785ISSN 1745-5057Womens Health (2010) 6(6), 785–78710.2217WH.docx

785ISSN 1745-5057Women's Health (2010) 6(6), 785–
78710.2217/WHE.10.66 © 2010 Future Medicine Ltd
This expression is different from the largely
adopted traditional expression of 220-(age) as
the predicted maximum heart rate. The formula
developed in the current study provided new
means of estimating failure to reach a target heart
rate. According to the traditional expression, 336
(7%) women failed to reach 85% of age-predicted
heart rate and according to this new expression,
173 (3%) participants failed. Chronotropic
index (ratio of heart rate reserve to the metabolic
reserve) was less than 0.8 in 939 (17%) women by
the traditional estimate. By contrast, chronotropic
index was estimated at less than 0.8 in 496 (9%)
using the equation derived in this study.
The authors evaluated chronotropic incom-
petence by estimating chronotropic index.
They found that participants with chrono-
tropic incompetence (chronotropic index < 0.8)
were older (55 ± 11 years vs 52 ± 11 years;
p < 0.0001), had a higher BMI (29.3 ± 6.7 kg/m2
vs 27 ± 5.6 kg/m2; p = 0.0001), were more fre-
quently smokers (140/496, [28%] vs 695/4941,
[14%]; p < 0.0001), had lower HDL-cholesterol
(47.1 ± 15.2 mg/dl vs 52.1 ± 14.7 mg/dl;
p < 0.0001), were more frequently hyperten-
sive (279/496, [56%] vs 2079/4941, [42%];
p < 0.0001) and had a higher Framingham score
index (8 ± 5.6 vs 5.5 ± 5.9; p = 0.0001).

Some variables of exercise stress testing
were also different between participants with
a chronotropic index of less than 0.8 and 0.8
or more, respectively: heart rate (beats per
minute [bpm]) at stage 2 (125 ± 13 bpm vs
145 ± 16 bpm; p < 0.0001), peak heart rate
(135 ± 12 bpm vs 162 ± 13 bpm; p < 0.0001),
change in heart rate from rest to peak exercise
Gulati and colleagues reported heart rate
response, chronotropic incompetence (defined
as an attenuated heart rate response to exer-
cise) and chronotropic reserve in asymptomatic
women submitted to symptom-limited exer-
cise stress testing according to the Bruce pro-
tocol [1]. The study population was a cohort of
5437 asymptomatic women aged 35 years or
older who volunteered to participate in the St
James Women Take Heart Project [2] after a call
in Chicago area in 1992 and were followed up for
15.9 ± 2.2 years [1]. In the same project, Gulati
and colleagues previously demonstrated that
exercise capacity was an independent predictor of
death in asymptomatic women (greater than in
men) [2] and later published a nomogram for pre-
dicted exercise c apacity in men and women [3].
Among the interesting characteristics of this
large study population was the fact that partici-
pants were asymptomatic women. It has long
been believed that the performance of men and
women submitted to exercise stress testing is dif-
ferent. The concept has a strong basis in clinical
practice. Previous reference values on the per-
formance of exercise stress testing were largely

based in study samples with male predominance
or symptomatic patients submitted to diagnostic
investigation. Furthermore, maximum heart rate
has usually been assumed to be 220-(age).
Results
The results of the study demonstrated a linear
relationship (p < 0.001) between increasing age
and a decrease in peak heart rate achieved with
exercise testing (linear regression). The derived
equation was: peak heart rate = 206-0.88(age).
Priority PaPer evaluation
Heart rate response and chronotropic
incompetence in exercise stress testing of
asymptomatic women
Alfredo Jose Mansur†1 & Rafael Amorim Belo Nunes1
Evaluation of: Gulati M, Shaw LJ, Thisted RA, Black HR,
Bairey Merz CN, Arnsdorf MF:
Heart rate response to exercise stress testing in asymptomatic
women: The St. James
Women Take Heart Project. Circulation 122, 130–137 (2010).
Peak heart rate achieved with
exercise in 5437 asymptomatic women submitted to symptom-
limited exercise stress testing
demonstrated an inverse relationship with increasing age,
expressed by 206-0.88(age), which is
lower than the traditional estimate of 220- (age). A nomogram
was derived. This new formula for
estimating peak heart rate during exercise and the derived
chronotropic incompetence was found
to be a more accurate predictor of all-cause mortality in this
study sample.

1Heart Institute (InCor), Hospital das
Clinicas of São Paulo University
Medical School, General Outpatient
Clinics Unit, Av. Dr. Eneas de Carvalho
Aguiar 44, 05403–900
São Paulo, Brazil
†Author for correspondence:
Tel.: +55 113 069 5237
Fax: +55 113 082 2354
[email protected]
Keywords
• exercise stress testing • heart
rate • prognosis • women
part of
For reprint orders, please contact: [email protected]
786 future science groupwww.futuremedicine.com
Priority PaPer evaluation – Mansur & Nunes
(56 ± 13 bpm vs 84 ± 15 bpm; p < 0.0001),
number of participants who reached 85% or
higher of age-predicted heart rate (323/496,
[65%] vs 4941/4941, [100%]; p < 0.0001), fre-
quency of angina (10/496, [2%] vs 30/4941,
[0.6%]; p < 0.0001) and exercise capacity in
METs (6.5 ± 2.5 vs 8.2 ± 2.7; p < 0.0001).
Furthermore, the researchers developed a
nomogram for asymptomatic women relative to
the traditional estimate. Values of 100% peak

heart rate for women expressed by 206-0.88(age)
were lower than the 100% peak heart rate for
men expressed by 220-(age).
The significant hazard ratios of all-cause mor-
tality in multivariate ana lysis were: stage 2 heart
rate: 0.97 (95% CI: 0.97–0.98; p < 0.001); peak
heart rate: 0.98 (95% CI: 0.97–0.99; p < 0.001);
heart rate increase to reach peak heart rate value:
0.98 (95% CI: 0.97–0.99; p < 0.001); 1 stand-
ard deviation or more below mean peak heart
rate: 1.84 (95% CI: 1.52–2.21; p < 0.001);
and chronotropic index, estimated with the
heart rate values estimates by the expression
derived in the current study, 206-0.88(age): 1.3
(95% CI: 1.03–1.63; p = 0.023). Interestingly,
chronotropic index estimated by age-predicted
heart rate made by the traditional definition,
220-(age), was included in the multivariate mod-
eling and was not significantly associated with
all-cause mortality.
The comparison of the best model between
chronotropic index and all-cause mortality
revealed that the model with the chronotropic
index defined in this study was better than the
chronotropic index defined according to the tra-
ditional estimate for age-predicted heart rate. The
new formula identified fewer women as chrono-
tropically incompetent and was a more accurate
predictor of all-cause mortality.
Significance
The findings of the study support the hypothesis
that maximum heart rate relative to age based on
studies with a predominance of male patients may

be an overestimate for women and demonstrated
an inverse relationship between peak heart rate
with increasing age. Previously, we have observed
that an inverse relationship of maximum daily
heart rate with increasing age was also apparent
in individuals with no evidence of heart disease
on common everyday living activities evaluated
by 24-h ECG monitoring [4].
Chronotropic incompetence as estimated by
the expression derived in this study made the sta-
tistical modeling a better fit to evaluate the asso-
ciation with all-cause mortality. Interestingly,
our observation of a smaller sample of asympto-
matic women with no evidence of heart disease
after clinical and laboratory examination submit-
ted to exercise stress testing did not demonstrate
a significant difference in peak heart rate reached
during exercise by women relative to men [5].
Furthermore, vascular function evaluated by
forearm blood flow in asymptomatic individuals
without any evidence of heart disease submitted
to isometric exercise (e.g., handgrip) was lower
in women and decreased as BMI increased [6].
The authors discussed the chronotropic incom-
petence as a surrogate of underlying autonomic
dysfunction not necessarily related with myocar-
dial ischemia. Previously, we have observed that
heart rate variability in asymptomatic individuals
without any evidence of heart disease revealed
differences relative to age and gender: variability
decreased significantly until the fourth decade
of life and decreased nonsignificantly thereafter
in older age groups; indexes of parasympathetic

modulation (i.e., HF, rMSSD, pNN50) were
higher in women [7]. Heart rate recovery after
exercise, is considered to be a function of reactiva-
tion of the parasympathetic drive and a decrease
in the sympathetic drive. Heart rate recovery
after exercise demonstrated a statistically signifi-
cant correlation with age: younger individuals
recovered faster than older ones from the second
to the fifth minute after exercise (r = 0.19–0.35;
p < 0.05). Heart rate recovery in women was
more rapid than in men: after exercise the rate
was 4 ± 1.1 (<0.05) beats more rapid at the first
minute; 5.7 ± 1.2 (p < 0.05) beats more rapid at
the second minute; and 4.1 ± 1.1 (p < 0.05) beats
more rapid than in men at the third minute. We
found no association between heart rate recovery
and heart rate variability for the first and second
minutes of recovery after exercise, neither in time
nor in frequency domains [8].
Executive summary
• Peak heart rate during exercise in asymptomatic women
demonstrated an inverse relationship with increasing age,
expressed by
206-0.88(age), which was lower than the traditional estimate of
220- (age).
• Chronotropic incompetence in asymptomatic women was
independently associated with an increased risk of all-cause
mortality.
• Chronotropic incompetence estimated with the new formula
206-0.88(age) derived in this investigation was a more accurate
predictor
of all-cause mortality in comparison to the traditional estimate

