Interpreting the Clinical Exercise Test
(Cont.)
• Cardiopulmonary Exercise Testing
• A major advantage of measuring gas exchange during exercise is a more accurate measurement of exercise capacity
• CPET data may be particularly useful in defining prognosis and defining the timing of cardiac transplantation and other advanced therapies in patients with heart failure
Interpreting the Clinical Exercise Test
(Cont.)
• Maximal versus Peak Cardiorespiratory Stress
• When an exercise test is performed as part of the evaluation of IHD, patients should be
encouraged to exercise to their maximal level of exertion or until a clinical indication to stop the test is observed
• Various criteria have been used to confirm that a maximal effort has been elicited during a GXT:
• A plateau in VO2peak
• Failure of HR to increase with increases in workload
• A post exercise venous lactate concertation > 8.0 mmol L-1
Diagnostic Value of Exercise Testing for
the Detection of Ischemic Heart Disease
• The diagnostic value of the clinical exercise test for the
detection of IHD is influenced by the principles of conditional probability
• The factors that determine the diagnostic value of exercise testing (and other diagnostic tests) are the sensitivity and
Diagnostic Value of Exercise Testing for
the Detection of Ischemic Heart Disease
(Cont.)
• Sensitivity, Specificity and Predictive Value
• Sensitivity refers to the ability to positively identify patients who truly have IHD
• Specificity refers to the ability to correctly identify patients who do not have IHD.
• The predictive value of clinical exercise testing is a measure of how accurately a test result (positive or negative) correctly
identifies the presence or absence of IHD in patients and is calculated from sensitivity and specificity
• TP and FN
Diagnostic Value of Exercise Testing for
the Detection of Ischemic Heart Disease
(Cont.)
• Clinical Exercise Test Data and Prognosis
• First introduced in 1991 when the Duke Treadmill Score was published, the implementation of various exercise test
scores that combine information derived during the exercise test into a single prognostic estimate has gained popularity. • The most widely accepted and used of these prognostic
Clinical Exercise Tests with Imaging
• When the resting ECG is abnormal, exercise testing may be coupled with other techniques designed to either augment the information provided by the ECG or to replace the ECG when resting abnormalities (Box 5.5) make evaluation of changes during exercise impossible
Field Walking Test
• Non–laboratory-based clinical exercise tests are also frequently used in patients with chronic disease. These are generally classified as field or hallway walking tests and are typically considered submaximal
• Similar to maximal exercise tests, field walking tests are used to evaluate exercise capacity, estimate prognosis, and evaluate response to treatment
Children and Adolescents
• Children and adolescents (defined as individuals 6–17 yr) are more physically active than their adult counterparts.
Children and Adolescents
• The 2008 Physical Activity Guidelines for Americans call for children and adolescents to engage in at least 60 min ∙ day−1
of moderate-to-vigorous intensity PA and to include vigorous intensity PA, resistance exercise, and bone loading activity on at least 3 d ∙ wk−1
• In addition to the PA guidelines, an expert panel from the National Heart, Lung, and Blood Institute and the American
Children and Adolescents (cont.)
• Children and adolescents are physiologically adaptive to endurance exercise training, resistance training, and bone loading exercise.
Children and Adolescents (cont.)
• Most young individuals are healthy and able to start moderate intensity exercise training without medical screening. Vigorous exercise can be initiated after safely participating in moderate exercise.
• Because prepubescent children have immature skeletons,
Children and Adolescents (cont.)
• Physiologic responses to acute, graded exercise are qualitatively similar to those seen in adults.
• There are important quantitative differences, many of which are related to the effects of body mass, muscle mass, and height.
Children and Adolescents Exercise Testing
• Exercise testing for clinical purposes is generally notindicated for children or adolescents unless there is a health concern.
• The exercise testing protocol should be based on the reason the test is being performed and the functional capability of the child or adolescent.
Children and Adolescents Exercise Testing (cont.)
• Treadmill and cycle ergometers should be available for testing. Treadmills tend to elicit a higher peak
oxygen uptake (VO2peak) and maximum HR (HRmax). Cycle ergometers provide less risk for injury but
need to be correctly sized for the child or adolescent.
• Children and adolescents may require extra
motivation and support during the exercise test compared to adults.
Children and Adolescents Exercise Testing
(cont.)
• Health/fitness testing may be performed outside of the clinical setting.
• The components of the Fitnessgram test battery include body composition (BMI or skinfold
thicknesses), cardiorespiratory fitness (1-min
