Jonathan Myers

Guidelines for Clinical Exercise Testing Laboratories A Statement for Healthcare Professionals From the Committee on Exercise and Cardiac Rehabilitation, American Heart Association

Exercise testing is a noninvasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercise. Exercise testing facilities range from the sophisticated research setting to more conventional equipment in the family practitioner’s or internist’s office. Regardless of the range of testing procedures performed in any given laboratory, basic equipment, personnel, and protocol criteria are necessary to conduct meaningful tests and ensure the comfort and safety of the patient. nnThis statement provides a guide to initiating and maintaining a high quality clinical laboratory for administering graded exercise tests to adults. Pediatric testing is addressed separately.1 nn### Environment nnExercise testing equipment varies in size. The testing room should be large enough to accommodate all the equipment necessary, including emergency equipment and defibrillator, while maintaining walking areas and allowing adequate access to the patient in emergency situations. Compliance with local fire codes and with procedures for other types of emergencies (eg, earthquake, hurricane) is essential. nnThe laboratory should be well lighted, clean, and well ventilated with temperature and humidity control. Including posters or pictures of outdoor scenes can reduce boredom and anxiety, particularly if the room has no windows. A wall-mounted clock with a “sweep” second hand or a digital counter is useful. The examining table should have space for towels, tape, and other items needed for patient preparation and testing. A curtain for privacy during patient preparation is useful. Minimizing interruptions and maintaining privacy allows the patient and laboratory personnel to concentrate on the testing procedure. nnTo assess the level of effort, a large-print scale of perceived exertion2 (Table 1⇓) should be mounted on the wall in clear view of the patient. The same scale has been used to assess symptoms of fatigue, dyspnea, or leg fatigue/pain.3 Dyspnea can also be measured by means of …

Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing: Data From the Fitness Registry and the Importance of Exercise National Database

OBJECTIVEnTo develop standards for cardiorespiratory fitness by establishing reference values derived from cardiopulmonary exercise testing (CPX) in the United States.nnnPATIENTS AND METHODSnEight laboratories in the US experienced in CPX administration with established quality control procedures contributed data from January 1, 2014, through February 1, 2015, from 7783 maximal (respiratory exchange ratio, ≥ 1.0) treadmill tests from men and women (aged 20-79 years) without cardiovascular disease (CVD) to the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). Percentiles of maximal oxygen consumption (VO 2max) for men and women were determined for each decade from 20 years of age through 79 years of age. Comparisons of VO 2max were made to reference data established with CPX data from Norway and to US reference data established without CPX measurements.nnnRESULTSnThere were significant differences between sex and age groups for VO 2max. In FRIEND, the 50th percentile VO 2max of men and women aged 20 to 29 years decreased from 48.0 and 37.6 mLO2 · kg(-1) · min(-1) to 24.4 and 18.3 mLO2 · kg(-1) · min(-1) for ages 70 to 79 years, respectively. The rate of decline in this cohort during a 5-decade period was approximately 10% per decade.nnnCONCLUSIONnThese are the first cardiorespiratory fitness reference data using measures obtained from CPX in the United States. FRIEND can be used to provide a more accurate interpretation of measured VO 2max from maximal exercise tests for the US population compared with previous standards on the basis of workload-derived estimations.

Cardiorespiratory Fitness and the Incidence of Chronic Disease

An inverse association between cardiorespiratory fitness and the incidence of chronic disease has been established by large, well-designed epidemiologic studies. Collectively, the findings support that these health benefits are realized at relatively moderate levels of exercise or physical activity and increase in a dose-response fashion. This supports the concept that physical activity should be promoted by health care professional for optimal health. This review is focused on the influence of physical activity and cardiorespiratory fitness on the incidence of cardiometabolic risk factors and diseases.