220- (age).
787future science group Women's Health (2010) 6(6)
Heart rate response & chronotropic incompetence – Priority
PaPer evaluation
Future perspective
Further studies may evaluate heart rate response
to exercise and chronotropic incompetence in
other samples of women with different genetics,
ethnicity, lifestyle and BMI to confirm the find-
ings of this study. In the event of confirmation
of the findings, maximum heart rate for women
submitted to electrocardiographic stress test-
ing will be estimated with an equation different
than 220-(age).
Financial & competing interests disclosure
The authors have no relevant af filiations or financial
involvement with any organization or entity with a finan-
cial interest in or financial conflict with the subject matter
or materials discussed in the manuscript. This includes
employment, consultancies, honoraria, stock ownership or
options, expert testimony, grants or patents received or
pending, or royalties.
No writing assistance was utilized in the production of
this manuscript.
Bibliography
1. Gulati M, Shaw LJ, Thisted RA, Black HR,
Bairey Merz CN, Arnsdorf MF: Heart rate

response to exercise stress testing in
asymptomatic women: the St. James Women
Take Heart Project. Circulation 122, 130–137
(2010).
2. Gulati M, Pandey DK, Arnsdorf MF et al.:
Exercise capacity and the risk of death in
women: the St James Women Take Heart
Project. Circulation 108, 1554–1559 (2003).
3. Gulati M, Black HR, Shaw LJ et al.: The
prognostic value of a nomogram for exercise
capacity in women. N. Engl. J. Med. 353,
468–475 (2005).
4. Silva de Paula R, Antelmi I, Vincenzi MA
et al.: Influence of age, gender, and serum
triglycerides on heart rate in a cohort of
asymptomatic individuals without heart
disease. Int. J. Cardiol. 105, 152–158 (2005).
5. Chalela WA, Fukushima RB, Araujo F,
Lima AC, Moffa PJ, Mansur AJ: Treadmill
exercise testing of asymptomatic men and
women without evidence of heart disease.
Braz. J. Med. Biol. Res. 42, 1230–1235
(2009).
6. Sartori TE, Nunes R A, da Silva GT et al.:
Influence of demographic and metabolic
variables on forearm blood flow and vascular
conductance in individuals without overt
heart disease. Vasc. Health Risk Manag. 6,
431–437 (2010).
7. Antelmi I, de Paula RS, Shinzato AR,

Peres CA, Mansur AJ, Grupi CJ: Influence of
age, gender, body mass index, and functional
capacity on heart rate variability in a cohort of
subjects without heart disease. Am. J. Cardiol.
93, 381–385 (2004).
8. Antelmi I, Chuang EY, Grupi CJ,
Latorre Mdo R, Mansur AJ: Heart rate
recovery after treadmill electrocardiographic
exercise stress test and 24-hour heart rate
variability in healthy individuals. Arq. Bras.
Cardiol. 90, 380–385 (2008).
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
Exercise Test in Women and Men Aged 75-77 Years
Wetterqvist, Hakon;Grimby, Gunnar;Lernfelt, Bodil;Svanborg,
Alvar
Cardiology; 2002; 98, 1-2; ProQuest Central
pg. 92

Abstract
Details
MeSH Female, Heart Ventricles -- physiology, Humans, Male,
Rest -- physiology, Electrocardiography (major),
Exercise -- physiology (major), Heart Rate -- physiology
(major), Sex Characteristics (major)

Title Effects of exercise training on heart rate and QT interval
in
healthy young individuals: are there gender differences?
Author Genovesi, Simonetta; Zaccaria, Daniele; Rossi,
Emanuela;
Valsecchi, Maria Grazia; Stella, Andrea;
Stramba-Badiale, Marco
Publication title Europace; Oxford
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document 1 of 1
Effects of exercise training on heart rate and QT interval in
healthy
young individuals: are there gender differences?
Genovesi, Simonetta; Zaccaria, Daniele; Rossi, Emanuela;
Valsecchi, Maria Grazia; Stella, Andrea; et al.
Europace; Oxford Vol. 9, Iss. 1, (Jan 2007): 55-60.
DOI:10.1093/europace/eul145
Aims The aim of the present study was to assess the effects of
exercise training on heart rate, QT interval, and on
the relation between ventricular repolarization and heart rate in
men and women.
Methods and results A 24 h Holter recording was obtained in 80
healthy subjects (40 males) who differed for the
degree of physical activity. Trained individuals showed a lower
heart rate and a higher heart rate variability than
sedentary subjects, independent of the gender difference in
basal heart rate. Mean 24 h QTc was similar in trained
and non-trained men, while a significant difference was

observed between trained and non-trained women. Exercise
training reduced the QT/RR slope in both genders. This effect
on the QT/RR relation was more marked in women; in
fact, the gender difference in the ventricular repolarization
duration at low heart rate observed in sedentary subjects
was no longer present among trained individuals.
Conclusion The results of this study suggest that the
cardiovascular response to exercise training may be different
in men and women. Women may benefit more from
interventions aimed to increase physical activity as a tool for
prevention of cardiovascular morbidity and mortality.
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Volume 9
Issue 1
Pages 55-60
Number of pages 6
Publication year 2007
Publication date Jan 2007
Publisher Oxford Publishing Limited(England)
Place of publication Oxford
Country of publication United Kingdom, Oxford
Publication subject Medical Sciences--Cardiovascular Diseases
ISSN 10995129
Source type Scholarly Journals
Language of publication English
Document type Clinical Trial
DOI http://dx.doi.org/10.1093/europace/eul145
Accession number 17224424
ProQuest document ID 198300280
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url=https://search.proquest.com/docview/198300280?

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Database ProQuest Central
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COMPARING THE ENERGY EXPENDITURE AND RATING
OF PERCEIVED
EXERTION OF VARIOUS EXERCISE MODES AT A
SPECIFIC HEART RATE
A Thesis
Presented to the
Faculty of
California State University, Fullerton
In Partial Fulfillment

of the Requirements for the Degree
Master o f Science
in
Kinesiology
By
Julie Lyn Smith
Approved by:
Dr. William Beam, Committee Chair
Department of Kinesiology
U - —
f. Jared Cobum, Member a
Department of Kinesiology /
Dr. Lee Brown, Member
Department of Kinesiology
Date
7 ( 7
Date
7 - 2 - . - O ' )
Date

U MI N u m b e r: 1 4 448 80
Copyright 2007 by
Smith, Julie Lyn
All rights reserved.
INFORMATION TO USERS
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of the copy
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UMI

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ProQuest Information and Learning Company
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P.O. Box 1346
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ABSTRACT
Aerobic exercise is one o f the key elements for the elimination
of obesity, which
is a national health problem. Presently, there is limited research
on energy expenditure
and rating of perceived exertion (RPE) when comparing the
elliptical machine, treadmill,
and cycle ergometer. The purpose of this study was to compare
the energy expenditure,
oxygen uptake, and RPE of various modes of exercise at three
specific heart rates (100

bpm, 130 bpm, and 160 bpm).
Twenty healthy, recreationally active men and women between
the ages of 18 and
29 participated in this randomized, two-week study. While
exercising, participants were
connected to a metabolic cart to measure metabolic responses
and wore a Polar heart rate
monitor to record heart rate. Participants completed all three
exercise trials in random
order. During each exercise test trial, they started slowly to
keep their heart rate at 100
bpm and remained at a steady state for energy expenditure,
oxygen uptake, and RPE to be
recorded. Resistance exercise intensity was increased to 130
bpm and 160 bpm,
respectively.
Heart rates fell within five beats of the intended range, with no
significant
differences at any range for the three modes. There was no
significant effect for mode in
oxygen uptake or energy expenditure, but there was a
significant effect for gender, with
men having significantly greater values than women for both

variables. There was no
ii
significant effect due to gender for RPE, but there was a
significant main effect due to
mode of exercise, with the cycle ergometer yielding a
significantly greater RPE at a heart
rate of 160 bpm than either o f the other two modes. The
elliptical machine and treadmill
are recommended over the cycle ergometer for fitness
improvements and weight loss due
to their ability to expend energy at a lower RPE in most people.
111
TABLE OF CONTENTS
ABSTRACT............................................................................
...................................... ii
LIST OF

TABLES.................................................................................
....................... vi
ACKNOWLEDGMENTS..........................................................
.................................. vii
Chapter
1.
INTRODUCTION....................................................................
........................... 1
Problem
Statement................................................................................
............... 2
Purpose of the
Study......................................................................................
...... 2
Hypothesis..............................................................................
............................. 3
Significance............................................................................
............................. 3
Operational
Definitions..............................................................................
.......... 3
Delimitations...........................................................................
............................. 5
Limitations..............................................................................
............................. 6
2. LITERATURE
REVIEW.................................................................................
... 7
Benefits of Physical
Activity............................................................................... 7
Exercise

Modes.....................................................................................
............... 8
Maximal Oxygen
Consumption...........................................................................
9
Heart R
ate..........................................................................................
.................. 9
Rate o f Perceived
Exertion..................................................................................
10
Research
Studies....................................................................................
.............. 10
Summary.................................................................................
............................. 20
3.
METHODS..............................................................................
............................ 21
Participants.............................................................................
.............................. 21
Instruments and
Measures.................................................................................
.. 21
Procedures..............................................................................
.............................. 22
Design and Statistical
Analysis............................................................................ 24
iv

4.
RESULTS...............................................................................
............................. 25
Heart R
ate..........................................................................................
.................. 25
Oxygen
Uptake....................................................................................
................ 25
Energy
Expenditure.............................................................................
................ 26
Rate of Perceived Exertion
(RPE)....................................................................... 26
5.
DISCUSSION..........................................................................
............................ 29
Energy
Expenditure.............................................................................
................ 29
Oxygen
Uptake....................................................................................
................ 30
Rate of Perceived Exertion
(RPE)....................................................................... 30
APPENDIX.............................................................................
...................................... 33
A. Consent
Form.......................................................................................

