST segment changes in patients with CAD CA Cannon et al. Am J Med Sport 6: 52-57, 2004

27. So, Where Does this Leave Us?

28. Summary • Talk Test---a good ‘old idea’ • Easy to perform • Eliminates need for maximal exercise • Accurately places exercisers in exercise intensity ranges defined by conventional criteria: • %HRmax • %VO2max • VT • RPE • Apparently useful as tool for avoiding exertional ischemia • Responsive to permutations in exercise capacity • Easy to translate into exercise training intensity