AEROBIC EXERCISE TESTING

Buffalo Concussion Treadmill Test

00:00:00:05 - 00:00:28:18
Speaker 1
Hello and welcome to the Buffalo Concussion treadmill test. So who is this for? This is for anyone less than three months out after injury or if you're more than three months out. But you did not score a positive test on the active stand test. This could be for you. Or if you did score a positive test, you've gone through the adaptive protocol and you're in stages 3 to 4 and you're ready to test for upright tolerance.
00:00:28:18 - 00:00:50:16
Speaker 1
So if you're any one of those, you are in the right place. So what to expect is this will take up to 20 to 30 minutes. Start to finish the test itself only takes 20 minutes. You'll have your results at the end and you can plan on recording your heart rate, your symptoms and your rate of perceived exertion, a.k.a..
00:00:50:16 - 00:01:15:13
Speaker 1
How hard does this feel? Frequently. And this. Finally, this is a walking test. So we're not going to be doing any running equipment that you'll need is a treadmill that can incline. You're going to need your heart rate monitor on and you want to be in a place where you can see your heart rate because we're going to be recording it multiple times in your workbook.
00:01:15:13 - 00:01:40:04
Speaker 1
You're also going to need a few pages handy. So one is the rate of perceived exertion and the visual analog scale. And those look like this. So the rate of perceived exertion is good red, yellow, orange, green one and the visual analog scale is your smiley faces. You'll also need your workbook page to record and your results page, and then, of course, something to write with.
00:01:40:04 - 00:02:00:12
Speaker 1
And if you have someone who can help you record, that can be really helpful. So your recording person too. And then of course you'll be in comfortable clothes and shoes. Now your results pages are going to look like this, so it'll say Buffalo concussion treadmill test. You have the date at the top. You have your sitting resting heart rate, which will take before the test.
00:02:00:12 - 00:02:17:10
Speaker 1
And I'll explain it all to you. And then you're going to have a couple of calculations that we're going to do together, which is your age expected, Max, and 90% of your heart rate. And then for each minute, I'm going to let you know, okay, time to record your heart rate, how you're perceiving your your exertion and your symptoms on a scale of 0 to 10.
00:02:17:10 - 00:02:44:05
Speaker 1
And you'll simply record them on each line. So before we again, we need to do a quick calculation, because one of the ways that this test stops is if we meet what's called 90% of your max heart rate. And we need to figure out what that is for each of you. So super simple calculations. So what you're going to do is you're going to take the number 220 and you are going to subtract your age.
00:02:44:05 - 00:03:25:14
Speaker 1
Once you have that number, you'll write it on the line that says age expected max at the top of your recording sheet. So 220 minus your age gives you your heart rate. Max. Then once you have that number, you're going to take that number and you're going to multiply it by point nine, and that's going to give you your 90% heart rate max, anyone needs any help with this?
00:03:25:14 - 00:03:54:21
Speaker 1
Just let me know. So again, you're taking to 20 minus your age and that's your age. Expected heart rate. Max, go right on the line on the left and then you'll take that number and multiply it by 0.9 and that'll give you 90% of your heart rate, max, when you are ready, go and type in the chat Ready.
00:03:56:03 - 00:04:35:24
Speaker 1
Make sure everyone has plenty of time here. Perfect. Ready? Great. Okay, cool, though, when you are ready, let's go ahead and get started and I'm going to guide you through every step of the way. So let's just start with an overview so you know what's actually happening. What we're going to do is we'll start with you seated for 2 minutes quietly, and then we're going to record your heart rate.
00:04:36:05 - 00:04:51:12
Speaker 1
That's going to be your sitting resting heart rate that you see at the top of your sheet. And then what we'll do is we'll have you stand up and you'll get onto the treadmill and you'll have one foot on either side of the belt. So you're not going to be standing on the moving part. You're going to stand on the outside and we're going to turn it on to a certain speed.
00:04:52:01 - 00:05:18:14
Speaker 1
And then you're going to have your sheets right in front of you so that you can see them for every single minute that we record. And then what we'll do is we'll take your heart rate. Then that'll be your it will say rest on the sheet, that'll be that line. And then will do is at every minute will increase the incline by one will record your heart rate.
00:05:18:22 - 00:05:39:08
Speaker 1
How hard this feels for you and your symptoms on a scale of 0 to 10. And we'll repeat that every minute until the test completes. Once you're done, you can slow it down to about two miles per hour for a cooldown for a couple of minutes if it feels okay, or you can simply sit and rest comfortably. So I want to explain the handouts to you first.
00:05:39:08 - 00:06:06:21
Speaker 1
You're going to have the visual analog scale, and I'm just going to call it the smiley faces throughout this thing. So, you know, in the doctor's office they say it's K scale of 0 to 10. Where are you at? This is going to be important because I'm going to ask you, when you're standing up with the treadmill on but not quite walking, what are your symptoms on a scale of 0 to 10, I just want you to take the big number, and this is important because the test is going to stop whenever we get to three points more than what your initial symptoms were.
00:06:07:05 - 00:06:24:11
Speaker 1
So every minute I'm going to say, okay, what's your heart rate? You're going to write it down. You say, okay, scale 0 to 10 on the smiley faces. Where are you at? You're going to write it down and I'm going to say, okay, what's your rate of perceived exertion? So how hard does this feel for you? You can see the scale goes from 6 to 20, so that's what your hands out are going to look like.
00:06:24:11 - 00:06:46:24
Speaker 1
And I want them in your visual eyeline throughout the test. So usually you can just put them right in front of you on the treadmill. The test will stop with when any of these things happen. So when your symptoms increase more than three points for your baseline, so say you start out at a three out of ten, like my symptoms are about a three out of ten and you get to the point where you get to a seven.
00:06:47:09 - 00:07:05:23
Speaker 1
Now you're more than three points and that would be your stopping point for the test. So any time you get more than three points, you would stop. Or if your rate of perceived exertion goes above 17, use 18 or 19 in the clinic. But since we're home, I'm going to be a little more conservative and we're going to stop at 17.
00:07:06:18 - 00:07:28:05
Speaker 1
Or if you're going, you're going, you're going, you're feeling pretty good and you reach your 90% age expected, Max, That number we just calculated if you get to that number and you're still doing pretty good without symptoms, you can stop the test because you passed it or if at any point you don't feel safe or you feel faint or you want to stop for any reason, you can always stop.
00:07:29:00 - 00:07:51:20
Speaker 1
Okay? And then since everyone will stop at different times, some people might reach that above three points at like 2 minutes. Other of you might take like 15. So whenever you hit your stopping point, you'll bring your treadmill back down to level zero and you'll walk at two miles per hour for 2 minutes as long as you feel okay.
00:07:51:20 - 00:08:08:01
Speaker 1
If you want to stop and get off and rest, you can. But if you can do a cooldown, it's going to help you feel a little bit better in the long run. And then once you're done with that, you can just rest in a chair, have some water, and when we finish, we can all do our results together.
00:08:08:01 - 00:08:28:16
Speaker 1
Okay, So our step here is going to be we need to take your resting heart rate. So I'm going to make sure that everyone has heart rate monitors on. You can see your heart rate that you have any papers you need to record on the treadmill. I don't want anyone to like have to look way over and like record over here.
00:08:28:16 - 00:08:37:17
Speaker 1
I want you to be able to keep going straight forward and just record there or have someone with a clipboard and you can just tell them how you're feeling. Are we all set up there?
00:08:40:05 - 00:09:53:10
Speaker 1
Okay, so what we're going to do is we're going to start and get your establish your sitting heart rate for 2 minutes. So I want everyone in a seated position. I'm going to put 2 minutes on the clock and we're just going to sit quietly. So sit quietly, breathe nice and easy, and I'll let you know when 10 minutes is up.
00:09:53:10 - 00:11:15:09
Speaker 1
One more minute interval. So now you now have your sitting resting heart rate. Go and record whatever your heart rate says now at the top of your sheet where it says sitting resting heart
rate. Now, what we're going to do that you have your heart recorded is you're going to go ahead and stand up and stand up on your treadmill.
00:11:15:09 - 00:11:43:08
Speaker 1
You won't need to see me anymore after this, but you can just listen to my voice or guide you with each stage. But I want everyone to stand on the treadmill and I want your foot on the outer edges. So not on the moving part. Now, remember, you're going to have your sheets right in front of you so you can see them easily and record without turning your head or having someone help you record.
00:11:43:08 - 00:12:14:08
Speaker 1
Okay. And then what I want you to do is if you are five, ten inches tall, in height or lower, I want you to turn on the treadmill to 3.2 miles per hour. So if you're five foot ten or shorter, you want to turn the treadmill on and set your speed to 3.2 miles per hour. If you are five, ten and taller, you're going to set your speed to 3.6 miles per hour.
00:12:14:08 - 00:12:48:00
Speaker 1
So again, five, ten and shorter, 3.2 miles per hour, five, ten and taller, 3.6 miles per hour, zero incline. So flat. Once the treadmill gets up, I'm going to give everyone just a minute to make sure everyone's treadmill is moving at the right pace. Remember, you're not walking yet. Your foot is on either side of the Nonmoving part.
00:12:48:00 - 00:13:12:23
Speaker 1
Okay. And once that's done, I want you to record your heart rate on the spot that says Rest, record your heart rate. I want you to record how hard you feel like you're working your rate of perceived exertion at 0 to 20 scale. And I also want you to record your symptoms on a scale of 0 to 10, where your symptoms starting at.
00:13:12:23 - 00:14:33:03
Speaker 1
And remember that numbers can be really important because if at any point you hit more than three from that number, that's one of your stopping points. So make sure you get your heart rate and scale 0 to 10 where your symptoms are out right now. Okay. When you're ready, go ahead and safely start walking on the treadmill. Okay.
00:14:33:03 - 00:15:32:19
Speaker 1
We're now at one minute. Go ahead. Increase your treadmill, incline up by one, and then you're going to record your heart rate, your rate of perceived exertion, how hard you're working and
your symptom severity. So your symptoms on the smiley face scale. So you're at a ten. We're going to do this every minute on the minute and you'll stay walking all time.
00:15:32:19 - 00:16:34:10
Speaker 1
Okay, We're at 2 minutes. Go ahead. Increase your treadmill incline by one Again, and then record your heart rate, the rate of perceived exertion and your symptoms on that 0 to 10 scale. If anyone's symptoms are over, that three or more from where you started, that would be your stopping point. For most of you, I suspect we're still going, okay, you're at 3 minutes.
00:16:34:10 - 00:17:33:24
Speaker 1
Go ahead. Increase your incline by one. Record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale. If at any point your symptoms are three or more than three points from where you started or your rate of perceived exertion is over 70, you'll stop and begin your cooldown. So, okay, we're at 4 minutes.
00:17:33:24 - 00:18:08:13
Speaker 1
Go ahead and increase your treadmill incline by one. Record your heart rate, record your rate of perceived exertion, then record your symptoms on that 0 to 10, Scale your smiley faces again. If you're more than three points from your symptom baseline 17 or more in your ease or you hit your 90% max, which shouldn't happen yet. If you do, those are your starting points.
00:18:08:13 - 00:19:32:22
Speaker 1
Remember, when you get to your stopping point, you can bring your treadmill back to level and just walk at two miles per hour for a couple of minutes and then sit down. As long as you feel safe, not you keep going, okay, you're at 5 minutes. Go ahead. Increase your incline by one. Record your heart rate, the rate of perceived exertion and your symptoms on that 0 to 10 smiley face scale.
00:19:32:22 - 00:20:07:09
Speaker 1
Okay, we're at 6 minutes. Gordon. Creature incline by one. Record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 smiley face scale. If any of you have more than three points from where you started on your symptoms, your RPE is over 17. Or if you're feeling faint or uncomfortable, you would stop your test here, lower your treadmill down, lower it down to two miles per hour to a couple of minute walk and then sit down.
00:20:08:10 - 00:21:34:01
Speaker 1
If you feel safe. You can also just sit down if you need to. We are at 7 minutes. Go ahead. Increase your incline by one. Record your heart rate, your rate of perceived exertion and your
symptoms on that 0 to 10 smiley face scale. If you hit any of the stopping points, begin your cooldown, not keep going. We're now at 8 minutes.
00:21:34:05 - 00:22:32:20
Speaker 1
You increase your incline by one. Record your heart rate, record your rate of perceived exertion and your symptoms on the 0 to 10 smiley face scale. If you hit any of your stopping points, begin your cooldown, lowering all the way back down and then walking at two miles per hour for 2 minutes and you can see if you're still going keep going.
00:22:32:20 - 00:22:58:01
Speaker 1
We are at 9 minutes. Go ahead. Increase your incline by one. Write down your heart rate, The rate of perceived exertion and your symptoms on the 0 to 10 scale. You haven't hit any stopping points. Keep on cruising along. If you have, go ahead and lower your treadmill all the way down, decrease your walking speed to two miles per hour and walk for 2 minutes.
00:22:59:01 - 00:24:03:05
Speaker 1
Then you can have a seat, get some water, rest up and stay with us until the end, and then we can go through the results. We're now at 10 minutes to increase your incline by one record your heart rate, the rate of perceived exertion and your smiley face 0 to 10 scale for your symptoms. If at any point you get more than three points from where your symptoms started, your RPE over 17 or you've hit your 90% heart rate max like you calculated on the top right hand corner your page, you'll stop everyone else.
00:24:03:05 - 00:24:50:10
Speaker 1
Continue on. And of course, if anyone ever feel dizzy or uncomfortable or unsafe, you also always stop. I would say dizzy to the point where you feel unsafe. You might feel a little dizzy and still feel safe, where at 11 minutes go increase your incline by one record your heart rate. The rate of perceived exertion and your symptoms on the 0 to 10 smiley face scale, you hit any of the stopping points, begin your cooldown.
00:24:50:23 - 00:26:04:06
Speaker 1
If not, keep going. Okay, we're now at 12 minutes. Increase your incline by one. Record your heart rate of court, your rate of perceived exertion, and your 0 to 10 smiley face scale. If the 0 to 10 smiley face scale is above three points from your resting, you'll stop. If your RPE is above 17, you'll stop. If you've reached 90% of your heart rate, max, you'll stop and begin your cooldown.
00:26:04:21 - 00:26:56:09
Speaker 1
Everyone else go and continue. All right. We're at 13 minutes. Could increase your incline by one record your heart rate, your rate of perceived exertion and your symptoms on the 0 to 10 smiley face scale. If you had any of those stopping points with those begin, your cooldown seemed completely lower. Your treadmill lower the speed down to two miles per hour, walk for 2 minutes and have a seat.
00:26:56:09 - 00:27:43:20
Speaker 1
Have some water. Not good. Keep going. This is usually where people start to get a little breathless, like with your chatting with them in the clinic usually go quiet. You're doing great. We are at 14 minutes. Go ahead and increase your incline by one. Record your heart rate, record your rate of perceived exertion and your symptoms on the 0 to 10 smiley face scale.
00:27:45:16 - 00:28:32:16
Speaker 1
If you've hit any of your stopping points, begin your cooldown. If not, we'll keep going. We have about six more minutes of the test total. Oftentimes people have stopped by now, so if you've stopped by now, no worries. You're still going. Let's keep going. I should say most people have stopped if they have a positive test. If you're still doing good, that's awesome.
00:28:32:16 - 00:29:22:14
Speaker 1
Okay, we're out 15 minutes. Go increase your incline by one. That's usually the as high as the treadmill goes. And then record your heart rate, your rate of perceived exertion and your symptoms. 0 to 10 scale. We're coming up on 16 minutes. Our next increase is going to look a little different. I just want to prep that We have about 10 seconds left.
00:29:22:14 - 00:29:55:14
Speaker 1
So now what I want you to do is go ahead and increase your treadmill speed by point four miles per hour now. So increase your treadmill speed by 0.4 miles per hour. Once you've done that, record your heart rate, your rate of perceived exertion, you're 0 to 10 smiley face scale. If you've hit any stopping points, you're more than three points on your 0 to 10 symptom scale from where you started at rest, you'll stop.
00:29:56:08 - 00:30:50:01
Speaker 1
You're 17 or above, you'll stop if you've hit 90% of your age. Heart rate, max, that number at the top of the page, you'll stop and begin your cooldown. Everyone else keep going. We only have about three and a half minutes left. Okay, we're at 17 minutes. Go increase your treadmill speed by 0.4 miles per hour. Record your heart rate, your rate of perceived exertion and your symptoms on the 0 to 10 smiley face scale.
00:30:50:01 - 00:32:31:15
Speaker 1
If you hit any stopping points, lower everything down and begin your cooldown. Two miles per hour for 2 minutes, not keep going. We're almost done. We're at 18 minutes. Go ahead. Increase your treadmill speed by 0.4 miles per hour, point four record your heart rate, the rate of perceived exertion and your 0 to 10 symptoms. We only have less than 2 minutes left of the test.
00:32:31:15 - 00:32:58:14
Speaker 1
Okay, We're at 19 minutes. This is our last increase. So increase 0.4 miles per hour. Then record your heart rate, your rate of perceived exertion and your 0 to 10 symptom score. If you've reached more than three points for your symptoms, more than 17 for your rate of perceived exertion or your heart rate, Max, your 90% heart rate max and number at the top, you can go and begin your cooldown.
00:32:58:14 - 00:33:55:01
Speaker 1
If not, we have 30 seconds left. So, okay, we're at 20 minutes. Go and record your final heart rate, your final rate of perceived exertion and your final symptoms. Symptom score on 0 to 10. Once you've done that, you can lower your treadmill down to zero incline, lower your speed down to two miles per hour, and do a two minute cooldown.
00:33:55:05 - 00:34:57:15
Speaker 1
As long as you're feeling okay. If you need to sit down, you can sit down. If you've already stopped and you're sitting, feel free to grab some water, any deep breathing, any other regulation techniques. If you're feeling a little yucky, it's going to give the final Cooldowns a couple minutes here, Let me know on the chart if you've already finished and finished your cooldown.
00:34:57:15 - 00:35:55:11
Speaker 1
And then within about a minute we're going to go over results together. And of course, as all the law is all done, Cool, cool. Very exciting. You're still finishing your cooldown. You've got about 30 seconds left. Everyone else just sitting comfortably, laying comfortably water. If you need rope. Keeps making weird noises today it's all quiet, but it's like, well, Julie's done beautiful.
00:35:55:11 - 00:36:35:00
Speaker 1
All right. Got about ten more seconds of the cooldown for the 20 minute people. All right. And cooldown is done. Go ahead and turn off your treadmill safely. Step off. You can go ahead and sit down, get some water. Let's chat results. So rest in a chair. All right. So let's go ahead and talk results. So if you were able to complete the whole test or you reached your 90% heart rate, Max, without much of an increase in symptoms.
00:36:35:08 - 00:37:07:20
Speaker 1
So either you want the whole 20 minutes for good to go or you got up to your 90% heart rate max and you hadn't really had much increase in symptoms. That's physiologic recovery. So that means the autonomic nervous system is recovered and we can move on to things like neck and vision of a similar if you stopped had any of those stopping points of your symptoms increase more than three points or up 19 But we used 17 RPE as your great candidate for some symptom threshold exercise.
00:37:07:21 - 00:37:32:09
Speaker 1
That means we have a little exercise intolerance going on. We know exactly how to treat it and we can treat it. Very catered to you, which is awesome so now that your testing is complete, you know what your autonomic nervous system needs to recover best and let's do so for anyone who let me go back for anyone who has an exercise intolerance box.
00:37:32:18 - 00:37:51:24
Speaker 1
So you stopped the test at any point due to your symptoms increasing more than three points, your RPE going over. You're a great candidate for some symptom threshold exercise program. And what I want you to really take note of is take note of the heart rate that you recorded when you were like, Oh, I'm more than three points over.
00:37:51:24 - 00:38:19:09
Speaker 1
My symptoms are, Oh, I'm more than 17 points, or I don't want you to write that heart rate on your next page where it says heart rate at symptom exacerbation can be really important. They want to record the heart rate where you had to stop. Once you write it down, you'll just tuck it away. We're going to need this when we get into your programs will prescribe your program based on this heart rate.
00:38:20:03 - 00:38:43:19
Speaker 1
Just really cool. Okay. And if you're like me, you like everything all in one place. If you checked the box for exercise and tolerance, you'll also check the box here at the top. And if you're in the under three month one and you'll be appropriate for the sub symptom threshold exercise program. If you did not check the box, you had a normal test.
00:38:43:21 - 00:39:10:09
Speaker 1
So you've passed the Buffalo test, but you're not exercising more than 100 aerobically more than about 150 minutes a week. I want you to do the reconditioning program. If you've passed this test and you're already exercising aerobically 150 minutes a week, but you're still
experiencing symptoms, that's usually letting us know that it's due to the other symptom domains like vision, vestibular, NEC, those things.
00:39:10:09 - 00:39:30:05
Speaker 1
So for you, you'll go and skip the rest of the aerobic exercise course because you're done and you can move on to the next module. So same thing if you're over three months, if you checked the box for exercise intolerance. So you stopped sooner for any of those reasons, you're going to do the sub symptom threshold exercise program.
00:39:31:08 - 00:39:51:01
Speaker 1
If you also had a hyper mobile score, if you did that test, if you were over three months, you'll check this box too. So those will be your two programs. If you passed this test and you've already passed the active stand test, but you're not walking or you're not getting a rollback exercise, about 150 minutes a week, you're going to do the reconditioning program.
00:39:52:11 - 00:40:16:02
Speaker 1
If you pass to this test, you pass the active stand test, you're able to exercise aerobics 150 minutes per week, but you're still experiencing symptoms. You're going to skip the rest of this module because you're good here and you're going to go into the rest of the symptom module, starting with the neck. Okay. And again, before making any changes, please see your health care provider.

