Step 1: Know your patient

Aim

• Eligibility for exercise testing and training?
  • Contraindications
  • level of supervision needed?

Absolute contra-indications

• Acute MI (<2 days)
• High risk unstable angina
• Uncontrolled cardiac dysrhythmias
• Active endocarditis
• Symptomatic or severe heart valve stenosis
• Decompensated symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute noncardiac disorder that may affect exercise performance or be aggravated by exercise
• Acute myocarditis or pericarditis
• Physical or mental disability that would preclude safe and adequate test performance
• Resting hypoxia with Sa <85%

Relative contra-indications

• Left main coronary stenosis or equivalent
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Tachyarrhythmias or bradyarrhythmias
• Atrial fibrillation with rapid ventricular rate
• Hypertrophic cardiomyopathy
• High degree AV block
• Severe resting arterial hypertension (SBP > 200mmHg, DBP > 110mmHg)

Content

• Why
  • Reason for visit/referral
• Who
  • demographics
    • age
    • sex
    • mental/social status
    • ...
  • cardiovascular risk factors
  • co-morbidities
  • medication and devices
  • lifestyle including physical activity
• What to evaluate
  • personal and medical history
  • physical examination
  • clinical examination

Step 2: Assess CPET + other relevant (fitness) tests

Aim

• Screening purposes
• Measure peak VO2 and other prognostic markers
• Underlying cause of exercise intolerance
• To identify strength and weaknesses
• Optimise exercise prescription
• Baseline and follow-up data to evaluate the progress of exercise program

Content

• Cardiorespiratory
  • Maximal aerobic power
  • Submaximal functional tests
• Muscular fitness
  • Isometric strength
  • Muscular strength
  • Muscular endurance
  • Power
• Morphological
  • Body composition
  • Body mass
  • Flexibility
  • Bone density
• Motor
  • Balance
  • Coordination
  • Agility
  • ...

Goals - of Step 1 and 2

• SMARTER
  • S: Specific
  • M: Measurable
  • A: Attainable
  • R: Relevant or realistic
  • T: Timely
  • E: Evaluate
  • R: Revise

Step 3.1: Exercise Prescription

Always apply basic principles of exercise program design

• Principle of interindividual variability
• Specificity -of- training principle
• Overload training principle
• Principle of Progression
• Principle of Initial values
• Principle of Diminishing returns
• Principle of Reversibility