......... 33
B. Exercise Risk
Assessment............................................................................
39
C.
Questionnaire..........................................................................
...................... 42
D. Appointment
Reminder................................................................................
. 43
E. RPE
Instructions.............................................................................
.............. 44
REFERENCES
...................................................................................... .........
............. 45
v
LIST OF TABLES
Table Page
1. Descriptive
Statistics.................................................................. ...............
...... 27
2. Results by mode and by
gender...................................................................... 28

vi
reproduction prohibited w ithout permission.
ACKNOWLEDGEMENTS
I would like to express my gratitude to my committee members
Dr. Jared Cobum
and Dr. Lee Brown for their support and encouragement during
my thesis study. I
especially thank my committee chairman, Dr. William Beam, for
his patience, wisdom,
knowledge, guidance, and unwavering belief in me. I
appreciated him making time for
me in spite o f his busy schedule, and his humor when I was
frustrated. Additionally, I am
grateful to my fellow graduate students, Connie Grant, Shawn
Olmstead, and Krystle
Rapisura, for their friendship and assistance in the lab. Lastly, I
acknowledge my parents
for their unconditional love and moral support. Without them,
this would not have been
possible.
vii

CHAPTER 1
INTRODUCTION
People participate in aerobic exercise to enhance health status,
alter body
composition, reduce disease risk, and increase fitness (Kravitz
& Vella, 2002). Various
exercise modes result in different energy expenditures. Varying
the intensity o f exercise
is best for cardiovascular benefits. Running on a treadmill,
pedaling on a cycle
ergometer, and exercising on an elliptical machine are three
different modes o f aerobic
exercise. More energy is expended when participating in a
weight-bearing activity, such
as walking or running, compared to non-weight bearing
activities like cycling (Kravitz &
Vella, 2002). Elliptical trainers are weight-bearing, non-impact
machines that feature a
“fluid” lower body elliptical motion (Batte, Darling, Evans,
Lance, Olson, & Pincivero,

2003).
Maximal oxygen consumption (VO2 max) is the highest rate at
which oxygen can
be taken up and consumed by the body during intense exercise
(Bassett & Howley,
2000). It is a measure o f fitness and health (Bassett & Howley,
2000). There is a linear
relationship between heart rate and VO2 during exercise. Heart
rate is used to estimate
exercise intensity and prescribe exercise (Crouter, Albright, &
Bassett, 2004). Rate of
perceived exertion (RPE) is based on the 15 point Borg scale (6-
20) and is the subjective
intensity of effort, strain, discomfort, and fatigue during intense
exercise.
1
2
Recent research reported that the treadmill and elliptical
machine were similar in

the amount of energy expended at the same exercise intensity
and RPE (Porcari, Zedaker,
Naser, & Miller, 1998; Green, Crews, Pritchett, Mathfield, &
Hall, 2004). Other studies
determined that the mode o f exercise did not matter as long as
participants exercised at a
high intensity (Glass & Chvala, 2001; Egana & Donne, 2004).
Problem Statement
Aerobic exercise is one o f the key elements for the elimination
of obesity, which
is a national public health problem. The mission of the
American College o f Sports
Medicine (ACSM) is to encourage the public to participate in
physical activity and fitness
(Whaley, 2006). In 1998, it was estimated that 40% of adults
did not participate in
physical activity (Whaley, 2006). Presently, there is no
conclusive research on energy
expenditure and rating o f perceived exertion when comparing
the elliptical machine,
treadmill, and cycle ergometer.
Purpose of the Study
The purpose of the study was to compare the energy expenditure

and the rate of
perceived exertion (RPE) of various modes o f exercise
(treadmill, elliptical machine, and
cycle ergometer) at three specific heart rates (100, 130, and 160
beats per minute). If
people were more aware o f the most efficient exercise mode
resulting in the highest
energy expenditure, they may be more inclined to exercise and
adhere to an appropriate
exercise program.
Hypothesis
3
1) The energy expenditure of the treadmill will be similar to
that o f the elliptical
machine, but will be significantly higher than the energy
expenditure o f the cycle
ergometer (at the heart rates of 100,130, and 160 beats per
minute).
2) The RPE of the cycle ergometer will be significantly higher
than the elliptical

machine and treadmill (at heart rates of 100,130, and 160 beats
per minute).
Significance
Research studies measuring the energy expenditure of elliptical
machines are
limited. Since the elliptical machine is a fairly new exercise
modality, there is not as
much research on it compared to the treadmill and cycle
ergometer. No studies have
been administered where the energy expenditure and RPE of
three modes of exercise
was recorded at specific heart rates. People should be taught
about which modes of
exercise have the highest energy expenditure and the greatest
cardiovascular benefits.
Operational Definitions
■ Borg Scale: The scale (6-20) used to measure rate of
perceived exertion
(RPE) during exercise (Whaley, 2006).
■ Cycle ergometer: A stationary bicycle that measures the
power of the rider
against a form o f resistance (Paton & Hopkins, 2001).

■ Elliptical machine: A low-impact exercise modality that
allows the feet to
move in a cyclic pattern that is similar to running kinematics
(Mercer, Dufek,
& Bates, 2001).
4
■ Energy expenditure: the amount of energy expended (calories
burned) during
exercise as measured by a metabolic cart (Kravitz & Vella,
2002).
■ Heart rate: The number of heart contractions per unit of time
(Thomas, 1997).
It is used to estimate intensity and prescribe exercise (Crouter,
Albright, &
Bassett, 2004).
■ Heart rate monitor: A device strapped around the chest, used
to record heart
rate during exercise, as well as estimate energy expenditure
(calories burned)
(Crouter, Albright, & Bassett, 2004).

■ Maximal oxygen consumption (VO2 max): The highest rate at
which oxygen
can be taken up and consumed by the body during intense
exercise. It is a
measure of fitness and health and is most commonly performed
on a treadmill
or cycle ergometer (Bassett & Howley, 2000).
■ Rate of perceived exertion (RPE): The subjective intensity of
effort, strain,
discomfort, and fatigue, felt during exercise. Based on the 15-
point Borg
scale from 6 to 20. It is used to observe maximal exertion
during physical
activity (Whaley, 2006; Moyna, Robertson, Meckes, Peoples,
Millich, &
Thompson, 2000).
■ Treadmill: Motor driven treadmills are used for maximal and
submaximal
exercise testing. Running and walking tests can be conducted.
Sedentary and
fit participants can use the treadmill (Whaley, 2006).

5
D elim itation s
Participants were twenty apparently healthy men and women,
between the ages of
18 and 29, who were at low risk for heart disease according to
the American College
of Sports Medicine. They were recreationally active, which was
defined as
participating in aerobic exercise two or more times per week in
the previous three
months. Participants were recruited from California State
University, Fullerton
Kinesiology classes to volunteer in the study. Low risk was
defined as men under the
age o f 45 and women under the age of 55, who are
asymptomatic and have one risk
factor or less (Whaley, 2006). Risk factors include:
1) Family history of myocardial infarction, coronary
revascularization, sudden death
before the age o f 55 years in a father or other male first degree
relative, or before

65 years of age in a mother or other female first-degree relative.
2) Current cigarette smoker or has quit in the previous 6
months.
3) Hypertension with a systolic blood pressure o f > 140 mm Hg
or a diastolic blood
pressure of > 90 mm Hg.
4) Dyslipidemia: Low-density lipoprotein (LDL) cholesterol
>130 mg/dL or high
density lipoprotein (HDL) cholesterol < 40 mg/dL, or on lipid-
lowering
medication, or if total serum cholesterol is > 200 mg/dL.
5) Impaired fasting glucose: Fasting blood glucose >100 mg/dL.
6) Obesity: Body mass index > 30 kg/m, or waist girth >102 cm.
for men and > 88
cm for women, or waist to hip ratio > 0.95 for men and > 0.86
for women.
6
7) Sedentary lifestyle: Not participating in regular exercise or
not meeting the

minimal physical activity recommendations from the U.S.
Surgeon General’s
Report.
Other exclusionary criteria include chronic asthma and
cardiovascular problems.
Limitations
Limitations to the study were small sample size and the use of
self-report to
define the term “recreationally active.”
CHAPTER 2
LITERATURE REVIEW
This literature review presents a broad base of knowledge
regarding aerobic
activity, exercise modes, energy expenditure, maximal oxygen
consumption, and heart
rate during exercise. The topics addressed are maximal oxygen
consumption during
maximal and submaximal exercise testing utilizing the
treadmill, cycle ergometer, and

elliptical trainer, and measuring the energy expenditure,
monitoring heart rate, and rating
of perceived exertion (RPE) during exercise.
Benefits of Physical Activity
Health-related components o f fitness are linked to health
promotion and disease
prevention, which include cardiovascular endurance, muscular
strength and endurance,
flexibility, and body composition. Moderate-intensity physical
activity has been
suggested to receive health benefits (Whaley, 2006). The
Surgeon General’s Report,
Physical Activity and Health, stated that individuals can benefit
from a moderate amount
of physical activity most days o f the week by walking briskly
for 30 minutes, or running
for 15 minutes. Increased physical activity for longer periods of
time yield more health
benefits. The Surgeon General recommended that people
participate in light to moderate
exercise most days of the week (U.S. Department o f Health and
Human Service, 2006).
ACSM proposed in 2001, that overweight people exercise at
least 45 minutes a day to

7
8
prevent weight gain or lose weight. However, the Institute of
Medicine (IOM) and
International Association for the Study o f Obesity (IASO) have
promoted exercising 60
to 90 minutes a day. According to ACSM, an optimal dose-
response relationship has not
been decided yet; however, the more a person exercises, the
more health benefits they
will receive (2006).
Exercise and physical activity prevent cardiac problems,
hypertension, and certain
cancers, decrease the occurrence of stroke, and obesity
(Whaley, 2006). Physically active
people have lower rates o f disease and mortality compared to
sedentary people. The
minimal dose of physical activity needed to obtain disease risk
reductions is uncertain

(Whaley, 2006).
Exercise Modes
When choosing an exercise mode people should take into
account personal
interest, risk of injury, facility availability, and fitness goals
(Kravitz & Vella, 2002).
Energy expenditure can be maximized by varying the intensity
of exercise, using a
machine that can be graded and adjusted. Running expends more
calories than walking
due to the increased intensity of the activity, but both result in
positive health benefits
(Kravitz & Vella, 2002). The elliptical machine has become a
popular choice for low-
impact, cardiovascular exercise and is beneficial to people with
injuries and weight
problems (Dalleck, Kravitz, & Robergs, 2004). During exercise
at a self-selected
intensity, Cook, Heelan, and Kruegar (2004) determined that
college-aged men and
women who exercised on an elliptical machine and treadmill
had similar energy
expenditures. However, Wallace, Sforzo, and Swensen (2004)
found that the treadmill

9
had a higher energy expenditure than the elliptical machine at
three ratings o f perceived
exertion (RPE) intensities in men and women.
Maximal Oxygen Consumption (VO? max)
Bassett and Howley (2000) defined VO2 max as the “highest
rate at which oxygen
can be taken up and consumed by the body during intense
exercise” (p. 70). It is a
measure of aerobic fitness and health (Bassett & Howley, 2000).
Various exercise modes
utilizing large muscle groups may be used to determine VO2
max, although, the treadmill
and cycle ergometer are the most common (Dalleck et al., 2004;
McArdle, Katch, &
Katch, 2001). Running on a treadmill typically yields the
highest VO2 max compared to
other modes, regardless of training level (Dalleck et al., 2004;
McArdle et al., 2001).

