The Talk Test
The Poor Man’s Way to Gauge Exercise Training Intensity
• Carl Foster, Ph.D., FACSM
• Department of Exercise and
Sport Science
• University of Wisconsin-La
Crosse
Every Story Starts Someplace
Some Stories Start Twice
1970
1998
Exercise is Medicine
Overwhelming Epidemiologic and Clinical Evidence
Event Free Survival
Risk of First Heart Attack
100
90
80
70
60
50
40
30
20
10
0
100
Relative Risk
Other Activities
Strenuous Sports
80
60
40
20
R.S. Paffenbarger et al
Am J Epidemiology 108: 161, 1978
0
1000
2000
3000
4000
Physical Acitivity Index
R Hambrecht et al.
Circulation 109: 1371-1378, 2004
5000
Exercise
PTCA
0
0
3
6
Months
9
12
Exercise is Medicine
Order of Magnitude Effect
Effect of Walking on 5 Year Mortality
Vs -1% with Rx for HTN & Cholesterol
Effect of CR on Outcome
1.2
1
0.8
*
*
0.6
0.4
0.2
0
All Cause Death
CV Mortality
Non Fatal
Recurrence
N.B Oldridge et. al. JAMA 260: 945-950, 1988
GT Oconnor et. al Circulation 80: 234-244, 1989
-8%
=stopping smoking vs continuing to smoke
after first MI
Hakim AA; New Engl J Med 1998 338:94 - 99
Components of an Exercise
Program
• Frequency
– 5-7 x weekly
• Intensity
– Hardest to define
• Time
– 20-60 min
• Type
Prescription of Exercise Training Intensity
•
Objective Markers
–
VO2 & METs
•
•
–
Heart Rate
•
•
•
Individual response thresholds
Wide prescriptive window
Metabolic markers
–
–
•
50/65-90% max
40/50-85% reserve
Limits of the “relative percent concept”
–
–
•
60-80% max
45/50-85% reserve
Ventilatory Threshold
Lactate Threshold
Subjective Markers
–
–
RPE
Talk Test
Talk Test
Historical Background
Long standing belief that highest exercise intensity compatible with “just
being able to speak” might be ‘just about right”
Prof John Grayson (Oxford University)

“Climb no faster than you can talk” (1939)
ACSM Guidelines (4th edition, 1991)
Prof Robert Goode (University of Toronto)

Hear your breathing test (1995)
Henry Ford Hospital, 1997

Abstracts
American Council on Exercise, 1997
UW-La Crosse, 1998
Common experience amongst exercisers

‘If we’re going to keep talking, you have to slow down’
What Does the Talk Test Look Like?
Speech Provoking Stimulus
90
30
*
*
VO2 (ml * kg -1 * min -1)
25
*
20
%METs
*
*
*
15
10
80
70
Rainbow
5
Pledge
* p < 0.05 vs. VT
0
VO2 @ VT
60
VO2 @ +
VO2 @ +/-
VO2 @ -
Detroit
LaCrosse
Detroit
LaCrosse
180
160
*
80
*
*
%HRR
HR (beats * min -1)
140
*
*
120
100
80
60
Rainbow
40
60
Pledge
20
0
70
50
* p < 0.05 vs. VT
HR @ VT
HR @ +
HR @ +/-
HR @ -
N Shafer et al. JCRP 20: 289, 2000
JP Porcari et al. JCRP 22: 369, 2002
(Amy Kelso-Amann)
Evidence that the Talk Test is a Marker of
Appropriate Exercise Intensity
%HRmax & %METs
100
90
Positive
80
Equivocal
Negative
70
60
%HR max
%METs
M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000
N Shafer et al. JCRP 20: 289, 2000
S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
R Persinger et al. MSSE 36: 1716-1722, 2004
C Foster et al. J Str Cond Res 23: 2425-2429, 2009 (Neepa Talati)
E Jeanes et al. J Str Cond Res 25: 590-596, 2011
+Talk Test vs VT
VO2 @ VT vs + Talk Test
60
y = 0.9344x + 0.1287
R2 = 0.9254
VO2 @ + Talk Test (ml/kg)
50
40
30
20
10
0
0
10
20
30
VO2 @ VT (ml/kg)
M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000
N Shafer et al. JCRP 20: 289, 2000
S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
R Persinger et al. MSSE 36: 1716-1722, 2004
40
50
60
+/-Talk Test vs VT
VO2 @ VT vs +/- Talk Test
60
y = 0.9435x + 2.6613
R2 = 0.9349
VO2 @ +/- Talke Test (ml/kg)
50
40
30
20
10
0
0
10
20
30
VO2 @ VT (ml/kg)
M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000
N Shafer et al. JCRP 20: 289, 2000
S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
R Persinger et al. MSSE 36: 1716-1722, 2004
40
50
60
-Talk Test vs VT
VO2 @ VT vs - Talk Test
60
y = 0.9869x + 6.463
R2 = 0.9152
VO2 @ - Talk Test (ml/kg)
50
40
30
20
10
0
0
10
20
30
VO2 @ VT (ml/kg)
M Dehart-Beverley et al. Clin Exerc Physiol 2: 34-38, 2000
N Shafer et al. JCRP 20: 289, 2000
S Voelker et al. Clin Exerc Physiol 4: 120-123, 2002
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
R Persinger et al. MSSE 36: 1716-1722, 2004
40
50
60
VO2 @ VT vs Talk Test
VO2 @ VT vs Talk Test
40
VO2 (ml/kg)
35
VT
Positive
Equivocal
Negative
*
30
*
25
20
1
-Talk Test vs RCT
5
y = 1.0417x - 0.1001
2
R = 0.993
Talk Test (Negative)
4
3
2
1
0
0
0.5
1
1.5
2
2.5
3
3.5
Respiratory Compensation Threshold (L/min)
P Recalde et al. S Afri J Sports Med 9: 5-8, 2002
4
4.5
5
Percent of VT vs Talk Test
140
120
Students
Athletes
Patients
VO2 as % VT
100
80
60
40
20
0
Positive
Equivocal
Stage of Talk Test
Negative
Ok, the Talk Test Matches VO2, HR and VT Markers of
Exercise Capacity……Does it Work in Real Life?
Does the Talk Test Reflect Changes in
Exercise Intensity?
Observed +
100
59
80
147
Protocol
60
Mean % VT
Expected -
Expected +
40
0
5
10
15
20
Time (minutes)
25
30
24
% Right = 73.1%
% Wrong = 26.9%
4
Observed Stage duration in relation to % VT
6
“If we’re going to keep talking,
you have to slow down”
Time (min)
% VO 2 @ VT
120
4
2
0
105% VT 110% VT 115% VT 120% VT 125% VT
Intensity (% of VT)
Can the Talk Test Prevent
Exertional Myocardial Ischemia?
• Exertional ischemia is the one substantial danger in ExRx
• K Meyer (Eur Heart J 16: 623, 1995) has shown that the VT often
precedes ST segment changes in patients with CAD
140
y = 0.4254x + 0.8629
R2 = 0.2962
8
135
130
6
Heart Rate
Last + TT
10
4
2
0
125
Ischemia
Positive TT
Equivocal TT
Negative TT
Ischemia -10
120
115
110
0
2
4
6
8
First Evidence of Ischemia
10
105
100
1
CA Cannon et al. Am J Med Sport 6: 52-57, 2004
Can the Talk Test Track
Permutations in Exercise Capacity?

