9
Appraisalof Cardiorespiratory Fitness Estimation Methods
Abstract
Introduction:TheMaximal Oxygen Consumption (VO_{2max)}depicts the capability to transport and take oxygen during extensiveexercises and it is used to reflect the effectiveness ofcardiorespiratory fitness.
Aim:The main objective of the current study was analyzed and the resultsobtained from incremental Treadmeal Test and Cooper Test withJackson’s predictive equation.
Method:167 (134 males and 33 females) healthy participants from the LeedsMetropolitan University was used as the main population. The studysample comprised on 167 Exercise and Sports students from LeedsMetropolitan University. Among them, females n=34 and males n=133.The average mass was 79.8323±10.41445,average height 1.64±.057,average age was 19.71±.836.Direct and indirect measurements for the VO_{2max}werecompared to those obtained from the NASA JSC predictive equation.
Results:The descriptive statistics derived from the three tests illustrated acorrelation coefficient between Jackson predictive equation andIncremental Treadmeal test was 0.4087 while the one obtained forCooper test and NASA was 0.3146. On the other hand, the correlationbetween the predicted and measured value was revealed a strongcorrelation.
Conclusion:NASAis the most appropriate method of estimating the maximum oxygenuptake.
KeyWords: Aerobic Capacity, Cardiorespiratory fitness and nonexercisingVO_{2max}prediction
Predictiveequations
Differentauthors have provided predictive equations for estimating the VO_{2max}.For instance, Jackson et al. (1990) provided the NASA predictiveequation for the nonexisting VO_{2max }estimatethat is usually based on age, weight, height and physical level ofactivities. Jacks et al (2011) define limiting factors that areinvolved with the direct estimation of VO_{2max}to encompass the logistical issues and the discomfort to theparticipants, meaning that the GXT maximal level of exertion isreached, therefore, increasing the risks associated with adversecardiac events (Dwyer and Shala, 2008).
Researchshows that in order to trigger VO_{2max}in a person who is asymptomatic, the tests on incremental treadmilltests should take place between 5 and 26minutes. According to Dlugoc(2013), validity is characterized by the steady state exercise forthe treadmill speeds that were over 5.0mph, which was equivalent to(134m.min^{1}).According to Hamlin et al. (2012) there existed a strong correlationbetween Jackson Predictive Equation and incremental treadmillprotocols (p=0.93). This illustrated the affirmation of the treadmillprotocols at low fitness levels in observing the variability fir theindividuals with an aerobic power of more than 50mL.kg^{1}min^{1}(Kedissi, 2005).
Noakes(2001) stated the laboratory protocols to lack ecological validity,hence failing to replicate the specific movement patterns associatedwith the team. On the other hand, fieldbased procedures enhance areduction in repeatability compared to the measurement of the VO_{2max}.Nevertheless, Guyton and Hall (2007) demonstrated the concurrentvalidity (p≤0.05) with the Cooper 12minute run denoting a verystrong correlation between the travelled distance travelled withinthose 12 minutes and recording the corresponding VO_{2max}(r=0.9, p=0.001) required to attain the oxygen efficiency consumptionas the exercise continued (Cooper, 1968).
Variousauthors have derived nonexercise equations to predict the VO_{2max}.Inthis research, the nonexercise methods applied the questionnairedata alongside the predictor variables in calculating the VO_{2max}using the physical activity rating (PAR) question to allow theparticipants provide the selfreport levels for the related physicalactivity(Hagerman, 1984).
Accordingto Jackson et al. (1990) c a crossvalidation analysis of thenonexercising model(Hirai, 2006), amongst the asymptomatic adultsrevealed that applying the PAR scores in the nonexercise regressionmodels was critical (r=0.810.94, SEE=3.095.35mL.kg^{1}.min^{1}).On the other hand, Kolata (2007) noted that an increase in the R^{2}with the additional variables such as gender, BMI, age and activitylevel, was critical in predicting the VO_{2max},Guyton and Hall (2007)) stated that BMI was a valid variable when thenonexercising protocols were used in predicting the VO_{2max}.
Themain physiological factors that limit VO_{2max}included the pulmonary diffusing capacity that results to inducedincreases in VO_{2max}.Such increases in VO_{2max}are as a result of high cardiac output instead of the widening of theavO_{2}diffthat induced the increases the VO_{2max}from 3.15 to 3.69L.min^{1}equivalent to a VO_{2max}increaseof 8.0%.
Aim
Thisstudy aimed at comparing the maximal running based on the VO_{2max}protocolsto the gold standard and Jackson predictive equation to predict thevalidity of the VO_{2max}estimationtechniques.
ResearchQuestions
Thecurrent research was based on the below research questions

