JoVE Logo
Faculty Resource Center

Sign In





Representative Results






Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans

Published: October 17th, 2018



1Department of Cardiovascular Diseases, Mayo Clinic, 2Department of Laboratory Medicine and Pathology, Mayo Clinic

To assess the influence of exercise intensity on physiologic and biologic responses, two different exercise testing protocols were utilized. Methods outlining exercise testing on a cycle ergometer as an incremental maximal oxygen consumption test and endurance, steady state submaximal endurance test are described.

Regular physical activity has a positive effect on human health, but the mechanisms controlling these effects remain unclear. The physiologic and biologic responses to acute exercise are predominantly influenced by the duration and intensity of the exercise regimen. As exercise is increasingly thought of as a therapeutic treatment and/or diagnostic tool, it is important that standardizable methodologies be utilized to understand the variability and to increase the reproducibility of exercise outputs and measurements of responses to such regimens. To that end, we describe two different cycling exercise regimens that yield different physiologic outputs. In a maximal exercise test, exercise intensity is continually increased with a greater workload resulting in an increasing cardiopulmonary and metabolic response (heart rate, stroke volume, ventilation, oxygen consumption and carbon dioxide production). In contrast, during endurance exercise tests, the demand is increased from that at rest, but is raised to a fixed submaximal exercise intensity resulting in a cardiopulmonary and metabolic response that typically plateaus. Along with the protocols, we provide suggestions on measuring physiologic outputs that include, but are not limited to, heart rate, slow and forced vital capacity, gas exchange metrics, and blood pressure to enable the comparison of exercise outputs between studies. Biospecimens can then be sampled to assess cellular, protein, and/or gene expression responses. Overall, this approach can be easily adapted into both short- and long-term effects of two distinct exercise regimens.

Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure1. Exercise is a physical activity that involves repetitive bodily movement done to improve or maintain one or more components of physical health2. At one time, physical activity was not recommended for those who were seriously ill. For individuals with cancer, heart failure, or even for those who were pregnant, bed rest was preferred over physical activity. Clinical practice has since drastically changed, as the benefits of exercise on overall health are becoming undeniable3. Regular ex....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

The protocol was approved by the Mayo Institutional Review Board and conformed to the Declaration of Helsinki. All participants provided written informed consent before participating in the testing described.

1. Calibration and Setup of Metabolic Cart

  1. Flow and volume (pneumotach) calibration
    NOTE: Specific materials and equipment are listed in the Materials Table.
    1. Open the pulmonary function and gas exchange software to calibrate for the test.

      Log in or to access full content. Learn more about your institution’s access to JoVE content here

The application of maximal or submaximal endurance exercise testing provides a stimulus or stressor in which the body responds to meet the increased physiological demands. Various modes of exercise can be used to compare the physiological and biological responses to a particular exercise by itself or when a drug/intervention is used, or to evaluate the differences in responses between different exercise loads. Maximal and endurance exercise loads differ in the duration (short/long respect.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

There is great potential for exercise to be incorporated as an adjunct/alternative therapeutic tool. Indeed, an emerging body of evidence strongly suggests that physical activity promotes good health. The use of exercise as a medicine or diagnostic tool would require an understanding of the right amount or "dose" of exercise to achieve the desired effect. The optimal dose of exercise should be estimated, as too much exercise may be detrimental to improving health. As such, an exercise regimen may need to be tailo.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

This study was funded by the Mayo Clinic Department of Laboratory Medicine and Pathology and other various internal sources.


Log in or to access full content. Learn more about your institution’s access to JoVE content here

Name Company Catalog Number Comments
Metabolic cart/portable system MCG Diagnostics Mobile Ultima CPX System The flow calibration syringe, and calibration gases should come with system. There are numerous possible options/alternatives.
Pulmonary function software (Breeze Suite) MCG Diagnostics Software used will depend on the metabolic system
Upright cycle ergometer Lode ergoline 960900 Numerous possible options/alternatives
12-Lead ECG GE Healthcare CASE Exercise Testing System Used for 12 lead ECG capture, control bike. Having a full 12-lead is ideal for maximal exercise test so can monitor for arhythmias, but alternative for just HR would be a wireless chest strap heart rate monitor
Pulse oximeter Masimo MAS-9500 Usually multiple probe options: finger, forehead, ear lobe.  Usually avoid finger as tight handlebar grip can cause measurement inaccuracies
Pneumotach (preVent Flow Sensor) MCG Diagnostics 758100-003 Alternative systems can use a turbine
Nose piece (disposable) MCG Diagnostics 536007-001  Numerous possible options/alternatives
Mouthpeice with saliva trap MCG Diagnostics 758301-001 Suggest filling the saliva trap with paper towel/gauze and tape cap to limit dripping
Headband Cardinal Health 292866 Used to secure the forehead pulse oximeter and the lines for the cart
Stethescope  3M Littman 3157SM Numerous possible options/alternatives
Blood pressure cuff HCS HCS9005-7 Cuff size will depend on the population planning to test
ECG Electrodes Cardinal Health M2570 only needed with lead based ECG/HR monitoring
K2EDTA tube 5mL Becton Dickinson 368661
*The table provides a list of the supplies and equipment utilized in this protocol and comments related to the equipment. Brand name/company is provided, but the use of other brands will not affect the results, key is to keep it consistent throughout testing in a particular study.

