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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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 !

12. 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 !

13. 6 - 20% effort 7 - 30% effort - Very, very light (Rest) 8 - 40% effort 9 - 50% effort - Very light - gentle walking 10 - 55% effort 11 - 60% effort - Fairly light 12 - 65% effort 13 - 70% effort - Somewhat hard - steady pace 14 - 75% effort 15 - 80% effort - Hard 16 - 85% effort 17 - 90% effort - Very hard 18 - 95% effort 19 - 100% effort - Very, very hard 20 - Exhaustion Borg Scale (6-20)

14. 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

15. 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

16. 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

17. 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