Can NASA predictive equation be correlated to Cooper Test in assessing VO_{2max}?

How is the correlation between NASA predictive equations Incremental Treadmeal Test in assessing VO_{2max}?

Which of the three tests has the strongest correlation between the running based protocols in assessing VO_{2max}?
Researchdesign
Datacollection was conducted at Leeds Metropolitan University and it tookthree weeks. The participants were divided into groups and testedconcurrently on same day for each day for the entire data collectionperiod. The participants were prohibited from taking part ifsuffering from any sickness or injury
Procedure
Beforeundertaking the study, an informed consent was sought (Appendix D).the informed consent contained the information regarding the twotests that the participants were required to complete. A preexercisescreening was conducted on compulsory basis while the data collectionwas undertaken under natural conditions. The participants wererequired not to be involved in any strenuous exercise 24 hours priorto the tests. The tests took a total of six weeks. This gave enoughtime to minimize any errors to the changes inVO_{2max}attributed to the effects of training. This assumption is affirmed bycarter et al. (2007) who a sixweek intervention in endurancetraining increased the maximal oygen uptake by 3 to 4 percent. Allthe participants were required to maintain their current level ofactivity in that duration to minimize changes in the VO_{2max}Values.
Table 1: Statistics for Male and Female Participants 

Mean 

Gender 
Age (Years) 
Height (M) 
Mass (kgs) 
Systolic BP (mmHg) 
Diastolic BP (mmHg) 
Male (n=134) 
20.14±1.133 
1.79±.065 
79.8323±10.41445 
125.07±8.157 
72.29±8.963 
Female (n=33) 
19.71±.836 
1.64±.057 
61.4382±8.20418 
118.74±11.123 
73.44±7.178 
Total (n=167) 
20.05±1.091 
1.76±.088 
76.0874±12.44254 
123.78±9.167 
72.53±8.622 
AnthropometricMeasurements
Inthese measurements, the stature and body were measured prior totesting exercise when clothed and without shoes. The assessment ofthe stature took place during the inspiration process and was roundedto the nearest 0.1 cm.
HemodynamicParameters
Themeasurement of the blood pressure was done using a cuff andstethoscope (Spirit, England) and mercury sphygmomanometer (Accoson,MK. 3, and England). The measurements were taken when theparticipants were seated with their left arm at the same level withthe heart during which the cuff measurement was in line with thebronchial artery.
Indirectnonexercising VO_{2max}Prediction
Theindirect measurement of VO_{2max}was carried out done using the Jackson predictive equation. Jacksonhad validated equation for the nonexercisingVO_{2max}andconsidered the gold standard. The two gender specific equations usedare as shown below.
Theuse of Body Mass Index (BMI) facilitated the assessment of body massin relation to the square of the height in meters (kg)/ (m^{2}).The variables that were used in predicting the VO_{2max}included age (years) and the level of physical activity. Everyparticipant completed the tests both in incremental treadmill testand volitional exhaustion (Ergo ELG2, Woodway, Germany), and CooperTest. This involved continuous recording of the heart rate, with alight weight facemask and headpiece fitted to allow simultaneousbreathing both through the mouth and nose. The participants undertooka standardized up for 5 minutes while jogging at a rate of 610m/sand 0 percent gradient. During this time, males and females began ata speed of 10m/s and 8m/s respectively. Thereafter, their inclinationincreased at 2% for every 2minutes. The expired oxygen and carbondioxide were determined using the gas analysis method (Cortex,Metalyzer 3B, Germany), which was calibrated with using known gasesprior to each test.
Howleyet al. (199) conducted the achievement criteria for VO_{2max}the findings showed the standard validity level as (variation ≤2mL.kg^{1}min^{1})with respect to the increments in VO_{2}.
Twelve–Minute Cooper Test
The12minute Cooper test was conducted on a 400m track during thistest, the subjects were required to cover the greatest distancewithin the 12minute test period. Every participant was required tohave a Polar Heart Rate Monitor, especially after the 12minuteperiod had elapsed. All the participants were required to remainactive for a period of 3 to 5minutes. This was to help in recoveryand preventing any venous pooling of the blood. The VO_{2max}wasestimated using the following formula.
Table 2: secondary Criteria to Assess Maximal Exertion Attainment (Davis, 2006) 