C.Foster et al: J Cardiopulm Rehabil
28: 24-30, 2008 (J Anderson, M
Paulson)

Experiments with venesection
Exeriments with short term training
15
VO2 @ LPTT (ml*min-1*kg-1)

Effect of Training and Blood Loss
Training
Blood Loss
10
5
0
-15
-10
-5
0
5
-5
-10
-15
VO2 @ VT (ml*min-1*kg-1)
10
15
Can You “Translate” From Exercise Testing to
Exercise Training with the Talk Test?
• C Foster et al.
• J Str Cond Res 23: 2425-2429,
2009
– Neepa Talati
• Sedentary individuals
• Incremental exercise test to
identify + +/- - stages of Talk
Test
• 20 min exercise bouts at LP-1,
LP, EQ
Translating GXT to Training
% HRmax
RPE
EqTT
100
10
LPTT
EqTT
LP-1TT
90
8
80
6
70
4
60
2
50
LPTT
LP-1TT
0
0
2
4
6
8
10 12
Time (min)
14
16
18
20
0
2
4
6
8
10 12
Time (min)
Talk Test Score
3
EqTT
LPTT
2.5
LP-1TT
2
1.5
1
0.5
0
0
2
4
6
8
10
12
Time (min)
14
16
18
20
14
16
18
20
Does “Translating” Exercise Intensity Work
for Fitter Individuals?
% HR max
100
90
%HR max
70
60
%HR LP-1
%HR LP
%HR EQ
50
40
0
10
20
30
40
Time (min)
RPE
10
8
RPE
6
4
2
xRPE LP-1
xRPE LP
xRPE EQ
0
0
10
20
30
40
30
40
Time (min)
Talk Test Score
3
TT score LP-1
TT score LP
TT score EQ
Talk Test Score
• EA Jeanes et al.
• J Str Cond Res 25: 590596, 2011
• Well-trained non athletes
including several “t-shirt
runners”
• Incremental exercise to
identify stages of TT
• 40 min stead state
exercise sessions at
– LP-1, LP, EQ
80
2
1
0
10
20
Time (minutes)
Newest Data on Translating Exercise
Training Intensity
• C Foster et al. J Str Cond Res
23: 2425-2429, 2009 (N Talati)
• EA Jeanes et al. J Str Cond
Res 25: 590-596, 2011
• + L Walraven
• + J Lueck
trLP1
trLP
trEQ
sedLP1
sedLP
sedEQ
100
%HRmax
90
80
70
60
50
0
10
20
30
20
30
Time (min)
RPE
10
trLP1
trLP
trEQ
sedLP1
sedLP
sedEQ
8
6
4
2
0
0
10
Time (min)
So, Where Does this Leave Us?
Summary
•
•
•
•
•
Talk Test---a good ‘old idea’
Easy to perform
eliminates need for maximal exercise
forgiving of variations in speech producing stimulus
Accurately places exercisers in exercise intensity defined
by conventional criteria
–
–
–
–
%HRmax
%VO2max
VT
RPE
• Apparently useful as tool for avoiding exertonal ischemia
• Responsive to permutations in exercise capacity
• Easy to translate into exercise training intensity
One Hippopotomus, Two Hippopotomus,
Three Hippopotomus, Four