Shape Up! : Fitness Tests Help Map Route to Better Body

If a catalogue could be kept of fervent New Year’s resolutions, the No. 1 item on the list probably would be a variation of: “I resolve to whip myself into shape this year.”

That could mean losing weight, getting into condition to run a 10K race or just trying to melt off a pair of persistent “love handles.” Whatever the goal, the whip-into-shape resolution almost always means the resolver is going to begin an exercise program.

But, say doctors and exercise physiologists, too often ambitious would-be athletes don’t know how far or how hard they can--or should--push their bodies. They have little clue about their strength or endurance or flexibility.

A short session of aerobic exercise that leaves you gasping may lead to two pivotal questions: “Just what sort of shape am I in?” and “What’s the best way I can improve it?”

To provide the answers, hospitals, health clubs, clinics and individual physicians throughout Orange County have begun to offer comprehensive fitness testing programs. These programs vary widely in scope but nearly all have as their goal an accurate determination of an individual’s cardiovascular fitness and conclude with specific recommendations for safe and beneficial exercise.

Testing May Be Simple

Fitness testing at its simplest, as it is practiced at a number of health clubs, gyms and spas--often free of charge to prospective members--can involve nothing more elaborate than a check of blood pressure, resting heart rate and heart rate after exercise in a simple “step test.”

The most elaborate testing facilities operating in Orange County, however, run participants through a complicated battery of tests--employing a number of sophisticated machines--that can last for several hours and include such procedures as lung capacity tests, hydrostatic weighing (in which the participant is weighed while suspended under water to determine percentage of body fat), blood profiles and a maximal, fully monitored treadmill stress test (usually supervised by a physician).

One of the most extensive of these programs is offered at the Rehabilitation and Conditioning Center (known as the RACC), a division of Western Medical Center in Santa Ana. The full battery of tests available are grouped under the name Executive Health Program and are priced as a package at $575. The testing requires two visits to the facility: four hours the first day for testing and two hours the second day for evaluation of the results, stress and diet counseling and a prescription for an exercise program.

After completing a medical history questionnaire, the participant undergoes tests that include a resting electrocardiogram (a measurement of heart activity, more commonly called an EKG), blood pressure and height and weight measurements and tests for vision and hearing. Tests for lung capacity, strength and flexibility also are conducted, along with a chest X-ray, urinalysis, blood testing, a treadmill stress test, posture screening and hydrostatic weighing.

The participant need not go through every test, said Renee Weiss, administrator of the facility. Testing programs can be tailored to individuals, and the total expense can be based on the cost of each test (the stress test with a physician present and monitoring the results, for instance, is the most expensive at $195).

Some Firms Pay Tab

Weiss estimated that about five people a month are given the full battery of tests. Among those, she said, “we get a number of people whose companies pick up the whole tab.” For others, the testing may be financed in part by their health insurance, she added.

Because of the relatively high cost of similar testing at other health facilities in Orange County, such a payment plan is a familiar one. Administrators and others who run the facilities admit that while companies may be willing to pay a high price to ensure the health of their top executives, the cost of such complete testing can be a deterrent to the average weekend athlete.

However, some individuals who have no corporate sponsor are willing to pay for a complete testing program. Among them is Tom Link, a tire dealer from Long Beach who recently went through the Personal Fitness Profile tests given--at a cost of $250--at Saddleback Community Hospital in Laguna Hills. Link, 43, had “been getting into cycling and thinking of racing. I’d heard about testing like this, and I became interested in it when an ad in a cycling magazine offered a 20% discount on this program.”

As the two-hour testing began, Link’s height and weight were recorded, and a blood sample was drawn from his arm by Cheryl Jacob, a registered nurse who administers the tests. The sample would be analyzed for cholesterol and high-density lipoproteins, which contribute to clogging of arteries.

Next Link’s lung capacity and elasticity were tested by a spirometer, a machine into which he expelled all the air he could force from his lungs. His percentage of body fat was then determined by what is known as a caliper, or skin fold test. The skin at seven different points on his body was pinched up by hand and measured with sensitive calipers to determine how far away he was from his ideal weight.

