Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association
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The ACC/AHA recognize that their recommendations for exercise testing are based on conflicting evidence and divergent expert opinions.
“The American College of Cardiology/American Heart Association recommend exercise testing before engaging in moderate- or vigorous-intensity exercise when the risk of CVD is increased but recognize that these recommendations are based on conflicting evidence and divergent expert opinions (15).”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [15]
The American College of Cardiology/American Heart Association recommend exercise testing before engaging in moderate- or vigorous-intensity exercise when the risk of CVD is increased.
“The American College of Cardiology/American Heart Association recommend exercise testing before engaging in moderate- or vigorous-intensity exercise when the risk of CVD is increased but recognize that these recommendations are based on conflicting evidence and divergent expert opinions (15).”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [15]
Manual auscultation remains the recommended approach for exercise BP measurement.
“Manual auscultation remains the recommended approach [15,42] although there are automated, motion-tolerant devices in widespread clinical use that have shown reasonable concordance with manual or invasive exercise BP measures [47,48].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [42]
Guidelines recommend that BP measurement should take place before the exercise test, at every stage of exercise, and in recovery from an exercise test.
“Guidelines recommend that BP measurement should take place before the exercise test, at every stage of exercise (including peak/maximal intensity if such a test is performed), and in recovery from an exercise test [15,42].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [42]
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The Surgeon General's Vision for a Healthy and Fit Nation
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European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
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2016 European Guidelines on cardiovascular disease prevention in clinical practice
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2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes
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2024 ESC Guidelines for the management of elevated blood pressure and hypertension
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“266 Age, sex, ethnicity, and comorbidities, as well as individual preferences, should be considered for individual exercise prescription.”
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2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
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Self-citation2016 European Guidelines on cardiovascular disease prevention in clinical practice
Authors/Task Force Members, Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M. T., Corrà, U., Cosyns, B., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316653709 · Cited by 1,409 · see citing works
“Aerobic interval training and high-intensity interval training cannot yet be broadly recommended until further data on safety and efficacy are available.(266)”
Amsterdam, E. A., WENGER, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H. M., Kelly, R. F., Kontos, M. C., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000133 · Cited by 1,258 · see citing works
The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers
Kasapis, C., & Thompson, P. D. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.12.077 · Cited by 1,149 · see citing works
Association of Lifestyle and Genetic Risk With Incidence of Dementia
Lourida, I., Hannon, E., Littlejohns, T. J., Langa, K. M., Hyppönen, E., Kuzma, E., & Llewellyn, D. J. (2019) · JAMA · doi:10.1001/jama.2019.9879 · Cited by 881 · see citing works
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
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Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes
Lavie, C. J., Arena, R., Swift, D. L., Johannsen, N. M., Sui, X., Lee, D.-C., Earnest, C. P., Church, T. S., O’Keefe, J. H., Milani, R. V., et al. (2015) · Circulation Research · doi:10.1161/circresaha.117.305205 · Cited by 782 · see citing works
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ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers
Henzlova, M. J., Duvall, W. L., Einstein, A. J., Travin, M. I., & Verberne, H. J. (2016) · Journal of Nuclear Cardiology · doi:10.1007/s12350-015-0387-x · Cited by 700 · see citing works
Updating ACSM's Recommendations for Exercise Preparticipation Health Screening
RIEBE, D., FRANKLIN, B. A., THOMPSON, P. D., GARBER, C. E., WHITFIELD, G. P., MAGAL, M., & PESCATELLO, L. S. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000664 · Cited by 688 · see citing works
“The American College of Cardiology/American Heart Association recommend exercise testing before engaging in moderate- or vigorous-intensity exercise when the risk of CVD is increased but recognize that these recommendations are based on conflicting evidence and divergent expert opinions (15).”
