Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation

Abstract

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

Objectively identified comorbidities in COPD: impact on pulmonary rehabilitation outcomes

“…Our study proves that common comorbidities, in general, do not influence the likelihood of improving following PR. Moreover, exercise has been suggested as the cornerstone of PR in COPD [1], and this strategy has been used as therapy in other chronic diseases as well, such as cardiovascular and metabolic diseases [14,15]. Therefore, patients with COPD and the above mentioned comorbidities may benefit even more from PR.…”

Effects of Different Aerobic Exercise Programs with Nutritional Intervention in Primary Hypertensive and Overweight/Obese Adults: EXERDIET-HTA Controlled Trial

“…First ventilatory threshold (VT 1 ) can be identified as the point of transition in the carbon dioxide production (VCO 2 ) vs. VO 2 slope from less than 1 to greater than 1, or VT 1 is also identifiable as the nadir of the ventilatory equivalent (VE) of VO 2 vs work rate relationship. Second ventilatory threshold (VT 2 ) is identifiable as the nadir of the VE/VCO 2 vs work rate relationship [26]. After completion of the test, participants will remain on the bike five more minutes for recovery with ECG and BP monitoring.…”

“…Peak oxygen uptake is defined as the highest oxygen uptake (VO 2 peak) value attained toward the end of the test. Achievement of true peak effort can be assumed in the presence of two or more of the following criteria: 1) volitional fatigue (>18 on BORG scale), 2) peak respiratory exchange ratio (VCO 2 /VO 2 ) ≥ 1.1, 3) achieving >85% of age predicted HRmax, and 4) failure of VO 2 and/or HR to increase with further increases in work rate [26]. Table 2: Overview of the assessment schedule at baseline and follow-up in the EXERDIET-HTA study.…”

Is the Cardiovascular Response Equivalent Between a Supervised Center-Based Setting and a Self-care Home-Based Setting When Rating of Perceived Exertion Is Used to Guide Aerobic Exercise Intensity During a Cardiac Rehabilitation Program?

“…Nevertheless, oxygen uptake is complex to assess and is not available across all exercise settings, and HR can be difficult to apply in some cardiac patients because of reasons such as arrhythmia or the use of β-blockers. 7 Rating of perceived exertion (RPE) 9 isasubjectiveassessment method that is widely accepted for guiding exercise intensity and recommended in current guidelines for exercise-based CR. 8,10 The simplicity of RPE makes it an ideal tool to use in routine practice across settings.…”

“…Adequate exercise intensity is a key consideration as it is closely associated with the level of improvement in exercise capacity and associated reduction in future cardiac events. 7,8 Exercise intensity is often estimated using objective measurements such as oxygen uptake or heart rate (HR). Nevertheless, oxygen uptake is complex to assess and is not available across all exercise settings, and HR can be difficult to apply in some cardiac patients because of reasons such as arrhythmia or the use of β-blockers.…”