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RehabMeasures Instrument

Maximal Oxygen Uptake: VO2max and VO2peak

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Purpose

Measures the aeroic fitness of the multiple sclerosis population by assessing their VO2max and VO2peak.

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Instrument Details

Area of Assessment

Aerobic Capacity

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Multiple Sclerosis

Key Descriptions

  • Maximal oxygen uptake (VO2max) is a widely reported measure of aerobic fitness.
  • VO2max is assessed during a graded exercise test.
  • This test is traditionally conducted using:
    1) a treadmill
    2) a lower extremity ergometer
    3) an upper extremity ergometer
    4) a combination of upper and lower extremity ergometer
  • VO2max is the point at which oxygen uptake no longer increases (or increases only marginally) with an increase in workload.
  • In the case that a plateau in oxygen uptake is never reached, this is a submaximal exercise test in which VO2peak is recorded.
  • VO2peak has been used to predict VO2max based on published formulas, although the accuracy of these predictive models in PWMS and in healthy controls is in question.
  • A review of submaximal aerobic exercise tests (not specific to PWMS) was reported by Noonan & Dean in 2000.

Number of Items

1

Equipment Required

  • VO2max is most accurately measured during a maximal exercise test with an open-circuit spirometer. The test is conducted on a treadmill or ergometer. Computerized systems are typically used. Data is collected and can provide a printout of test results.
  • Sub-maximal exercise tests can be used to measure VO2peak and/or estimate VO2max. Please see the reivew by Noonan & Dean for an overview of equipment required for some of these tests.
  • If client is "high risk" because of cardiovascular issues or autonomic dysfunction, it is recommended there are site personnel certified in basic life support and automated external defibrillator training.
  • If client is "high risk" as above, then there should be equipment to monitor blood pressure and ECG changes. Personnel with certification in first aid and eadvanced cardiac life support are preferred.

Time to Administer

60 minutes

Approximately one hour is required for setup and orientation, the exercise test (about 15-20 minutes), and a cool down period.

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Evan Cohen, PT, MA, PhD, NCS and the MS Edge Taskforce of the Neurology Section of the APTA.

ICF Domain

Body Structure

Professional Association Recommendation

  • Most appropriate for outpatient setting
  • Widest use in EDSS range of 0 – 5.5. May be useful with higher EDSS scores through sub-maximal testing with an appropriate ergometry device
  • From Kluding’s review of VO2max in the Stroke EDGE Summary: “Maximal tests are not recommended for clinical practice because of limited feasibility: tests require extensive knowledge of exercise physiology, ECG interpretation, ability to respond to cardiac complications, expensive equipment, and physician supervision. However, referral to cardiac rehab settings for these tests is appropriate before initiating a moderate/vigorous aerobic training program.”
  • The terms VO2max and VO2peak are often used interchangeably, however, they are distinct. True VO2max is measured less often than VO2peak. Researchers and readers of the literature must be careful to correctly apply and interpret these terms

Considerations

  • VO2max and VO2peak testing are physically demanding. MS-related fatigue may limit the individual’s ability to participate in the testing
  • As PWMS have varied clinical presentations, the mode of exercise testing (upper vs. lower extremity ergometry, upright vs. recumbent seating, etc0 must be matched to the person’s abilities
  • Careful consideration must be given to any co-morbidities that might place the individual at risk. Particular attention must be pain to abnormalities in exercise response due to autonomic involvement. The ACSM recommends a medical examination and the introduction of graded exercise before maximal testing is conducted
  • Although VO2max and VO2peak are commonly used measures of aerobic fitness in PWMS, two studies raise significant limitation for their use. Agiovlastis, Motl and Fernhall found that the formulas by the ACSM and by vander Walt and Wyndham underestimated VO2max in a sample of PWMS and in healthy controls. The discrepancy between actual and predicted oxygen consumption values increased with higher workloads. Another study found that VO2max was overestimated based on some sub-maximal (VO2peak) testing models. The was explained by the reduced heart rate response to the increasing workload in the sample of PWMS. The confounding effect of the abnormal HR response was minimized by the use of VO2max prediction equation which excluded HR from the model, but which requires a maximal exercise test protocol. Clinicians and researchers who use VO2max and peak testing in PWMS must carefully consider the predictive models upon which their calculations are based.

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Multiple Sclerosis

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Normative Data

Multiple Sclerosis:

(Lippincott Williams & Wilkins et al, 2010)

  • VO2max values and their percentile rankings by gender and age grouping can be found in the ACSM guidelines for exercise and testing perscription

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Rasova K et al, 2005; n = 112 patients with MS selected as population-based sample and examined on impairment, disability, handicap, quality of life, fatigue, depression, respiratory function and physical fitness with spiroergometric and spirometric paratmeters)

  • Adequate correlation between with VO2peak with the Barthel Index (r = 0.40)
  • Adequate correlation between VO2peak and the physical subscale of the Multiple Sclerosis Quality of Life-54 (r = 0.32)
  • Poor correlation between VO2peak and the Environment Status Scale (r = -0.27)
  • Adequate correlation between VO2peak and EDSS population of 112 PWMS score of 3.07 (1.68) (r = -0.46)

(Romberg A et al, 2004; n = 91 MS patients randomly assigned to exercise or control group; EDSS = 1.0 - 5.5)