Buffalo Concussion Bike Test

 

00:00:00:10 - 00:00:27:06
Speaker 1
All right. Also, welcome to the Buffalo concussion bike test. So this is for anyone who is less than three months out after injury or for anyone who's more than three months out after injury but did not score a positive test on the active stand test. What you can expect is this test takes 20 minutes in and of itself will probably go about 30 minutes just with explaining and supporting the results.

00:00:27:19 - 00:00:49:04
Speaker 1
You'll have your results at the end, which is very exciting. And you can expect to record your heart rate, your symptoms and your rate of perceived exertion multiple times. And then just this is a biking test, so you'll be on a bike. So what you'll need is a recumbent bike. And typically we have this test done with, you know, the bike where your legs are out in front of you.

00:00:49:05 - 00:01:07:14
Speaker 1
You're leaning back on a seat and you're biking that way. If you have that, that's fantastic. With that said, we're not in a research lab and we just need to know how you are doing aerobics and what heart rate your body is struggling to adapt. So if you have a different kind of bike that is okay, we can adapt it.

00:01:07:22 - 00:01:24:09
Speaker 1
So if you have one of the bikes like a peloton or something like that, what I would just say is I want you to stay sitting up rather than leaning forward over the handlebars. So either is going to work, you're going to have a heart rate monitor, you're going to have it on and you're going to have your heart rate visible.

