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Original Research ·

Regression Formulas That Predict VO2peak — 125

Pediatric Exercise Science, 2002, 14, 125-134


© 2002 Human Kinetics Publishers, Inc.

Comparing Two Regression Formulas


·
That Predict VO Using the 20-M
2peak
Shuttle Run for Children and Adolescents

Kenneth H. Pitetti, Bo Fernhall, and Steve Figoni

Two regression equations were developed to predict cardiovascular fitness


(CVF) based on the 20-m shuttle run test (20-MST) for nondisabled youth and
for youth with mild mental retardation (MR). The purpose of this study was to
compare the validity of both regression formulas to predict CVF in nondisabled,
healthy youths (ages 8 to 15 yrs; 38 females and 13 males). Participants per-
formed two modified Bruce protocol treadmill (TM) tests and two 20-MSTs
·
on separate days. CVF (VO2peak, ml · kg–1 · min–1) was measured during the TM
tests and computed for the 20-MST using both regression equations. Results
indicate that test-retest correlations for the 20-MST (# of laps; r = 0.89) and
· ·
TM test (VO2peak, ml · kg–1 · min–1; r = 0.86) were high. Predicted VO2peak values
were moderately significant (nondisabled youth: r = 0.55, p < .01; youth with
·
MR: r = 0.66, p < .01) when compared with TM VO2peak. Correlation between
the two regression equations was significant (r = 0.78, p < .01).
·
Cardiovascular fitness as indicated by maximal aerobic power (VO2max) has
been shown to be inversely related to the risk of cardiovascular disease (CVD),
which is the number one killer of American adults today. This highlights the ne-
cessity of using cardiovascular fitness (CVF ) testing to determine a person’s risk
of developing CVD. While overt symptoms of CVD are seldom seen in children, it
is in childhood that genetic, physiologic, and lifestyle factors signify susceptibility
to CVD later in life (14). In a conservative estimate, 40% of children aged 5–8
years have at least one coronary risk factor (9). It is recommended that CVD inter-
ventions begin before the onset of vascular changes in childhood (15, 22). These
findings demonstrate the need for CVF testing of all youth.
Theoretically, V·O2max is determined at the end of an exhaustive treadmill
(TM) or leg cycle ergometer exercise tests by indirect calorimetry/closed-circuit
·
spirometry. However, in the majority of children, the classic VO2max is difficult to
demonstrate (1, 21). Children can be reluctant to exercise to exhaustion due to lack
of motivation and the immature level of their energy system (8, 10). Maximal V·O2
values at the end of an exhaustive TM or leg cycle ergometer test must reach a
plateau in order to reach a true V·O2max (3). If this criteria is not met, the appropriate

K.H. Pitetti is with the Department of Public Health Sciences, College of Health
Professions, Wichita State University, Wichita, KS; B. Fernhall is with the Department of
Exercise Science, Syracuse University, Syracuse, NY; and S. Figoni is with Children’s Mercy
Hospital, Kansas City, MO.
125
126 — Pitetti, Fernhall, and Figoni

term to describe CVF is V·O2peak rather than V·O2max. It is now generally accepted in
a CVF test that a progressively increasing work rate to a point of fatigue produces
· · ·
a VO2peak that closely approximates a VO2max even when a plateau in VO2 is not
evident (24).
Although a TM test to exhaustion using indirect calorimetry/closed circuit
spirometry is the most accurate method for evaluating the CVF in children and
adolescents, the equipment, personnel, and time needed to administer the TM test
is of practical concern. If V·O2peak testing is to be used effectively to determine the
risk for CVD in children, then it should be administered in a school setting, but
currently there are no feasible methods of administering TM testing for large groups.
This has led some researchers to develop inexpensive and practical field tests that
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can be used in a school setting.


