ACSM’s Guidelines For Exercise Testing And Prescription Chapter 5 Clinical Exercise Testing

Exercise Testing l Best used for : l Patients w/ signs & symptoms who are probably + for CAD l Persons w/ multiple risk factors but who are asymptomatic

l Individuals who have jobs requiring high work capacities or for jobs where public safety is of primal importance l People with CAD to assess residual cardiac function

Adverse Exercise Signs Indicating Poor Prognosis l Work capacities < 5 METs l Significant ST segment depression w/ low level work intensities l Hypotensive BP w/ exercise

Types Of Tests l Treadmill tests l Bruce or Ellestad - good for young folks because the between-stage graduations of grade and speed are more aggressive l USAFSAM or Naughton - good for older folks because of the more gradual between-stage progressions of grade and speed

Bruce Protocol GXT StageSpeedGradeDur. I1.7 mph 10 %3 min II2.5 mph 12 %3 min III3.4 mph 14 %3 min IV4.2 mph 16 %3 min V5.0 mph 18 %3 min VI5.5 mph 20 % 3 min

Modified Bruce StageSpeedGradeDur. I1.7 mph 0 %3 min II1.7 mph 5 %3 min III1.7 mph 10 %3 min IV2.5 mph 12 %3 min V3.4 mph 14 %3 min VI4.2 mph 16 %3 min VII5.0 mph 18 %3 min

USAFSAM GXT StageSpeedGradeDur. I2.0 mph 0 %3 min II3.3 mph 0 %3 min III3.3 mph 5 %3 min IV3.3 mph 10%3 min V3.3 mph 15%3 min VI3.3 mph 20%3 min

Reasons To Stop The Test l Drop in BP with increases in workload l Moderate to severe angina l Ataxia, dizziness, syncope l Dysrhythmias l ST segment elevations and depressions l Hypertensive responses l SOB beyond exercise norms

How Should I Monitor The Patient ? l HR & BP l Anginal Scale l Dyspnea Scale l Borg’s RPE Scale l EKG monitoring - Leads I, II, V5 l Patient’s subjective symptomatology

Anginal Scale 1+ : faint pain is present - patient can continue 2+ : pain clearly present - patient can continue 3+ : pain is very bad - patient must stop exercise soon 4+ : Pain is the worse ever - exercise must stop now !

Dyspnea Scale 1+ : slight breathlessness - patient can continue 2+ : moderate breathlessness - patient can continue 3+ : moderately severe breathlessness - patient must stop exercise soon 4+ : severe breathlessness - exercise must stop now !

6 - 20% effort % effort - Very, very light (Rest) % effort % effort - Very light - gentle walking % effort % effort - Fairly light % effort % effort - Somewhat hard - steady pace % effort % effort - Hard % effort % effort - Very hard % effort % effort - Very, very hard 20 - Exhaustion Borg Scale (6-20)

Borg Scale (1-10) l 0 - Nothing at all l 1 - Very light l 2 - Fairly light l 3 - Moderate l 4 - Some what hard l 5 - Hard l 6 l 7 - Very hard l 8 l 9 l 10 - Very, very hard

How Do I Choose A Test ? l Let the clinical exercise test reflect the type of job that will be performed in the workplace. l Treadmill tests l Upper arm ergometry l Repetitive lifting/weight carrying test

When Does the Patient Return To Work ? l Perhaps a job analysis is appropriate to help the patient make the decision as to when they return to work

Possibly……. l Ascertain the job demands in terms of maximal METs required to function in a satisfactory fashion l Individualize rehab to match job demands l Ergonomic evaluation of the work station