00:01:24:15 - 00:01:50:00
Speaker 1
So we're going to be recording it multiple times. You're going be wearing your heart rate monitor and you want to be able to see it in your workbook. You're going to have your rate of perceived exertion scale and your various scale. And those look like this. So it's your green, yellow, orange, red scale and the smiley faces. You're also going to have your workbook page to record and your results page.

00:01:50:00 - 00:02:13:22
Speaker 1
And then of course, something to write with. And if you're able, it can be really helpful to have someone record your heart rate for you. But if not, that's okay. You can do it on your own. We'll talk about that. And then, of course, just be dressed for exercise and hydrated. So your recording sheets look like this. It says buffalo concussion bike test at top at the top.

00:02:13:22 - 00:02:39:02
Speaker 1
And then on the at the next page, it has a spot where you can record your final heart rate. You're going to write your the date up top here. We're not going to need the weight. We typically do that when we're in the clinic. We're not going to use that today. But what we are going to use is we can write a little spot at the top that says 90% heart rate max, because we are going to use that number.

00:02:39:02 - 00:02:58:16
Speaker 1
So let's get started. I'm going to guide you step by step. And we're going to start with an overview. So I just want you to understand what's coming. So basically what we do is we're going to have your rate of perceived exertion so that colorful one and the visual analog scale. So your smiley face 0 to 10 on the bike in front of you.

00:02:58:16 - 00:03:15:10
Speaker 1
I want you to be able to see those because we're going to record every minute. How are your feeling on those? You're also going to have obviously your heart rate monitor and then you can either record, maybe you have the sheet on your lap on a book or a clipboard, or if someone can record for you, they can record for you.

00:03:15:10 - 00:03:39:03
Speaker 1
But what we're going to do is we're going to start you sitting for 2 minutes and you're just going to sit comfortably and then we're going to record your heart rate and that'll be your resting heart rate. And then what we'll have you do is go ahead and get you on the bike. We'll make sure that the bike is set up appropriately for you, and then we'll go ahead and once we're ready, will record your heart rate and your symptoms once more.

00:03:40:02 - 00:03:55:02
Speaker 1
Now, those symptoms in the beginning is going to be really important because we're going to say, okay, on a smaller scale, 0 to 10, where are your symptoms at right now? They were caught that in the beginning. And then at any point during the test, if you get above three points or more on that, that's how we know to stop.

00:03:56:01 - 00:04:20:11
Speaker 1
So we'll gradually increase the resistance of the bike every minute until we reach any stopping points. So first I want you to understand the out so you have your rate of perceived exertion and this just means how hard are you working? So it's a 0 to 20 scale and it's just how challenging does this feel for you? You're also going to have what's called a visual analog scale.

00:04:20:14 - 00:04:40:10
Speaker 1
I'm just going to refer to as the smiley face scale, where you rate your symptoms on a scale of 0 to 10, kind of like you see in the doctor's office. So we'll rate these at every minute. The test will stop when your symptoms increase more than three points from your baseline. So say we're we've got you sitting on the bike.

00:04:40:16 - 00:05:02:03
Speaker 1
We're like, okay, let's record your heart rate. Where are your symptoms starting out? And let's say you're starting at a three out of ten. So that means any time your symptoms got to a seven, that's when you would stop, because that's more than three points or let's say you're out of five. That would mean if you get to a nine, you would stop because you're more than three points above your baseline from where you started.

00:05:02:03 - 00:05:29:13
Speaker 1
You'll also stop the test If your RPE goes above 17. In the clinic, we use 18 or 19. But since we're home, I want to be a little more conservative here, meaning 17 or if you reach what's called 90% of your age, predicted, Max, without any symptoms that we're going to calculate in a bit here, or if at any point you don't feel safe or you feel faint or for any other reason you want to stop, you are welcome to stop at any time.

00:05:30:06 - 00:05:58:02
Speaker 1
Okay? And everyone will be stopping at different points. Now we have a line and then we'll have this as a recording. So wherever your stopping point is, you're going to begin your cooldown. So what you'll do is you'll lower the bike or it's a zero incline slower. That's a miss type. You'll lower the speed down to two miles per hour and you'll just go for a couple of minutes and you'll lower the resistance, that should say.

00:05:58:11 - 00:06:20:11
Speaker 1
And then you can sit in a chair, get water as needed. So before we establish your resting heart rate, I want to take the time to do one quick calculation. And so what you're going to do is you might want your phone calculate to, um, but what I want you to do is take the number 220 and subtract your age.

00:06:21:19 - 00:07:10:11
Speaker 1
So you're going to take the number 220 and subtract your age. And then once you have that, you're going to multiply it by point nine. So 0.9 and when you get that number, I want you to write it at the top of your sheet, maybe just next to the date, because that's your 90% heart rate, max. I'm going to give a minute to do that.

00:07:10:11 - 00:07:36:13
Speaker 1
Okay. So everyone has their heart rate or 90% heart rate, Max. Beautiful. Right. So now we're going to do is I just want you to sit in a chair resting comfortably, have your heart rate monitor on, and your ability to see what your heart rate is. And we're just going to sit for 2 minutes to establish our resting heart rate.

00:07:36:13 - 00:10:06:23
Speaker 1
Okay. So when everybody is ready, Erin, are you ready? Do you want to just put ready in the chart if you're ready to roll. Perfect. Okay. I'm going to put 2 minutes on the clock. Go ahead and sit and rest comfortably. Now, a little less than a minute. Keep resting. Okay. Go ahead and record your resting heart rate where it says rest in heart rate column.

00:10:06:23 - 00:10:36:06
Speaker 1
Be the first spot. You can write your heart rate in the little table. Okay. Our next step is to ready the bike. So I want you to sit on your bike, make sure you have your rate of perceived exertion and your smiley face scale handy. Make sure you have your recording sheet handy. You can have someone record it for you.

00:10:36:18 - 00:10:57:06
Speaker 1
Or if you are going to record, you can either have it on your lap or somewhere where you're not going to have to like turn your head and move or bend over and move. You want to have it easily recordable. Your pedals are going to be where when your feet are in the stirrups, that you just have a slight bend in your knee.

00:10:57:06 - 00:11:24:15
Speaker 1
When you go straight, you don't want to feeling like you're reaching. You want your knees all the way up in the chest. So we're going to set your pedal length and move the seat at all if you need. And then once you are ready, you're going to then look at your heart rate again and record that heart rate next to where it says stage and minute zero.

00:11:24:15 - 00:12:01:09
Speaker 1
So in that call in that row, you'll record your heart rate. And then you're also going to record on 0 to 10 where your symptoms are at. So using that smiley face scale 0 to 10 overall, how are your symptoms doing? And remember, if at any point during this test you get more than three above your 0 to 10 where you're starting, that will be a stopping point.

00:12:01:09 - 00:12:28:08
Speaker 1
Awesome. Okay, let's go ahead and get started. Let me pull up my timer. So we'll go the full testing time. But if people have stopping points sooner, please feel free to stop when that test stops for you. And I'll remind you of what those stopping points are at each at each level. Okay, so you're going to go ahead and make sure your resistance is at zero.

00:12:29:03 - 00:13:57:20
Speaker 1
And I want you to start pedaling the bike at 60 RPMs and will stay at 60 RPMs the entire time. So you don't have to change your speed at all. Okay, putting the timer on. So we'll be biking at 60 RPMs. And in one minute we're going to take your first reading. Okay, We're at one minute. So go ahead and increase the resistance by one.

00:13:57:20 - 00:14:55:00
Speaker 1
If you're on a bike where it has the term knob instead of the button, you can do half a turn keeping the same speed, and then you're going to record your heart rate, your rate of perceived exertion. So how hard it is and that 0 to 10 smiley face skill. All right, 2 minutes. Go ahead and increase your intensity up by one.

00:14:55:18 - 00:15:20:20
Speaker 1
Or if you have the knob, you can increase it another half turn. You're going to record your heart rate, your rate of perceived exertion, and your 0 to 10 smiley face skill. Remember, if at any point your symptoms go up by more than three from your baseline, your rate of perceived exertion is over 17 or you've reached your 90% heart rate.

00:15:20:20 - 00:16:51:12
Speaker 1
Max. That number we calculated at the top of the page, you'll stop, take out the resistance and begin your cooldown. If not, keep on going. All right. We're at 3 minutes. Go ahead and increase your intensity by or your resistance, I should say by one. If you have the turn log, you can do another half term and then you're going to record your heart rate, your rate of perceived exertion, and that 0 to 10 smiley face, symptom scale.

00:16:51:12 - 00:17:17:13
Speaker 1
Okay, we're at 4 minutes. Go ahead and increase your resistance by one or turn that knob another half turn. Record your heart rate, your rate of perceived exertion and your 0 to 10 symptom scale. If at any point you're at this point, your above three on your symptoms from where you started your rate of perceived exertion is above 17.

00:17:18:17 - 00:18:10:04
Speaker 1
We're probably a little too soon to reach your heart rate maxed. If you've reached 90% heart rate max, you can stop and begin your cooldown. If not, keep on going. All right, run 5 minutes. Go ahead and increase the resistance by one or if you have the turn on turn, record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 smiley face scale.

00:18:10:04 - 00:19:05:24
Speaker 1
If you're doing good, keep going. If you've hit any of your stopping points, go and take off the resistance. Lower your pace to about 30 RPMs and begin a couple of minute cooldown. Okay, we're at 6 minutes. Go ahead. Increase the resistance by one or half the turn and then record your heart rate, your rate of perceived exertion and your 0 to 10 symptoms.

00:19:05:24 - 00:19:56:00
Speaker 1
You're doing good. Keep going. If you've reached any of your stopping points, take off the resistance lower down to about 30 RPMs and do a two minute cooldown and then you can hop off and have some water or lay down whatever you feel like you need to recover. Right at 7 minutes, go ahead and increase the resistance by one.

00:19:56:19 - 00:20:34:21
Speaker 1
Or if you're on the turn knob kind of bike, increase it by half, record your heart rate, the rate of perceived exertion and your symptoms on the 0 to 10 scale. Remember, your stopping points are if your symptoms go up more than three points from your baseline. So from the first time you wrote them down, if your reps are over 17 or if you've reached that 90% heart rate max number you wrote at the top of your page, or for whatever reason, you don't want to continue, always have the choice to stop whenever you like, but still good.

00:20:34:21 - 00:22:08:04
Speaker 1
Keep on going. All right. We're at 8 minutes. Could increase the intensity by one. Record your heart rate. Right. Of perceived exertion and three out of ten symptoms or symptoms on a 0 to 10 scale. All right. At 9 minutes could increase the resistance. One more or another half turn. If you're on a turn bike and then record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale.

00:22:08:04 - 00:22:53:05
Speaker 1
If you're still cruising along, great. If you've reached any of your stopping points, take off all the resistance, reduce your speed by about half and cooldown for a couple of minutes. Once you're done with that, you can sit really down, grab some water and hang out till we finish up the test here and we'll get yours. Okay? We're at 10 minutes.

00:22:53:07 - 00:23:53:04
Speaker 1
Go ahead and increase your intense or your resistance by one more by another half turn. Record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale. Remember your stopping points as if your symptoms increase more than three points from your baseline. So from the first time you recorded it, if your reps are over 17 or if you've reached that 90% of your heart rate max number, we're about halfway through the test.