BackgroundSmith, S. C., Blair, S. N., Bonow, R. O., Brass, L. M., Cerqueira, M. D., Dracup, K., Fuster, V., Gotto, A., Grundy, S. M., Miller, N. H., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01682-5 · Cited by 691 · see citing works
Medina-Leyte, D. J., Zepeda-García, Ó., Domínguez‐Pérez, M., González-Garrido, A., Villarreal-Molina, M. T., & Jacobo‐Albavera, L. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22083850 · Cited by 629 · see citing works
Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000134 · Cited by 1,059 · see citing works
Promoting Physical Activity and Exercise
Fletcher, G. F., Landolfo, C. K., Niebauer, J., Ozemek, C., Arena, R. A., & Lavie, C. J. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.2141 · Cited by 512 · see citing works
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M. T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.05.037 · Cited by 488 · see citing works
Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing
Kaminsky, L. A., Arena, R., & Myers, J. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.07.026 · Cited by 461 · see citing works
Self-citationGuazzi, M., Arena, R. A., Halle, M., Piepoli, M. F., MYERS, J. N., & Lavie, C. J. (2016) · Circulation · doi:10.1161/cir.0000000000000406 · Cited by 458 · see citing works
Ades, P. A., Keteyian, S. J., Wright, J. S., Hamm, L. F., Lui, K., Newlin, K., Shepard, D. S., & Thomas, R. J. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.10.014 · Cited by 450 · see citing works
Lobelo, F., Rohm Young, D., Sallis, R., Garber, M. D., Billinger, S. A., Duperly, J., Hutber, A., Pate, R. R., Thomas, R. J., Widlansky, M. E., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000559 · Cited by 402 · see citing works
Price, K. J., Gordon, B. A., Bird, S. R., & Benson, A. C. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316657669 · Cited by 401 · see citing works
“The main scientific societies for cardiac rehabilitation, including the AHA, AACVPR, EACPR and CACR, strongly recommend that patients undergo a symptom-limited, ECG-monitored exercise stress test in order to identify any abnormal signs or symptoms present during exercise and determine any contraindications to higher e…”
BackgroundPeak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation
Kavanagh, T., Mertens, D. J., Hamm, L. F., Beyene, J., Kennedy, J., Corey, P., & Shephard, R. J. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.07.028 · Cited by 380 · see citing works
Scott, J. M., Zabor, E. C., Schwitzer, E., Koelwyn, G. J., Adams, S. C., Nilsen, T. S., Moskowitz, C. S., Matsoukas, K., Iyengar, N. M., Dang, C. T., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.77.5809 · Cited by 345 · see citing works
“hospital admissions, and improvements in quality of life in numerous clinical conditions.(21,22) To our knowledge, only one prior meta-analysis has been specifically designed to examine the efficacy of exercise therapy on VO2peak in patients with cancer.”
BackgroundERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases
Radtke, T., Crook, S., Kaltsakas, G., Louvaris, Z., Berton, D. C., Urquhart, D. S., Kampouras, A., Rabinovich, R., Vergès, S., Kontopidis, D., et al. (2019) · European Respiratory Review · doi:10.1183/16000617.0101-2018 · Cited by 343 · see citing works
“Contraindications include the following [11, 37].”
Hansen, D., Abreu, A., Ambrosetti, M., Cornelissen, V., Gevaert, A. B., Kemps, H., Laukkanen, J. A., Pedretti, R. F. E., Simonenko, M., Wilhelm, M., et al. (2021) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwab007 · Cited by 339 · see citing works
Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319 · see citing works
Chew, D. P., Scott, I. A., Cullen, L., French, J. K., Briffa, T. G., Tideman, P. A., Woodruffe, S., Kerr, A., Branagan, M., & Aylward, P. E. (2016) · Heart Lung and Circulation · doi:10.1016/j.hlc.2016.06.789 · Cited by 316 · see citing works
The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease
Kaminsky, L. A., German, C. A., Imboden, M. T., Ozemek, C., Peterman, J. E., & Brubaker, P. H. (2021) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2021.12.001 · Cited by 293 · see citing works
JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease
Makita, S., Yasu, T., Akashi, Y. J., Adachi, H., Izawa, H., Ishihara, S., Iso, Y., Ohuchi, H., Omiya, K., Ohya, Y., et al. (2022) · Circulation Journal · doi:10.1253/circj.cj-22-0234 · Cited by 296 · see citing works
Oppert, J., Bellicha, A., van Baak, M. A., Battista, F., Beaulieu, K., Blundell, J. E., Carraça, E. V., Encantado, J., Ermolao, A., Pramono, A., et al. (2021) · Obesity Reviews · doi:10.1111/obr.13273 · Cited by 282 · see citing works
“Such testing may however be important to search for underlying coronary heart disease in high-risk patients and/or to adapt the exercise load on a quantitative basis.(27) A specific goal should be defined for the patient and specific activities or programs proposed to reach that goal (“Advise”).”
