Fitmate MED: Clinical Exercise Testing (Desktop), via Flickr.

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ACSM's Guidelines for Exercise Testing and Prescription

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  • In the last several years, Clinical Exercise Testing has become an increasingly important tool for patient evaluation in clinical medicine due to a growing awareness of the limitations of traditional resting cardiopulmonary measurements. Emphasizing scientific and technological advances and focusing on clinical applications for patient diagnosis and management, this volume provides a comprehensive interdisciplinary review of clinical exercise testing, concentrating on Cardiopulmonary Exercise Testing (CPET). 25 reader-friendly chapters discuss important topics, including the physiologic responses to exercise in normal subjects, in the aged and in various disease states; the set-up of an exercise lab; the methodology and protocols used for clinical exercise testing; and an integrative approach to the interpretation of CPET results. CPET in heart failure, deconditioning, COPD, ILD, pulmonary vascular disease, neuromuscular disease, and asthma is thoroughly discussed.

    An emergency medical response plan, coupled with periodic emergency drills, should be in place in any facility that conducts clinical exercise testing.

  • In support of previously published guidelines and a recent AHA scientific statement, it is the consensus of this writing group that, in most cases, clinical exercise tests can be safely supervised by properly trained nonphysician health professionals if the individual supervising the test meets competency requirements for exercise test supervision, is fully trained in cardiopulmonary resuscitation, and is supported by a physician skilled in exercise testing or emergency medicine who is in close proximity for pretest assessments or complications that may arise.

    The qualified nonphysician exercise test supervisor should secure and strive to maintain competencies consistent with his/her assigned duties, education, and credentialing. Preferably, this may be accomplished by maintaining active status with an appropriate professional credential and engaging in continuing education activities. These individuals also should interact with the medical director in jointly conducted clinical exercise tests and emergency drills. Maintenance of skills related to basic life support training also is essential, including use of an automated external defibrillator. The nonphysician delegate supervising any exercise test may be expected to activate a physician-directed emergency response when a need arises.

    Assessment
    Must
    Complete
    Title Exam Length Weight Mode No. Words
    Practical Examination 10%
    Assessment Notes

    10 minutes practical examination of particular skills in the exercise laboratory

    Relates to Learning Outcomes (LO)

    LO: 1, 2, 3, 4

    Practical Report 30% 3000
    Assessment Notes

    Four practical reports. It is mandatory to pass this component in order to pass the unit.

    Relates to Learning Outcomes (LO)

    LO: 1, 2, 4

    Final Examination 2 hrs 15 mins 60%
    Assessment Notes

    It is mandatory to pass this component in order to pass the unit.

    Relates to Learning Outcomes (LO)

    LO: 1, 2, 4


    Learning Outcomes (LO) Upon completion of this unit, students will be able to:
    1. capture medical and personal history and using applied knowledge and judgement assess a person's suitability to undertake a clinical exercise test;
    2. prepare the person, with demonstrated autonomy, for a clinical exercise test, including ECG;
    3. use technical analysis skills to interpret common ECG rhythms; and
    4. develop and transmit, using specialist advice, individually tailored exercise testing protocol for a person.

  • Chapter 1 Determinants of the physiological systems responses to muscular exercise in healthy subjects
    1
    Chapter 2 Discriminating features of responses in cardiopulmonary exercise testing
    36
    Chapter 3 Patterns of cardiopulmonary response to exercise in lung diseases
    69
    Chapter 4 Patterns of response diagnostic for cardiac disease
    93
    Chapter 5 Equipment measurements and quality control in clinical exercise testing
    108
    Chapter 6 Laboratory tests
    129
    Chapter 7 Walking for the assessment of patients with chronic obstructive pulmonary disease
    148

    Accurate measurement of myocardial oxygen uptake requires cardiac catheterization to obtain coronary arterial and venous oxygen content. Myocardial oxygen uptake can be estimated during clinical exercise testing by the product of heart rate and systolic blood pressure, which is called the double product or rate-pressure product. There is a linear relation between myocardial oxygen uptake and coronary blood flow. During exercise, coronary blood flow increases as much as 5-fold above the resting value. A subject with obstructive coronary artery disease (CAD) often cannot maintain adequate coronary blood flow to the affected region and supply the metabolic demands of the myocardium during exercise; consequently, myocardial ischemia occurs. Myocardial ischemia usually occurs at the same rate-pressure product rather than at the same external workload (eg, exercise test stage).

Clinical Exercise Testing-Test 2 Flashcards | Quizlet

The logistics of each clinical exercise test performed should account for characteristics of the individual patient undergoing the assessment. For example, patients who present with significant functional compromise (eg, New York Heart Association class III heart failure) would benefit from a conservative testing protocol. Likewise, older patients often benefit from lower-intensity protocols than those used in young adults. The nonphysician health professional must demonstrate an ability to make appropriate decisions about the mode of exercise and the protocol to use on a case-by-case basis. He/she must also demonstrate an ability to appropriately explain the rationale for exercise testing to the patient, to obtain informed consent, and to prepare the patient for the exercise test.