00:23:53:04 - 00:25:06:17
Speaker 1
All right. We're out 11 minutes. Go ahead and increase your intensity by one for your resistance, I should say. And then record your heart rate, your rate of perceived exertion and your 0 to 10 symptoms. All right. We're at 12 minutes. Go ahead. Increase your intensity by one or that half knob. Turn. Write down your heart rate, your rate of perceived exertion, and your 0 to 10 symptoms.

00:25:07:18 - 00:25:33:04
Speaker 1
It's probably feeling pretty challenging at this point. So if you hit above three out of ten on your symptoms or above three points from where you started on your symptoms, your rate of perceived exertion is above 17 or you've met your 90% heart rate max, then you can go ahead and stop the test, take off your resistance, what your speed by half and do a two minute cooldown.

00:25:34:12 - 00:26:58:15
Speaker 1
I'm not going keep going. All right. We're at 13 minutes. Go ahead. Increase your intensity by one or another. Half turn. Write down your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale. You haven't been any stopping points. Keep going. If you have gotten started, cooldown. All right. What 14 minutes? Go ahead and do one more resistance increase or a half turn on the knob.

00:26:59:05 - 00:28:11:24
Speaker 1
Write down your heart rate, your rate of perceived exertion and your symptoms on the 0 to 10 scale. If you've hit any stopping points, begin your cooldown. If not, keep on going. We have under 6 minutes left. All right, we're out. 15 minutes. Go ahead and increase your resistance by one or a half. Turn and then write down your heart rate, your rate of perceived exertion, and your zero or 0 to 10 smiley face, symptom scale.

00:28:11:24 - 00:29:03:22
Speaker 1
We're almost done. Less than 5 minutes of the test. If you had any of your stopping points, take off your resistance, slow your speed, do a two minute cooldown. If you're still going, we're almost done. It's probably getting harder. All right. We're at 16 minutes. Go ahead and increase your resistance by one or a half turn if you're on a turn back and then record your heart rate, your rate of perceived exertion and your symptoms.

00:29:03:22 - 00:29:51:21
Speaker 1
0 to 10. Remember your stopping points as if your symptoms increased more than three points on that ten point scale from where you started. If your rate of perceived exertion is over 17 or if you've reached 90% of your heart rate max, the number we calculated and wrote at the top where if you feel unsafe for any reason.

00:29:51:21 - 00:30:16:00
Speaker 1
All right, we're at 17 minutes, so go ahead and increase your resistance by one or a quarter. Turn on the turn back. Record your heart rate, your rate of perceived exertion and your 0 to 10 symptoms. If you've reached any of the stopping points, go and take off your resistance, slow your speed by half and do a two minute cooldown.

00:30:16:00 - 00:31:10:18
Speaker 1
Then you can safely get off the bike, have some water, sit, lay down whatever feels comfortable for you. If not, we have two and a half minutes left. We're 18 minutes. Go ahead and increase your resistance by one more quarter. Turn on the knob. Record your heart rate rate of perceived exertion and your three out of ten or Oh, my gosh, keep saying that 0 to 10 smiley face symptoms scale.

00:31:10:18 - 00:32:09:09
Speaker 1
If you're hitting and you're stopping points, go and begin your cooldown if you're still going. We have a minute and a half left. Okay. At 90 minutes, go and do your last resistance. Increase by one or turn the knob another half way. Write down your heart rate, your rate of perceived exertion, and your 0 to 10 smiley face symptom score.

00:32:09:09 - 00:33:07:02
Speaker 1
If you've hidden your stopping points, go ahead and stop and cool down. If not, we are almost finished. Well, all right, that's 20 minutes. Go ahead and record your final heart rate. Your final rate of perceived exertion and your final 0 to 10 smiley face, symptom scale. Go ahead and take all the resistance off the bike. Reduce your speed by half.

00:33:07:02 - 00:35:07:24
Speaker 1
So to 30 are RPMs, and we're going to begin a two minute cooldown. If you are already completed your cooldown, you can hang out in the chair or lay down, have some water, and we're going to go over the results in a couple of minutes here. One more minute of the cooldown. Those that stopped at 20. All right.

00:35:07:24 - 00:35:43:02
Speaker 1
Go ahead and slow your speed. Come to a stop when you're ready. You can get off the bike safely and then you can rest in a chair, maybe grab some water, can lay down if you feel like you need it. However you want to recover. Okay. So let's talk results. If you're watching the replay, you can pause me if you need a little more time.

00:35:43:11 - 00:36:05:11
Speaker 1
If you're ready, let's talk results of the bike test. So if you were able to reach 90% of your heart rate, Max, without an increase in symptoms, that signals physiologic recovery, meaning that the nervous system is adapting to exercise as we want it to, and the cerebral blood flow in the brain is being controlled and regulated as we would like it to.

00:36:06:15 - 00:36:39:00
Speaker 1
If you stopped due to an increase of symptoms of three points or more than three points or this RPE of 19, we set an RPE of about 17 and that means you are the ideal candidate for the sub symptom exercise program. So if you stopped early, go ahead and check this aerobic or exercise intolerance box. If you made it either all the way to the end or to the 90% of your heart rate, max, without an increase in symptoms can check physiologic recovery.

00:36:39:00 - 00:37:06:14
Speaker 1
Now, if you checked the exercise intolerance box, what I want what will be really important to do is take a look at the heart rate you recorded when you stopped. So that last recording, because you're like, Oh, I got over one of those stopping points, whatever that heart rate was, I want you to write it here on this line because we're going to use this number to help prescribe your sub symptom threshold.

00:37:06:14 - 00:37:41:11
Speaker 1
Exercise programs will be tailored to you where your body is struggling and where we need to retrain to go and record that number here. Okay. And then let's do our final all in one place, because we know we all love it. If you were under three months and you checked the exercise intolerance box, you will be doing the sub symptom threshold exercise program.

00:37:41:11 - 00:38:13:05
Speaker 1
Congratulations. It is highly effective and we can tailor it to you if you passed this test. Meaning you checked that physiologic recovery box, but you're not aerobically exercising for 150 minutes a week in the RECONDITIONING program. If you passed the Buffalo concussion treadmill or this or this test and you're exercising aerobically for more than a 150 minutes or at least 150 minutes a week, but you're still experiencing symptoms, that usually means it's from other domains.

00:38:13:05 - 00:38:35:20
Speaker 1
So your neck, your vision, your vestibular, things like that. So for you, you'll go and skip the rest of the exercise module because you won't need it. Then you can go right into the next module. After that, if you're over three months, pretty similar here. So if you checked the exercise intolerance box, you're going to go into the sub symptom threshold exercise program.

00:38:37:10 - 00:39:10:22
Speaker 1
If you passed this test and the active stand test, but you're not doing 150 minutes per week of aerobic exercise, you're going to go into the reconditioning program. If you passed this test, you passed the active stand test and you're exercising for 150 aerobics, 450 minutes per week, but you're still experiencing symptoms, then you're going to skip this module and continue on to the next module in the next, like we talked about, then that's letting us know, okay, it's not our blood flow or nervous system adapting to the exercise.

00:39:10:22 - 00:39:27:03
Speaker 1
It's more how is the neck doing, how's vision, vestibular, things like that. And then of course, if you had the hyper mobility positive score on that test, you can check this to see you may have two programs that you do, although this one will be quite short. Okay.

 

Buffalo Concussion March Test

 

00:00:00:02 - 00:00:03:11
Speaker 1
Hello everyone, and welcome to the Buffalo Concussion.

00:00:03:11 - 00:00:03:24
Speaker 2
March.

00:00:03:24 - 00:00:06:12
Speaker 1
Test. So this test is.

00:00:06:12 - 00:00:08:10
Speaker 2
For you If you are less than three months.

00:00:08:10 - 00:00:09:00
Speaker 1
Out after.

00:00:09:00 - 00:00:11:13
Speaker 2
Injury or you're more than three.

00:00:11:13 - 00:00:14:19
Speaker 1
Months out, but you did the active stand test and you did not have a.

00:00:14:19 - 00:00:15:15
Speaker 2
Positive score.

00:00:15:23 - 00:00:17:24
Speaker 1
You moved on to exertion testing.

00:00:18:17 - 00:00:19:08
Speaker 2
Or you.

00:00:19:08 - 00:00:24:24
Speaker 1
Did have a positive active stand test and you've done the adaptive protocol and now you're about to move from stage.

00:00:24:24 - 00:00:27:15
Speaker 2
3 to 4, where we want to test your tolerance to.

00:00:27:15 - 00:00:28:21
Speaker 1
Exercise and standing.

00:00:29:04 - 00:00:30:07
Speaker 2
So this would be for you to.

00:00:32:20 - 00:00:36:21
Speaker 1
What you expect is the test itself takes 20 minutes, will be.

00:00:36:21 - 00:00:38:07
Speaker 2
Here up to 30.

00:00:38:07 - 00:00:39:11
Speaker 1
5 minutes. By the time.

00:00:39:11 - 00:00:40:20
Speaker 2
We get results and everything.

00:00:40:20 - 00:00:41:04
Speaker 1
Done.

00:00:41:15 - 00:00:43:12
Speaker 2
You'll have your score and your results.

00:00:43:12 - 00:00:45:03
Speaker 1
At the end. You can.

00:00:45:03 - 00:00:46:23
Speaker 2
Expect to record your heart rate.

00:00:47:00 - 00:00:48:09
Speaker 1
Symptoms and.

00:00:48:09 - 00:00:49:24
Speaker 2
Rate of perceived exertion.

00:00:50:03 - 00:00:54:21
Speaker 1
Okay. How hard does this feel? Multiple times. And this is a standing.

00:00:54:21 - 00:00:55:06
Speaker 2
Marching.

00:00:55:06 - 00:01:01:05
Speaker 1
Test. So equipment you'll need here is a piece of tape or a sticker.

00:01:01:05 - 00:01:01:18
Speaker 2
Or.

00:01:01:19 - 00:01:06:18
Speaker 1
A post-it note, something sticky that you can stick on the wall. You'll need a metronome.

00:01:06:18 - 00:01:07:13
Speaker 2
App, or you can.

00:01:07:13 - 00:01:10:13
Speaker 1
Simply type a metronome into Google and it'll show up at the.

00:01:10:13 - 00:01:15:06
Speaker 2
Very top. It's super easy. You'll need your heart rate monitor on.

00:01:15:18 - 00:01:16:14
Speaker 1
And you'll need to be able to.

00:01:16:14 - 00:01:22:23
Speaker 2
See your heart rate. And then you'll need your workbook pages. You're going to have your rate of perceived exertion.

00:01:22:23 - 00:01:29:23
Speaker 1
And visual analog scale and those look like this. So the colorful one here and that smiley face.

00:01:29:23 - 00:01:30:08
Speaker 2
Zero to.

00:01:30:08 - 00:01:32:05
Speaker 1
Ten scale.

00:01:32:05 - 00:01:33:21
Speaker 2
You're also going to need your workbook.

00:01:33:21 - 00:01:34:11
Speaker 1
Page to.

00:01:34:11 - 00:01:35:19
Speaker 2
Record and your results.

00:01:35:19 - 00:01:39:08
Speaker 1
Page along with something to write with. And it's ideal if someone.

00:01:39:08 - 00:01:40:23
Speaker 2
Can help you record on.

00:01:40:23 - 00:01:44:17
Speaker 1
This, but if you don't have that, I can walk you through it as well. And then just be.

00:01:44:17 - 00:01:46:16
Speaker 2
Dressed for exercise.

00:01:46:16 - 00:01:51:22
Speaker 1
Comfortable shoes, comfortable clothes and well-hydrated.

00:01:51:22 - 00:01:53:24
Speaker 2
So your testing worksheets.