Link then was run through a handful of strength tests, during which he performed push-ups, sit-ups, pull-ups and vertical jumps.

The final item on the agenda was the treadmill stress test. First, electrodes were fixed to Link’s torso and a resting electrocardiogram was taken while he was lying down. He then began the test on the flat treadmill at a slow walk. As the test continued, the speed of the treadmill increased slowly to a run, and the machine itself was periodically tipped at an angle to simulate the effect of walking or running uphill. Link’s heart rate and EKG were monitored on an adjacent screen.

Formula Used

At Saddleback, a participant’s maximum desirable heart rate during exercise is determined by a widely used formula subtracting the person’s age from 220. The slower the person arrives at that heart rate while on the treadmill, the better shape he is in, said Jacob. The test is stopped when the participant’s heart rate reaches that point or if the person becomes lightheaded, nauseated, short of breath or if a heart irregularity shows up on the screen.

A “cooling down” period of several minutes follows the test, during which Link continued to walk on the treadmill for a short time and then stepped off, his heart rate and EKG still being monitored.

Link would return a week later to be advised on the results of his tests. He also would be counseled on how to improve his diet, exercise regimen and other health-related habits.

The Saddleback method of testing was developed by the Arizona Heart Institute and is not untypical of other comprehensive testing programs in Orange County. One similar program, however, is designed primarily for healthy, active individuals and attracts a number of athletes.

At the South Coast Institute of Athletic Medicine in Laguna Niguel, open since last December, people who have a history of heart problems are not admitted for testing. And anyone over the age of 35 or who exhibits cardiac risk factors must be referred by a physician.

Two particular tests in South Coast’s battery are rare in Orange County: muscle analysis using a Kin-Com machine and a maximal stress test.

The Kin-Com machine, explained Matt Barenda, an exercise physiologist at the institute, exerts measured stress on different muscle groups--the legs, arms and others--and allows the person being tested to press back against it. The results of the muscle activity are shown on a line graph that appears on an electronic screen. The tester can determine from the graphs if there is an irregularity or weakness in any muscle or if there is an injury. Specific exercise can then be prescribed for specific muscles.

During the stress test--on a treadmill or stationary bicycle--EKG and heart rate are measured at increasing levels of exertion. At the same time, use of oxygen and expulsion of carbon dioxide are measured as the participant breathes continuously into a mouthpiece connected to measuring instruments.

“With that, we know exactly how much work they’re doing with each step,” said Barenda. “We can tell the size of their heart, or if they have lung problems. It tells you if you have endurance potential, 85% of which is hereditary. You can only improve it by 15% through exercise.”

‘Symptom-Limited’ Test

The stress test also is something of a rarity in that it is termed “symptom-limited,” meaning that in almost every case the test is stopped by the participant himself when he feels he literally can go no further. The test also is stopped if a health irregularity appears during testing.

The maximum heart rate for a healthy, physically active participant at the institute is not based on the 220-minus-age formula, said Barenda, but on the participant’s ability to function smoothly at a high rate of exertion. The object of such a test, he said, is to discover the participant’s anaerobic threshold--that point at which the person is using every bit of strength and endurance and oxygen before he begins to “shut down.”

“At that point, after you get past 90% (of the person’s capacity), it’s kind of like icing on the cake,” said Barenda. “You get a really accurate cardiovascular picture of the person. I or the doctor there will keep asking them if they’re OK, and if they say all right or give a thumbs-up and everything looks OK (on the screen), we’ll keep going.”

Most spas, gyms and health clubs don’t offer extensive health testing of the type conducted at Saddleback, South Coast or the RACC. Doctors, exercise physiologists and others say such clubs can’t afford the necessary equipment or don’t employ people qualified to administer and interpret such tests. For the most part, health clubs administer simpler tests to new members in order to determine the person’s basic strength and endurance before assigning a workout program.