VO_{2max} Secondary Criteria 

Respiratory Exchange Ratio 
≥1.15 
Heart Rate 
≥90% of the predicted maximal HR (HR_{max}) 
Subjective fatigue & volitional exhaustion 
RPE 1920 
Incrementaltreadmill test (TR)
Asubsample of study participants (n = 147) took part in the treadmilltest. The test was performed using ParvoMedics TrueMax 2400 that wasused in measurement of oxygen consumption. The speed of warmup wasat 4.5 to 7mph, though this depended on relative fitness of theparticipant. After the warmup, treadmill grade was increased by 3%for the first three minutes, and at the final stage, the speed of thetreadmill was increased by 0.5mph. The speed of the treadmill wasstopped after the participant reached the RPE of 13 to 14 Borg Scaleunits, and terminated after the participant indicated inability tocontinue with the test.
Atrue maximal test resulted when participant reached a VO_{2}plateau characterized by oxygen uptake difference of at most 2.1mL/kgwhen compared to the previous stage with a RER of more than 1.15 anda maximal heart rate of ±10 beats.
StatisticalAnalyses
TheIBM statistics, SPSS was used to perform the statistical analysiswhile the regression plots were done using Microsoft Excel. Thesignificance tests were applied at 95 percent confidence interval andthe expression of the data was either in terms of the mean andstandard deviation. The KolmogrorovSmirnoff test was used indetermining normality.
Theinterpretation of the results was based on the following table
‘r’ Value 
Interpretation 
±0.000.19 
Very weak 
±0.200.39 
Weak, Small 
±0.400.59 
Moderate 
±0.600.79 
High, Strong 
±0.800.99 
Very Strong 
Results
Thecharacteristics of the participants’ were recorded in Table 1.Also, the means were generated and presented in Table 3. The standarddeviation was also obtained and the deviations from VO_{2max}obtainedusing the predictive VO_{2max}equations,the incremental Treadmill Test and the Cooper test. _{.}
CorrelationAnalysis
Thiswas carried out to determine the existence of any relationshipbetween the tests.
MeasuredValue vs. Predicted Value
Model Summary 

Model 
R 
R Square 
Adjusted R Square 
Std. Error of the Estimate 
1 
.512^{a} 
.262 
.257 
6.94197 
a. Predictors: (Constant), Predicted VO2max (ml/kg/min) 

b. Dependent Variable: Jackson Predictive Equation 
Figure1: PredictedMeasure vs. Measured Value VO_{2max}
Itcan be observed from the figure above that the correlationcoefficient, ‘r’, for the predicted VO_{2max}and the measured VO_{2max}values is 0.5119. This reflects a moderately positive strongcorrelation (r=0.5119, n=167).
12MinuteCooper Test vs. Jackson Predictive Equation
Model Summary 

