CHAPTER 20 • EXERCISE TESTING 125- If score is up to +5, the patient has a very good prog-
nosis and can be followed safely with regular exercise
testing. The 5-year survival for this group was 97%. A
patient in the high-risk group (TM score ≤11) has a
poor prognosis with a 5-year mortality >25%. The ET
score is thus valuable for prognosis and should be cal-
culated in all patients undergoing CAD evaluation.
EXERCISE PRESCRIPTION (ACC/AHA GUIDELINES
FOR EXERCISE TESTING, 1997; AMERICAN
COLLEGE OF SPORTS MEDICINE, 2000a)
- The exercise test can assist in writing the exercise pre-
scription. A symptom-limited test establishes a base-
line fitness level and establishes a parameter for
improving fitness. The ACSM recommends exercise
intensities between 55 and 90% of HRmax, or 50–85%
of VO2 max. The conditioning range for most adults to
improve cardiorespiratory fitness is between 70 and
85% of HRmax (65–80% VO2 max).
SPECIAL CONSIDERATIONS
IN ATHLETES
- There are no specific indications for testing athletes,
although they are tested occasionally for fitness and
exercise prescription. The Bruce protocol, with gas
exchange to establish a VO2 max, is most often
employed. The Astrand, Costill, or ramp protocols
may also be used (Marolf, Kuhn, and White, 2001). - Athletes manifest many differences than the general
population both clinically and on EKG. They com-
monly have increased ventricular volume and mass,
along with sinus bradyarrhythmias. It is not uncom-
mon to see certain EKG findings such as 1st degree
AV blocks, right axis deviation, ventricular hypertro-
phy with repolarization abnormalities, or incomplete
right bundle branch block. All these findings are
normal variants known as the athletic heart syndrome
(Hughston, Puffer, and Rodney, 1985). - Interpretation of the exercise test in this population
incorporates the same criteria as the general popula-
tion; however, because of the variants stated above,
there is a greater probability of a false positive test.
SUMMARY
- The EST remains a valuable tool for diagnosing coro-
nary artery disease, evaluating prognosis, and devel-
oping an exercise prescription. By implementing the
test appropriately, the primary care physician can
enhance its validity and usefulness in clinical decision
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