00:01:53:24 - 00:01:59:07
Speaker 1
Look like this. They say the Buffalo Concussion March test. They have the date.

00:01:59:07 - 00:02:00:06
Speaker 2
Which you can record.

00:02:00:06 - 00:02:01:08
Speaker 1
And then they have something that says.

00:02:01:08 - 00:02:01:18
Speaker 2
Heart rate.

00:02:01:18 - 00:02:04:08
Speaker 1
Max. You can write a 90 in front of that, witnessing.

00:02:04:08 - 00:02:05:18
Speaker 2
90% of your heart rate.

00:02:05:18 - 00:02:07:07
Speaker 1
Max. And then you can.

00:02:07:07 - 00:02:09:07
Speaker 2
See your final recording sheet here.

00:02:09:21 - 00:02:10:05
Speaker 1
And we'll.

00:02:10:05 - 00:02:11:03
Speaker 2
Go over those as.

00:02:11:03 - 00:02:11:10
Speaker 1
Well.

00:02:13:08 - 00:02:15:03
Speaker 2
So before we begin, we have one.

00:02:15:03 - 00:02:18:11
Speaker 1
Quick calculation to do, and that is to find.

00:02:18:11 - 00:02:19:14
Speaker 2
What your 90% max.

00:02:19:14 - 00:02:20:01
Speaker 1
Is.

00:02:20:01 - 00:02:22:23
Speaker 2
So it's a real easy calculation. What I want you to.

00:02:22:23 - 00:02:25:02
Speaker 1
Do is take the number 220.

00:02:26:03 - 00:02:27:12
Speaker 2
And subtract your age.

00:02:28:06 - 00:02:35:15
Speaker 1
So the number 220 and subtract your age, then multiply that number by point nine.

00:02:38:14 - 00:02:40:12
Speaker 2
And that number is your 90% heart rate.

00:02:40:12 - 00:02:43:15
Speaker 1
Max. And you can write that at the top of your sheet on the.

00:02:43:15 - 00:02:44:18
Speaker 2
Line where it says heart rate.

00:02:44:18 - 00:02:54:24
Speaker 1
Max So one more time, take 220, subtract your age, and then from.

00:02:54:24 - 00:02:57:09
Speaker 2
That number you're going to multiply it by zero.

00:02:57:09 - 00:03:02:02
Speaker 1
Point nine and that'll give you your 90.

00:03:02:02 - 00:03:03:03
Speaker 2
Percent heart rate max.

00:03:03:03 - 00:03:04:11
Speaker 1
Which will right at the top of.

00:03:04:11 - 00:03:09:00
Speaker 2
Your sheet here.

00:03:09:00 - 00:03:12:09
Speaker 1
Wonderful. Okay, so let's.

00:03:12:09 - 00:03:12:23
Speaker 2
Get started.

00:03:12:23 - 00:03:14:23
Speaker 1
I will guide you step by step.

00:03:14:23 - 00:03:16:08
Speaker 2
And we're going to start with your.

00:03:16:08 - 00:03:16:22
Speaker 1
Set up and.

00:03:16:22 - 00:03:18:08
Speaker 2
Then overview. So there's.

00:03:18:08 - 00:03:19:22
Speaker 1
Only one piece of setup you need.

00:03:19:22 - 00:03:20:11
Speaker 2
Here and.

00:03:20:11 - 00:03:22:24
Speaker 1
It's we need to put that piece of tape on the wall.

00:03:23:11 - 00:03:25:11
Speaker 2
The reason we do this is when you're marching.

00:03:25:11 - 00:03:27:09
Speaker 1
We need to know how high to.

00:03:27:09 - 00:03:28:05
Speaker 2
Lift your legs.

00:03:28:05 - 00:03:31:09
Speaker 1
During the march. So this is a standardized test.

00:03:31:09 - 00:03:32:13
Speaker 2
This has been determined in.

00:03:32:13 - 00:03:33:13
Speaker 1
The clinic so that it's the.

00:03:33:13 - 00:03:34:09
Speaker 2
Same for everyone.

00:03:34:09 - 00:03:35:04
Speaker 1
So we know.

00:03:35:17 - 00:03:36:21
Speaker 2
That we're getting accurate results.

00:03:36:21 - 00:03:39:03
Speaker 1
So to do this, what I want you to do is stand.

00:03:39:03 - 00:03:42:14
Speaker 2
In front of either the wall or the area that you're going to be.

00:03:42:14 - 00:03:49:08
Speaker 1
Doing this test. And I want you to look at the height that's about midway down your side.

00:03:50:08 - 00:03:51:09
Speaker 2
So if I were to, like.

00:03:51:11 - 00:03:53:22
Speaker 1
Put my finger in the middle of halfway.

00:03:53:22 - 00:03:54:06
Speaker 2
Down your.

00:03:54:06 - 00:03:57:03
Speaker 1
Thigh at that height, I want you to put a.

00:03:57:03 - 00:03:58:17
Speaker 2
Sticker on the wall or a piece of.

00:03:58:17 - 00:04:17:22
Speaker 1
Tape on the wall or Post-it note. So we see that one more time. So take the height midway down your thigh and then put a tape piece on the wall at that height. And then once you have that done, we'll.

00:04:17:22 - 00:04:19:02
Speaker 2
Move on to our goal review.

00:04:20:20 - 00:04:21:09
Speaker 1
So this.

00:04:21:09 - 00:04:21:23
Speaker 2
Is a marching.

00:04:21:24 - 00:04:23:19
Speaker 1
Test. You'll be.

00:04:23:19 - 00:04:24:06
Speaker 2
Marching.

00:04:24:06 - 00:04:29:16
Speaker 1
In place or you will be moving and you'll be lifting your leg to the height of the tape that you put on the wall.

00:04:30:09 - 00:04:32:00
Speaker 2
Will start with a seated rest.

00:04:32:00 - 00:04:33:23
Speaker 1
For 2 minutes just to get a sense of what your.

00:04:33:23 - 00:04:34:20
Speaker 2
Resting heart rate.

00:04:34:20 - 00:04:38:19
Speaker 1
Is, then I'll have you stand up. Kind of get ready.

00:04:38:24 - 00:04:40:01
Speaker 2
Will make sure that your.

00:04:41:09 - 00:04:41:20
Speaker 1
Your.

00:04:41:20 - 00:04:43:05
Speaker 2
Rate of perceived exertion.

00:04:43:05 - 00:04:44:01
Speaker 1
And that smiley face.

00:04:44:01 - 00:04:45:06
Speaker 2
Scale are a viewing.

00:04:45:06 - 00:04:46:03
Speaker 1
Distance and.

00:04:46:03 - 00:04:49:20
Speaker 2
That you're placed to record. You can also just record easily.

00:04:49:20 - 00:04:50:17
Speaker 1
Without having to walk.

00:04:50:17 - 00:04:52:02
Speaker 2
Somewhere else and do it or bend.

00:04:52:02 - 00:04:52:13
Speaker 1
Over.

00:04:53:13 - 00:04:55:14
Speaker 2
So you either need it to be right there or you can just.

00:04:55:22 - 00:04:56:03
Speaker 1
Put.

00:04:56:03 - 00:04:56:16
Speaker 2
Your arm down.

00:04:56:16 - 00:04:57:01
Speaker 1
And write the.

00:04:57:01 - 00:04:59:10
Speaker 2
Number or have someone record it for you.

00:04:59:17 - 00:05:02:16
Speaker 1
When I don't want you to do is to stop marching and have to go somewhere.

00:05:02:17 - 00:05:03:05
Speaker 2
Or bend.

00:05:03:05 - 00:05:05:22
Speaker 1
Over to have to do it, because that's going to disrupt our results.

00:05:07:08 - 00:05:08:10
Speaker 2
So you'll march.

00:05:09:00 - 00:05:19:20
Speaker 1
Anywhere up to 20 minutes, just depending on when you end up needing to stop the test. Yeah. And then we'll have a metronome on your phone. So you'll go to the beat of the metronome and it will steadily.

00:05:19:20 - 00:05:21:06
Speaker 2
Increase throughout.

00:05:21:06 - 00:05:23:01
Speaker 1
The test. So again.

00:05:23:01 - 00:05:24:21
Speaker 2
We'll get your two minute resting heart rate.

00:05:24:21 - 00:05:25:22
Speaker 1
We'll have you stand up.

00:05:25:22 - 00:05:28:16
Speaker 2
Get everything ready. We'll take your heart rate one more time.

00:05:28:16 - 00:05:30:24
Speaker 1
And we'll take what your symptoms are On a scale.

00:05:30:24 - 00:05:31:11
Speaker 2
Of zero to.

00:05:31:11 - 00:05:35:19
Speaker 1
Ten and then we'll begin the marching test. And each minute will take.

00:05:35:19 - 00:05:39:05
Speaker 2
Your heart rate, your rate of perceived exertion, and your 0 to 10.

00:05:39:05 - 00:05:42:23
Speaker 1
On that smiley face skill with the pace getting faster and faster.

00:05:42:23 - 00:05:45:24
Speaker 2
Each time.

00:05:45:24 - 00:05:47:01
Speaker 1
So I want to talk a little.

00:05:47:01 - 00:05:47:10
Speaker 2
Bit more.

00:05:47:10 - 00:05:48:11
Speaker 1
About these handouts just to.

00:05:48:11 - 00:05:49:14
Speaker 2
Make sure everyone's.

00:05:49:14 - 00:06:00:11
Speaker 1
Feeling comfortable. So you have your visual analog scale is the fancy name, but I'm going to call it the smiley face scale so that we all know what we're talking about. So what's that, 0 to 10?

00:06:00:18 - 00:06:02:11
Speaker 2
How would you rate your symptoms?

00:06:03:00 - 00:06:03:14
Speaker 1
So this will.

00:06:03:14 - 00:06:04:15
Speaker 2
Be very important.

00:06:04:15 - 00:06:09:15
Speaker 1
So you want to make sure you have this in front of you. And then the second thing you'll be reading.

00:06:09:15 - 00:06:11:10
Speaker 2
Is your rate of perceived exertion.

00:06:11:10 - 00:06:19:15
Speaker 1
And all that means is like, how hard does this feel for you? So you can see it's a scale from 6 to 20 with six being like zero.

00:06:19:15 - 00:06:20:12
Speaker 2
This is super.

00:06:20:12 - 00:06:29:21
Speaker 1
Easy and ten being like, I'm at my Mac or 20 being at your marks. So you'll rate those each time when the test stops is.

00:06:30:01 - 00:06:31:02
Speaker 2
Different for everyone.

00:06:31:02 - 00:06:31:24
Speaker 1
So it'll start for.

00:06:31:24 - 00:06:34:12
Speaker 2
You when your symptoms increase more than three.

00:06:34:12 - 00:06:37:07
Speaker 1
Points from your baseline. So we'll.

00:06:37:07 - 00:06:41:01
Speaker 2
Say, What's your symptoms on 0 to 10 before we get started and then we'll start marching.

00:06:41:01 - 00:06:42:09
Speaker 1
In. If at any point.

00:06:42:19 - 00:06:43:10
Speaker 2
You're.

00:06:43:20 - 00:06:46:23
Speaker 1
Symptom score on the smiley face, scale goes.

00:06:47:05 - 00:06:48:00
Speaker 2
Three points.

00:06:48:00 - 00:06:48:18
Speaker 1
Above.

00:06:48:18 - 00:06:49:17
Speaker 2
Where you started.

00:06:50:01 - 00:06:51:13
Speaker 1
You'll stop. So if.

00:06:51:13 - 00:06:52:01
Speaker 2
You were at.