Model 
R 
R Square 
Adjusted R Square 
Std. Error of the Estimate 
1 
.316^{a} 
.100 
.092 
7.82929 
a. Predictors: (Constant), Estimated VO2max (ml/kg/min) 
Figure2: Weakcorrelation (n=167, r=0.3146) between VO_{2max}scores for Cooper test vs. Jackson predictive Equation
Fromthe correlation analysis (n=167, r=0.3146). This implies that thereis a small correlation between The Cooper test and Jackson PredictiveEquation cannot be correlated. Also, from the R^{2}value, it can be concluded that 10% of the VO_{2max}scores obtained using the Jackson predictive Equation remainsunaccounted for by the results obtained from 12Minute Cooper Test.
ModifiedIncremental Treadmeal vs. Jackson Predictive Equation
Theregression analysis was carried out to determine the correlationcoefficient for the predicted measure of VO_{2max}and measured VO_{2max}
Model Summary 

Model 
R 
R Square 
Adjusted R Square 
Std. Error of the Estimate 
1 
.409^{a} 
.167 
.160 
7.52223 
a. Predictors: (Constant), Estimated VO2max (ml/kg/min) 

b. Dependent Variable: Jackson Predictive Equation 
Figure3: ModeratePositive Correlation (n=167, r=0.4087) between scores obtained byusing Modified Incremental Treadmeal vs. Jackson predictive Equationin predicting VO_{2max}
Fromthe r value obtained, it can be concluded that there exists amoderate positive correlation between modified Incremental Treadmealand Jackson Predictive Equation. This is affirmed by the significancelevel of (p≤0.05). On the other hand, the R^{2}value is 0.167, illustrating that 16.3% of the VO_{2max}scores obtained using the Jackson Equation remains unaccounted for bythe results obtained from Modified Incremental Treadmeal.
SignificanceTests
OneSample KolmogorovSmirnov Test 

12 minute Cooper Test 
Modified Incremental Treadmeal 
Jackson Predictive Equation 
Age (Years) 
Height (M) 
Mass (kegs) 

N 
153 
147 
137 
167 
167 
167 

Normal Parameters^{a,b} 
Mean 
55.0331 
55.8527 
46.6645 
20.05 
1.76 
76.0874 
Std. Deviation 
6.45488 
9.76539 
8.05281 
1.091 
.088 
12.44254 

Most Extreme Differences 
Absolute 
.086 
.066 
.068 
.230 
.090 
.034 
Positive 
.037 
.066 
.047 
.230 
.055 
.025 

Negative 
.086 
.058 
.068 
.168 
.090 
.034 

KolmogorovSmirnov Z 
1.063 
.797 
.793 
2.973 
1.160 
.444 

Asymp. Sig. (2tailed) 
.208 
.549 
.555 
.000 
.136 
.989 

a. Test distribution is Normal. 