Examples of field tests used to predict V·O2peak include the PWC170 cycle er-
gometer test, the 20-m shuttle run (20-MST), step tests (variable- and fixed-height
and pace), and endurance runs (i.e., 1-mile, 6-min, or 12-min run/walk). Of these,
the 20-MST has received the most attention due to its practical advantages. The
20-MST can be administered in a standard gymnasium or school yard, adminis-
tered to 2–8 children at the same time, does not require a great deal of equipment
or tester experience, and is thought to be less dependent of the child’s emotions
and motivation (4, 5, 11, 12, 17, 18, 23).
While the 20-MST has been used by researchers to test various age groups,
there are still issues to be resolved before it can be accepted for widespread CVF
assessing in American Schools. First, the methods by which V·O2peak is predicted
from the 20-MST vary among these researchers. These include maximal shuttle
run speed or “paliers,” with each palier lasting 1 min, the total number of laps (one
lap being 20 m), or a combination of these methods (1, 4, 5, 17, 19, 23). Counting
laps would be the most feasible method in establishing a simple field test to use in
schools. This method offers the tester a simple technique of recording group re-
sults and also offers children immediate feedback that they can understand (i.e.,
the more laps run, the higher their physical fitness). A valid regression formula has
·
been developed to predict VO2peak for children and adolescents with mental retarda-
tion (MR) that incorporates number of laps run (12, 13). Although high linear
regression values have demonstrated validity between the number of laps com-
·
pleted and actual VO2peak (i.e., determined by an incremental TM test) for children
and adolescents with MR, to date, no predictive equations incorporating number
of laps run have been developed for children and adolescents without disabilities.
The second issue concerns the necessity to include skinfold measurements in esti-
mating V·O2peak from the 20-MST. Researchers who include skinfold measurements
in their regression formulas demonstrate improved predictive power of the test (4,
19). Considering the equipment, tester experience, and time necessary to take
skinfold measurements on every child, the feasibility of such measurement in the
school setting would be of concern.
·
The third issue is how gender and age affect the VO2peak predictive power of
the 20-MST. Leger and Lambert (16) and Leger and colleagues (17) reported that
gender had little effect on predicting V·O2peak. However, Barnett et al. (4) found that
an inclusion of gender factor in the determination of the regression equations used
to predict V·O2peak improved the accuracy of prediction. Boreham and colleagues
(5) indicated a higher correlation between the 20-MST and V·O2peak for girls than
boys (r = .90 vs. r = .64, respectively), and McVeigh et al. (19) found that the plot
·
Regression Formulas That Predict VO2peak — 127

·
of VO2peak against 20-MST performance showed distinct gender groups and diver-
gent regression lines for the two genders.
The final issue concerns disability. In schools across the United States, chil-
dren with disabilities are now “included” or “mainstreamed” into physical educa-
tional classes. Many of the children mainstreamed into physical education classes
have mild to moderate mental retardation (MR) without Down syndrome. Fernhall
and colleagues (12, 13) found the 20-MST to be a reliable and valid instrument in
predicting the V·O2peak of children and adolescents with mild to moderate MR, with-
out DS. They (12, 13) found that age, body weight, and height were not significant
·
predictors of VO2peak for this population. The regression equation developed by
Fernhall and colleages (12) included number of laps, BMI, and gender.
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The authors of this report have found the regression formula developed by
Fernhall and colleagues (12) to be more feasible in the school setting than regres-
sion formulas that include skinfolds or speed at which the child stops during the
20-MST. However, whether or not the regression formula developed for children
and adolescents with MR (12) is also valid for children and adolescents without
disabilities has not been studied. If the regression formula for the 20-MST devel-
oped by Fernhall and colleagues (12) was equally valid for children and adoles-
cents with and without MR, it would offer a valuable tool for physical educators to
use in assessing the CVF of their students even when their class includes children
or adolescents with MR.
Therefore, the purpose this study was to determine if the regression formula de-
veloped for children and adolescents with MR is valid for children and adolescents
without disabilities. Of secondary importance was to compare the 20-MST regres-
sion formula for predicting V·O2peak developed by Fernhall and colleagues (12) to
one that is commonly used for children and adolescents without disabilities (16).

Methods
Participants
Participants consisted of 51 healthy, non-disabled children and adolescents (fe-
males, n = 38; males, n = 13) ranging in age from 8 to 15 years (10.9 – 1.3 yrs).
None of the participants had a history of cardiopulmonary pathology and all were
functioning in a normal classroom within two years of the educational level appro-
priate for their age. Participants were recruited from a Midwestern city, and both
participant and parent consent were obtained prior to testing. The study was ap-
proved by the University Institutional Review Board. The sampling design was of
convenience.