00:06:52:01 - 00:06:57:12
Speaker 1
A two out of ten when you started, you'll stop when you get to a six because that's when it gets above three.

00:06:58:03 - 00:07:00:14
Speaker 2
Let's say you were at a four out of ten.

00:07:00:16 - 00:07:06:02
Speaker 1
You'll stop when you get to an eight because that's above three. You'll also stop.

00:07:06:02 - 00:07:08:01
Speaker 2
If your rate of perceived exertion.

00:07:08:01 - 00:07:13:17
Speaker 1
How hard does this feel? Goes above 17 now in the clinic we use 18 or 19, but since we're at.

00:07:13:17 - 00:07:14:04
Speaker 2
Home.

00:07:14:04 - 00:07:15:08
Speaker 1
I just want to be a little bit more.

00:07:15:08 - 00:07:18:00
Speaker 2
Conservative and make sure you're safe. 2017.

00:07:19:08 - 00:07:22:24
Speaker 1
And then the last way of you'll stop is if.

00:07:22:24 - 00:07:25:22
Speaker 2
You reach 90% of your age predicted.

00:07:25:22 - 00:07:28:24
Speaker 1
Max, without increasing symptoms. So that's.

00:07:28:24 - 00:07:30:09
Speaker 2
The number that you recorded at the.

00:07:30:09 - 00:07:32:11
Speaker 1
Top of the sheet. And that to 20.

00:07:32:11 - 00:07:33:07
Speaker 2
Nine is your age.

00:07:33:12 - 00:07:38:04
Speaker 1
Times point nine. And then last, if you don't feel safe at any point.

00:07:38:04 - 00:07:38:22
Speaker 2
Or you feel.

00:07:38:22 - 00:07:39:12
Speaker 1
Faint.

00:07:39:12 - 00:07:41:02
Speaker 2
Or for whatever reason you don't.

00:07:41:02 - 00:07:49:08
Speaker 1
Want to continue, you do not have to. You can stop at any time you like. Okay. And I'll remind you of these stopping points.

00:07:49:08 - 00:07:49:19
Speaker 2
Regularly.

00:07:49:19 - 00:07:50:07
Speaker 1
As we go.

00:07:52:01 - 00:07:52:23
Speaker 2
Now everyone will.

00:07:52:23 - 00:07:54:13
Speaker 1
Stop at different times.

00:07:54:13 - 00:07:55:14
Speaker 2
So whenever your.

00:07:55:14 - 00:07:56:16
Speaker 1
Stopping point is.

00:07:56:16 - 00:07:57:12
Speaker 2
Afterwards, you're going to.

00:07:57:12 - 00:07:59:19
Speaker 1
Begin a cooldown. So to.

00:07:59:19 - 00:08:03:12
Speaker 2
Do a cooldown, you're going to do a really slow, easy march, so slow.

00:08:03:12 - 00:08:04:11
Speaker 1
It way down.

00:08:04:23 - 00:08:05:14
Speaker 2
Or you're just going.

00:08:05:14 - 00:08:12:06
Speaker 1
To stand for a couple of minutes. If you feel like that feels like too much, you can go ahead and take a seat and just have some.

00:08:12:06 - 00:08:12:18
Speaker 2
Water.

00:08:12:24 - 00:08:13:13
Speaker 1
Rest.

00:08:14:04 - 00:08:15:06
Speaker 2
But if you're able to do the.

00:08:15:06 - 00:08:16:20
Speaker 1
Cooldown after the cooldown, you'll sit.

00:08:16:20 - 00:08:19:20
Speaker 2
In the chair, grab some water, and then wait for everyone else.

00:08:19:20 - 00:08:26:16
Speaker 1
To finish and we'll get the results. So let's go ahead and establish.

00:08:26:16 - 00:08:28:09
Speaker 2
Your resting heart rate.

00:08:29:07 - 00:08:34:00
Speaker 1
So remember, at this point, I want you to have the metronome app up.

00:08:34:00 - 00:08:34:11
Speaker 2
And ready.

00:08:34:11 - 00:08:35:00
Speaker 1
To go.

00:08:35:00 - 00:08:36:16
Speaker 2
Your heart rate monitor is on.

00:08:36:16 - 00:08:37:07
Speaker 1
You can see the.

00:08:37:07 - 00:08:39:10
Speaker 2
Score and you have your tape on the.

00:08:39:10 - 00:08:39:23
Speaker 1
Wall and you.

00:08:39:23 - 00:08:42:13
Speaker 2
Have your papers where you can record easily.

00:08:42:13 - 00:08:46:14
Speaker 1
Okay. So once you have all that in place, I want you to sit in a chair.

00:08:46:22 - 00:08:47:13
Speaker 2
And we're just going.

00:08:47:13 - 00:08:48:24
Speaker 1
To sit quietly for 2 minutes.

00:08:49:11 - 00:08:52:06
Speaker 2
And then after 2 minutes, we're going to take your heart rate.

00:08:52:06 - 00:08:54:02
Speaker 1
So when you.

00:08:54:02 - 00:08:55:11
Speaker 2
Are ready.

00:08:55:11 - 00:10:00:17
Speaker 1
Go and sit on down. And 2 minutes is on the clock. Now we have about one more minute.

00:10:00:17 - 00:10:01:09
Speaker 2
Just rest.

00:10:01:09 - 00:10:02:06
Speaker 1
Easy.

00:10:02:06 - 00:11:02:13
Speaker 2
In your chair.

00:11:02:13 - 00:11:05:21
Speaker 1
Okay? That's 2 minutes. So go ahead and.

00:11:05:21 - 00:11:22:21
Speaker 2
Record your heart rate here. You're going to record it in the row that says rest and under each hour for heart rate, you're going to record your resting heart rate there. When you're ready, you're going.

00:11:22:21 - 00:11:24:08
Speaker 1
To stand up and get.

00:11:24:08 - 00:11:25:02
Speaker 2
In your march.

00:11:25:02 - 00:11:27:09
Speaker 1
Position again, make.

00:11:27:09 - 00:11:27:18
Speaker 2
Sure.

00:11:27:18 - 00:11:29:07
Speaker 1
That the handouts.

00:11:29:07 - 00:11:30:00
Speaker 2
Are really.

00:11:30:00 - 00:11:30:23
Speaker 1
Available, and.

00:11:30:23 - 00:11:32:04
Speaker 2
Then you're going to set.

00:11:32:04 - 00:11:42:17
Speaker 1
Your metronome to 70, 70 beats per minute and click start. So your metronome should be beating at 70.

00:11:42:17 - 00:11:46:19
Speaker 2
Beats per minute. You're still.

00:11:46:19 - 00:11:51:12
Speaker 1
Standing still. Once that is done.

00:11:51:15 - 00:11:51:24
Speaker 2
And you're.

00:11:51:24 - 00:11:52:24
Speaker 1
Still standing still.

00:11:52:24 - 00:12:02:13
Speaker 2
Record your heart rate per row zero Siri and record your heart rate. And you're also going to record your zero to.

00:12:02:13 - 00:12:06:08
Speaker 1
Ten smiley face scale under the column that says VA scale.

00:12:07:02 - 00:12:17:00
Speaker 2
So you're going to write 0 to 10 what your symptoms are right now.

00:12:17:00 - 00:12:17:14
Speaker 1
Beautiful.

00:12:18:10 - 00:12:19:23
Speaker 2
And when you're ready.

00:12:19:23 - 00:12:27:09
Speaker 1
I'm going to go ahead and hit start. So if you need another minute, pause me. But if not, we're going to go ahead and get started. So your metronome is going go and start.

00:12:27:09 - 00:12:28:02
Speaker 2
Marching.

00:12:28:02 - 00:13:30:00
Speaker 1
Now. Okay. We're at one minute. Go ahead and.

00:13:30:00 - 00:13:31:00
Speaker 2
Increase your.

00:13:31:00 - 00:13:38:01
Speaker 1
Metronome tempo by ten beats per minute sort of go from 70 to 80. And then your.

00:13:38:01 - 00:13:43:18
Speaker 2
Record, your heart rate, your perceived rate of exertion.

00:13:44:15 - 00:13:45:18
Speaker 1
And your symptoms.

00:13:45:18 - 00:13:47:07
Speaker 2
Severity. So that 0 to 10.

00:13:47:08 - 00:13:54:05
Speaker 1
Smiley face scale. Remember, you're continuing.

00:13:54:05 - 00:13:55:05
Speaker 2
Marching this entire.

00:13:55:05 - 00:13:56:09
Speaker 1
Time. We're not pausing.

00:14:00:08 - 00:14:00:19
Speaker 2
And you're going to.

00:14:00:19 - 00:14:29:00
Speaker 1
March to the height of the tape on the wall at the pace of the metronome.

00:14:29:00 - 00:14:30:12
Speaker 2
Okay, we're at 2 minutes.

00:14:30:12 - 00:14:31:16
Speaker 1
Good. And continue marching.

00:14:31:16 - 00:14:32:10
Speaker 2
And increase.

00:14:32:12 - 00:14:36:10
Speaker 1
The tempo on the metronome by another ten beats.

00:14:36:10 - 00:14:36:20
Speaker 2
Now we're at.

00:14:36:20 - 00:14:37:08
Speaker 1
90.

00:14:38:01 - 00:14:42:19
Speaker 2
And then you'll record your heart rate, your rate of perceived exertion and your.

00:14:42:19 - 00:14:44:01
Speaker 1
Symptoms On a scale.

00:14:44:01 - 00:14:49:17
Speaker 2
Of 0 to 10, if you've reached.

00:14:49:17 - 00:14:50:20
Speaker 1
Any of the stopping points.

00:14:50:20 - 00:14:53:01
Speaker 2
Of your symptoms increasing by more than three.

00:14:53:01 - 00:14:55:03
Speaker 1
Points.

00:14:55:03 - 00:14:57:06
Speaker 2
Your rate of perceived exertion being.

00:14:57:06 - 00:14:58:11
Speaker 1
More than 17.

00:14:58:24 - 00:15:02:07
Speaker 2
Or probably too soon, that reached your 90% heart rate max.

00:15:02:07 - 00:15:33:03
Speaker 1
You would stop and begin your cooldown. If not, continue going. Okay, we're now at 3 minutes. Go ahead and increase the tempo of the metronome by.

00:15:33:03 - 00:15:33:15
Speaker 2
Another.

00:15:33:15 - 00:15:37:06
Speaker 1
Ten beats per minute and then you rate.

00:15:37:11 - 00:15:41:10
Speaker 2
Or record your heart rate, rate your perceived exertion.

00:15:41:21 - 00:15:42:07
Speaker 1
And that.

00:15:42:07 - 00:15:42:21
Speaker 2
Zero to.

00:15:42:21 - 00:15:43:04
Speaker 1
Ten.

00:15:43:04 - 00:15:44:11
Speaker 2
Scale where your symptoms.

00:15:44:11 - 00:16:28:23
Speaker 1
Are at.

00:16:28:23 - 00:16:30:07
Speaker 2
Hey, we're at 4 minutes.

00:16:30:07 - 00:16:30:18
Speaker 1
Go ahead.

00:16:30:18 - 00:16:31:08
Speaker 2
Increase your.

00:16:31:08 - 00:16:33:15
Speaker 1
Tempo by another ten beats per minute.

00:16:34:07 - 00:16:37:11
Speaker 2
And record your heart rate, your rate of perceived exertion.

00:16:38:03 - 00:16:44:22
Speaker 1
And your symptoms on that 0 to 10 smiley face scale if you've hit any of the stopping points.

00:16:44:22 - 00:16:46:20
Speaker 2
So your symptoms are more than three.

