Exercise Standards

Publisher Website
Google Scholar
Abstract
The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals free from clinical manifestations of cardiovascular disease as well as those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in the regular exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association in Circulation (1992;86:340-344). These guidelines are a revision of the 1990 standards1 of the AHA that addressed the issues of exercise testing and training. An update of background, scientific rationale, and selected references are provided, and current issues of practical importance in the clinical use of these standards are considered. ### The Cardiovascular Response to Exercise Exercise, a common physiological stress, can elicit cardiovascular abnormalities not present at rest and can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a “stress test.” This is particularly relevant considering the increased use of nonexercise stress tests. #### Types of Exercise Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistive (a combination of isometric and isotonic).2 3 Isometric exercise, defined as a muscular contraction without movement (eg, handgrip), imposes greater pressure than volume load on the left ventricle in relation to the body’s ability to supply oxygen. The cardiovascular response to isometric exercise is difficult to grade. In addition, cardiac output is not increased as much as in isotonic exercise because increased resistance in active muscle groups limits blood flow. Isotonic exercise, defined as muscular contraction resulting in movement, primarily …