Testing Procedure
Height and weight of each participant were measured using a standard physician
scale (Detecto) prior to each test. Participants were instructed to wear shorts, a T-
shirt, and athletic shoes for the testing. During testing, room temperature was main-
tained between 21 to 23 C. The treadmill protocol included 3 phases. Phase 1
consisted of laboratory familiarization at which time the participants walked on
the treadmill and breathed through a respiratory collection system. Phase 2 con-
sisted of actual data collection. Phase 3 consisted of a second test of data collec-
tion, which was compared to the first test to ensure validity.
128 — Pitetti, Fernhall, and Figoni

A modified Bruce treadmill protocol was used, with starting speeds indi-
vidualized to the ability of the participants (2 to 3.5 mph or 3.3 to 5.8 k · hr–1). The
participants started walking at 0% grade, and the grade was increased 4% every 2
min until a 12 % grade was achieved. At this point the speed was increased 0.5
mph (.83 k · h–1) every minute until the participant could no longer continue. The
participants were verbally encouraged to push themselves as far as they could. The
TM protocol used for the present study followed the guidelines established for
girls and boys (4–18 years) without disabilities (6).
A Polar heart rate monitor (Polar Inc, Port Washington, NY) was used to
determine heart rates, which were recorded every 30 s. Participants breathed into a
Hans-Rudolph valve (Hans Rudolph, Inc., Kansas City, MO), and expired air was
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collected and analyzed by either a SensorMedics 2900 metabolic system


(SensorMedics Corporation, Yorba Linda, CA) or a Quinton Q-Plex (Quinton In-
struments, Bothell, WA) metabolic system. Metabolic data were calculated and
displayed in 1-min averages. The metabolic systems were calibrated prior to each
· ·
test. The highest VO2 obtained was recorded as VO2peak.
The 20-MST was completed on a tennis court surface, with the distance
marked by painted stripes on the ground and cones set on each stripe. The children
were instructed to run the distance between the cones in the time allotted, follow-
ing the Prudential FITNESSGRAM tapes (7). Participants ran in groups of no
larger than 8. As necessary, a researcher ran with the participants as a pacer to
encourage and motivate. A pre-recorded tape of the Prudential FITNESSGRAM
pacer test signaled the start of the test, and each subsequent sound signaled the
beginning of the next lap. The time allotted to run the 20 m is 9 s (8.5 km · h–1) for
the first minute, then each minute, the speed is increased 0.5 km · h–1. When a
participant stopped or failed to get within approximately 3 m of an end line on two
consecutive laps, the last lap was recorded and the test ended. Each participant
completed two 20-MST.

Data Analyses
·
VO2peak was predicted by two regression equations based on the 20-MST outcomes.
The first regression equation developed by Fernhall and colleagues (12) is: V·O 2peak
(ml · kg–1 · min–1) = 0.35 x (# of laps) - 0.59 x BMI - 4.61 x (male = 1, female = 2)
·
+ 50.6. The second regression equation, developed by Leger et al. (17) is: VO2peak
(ml · kg–1 · min–1) = 31.025 + 3.238 (speed of level stopped in km · hr–1) - 3.248 x
age (yrs) + 0.1536 x (speed x age). For the Leger et al. (1988) formula, number of
laps completed was converted to speed, accordingly.
Means and standard deviations (SDs) were calculated for all variables.
Intraclass coefficients were calculated to determine test-retest (trial-to-trail) reli-
ability and paired differences of the mean and SD of the mean for the number of
laps completed for the 20-MSTs and V·O2peak (ml · kg–1 · min–1) measured during the
treadmill tests, respectively.
·
The highest number of laps run for the 20-MST and the highest VO2peak at-
tained during the TM test were used for data analyses. The relationship between
the TM V·O2peak and predicted V·O2peak from the regression equations developed by
Fernhall and Collegues (12, 13) and Leger et al. (17) and number of laps were
determined by Pearson product-moment correlations. An analysis of variance
(ANOVA) was used to evaluate possible mean differences between TM V·O2peak
·
Regression Formulas That Predict VO2peak — 129

·
and VO2peak predicted by the two regression equations. The relationship between
TM V·O2peak, number of laps run, age, height, weight, gender, and BMI was deter-
mined by a Person product-moment correlation. The level of significance was set
at 0.05. All statistics were calculated using SPSS version 9.