An exception is Racquetball World in Fullerton, which offers a program of testing at its Lifetime Medical Fitness Center. There are three levels of testing offered, from cardiac, pulmonary and simpler strength and flexibility tests to more elaborate screenings that include a doctor’s physical and blood, urine and stool analysis. The program also includes counseling and an exercise prescription. Fees for non-members range from $209 to $588. Members pay from $150 to $420.

If there is a common denominator in many of the health testing programs offered throughout the county, it is the treadmill stress test.

There are two basic categories of stress tests: maximal and sub-maximal. A maximal stress test is designed to be just that, a test to take a person to his anaerobic threshold or to a point at which continued exertion causes physical problems.

In a sub-maximal test--a controversial procedure that some claim may not be a true determiner of cardiovascular fitness--the participant is brought up to perhaps 80% of his maximum stress level, the test is stopped and further heart rates and other physical patterns are estimated and extrapolated to 100%. By law a doctor must be present during a maximal test, but not during a sub-maximal one.

It is the guesswork involved in the sub-maximal test that is the source of most contention.

“There can be a number of errors and a number of problems with the estimated formula,” said Brian Roberts, manager of the RACC. “It’s like getting a tune-up on your car and having it tuned while it’s in idle. A lot of the changes that occur in the heart take place above 90% of maximal stress.”

Vince Caiozzo, a research associate at UC Irvine’s Human Performance Lab, a research facility designed to monitor and test the physical performance of athletes, said the maximal test “probably is the way to go. The reason behind that is that during the maximal test the heart is required to do a lot more work. So if there’s a problem (with the heart) your chances of seeing it are a lot greater. A lot of sub-maximal tests are predicated on a predicted maximal heart rate, but that predicted value has a tremendous amount of variation about it.”

The sub-maximal test is best used for health screening on younger participants who are in good physical shape to begin with, said Dr. Stephen Weiss, an orthopedic surgeon and executive director of RACC. For older, less active people, however, that test “is going under a false assumption. That person may be in such good shape that the 220-minus-age formula may not get them to their maximal stress.”

Dr. John Zamarra, a cardiologist and the director of cardiac rehabilitation at Placentia Linda Hospital, uses a treadmill stress test in his practice but says he doesn’t recommend its use in mass health screenings.

“With normal individuals, it’s not worth the time or the money,” he said. “Selectively, it can be important. If someone is over age 40 and considering a program of exercise, I’d say yes. But if the person is younger, with no problems, is entirely healthy and has no family history of cardiac risk factors, then I’d say it would be optional.”

“The concept is a good one, but it has to be offered on several levels,” said Dr. Donald Ball, an orthopedic surgeon and sports medicine specialist who practices in Orange. “It shouldn’t be limited to the executive. The working man needs it, too.”

Ball said: “I see a problem with people going out and getting into an exercise program, and if they’re 35 thinking they can progress as rapidly as they did when they were 20 and neglecting symptoms or advice. Really, anyone who’s never been in an exercise mode should be tested in some way.”

That testing, said Zamarra, may become even more exacting in the future.

“There’s a test called the stress electrocardiogram,” he said, “that I think is the test of the future. It has a decided advantage over the treadmill, and there are places that are just starting to use them.”

The test, said Zamarra, involves the use of ultrasound devices which, when applied to the chest, can project a picture of the moving, working heart on a monitor screen. (The test is currently in use at Personal Fitness Profile, a testing program in Fountain Valley, said Mike Martin, the administrator of the program. Personal Fitness Profile, like the Saddleback program, is a franchise of the Arizona Heart Institute.)

The testing programs, say their administrators, are thriving.

“People are educated now,” said South Coast’s Matt Barenda. “They want to know at what level they should work out. And people are shoppers, too. They’re looking around for the right place.”

Said the RACC’s Dr. Stephen Weiss: “I think the public is more conscious of health and fitness and the medical community is more aware of the preventive aspects of medical care. We’re much busier now than when we opened our doors two years ago.”

The analysis by Randy Olshen, an exercise physiologist technician at Racquetball World, may have cut to the very core.

“People are interested in this because they don’t want to have a heart attack,” he said. “They’re concerned about dying.”