Fitness Testing with Sleep Apnea

Sleep apnea has profound effects on the cardiovascular system:

• Nocturnal Hypoxia: Repeated drops in blood oxygen levels stress the cardiovascular system and trigger sympathetic nervous system activation
• Hypertension: 50 to 60% of people with sleep apnea have high blood pressure. Sleep apnea is a leading cause of resistant hypertension
• Atrial Fibrillation: 4 to 5 times higher risk of arrhythmias
• Heart Failure: Sleep apnea is common in heart failure patients and worsens outcomes
• Coronary Artery Disease: Increased risk of heart attacks
• Stroke: 2 to 4 times higher risk

This is why cardiovascular fitness assessment is particularly important for individuals with sleep apnea.

Regular physical activity supports sleep apnea management through multiple mechanisms:

• Weight Loss: For overweight individuals, losing just 10 to 15% of body weight can reduce sleep apnea severity by 50% or more. Exercise is crucial for sustainable weight loss
• Improved Sleep Quality: Regular exercise improves overall sleep architecture, increases slow-wave sleep (deep sleep), and reduces sleep fragmentation
• Upper Airway Muscle Tone: Some research suggests exercise may improve muscle tone in the throat, reducing collapse during sleep
• Cardiovascular Protection: Exercise mitigates some of the cardiovascular damage caused by sleep apnea
• Inflammation Reduction: Regular physical activity lowers inflammatory markers elevated in sleep apnea
• Improved Oxygen Utilization: Better cardiovascular fitness helps body cope with intermittent hypoxia
• Daytime Energy: Exercise can help combat excessive daytime sleepiness common in sleep apnea

Important: Exercise complements but does not replace CPAP or other medical treatments. Continue all prescribed therapies.

VO₂ max testing assesses cardiovascular fitness and provides exercise prescription:

• Baseline Cardiovascular Fitness: Sleep apnea often reduces exercise capacity due to poor sleep quality, daytime fatigue, and cardiovascular effects. Know your starting point
• Individualized Exercise Zones: Get precise heart rate zones based on YOUR physiology, accounting for any cardiovascular effects of sleep apnea
• Safe Exercise Intensity: Especially important if you have cardiovascular complications (hypertension, heart disease) related to sleep apnea
• Zone 2 for Weight Loss: Discover your fat-burning zone (typically 60 to 70% maximum heart rate) for sustainable weight loss
• Track Improvements: Retest every 8 to 12 weeks. As sleep apnea treatment progresses and weight decreases, VO₂ max often improves
• Motivation Through Data: Seeing objective fitness improvements provides motivation to continue exercise and treatment adherence

Testing Process: 45 to 60 minute appointment on your choice of equipment (treadmill, bike, rower, or stair mill). Same day results with detailed heart rate zones and training recommendations.

Weight loss is often the single most effective intervention for improving sleep apnea severity in overweight individuals:

• Precise Calorie Needs: Know your exact resting metabolic rate. Online calculators can be off by 300 to 600 calories, sabotaging weight loss efforts
• Impact on Sleep Apnea: Research shows 10% weight loss can reduce AHI (Apnea-Hypopnea Index) by approximately 26%. Some people achieve complete remission with sufficient weight loss
• Safe Weight Loss Target: Create appropriate 300 to 500 calorie daily deficit for 0.5 to 1 pound per week loss
• Preserve Muscle Mass: Adequate protein and proper deficit prevent muscle loss, which is important for maintaining metabolism and potentially for upper airway muscle tone
• Adjust as Weight Decreases: Retest RMR every 3 to 6 months. As you lose weight, your metabolism will decrease and calorie targets need adjustment

Testing Process: 20 to 30 minute appointment. Fast for 4 to 5 hours before testing. Same day results with personalized calorie and macronutrient targets.

Best Value: VO₂ max plus RMR testing (save $25)

Combining both tests provides complete data for improving sleep apnea through lifestyle:

• Exercise Prescription: Heart rate zones for cardiovascular training from VO₂ max testing
• Nutrition Targets: Precise calorie goals for weight loss from RMR testing
• Address Multiple Factors: Sleep apnea improvement requires both weight loss and fitness gains
• Track Progress Comprehensively: Monitor both metabolic and cardiovascular changes

Discuss testing with your physician if you have:

• Severe sleep apnea (AHI 30 or higher), especially if untreated
• Cardiovascular disease (heart failure, coronary artery disease, arrhythmias)
• Uncontrolled hypertension
• Excessive daytime sleepiness affecting safety
• Recent cardiac events or procedures

When Testing May Need to Be Deferred: Untreated severe sleep apnea with significant cardiovascular complications, recent cardiovascular events, excessive daytime sleepiness that could affect safety during exercise testing.

