Exercise testing is a very important part of a cardiac exercise program prior to admission and throughout the further course. It gives indispensable data regarding functional capacity, heart rate and blood pressure adaptation to exercise, residual myocardial ischaemia, cardiac arrhythmia. It allows the calculation of a training heart rate (THR) for aerobic training. It is also very useful in detecting changes in clinical status, adjusting the intensity of the training program and to simply measure the gains achieved through a cardiac rehabilitation program. Exercise prescription is based on reliable exercise testing and is fundamental to create your individual Heartworks Exercise Plan.

Heart Rate Response

Heart rate (HR) is a key parameter in heart performance testing and training. But not just the peak predicted HR, but also baseline, increase with exercise and rate of recovery give us relevant information.

Diagnosis

In cardiac rehabilitation and fitness exercise testing is mainly used to design a training program and to ensure safe training goals. Exercise testing is also used in the initial diagnosis of coronary artery disease, however the specificity and sensitivity of the test are greatly improved by combing it with an echocardiogram to a stress echo. 

Individual Parameter

Workload is simulated by the treadmill speed (km/h) and incline grade (%), bike ergometers use Watt. METs measure metabolic equivalent, it is defined as the amount of oxygen consumed and 1 MET is equivalent to 3.5 ml O2 / kg / min. We can calculate predicted and achieved METs and use this to classify the functional capacity, track progress and design training programs.
ischaemia - Cardiac ischemia may be asymptomatic or may cause chest pain, known as angina pectoris. It occurs when the heart muscle, or myocardium, receives insufficient blood flow. This most frequently results from atherosclerosis, which is the long-term accumulation of cholesterol-rich plaques in the coronary arteries. Ischemic heart disease is the most common cause of death in most Western countries and a major cause of hospital admissions.
Click to learn more about heart anatomy. 

Individual Risk

Exercise with coronary artery disease is generally beneficial, however it needs to be tailored to the individual patient. Above is an example of a patient with remaining coronary artery disease - an angiogram has shown that small arteries coming off the right coronary artery are blocked and too small for a stent. At a heart rate of 131 /min there is evidence for ischaemia, he stopped the test at 137 bpm. An exercise program would have to be designed avoiding ischaemia, this will have to be re assessed over time. Also his medication might have to be adjusted which might affect the training program highlighting the need for an individual approach. 
From the American College of Cardiologists / American Heart Association:
" Exercise testing in cardiac rehabilitation is essential in development of the exercise prescription to establish a safe and effective training intensity, in risk stratification of patients to determine the level of supervision and monitoring required during exercise training sessions, and in evaluation of training program outcome "
"Exercise testing in the stable cardiac patient who continues an exercise training program is often performed after the initial 8 to 12 weeks of exercise training and periodically thereafter [...] Such testing may be useful to rewrite the exercise prescription, evaluate improvement in functional capacity, and provide feedback to the patient"