Recommendations for Clinical Exercise Laboratories

Myers, Jonathan; Arena, Ross; Franklin, Barry A.; Piña, Ileana L.; Kraus, William E.; McInnis, Kyle; Balady, Gary J.

doi:10.1161/circulationaha.109.192520

Cited by 273 publications

(123 citation statements)

References 77 publications

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“…1 Performance of exercise testing describing normal and abnormal response to exercise, evaluation of the test results are described in detail in 2013 Exercise Standards for Testing and Training: a scientific statement from the American Heart Association. 2 Recommendations for performance of exercise testing by nonphysicians (clinical exercise physiologists, registered nurses, nurse practitioners, physician assistants, and physical therapists) as well as the role of supervising physician have been published recently.…”

Section: Exercise Testingmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

516

386

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Section: Exercise Testingmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

516

386

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“…Detailed discussions of methods and quality control are available in recent statements. 4,9 Experience With CPX in Selected Patient Populations…”

Section: Methodsologymentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

2011

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Exercise tests are commonly used in clinical practice for both functional and diagnostic assessments. Many exercise tests are designed to produce a single measurement relevant to a specific clinical setting such as a timed walking distance as a measure of functional capacity in rehabilitation candidates or the presence of ECG changes consistent with myocardial ischemia in patients with chest pain. Cardiopulmonary exercise testing (CPX) measures a broader range of variables related to cardiorespiratory function, including expiratory ventilation (VE) and pulmonary gas exchange (oxygen uptake [VO 2 ] and carbon dioxide output [VCO 2 ]), along with the ECG and blood pressure, with the goal of quantitatively linking metabolic, cardiovascular, and pulmonary responses to exercise. [1][2][3] With increased availability of instruments for the facile measurement of exercise gas exchange, experience with CPX has expanded from clinical research applications to a broad range of clinical practice settings. 4 Interpretation of CPX for clinical purposes includes comparison of data from individual patients with those from healthy and disease populations. Substantial data are available characterizing exercise responses of patients with certain common heart and lung diseases, providing a basis for using CPX to compare individual patients' impairment relative to others from the same populations. Diagnostic applications of CPX, eg, for evaluating unexplained dyspnea or exercise intolerance, also rely on a comparison of patients' data with those of patients with known diagnoses. In clinical practice, in contrast to much of the research related to specific disorders, patients frequently have multiple medical problems, confounding the assessment of impairment or the attribution of symptoms to one or another condition. Although there are few systematic analyses of the effects of coexistent conditions on exercise responses, an advantage of CPX compared with other forms of testing is the potential for gaining insight into these interactions. This review highlights CPX findings in selected clinical populations and the implication of these observations to the clinical evaluation of patients with heart and/or lung diseases. Rationale and TerminologyTo contract, skeletal muscle uses energy in the form of adenosine triphosphate, generated from oxidative metabolism of substrate, involving the consumption of O 2 and production of CO 2 . Exchange of these gases in the muscle requires equivalent rates of exchange with the environment. Transport of gases between muscle and environment is mediated by the integrated function of multiple organ systems, any of which could become limiting to exercise if sufficiently impaired. The dependence of gas transport on large excursions in output of the heart and lungs makes disease of these organs particularly common causes of exercise intolerance.The standard expression of capacity for endurance, or aerobic, exercise is the maximumVO 2 , reflecting the highest attainable rate of transport and use of oxygen. Pe...

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“…75 From a technical perspective, the routine use of CPX to determine CRF in selected patient populations has become increasingly accepted. 152 Factors that were once considered barriers, such as the rationale for CPX, costs associated with equipment, and the need for professionals with advanced training, are less problematic. 74 A major hurdle to performing CPX in the clinical setting was cleared with the recent recommendation that most maximal exercise tests can be supervised by appropriately trained nonphysician health professionals.…”

Section: Crf and Disabilitymentioning

confidence: 99%

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

Ross¹,

Blair²,

Arena³

et al. 2016

Circulation

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1,678

1,697

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ABSTRACT:Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.M ounting evidence over the past 3 decades has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality, as well as mortality rates attributable to various cancers, especially of the breast and colon/digestive tract. [1][2][3][4] Importantly, improvements in CRF are associated with reduced mortality risk.5 Although CRF is now recognized as an important marker of cardiovascular health, it is currently the only major risk factor not routinely assessed in clinical practice.In 2013, the American Heart Association and the American College of Cardiology jointly released new guidelines for the prevention and treatment of coronary artery disease.6 Although CRF is the fourth-leading risk factor for CVD and has long been established as a significant prognostic marker, 7 it was excluded from the risk calculator. The authors of the guidelines noted that the evidence that CRF would enhance risk classification was inconclusive, and thus, the added contribution of CRF to determine CVD risk was uncertain. There is, however, a large body of epidemiological and clinical evidence demonstrating not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus (T2DM), but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.

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Recommendations for Clinical Exercise Laboratories

Cited by 273 publications

References 77 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

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