We will screen for contraindications and may request physician clearance based on your specific situation. Your safety is our priority.

Based on research and clinical guidelines for sleep apnea management:

• Aerobic Exercise:
  • • Minimum: 150 minutes per week moderate intensity (Zone 2)
  • • For weight loss: Target 250 to 300 minutes per week
  • • Spread throughout the week, 5 to 7 days ideally
  • • Examples: brisk walking, cycling, swimming, elliptical
• Resistance Training: 2 to 3 days per week. Builds muscle mass, which increases resting metabolic rate and supports weight management
• Timing Considerations: Some people with sleep apnea have excessive daytime fatigue. Morning exercise may be easier. Avoid vigorous exercise within 2 to 3 hours of bedtime as it can interfere with sleep
• Start Gradually: If you have significant daytime sleepiness or low fitness, start with 10 to 15 minute sessions and gradually increase

Important relationship between CPAP use and exercise:

• Continue CPAP: Do not stop CPAP therapy, even if you are exercising and losing weight. Only discontinue under physician guidance after repeat sleep study confirms improvement
• CPAP Improves Exercise Tolerance: Treating sleep apnea with CPAP often improves daytime energy, making exercise easier and more sustainable
• Exercise Improves CPAP Adherence: People who exercise regularly tend to have better CPAP compliance
• Synergistic Effects: CPAP plus exercise plus weight loss produces best outcomes for cardiovascular health

Use RMR data to create effective nutrition plan:

• Calorie Deficit: Use RMR results to calculate 300 to 500 calorie daily deficit
• Anti-Inflammatory Foods: Mediterranean diet pattern may help reduce inflammation associated with sleep apnea
• Avoid Heavy Evening Meals: Large meals before bed can worsen sleep apnea symptoms
• Limit Alcohol: Alcohol relaxes throat muscles and worsens sleep apnea. If you drink, do so earlier in the day
• Adequate Protein: 0.8 to 1.0 grams per pound body weight supports muscle preservation during weight loss

Track multiple markers with your healthcare team:

• Sleep Study: Repeat polysomnography every 6 to 12 months or after significant weight loss to assess AHI changes
• CPAP Data: Modern CPAP machines track AHI and usage. Review with sleep specialist
• Body Weight: Track weekly. Target 0.5 to 1 pound per week loss
• Neck Circumference: Reducing neck circumference often correlates with sleep apnea improvement
• Blood Pressure: Often improves as sleep apnea is treated and weight decreases
• Daytime Sleepiness: Use Epworth Sleepiness Scale to quantify improvements
• VO₂ Max: Retest every 8 to 12 weeks to track cardiovascular fitness gains
• RMR: Retest every 3 to 6 months to adjust calorie targets

Comprehensive sleep apnea management includes:

• Sleep Position: Side sleeping often reduces sleep apnea severity compared to back sleeping
• Avoid Sedatives: Sleeping pills and sedatives can worsen sleep apnea
• Smoking Cessation: Smoking increases inflammation and fluid retention in upper airway
• Nasal Congestion Management: Address allergies and congestion that can worsen OSA
• Regular Sleep Schedule: Consistent bed and wake times improve overall sleep quality

Share your fitness testing results with your healthcare team:

• Sleep Specialist: Manages sleep apnea treatment, orders follow-up sleep studies
• Primary Care Physician: Monitors overall health, cardiovascular risk factors
• Cardiologist: If you have cardiovascular complications from sleep apnea
• Registered Dietitian: Uses RMR data to create weight loss meal plans
• Personal Trainer: Uses VO₂ max zones to design effective workouts (visit rockurbody.com for coaching)

With consistent exercise, weight loss, and continued CPAP therapy:

• AHI Reduction: 10% weight loss typically reduces AHI by approximately 26%
• CPAP Pressure: May be able to reduce pressure settings (under physician guidance)
• Cardiovascular Health: Improved blood pressure, reduced arrhythmia risk
• Daytime Function: Less sleepiness, improved cognition, better mood
• Quality of Life: Better energy, physical function, and overall wellbeing

Timeline varies, but many people see improvements within 3 to 6 months of consistent lifestyle changes.

VO₂ Max Test: $250

RMR Test: $75

Performance Pack (Both): $300

Fit Evaluations
311 Soquel Ave
Santa Cruz, CA 95062

Behind Hindquarter restaurant (second entrance off Dakota St.)

Phone: 831-400-9227
Email: info@fitevals.com

Call to discuss your sleep apnea status and whether physician clearance is needed.