The concurrent validity and test-retest reliability of a submaximal exercise test in adolescents with autism



Measuring cardiorespiratory fitness (CRF), or how well your body uses oxygen during exercise, is crucial for maintaining overall health and well-being. This is especially true for adolescents, as establishing healthy habits early in life can have lasting positive impacts. However, evaluating CRF in individuals with Autism Spectrum Disorder (ASD) can present unique challenges. Traditional maximal exercise tests, which require pushing oneself to exhaustion, might not be feasible or comfortable for everyone with ASD.

A welcome addition to the field is a recent study published in April 2024 titled “The concurrent validity and test-retest reliability of a submaximal exercise test in adolescents with autism.” This research investigates the potential of the Astrand-Rhyming Test (ART) as a reliable and accessible tool for assessing CRF in adolescents with ASD.

The Astrand-Rhyming Test: A Submaximal Approach


The ART differs from traditional maximal exercise tests in that it doesn’t require participants to reach their point of maximum exertion. This submaximal approach can be advantageous for several reasons. First, it can be less physically demanding and more tolerable for individuals with ASD who might experience sensory overload or discomfort during strenuous exercise. Second, submaximal tests can be easier to administer and require less specialized equipment compared to maximal exercise testing.

The ART itself involves a series of increasingly difficult cycling stages, with participants rhyming words at a predetermined pace throughout the test. Researchers can monitor heart rate, oxygen uptake, and other physiological markers during the test to estimate CRF.

Reliability: How Consistent are the ART’s Measurements?


An important aspect of any fitness test is its reliability. To assess this, the researchers evaluated the test-retest reliability of the ART. In simpler terms, they examined whether the ART produced consistent results within the same individuals across multiple testing sessions. The study revealed strong test-retest reliability, indicating that the ART can be a reliable measure of CRF within an individual over time. This is positive news, as it suggests that the ART can track changes in CRF for a particular adolescent over the course of a fitness program or intervention.

However, the study also highlights the importance of considering absolute reliability. While the ART showed consistency within individuals, there was some variability in the measurements between participants. This means that directly comparing raw CRF values obtained from the ART between different adolescents might not be the most accurate approach.

Does the ART Align with Established Measures?


Another key concept in evaluating a new test is its concurrent validity. This essentially means comparing the results of the new test (in this case, the ART) with a well-established gold-standard measure. For CRF assessment, the gold standard is typically a maximal exercise test like CPET (cardiopulmonary exercise testing).

The researchers compared the ART results with CPET results obtained from the same participants. The study found moderate positive correlations between the two methods, indicating that the ART results generally aligned in the same direction as the CPET results. However, the correlations weren’t perfect, suggesting that there might be some discrepancies between the ART and CPET in certain cases.

The ART: A Promising Tool with Room for Improvement


Overall, the study provides encouraging evidence for the ART as a potentially reliable tool for assessing CRF in adolescents with ASD. The strong test-retest reliability suggests the ART can produce consistent results when measuring an individual’s CRF over time. However, limitations exist, such as variability in measurements between participants and imperfect agreement with the gold-standard CPET.

These findings pave the way for future research to refine the ART and improve its accuracy. Further studies could explore ways to standardize the ART for better comparison between participants and investigate methods to enhance its alignment with CPET results. Additionally, research could examine the feasibility and effectiveness of using the ART in clinical settings or fitness programs designed for adolescents with ASD.

The development of reliable and accessible tools like the ART is crucial for promoting health and well-being in adolescents with ASD. By being able to accurately assess CRF, healthcare professionals and fitness specialists can design personalized exercise programs that cater to the individual needs and preferences of adolescents on the spectrum. This can lead to improved cardiovascular health, increased physical activity levels, and a better overall quality of life.



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