The Talk TestThe Talk TestThe Poor Man’s Way to Gauge Exercise Training Intensity
• Carl Foster, Ph.D., FACSM• Department of Exercise and
Sport Science• University of Wisconsin-La
Crosse
Every Story Starts SomeplaceSome Stories Start Twice
1970 1998
Exercise is MedicineOverwhelming Epidemiologic and Clinical Evidence
Risk of First Heart Attack
0102030405060708090
100
0 1000 2000 3000 4000 5000Physical Acitivity Index
Rel
ativ
e R
isk
Other ActivitiesStrenuous Sports
R.S. Paffenbarger et al Am J Epidemiology 108: 161, 1978
0
20
40
60
80
100
0 3 6 9 12
Exerc isePTCA
Event Free Survival
Months
R Hambrecht et al.Circulation 109: 1371-1378, 2004
Exercise is MedicineOrder of Magnitude Effect
Effect of CR on Outcome
0
0.2
0.4
0.6
0.8
1
1.2
All Cause Death CV Mortality Non FatalRecurrence
N.B Oldridge et. al. JAMA 260: 945-950, 1988GT Oconnor et. al Circulation 80: 234-244, 1989
* *
Hakim AA; New Engl J Med 1998 338:94 - 99
Effect of Walking on 5 Year MortalityVs -1% with Rx for HTN & Cholesterol
=stopping smoking vs continuing to smokeafter first MI
-8%
Components of an Exercise Program
• Frequency– 5-7 x weekly
• Intensity– Hardest to define
• Time– 20-60 min
• Type
Prescription of Exercise Training Intensity
• Objective Markers– VO2 & METs
• 60-80% max• 45/50-85% reserve
– Heart Rate• 50/65-90% max• 40/50-85% reserve
• Limits of the “relative percent concept”– Individual response thresholds– Wide prescriptive window
• Metabolic markers– Ventilatory Threshold– Lactate Threshold
• Subjective Markers– RPE– Talk Test
Historical BackgroundLong standing belief that highest exercise intensity compatible with “just being able to speak” might be ‘just about right”Prof John Grayson (Oxford University) “Climb no faster than you can talk” (1939)
ACSM Guidelines (4th edition, 1991)Prof Robert Goode (University of Toronto) Hear your breathing test (1995)
Henry Ford Hospital, 1997 Abstracts
American Council on Exercise, 1997UW-La Crosse, 1998Common experience amongst exercisers ‘If we’re going to keep talking, you have to slow down’
Talk Test
What Does the Talk Test Look Like?
Speech Provoking Stimulus
0
5
10
15
20
25
30
VO2 @ VT VO2 @ + VO2 @ +/- VO2 @ -
VO2
(ml
* kg
-1 *
min
-1)
Rainbow
Pledge
*
**
**
*
* p < 0.05 vs. VT
020406080100120140160180
HR @ VT HR @ + HR @ +/- HR @ -
HR
(bea
ts
* m
in-1)
Rainbow
Pledge
**
**
*
* p < 0.05 vs. VT
60
70
80
90
Detroit LaCrosse
%M
ETs
50
60
70
80
Detroit LaCrosse%
HR
R
N Shafer et al. JCRP 20: 289, 2000 JP Porcari et al. JCRP 22: 369, 2002(Amy Kelso-Amann)
Evidence that the Talk Test is a Marker of Appropriate Exercise Intensity
%HRmax & %METs
60
70
80
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100
%HR max %METs
PositiveEquivocalNegative
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
C Foster et al. J Str Cond Res 23: 2425-2429, 2009 (Neepa Talati)E Jeanes et al. J Str Cond Res 25: 590-596, 2011
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 60VO2 @ VT (ml/kg)
VO2
@ +
Tal
k Te
st (m
l/kg)
+Talk Test 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
+/-Talk Test 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 60VO2 @ VT (ml/kg)
VO2
@ +
/- Ta
lke
Test
(ml/k
g)
-Talk Test 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 60VO2 @ VT (ml/kg)
VO2
@ -
Talk
Tes
t (m
l/kg)
VO2 @ VT vs Talk Test
20
25
30
35
40
1
VO2
(ml/k
g)
VTPositiveEquivocalNegative
VO2 @ VT vs Talk Test
*
*
-Talk Test vs RCT
y = 1.0417x - 0.1001R2 = 0.993
0
1
2
3
4
5
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Respiratory Compensation Threshold (L/min)
Talk
Tes
t (N
egat
ive)
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
Percent of VT vs Talk Test
0
20
40
60
80
100
120
140
Positive Equivocal NegativeStage of Talk Test
VO2
as %
VT
StudentsAthletesPatients
Ok, the Talk Test Matches VO2, HR and VT Markers of Exercise Capacity……Does it Work in Real Life?
