of experts from the Working Group on Cardiac Rehabilitation and Exercise Physiology of the Polish Cardiac Society concerning the indications, performance technique, and interpretation of results for CPET in adult cardiology. Cardiopulmonary exercise testing CPET is an electrocardiographic exercise test expanded with exercise evaluation of ventilation and

he number of people who survive myocardial infarction or undergo percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) is growing. These people require adequate treatment and care not only pharmacologically but also nonpharmacologically: physiotherapeutic, psychological and educational. Comprehensive cardiac rehabilitation (CR) is designed to support patients with coronary heart disease (CHD) in their physical, psychological and emotional recovery after acute coronary events and to help them change lifestyle and risk factors, as well as to make their lives longer and improve their quality.Most published studies analyzing the effects of CR have revealed a reduction in total mortality by an average of 30% and cardiovascular mortality by an average of 40% [1][2][3][4][5][6][7][8][9][10] and also reduction in cardiovascular events risk. 1,4,11 Recently, not only mortality and morbidity but also healthrelated quality of life (QOL) has become a key goal for patients with CHD. Many published studies have revealed improvements in the health-related QOL of patients with CHD after CR programs, either the residential model or ambulatory CR (ACR). [12][13][14][15][16][17][18][19][20][21][22][23] The aim of this study was to evaluate the impact of different models of CR, residential vs ambulatory, on healthrelated QOL according to the exercise capacity of patients with CHD. MethodsThis study was designed as a nonrandomized prospective multicenter study in Poland: the National Program of Prevention and Therapy of Cardiovascular Diseases (POLKARD). We studied 562 patients with CHD from 9 centers of CR in Poland. Consecutive patients were referred to 3 ACR and 6 residential CR (RCR) centers no longer than 2 weeks after myocardial infarction or PCI, and no longer than 6 weeks after CABG.The reason for the choice of ACR or RCR center was not the patient's clinical state or risk profile for cardiovascular events, but which type of CR was available where the patient lived. Therefore, randomization in our study was impossible.The first group consisted of 313 patients aged 56.1±8.8 (Received April 24, 2008; revised manuscript received October 8, 2008; accepted October 26, 2008; released online January 29, 2009) Background: The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD). Methods and Results:The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in bo...

A b s t r a c tElectrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk stratification in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

The intensity of NW training in field conditions in patients after coronary events was 59% of VO₂ reserve, and its peak instantaneous intensity reached values obtained during CPET on a treadmill. EE during NW in the study group was 8.1 kcal/min. Chronotropic response during NW was 64% of HRR, and its instantaneous increase reached the maximum HR obtained during CPET.

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