00:16:46:20 - 00:16:47:12
Speaker 1
Points.

00:16:47:24 - 00:16:49:23
Speaker 2
Above where they were at baseline.

00:16:50:22 - 00:16:52:17
Speaker 1
You've hit above a 17.

00:16:52:17 - 00:17:00:24
Speaker 2
On your rate of perceived exertion or you've hit your 90% heart rate. Max. You can stop your test here and begin your cooldown.

00:17:02:01 - 00:17:02:24
Speaker 1
If not, continue.

00:17:02:24 - 00:17:29:13
Speaker 2
Marching more at.

00:17:29:13 - 00:17:34:03
Speaker 1
5 minutes. Go ahead. Increase the tempo of your metronome up by ten beats per minute.

00:17:35:06 - 00:17:39:18
Speaker 2
And then record your heart rate rate of perceived exertion and your symptoms.

00:17:39:18 - 00:17:50:13
Speaker 1
On the 0 to 10 scale. If you hit any of the stopping points, go ahead and begin any cooldown. So slow pace for a couple.

00:17:50:13 - 00:17:51:14
Speaker 2
Minutes or simply.

00:17:51:14 - 00:18:29:07
Speaker 1
Standing. If you're still go up, keep going.

00:18:29:07 - 00:18:30:20
Speaker 2
Well, regrets 6 minutes.

00:18:30:20 - 00:18:34:08
Speaker 1
Go ahead and increase the tempo by ten beats per minute.

00:18:35:07 - 00:18:36:07
Speaker 2
And record.

00:18:36:11 - 00:18:38:01
Speaker 1
Your heart rate.

00:18:38:19 - 00:18:40:16
Speaker 2
Rate of perceived exertion and your.

00:18:40:16 - 00:18:47:19
Speaker 1
Symptoms on the 0 to 10 scale if you've hit any of the stopping points.

00:18:47:19 - 00:18:49:17
Speaker 2
So three.

00:18:50:17 - 00:18:51:03
Speaker 1
Above.

00:18:51:03 - 00:18:53:02
Speaker 2
Three points from your baseline.

00:18:53:02 - 00:18:54:21
Speaker 1
Symptoms.

00:18:54:21 - 00:19:00:14
Speaker 2
17 or more on your rate of perceived exertion or 90% of your heart rate max number we wrote.

00:19:00:14 - 00:19:03:08
Speaker 1
And calculated at the top, you would stop.

00:19:03:08 - 00:19:04:10
Speaker 2
And begin your cooldown.

00:19:05:06 - 00:19:34:07
Speaker 1
If not, continue marching at the metronome pace. Can't be reached 7 minutes. Go ahead and increase your metronome by ten beats per.

00:19:34:07 - 00:19:41:19
Speaker 2
Minute and then record your heart rate, your rate of perceived exertion, and your zero to.

00:19:41:19 - 00:19:47:14
Speaker 1
Ten smiley face symptom scale.

00:19:47:14 - 00:19:48:18
Speaker 2
If you've reached a stopping.

00:19:48:18 - 00:19:49:03
Speaker 1
Point.

00:19:49:03 - 00:19:49:14
Speaker 2
Begin your.

00:19:49:14 - 00:19:56:11
Speaker 1
Cooldown. Or if you don't feel up to it, you can simply sit or lie down, have some water.

00:19:56:11 - 00:19:57:18
Speaker 2
If you haven't reached your stopping.

00:19:57:18 - 00:19:58:23
Speaker 1
Points, continue on.

00:20:00:05 - 00:20:01:06
Speaker 2
In. Remember, we're marching.

00:20:01:06 - 00:20:32:00
Speaker 1
This entire time. We are at 8 minutes. Go ahead and increase.

00:20:32:00 - 00:20:32:04
Speaker 2
Your.

00:20:32:04 - 00:20:34:01
Speaker 1
Tempo by ten beats per minute.

00:20:35:03 - 00:20:38:13
Speaker 2
And then record your heart rate rate of perceived exertion.

00:20:39:06 - 00:21:31:03
Speaker 1
And symptoms on the 0 to 10 smiley face scale. Okay, you're at 9 minutes, so go ahead and.

00:21:31:03 - 00:21:31:14
Speaker 2
Increase.

00:21:31:14 - 00:21:32:04
Speaker 1
The tempo.

00:21:32:04 - 00:21:33:00
Speaker 2
By another ten.

00:21:33:00 - 00:21:33:21
Speaker 1
Beats per minute.

00:21:34:10 - 00:21:43:15
Speaker 2
And record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale. Remember, your.

00:21:43:15 - 00:21:44:02
Speaker 1
Stopping.

00:21:44:02 - 00:21:47:03
Speaker 2
Points are if your symptoms increase more than three points from.

00:21:47:03 - 00:21:49:08
Speaker 1
Your baseline. On that ten point scale.

00:21:50:00 - 00:21:51:18
Speaker 2
Your rate of perceived exertion.

00:21:51:20 - 00:21:53:08
Speaker 1
Goes above 17.

00:21:54:00 - 00:21:56:01
Speaker 2
Or you hit your 90% of your heart rate.

00:21:56:01 - 00:22:07:01
Speaker 1
Max. If you hit any of those, you can begin your cooldown, not we'll continue on. We're almost halfway.

00:22:07:01 - 00:22:29:08
Speaker 2
Through. All right.

00:22:29:11 - 00:22:33:14
Speaker 1
At 10 minutes, go ahead and increase your tempo by ten beats per minute.

00:22:34:19 - 00:22:38:01
Speaker 2
Record your heart rate, your rate of perceived exertion.

00:22:38:23 - 00:22:47:04
Speaker 1
And your symptoms on a 0 to 10 scale. You know, halfway through the test, about ten more minutes to go.

00:22:49:07 - 00:23:28:23
Speaker 1
Again, if you hit any of your stopping points, that's when you stop will be a little different for everyone.

00:23:28:23 - 00:23:29:14
Speaker 2
Okay. Right.

00:23:29:14 - 00:23:30:09
Speaker 1
11 minutes.

00:23:30:11 - 00:23:30:22
Speaker 2
Go ahead and.

00:23:30:22 - 00:23:33:12
Speaker 1
Increase your tempo by another ten beats per minute.

00:23:34:16 - 00:23:37:23
Speaker 2
Record your heart rate, your rate of perceived exertion.

00:23:38:14 - 00:23:46:24
Speaker 1
And your symptoms on a 0 to 10 scale smiley face, scale. If you've hit your starting points.

00:23:46:24 - 00:23:48:03
Speaker 2
Begin your cooldown.

00:23:48:15 - 00:23:50:10
Speaker 1
Or if you don't feel up to the cooldown, you can always sit.

00:23:50:10 - 00:23:50:17
Speaker 2
Or lie.

00:23:50:17 - 00:23:51:09
Speaker 1
Down, have some.

00:23:51:09 - 00:23:54:00
Speaker 2
Water, recover.

00:23:54:00 - 00:24:00:08
Speaker 1
You have not hit stopping points, continue on. And again, if at any point.

00:24:00:08 - 00:24:01:08
Speaker 2
For whatever reason you want.

00:24:01:08 - 00:24:28:21
Speaker 1
To stop again, you know, you know when you have to do anything, hey.

00:24:29:05 - 00:24:29:20
Speaker 2
We're at 12.

00:24:29:20 - 00:24:33:18
Speaker 1
Minutes. Go ahead. Increase the tempo again by another ten beats per minute.

00:24:34:15 - 00:24:39:15
Speaker 2
And then record your heart rate, your rate of perceived exertion and your symptoms on a 0 to 10.

00:24:39:15 - 00:24:53:19
Speaker 1
Scale is usually when people go quiet in the clinic because it's getting a.

00:24:53:19 - 00:25:30:22
Speaker 2
Little harder. Okay, we're at 13 minutes.

00:25:30:22 - 00:25:34:00
Speaker 1
Go ahead and increase the tempo, another ten beats per minute.

00:25:34:19 - 00:25:39:21
Speaker 2
And then record your heart rate, your rate of perceived exertion and your zero to.

00:25:39:21 - 00:26:29:10
Speaker 1
Ten symptom score. If you are at any of the stopping points, begin your cooldown. If not, keep going.

00:26:29:10 - 00:26:31:03
Speaker 2
Okay, we're at 14 minutes.

00:26:31:03 - 00:26:31:12
Speaker 1
Go out and.

00:26:31:12 - 00:26:31:24
Speaker 2
Increase.

00:26:31:24 - 00:26:34:04
Speaker 1
The tempo ten beats per minute.

00:26:35:05 - 00:26:42:20
Speaker 2
And record your heart rate rate of perceived exertion and where your symptoms are on about zero to.

00:26:42:20 - 00:26:46:06
Speaker 1
Ten smiley face scale.

00:26:46:06 - 00:26:46:18
Speaker 2
You are.

00:26:46:18 - 00:26:49:00
Speaker 1
Stopping if you hit above.

00:26:49:00 - 00:26:49:09
Speaker 2
Three.

00:26:49:09 - 00:26:50:17
Speaker 1
Points on the.

00:26:50:22 - 00:26:51:07
Speaker 2
Zero to.

00:26:51:07 - 00:26:52:02
Speaker 1
Ten scale.

00:26:52:02 - 00:26:52:16
Speaker 2
From where your.

00:26:52:16 - 00:26:53:13
Speaker 1
Baseline was.

00:26:55:02 - 00:26:57:18
Speaker 2
Or if you hit a rate of perceived exertion above.

00:26:57:18 - 00:26:58:14
Speaker 1
17.

00:26:59:16 - 00:27:03:18
Speaker 2
Or if you hit your 90% heart rate max. So that number we calculated at the.

00:27:03:18 - 00:27:03:24
Speaker 1
Top.

00:27:06:12 - 00:27:06:21
Speaker 2
Or.

00:27:06:24 - 00:27:08:01
Speaker 1
You don't feel.

00:27:08:01 - 00:27:09:00
Speaker 2
Safe or for any.

00:27:09:00 - 00:27:29:02
Speaker 1
Reason you want to, you can still go on and keep going.

00:27:29:02 - 00:27:29:17
Speaker 2
Okay, we're.

00:27:29:17 - 00:27:32:09
Speaker 1
At 15 minutes. There's only 5 minutes left. Go ahead.

00:27:32:10 - 00:27:33:15
Speaker 2
Increase your.

00:27:33:15 - 00:27:35:10
Speaker 1
Tempo at ten beats per minute.

00:27:36:09 - 00:27:39:23
Speaker 2
And then record your heart rate, your rate of perceived exertion.

00:27:40:13 - 00:28:29:00
Speaker 1
And your symptoms on that 0 to 10 scale. If you hit a stopping point, begin your cooldown, if not continual.

00:28:29:00 - 00:28:30:14
Speaker 2
Okay, we're at 16 minutes.

00:28:30:14 - 00:28:33:10
Speaker 1
Go ahead and increase the tempo. Another ten beats per minute.

00:28:34:11 - 00:28:37:20
Speaker 2
Record, the heart rate rate of perceived exertion.

00:28:38:15 - 00:28:40:06
Speaker 1
And symptoms on a scale.

00:28:40:06 - 00:28:40:17
Speaker 2
Of zero to.

00:28:40:17 - 00:29:34:21
Speaker 1
Ten, if you've hit any stopping points, begin your cooldown. If not, go and keep going. All right. We're at 17 minutes. 3 minutes to go. Increase your tempo by ten beats per minute.

00:29:35:13 - 00:29:39:22
Speaker 2
And then record your heart rate, your rate of perceived exertion and your.

