What does the PNOE Resting Assessment measure?

• Metabolic Fitness
• Resting Metabolic Rate
• Fat-Burning Efficiency
• Heart Fitness
• Lung Fitness
• Breathing & Cognition
• Breathing & Posture
• Diabetes Risk
• Medical History
• Training History
• Nutrition History

What does the PNOE Active test measure?

• Aerobic Health
• Cardiovascular Fitness
• Respiratory Capacity
• Respiratory Capability
• Expiratory Power
• Respiratory Coordination
• Breathing & Cognition
• Breathing & Stability
• Fat Burning Efficiency
• Metabolic Rate
• High-Intensity Performance
• Movement Economy
• Recovery Capacity

What is the ideal to test both resting and active test with assessment to create a personalized program?

How to prepare for PNOE Resting Metabolic test and Breathe Assessment:

• PNOĒ recommends a minimum 5 hour fast (preferably overnight) with no alcohol, nicotine, or caffeine
• No vigorous exercise for at least 48 hours and no light exercise for at least 24 hours before RMR testing
• The day before the test should be a rest day
• The client should be in a quiet, temperature-controlled environment
• They should rest for at least 10-20 minutes before the test
• Have them arrive early and place them in a quiet secluded area in sitting or lying

After gauging the available literature data, PNOĒ has developed its own RMR test prerequisites, which are laid out below.

• At least five hours, preferably overnight, fast, with no alcohol, caffeine, or nicotine use.
• No vigorous exercise for at least forty-eight hours and no light-to-moderate for at least twenty-four hours before the measurement.
• Essentially, the previous day should be a rest day.
• A quiet setting with a temperature-controlled environment, between twenty-eight and thirty-two degrees Celcius
• A resting period of at least ten to twenty minutes, where the subject will arrive earlier than the scheduled time and the trainer will place them sitting or lying, depending on which position the RMR measurement will be conducted, in a space where the measurement will take place.

What can we learn from your Resting Metabolic Test?

Besides the RMR, indirect calorimetry (IC) can also determine the relative proportion of the substrate, namely carbohydrates and fat, utilization to the RMR by calculating the respiratory exchange ratio (RER). RER is the ratio of the volume of carbon dioxide expired to the volume of oxygen inspired (VCO2/VO2).

Under typical metabolic conditions, with stable respiratory function, RER ranges between point seven to one.

A pure oxidation of carbohydrates generates an RER value of one, while a pure oxidation of fat generates an RER of point seven.

The average resting RER of point eighty-two is indicative of mixed substrate oxidation.

Although indirect calorimetry provides a reliable, non-invasive, and easy-to-perform method to precisely measure RMR, RER values that fall out of the normal range represent a violation of one or more of the best testing practices described above, therefore, should not be trusted.

Metabolic causes for an RER below point seven may be untreated diabetes mellitus, alcohol overconsumption, or prolonged starvation.

On the other hand, metabolic causes for an RER above one may be overfeeding, de novo lipogenesis, which will be thoroughly discussed in a next module, and high blood lactate.  However, it should not be neglected that RER values outside of the normal range may also be attributed to technical issues with the measurement, and these should always be adequately addressed.

• Apart from RMR, IC can also determine the proportion of substrates’ (carbohydrates and fats) utilization to the RMR, by calculating the respiratory exchange ratio (RER).
• RER (VCO2/VO2) reflects the ratio of carbohydrate (CHO) to fat oxidation and under typical metabolic conditions with stable respiratory function ranges from 0.7 to 1.0.
• The complete oxidation of glucose generates an RER value of 1.0, while the complete oxidation of fat generates an RER of 0.7.
• The average resting RER of 0.82 is indicative of a mixed substrate oxidation.
• Although IC has been shown to provide a reliable, non-invasive, and easy-to perform measurement of a subject’s resting energy expenditure, RER values out of the normal range represent protocol violation of the RMR measurement and therefore should not be trusted.
• Metabolic causes for an RER < 0.7 may be untreated diabetes mellitus, oxidation of ethanol, lipolysis or prolonged starvation.
• Metabolic causes for an RER > 1.0 may be excessive recent energy consumption (overfeeding), lipogenesis and high blood lactate.
• Off RER values may also be attributed to technical issues with the measurement.

PNOE testing shows…

“There are many factors influencing RER, towards either mainly fat oxidation, meaning RER values closer to point seven or mostly carbohydrate oxidation, meaning RER values closer to one.

Factors that may increase RER, hence favor carbohydrate oxidation at rest, are a long-term high-carb diet, increased glycogen stores, caloric surplus, pregnancy, especially the third trimester, and de novo lipogenesis.

Factors that may decrease RER, hence favor fat oxidation at rest, are a long-term high-fat diet, reduced glycogen stores, caloric deficit, type one diabetes, and gluconeogenesis, meaning the metabolic process that transforms non-carbohydrate substrates, such as lactate, amino acids, and glycerol, into glucose.

Test your body composition with your metabolic test for best results.

• Conducting IC along with body composition measurement is useful to further optimize the nutrition prescription.
• Altogether, IC is the best way to accurately determine energy needs for a nutrition prescription which in combination with a body composition measurement and a nutrition questionnaire provides the dietitian with the ultimate guide for a very high-level individualized nutrition program.
• A comprehensive nutritional assessment that will comprise the foundation for an optimal nutrition prescription, meaning a diet plan, apart from an RMR measurement with a metabolic analyzer, also requires a body composition analysis and an extensive nutrition history.
• The body composition analysis will determine the body fat and muscle percentage and provide segmental fat analysis of the different body parts, among others. It will score the individual’s visceral fat, the fat stored around the organs, and is the culprit of chronic diseases such as type two diabetes and cardiovascular disease.
• The nutrition history can be taken through an extensive nutrition questionnaire which will encompass information about the weight history of the individual, their food preferences, and their meals’ structure.

To sum it all up, the main components of total energy expenditure (TEE), namely the RMR, which corresponds to sixty to seventy-five percent of TEE, the activity-induced energy expenditure, which presents great inter-individual variability and can reach up to thirty-five percent of TEE, and the thermic effect of food which corresponds to an approximately constant ten percent of TEE.

The indirect calorimetry, the gold standard method for measuring RMR.

Indirect calorimetry transforms respiratory gases into resting calories, outlined the prerequisites for a correct RMR protocol execution, and the concept of the RER in terms of carbohydrate and fat utilization.

The limitations of the indirect calorimetry in terms of the RER acceptable range of point seven to one and how metabolic disturbances or technical issues with the measurement may throw this off.

The importance of having a complete nutritional assessment, which, apart from the measured RMR through the indirect calorimetry, will also encompass a body composition analysis and a nutrition history = the ideal to create personalized coaching program.

• Total Energy Expenditure components
  • RMR →  60-75%
  • AEE →  varies
  • TEF → 10%
• Indirect Calorimetry
  • Gold standard method of measuring RMR
  • Strict protocol measurement parameters
  • Measures volumes of respiratory gases (VO2/VCO2)
  • Determines carbohydrates and fat metabolism (RER)
• Limitations
  • RER<0.7 and/or >1.0
  • Technical issues with the measurement
  • Pathophysiological factors and metabolic disturbances
  • Ideally need a more complete nutritional assessment (body composition and nutrition history)
• Schedule your Metabolic test with Coach Debbie Potts