  • Adequate correlation between VO2peak with 59 women with EDSS mean score = 2.2; range = 1 - 4 (r = -0.31)
  • Adequate correlation between VO2peak and 33 men with MS and EDSS score of 3.0; range = 1 – 5.5 (r = -0.50)
  • Each 1-point increase in EDSS is associated with a decrease in relative VO2peak of about 2 ml/kg/min

(Foglio K et al, 1994; n = 24 MS patients; 17 females, 7 males; age = 48 (9) years; weight = 65 (12) kg; EDSS = 0.00 - 6.0)

  • Adequate correlation between VO2peak and maximal inspiratory pressure endurance (an inability to sustain pressure for longer than three consecutive breaths) (= 0.52)

(Patejan JH et al, 1996; n = 54 MS patients randomly assigned to exercise or non-exercise groups; exercise groups had 15 weeks of aerobic training)

  • Adequate correlation between post-training improvements in VO2max with POMS subscales for tension (r = -0.50)
  • Adequate correlation between post-training improvements in VO2max with POMS subscales for vigor (r = -0.39)
  • Excellent correlation between post-training improvements in VO2max with POMS subscales for fatigue (r = -0.68)
  • Adequate correlation between post-training improvements in VO2max with POMS subscales in confusion (r = -0.40)
  • Adequate correlation between post-training improvements in VO2max with POMS subscales in physical and psychosocial dimension of the SIP (r = -0.47 and -0.37)

Floor/Ceiling Effects

Multiple Sclerosis:

  • Not specifically reported in PWMS, but seems unlikely as aerobic fitness can continually improve with training
  • Some PWMS may be unable successfully complete the test due to fatigue or other symptoms

Bibliography

Agiovlasitis, S., Motl, R. W., et al. (2010). "Prediction of oxygen uptake during level treadmill walking in people with multiple sclerosis." Journal of Rehabilitation Medicine 42(7): 650-655. Find it on PubMed

Billinger, S. A., Tseng, B. Y., et al. (2008). "Modified total-body recumbent stepper exercise test for assessing peak oxygen consumption in people with chronic stroke." Phys Ther 88(10): 1188-1195. Find it on PubMed

Dobrovolny, C. L., Ivey, F. M., et al. (2003). "Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke." Arch Phys Med Rehabil 84(9): 1308-1312. Find it on PubMed

Eng, J. J., Dawson, A. S., et al. (2004). "Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption." Arch Phys Med Rehabil 85(1): 113-118. Find it on PubMed

Foglio, K., Clini, E., et al. (1994). "Respiratory muscle function and exercise capacity in multiple sclerosis." European Respiratory Journal 7(1): 23-28. Find it on PubMed

Noonan, V. and Dean, E. (2000). "Submaximal exercise testing: clinical application and interpretation." Physical Therapy 80(8): 782-807. Find it on PubMed

Petajan, J. H., Gappmaier, E., et al. (1996). "Impact of aerobic training on fitness and quality of life in multiple sclerosis." Annals of Neurology 39(4): 432-441. Find it on PubMed

Ponichtera-Mulcare, J., Glaser, R., et al. (1993). "In the Field-Maximal aerobic exercise in persons with multiple sclerosis." Clinical Kinesiology 46: 14-14. Find it on PubMed

Ponichtera-Mulcare, J., Mathews, T., et al. (1995). "From the Field-Maximal aerobic exercise of individuals with multiple sclerosis: Using three modes of ergonometry." Clinical Kinesiology 49: 4-4. Find it on PubMed

Rasova, K., Brandejsky, P., et al. (2005). "Spiroergometric and spirometric parameters in patients with multiple sclerosis: are there any links between these parameters and fatigue, depression, neurological impairment, disability, handicap and quality of life in multiple sclerosis?" Multiple Sclerosis 11(2): 213-221. Find it on PubMed

Romberg, A., Virtanen, A., et al. (2004). "Exercise capacity, disability and leisure physical activity of subjects with multiple sclerosis." Multiple Sclerosis 10(2): 212-218. Find it on PubMed

Romberg, A., Virtanen, A., et al. (2004). "Effects of a 6-month exercise program on patients with multiple sclerosis." Neurology 63(11): 2034-2038. Find it on PubMed

Ryan, A. S., Dobrovolny, C. L., et al. (2000). "Cardiovascular fitness after stroke: role of muscle mass and gait deficit severity." Journal of Stroke and Cerebrovascular Diseases 9(4): 185-191. Find it on PubMed

Storer, T. W., Davis, J. A., et al. (1990). "Accurate prediction of VO2max in cycle ergometry." Med Sci Sports Exerc 22(5): 704-712. Find it on PubMed

Tang, A., Sibley, K. M., et al. (2006). "Maximal exercise test results in subacute stroke." Arch Phys Med Rehabil 87(8): 1100-1105. Find it on PubMed

Tseng, B. Y. and Kluding, P. (2009). "The relationship between fatigue, aerobic fitness, and motor control in people with chronic stroke: a pilot study." Journal of Geriatric Physical Therapy 32(3): 97-102. Find it on PubMed

Van der Walt, W. and Wyndham, C. (1973). "An equation for prediction of energy expenditure of walking and running." Journal of Applied Physiology 34(5): 559-563. Find it on PubMed

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