Strong relationship with good health Related to performing daily activities with

vigor Associated with low risk of premature

development of the hypokinetic diseases

Educate participants of health-related fitness status

Provide data helpful in development of exercise prescriptions

Collecting baseline that allow evaluation of exercise program

Motivational tool--establish reasonable and attainable fitness goals

Stratifying cardiovascular risk

Minimal recommendation is completion of a questionnaire (e.g. PAR-Q)

Participant should follow testing guidelines (ch.2)

Forms: informed consent, score sheets, tables,

graphs, and other testing documents Calibrate all equipment Maintain room temperature of 68°F to

72°F (20°C to 22°C) and humidity of <60%

Prescreening/risk stratification Resting HR, BP, height, weight, body mass

index, ECG (if appropriate) Body composition Cardiorespiratory fitness Muscular strength Muscular endurance Flexibility

Resting measurements:Heart rate Blood pressure HeightWeight Body composition

Fitness measurements: Cardiorespiratory (CR) endurance,Muscular fitnessFlexibility

Anthropometric methods Body mass index Circumferences Skinfold measurements

Densitometry Hydrodensitometry (underwater) weighing Plethysmography

Other Dual energy x-ray absorptiometry Total body electrical conductivity Bioelectrical impedance analysis Near-infrared intercadence

Table 4-2

Table 4-5

Table 4-6

Low levels of CR fitness associated increased risk of premature death from all causes and specifically from cardiovascular disease.

Assessment of CR fitness is an important part of a primary or secondary prevention program

Commonly modes for exercise testing : cycle ergometry tests, treadmill tests, andstep tests

Estimates of VO2max from the HR response to submaximal exercise tests are based on these assumptions:Steady-state HR is obtained for each work rateTest terminated at 70% of PMHR OR signs/symptomsA linear relationship exists between HR and work rateThe maximal workload is indicative of the VO2max

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The ability to carry out the activities of daily living, which is related to self-esteem

The fat-free mass and resting metabolic rate, which are related to weight management

Muscular strength The ability of the muscle to exert forceTraditionally, the one-repetition maximumMultiple RM can be used to determine 1RM

Muscular endurance the muscle’s ability to continue to perform

for successive exertions or many repetitionsCurl-up (crunch) testMaximum number of push-ups

Flexibility is the ability to move a joint through its complete range of motion. Normal Range of Motion for common jointsSit and Reach

The exercise test may be used for diagnostic, prognostic, and therapeutic applications, especially in regard to exercise prescription.

Exercise test may be used for diagnostic, prognostic, and therapeutic applications, especially in regard to exercise prescription

Greatest utility with intermediate probability

magnitude of ischemia is proportional to the degree of ST-segment depression

high probability of disease to assess residual myocardial ischemia to assess threatening ventricular

arrhythmiasprognosis rather than for diagnostic

purposes Low-level testing provides sufficient

data to make recommendations about ability to safely perform activities of daily living

Exercise testing after myocardial infarction can be performed:before or soon after hospital discharge for prognostic

assessment, for activity prescription, for evaluation of further medical therapy, and for interventions, including coronary

revascularization.

Most common clinical exercise testing treadmill, cycle ergometer, arm ergometer

Treadmill testing provides a more common form of physiologic stress handrails for balance and stability, but can reduce

the accuracy ECG recording emergency stop button

Cycle ergometers electronically or mechanically braked less movement =better-quality ECG unfamiliar method of exercise localized leg fatigue=early end Lower values for maximal oxygen consumption

Arm ergometry alternative method smaller muscle mass =20% to 30% lower V02

Protocol employed should consider: purpose of the evaluationspecific outcomes desiredcharacteristics of the individual being

tested (e.g., age, symptomatology) Most common exercise test protocols

BruceEllestadtNaughtonBalke-WareRamp

Common variables assessed during clinical exercise testing include: heart rate and blood pressureECG changessubjective ratingssigns and symptomsexpired gases and ventilatory response

Heart rate and blood pressure responses should be measured before, during, and after the GXT.

A standardized procedure should be adopted for each laboratory so that baseline measures can be assessed more accurately when repeat testing is performed.

The measurement of perceptual responses during exercise testing can provide useful clinical information.

Ratings of perceived exertion (RPE) and/or specific symptomatic complaints include:degree of chest pain, burning, and

discomfortdyspnea lightheadedness leg discomfort/pain.

Situations in which gas exchange and ventilation measurements are appropriate include the following:When a precise cardiopulmonary response

to a specific therapeutic intervention is required

When the etiology of exercise limitation or dyspnea is uncertain

When evaluation of exercise capacity in patients with heart failure is used to assist in the estimation of prognosis and assess the need for cardiac transplantation

If maximal sensitivity is to be achieved with an exercise test, patients should assume a supine position during the postexercise period.

In patients who are severely dyspneic, the supine posture may exacerbate the condition, and sitting may be a more appropriate posture.

When the test is being performed for nondiagnostic purposes, an active cool-down usually is preferable.

Monitoring should continue for at least 5 minutes after exercise or until ECG changes return to baseline and significant signs and symptoms resolve.

Exercise echocardiography Exercise nuclear imaging Pharmacologic stress testing Computed tomography