b. Calculated from data. 
Fromthe significance analysis, the KS=0.797, p=0.549 for ModifiedIncremental Treadmeal, KS=1.063, p=0.208 for 12Minute Cooper Testwhile the Jackson Predictive Test has KS=0.793, p=0.555. From theseresults, Jackson Predictive equation is more significant, followed byIncremental Treadmeal and 12Minute Cooper Test.
Discussion
Findingsand Implications
Fromthe analysis, it can be established that the correlation coefficientobtained when correlating NASA with Incremental Treadmeal isrelatively higher, 0.4087, than the ‘r’ value obtained bycorrelating the NASA and 12Minute Cooper Test, 0.3146. This impliesthat since NASA is considered as the most valid and reliable methodof measuring VO_{2max},then Incremental Treadmeal is significantly correlated to it. The ‘r’values are in accordance to research by Groot (2009) who demonstrateda strong correlation between Incremental Treadmeal with NASAequation.
Moreover,from the KolmogorovSmirnoffstatistics, the significance value (p) was comparatively higher inNASA followed by IncrementalTreadmeal then12MinuteCooper Test.Bruce et al. Had reported a correlation coeffcienct between thepredicted and measure value of 0.94. From the analysis, the r valueobtained from correlating the measured and predicted value was0.5119. The difference is not too high, hence predicting somecorrelation between the measured and predicted value.
Boththe Cooper and Treadmill tests involve running and it is thereforesurprising for the huge difference in when correlated to the NASAresults. The less accurate prediction of the maximum oxygen uptakeusing 12Minute Cooper test implies that IncrementalTreadmeal should be used instead of 12minute Cooper test. Accordingto Dwyer and Shala (2008)12minute Cooper Test normally givesunderestimate values for maximum oxygen uptake.The current study aimed at determining the reliability and validityof the 12minute Cooper test and Incremental Treadmill tests againstthe Jackson predictive equation in assessment of the maximal oxygenuptake. A number of key findings by Lambert and Leger (1982) wherethey concluded that Incremental Treadmill tests and Cooper tests werevalid and reliable tests for predicting the VO_{2max}.Additionally, Andrew (2007) noted that the Treadmeal IncrementalTests have low underestimates that the 12minute Cooper tests. Nevertheless, Hayward (2002) contradicts the results obtained in thecurrent research when he said that tests requiring the subjectsperform maximal capacity must involve the aerobic and anaerobiccomponents. If this was true, then the VO_{2max}obtained can be overestimated because the contribution of anaerobiccomponent may not be known, hence its validity would remainquestionable.
Justas indicated by the results from regression analysis, the aerobiccomponent for the two tests in embedded within the predictiveequation. Hergenroederand Schoene (1989) had established that the major assumption can beon aerobic component affecting the distance travelled. However, ifthe low anaerobic power was the main reason for the differences incorrelation coefficients, then it remains unclear why the resultsobtained for Treadmill tests appeared to have a high correlationcoefficient.
Accordingto Bruce et al. (1991) the correlation coefficient (r) between themeasured and predicted VO_{2max}is approximately .94 for n=94. On the other hand, Fletcheret al (1990) carried out a comparison of measured and predictedVO_{2max}and established an average error (predicted) of 0.6 mL·kg^{−1}·min^{−1}when applied in general equation and −2.0 mL·kg^{−1}·min^{−1}when applied for populationspecific equations. On the other hand,the 12MRT by Cooper indicated that different runwalk tests can becorrelated based on the distance travelled within a given period andthe time required to complete the distance. Cooper had reported atestretest reliability of 0.90. Based on validity, Cooper (1990) hadreported a correlation of 0.9 between the VO_{2max}and 12MRT distance. Jessup et al. (1974) found out a low correlationfor the VO_{2max}and 12MRT for males at the age of 18 to 23 years. Also, Safrit et al(1998) had reported similar findings to Jessup et al.(1974)
Limitations
Themain limitation of the current research was that the process of thetests was time consuming and high costs were involved. Also, Modifiedtreadmill tests are applied widely in diagnosis of coronary heartdisease hence providing the normative data. However, the method isapplicable to individual having low functionality capacity. Themanual measurement of the pulse rates posed a major drawback. Thismeant that the results of the current study were prone to human bias.Also, despite the fact prepractice exercises were done prior to themain tests, some participants could not manage to engage in the walkfor continuous periods.
Recommendationsfor Further Research
Itis recommended that the participants be trained thoroughly before thetest. Also, in future, the researchers should consider using moreautomated tools to enhance accuracy of the measurements. In thecurrent research, analysis was only carried out for three methodshowever, the comparison between more than three methods would becritical in making more conclusive recommendations.
Conclusion
Fromthe analysis, it can be concluded that NASA is the more significantand reliable method in Predicting the VO_{2max}scores. This is followed by Incremental Treadmeal, and finally12Minute Cooper Test. The results obtained affirmed the research byClemente (2009) who suggested that NASA is the most valid equationfor the athletic populations. Therefore, the objectives of thecurrent research were fulfilled. The findings revealed thatIncremental Treadmeal is strongly correlated to NASA while 12MinuteCooper Test is moderately correlated to NASA. In overall, it can beconcluded that NASA is the most appropriate method for predictingaerobic capacity in Cardiorespiratory fitness.
References
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Appendix
AppendixA:Descriptive Statistics
Gender 
Age (Years) 
Height (M) 
Mass (Kgs) 
Jackson Predictive Equation 
Rockport 1Mile Walk Test 
Queens College Step Test 
12minute Cooper Test 
Modified Incremental Treadmeal 
Systolic BP (mmHg) 
Diastolic BP (mmHg) 