Cardiorespiratory Fitness and Mortality in Healthy Men and Women
Imboden, M. T., Harber, M. P., WHALEY, M. H., Finch, W. H., Bishop, D. L., & Kaminsky, L. A. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.2166 · Cited by 277 · see citing works
“The results of this study align with recommendations of recent scientific and policy statements (1,15,17) that regard CRF as a clinical vital sign and highlight the importance of accurately quantifying CRF in apparently healthy adults given its diagnostic and prognostic capabilities.”
BackgroundResultThornton, J. S., Frémont, P., Khan, K., Poirier, P., Fowles, J. R., Wells, G. D., & Frankovich, R. J. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-096291 · Cited by 270 · see citing works
Guazzi, M., Arena, R. A., Halle, M., Piepoli, M. F., MYERS, J. N., & Lavie, C. J. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw180 · Cited by 268 · see citing works
Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science
McSweeney, J., Rosenfeld, A., Abel, W. M., Braun, L., Burke, L. E., Daugherty, S., Fletcher, G., Gulati, M., Mehta, L. S., Pettey, C. M., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000381 · Cited by 235 · see citing works
Mont, L., Pelliccia, A., Sharma, S., Biffi, A., Börjesson, M., Brugada, J., Carré, F., Guasch, E., Heidbüchel, H., Gerche, A. L., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316676042 · Cited by 262 · see citing works
“American Heart Association guidelines on assessing CAD risk in athletes and active individuals recommend exercise testing prior to the initiation of vigorous exercise training in those at high risk of coronary events, including men >40 years of age and women >50 years of age (or postmenopausal) with one or more corona…”
BackgroundSaberi, S., Wheeler, M. T., Bragg‐Gresham, J. L., Hornsby, W., Agarwal, P., Attili, A. K., Concannon, M., Dries, A. M., Shmargad, Y., Salisbury, H., et al. (2017) · JAMA · doi:10.1001/jama.2017.2503 · Cited by 246 · see citing works
Exercise therapy and cardiovascular toxicity in cancer
Scott, J. M., Nilsen, T. S., Gupta, D., & Jones, L. W. (2018) · Circulation · doi:10.1161/circulationaha.117.024671 · Cited by 239 · see citing works
High Intensity Interval Training for Maximizing Health Outcomes.
Karlsen, T., Aamot, I., Haykowsky, M., & Rognmo, Ø. (2017) · Progress in cardiovascular diseases · doi:10.1016/j.pcad.2017.03.006 · Cited by 212 · see citing works
The Role of Exercise Training in Heart Failure
Downing, J., & Balady, G. J. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.020 · Cited by 232 · see citing works
Cardiorespiratory Fitness and Cardiovascular Disease Prevention: an Update
Al-Mallah, M. H., Sakr, S., & Alqunaibet, A. (2018) · Current Atherosclerosis Reports · doi:10.1007/s11883-018-0711-4 · Cited by 231 · see citing works
Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
Valenzuela, P. L., Ruilope, L. M., Santos-Lozano, A., Wilhelm, M., Kränkel, N., Fiuza-Luces, C., & Lucia, A. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad170 · Cited by 237 · see citing works
Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure
Kamiya, K., Sato, Y., Takahashi, T., Tsuchihashi‐Makaya, M., Kotooka, N., Ikegame, T., Takura, T., Yamamoto, T., Nagayama, M., Goto, Y., et al. (2020) · Circulation Heart Failure · doi:10.1161/circheartfailure.119.006798 · Cited by 232 · see citing works
Exercise and cardiovascular risk in patients with hypertension
Sharman, J. E., La Gerche, A., & Coombes, J. S. (2015) · American Journal of Hypertension · doi:10.1093/ajh/hpu191 · Cited by 224 · see citing works
Mont, L., Pelliccia, A., Sharma, S., Biffi, A., Börjesson, M., Brugada, J., Carré, F., Guasch, E., Heidbüchel, H., Gerche, A. L., et al. (2016) · EP Europace · doi:10.1093/europace/euw243 · Cited by 223 · see citing works
