Exercise prescription when there is no exercise test: the talk test

The Talk Test is a subjective measure of exercise intensity which, like RPE, has come to be accepted as an alternative to objective measures (%HRR, %VO2max) for exercise evaluation and prescription. This paper reviews the history and indications for using the Talk Test as a tool for both exercise evaluation and exercise prescription. The Talk Test, in one form or the other, has a long history, dating from at least 1937. It appears to be robust relative to the method of provoking speech and to the exercise mode. In the most widely used version, the subject recites a standard paragraph of 30-100 words, and responds to the question ‘Can you speak comfortably?’ With answers of ‘Yes’ (POSITIVE), ‘Yes, but…’ (EQUIVOCAL), and ‘No” (NEGATIVE), the Talk Test appears to be able to identify exercise intensities closely associated with the ventilatory (VT) and respiratory compensation (RCT) thresholds, and to bracket subjects into %HRR intensities closely associated with the accepted exercise/training intensity guidelines, without the need for performing a maximal exercise test. The Talk Test appears to work well in a range of populations from college students, healthy adults, elite athletes to patients with chronic diseases. It also seems to be a valid and reliable marker of the presence of exertional ischemia. In a variety of populations, the Talk Test appears capable of being translated into absolute exercise training intensities, on the basis of a commonsense step down sequence. The Talk Test appears to work by allowing detection of when the suppression of breathing frequency, which is necessary for speech, begins to lead to CO2 trapping, which interferes with breathing comfort. Its response to disrupting stimuli such as stochastic exercise, exercise training and blood donation follow predictable patterns. Guiding exercise intensity using the Talk Test instead of %HRR provides comparable responses during exercise training, without the need for an anchoring maximal exercise test. In summary, the Talk Test seems to offer a considerable promise as a means of exercise evaluation and prescription, in a wide variety of exercising individuals, without the need for a preliminary exercise test

Exercise prescription when there is no exercise test: the talk test

The Talk Test is a subjective measure of exercise intensity which, like RPE, has come to be accepted as an alternative to objective measures (%HRR, %VO2max) for exercise evaluation and prescription. This paper reviews the history and indications for using the Talk Test as a tool for both exercise evaluation and exercise prescription. The Talk Test, in one form or the other, has a long history, dating from at least 1937. It appears to be robust relative to the method of provoking speech and to the exercise mode. In the most widely used version, the subject recites a standard paragraph of 30-100 words, and responds to the question ‘Can you speak comfortably?’ With answers of ‘Yes’ (POSITIVE), ‘Yes, but…’ (EQUIVOCAL), and ‘No” (NEGATIVE), the Talk Test appears to be able to identify exercise intensities closely associated with the ventilatory (VT) and respiratory compensation (RCT) thresholds, and to bracket subjects into %HRR intensities closely associated with the accepted exercise/training intensity guidelines, without the need for performing a maximal exercise test. The Talk Test appears to work well in a range of populations from college students, healthy adults, elite athletes to patients with chronic diseases. It also seems to be a valid and reliable marker of the presence of exertional ischemia. In a variety of populations, the Talk Test appears capable of being translated into absolute exercise training intensities, on the basis of a commonsense step down sequence. The Talk Test appears to work by allowing detection of when the suppression of breathing frequency, which is necessary for speech, begins to lead to CO2 trapping, which interferes with breathing comfort. Its response to disrupting stimuli such as stochastic exercise, exercise training and blood donation follow predictable patterns. Guiding exercise intensity using the Talk Test instead of %HRR provides comparable responses during exercise training, without the need for an anchoring maximal exercise test. In summary, the Talk Test seems to offer a considerable promise as a means of exercise evaluation and prescription, in a wide variety of exercising individuals, without the need for a preliminary exercise test

Do Surgical Trials Meet the Scientific Standards for Clinical Trials?

Unlike medications, the dissemination of surgical procedures into practice is not regulated. Before marketing, pharmaceutical products are required to be shown safe and efficacious in comparative clinical trials that use bias-reducing strategies designed to reduce the distortion of estimates of treatment effect by predispositions toward the investigational intervention or control. Unless an investigational device is involved, the corresponding process for surgical innovations is usually unregulated and therefore may not be based on adequate evidence. Given these differences, we sought to evaluate the state of clinical research on invasive procedures. We conducted a systematic review of publications from 1999 through 2008, which reported the results of studies evaluating the effects of invasive therapeutic procedures, focusing on trials that appeared to influence practice. Our objective was to determine what proportion of studies evaluating surgical procedures use a comparative clinical trial design and methods to control bias. This article reports our results and raises concerns about the methodologic, and therefore the ethical, quality of clinical research used to justify the implementation of surgical procedures into practice

Can the talk test identify maximal lactate steady state?

Introduction: The Talk Test (TT) has been shown to be an effective sun·ogate of standard methods of prescribing exercise training intensity. This study was designed to evaluate if the talk test can identify MLSS. Methods: Apparently healthy triathletes (N~I2) volunteered and served as subjects. Each subject perfotmed two incremental exercise tests on a cycle ergometer to measure VT, RCT, and V02max and to identify stages of the TT (LP-1, LP, EQ, NEG). Subsequently, subjects performed 30 minute steady rides at a constant power output to determine MLSS. In all of the tests and trials, HR and RPE (Borg 0-10 scale) were collected. During the MLSS trials, blood lactate was measured. Results: The PO measurements indicated that the NEG TT stage occurred at a PO that was significantly greater than the MLSS PO. The LP-1 TT occurred at a PO that was significantly lower than the MLSS PO, while the PO at the LP TT was not significantly different than the PO of the MLSS. Conclusion: The combined observations suggest if the TT is clamped at the NEG, the exercise intensity will be higher than the MLSS, which occurs close to the intensity of the LP TT during incremental exercise