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ACSM’s Guidelines For Exercise Testing And Prescription. Chapter 5 Clinical Exercise Testing. Exercise Testing. Best used for : Patients w/ signs & symptoms who are probably + for CAD Persons w/ multiple risk factors but who are asymptomatic.

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exercise testing
Exercise Testing
  • Best used for :
      • Patients w/ signs & symptoms who are probably + for CAD
      • Persons w/ multiple risk factors but who are asymptomatic
slide3
Individuals who have jobs requiring high work capacities or for jobs where public safety is of primal importance
  • People with CAD to assess residual cardiac function
adverse exercise signs indicating poor prognosis
Adverse Exercise Signs Indicating Poor Prognosis
  • Work capacities < 5 METs
  • Significant ST segment depression w/ low level work intensities
  • Hypotensive BP w/ exercise
types of tests
Types Of Tests
  • Treadmill tests
      • Bruce or Ellestad - good for young folks because the between-stage graduations of grade and speed are more aggressive
      • USAFSAM or Naughton - good for older folks because of the more gradual between-stage progressions of grade and speed
bruce protocol gxt
Bruce Protocol GXT

Stage Speed Grade Dur.

I 1.7 mph 10 % 3 min

II 2.5 mph 12 % 3 min

III 3.4 mph 14 % 3 min

IV 4.2 mph 16 % 3 min

V 5.0 mph 18 % 3 min

VI 5.5 mph 20 % 3 min

modified bruce
Modified Bruce

Stage Speed Grade Dur.

I 1.7 mph 0 % 3 min

II 1.7 mph 5 % 3 min

III 1.7 mph 10 % 3 min

IV 2.5 mph 12 % 3 min

V 3.4 mph 14 % 3 min

VI 4.2 mph 16 % 3 min

VII 5.0 mph 18 % 3 min

usafsam gxt
USAFSAM GXT

Stage Speed Grade Dur.

I 2.0 mph 0 % 3 min

II 3.3 mph 0 % 3 min

III 3.3 mph 5 % 3 min

IV 3.3 mph 10% 3 min

V 3.3 mph 15% 3 min

VI 3.3 mph 20% 3 min

reasons to stop the test
Reasons To Stop The Test
  • Drop in BP with increases in workload
  • Moderate to severe angina
  • Ataxia, dizziness, syncope
  • Dysrhythmias
  • ST segment elevations and depressions
  • Hypertensive responses
  • SOB beyond exercise norms
how should i monitor the patient
How Should I Monitor The Patient ?
  • HR & BP
  • Anginal Scale
  • Dyspnea Scale
  • Borg’s RPE Scale
  • EKG monitoring - Leads I, II, V5
  • Patient’s subjective symptomatology
how do i choose a test
How Do I Choose A Test ?
  • Let the clinical exercise test reflect the type of job that will be performed in the workplace.
      • Treadmill tests
      • Upper arm ergometry
      • Repetitive lifting/weight carrying test
when does the patient return to work
When Does the Patient Return To Work ?
  • Perhaps a job analysis is appropriate to help the patient make the decision as to when they return to work
possibly
Possibly…….
  • Ascertain the job demands in terms of maximal METs required to function in a satisfactory fashion
  • Individualize rehab to match job demands
  • Ergonomic evaluation of the work station