Does the Talk Test Reflect Changes in Exercise Intensity?
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60
80
100
120
0 5 10 15 20 25 30Time (minutes)
% V
O2
@ V
T
Protocol
Mean % VT
Observed +
Observed -
Expected +Expected -
59 147
24 4
% Right = 73.1%% Wrong = 26.9%
Stage duration in relation to % VT
0
2
4
6
105% VT 110% VT 115% VT 120% VT 125% VT
Intensity (% of VT)
Tim
e (m
in)
“If we’re going to keep talking, you have to slow down”
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
y = 0.4254x + 0.8629R2 = 0.2962
02468
10
0 2 4 6 8 10First Evidence of Ischemia
Last
+ T
T
100
105
110
115
120
125
130
135
140
1
Hear
t Rat
e
IschemiaPositive TTEquivocal TTNegative TTIschemia -10
CA Cannon et al. Am J Med Sport 6: 52-57, 2004
Can the Talk Test Track Permutations in Exercise Capacity? C.FosterC.Foster et al: et al: J J CardiopulmCardiopulmRehabilRehabil
28: 2428: 24--30, 2008 (J Anderson, M 30, 2008 (J Anderson, M Paulson)Paulson)
Experiments with Experiments with venesectionvenesection ExerimentsExerimentswith short term trainingwith short term training
Effect of Training and Blood Loss
-15
-10
-5
0
5
10
15
-15 -10 -5 0 5 10 15
VO2 @ VT (ml*min-1*kg-1)
VO2
@ L
PTT
(ml*m
in-1
*kg-
1)
TrainingBlood Loss
Can You “Translate” From Exercise Testing to Exercise Training with the Talk Test?
• C Foster et al. • J Str Cond Res 23: 2425-2429,
2009– Neepa Talati
• Sedentary individuals• Incremental exercise test to
identify + +/- - stages of Talk Test
• 20 min exercise bouts at LP-1, LP, EQ
Translating GXT to Training
Talk Test Score
0
0.5
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1.5
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2.5
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0 2 4 6 8 10 12 14 16 18 20Time (min)
EqTTLPTTLP-1TT
RPE
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0 2 4 6 8 10 12 14 16 18 20Time (min)
EqTTLPTTLP-1TT
% HRmax
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0 2 4 6 8 10 12 14 16 18 20Time (min)
EqTTLPTTLP-1TT
Does “Translating” Exercise Intensity Work for Fitter Individuals?
• EA Jeanes et al.• J Str Cond Res 25: 590-
596, 2011• Well-trained non athletes
including several “t-shirt runners”
• Incremental exercise to identify stages of TT
• 40 min stead state exercise sessions at – LP-1, LP, EQ
% HR max
40
50
60
70
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90
100
0 10 20 30 40Time (min)
%H
R m
ax
%HR LP-1%HR LP%HR EQ
RPE
0
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0 10 20 30 40Time (min)
RPE
xRPE LP-1xRPE LPxRPE EQ
Talk Test Score
1
2
3
0 10 20 30 40Time (minutes)
Talk
Tes
t Sco
re
TT score LP-1TT score LPTT score EQ
Newest Data on Translating Exercise Training Intensity
• C Foster et al. J Str Cond Res 23: 2425-2429, 2009 (N Talati)
• EA Jeanes et al. J Str Cond Res 25: 590-596, 2011
• + L Walraven• + J Lueck
RPE
0
2
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10
0 10 20 30Time (min)
trLP1trLPtrEQsedLP1sedLPsedEQ
%HRmax
50
60
70
80
90
100
0 10 20 30Time (min)
trLP1trLPtrEQsedLP1sedLPsedEQ
So, Where Does this Leave Us?
Summary • Talk Test---a good ‘old idea’• Easy to perform• eliminates need for maximal exercise• forgiving of variations in speech producing stimulus• Accurately places exercisers in exercise intensity defined
by conventional criteria– %HRmax– %VO2max– VT– RPE
• Apparently useful as tool for avoiding exertonal ischemia• Responsive to permutations in exercise capacity• Easy to translate into exercise training intensity
One Hippopotomus, Two Hippopotomus, Three Hippopotomus, Four