The Talk TestThe Talk Test

The 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

Talk TestTalk 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

Every Story Starts SomeplaceEvery Story Starts Someplace

1998

Components of an Exercise Components of an Exercise ProgramProgram

• Frequency– 5-7 x weekly

• Intensity– Hardest to define

• Time– 20-60 min

• Type

Prescription of Exercise Training IntensityPrescription 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

ATP

Aerobic

Anaerobic

Aerobic

Anaerobic

(CO2 and H20)

(LAH)

(LAH+ + H2CO3- H2CO3 CO2 and H2O)

What does this have to do with anything?What does this have to do with anything?

2 studies: Katch et al., 1978 2 studies: Katch et al., 1978

Dwyer et al., 1994Dwyer et al., 1994

• At 55% of HR reserve, 50% of cardiacAt 55% of HR reserve, 50% of cardiac

patients were above their anaerobicpatients were above their anaerobic

threshold and 50% were belowthreshold and 50% were below

HR Training Zone

HR Training Zone

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

BOTTOM LINEBOTTOM 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.

Our research sought to:Our research sought to:

1. Determine the relationship between the Talk Test and other physiological measures (e.g., VT, HR, VO2, RPE, etc.).

2. Determine how we could translate this information into a useful exercise prescription in the clinic.

TerminologyTerminology

• 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

What Does the Talk Test Look Like?What Does the Talk Test Look Like?

VO2 @ VT vs + Talk Test

y = 0.9344x + 0.1287R2 = 0.9254

0

10

20

30

40

50

60

0 10 20 30 40 50 60

VO2 @ VT (ml/kg)

VO

2 @

+ T

alk

Te

st

(ml/k

g)

Last + Stage vs VT

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

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

Equivocal Stage vs VTVO2 @ VT vs +/- Talk Test

y = 0.9435x + 2.6613R2 = 0.9349

0

10

20

30

40

50

60

0 10 20 30 40 50 60

VO2 @ VT (ml/kg)

VO

2 @

+/-

Tal

ke T

est

(ml/k

g)

Negative Stage vs VT

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

VO2 @ VT vs - Talk Test

y = 0.9869x + 6.463R2 = 0.9152

0

10

20

30

40

50

60

0 10 20 30 40 50 60

VO2 @ VT (ml/kg)

VO

2 @

- T

alk

Tes

t (m

l/kg

)

%HRmax & %METs

60

70

80

90

100

%HR max %METs

Positive

Equivocal

Negative

• 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.

OK, the Talk Test Matches VOOK, the Talk Test Matches VO22, HR and VT , HR and VT

Markers of Exercise Capacity……Does it Markers of Exercise Capacity……Does it Work in Real Life?Work in Real Life?

How to develop an exercise prescription using How to develop an exercise prescription using the Talk Testthe 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

Translating GXT to TrainingTranslating GXT to Training

Talk Test Score

0

0.5

1

1.5

2

2.5

3

0 2 4 6 8 10 12 14 16 18 20Time (min)

EqTT

LPTT

LP-1TT

RPE

0

2

4

6

8

10

0 2 4 6 8 10 12 14 16 18 20Time (min)

EqTT

LPTT

LP-1TT

% HRmax

50

60

70

80

90

100

0 2 4 6 8 10 12 14 16 18 20Time (min)

EqTT

LPTT

LP-1TT

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

40

60

80

100

120

0 5 10 15 20 25 30

Time (minutes)

% V

O2

@ V

T

Protocol

Mean % VT

Can the Talk Test Prevent Exertional Can the Talk Test Prevent Exertional Myocardial Ischemia?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

y = 0.4254x + 0.8629R2 = 0.2962

0

2

4

6

8

10

0 2 4 6 8 10

First Evidence of Ischemia

Last

+ T

T

100

105

110

115

120

125

130

135

140

1

Hea

rt R

ate

Ischemia

Positive TT

Equivocal TT

Negative TT

Ischemia -10

CA Cannon et al. Am J Med Sport 6: 52-57, 2004

So, Where Does this Leave Us?So, Where Does this Leave Us?

SummarySummary

• 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