Not a patient information leaflet - The Exercise Test

Ok, as with the MDT blog I wrote a little while ago, this is not a patient information leaflet – but as I’ve never been sent one it might help some people.

So, the dreaded exercise test, the test that some of those in the congenital heart defect community hate more than any other.

The letter comes, in my case without a patient leaflet, and suggests you dress for exercise… Not the most helpful statement in the world – for those who don’t do a lot of exercise, or for me, who has a range of “outfits” for exercise, ranging from skimpy shorts through to full on winter walking gear (complete with crampons & ice axe) – think of me as a cheap rate Action Man figure…

So, based on having done these tests twice – shorts, or not too baggy leggings, and trainers.  If you’re male don’t worry too much about the top half, ladies a comfy bra – they’ll be attaching a 12-lead ECG to you.  In my case they shave the bits they want to attach the electrodes to, and just for fun abrade it for better connectivity (yes, they sandpaper my chest).

They’ll measure your face – so they get a mask that is the right fit – it looks like a gas mask, with a tube coming out of it, it’s strapped on tight and you’ll be asked to breathe in and out with the end closed (it's a simple way of checking the seal).

In my case it's a bike test, so there’ll be the usual faff of trying to get the seat at the right height, it's about making it as comfortable as possible for you do what you need to do – which is pedal.

They’ll attach a pulse oximetry gizmo to either your finger or your ear, and you’ll sit there for a couple of minutes as they get baseline figures, and then you start pedalling, at 60rpm.

And stay at 60rpm…

The resistance in the system will slowly but constantly increase, like cycling up a long slow hill that gets steeper and steeper (more and more resistance).  The point of the test is make you fail (with the emergency exit of if they see something dodgy on the ECG or pulse-ox they will stop you).  Failure isn’t a nice end point, but it's meant to take you to your maximal output which is as good a diagnostic end point as they’ve found as a measure of fitness.

You’ll still be pedalling at 60rpm, and the team in the room will be encouraging you all the time, keeping you going as the resistance first gets noticeable, begins to get tough and then gets hard.

And you keep going, as long as you can… And then as you’re about to fail, they let you rip – cycling faster than the 60rpm in a sprint finish – 30s of hammering it as hard as you can, at the end of a never ending hill…

They might be able to give you some feedback there and then, especially if you’ve had a recent test… They may need to go and look at the details.

So, the me bit…

I know I’m fitter than last year – in total last year I ran three half-marathons, I’ve been close to, or through, half marathon distance in the last three weeks.  I’m running better than ever, to the point that my bank balance is moaning about my PB protocol.

Not having long to prep for the exercise test was probably a good thing, I got one short session in the gym this week, but it meant that it was a good reading of my fitness levels rather than my ability but to ride a bike.  I did skip the short runs during the week, so the legs were fresh (also while I’ll run in most weathers, hail I do not do) and I did sneak some pre-exercise sugar into the system.

So, they set me up and let me go… 60rpm is painfully slow, especially when there’s no load on the system.  The team were telling me how well I was doing, and noted when I went through last years numbers, which was pleasingly before I hit the sprint section… As you’d expect I did ask how I did… When you’re told that you’re close to what they’d expect for age, weight and gender without the heart condition you can’t be anything other than chuffed.

There may be something in the gas exchange, or the detailed look at the ECG to give the experts some concern, but I’ll take that result as at least case-study level evidence that doing reasonable, structured exercise is beneficial – that’s the only difference between last year and this.  I may be unique, but we all are.

So, the marathon training continues – short rest run this weekend (10k) and then back out to long distances next weekend.

Failure was the end point, but as I said a couple of weekends ago – sometimes you have to fail to succeed.




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