Results
Participants descriptive statistics are displayed in Table 1. No significant differ-
ences were seen for age, height, weight, and BMI between genders. Peak physi-
ological parameters from the TM test also are shown shown in Table 1. No differ-
·
ences were seen between genders for mean absolute VO2peak (ml · min–1), VEpeak,
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· –1 –1
and RERpeak, and relative VO2peak (ml · kg · min ), although a p value of 0.071 was
seen between genders for relative V·O2peak. Differences were seen between genders
for HRpeak, with the female participants demonstrating a higher mean HRpeak (199
vs 189 bpm).
Intraclass coefficients for test-retest (trial-to-trial) reliability for the number
·
of laps run for the 20-MST and the TM VO2peak (ml · kg–1 · min–1) and paired differ-
ences of the mean and SD of the mean are found in Table 2. Intraclass coefficients
were significantly high (p > 0.001) for both 20-MST and TM V·O2peak (ml · kg–1 ·
min–1) whether they were determined for each gender or as a group. For the males,
no significant differences were seen in paired differences of the mean and SD of
the mean for both number of laps run for 20-MST and TM V·O2peak. For the females,

Table 1 Descriptive Characteristics of Participants and Peak Physiological


Parameters

Males Females All


(n = 13) (n = 38) (n = 51)

Descriptive
characteristics
Age (yr) 10.5 – 1.8 11.1 – 1.1 10.9 – 1.3
Height (cm) 146 – 10 149 – 11 148 – 11
Weight (kg) 38.2 – 8.4 41.5 – 11.5 40.6 – 10.9
Body Mass Index 17.7 – 1.9 18.4 – 3.4 18.2 – 3.1
Peak physiological
parameters
·
VO2peak (ml · min) 1873 – 472 1830 – 409 1841 – 422
·
VO2peak (ml · kg–1 · min–1) 49.4 – 7.7 45.0 – 7.2 46.2 – 7.6 #
HRpeak (bpm) 189 – 9 199 – 8 196 – 9*
· ·
RERpeak (VCO2 · VO2–1) 1.19 – .11 1.13 – .10 1.15 – .10
–1
VEpeak (L · min ) 69.4 – 18.6 68.1 – 16.9 68.5 – 17.4

# Males higher (p = 0.071); * Females significantly higher (p < .01).


130 — Pitetti, Fernhall, and Figoni

no significant differences were seen in paired differences of the mean and SD of


the mean for number of laps completed, but significant differences in these param-
eters were seen for TM V·O2peak. When taken as a group, no significant differences
were seen in paired differences of the mean and SD of the mean for number of
laps completed, but significant differences in these parameters were seen for
TM V·O2peak.
·
Pearson product-moment correlations between TM VO2peak, number of laps
for the 20-MST, and age, weight, height, and BMI are shown in Table 3. Significant
positive relationships existed between the number of laps for 20-MST and TM
· ·
VO2peak, while significant negative positive relationships existed between TM VO2peak
and BMI and weight. No significant relationships were seen between number of
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laps for 20-MST and age, height, weight, BMI, and gender.
·
Pearson product-moment correlations between the TM VO2peak and regres-
·
sion equations to predict VO2peak developed by Fernhall and colleagues (12) and
Leger and Lambert (16) are shown in Table 4. Significant but modest relationships
·
were seen between both predictive regression equations and TM VO2peak.
· ·
Comparison of the means of TM VO2peak and VO2peak predicted by the two
regression equations are displayed in Table 5. Whether V·O2peaks were compared
between genders or as a group, there were no significant differences between
means.

