Exercise standards. A statement for health professionals from the American Heart Association. G F Fletcher, V F Froelicher, L H Hartley, W L Haskell and M L Pollock Circulation. 1990;82:2286-2322 doi: 10.1161/01.CIR.82.6.2286 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1990 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/82/6/2286.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
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2286
AIL4 Medical/Scientific Statement Special Report
Exercise Standards A Statement for Health Professionals From the American Heart Association Writing Group Gerald F. Fletcher, MD, Chairman; Victor F. Froelicher, MD; L. Howard Hartley, MD; William L. Haskell, PhD; and Michael L. Pollock, PhD T he purpose of this report is to provide standards and guidelines for exercise testing and training of persons free of clinical manifestations of cardiovascular disease and those with known cardiovascular disease. They are directed to and appropriate for physicians, nurses, exercise specialists, technologists, and other health professionals involved in regular exercise testing and training of these populations. These standards and guidelines coincide with the American Heart Association's "Statement on Exercise" published in Circulation
(1990;81:396-398). These guidelines constitute a revision of earlier publications of the American Heart Association (AHA) that addressed the issues of exercise testing and training. Background and scientific rationale are provided and issues of practical importance in the clinical use of these standards are considered. Selected references are included.
Exercise Testing The Cardiovascular Response to Exercise Exercise, a common physiological stress, can elicit cardiovascular abnormalities not present at rest and can be used to determine the adequacy of cardiac function. Exercise is only one of many stresses to which humans can be exposed; therefore, it is more appropriate to call an "exercise" test exactly that and not a "stress test." Types of exercise Two types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: Isometric (static) or isotonic (dynamic).1 Isometric exercise, defined as a constant muscular contraction without movement (e.g., handgrip), imposes greater pressure than volume load on the left ventricle in "Exercise Standards" was approved by the American Heart Association Steering Committee on February 21, 1990. Correspondence should be sent to the Office of Scientific Affairs, American Heart Association, 7320 Greenville Avenue, Dallas, TX 75231.
relation to the body's ability to supply oxygen. The cardiovascular response to isometric exercise is difficult to grade since the response to activation of a small muscle group is similar to the response to a large muscle group. In addition, cardiac output is not increased as much since increased resistance in active muscle groups limits blood flow. Isotonic exercise, defined as muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the cardiovascular response is proportional to the severity of the exercise. Key Point: Dynamic exercise is preferred for testing because it puts a volume stress rather than a pressure stress on the heart and it can be graduated. However, most activities usually combine, in varying degrees, both types of exercise. Maximum oxygen uptake When dynamic exercise is begun, oxygen uptake by the lungs quickly increases. After the second minute, oxygen uptake usually remains relatively stable (steady state) at each intensity of exercise. During a steady state, heart rate, cardiac output, blood pressure, and pulmonary ventilation are maintained at reasonably constant levels.1 V°2 max is the greatest amount of oxygen a person can use while performing dynamic exercise involving a large part of total muscle mass.2 Vo2 max represents the amount of oxygen transported and used in cellular metabolism. It is convenient to express oxygen uptake in multiples of sitting, resting requirements. The metabolic equivalent (MET) is a unit of sitting, resting oxygen uptake (3.5 ml 02 per kilogram of body weight per minute [ml . kg` * min-1]). Rather than determining each person's true resting oxygen uptake, a MET is taken as this average. Vo2 ma, is significantly related to age, gender, exercise habits, heredity, and cardiovascular clinical status. Age: Maximum values of V02 max occur between ages 15 and 30, decreasing progressively with age. At age 60, mean Vo2 max in men is approximately three fourths that at age 20. With a sedentary lifestyle,
Downloaded from http://circ.ahajournals.org/ at Tulane University on September 8, 2014
Writing Group Exercise Standards TABLE 1. Clinically Significant Key Metabolic Equivalents for Maximum Exercise 1 MET=resting 2 METs=level walking at 2 mph 4 METs=level walking at 4 mph
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/82/6/2286.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ at Tulane University on September 8, 2014
2286
AIL4 Medical/Scientific Statement Special Report
Exercise Standards A Statement for Health Professionals From the American Heart Association Writing Group Gerald F. Fletcher, MD, Chairman; Victor F. Froelicher, MD; L. Howard Hartley, MD; William L. Haskell, PhD; and Michael L. Pollock, PhD T he purpose of this report is to provide standards and guidelines for exercise testing and training of persons free of clinical manifestations of cardiovascular disease and those with known cardiovascular disease. They are directed to and appropriate for physicians, nurses, exercise specialists, technologists, and other health professionals involved in regular exercise testing and training of these populations. These standards and guidelines coincide with the American Heart Association's "Statement on Exercise" published in Circulation
(1990;81:396-398). These guidelines constitute a revision of earlier publications of the American Heart Association (AHA) that addressed the issues of exercise testing and training. Background and scientific rationale are provided and issues of practical importance in the clinical use of these standards are considered. Selected references are included.
Exercise Testing The Cardiovascular Response to Exercise Exercise, a common physiological stress, can elicit cardiovascular abnormalities not present at rest and can be used to determine the adequacy of cardiac function. Exercise is only one of many stresses to which humans can be exposed; therefore, it is more appropriate to call an "exercise" test exactly that and not a "stress test." Types of exercise Two types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: Isometric (static) or isotonic (dynamic).1 Isometric exercise, defined as a constant muscular contraction without movement (e.g., handgrip), imposes greater pressure than volume load on the left ventricle in "Exercise Standards" was approved by the American Heart Association Steering Committee on February 21, 1990. Correspondence should be sent to the Office of Scientific Affairs, American Heart Association, 7320 Greenville Avenue, Dallas, TX 75231.
relation to the body's ability to supply oxygen. The cardiovascular response to isometric exercise is difficult to grade since the response to activation of a small muscle group is similar to the response to a large muscle group. In addition, cardiac output is not increased as much since increased resistance in active muscle groups limits blood flow. Isotonic exercise, defined as muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the cardiovascular response is proportional to the severity of the exercise. Key Point: Dynamic exercise is preferred for testing because it puts a volume stress rather than a pressure stress on the heart and it can be graduated. However, most activities usually combine, in varying degrees, both types of exercise. Maximum oxygen uptake When dynamic exercise is begun, oxygen uptake by the lungs quickly increases. After the second minute, oxygen uptake usually remains relatively stable (steady state) at each intensity of exercise. During a steady state, heart rate, cardiac output, blood pressure, and pulmonary ventilation are maintained at reasonably constant levels.1 V°2 max is the greatest amount of oxygen a person can use while performing dynamic exercise involving a large part of total muscle mass.2 Vo2 max represents the amount of oxygen transported and used in cellular metabolism. It is convenient to express oxygen uptake in multiples of sitting, resting requirements. The metabolic equivalent (MET) is a unit of sitting, resting oxygen uptake (3.5 ml 02 per kilogram of body weight per minute [ml . kg` * min-1]). Rather than determining each person's true resting oxygen uptake, a MET is taken as this average. Vo2 ma, is significantly related to age, gender, exercise habits, heredity, and cardiovascular clinical status. Age: Maximum values of V02 max occur between ages 15 and 30, decreasing progressively with age. At age 60, mean Vo2 max in men is approximately three fourths that at age 20. With a sedentary lifestyle,
Downloaded from http://circ.ahajournals.org/ at Tulane University on September 8, 2014
Writing Group Exercise Standards TABLE 1. Clinically Significant Key Metabolic Equivalents for Maximum Exercise 1 MET=resting 2 METs=level walking at 2 mph 4 METs=level walking at 4 mph