  1. Caspersen, C. J., Powell, K. E., Christenson, G. M. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports. 100 (2), 126-131 (1985).
  2. Pedersen, B. K., Saltin, B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal Medicine & Science in Sports. 25, 1-72 (2015).
  3. Barlow, C. E., et al. Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women. American Journal of Epidemiology. 163 (2), 142-150 (2006).
  4. Blair, S. N., et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy. 273 (14), 1093-1098 (1995).
  5. Marson, E. C., Delevatti, R. S., Prado, A. K., Netto, N., Kruel, L. F. Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic review and meta-analysis. Preventive Medicine. 93, 211-218 (2016).
  6. Peel, J. B., et al. A prospective study of cardiorespiratory fitness and breast cancer mortality. Medicine and Science in Sports and Exercise. 41 (4), 742-748 (2009).
  7. Sui, X., et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA. 298 (21), 2507-2516 (2007).
  8. Shulman, L. M., et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurology. 70 (2), 183-190 (2013).
  9. Fleg, J. L., et al. Exercise training as therapy for heart failure: current status and future directions. Circulation. Heart Failure. 8 (1), 209-220 (2015).
  10. Flynn, K. E., et al. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 301 (14), 1451-1459 (2009).
  11. Scott, J. M., et al. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Circulation. 124 (5), 642-650 (2011).
  12. American College of Sports Medicine. . ACSM's guidelines for exercise testing and prescription. , (2013).
  13. Gustafson, M. P., et al. A systems biology approach to investigating the influence of exercise and fitness on the composition of leukocytes in peripheral blood. Journal for Immunotherapy of Cancer. 5, 30 (2017).
  14. Freidenreich, D. J., Volek, J. S. Immune responses to resistance exercise. Exercise Immunology Review. 18, 8-41 (2012).
  15. Campbell, J. P., et al. Acute exercise mobilises CD8+ T lymphocytes exhibiting an effector-memory phenotype. Brain Behavior and Immunity. 23 (6), 767-775 (2009).
  16. Gustafson, M. P., et al. A method for identification and analysis of non-overlapping myeloid immunophenotypes in humans. PLoS One. 10 (3), e0121546 (2015).
  17. Miller, M. R., et al. Standardisation of spirometry. European Respiratory Journal. 26 (2), 319-338 (2005).
  18. Miller, M. R., et al. General considerations for lung function testing. European Respiratory Journal. 26 (1), 153-161 (2005).
  19. Borg, G. Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test. International Journal of Sports Medicine. 3 (3), 153-158 (1982).
  20. Norton, K., Norton, L., Sadgrove, D. Position statement on physical activity and exercise intensity terminology. Journal of Science and Medicine in Sport. 13 (5), 496-502 (2010).
  21. Lansley, K. E., Dimenna, F. J., Bailey, S. J., Jones, A. M. A 'new' method to normalise exercise intensity. International Journal of Sports Medicine. 32 (7), 535-541 (2011).
  22. Poole, D. C., Burnley, M., Vanhatalo, A., Rossiter, H. B., Jones, A. M. Critical Power: An Important Fatigue Threshold in Exercise Physiology. Medicine and Science in Sports and Exercise. 48 (11), 2320-2334 (2016).
  23. Gustafsson, A., et al. Effects of Acute Exercise on Circulating Soluble Form of the Urokinase Receptor in Patients With Major Depressive Disorder. Biomarker Insights. 12, 1177271917704193 (2017).
  24. Hallberg, L., et al. Exercise-induced release of cytokines in patients with major depressive disorder. Journal of Affective Disorders. 126 (1-2), 262-267 (2010).
  25. Bengtsson Lindberg, M., Wilke, L., Vestberg, S., Jacobsson, H., Wisén, A. Exercise-induced Release of Cytokines/Myokines in a Single Exercise Test before and after a Training Intervention in Patients with Mild Cognitive Impairment. International Journal of Physical Therapy & Rehabilitation. 3, (2017).

This article has been published

Video Coming Soon

JoVE Logo


Terms of Use





Copyright © 2024 MyJoVE Corporation. All rights reserved