Women tend to have a decreased VO2 max (5-15%) compared
to men, relative to body
mass (Deschenes, Hillard, Wilson, Dubina, & Eason, 2006).
Other variables resulting in
a lower VO2 max are decreased stroke volume, reduced
maximal cardiac output, and
lowered hemoglobin concentration (Deschenes et al., 2006).
Heart Rate
Heart rate is used to estimate exercise intensity and prescribe
exercise using a
percentage o f a person’s maximal heart rate values (Crouter,
Albright, & Bassett, 2004).
There is a linear relationship between heart rate and oxygen
uptake (VO2 ) when large
muscle groups are used during exercise. Heart rate and VO2
provide a rough estimate of
energy expenditure. Heart rate helps to detect changes in
exercise intensity; however,
heart rate can be affected by gender, stress, training status,
exercise mode, temperature,

10
and hydration level. Heart rate monitors are beneficial for
people looking to improve
fitness (Crouter et al., 2004).
Rate o f Perceived Exertion
Rate of perceived exertion (RPE) is the subjective intensity o f
effort, strain,
discomfort, and/or fatigue felt during exercise (Moyna,
Robertson, Meckes, Peoples,
Millich, & Thompson, 2000). The 15-point Borg scale (6-20)
was created for the
participant to rate his/her feelings during exercise, while
accounting for environmental
conditions, personal fitness level, and fatigue (Whaley, 2006).
RPE is also used to
observe maximal exertion during physical activity. When
prescribing exercise to a
participant, their response to exercise should be measured via
blood pressure, heart rate,
RPE, VO2 max, and electrocardiogram (ECG) when appropriate
(Whaley, 2006).
Glass and Chvala (2001) administered a study on men and
women to measure the

influence of exercise mode on self-selected exercise intensities.
Participants (n= 12 men;
n=6 women) were between the ages o f 18 and 25. Participants
performed a maximal
exercise test on a cycle ergometer and treadmill, as well as
three submaximal tests on a
cycle ergometer, stair-stepper, and treadmill where they
reported ratings o f preferred
exertion. Glass and Chvala (2001) found when fit and healthy
men and women
completed 20-minute submaximal exercise tests at self-selected
intensities on the cycle
ergometer, treadmill, and stair-stepper, the exercise intensities
they chose were within the
ACSM guidelines o f 50-85% VO2 max. The cycle ergometer
intensity was significantly
higher than the other two exercise modes. As the exercise bouts
progressed, heart rate,
oxygen consumption, and rate o f perceived exertion (RPE)
increased in a linear manner.
11

The cycle ergometer mean relative VO2 was significantly
higher than the treadmill and
stair-stepper; whereas the relative heart rate for the stair-stepper
and cycle ergometer
were significantly higher than the treadmill. Glass and Chvala
(2001) determined that
self-selected exercise intensities are similar for various exercise
modes.
The energy expenditure from six exercise machines at selected
intensities (RPE
11,13,15) was evaluated (Moyna, Robertson, Meckes, Peoples,
Millich, & Thompson,
2000). Participants («=9 men, w=10 women) completed maximal
exercise tests on six
exercise machines using the Borg scale to rate RPE: treadmill,
stair-stepper, cycle
ergometer, rowing ergometer, cross-country ski simulator, and
rider. Three six-minute
submaximal exercise tests were performed for each modality at
an RPE of 11 (fairly
light), 13 (somewhat hard), and 15 (hard). The treadmill and ski
simulator produced the
greatest energy expenditure for the men, while the treadmill, ski
simulator, and rowing

ergometer resulted in the highest energy expenditure for the
women. When RPE was
taken into account, the men had higher energy expenditures then
the women. At all three
RPEs (11,13, and 15) there were large differences in the
exercises between the men and
women. The treadmill and ski simulator were similar for men
and women since they
expended the most calories on those machines (Moyna et al.,
2000).
Robertson, Moyna, Sward, Millich, Goss and Thompson (2000)
measured the
effect o f gender on ratings of perceived exertion (RPE) of
overall body (RPE-O), legs
(RPE-L), chest (RPE-C), and arms (RPE-A). Heart rate and
relative VO2 were compared
to heart rate and absolute VO2 . Participants («=9 men, «=10
women) performed six-
minute trials on a treadmill, cross-country ski simulator, and
cycle ergometer while using

12
RPE to rate the intensity of exercise. Women perceived the
exercise intensities to be
higher than the men for RPE-overall, RPE-legs, RPE-chest, and
RPE-arms for the
submaximal absolute VO2 . When relative VO2 criteria were
evaluated, there was no
difference between men and women for RPE. Robertson et al.
(2000) concluded that
during 70-90% of mode specific peak values, there were no
differences between RPE and
gender.
Porcari, Zedaker, Naser, & Miller (1998) compared the
physiological responses of
the elliptical machine to the treadmill (run), treadmill (walk),
cycle ergometer, and stair-
stepper. Participants (JV=16; n=8 men; «=8 women) performed
a 20-minute exercise bout
on each exercise mode, at a self-selected intensity. Energy
expenditure, VO2 , heart rate,
and rate o f perceived exertion (RPE) were recorded throughout
the exercise tests. It was
found that VO2 , heart rate, and energy expenditure were not
significantly different when

comparing the elliptical machine and treadmill (run); however,
they were significantly
greater than the cycle ergometer, stair-stepper, and treadmill
(walk). RPE was similar for
all modes of exercise. At a self-selected intensity, treadmill
(run) and the elliptical
machine resulted in a larger physiologic load (Porcari et al.,
1998).
Egana & Donne (2004) studied the cardiorespiratory response to
exercise in semi-
sedentary women using an elliptical machine, treadmill, and
stair-climber. Participants
(/V=24) were randomly assigned to one o f three exercise
groups. They exercised three
times per week for 12 weeks. They worked out for 30 minutes at
70-80% o f heart rate
maximum and progressed to 40 minutes at 80-90% of heart rate
maximum. Participants
performed at maximal exercise test on a cycle ergometer as well
as submaximal tests.

13
Submaximal tests were completed during weeks 0, 4, 8, and 12
on a cycle ergometer.
From weeks 0-4 and 4-8, submaximal heart rate was
significantly reduced. When
training intensity, volume, and frequency were similar (%
HRmax), there were
physiologic improvements in the elliptical machine, stair-
climber, and treadmill (Egana
& Donne, (2004).
Dalleck, Kravitz, and Robergs (2004) recruited recreationally
active participants
(«=10 men, «=10 women) and evaluated two maximal exercise
tests using the treadmill
and elliptical machine. The Balke protocol was followed during
the treadmill test.
Participants were assigned instructions for the elliptical
maximal test based on gender and
activity level. No significant differences were reported
regarding physiological effects
between the two modes when mean VO2 max, maximal heart
rate and maximal
respiratory exchange ratio were assessed. Researchers suggested
that the elliptical trainer

could be used to measure maximal oxygen consumption in men
and women since similar
values were recorded from the treadmill test (Dalleck et al.,
2004).
Mercer, Dufek, and Bates (2001) administered a study
comparing peak oxygen
consumption (VO2 ) and heart rate during treadmill and
elliptical exercise tests. Fourteen
physically active college students (n=9 men, n=5 women)
completed a graded exercise
test (GXT) on the treadmill and elliptical machine on separate
days. There were similar
correlations in VO2 peak and peak heart rate between the
treadmill and elliptical tests.
Investigators determined that the elliptical machine could be
used in place of the
treadmill since there were similar results for both modes of
exercise (Mercer et al., 2001).
14
Kravitz, Robergs, Heyward, Wagner, & Powers (1997)

evaluated VO2 and energy
expenditure after twenty minutes of self-selected submaximal
exercise. Participants (n=9
men, n=9 women) completed treadmill running, simulated cross-
country skiing, cycling,
and aerobic riding. Treadmill running produced a significantly
higher total VO2 and
energy expenditure for men and women compared to the other
modes. Men had a
significantly larger VO2 and energy expenditure, whereas
women had a higher heart rate
(Kravitz et al., 1997).
Researchers compared VO2 , ventilation, heart rate, and rate of
perceived exertion
(RPE) while participants exercised at self-selected intensities on
various modes of
exercise (Crommett, Kravitz, Wongsathikun, & Kemerly, 1999).
Participants (N= 20 men
and women) performed 6-minute randomized trials on a lower
body elliptical,
upper/lower elliptical, and treadmill. There was a significant
within group effect for
ventilation and heart rate. There were no differences in VO2 ,
however the upper/lower

elliptical trial did have an increased response to ventilation,
heart rate and RPE
(Crommett et al., 1999).
Green, Crews, Pritchett, Mathfield, and Hall (2004)
administered a study
comparing heart rate and ratings of perceived exertion (RPE)
between the elliptical
machine and treadmill. Participants (n= 13 men, n=9 women)
completed a maximal
treadmill test and two elliptical exercise tests while wearing
Polar heart rate monitors.
They were directed to provide RPE according to overall
exertion (RPE-Overall), leg
exertion (RPE-Legs), and breathing/chest (RPE-Chest). The first
elliptical test estimated
RPE and the second test had the participants exercising
progressively to their overall
RPE. There were no significant differences in the overall
ratings o f perceived exertion
(RPE-Overall) or breathing/chest effort (RPE-Chest). When

comparing heart rate
responses, there were no significant differences between the
elliptical trainer and
treadmill. During elliptical exercise, participants reported a
higher mean RPE for legs as
opposed to treadmill running. Investigators believed that
elliptical exercise may be more
intense due to the perceived leg exertion and that RPE can
regulate heart rate during
exercise (Green et al., 2004).
Batte and colleagues (2003) conducted a study measuring
oxygen uptake (VO2 )
and heart rate during a maximal and submaximal exercise bout
on an elliptical trainer.
On day 1, participants («=8 men; «=12 women) performed a
progressive maximal
exercise test on an elliptical machine and reported their rating
of perceived exertion (1-
10) at test termination. During day 2, participants completed a
15-minute submaximal
elliptical test and were instructed to build up to an RPE of six
out of ten on the Borg
Scale. Heart rate and VO2 were significantly higher than the
participants perceived when

using the Borg scale for ratings of perceived exertion (RPE). It
was determined that
young, recreationally active participants under-estimated their
perceived efforts when
performing a maximal exercise bout on an elliptical machine
(Batte et al., 2003).
Twenty recreationally active, healthy participants (n=10 men,
w=10 women)
performed a maximal exercise test on a cycle ergometer to
volitional exhaustion and later
performed a submaximal test at 60-65% of their VO2 peak
(Deschenes et al., 2006). Men
had significantly higher VO2 max values than women when
comparing the maximal
exercise test, but men and women showed similar physiologic
responses to the
16
submaximal test. During submaximal cycling, men recorded
significantly higher systolic
blood pressure values at the 15- and 30- minute time points and

also had larger plasma
volume shifts, respiratory exchange ratio values, and
concentrations of plasma lactate.
Men and women exhibited similar values for heart rate, mean
arterial pressure, and
temperature during exercise and recovery (Deschenes et al.,
2006).
Researchers conducted a study to produce the first VO2 max
prediction equation
for a submaximal elliptical exercise test (Dalleck, Kravitz &
Robergs, 2006).
Participants (N= 54; n=25 men; n=29 women) completed a
submaximal elliptical exercise
test and a VO2 max test 15 minutes apart. The prediction
equation was derived using
stepwise multiple regression analyses and was tested by using
data from the cross-
validation group. There was no significant difference between
predicted and measured
VO2 max when dependent t-tests were calculated. The
investigators reported that the
prediction equation and protocol could be a new way to
approximate VO2 max in a non-
laboratory environment (Dalleck et al., 2006).

