Graded Cycling Test Combined With the Talk Test Is Responsive in Cardiac Rehabilitation

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To evaluate clinical assessment outcome of cardiac rehabilitation, a simple and reliable submaximal exercise test, not based on heart rate, is warranted. The Talk Test (TT) has been found to correlate well with the ventilatory threshold, and excellent reliability was observed for TT combined with the Graded Cycling Test (GCT-TT) in cardiac patients. The purpose was to investigate responsiveness of GCT-TT in cardiac rehabilitation patients.


Patients (n = 93) referred to 8 weeks of cardiac rehabilitation were included. Pre- and posttests were performed using GCT-TT. Mean test changes in watts (W) were compared with the standard error of measurement (SEM95) for groups and the smallest real difference (SRD) for individuals. Minimal clinically important difference was assessed by comparing patient perceived changes in physical fitness with the test changes.


A statistically significant improvement of GCT-TT was observed; 18.1 ± 21.1 W (mean ± SD) (P < .001). This was close to the previously observed SEM95 of 18.3 W. Thirty-six percent of the patients exceeded SRD (2 test stages). The subgroup with a perceived “major change” improved 28.8 ± 20.7 W compared with the groups reporting “some” (P < .001) and “no or minor” change (P = .002). A change of 30 W (equivalent to 2 stages ≈ 1 metabolic equivalent task [MET]) in the present test protocol is suggested as the minimal clinically important difference.


GCT-TT was responsive to changes of power output for these patients, and these changes were generally in agreement with patient perceived changes in physical fitness.

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