Exercise Standards for Testing and Training

Fletcher, Gerald F.; Ades, Philip A.; Kligfield, Paul; Arena, Ross; Balady, Gary J.; Bittner, Vera; Coke, Lola; Fleg, Jerome L.; Forman, Daniel E.; Gerber, Thomas C.; Gulati, Martha; Madan, Kushal; Rhodes, Jonathan; Thompson, Paul D.; Williams, Mark A.

doi:10.1161/cir.0b013e31829b5b44

Cited by 1,551 publications

(751 citation statements)

References 646 publications

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“…Although exercise plays an important role in preventing chronic heart disease and maintaining good health,1 recent studies have reported a transient rise in the incidence of acute myocardial infarction and sudden cardiac arrest during strenuous exercise 2, 3, 4. Consequently, improving bystander response and survival following exercise‐related cardiac arrest are critical public health issues.…”

Section: Introductionmentioning

confidence: 99%

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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BackgroundExercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise‐related out‐of‐hospital cardiac arrest (OHCA).Methods and Results OHCA data between 2005 and 2012 were obtained from a prospective population‐based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise‐related OHCA over the 8‐year study period were assessed. Among patients with bystander‐witnessed, exercise‐related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public‐access defibrillation, and outcome were evaluated. The primary outcome was 1‐month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise‐related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander‐witnessed, exercise‐related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public‐access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1‐month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012).ConclusionsThe incidence rate of exercise‐related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public‐access defibrillation rates were associated with improved outcome among patients with bystander‐witnessed, exercise‐related OHCA.

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Section: Introductionmentioning

confidence: 99%

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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“…Symptom‐limited ETT was performed according to the recommended Bruce treadmill protocol 20. Heart rate, blood pressure, and 12‐lead ECGs were recorded at rest and during each minute of exercise.…”

Section: Methodsmentioning

confidence: 99%

“…ECGs were analyzed by an investigator using a Mortara X‐Scribe II system (Mortara Instruments, Milwaukee, WI). Criteria for test positivity included the following: (1) horizontal or downsloping ST‐segment depression ≥1 mm (0.1 mv) at 60 ms after the J point and (2) ST‐segment elevation ≥1 mm at 60 ms after the J point 20. Duke Treadmill Score (DTS) is a weighted combination of exercise duration, ST‐segment deviation, and the presence and nature of angina during testing.…”

Section: Methodsmentioning

confidence: 99%

“…Exercise treadmill testing (ETT) is a recommended noninvasive diagnostic test for detection of CAD in patients with chest pain (chest discomfort) syndromes or potential symptom equivalents20; however, its limited sensitivity and specificity have been highlighted 21. The purpose of the present study in consecutively enrolled patients with suspected stable angina pectoris (SAP) was to investigate whether ascending aortic strain assessed by 2D‐ST echocardiography at rest predicts the presence of significant CAD and is related to the severity of CAD.…”

Section: Introductionmentioning

confidence: 99%

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Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Fan

et al. 2018

JAHA

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BackgroundArterial stiffening and atherosclerosis tend to coexist. Strain imaging, using a 2‐dimensional speckle tracking (2D‐ST) method, has been used for arterial stiffness assessment and early identification of atherosclerosis. We investigated whether the ascending aortic strain assessed by 2D‐ST echocardiography at rest can predict the presence of coronary artery disease (CAD).Methods and ResultsTwo hundred seventy‐one consecutive patients with suspected stable angina pectoris sequentially underwent exercise treadmill testing, 2‐dimensional echocardiography, M‐mode echocardiography, 2D‐ST echocardiography, and coronary angiography. Circumferential ascending aortic strain (CAAS) and radial ascending aortic strain were assessed by 2D‐ST echocardiography. Ninety‐two patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD. Global CAAS was significantly lower in patients with significant CAD (7.41±2.30% versus 11.54±4.03%; P<0.001) and remained an independent predictor of significant CAD (odds ratio, 0.64 [0.54–0.75]; P<0.001) after multivariate regression. Based on the receiver operating characteristic curve for diagnosing significant CAD, the optimal cut‐off value of global CAAS was ≤9.22% (sensitivity, 86%; specificity, 70%; area under curve=0.82; P<0.001). Global CAAS decreased with increasing severity of CAD and was significantly associated with 3‐vessel disease (odds ratio, 0.58 [0.42–0.79]; P<0.001). Diagnostics for significant CAD were remarkably better for global CAAS combined with exercise treadmill testing than for exercise treadmill testing alone (area under curve=0.88 versus 0.78; P<0.001).ConclusionsGlobal CAAS assessed by 2D‐ST echocardiography at rest was able to predict the presence of significant CAD and identify multivessel disease. In addition, global CAAS combined with exercise treadmill testing remarkably improved the diagnostics for significant CAD.

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“…HRR is the difference between maximum heart rate and resting heart rate. Heart rate reserve was used to calculate heart rate exercise zones by the Karvonen Formula [13,14]. The ERS-2 Ergoline bicycle system (Ergoline GmbH) allowing to control the exercise load was used for the titrated exercise training.…”

Section: Supervised Aerobic Physical Training Protocolmentioning

confidence: 99%

Positive impact of a 4-week duration supervised aerobic training on anthropometric, metabolic, hemodynamic and arterial wall parameters in metabolic syndrome subjects

Slivovskaja

Buzinskaitė

Ryliškytė

et al. 2017

Seminars in Cardiovascular Medicine

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SummaryObjectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects.Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training.Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m 2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034).Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.

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Exercise Standards for Testing and Training

Cited by 1,551 publications

References 646 publications

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Positive impact of a 4-week duration supervised aerobic training on anthropometric, metabolic, hemodynamic and arterial wall parameters in metabolic syndrome subjects

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