Table 2 Test-Retest Intraclass Coefficients (R) and Paired Differences of the


·
Mean and Standard Deviation for the 20-MST and TM VO2peak

Paired
differences
Test #1 Test #2 R p Mean SD p

20-MST
(# of laps)
Males 32.4 – 16 32.2 – 15 0.81 0.001 0.54 9.47 0.84
(n = 13)
Females 33.4 – 15 33.4 – 12 0.92 0.001 –.80 6.24 0.43
(n = 37)
All 33.1 – 13 33.6 – 14 0.89 0.001 –.47 7.11 0.64
(n = 51)
Treadmill Test
·
(VO2peak, ml · kg–1 · min–1)
Males 48.1 – 8.4 47.8 – 7.2 0.87 0.001 0.27 4.12 0.82
(n = 13)
Females 41.0 – 8.5 44.9 – 7.1 0.86 0.001 –3.84 4.35 0.01
(n = 37)
All 42.8 – 8.9 45.7 – 7.2 0.86 0.001 –2.82 4.65 0.01
(n = 51)
·
Regression Formulas That Predict VO2peak — 131

·
Table 3 Pearson Product-Moment Correlations Between TM VO2peak,
Number of Laps for 20-MST and Age, Weight, Height, and BMI

# of Laps
20-MST Age Height Weight BMI Gender

·
TM VO2peak 0.529* –.173 –.187 –.425* –.453* –.255
# of Laps 20-MST 1.000 0.239 0.040 –.150 –.243 0.015
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*p < .01

·
Table 4 Pearson Product-Moment Correlations Between TM VO2peak
·
and Predicted VO2peak From Regression Formulas Developed by Fernhall
and Colleagues (12) and Leger and Lambert (16)

·
VO2peak Fernhall and Leger and
·
(ml · kg–1 · min–1) TM VO2peak Lambert (16) Colleagues (12)

TM 1.00 0.66* 0.57*


Fernhall and Colleagues (12) 0.66* 1.000 0.78*
Leger and Lambert (16) 0.57* 0.78* 1.000

*Significance at the 0.01 level.

· ·
Table 5 Means and SD of TM VO2peak and VO2peak (ml · kg–1 · min–1)
Predicted by the Two Regression Formulas

·
TM VO2PEAK Fernhall et al.(12) Leger et al. (16)

Males (n = 13) 49.4 – 7.7 48.0 – 4.5 47.5 – 4.4


Females (n = 38) 45.0 – 7.2 43.1 – 6.0 46.8 – 3.4
All (n = 51) 46.2 – 7.6 44.4 – 6.0 47.0 – 3.7

Discussion
The purpose of this study was to determine if the regression formula for predicting
CVF (V·O2peak) developed for children and adolescents with MR (12, 13) is valid
132 — Pitetti, Fernhall, and Figoni

for children and adolescents without disabilities. For the participants in this study,
the equation developed by Fernhall and colleagues (12) demonstrated moderate
validity to actual V·O2peak. Of interest, the formula developed by Leger and Lambert
(16) for predicting CVF for non-disabled children and adolescents also showed
mild validity. The correlation between the two regression formulas was signifi-
cantly high (r = .78).
Test-retest reliability for the 20-MST reported in the present study is higher
than that of McVeigh et al. (19), similar to Liu et al. (18), and lower than Fernhall
et al.(12). Interestingly, the participants in the study by Fernhall et al. (12) had
mild to moderate MR. Motivation and task understanding have been reported as
major obstacles when evaluating the physical capacities of persons with MR (11,
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20). In order to compensate for the motivation and task understanding factor,
Fernhall and colleagues (12) had the participants practice the shuttle, and each
participant ran the 20-MST with a pacer.
For the participants in the present study, the correlation between number of
·
laps run and VO2peak was significant but not strong. It was similar to the correla-
tions seen for the level attained by Armstrong et al. (2) and for the speed attained
by female participants in the study by Liu et al. (18), but other studies, such as
Boreham et al. (5; r = .93) and McVeigh et al. (19; r = .79) reported much higher
correlation coefficients when actual V·O2peak was compared to either level or maxi-
mal speed attained. Since most the studies followed similar V·O2peak criterion (i.e.,
continuous modified Bruce TM test) and the same 20-MST protocol, methodological
differences would not be a contributing factor to our findings. In addition, the fact
that age and gender showed no relationship to V·O2peak in the present study indicates
that differences in age and gender reported in other studies is not a factor. There-
fore, the reason(s) for such low correlation coefficients between number of laps
run and V·O2peak seen in the present study when compared to the other studies can-
not be explained.
Although the regression coefficients for both regression equations used in
this study were significant, they were also lower than those reported in other stud-
ies. Those studies that used the equation of Leger et al. (16) reported correlation
coefficients of 0.71 (17), 0.72 (18), and 0.72 (4). The regression equations that
best predicted V·O2peak reported by Barnett et al. (4) included triceps skinfold (R =
0.85, SEE = 3.7), gender and weight (R = 0.84, SEE = 3.7), and gender and age
(R = 0.82, SEE = 4.0). McVeigh et al. (19), whose regression equation included
skinfolds (triceps and subscapular, mm), reported the highest regression coeffi-
cients (males = 0.92; females = 0.83) and the lowest SEE (males = 2.4; females =
2.8). The formula of Fernhall and colleagues (12) showed significantly higher re-
gression coefficients (R = 0.88) and lower SEE (4.5) for children and adolescents
with MR when compared to the present study.
Perhaps the lower regression coefficients and higher SEE seen in this study
when compared to the other studies are due to (a) age and/or gender/weight, sig-
nificant predictors of V·O2peak in the Leger et al. (16) and Barnett et al. (4) regres-
·
sion formulas, showing no relationship to number of laps for 20-MST or TM VO2peak;
·
and (b) gender and BMI, significant predictors of VO2peak in the Fernhall et al. (12)
regression formula, showing no relationship to the number of laps in 20-MST and
·
showing a significant negative relationship to TM VO2peak. Indeed, for the partici-
pants in this study, multiple regression equations using age and number of laps
(R = 0.613; SEE = 6.1) or BMI, gender, and number of laps (R = 0.671; SEE = 5.8)
·
Regression Formulas That Predict VO2peak — 133