Skinner, Gaskill, Rankinen, Leon, Rao, Wilmore, and Bouchard
(2003) used the
linear relationship between oxygen uptake (VO2 ), heart rate,
and exercise intensity in the
HERITAGE study to conduct a study on 653 sedentary
participants. Participants
performed two maximal and one submaximal exercise tests on a
cycle ergometer before
and after completing a 20-week training program. After the
training program, a
significant decrease in heart rate at the same absolute power
output for the total group
was seen, as was a significantly higher VO2 max for the whole
group. At the same
absolute power output, women had a significantly higher heart
rate. At the completion of
17
training, all three age groups exhibited a significant decrease in
heart rate at the same
absolute power output. Skinner and colleagues reported that

training did not affect heart
rate at a given % VO2 max in a diverse population (2003).
Investigators conducted a study measuring the accuracy of the
Polar S410 heart
rate monitor for assessing energy expenditure utilizing
predicted and measured heart rate
max and VO2 max on 20 participants («=10 men, «=10 women)
(Crouter, Albright, &
Bassett, 2004). VO2 max and heart rate max were calculated
during a maximal treadmill
test. Submaximal exercise testing was performed three times
each on a cycle ergometer,
treadmill, and rowing ergometer while participants wore two
watches, one predicting and
one measuring heart rate and VO2 max. Investigators reported
no significant differences
for average energy expenditure regarding the predicted heart
rate monitor, actual heart
rate monitor, or indirect calorimetry for any mode o f exercise.
For all exercise modes,
the predicted heart rate monitor for females significantly
overestimated energy
expenditure. VO2 max in men was predicted accurately, but not
in women, explaining

that actual measured values need to be used. It was determined
that the Polar S410 heart
rate monitor gave practical approximations of energy
expenditure during three exercise
testing modes (Crouter et al., 2004).
Researchers recruited eight triathletes («=4 men, n=4 women) to
participate in
maximal exercise tests using a cycle ergometer and treadmill
three times throughout their
training year (Basset & Boulay, 2003). They were tested in the
fall during the
preparatory training phase (phase I), in the winter during the
specific training phase
(phase II), and in the summer at the start of the competitive
season (phase III). Maximal
exercise tests were completed between two and seven days
apart. Maximal heart rate was
significantly higher during the treadmill test than the cycle
ergometer test during all three
phases. Relative treadmill VO2 max was significantly increased

compared to the cycle
ergometer during the three testing sessions. Basset & Boulay
(2003) determined that
treadmill and cycle ergometer maximal exercise tests can be
used interchangeably in
athletes to evaluate training intensities.
Strath, Swartz, Bassett, O’Brien, King, and Ainsworth (2000)
administered a
study examining the relationship between heart rate and VO2
during moderate intensity
field and laboratory activities. Participants (N=61) performed
activities such as
vacuuming, laundry, gardening, and walking. Energy
expenditure was predicted from
heart rate when age and fitness level was adjusted. Researchers
found that heart rate and
VO2 during moderate intensity activities are correlated. Heart
rate was a strong predictor
o f energy expenditure (Strath et al., 2000).
Investigators compared RPE-0 (overall), RPE-L (legs), and
RPE-C (chest) at the
respiratory compensation threshold (RCT) on different modes of
exercise (Green Crews,

Bosak, & Peveler, 2003). Participants («=18 men, «=16 women)
ran on a treadmill and
rode a cycle ergometer, while estimating their RPE every
minute. RPE was significantly
higher during cycling than treadmill running. RPE-L (legs) was
significantly greater than
overall and chest (Green et al., 2003).
Dunbar, Goris, Michielli, and Kalinski (1994) assessed the
accuracy of utilizing
ratings of perceived exertion (RPE) to regulate exercise
intensity. Participants (n~9 men,
«=10 women) performed four production trials: two on a
treadmill (PI A, P1B), and two
19
on a cycle ergometer (P2A, P2B). Target RPE calculated was
60% of VO2 max.
Exercise intensity was similar for PI A, PI B, and P2A, but was
less for P2B. Heart rate
was also lower than the target for P2A and P2B. Investigators
revealed that RPE can be

used during acute bouts o f treadmill exercise at 60% VO2 max
to monitor exercise
intensity, though cycle ergometer exercise may be below the
target RPE (Dunbar et al.,
1994).
Researchers evaluated participants running on a treadmill
indoors and running on
an outdoor track using rate of perceived exertion (RPE), while
exercising three to five
times per week (Ceci & Hassmen, 1991). Participants (n= 1
men) ran on an indoor
treadmill and outdoor track for 3-minute stages at an RPE 11
(light exertion), RPE 13
(somewhat hard), and RPE 15 (hard) for 5 minutes. Heart rate,
blood lactate, and
velocity were significantly different for the three RPE levels.
Ceci and Hassmen (1991)
found that RPE was an efficient means of measuring exercise
intensity.
Glass, Knowlton, and Becque (1992) investigated the accuracy o
f an exercise
intensity prescription based upon a graded exercise test (GXT)
and perceptual feedback.
Participants (n=15 men) performed a GXT on a treadmill while

heart rate, oxygen uptake
(VO2), and rate of perceived exertion (RPE) were measured
each minute. The
participants completed a 10-minute exercise trial (EXT) 48
hours later at the prescribed
RPE on a treadmill. The GXT and EXT resulted in significant
mean differences for heart
rate, although there were no significant differences for oxygen
uptake. Researchers
determined that participants could use RPE to prescribe exercise
intensity for a GXT on a
treadmill (Glass et al., 1992).
20
Summary
There are various modes of aerobic exercise that can encourage
people to be more
active, such as the elliptical machine, treadmill, and cycle
ergometer. Many studies
determined that participants who exercised at self-selected
intensities obtained

cardiovascular benefits and were within the American College
of Sports Medicine
(ACSM) guidelines of 50-85% o f VO2 max for cardiovascular
benefits. Rating of
perceived exertion (RPE) was used to rate discomfort, intensity
of effort, strain and
fatigue felt during exercise. The majority of research studies
indicated that the
elliptical machine and treadmill (running) resulted in the
highest energy expenditure
compared to the cycle ergometer and treadmill (walking). The
more energy one can
expend while exercising reduces cardiovascular disease risk and
other chronic
conditions. Being more knowledgeable o f the most efficient
exercise mode may
result in higher adherence to exercise programs.
CHAPTER 3
METHODS

Participants
Twenty healthy, recreationally active men and women, between
the ages of 18
and 29, participated in this randomized, two-week study.
Participants were recruited
from California State University, Fullerton Kinesiology classes
to volunteer for the study.
Participants read and completed medical history forms and
informed consent forms
dining their first visit.
Instruments and Measurements
Participants were escorted to the Exercise Physiology
Laboratory or the Lifespan
Wellness Center in the Kinesiology Department for the three
exercise sessions. Exercise
testing was completed on a Monark cycle ergometer (Ergomedic
839E, Seattle, WA),
Trackmaster TM225 treadmill (Newton, KS), and Precor EFX
544 Elliptical machine
(Precor Inc., Bothel, WA), while hooked up to a rubber
mouthpiece, and connected to a
Parvo Medic MMS-2400 metabolic cart (Consentius
Technologies, Sandy, UT). While

exercising, participants wore a Polar heart rate monitor (Polar
Inc., Westbury, NY, USA)
to record heart rate. The cycle ergometer was calibrated by
hanging known weight from
the belt to make sure it measured the load correctly. Treadmills
were self-calibrated for
velocity using reflective markers on the belt. The metabolic cart
was calibrated for gas
21
22
concentrations and flow from a tank with a known gas
composition using a 3-liter
calibration syringe.
Procedures
Participants came into the laboratory during the first visit for
height and weight
measurements, provided their age, and were randomly assigned
to an exercise order
(treadmill, elliptical machine, or cycle ergometer). They were
also instructed on rating of

perceived exertion (RPE) so they could provide it during each
exercise session at heart
rates of 100 bpm, 130 bpm, and 160 bpm. Participants
completed all three exercise trials.
Participants were instructed to come to the laboratory hydrated
by consuming 1 liter of
water the night before and 1 liter of water the morning of the
exercise test. They were to
refrain from food and caffeine for at least three hours prior to
the test. Participants wore
a nose-clip and rubber mouthpiece connected to a metabolic cart
for gas exchange data to
be recorded and analyzed.
During the treadmill test, the participants started slowly at 1.5
mph, on a flat
incline, without holding the handrails. Every thirty seconds to
one minute, the speed was
gradually increased to elicit a heart rate within five beats of the
desired heart rate range
(95-105 beats per minute). They were at a steady state for three
to five minutes while
oxygen uptake, energy expenditure, and RPE were recorded. For
the second heart rate

range, the speed was increased every thirty seconds to within
five beats of 130 bpm. If
their heart rate was not elevated enough, they were to stay at the
fastest, most
comfortable walking speed (3-4 mph) and raise the incline 2-3%
per minute until the
heart rate reached 130 bpm. They remained at a steady state for
three to five minutes
23
while oxygen uptake, energy expenditure, and RPE were
recorded. During the third heart
rate, the speed was increased to a comfortable running speed (6-
7 mph) within five beats
of 160 bpm. The participants stayed at a steady state for three to
five minutes for oxygen
uptake, energy expenditure, and RPE to be recorded. For the
maximal test, the elevation
and speed were increased until voluntary exhaustion. Maximal
oxygen uptake (VO2
max) is a measure o f cardiorespiratory fitness and is associated
with the functional

