Exercise Prescription Guidelines for Cardiovascular Disease Patients in the Absence of a Baseline Stress Test

Abstract

Aerobic exercise is a core component of cardiac rehabilitation (CR). Leading organizations recommend that the exercise prescriptions should be based on a symptom limited baseline graded exercise test (GXT). However, recent evidence suggests that only ~30% of CR clinics perform baseline GXTs. Consequently, exercise prescriptions including exercise progression in CR are not following standard exercise prescription guidelines. Therefore, the purpose of this review is to provide clinicians with evidence-based techniques for prescribing exercise in the absence of a baseline GXT. Intensity indicators (e.g., heart rate, perceived exertion) are reviewed, along with special exercise considerations for various disease states (e.g., heart failure, peripheral artery disease, and coronary artery disease). Baseline exercise testing remains the gold standard approach for prescribing exercise among heart disease patients, however, clinicians must be prepared to safely develop and monitor patients when a baseline GXT is not performed.

Use of the six-minute walk test in exercise prescription in male patients after coronary artery bypass surgery

“…The most appropriate factors that enable customization of training sessions and individualization of its intensity remain questionable [ 3 , 8 ]. Commonly used in clinical practice markers are HR and rate of perceived exertion (RPE) [ 2 , 3 ]. Strategies of tailoring the exercise intensity based on determining the target HR are the most frequent, but are criticized because of not taking into account the chronotropic specificity, which may vary to a great extent in patients with a history of cardiovascular diseases.…”

“…Walking speed can be used independently of HR [ 3 ], and may be estimated on the basis of walking tests outcomes [ 2 , 3 ]. Speed values of walking tests are not transferable to a treadmill due to radically different types of effort and energy demands [ 3 ].…”

“…It enables the assessment of the submaximal level of functional capacity and guiding cardiac rehabilitation, but cannot be performed as a substitute of the cardiopulmonary exercise stress test (CPET) [19]. In this study, we developed a model of continuous training because, in general, patients without initial CPET should begin cardiac rehabilitation with conventional continuous aerobic exercises for several weeks to months [2]. Due to the fact that exercise prescription techniques in cardiac rehabilitation are of criti- Use of the six-minute walk test in exercise prescription in male patients after coronary artery bypass surgery cal importance since many patients do not undergo baseline CPET to set exercise intensity [2,3], we used the 6-MWT in our study to determine the initial speed of walking and its increase during walking training sessions on a treadmill in CABG patients.…”

“…The test is safe for patients, easy to perform and to interpret, does not require specialized equipment or special training of personnel and the risk of complications is low. 6-MWT results enable the classification of patients for physical training of appropriate intensity; moreover, the test can also be used to assess the effectiveness of cardiac rehabilitation [ 1 , 2 ]. However, it is still not clear whether it is possible to safely and effectively determine the training load on the basis of the 6-MWT in patients after cardiac surgery with low tolerance of physical exercise [ 2 , 3 ].…”

Women’s Lives Matter—The Critical Need for Women to Prioritize Optimal Physical Activity to Reduce COVID-19 Illness Risk and Severity

“…Since VO 2 max, heart rate (HR), and RPE (on a 6–20 scale) are well correlated, it is possible for a person to assess their PA intensity based on RPE and to use RPE as a guide to engage in optimal PA based on their own capacity [ 58 ] ( Figure 2 B). The promising aspect of using RPE to adjust PA intensity is not only its simplicity but also its ability to account for HR changes, which may be caused by cardiovascular medications [ 66 , 67 , 68 ].…”