AHA Scientific Statement 873 T he 2001 version of the exercise standards statement 1 has served effectively to reflect the basic fundamentals of ECG–monitored exercise testing and training of both healthy subjects and patients with cardiovascular disease (CVD) and other disease states. These exercise standards are intended for use by physicians, nurses, exercise physiologists and special- ists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. Because of an abundance of new research in recent years, a revision of these exercise standards is appropriate. The revision deals with basic fundamentals of testing and training, with no attempt to dupli- cate or replace current clinical practice guidelines issued by the American Heart Association (AHA), the American College of Cardiology Foundation (ACCF), and other professional societies. (Circulation. 2013;128:873-934.) © 2013 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0b013e31829b5b44 The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 1, 2013. A copy of the document is available at http://my.americanheart.org/statements by selecting either the “By Topic” link or the “By Publication Date” link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com. The American Heart Association requests that this document be cited as follows: Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873–934. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the “Policies and Development” link. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright- Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page. Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association Gerald F. Fletcher, MD, FAHA, Chair; Philip A. Ades, MD, Co-Chair; Paul Kligfield, MD, FAHA, Co-Chair; Ross Arena, PhD, PT, FAHA; Gary J. Balady, MD, FAHA; Vera A. Bittner, MD, MSPH, FAHA; Lola A. Coke, PhD, ACNS, FAHA; Jerome L. Fleg, MD; Daniel E. Forman, MD, FAHA; Thomas C. Gerber, MD, PhD, FAHA; Martha Gulati, MD, MS, FAHA; Kushal Madan, PhD, PT; Jonathan Rhodes, MD; Paul D. Thompson, MD; Mark A. Williams, PhD; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention Table of Contents Exercise Testing ................................. 874 Purposes of Exercise Testing ..................... 874 Physiology of Exercise Testing ................... 874 Types of Exercise .............................. 874 Cardiovascular Responses to Exercise in Normal Subjects........................... 874 Exercise Testing Procedures ..................... 876 Clinical and Cardiopulmonary Responses During Exercise ............................. 882 The ECG During Exercise ....................... 883 Stress Imaging Modalities and Exercise Testing ...... 889 Prognosis and Diagnosis ........................ 890 Additional Uses of Exercise Testing ............... 893 Interpretation of the Exercise Test in Specific Populations and Settings ............... 893 Drugs and Electrolytes in Exercise Testing .......... 902 The Exercise Electrocardiographic Test Report ....... 903 Exercise Training ................................ 903 Exercise and Health ............................ 903 Exercise Prescription for Apparently Healthy Individuals .......................... 907 Exercise Training Techniques .................... 908 Behavioral Aspects of Initiating and Sustaining an Exercise Program ................ 911 Evaluation and Exercise Prescription in Patients With CVD........................... 912 Effects of Exercise Training in Patients With CVD........................... 914 Prognostic Benefits of Exercise in Patients With CVD........................... 914 Targeting Exercise Prescription to Relevant Outcomes .......................... 915 References ..................................... 920 by guest on May 27, 2016 http://circ.ahajournals.org/ 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