capacity of the heart (Whaley, 2006).
The participants began the cycle ergometer test between 60-90
rpm and 15 W for
women and 25 W for men. The power was increased slowly in 5
W increments to within
five beats o f 100 bpm. The participants remained at a steady
state for three to five
minutes while oxygen uptake, energy expenditure, and RPE
were recorded. The power
was increased to 130 bpm where they stayed at a steady state
for three to five minutes to
record oxygen uptake, energy expenditure, and RPE. As the
participants pedaled, the
power was increased to reach a heart rate within five beats of
160 bpm. They remained at
a steady state for three to five minutes for oxygen uptake,
energy expenditure, and RPE
to be recorded. There was no maximal test for the cycle
ergometer.
The elliptical machine test started out slowly at 60-80 strides
per minute without
arm movements, at the lowest level (1). The level was increased
with slow strides to 100

bpm. Participants remained at a steady state for three to five
minutes for oxygen uptake,
energy expenditure, and RPE to be recorded. The level was
increased to 80-100 strides
per minute toward a heart rate o f 130 bpm. They remained at a
steady state for three to
five minutes to record oxygen uptake, energy expenditure, and
RPE. For the third heart
24
rate range, the level and the strides were increased to between
100-120 strides per minute
to reach 160 bpm. Participants remained at a steady state for
three to five minutes for
oxygen uptake, energy expenditure, and RPE to be measured.
There was no maximal test
for the elliptical machine.
Participants were instructed to cool down to below 120 bpm and
scheduled a day
and time for their next exercise test, two to seven days later at
the same time of day. At

the completion of the second trial, they signed up for their third
exercise trial for the same
time of day. Only the principal investigator and advisor had
access to the data, which
were stored securely by the principal investigator.
Design and Statistical Analysis
Data were analyzed using Statview software. Three separate 3 x
3 x 2 repeated
measures Analysis o f Variance (ANOVA) were used to evaluate
the overall effect of
exercise mode at three heart rates on oxygen uptake, energy
expenditure, and RPE. The
independent variables were the three exercise modes (elliptical
machine, treadmill, and
cycle ergometer), three specific heart rates (100,130, and 160
bpm), and sex (male and
female). Dependent variables were oxygen uptake, energy
expenditure and rate of
perceived exertion (RPE). Statistical significance was set at P <
0.05. A post-hoc
Scheffe test was implemented to isolate differences identified
by the ANOVA.

CHAPTER 4
RESULTS
Table 1 displays the descriptive statistics for age, height,
weight, heart rate (HR)
peak, VO2 peak, and rate of perceived exertion (RPE) peak.
Peak HR was within ten
beats of the age predicted maximum HR. Peak VO2 values
using the treadmill were 38.8
ml/kg for women and 47.6 ml/kg for men, indicating a fit
sample of participants. Peak
RPE was high, with the average being 19 out of 20 on the Borg
scale. Table 2 shows the
results for heart rate, oxygen uptake, energy expenditure, and
RPE by mode and gender.
Heart Rate
The desired heart rate at each stage was 100 bpm, 130 bpm, and
160 bpm,
respectively. Overall, it was observed that heart rate fell within
5 beats of the intended
heart rates. There was no statistical difference in heart rate at
any level for the three

modes, which was expected since heart rate was controlled for.
There was a significant
main effect by mode of exercise (p = .0471)
Oxygen (Of) Uptake
There was no significant difference in oxygen uptake by mode
of exercise;
however, there was a significant effect by gender (p < .0001).
On average, men had a
relative O2 uptake about 2 ml higher at 100 bpm, 4 ml higher at
130 bpm, and 6 ml higher
at 160 bpm.
25
26
Energy Expenditure (kcal/min)
There was no significant difference in energy expenditure
between the three
modes of exercise, but there was a significant effect by gender
(p < .0001). Men
exhibited energy expenditures about 1 kcal/min higher at a heart

rate of 100 bpm, 3
kcal/min at 130 bpm, and 5 kcal/min at 160 bpm, compared to
women.
Rate of Perceived Exertion (RPE)
There was no significant effect due to gender for RPE; however,
there was a
significant main effect due to mode o f exercise (p = .0466).
When the participants
exercised on the cycle ergometer, it yielded the highest RPE at
all three heart rates, while
stepping on the elliptical machine resulted in the lowest RPE at
heart rates of 100 bpm
and 130 bpm. When participants exercised on the elliptical
machine and treadmill, the
RPE for both were significantly lower than when they pedaled
on the cycle ergometer at
160 bpm. There was no difference between the elliptical
machine and treadmill tests.
27
Table 1. Descriptive statistics of sample.

Men (N = 11) Women ( N =9)
M S D M S D
Age (y) 22.3 2.2 22.0 1.1
Height (in) 70.7 3.5 65.6 2.7
Weight (lb) 174.5 30.4 145.3 35.0
HR peak (bpm) 192.3 8.1 190.0 8.6
V 0 2 peak (ml-kg'1-min"1) 47.6 5.1 38.8 5.2
RPE peak 19.5 0.5 19.7 1.0
28
Table 2. Resuits for heart rate, oxygen uptake, energy
expenditure, and rate of perceived
exertion (RPE) by mode and by gender.
Heart rate Men ( N = 11) W om en (N =9) Total (N = 20)
(bpm) L 1 L 2 L 3 L 1 L 2 L 3 L 1 L 2 L 3
Treadmill M 100.3 132.9 163.9 99.1 132.7 163.8 99.8 132.8
163.9
SD 2.2 4 .8 6 .4 5.3 6 .3 2.6 5.4 5.4 4 .9
Cycle M 101.0 131.2 162.6 101.8 133.3 163.7 101.4 132.1 163.1

SD 2.9 2 .7 3.3 6 .7 3.5 2 .3 4 .9 3.2 2.9
Elliptical M 104.0 130.5 163.0 106.0 131.9 165.3 104.9 131.1
164.0
SD 7.8 3.3 4.4 8.7 4 .5 4 .0 8 .0 3.8 4 .3
Oxygen uptake Men (N - 11) W om en (N =9) Total ( N - 20)
(ml-kg~1-min'1) L 1 L 2 L 3 L 1 L 2 L 3 L 1 L 2 L 3
Treadmill M 12.1 24.0 32.8 10.5 18.6 27.3 11.4 2 1 .6 3 0.4
SD 3.3 5.8 5.3 2.1 3.1 4 .0 2 .8 5.4 5.4
Cycle M 14.5 23.9 33.5 12.1 19.3 26.1 13.4 2 1.8 30.1
SD 2.9 4 .6 6.1 2.1 3.4 3.9 2.8 4 .6 6 .4
Elliptical M 14.3 23.1 33.5 13.0 18.5 26.6 13.7 2 1 .0 3 0.4
SD 2.5 4.8 6.4 1.4 3.9 4.7 2.1 4 .9 6 .6
Energy Men (N = 11) W om en (N -9 ) Total (N= 20)
(kcal-min'1) L 1 L 2 L 3 L 1 1 2 L 3 L 1 L 2 L 3
Treadmill M 4 .6 9.1 12.7 3.4 6.1 8.9 4.1 7.8 11.0
SD 1.0 1.8 1.6 1.4 2 2 2.1 1.3 2.5 2 .6
Cycle M 5.5 9.3 13.4 3.9 6.3 8 .6 4.8 8.0 11.2
SD 0 .7 1.8 2.7 1.0 1.8 1.9 1.2 2.3 3.4
Elliptical M 5.4 9.0 13.3 4.2 6.0 8 .5 4 .9 7.6 11.2
SD 0.6 1.7 2.8 0.8 1.5 1.6 0.9 2.2 3.4
RPE
Men (N = 11) W om en (N =9) Total (A/= 20)
L 1 L 2 L 3 I 1 L 2 L 3 L 1 L 2 L 3
Treadmill M 7.7 11.0 13.5 7.3 11.5 13.7 7.4 10.9 13.6

SD 2.0 2.1 2.3 1.1 1.1 1.4 1.6 1.7 1.9
Cycle M 7.8 11.2 15.6 7.7 11.6 14.6 7.8 11.4 15.2
SD 1.9 2.8 2.3 1.6 1.7 1.4 1.7 2 .3 2 .0
Elliptical M 7 .0 10.8 14.4 7.2 9.3 12.8 7.1 10.1 13.7
SD 1.3 1.8 1.8 1.7 2.3 1.1 1.4 2 .0 1.7
Note: L 1 = desired HR of 100 bpm; L 2 = desired HR of 130
bpm; L 3 = desired HR of 160 bpm.
CHAPTER 5
DISCUSSION
The purpose of the study was to compare the energy
expenditure, oxygen uptake,
and the rate of perceived exertion (RPE) of various modes of
exercise (treadmill,
elliptical machine, and cycle ergometer) at three specified heart
rates (100 bpm, 130 bpm,
and 160 bpm). It was determined that the participants in this
study could get the same
oxygen uptake and energy expenditure at a lower rate of
perceived exertion (RPE) when
using the elliptical machine and the treadmill at all three heart

rates. When compared to
the cycle ergometer, either the elliptical machine or treadmill
would be preferred for a
person to lose weight, because they expend more energy at the
same or lower RPE due to
incorporating more muscle mass. The cycle ergometer yielded a
higher RPE at all three
heart rates (100 bpm, 130 bpm, and 160 bpm).
The energy expenditure was greater in men for all levels and
modes of exercise,
which is in agreement with other studies. Cook et al. (2004)
found that when comparing
the treadmill and elliptical machines at self-selected intensities,
men used more total
energy than women. When performing submaximal exercise
tests on the treadmill, stair-
stepper, cycle ergometer, rowing ergometer, ski simulator, and
aerobic rider at RPEs of
11,13, and 15, men on average had 50% greater energy
expenditure on all exercise
modalities compared to the women (Moyna et al., 2000). The
current study demonstrates
29