·
for predicting VO2peak demonstrated lower regression coefficients than seen in the
other studies. Therefore, for the participants in this study, age, gender, weight, and
BMI were not significantly related to the number of laps and V·O2peak.
Until recently, the prediction equation of Leger et al. (17) was the only one
available in the literature to convert 20-MST data to V·O2peak (ml · kg–1 · min–1) for
children and adolescents 8–19 years old (17). The ability to convert 20-MST data
·
to VO2peak values with an acceptable error is extremely practical in comparison to
other field tests (i.e., PWC170, step tests, and endurance runs) for children and ado-
lescents. The Leger et al. (16) regression equation showed similar regression coef-
ficients and similar SEE in the study by Liu et al. (18) for adolescents 12 to 15
years and in Barnett et al. (4) for adolescents 12 to 17 years. Barnett et al. (4)
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demonstrated regression equations that converted maximal speed attained and gen-
der and weight (R = 0.84, SEE = 3.7) or maximal speed attained and gender and
age (R = 0.82, SEE = 4.0). In 1995, McVeigh and colleagues (19) established a
regression formula that converted 20-MST data and the sum of skinfolds to V·O2peak
that had higher regression coefficients and smaller SEE than the regression equa-
tion of Leger et al. (16). Recently, Fernhall and colleagues (12, 13) developed a
regression formula for children and adolescents (ages 8–15 yrs) with MR that were
based on 20-MST data, gender, and BMI with higher regression coefficients and
lower SEE than was shown by the Leger and Lampert (16) regression formula. For
children and adolescents with MR, age was not included as a significant predictor
·
of VO2peak for the 20-MST (12). In the present study, age, gender, and BMI were
not significantly related to either laps completed for the 20-MST or TM V·O2peak,
and Leger et al. (17) and Fernhall and colleagues (12) regression formulas pro-
duced significant but low regression coefficients. The participants in the Leger et
al. (17) study were Canadian; the participants in Liu et al. (18), Fernhall et al. (12,
13), and the present study were American; the participants in Barnett et al. (4)
were Japanese; and the participants in the McVeigh et al.(19) study were Scottish.
As was stated in the introduction, there are still some issues to be resolved with the
20-MST before it can be accepted for widespread CVF assessing in American
Schools.
To summarize the results of the present study, (a) test-retest correlation coef-
ficients for both the 20-MST and TM V·O2peak were high; (b) age, gender, and BMI
were not related to laps for the 20-MST or TM V·O2peak; (c) TM V·O2peak was moder-
ately related to both regression equations (12, 16); (d) correlation between the two
regression equations was significantly high; and (e) both regression equations (12,
16) had similar validity.

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