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© 2002 Human Kinetics Publishers, Inc.

·

That Predict VO Using the 20-M

2peak

Shuttle Run for Children and Adolescents

(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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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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(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,

Parameters

(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

130 — Pitetti, Fernhall, and Figoni

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.

·

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)

Fernhall and Colleagues (12) 0.66* 1.000 0.78*

Leger and Lambert (16) 0.57* 0.78* 1.000

· ·

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)

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.

References

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capacity in children. Pediatr. Exerc. Sci. 4:312-318, 1992.

2. Armstrong, N., and J.R. Welsman. Assessment and interpretation of aerobic fitness in

children and adolescents. Exerc. Sport Sci. Rev. 22:435-476, 1994.

3. Astrand, P.-O., and K. Rodahl. Textbook of Exercise Physiology (2nd ed.). New York:

McGraw-Hill, 1986, pp. 354-363.

4. Barnett, A., L.Y.S. Chan, and I.C. Bruce. A preliminary study of the 20-m multistage

·

shuttle run as a predictor of peak VO2 in Hong Kong Chinese students. Pediatric Exer-

cise Science 5:42-50, 1993.

134 — Pitetti, Fernhall, and Figoni

5. Boreham, C.A.G., V.J. Paliczka, and A.K. Nichols. A comparison of the PWC170 and

20-MST tests of aerobic fitness in adolescent schoolchildren. J. Sports Med. Physical

Fit. 30:19-23, 1990.

6. Cumming, G.R., D. Everatt, and L. Hastman. Bruce treadmill test in children; normal

values in a clinic population. Amer. J. Cardiol. 4:69-80, 1978.

7. Cureton, K.J. Aerobic capacity. In J.R. Morrow, H.B. Falls, and H.W. Kohl (Eds.),

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