30
energy expenditure for men is 40% higher than women. When
comparing twenty
minutes of self-selected exercise on the treadmill, cross country
ski simulator, aerobic
rider, and cycle ergometer, men had significantly greater energy
expenditure than women
(Kravitz et al., 1997). At each o f the three intended ranges,
heart rate was 30 beats higher
for the three modes, which led to an energy expenditure
increase of 3 kcal/min. On
average for a 10-beat increase in heart rate, there was an
increase in energy expenditure
of about 1 kcal/min regardless of exercise mode.
Oxygen uptake in men was 25-30% greater than women at all
three heart rates
(100 bpm, 130 bpm, and 160 bpm), which is in agreement with
other studies. When
comparing four modes o f self-selected submaximal exercise,
men had significantly

higher oxygen uptake levels (25-30% higher) than women
(Kravitz et al., 1997). Moyna
and colleagues (2000) determined that maximum oxygen uptake
was 10-20% higher in
men than women on each exercise modality. This result is most
likely due to men having
less body fat compared to women (Moyna et al., 2000). Men
have greater body mass,
lean tissue mass, VO2 max, lower relative body fat, and are
taller than women (Green et
al., 2003).
There was a difference in RPE based on the mode of exercise.
Participants
reported lower RPE values at the same heart rate when
exercising on the elliptical
machine and treadmill, compared to the cycle ergometer. The
higher RPE values may be
due to participants being unfamiliar with the cycle ergometer,
less muscle mass involved,
and localized muscle fatigue. Green et al. (2003) found that
cycling had a significantly
higher RPE compared to the treadmill, specifically, RPE-legs
was significantly greater

31
than RPE-overall and RPE-chest. Batte and colleagues (2003)
determined that when
participants exercised on the elliptical machine at an intensity
of six out of ten on the
Borg Scale that their heart rate and oxygen uptake were
significantly greater than what
they perceived. Green et al. (2004) compared RPE between the
treadmill and elliptical
machine. They found during the elliptical exercise that RPE-
legs was significantly
greater compared to the treadmill.
In addition to quantitative data, the participants completed a
questionnaire asking
them to rank each exercise mode on a scale of one to 10,
explain what they liked and
disliked about each mode, and which mode they preferred and
why. The majority (9/20)
preferred the elliptical machine, followed by the treadmill
(7/20), and cycle ergometer
(4/20). Many of the participants who preferred the elliptical

machine said they liked that
they could work at a lower perceived intensity and raise their
heart rate easily. They also
liked that the elliptical machine was low impact and did not hurt
their knees. The
participants who preferred the treadmill exercise enjoyed
running and pushing themselves
to a higher RPE. Of those who preferred the cycle ergometer,
they liked the increased
resistance and enjoyed strengthening their lower body. All o f
the participants reported
discomfort with the cycle ergometer seat and disliked the
mouthpiece, which measured
oxygen consumption in all three exercise modes.
When applying the results of this study in a fitness setting, the
treadmill and
elliptical machine elicit the same RPE, oxygen uptake, and
energy expenditure, at the
same or lower heart rate than the cycle ergometer. The elliptical
machine and treadmill

32
are recommended for fitness improvements and weight loss
when participants self-select
an exercise intensity.
APPENDIX A
California State University, Fullerton (CSUF)
CONSENT TO ACT AS A HUMAN RESEARCH SUBJECT
Comparing the Energy Expenditure and Rating of Perceived
Exertion of Various
Exercise Modes at Specified Heart Rates
Participation in this research study is completely voluntary.
Please read this information
below and ask questions about anything that you do not
understand before deciding if you
want to participate. A researcher listed below will be available
to answer your questions.
INVESTIGATORS AND SPONSOR
Lead Researcher
• Julie Smith - Department o f Kinesiology
Study Location(s):
• Cal State University, Fullerton

Study Sponsor(s):
• William Beam, Ph.D. - Department of Kinesiology
PURPOSE OF STUDY
The purpose of the study is to compare the energy (calories)
expended and the rate of
perceived exertion (RPE) of various modes of exercise
(treadmill, elliptical machine, and
cycle ergometer) at three specified heart rates (100,130, and 160
bpm). There is no
conclusive research comparing energy expenditure and RPE of
these three exercise
modes. If people were more aware of the most efficient exercise
mode resulting in the
highest energy expenditure, they may be more inclined to
exercise and adhere to an
appropriate exercise program.
WHY THIS IS A RESEARCH STUDY
33
34
We want to know if there is a difference in the energy expended
and in the perceived
effort of participants between three different exercise modes
(elliptical machine,
treadmill, and cycle ergometer) at three heart rates (100,130,

and 160 bpm). We want to
know what mode of exercise will expend the most energy
(calories) with the feeling of
least exertion at each of the three heart rates. Participants will
exercise on all three
modes of exercise in random order.
PARTICIPANTS
Inclusion Criteria:
Participants in this study will be apparently healthy men and
women, between the ages of
18 and 29, who are at a low risk for heart disease according to
the American College of
Sports Medicine. They will be recreationally active, defined as
participating in aerobic
exercise two or more times per week in the past three months.
Participants will be
recruited from California State University, Fullerton to
volunteer in the study. Low risk is
defined as men under the age of 45 and women under the age of
55, who are
asymptomatic and have no more than one major risk factor for
cardiovascular disease
(Whaley, 2006). Major risk factors include:
1) Family history o f myocardial infarction, coronary
revascularization, sudden death
before the age o f 55 years in a father or other male first degree
relative, or before 65
years of age in a mother or other female first-degree relative.
2) Current cigarette smoker or has quit in the previous 6
months.
3) Hypertension with a systolic blood pressure of > 140 mm Hg
or a diastolic blood

pressure o f > 90 mm Hg.
4) Dyslipidemia: Low-density lipoprotein (LDL) cholesterol
>130 mg/dL or high
density lipoprotein (HDL) cholesterol < 40 mg/dL, or on lipid-
lowering medication,
or if total serum cholesterol is > 200 mg/dL.
5) Impaired fasting glucose: Fasting blood glucose >100 mg/dL.
6) Obesity: Body mass index > 30 kg/m, or waist girth >102 cm.
for men and > 88 cm
for women, or waist to hip ratio > 0.95 for men and > 0.86 for
women.
7) Sedentary lifestyle: Not participating in regular exercise or
not meeting the minimal
physical activity recommendations from the U.S. Surgeon
General’s Report.
Exclusion Criteria:
Anyone who does not fit the inclusion criteria will be excluded
- specifically anyone
outside the age range (18-29 y), or anyone who does not qualify
as low risk by ACSM
definition.
Number o f participants:
The investigator plans to enroll 30 participants at this site.

35
PROCEDURES
• Preliminary Testing - Participants will read and complete
medical history forms and
consent forms. They will be randomly assigned to an exercise
order. Participants will
schedule a day and time for their exercise tests.
• Testing - The day of the exercise test, participants will come
into the lab hydrated by
drinking 1 liter o f water the night before and drinking 1 liter of
water the morning of
the test. They must refrain from food or caffeine at least 3 hours
prior to the exercise
test. Participants will be measured for height and weight and
provide their age.
They will be instructed on rating o f perceived exertion (RPE)
in order to report their
RPE during the exercise session at heart rates o f 100,130, and
160 bpm. Participants
will wear a heart rate monitor and will be connected via a
rubber mouthpiece to a
metabolic cart for gas exchange data to be recorded and
analyzed.
• For the treadmill test, the participants will start stage 1 (-100
bpm) slowly on a flat
incline walking at 1.5 mph, without using the handrails.
Depending on how slow or
fast their heart rate elevates, the speed will increase every 30
sec to 1 min. They will
gradually increase speed to within 5 beats of the desired heart
rate range (95-105
bpm). Participants will remain at a steady state for 3 to 5

minutes while energy
expenditure and RPE are recorded. From there, the participant
will begin stage 2
(-130 bpm) by increasing the speed every 30 seconds to within 5
beats of 130 bpm.
If heart rate is not elevated enough, participants will stay at
their fastest, most
comfortable walking speed (3-4 mph) and raise the incline 2-3%
per minute. They
will stay at a steady state for 3 to 5 minutes while energy
expenditure and RPE are
recorded. During stage 3 (-160 bpm) the speed will be increased
to a comfortable
running speed (5-7 mph) to within 5 beats of 160 bpm. The
participants will stay at a
steady state 3 to 5 minutes while energy expenditure and RPE
are recorded.
Following stage 3, each participant will complete a maximal
exercise test through a
continual increase in speed and grade until voluntary
exhaustion.
• Participants will begin stage 1 (-100 bpm) o f the cycle
ergometer test at 60-90 rpm
and 15 Watts (W) for women and 25 W for men. The power will
be increased slowly
in 5 W increments to within 5 beats o f 100 bpm and they will
remain at a steady state
for 3 to 5 minutes for energy expenditure and RPE to be
recorded. During stage 2
(-130 bpm) power will be increased slowly in 5 W increments
until heart rate is
within 5 beats of 130 bpm and stay at a steady state for 3 to 5
minutes to record
energy expenditure and RPE. During stage 3 (-160 bpm) power
will be increased

slowly in 5 W increments until heart rate is within 5 beats of
160 bpm and stay at a
steady state for 3 to 5 minutes to record energy expenditure and
RPE. Following
stage 3, each participant will complete a maximal exercise test
through a continual
increase in power until voluntary exhaustion.
• The elliptical test will begin with stage 1 (—100 bpm). The
participant exercises
slowly at 60-80 strides/min without arm movement, at the
lowest level (level 1).
Participants will increase the level until heart rate is within 5
beats o f 100 bpm and
will stay at a steady state 3 to 5 minutes to record energy
expenditure and RPE.
During stage 2 (-130 bpm) the level will be increased to 80-100
strides/minute to
36
reach 130 bpm. They will remain at a steady state for 3 to 5
minutes to record the
energy expenditure and RPE. For stage 3 (-160 bpm) there will
be an increase in
level and strides to 100-120 strides/minute to reach 160 bpm.
Participants will
remain at a steady state for 3 to 5 minutes to record energy
expenditure and RPE.
Following stage 3, each participant will complete a maximal
exercise test through a

continual increase in stride rate and level until voluntary
exhaustion.
• Participants will be instructed to warm down and schedule a
day and time for their
next exercise test, 2 to 7 days later at the same time of day. At
the completion of the
second trial, they will sign up for their third exercise trial. Only
the principle
investigator and advisor will have access to the data, which will
be stored securely by
the principle investigator.
Total Time Involved:
You will be involved in this study for approximately 2 weeks.
You will need to come
into the lab 3 times for each exercise test for approximately 60
minutes each time. Each
exercise session will be separated by two to seven days.
RISKS
Risk of Testing
• Less Likely/Serious - Shortness of breath
• Less Likely/Serious - Light headedness
• Likely/Not Serious - Sweating
• Less Likely/Very Serious - Cardiovascular events
• Less Likely/Very Serious - Death
Risks fo r Other Procedures
• Exercise testing - The exercise test may cause muscle
soreness, dizziness, or
shortness of breath. In rare instances, exercise tests may cause
chest pain,
tightness, or a change in vital signs.