“50 years of age (or postmenopausal) with one or more coronary risk factors.(99) European professional society recommendations for PPE in master athletes approach this issue by assessing the cardiovascular risk profile (by a validated risk score form) of the candidate and the type and intensity of ath-”
BackgroundSecondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults
Fleg, J. L., Forman, D. E., Berra, K. A., Bittner, V., Blumenthal, J. A., Chen, M. A., Cheng, S. C., Kitzman, D. W., Maurer, M. S., Rich, M. W., et al. (2013) · Circulation · doi:10.1161/01.cir.0000436752.99896.22 · Cited by 220 · see citing works
Taylor, J. L., Holland, D. J., Spathis, J. G., Beetham, K. S., Wisløff, U., Keating, S. E., & Coombes, J. S. (2019) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2019.01.004 · Cited by 220 · see citing works
2024 Clinical practice guidelines for Hypertension in adults
Кобалава, Ж. Д., Конради, А. О., Nedogoda, S. V., Shlyakhto, E. V., Arutyunov, G. P., Баранова, Е. И., Барбараш, О. Л., Bobkova, N. V., Boytsov, S. A., Bubnova, M. G., et al. (2024) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2024-6117 · Cited by 260 · see citing works
Stavropoulos‐Kalinoglou, A., Metsios, G. S., Zanten, J. V., Nightingale, P., Kitas, G. D., & Koutedakis, Y. (2012) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2012-202075 · Cited by 220 · see citing works
Management of cardiovascular diseases in patients with obesity
Lavie, C. J., Arena, R., Alpert, M. A., Milani, R. V., & Ventura, H. O. (2018) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2017.108 · Cited by 218 · see citing works
Self-citation2018 Guidelines for the management of dyslipidemia
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Sudden Cardiac Arrest During Sports Activity in Middle Age
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“The medical benefits of daily physical activity have been proven.(6) Unfortunately, despite the clinical effectiveness of hospital-based CR, the long-term clinical effectiveness of this intervention is often poor, due to the lack of attendance at rehabilitation sessions and nonadherence to recommendations.”
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“InpatientswithCAD, traditional exercise prescription has included continuous aerobic exercise, such as walking or cycling, at a moderate intensity (40-80% VO2peak) for 30-60 minutes [6].”
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“If testing for any of these is not available, clinical signs and symptoms of these entities should be determined.(18)”
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“Importantly, exercise testing should be avoided during the acute phase of infection, given the risk to staff from contamination of lab space and possible aerosol generation (71) and for excess risk to the patients, particularly those with active myocarditis, as this is an absolute contraindication to exercise testing…”
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- Authors
- Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., Coke, L. A., Fleg, J. L., Forman, D. E., Gerber, T. C., Gulati, M., Madan, K., Rhodes, J., Thompson, P. D., & Williams, M. A.
- Affiliations
- Mayo Clinic (US)
- ORCID
- Venue
- Circulation
- Published
- 2013-08-20
- Volume
- 128
- Issue
- 8
- Pages
- 873-934
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2120888944
- Cited by
- 2,235
- References
- 823
- Citations by year
- 2026: 163 · 2025: 181 · 2024: 165 · 2023: 218 · 2022: 192 · 2021: 223 · 2020: 209 · 2019: 184 · 2018: 152 · 2017: 141 · 2016: 127 · 2015: 99 · 2014: 68 · 2013: 13 · 2012: 9
- FWCI
- 241.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Physical Education and Training Studies
- Keywords
- exercise testing, exercise training, exercise prescription, aerobic exercise
- MeSH terms
- Cardiovascular Diseases, Exercise Test, Exercise Therapy, Humans, Exercise, Resistance Training
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