00:29:39:22 - 00:29:52:02
Speaker 1
Symptoms on that 0 to 10 scale. If you've hit any stopping points, begin your cooldown. If it feels safe, if you need to sit, you can also sit. If not, continue on.

00:29:53:02 - 00:29:54:04
Speaker 2
There's less than 3 minutes.

00:29:54:04 - 00:29:54:19
Speaker 1
Of the test.

00:30:29:08 - 00:30:29:13
Speaker 2
Rate.

00:30:29:17 - 00:30:33:13
Speaker 1
We're at 18 minutes. Go ahead. Increase the tempo by ten beats per minute.

00:30:34:21 - 00:30:43:22
Speaker 2
Record your heart rate, your rate of perceived exertion and your symptoms on that 0 to 10 scale.

00:30:43:22 - 00:31:29:11
Speaker 1
If any of those are stopping points, begin your cooldown. If not, we have less than 2 minutes to go.

00:31:29:11 - 00:31:30:06
Speaker 2
Hey, we're at.

00:31:30:06 - 00:31:32:04
Speaker 1
19 increase ten.

00:31:32:04 - 00:31:33:21
Speaker 2
Beats per minute. So your last.

00:31:33:21 - 00:31:34:05
Speaker 1
One.

00:31:34:23 - 00:31:38:11
Speaker 2
Record, your heart rate rate of perceived exertion.

00:31:39:01 - 00:31:40:03
Speaker 1
And symptoms.

00:31:40:03 - 00:31:40:17
Speaker 2
On a zero to.

00:31:40:17 - 00:32:31:12
Speaker 1
Ten scale. If it's your stopping point, begin your cooldown, if not continuously for the last minute. Here. All right. That's 20 minutes. Go ahead and.

00:32:31:12 - 00:32:35:22
Speaker 2
Record your final heart rate. Your final rate of perceived exertion.

00:32:36:06 - 00:32:37:22
Speaker 1
And your final symptoms on that.

00:32:37:22 - 00:32:38:07
Speaker 2
Zero to.

00:32:38:07 - 00:32:42:13
Speaker 1
Ten scale. And then if you feel up to it, I'm going to start.

00:32:42:13 - 00:32:42:22
Speaker 2
The clock.

00:32:42:22 - 00:32:46:03
Speaker 1
For a two minute cooldown. So just March slow.

00:32:47:17 - 00:32:48:01
Speaker 2
Or.

00:32:48:01 - 00:32:52:08
Speaker 1
Standing feels okay. You can do that. If neither of those feel okay.

00:32:52:08 - 00:32:52:19
Speaker 2
Feel free.

00:32:52:19 - 00:32:53:19
Speaker 1
To sit down and have some.

00:32:53:19 - 00:32:55:23
Speaker 2
Water. But for those who are able.

00:32:55:23 - 00:33:02:15
Speaker 1
To do it, cool down for 2 minutes. It can help with some delayed symptoms if you.

00:33:02:22 - 00:33:03:20
Speaker 2
Are in that camp.

00:33:03:20 - 00:33:05:22
Speaker 1
So you're nice to.

00:33:05:22 - 00:33:06:22
Speaker 2
Help ramp your nervous.

00:33:06:22 - 00:33:27:10
Speaker 1
System down nice and easy.

00:33:27:10 - 00:34:36:15
Speaker 2
You've already stopped in your resting. Just hang out for another minute or so and then we're going to go through the results. One more minute of a cooldown. A few more seconds here.

00:34:37:20 - 00:34:39:11
Speaker 1
Slowed it down a little.

00:34:39:11 - 00:34:40:01
Speaker 2
More.

00:34:42:20 - 00:34:45:00
Speaker 1
And go ahead and stop here.

00:34:45:01 - 00:34:46:11
Speaker 2
Grab some water.

00:34:46:11 - 00:34:52:12
Speaker 1
Take a seat, go and just rest in a.

00:34:52:12 - 00:35:08:15
Speaker 2
Chair and recover as long as you need. If you'd like more recovery time, just pause me here until you're ready. If you are ready, let's.

00:35:08:15 - 00:35:14:09
Speaker 1
Get into results. So the Buffalo concussion test results here.

00:35:14:20 - 00:35:18:22
Speaker 2
So if you were able to reach 90% of your personal heart rate, Max.

00:35:18:22 - 00:35:25:12
Speaker 1
Without increasing symptoms, that is considered physiologic recovery, meaning the blood flow.

00:35:25:12 - 00:35:26:03
Speaker 2
To your brain.

00:35:26:03 - 00:35:27:01
Speaker 1
Is being controlled.

00:35:27:01 - 00:35:28:10
Speaker 2
And regulated properly.

00:35:29:08 - 00:35:37:03
Speaker 1
And this part of the concussion has recovered, which is great. If you stopped the exercise due to symptom.

00:35:37:03 - 00:35:40:15
Speaker 2
Increase of more than three points from where you started or.

00:35:40:15 - 00:35:44:05
Speaker 1
From 17 RPE, this is 19, but we use 17 to be a little.

00:35:44:05 - 00:35:45:00
Speaker 2
More conservative.

00:35:45:12 - 00:35:54:09
Speaker 1
That makes you a great candidate for the sub symptom threshold exercise program. So if you stopped due to one of the stopping points.

00:35:54:09 - 00:36:00:15
Speaker 2
You're going to click exercise intolerance. If you were able to complete 90% of your heart rate.

00:36:00:15 - 00:36:03:08
Speaker 1
Max, then you can click.

00:36:03:08 - 00:36:04:12
Speaker 2
Physiologic recovery.

00:36:06:06 - 00:36:11:06
Speaker 1
So what does that mean? It looks like.

00:36:11:06 - 00:36:17:03
Speaker 2
This has the wrong recording page here. So we want you to record your ending heart rate. So after this page is going to be one more.

00:36:17:03 - 00:36:19:07
Speaker 1
Page after this that says.

00:36:19:14 - 00:36:20:04
Speaker 2
Heart rate at.

00:36:20:04 - 00:36:20:15
Speaker 1
Symptom.

00:36:20:15 - 00:36:26:07
Speaker 2
Exacerbation and whatever level you stopped, whichever one was the last one that you recorded before you hit.

00:36:26:07 - 00:36:27:05
Speaker 1
A stopping point, I.

00:36:27:05 - 00:36:29:15
Speaker 2
Want you to record that heart rate.

00:36:30:08 - 00:36:41:01
Speaker 1
On the next page. So this is page 26. So you're recorded on page 27. You're going to see a box for that.

00:36:41:01 - 00:36:47:12
Speaker 2
That will be very important for when we prescribe your exercise program.

00:36:47:12 - 00:36:50:01
Speaker 1
Okay. So let's talk final results. So for those of you.

00:36:50:01 - 00:36:51:05
Speaker 2
Under three months.

00:36:51:05 - 00:36:53:01
Speaker 1
Go ahead and listen up. If you clicked.

00:36:53:01 - 00:36:54:09
Speaker 2
The exercise intolerance.

00:36:54:09 - 00:36:57:04
Speaker 1
Box, you will be doing the sub symptom threshold.

00:36:57:04 - 00:36:58:07
Speaker 2
Exercise program.

00:36:59:04 - 00:37:01:18
Speaker 1
If you passed this test but are not.

00:37:01:18 - 00:37:03:21
Speaker 2
Exercising aerobics for 150.

00:37:03:21 - 00:37:04:24
Speaker 1
Minutes a week.

00:37:04:24 - 00:37:06:18
Speaker 2
You're going to do the reconditioning program.

00:37:07:18 - 00:37:09:16
Speaker 1
If you passed this test and you're.

00:37:09:16 - 00:37:11:10
Speaker 2
Exercising aerobics for 100.

00:37:11:10 - 00:37:11:19
Speaker 1
And 50.

00:37:11:19 - 00:37:13:17
Speaker 2
Minutes per week, you're still experiencing.

00:37:13:17 - 00:37:17:21
Speaker 1
Symptoms. That's let's it lets us know it's from the other domains like your.

00:37:17:21 - 00:37:19:04
Speaker 2
Neck, your vision, your.

00:37:19:04 - 00:37:20:18
Speaker 1
Vestibular system, etc..

00:37:21:04 - 00:37:21:20
Speaker 2
So for you.

00:37:21:20 - 00:37:22:07
Speaker 1
You'll go ahead and.

00:37:22:07 - 00:37:23:01
Speaker 2
Skip the rest.

00:37:23:01 - 00:37:24:24
Speaker 1
Of this module because.

00:37:24:24 - 00:37:25:23
Speaker 2
You're good.

00:37:25:23 - 00:37:28:05
Speaker 1
To go, but you will begin.

00:37:28:13 - 00:37:29:11
Speaker 2
The other symptom.

00:37:29:15 - 00:37:34:23
Speaker 1
Domains. So starting with the neck after this.

00:37:34:23 - 00:37:37:14
Speaker 2
If you are over three months, pretty similar here.

00:37:37:22 - 00:37:46:10
Speaker 1
So if you have exercise intolerance, you'll check this box again. You'll be doing sub symptom threshold exercise. If you have the modifier.

00:37:46:10 - 00:37:47:07
Speaker 2
For Hypermobility.

00:37:47:07 - 00:37:50:22
Speaker 1
You'll also do that one. If, however.

00:37:50:22 - 00:37:51:07
Speaker 2
You.

00:37:51:07 - 00:37:55:08
Speaker 1
Passed this test and you passed the active stand test.

00:37:55:20 - 00:37:56:07
Speaker 2
But you're.

00:37:56:12 - 00:37:57:21
Speaker 1
Conditioned, meaning.

00:37:57:21 - 00:38:04:17
Speaker 2
You're not exercising aerobically more than 100 or 150 minutes or more, then I want you do the reconditioning program.

00:38:05:12 - 00:38:09:09
Speaker 1
If you passed the Buffalo test, you've passed the active stand test.

00:38:09:18 - 00:38:11:04
Speaker 2
And you're able to exercise.

00:38:11:04 - 00:38:17:10
Speaker 1
150 minutes a week. But still experience symptoms. Again, this means we physiologically recover.

00:38:17:10 - 00:38:18:01
Speaker 2
So the nervous.

00:38:18:01 - 00:38:28:06
Speaker 1
System is able to adapt to exercise. We're getting normal blood flow and exercise and it means there's other domains causing the symptoms. So that would be neck vision, vestibular, etc..

00:38:28:17 - 00:38:29:16
Speaker 2
So for you, you can.

00:38:29:16 - 00:38:30:07
Speaker 1
Go ahead and skip.

00:38:30:07 - 00:38:31:16
Speaker 2
The rest of the aerobic.

00:38:31:16 - 00:38:38:16
Speaker 1
Exercise module and go directly into the next one, which is the neck. The only thing I would.

00:38:38:16 - 00:38:39:17
Speaker 2
Say here is if.

00:38:39:17 - 00:38:41:20
Speaker 1
You physiologically.

00:38:41:20 - 00:38:43:18
Speaker 2
Were okay here and you're doing good.

00:38:43:18 - 00:38:49:02
Speaker 1
But you have the modifier, I still want you to do the hypermobility. It'll be a quick little one.

00:38:49:14 - 00:38:50:16
Speaker 2
Just because there are some ways that.

00:38:50:16 - 00:38:51:16
Speaker 1
We can modify to help.

00:38:51:16 - 00:38:54:00
Speaker 2
You improve recovery, including in your neck.

00:38:54:18 - 00:38:55:04
Speaker 1
And also.

00:38:55:04 - 00:38:56:03
Speaker 2
Protect your joints for a.

00:38:56:03 - 00:38:56:16
Speaker 1
Long term.