BENEFITS
To the Participant
You will benefit directly from this study by learning about the
number of calories you
expend on different exercise machines and the rate of perceived
exertion for those
exercises at three different heart rates. Exercise testing is free
to participants in this
study.
ALTERNATIVES TO PARTICIPATION
The alternative is to not participate in this study.
37
COMPENSATION/COST/REIMBURSEMENT
You will not be required to pay for research related
procedures/treatments.
COMPENSATION FOR INJURY
I understand that if I am injured as a result o f my participation
in this study, I will be
provided reasonable and necessary medical care to treat the
illness or injury at no cost to
me or to my insurer/third party payer. CSU Fullerton does not
provide any other form of
compensation for injury. I understand that I must report any
suspected study-related
illness or injury to the study investigator immediately.

WITHDRAWAL OR TERMINATION FROM STUDY
You are free to withdraw from the study at any time. If you
decide to withdraw from the
study, you should inform the researchers immediately. You may
also be removed from
the study without your consent because of the following: A)
based on the researcher's
judgment to improve your health and welfare, or B) because you
have not followed the
study procedures.
CONFIDENTIALITY
Data Storage
Your research records including computer-based data or other
identifying information
will be stored in a secured building and on a password protected
computer. Your data
may be used for future research that may be published.
Data Access
The research team, authorized CSUF personnel, and regulatory
entities may have access
to your study records to protect your safety and welfare. Data
will be kept confidential to
the extent allowed by law. Data will be reported without
identifiers.
Level o f Privacy
• To protect your privacy and the confidentiality of the data, all
personal identifiers
will be removed from the data records and a code will be used
in place of your
name.
Data Privacy

• The research data will be maintained indefinitely.
NEW FINDINGS
If during the course o f this study, significant new information
becomes available that may
38
relate to your willingness to continue to participate, this
information will be provided to
you by the investigator
IF I HAVE QUESTIONS
For questions about your rights as a research participant, you
may contact California
State University, Fullerton Regulatory Compliance Coordinator
at (714) 278-2327, or the
Institutional Review Board (IRB) Chair at (714) 278-2141
Contacts:
• Dr. William Beam
Daytime Phone: (714) 278-3432 Email: [email protected]
• Julie Smith, Department of Kinesiology
Daytime Phone: (714) 854-7347 Email: [email protected]
. VOLUNTARY PARTICIPATION
I have read the attached "Experimental Subject's Bill o f Rights"
and have been
given a copy of it and this consent form to keep. I understand
that participation in
this study is voluntary. I may refuse to answer any question or

discontinue my
involvement at any time without penalty or loss of benefits to
which I might
otherwise be entitled. My decision will not affect my future
relationship with or
the quality of care I receive at CSU Fullerton. My signature
below indicates that I
have read the information in this consent form and have had a
chance to ask any
questions I have about the study. I consent to participate.
Signature of Participant Date
Signature of Witness Date
Signature of Investigator Date
APPENDIX B
Medical History Questionnaire
Name ________________________________________ Gender
Age ______
E-mail Address
Phone
Please provide the following information as accurately and
completely as possible so that
your risk of exercise may be assessed.

Known Cardiovascular, Pulmonary or Metabolic Disease
Have you been diagnosed with any of the following
diseases/disorders/conditions or had
any of the following procedures?
□ Yes □ No Myocardial infarction (“heart attack”) 1
□ Yes □ No Stroke or ischemic attack (“mini-stroke”) 2
□ Yes □ No Heart bypass surgery or other heart surgery 3
□ Yes □ No Coronary catheterization and/or angioplasty 4
□ Yes □ No Abnormal ECG (tachycardias, heart blocks, etc.) 5
□ Yes □ No Other cardiovascular disease/disorder (aneurysm,
etc.) 6
□ Yes □ No Chronic obstructive pulmonary disease (COPD,
etc.) 7
□ Yes □ No Diabetes (insulin dependent, non-insulin dependent,
etc.) s
□ Yes □ No Hyperlipidemia (high LDL, low HDL, etc.) 9
Comment:
Signs or Symptoms Suggestive of Cardiovascular and
Pulmonary Disease
Have you experienced any of the following?
□ Yes □ No Pain/discomfort in your chest, jaw or arms 10
□ Yes □ No Shortness of breath at rest or mild exertion 11
□ Yes □ No Dizziness or fainting spells 12
□ Yes □ No Difficulty breathing while lying down 13
n Yes □ No Swelling of your ankles 14
39

40
□ Yes □ No “Skipped” heart beats or a “racing” heart beat 15
□ Yes □ No Occasional leg pain, especially while walking 16
□ Yes □ No Heart murmur n
□ Yes □ No Fatigue or shortness of breath with usual activities
is
Comment:
Risk Factors o f Cardiovascular Disease
Do you have a personal history of any of the following?
□ Yes □ No Cigarette smoking 19 Packs/day____ ,yrs smoked
□ Yes □ No Obesity or highly overweight 20
□ Yes □ No Physical inactivity 21
□ Yes □ No High blood pressure (over 140/90 mmHg) 22 Blood
pressure
□ Yes □ No High cholesterol (over 200 mg/dl) 23 Cholesterol
_____
Yes □ No Diabetes or high blood sugar (over 110 mg/dl) 24
Blood glucose
□ Yes □ No Family history of heart attack/stroke, at young age
25
Comment:
Other Information Concerning Personal Health History
List anything else concerning your personal health history.
Comment:
Physical Activity Readiness Questionnaire (PAR-Q)
Has your doctor ever said you have a heart condition and should
only do
physical activity recommended by a doctor? 26
Do you feel pain in your chest when you do physical activity?
27

In the past month, have you had chest pain when you were not
physically
activity? 28
Do you lose your balance because of dizziness or do you ever
lose
consciousness? 29
Do you have a bone or joint problem that could be made worse
by a
change in your physical activity? 30
Is your doctor currently prescribing drugs for your blood
pressure or
heart condition? 31
Do you know of any other reason why you should not do
physical
□ Yes □ No
□ Yes □ No
a Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
activity? 32
Comment:
41

Medications
Please list any prescription or over the counter (OTC)
medications you are currently
taking.
In Case of Emergency
Name
Phone
APPENDIX C
QUESTIONNAIRE
Comparing the Energy Expenditure and Rating of Perceived
Exertion of Various
Exercise Modes at Specified Heart Rates
Principal Investigator: Julie Smith
Thank you for participating in my study. Please take a moment
to answer the following
questions.
1. Please rank your experience with each exercise test on a scale
of 1-10:
Treadmill:

Cycle Ergometer:
Elliptical Machine:
2. Please explain what you liked and disliked about each
exercise test:
Treadmill:
Cycle Ergometer:
Elliptical Machine:
3. What exercise test did you prefer and why? Please be as
detailed as possible.
42
APPENDIX D
Appointment Reminder for Exercise Testing
Test Date Time
1. The testing is done in KHS-014 or the Lifespan Wellness
Center (basement of
KHS building).
2. Please come into the lab hydrated by drinking 1 Liter of
water the night before
the test and drinking 1 Liter of water the morning of the test.

3. You must be fasted before the test; no food except for water
3 hours prior to the
test.
4. Do not have any caffeine (coffee, Cola, Red Bull, NoDoz,
etc.) at least 3 hours
prior to the test.
5. Do not smoke cigarettes within 3 hours o f the test.
6. Take prescription drugs as normal. Bring your inhaler if you
are asthmatic.
7. Do not take non-prescription drugs or consume alcohol the
day o f the test.
8. Please wear a t-shirt, shorts, and running shoes.
9. Please be on time for your appointment. You should only
miss because of illness
or emergency. Please call if you cannot make your appointment.
43
APPENDIX E
Rate o f Perceived Exertion (RPE) INSTRUCTIONS
20
Very very hard (heavy)
19

18
Very hard (heavy)
17
16
Hard (heavy)
15
14
Somewhat hard (heavy)
13
12
Fairly easy (light)
11
10
Very easy (light)
9
8
Very, very easy (light)
7
6

REFERENCES
Basset, F. A., & Boulay, M. R. (2003). Treadmill and cycle
ergometer tests are
interchangeable to monitor triathletes’ annual training. Journal
o f Sports Science
& Medicine, 2, 110-116.
Bassett, D. R. & Howley, E. T. (2000). Limiting factors for
maximum oxygen uptake
and determinants of endurance performance. Medicine &
Science in Sports &
Exercise, 32, 70-84
Batte, A. L., Darling, J., Evans, J., Lance, L. M., Olson, E. I., &
Pincivero, D. M. (2003).
Physiologic response to a prescribed rating o f perceived
exertion on an elliptical
fitness cross-trainer. Journal o f Sports Medicine and Physical
Fitness, 43, 300-
305.
Carter, H., Jones, A. M., Barstow, T. J., Burnley, M., Williams,
C. A., & Doust, J. H.
(2000). Oxygen uptake kinetics in treadmill running and cycle
ergometry: a

comparison. Journal o f Applied Physiology, 89, 899-907.
Ceci, R., & Hassmen, P. (1991). Self-monitored exercise at
three different rpe intensities
in treadmill vs. field running. Medicine & Science in Sports &
Exercise, 6, 732-
738.
45
46
Cook, C., Heelan, K. A., & Kruegar, R. (2004). Comparison of
energy expenditure on
the treadmill vs. the elliptical machine at a self-selected
intensity. Medicine &
Science in Sports & Exercise, 36, S249.
Crommett, A., Kravitz, L., Wongsathikun, J., & Kemerly, T.
(1999). Comparison of
metabolic and subjective response of three modalities in
college-age subjects.
Medicine & Science in Sports & Exercise, 31, S I58.
Crouter, S. E., Albright, C., & Bassett, D. R. Jr. (2004).

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