Male 
Mean 
20.14 
1.79 
79.8323 
47.7039 
48.8830 
45.7183 
55.1033 
58.8834 
125.07 
72.29 
Std. Deviation 
1.133 
.065 
10.41445 
8.01208 
6.89117 
4.71821 
6.49741 
8.61758 
8.157 
8.963 

Minimum 
19 
2 
54.00 
30.00 
37.99 
32.80 
34.22 
34.00 
102 
48 

Maximum 
25 
2 
112.00 
72.94 
70.80 
53.30 
68.83 
81.09 
145 
92 

Range 
6 
0 
58.00 
42.94 
32.81 
20.50 
34.61 
47.09 
43 
44 

Female 
Mean 
19.71 
1.64 
61.4382 
42.4296 
39.2585 
38.0467 
54.7675 
44.9613 
118.74 
73.44 
Std. Deviation 
.836 
.057 
8.20418 
6.84767 
9.45885 
12.24909 
6.38630 
4.41693 
11.123 
7.178 

Minimum 
19 
2 
46.00 
25.00 
16.52 
.00 
43.00 
35.52 
98 
60 

Maximum 
21 
2 
81.00 
53.10 
54.89 
43.80 
69.10 
58.60 
137 
88 

Range 
2 
0 
35.00 
28.10 
38.37 
43.80 
26.10 
23.08 
39 
28 

Total 
Mean 
20.05 
1.76 
76.0874 
46.6645 
46.6448 
43.9479 
55.0331 
55.8527 
123.78 
72.53 
Std. Deviation 
1.091 
.088 
12.44254 
8.05281 
8.54638 
7.74837 
6.45488 
9.76539 
9.167 
8.622 

Minimum 
19 
2 
46.00 
25.00 
16.52 
.00 
34.22 
34.00 
98 
48 

Maximum 
25 
2 
112.00 
72.94 
70.80 
53.30 
69.10 
81.09 
145 
92 

Range 
6 
0 
66.00 
47.94 
54.28 
53.30 
34.88 
47.09 
47 
44 
Independent Samples Test 

Levene`s Test for Equality of Variances 
ttest for Equality of Means 

F 
Sig. 
t 
df 
Sig. (2tailed) 
Mean Difference 
Std. Error Difference 
95% Confidence Interval of the Difference 

Lower 
Upper 

Age (Years) 
Equal variances assumed 
.035 
.851 
1.374 
117 
.172 
.333 
.242 
.147 
.813 
Equal variances not assumed 
1.626 
49.522 
.110 
.333 
.205 
.078 
.745 

Height (M) 
Equal variances assumed 
.949 
.332 
9.783 
117 
.000 
.143 
.015 
.114 
.172 
Equal variances not assumed 
10.782 
43.602 
.000 
.143 
.013 
.117 
.170 

Mass (Kgs) 
Equal variances assumed 
2.725 
.101 
8.732 
117 
.000 
20.47864 
2.34522 
15.83406 
25.12322 
Equal variances not assumed 
10.053 
47.044 
.000 
20.47864 
2.03698 
16.38087 
24.57640 

