New Jersey  Sports Medicine and Performance Lab                                Marc Richard Silberman, MD                                       AUTHORIZATION AND CONSENT FOR THE MAXIMUM AEROBIC POWER TEST INFORMATION STATEMENT As part of New Jersey Sports Medicine and Performance Lab, a fitness evaluation test will be performed.  The test is designed to estimate and describe: 1. the maximum aerobic power (MAP) while cycling; 2. the maximum oxygen uptake (VO2max); 3. the evolution pattern of the heart rate as power output increases; 4. the evolution pattern of blood lactate levels as power output increases; 5. the athlete’s maximum heart rate.  Before the test you will be screened by a physician experienced in exercise testing.  For the test, you will ride your own bicycle mounted to a Computrainer.   Remaining seated, you will pedal at a steady cadence of 90 revolutions per minute (RPM) against a progressively higher resistance until you can longer maintain the target cadence.  The test is a progressive and maximal test whose results depend on your ability to go as far as possible before voluntarily stopping the test.  If you experience such symptoms as excessive fatigue, breathlessness, chest pain, muscle pain, or any other symptoms out of your ordinary, you will stop the test.  You can stop the test voluntarily at any time. Blood pressure will be taken prior to the test and if elevated, the test will be postponed.  Your RPMs, heart rate, power output in watts, blood lactate levels, and expiratory gases will be monitored during the test. RISKS of testing include muscle injury, a remote chance of fainting and a very rare chance of abnormal heart rhythm or heart attack, and death. BENEFITS of testing include assessment of cycling fitness and development of power-based training zones.  The knowledge gained from the test facilitates development of a power based training program, evaluation and monitoring of training progress, and prevention of overtraining and injury. ______________________________________________________________________________________ CONSENT Your signature on the line provided below indicates:  (1) you have read, understood, and agreed to all of the above statements; and, (2) you had an opportunity to ask questions about the exercise test, the test has been adequately explained to you, and you have sufficient information regarding the test and its risks and benefits; and, (3) your consent to take the exercise test is given voluntarily as you have the right not to take the test if you so choose. I HEREBY CONSENT TO THE PERFORMANCE OF THE FITNESS TEST UNDER THE SUPERVISION OF: _____________________________________        __________________________________ (Physician’s Name)                                                 (Patient’s Signature) ________________________________________   ____________________________________________ (Witness)                                                                  (Parent or Guardian Signature, if athlete < 18 years) ________________________________________ (Date/Time)