Jackson Predictive Equation 
Equal variances assumed 
.025 
.874 
2.964 
117 
.004 
5.30247 
1.78870 
1.76004 
8.84491 
Equal variances not assumed 
3.213 
42.433 
.003 
5.30247 
1.65053 
1.97257 
8.63237 

12minute Cooper Test 
Equal variances assumed 
.014 
.907 
.087 
117 
.931 
.13085 
1.49954 
2.83891 
3.10062 
Equal variances not assumed 
.089 
38.551 
.930 
.13085 
1.47689 
2.85755 
3.11926 

Modified Incremental SRT 
Equal variances assumed 
12.186 
.001 
7.630 
117 
.000 
13.90244 
1.82206 
10.29395 
17.51094 
Equal variances not assumed 
10.505 
70.044 
.000 
13.90244 
1.32337 
11.26310 
16.54179 
One Way ANOVA 

Sum of Squares 
df 
Mean Square 
F 
Sig. 

12minute Cooper Test 
Between Groups 
2511.223 
46 
54.592 
1.464 
.072 

Within Groups 
2684.581 
72 
37.286 

Total 
5195.804 
118 

Modified Incremental SRT 
Between Groups 
5228.547 
46 
113.664 
1.308 
.152 

Within Groups 
6258.934 
72 
86.930 

Total 
11487.481 
118 
Tests of Normality 

KolmogorovSmirnov^{a} 
ShapiroWilk 

Statistic 
df 
Sig. 
Statistic 
df 
Sig. 

Age (Years) 
.233 
119 
.000 
.782 
119 
.000 
Height (M) 
.077 
119 
.082 
.978 
119 
.049 
Mass (Kgs) 
.057 
119 
.200^{*} 
.986 
119 
.262 
Systolic BP (mmHg) 
.082 
119 
.048 
.980 
119 
.074 
Diastolic BP (mmHg) 
.108 
119 
.002 
.975 
119 
.028 
Jackson Predictive Equation 
.077 
119 
.084 
.985 
119 
.199 
12minute Cooper Test 
.087 
119 
.027 
.976 
119 
.030 
Modified Incremental SRT 
.074 
119 
.154 
.988 
119 
.353 
*. This is a lower bound of the true significance. 

a. Lilliefors Significance Correction 
AppendixB: NASAJSC Physical Activity Scale
NASAJSC Physical Activity Scale 

Do not exercise regularly, i.e. 

0 
Avoid walking or exertion, e.g. always use elevator, drive whenever possible Instead of walking. 
1 
Walk for pleasure, routinely use stairs, occasionally exercise sufficiently to Cause heavy breathing or perspiration. 
Participate regularly in recreation or work requiring modest physical activity, Such as golf, horseback riding, calisthenics, table tennis, bowling, weightlifting or yard work. 

2 
1060minper week. 
3 
Over 1 hour per week. 
Participate regularly in heavy physical exercise, e.g., running or a comparable Activity such as brisk walking, indoor biking, swimming, cycling,rowing, skipping rope, running inplace, or engaging in vigorous aerobic exercise such as tennis, basketball, or handball. 

4 
Run less than1 mile per week or walk lessthan1.3 miles per week or spend Less than30min per week incomparable physical activity. 
5 
Run15milesper week or walk 1.36.9milesper week or spend3060minper Week incomparable physical activity. 
6 
Run610milesper week or walk 713.9milesperweek or spend13hper Week incomparable physical activity. 
7 
Run1115miles per week or walk 1420miles per week or spend46h per Week incomparable physical activity. 
8 
Run1620miles per week or walk 2126.9 miles per week or spend79h per Week incomparable physical activity. 
9 
Run2125miles per week or walk 2733.9 miles per week or spend1012hper Week incomparable physical activity. 
10 
Run over 25 miles per week or walk over 34 miles per week or spend over 12 h Per week incomparable physical activity. 
AppendixC:Equipment Used During the Analysis
AppendixD:Consent Form