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Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association
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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
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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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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 1,435
“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 1,266
The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers
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Updating ACSM's Recommendations for Exercise Preparticipation Health Screening
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“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
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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
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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 502
Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing
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“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
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“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
“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 344
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The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease
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JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease
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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
“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
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“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 296
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Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science
McSweeney, J. C., Rosenfeld, A. G., Abel, W. M., Braun, L. T., Burke, L. E., Daugherty, S. L., Fletcher, G. F., Gulati, M., Mehta, L. S., Bricker, C., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000381 · Cited by 276
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 268
“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., Bragg-Gresham, J., Hornsby, W., Agarwal, P. P., Attili, A., Concannon, M., Dries, A. M., Shmargad, Y., Salisbury, H., et al. (2017) · JAMA · doi:10.1001/jama.2017.2503 · Cited by 241
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Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
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The Role of Exercise Training in Heart Failure
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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 237
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
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 226
“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 225
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
2024 Clinical practice guidelines for Hypertension in adults
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Management of cardiovascular diseases in patients with obesity
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Self-citation2018 Guidelines for the management of dyslipidemia
Rhee, E., Kim, H. C., Kim, J. H., Lee, E. Y., Kim, B. J., Kim, E. M., Song, Y., Lim, J. H., Kim, B. J., Choi, S., et al. (2019) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2019.188 · Cited by 221
Sudden Cardiac Arrest During Sports Activity in Middle Age
Marijon, É., Uy‐Evanado, A., Reinier, K., Teodorescu, C., Narayanan, K., Jouven, X., Gunson, K., Jui, J., & Chugh, S. S. (2015) · Circulation · doi:10.1161/circulationaha.114.011988 · Cited by 217
Cardiac Rehabilitation and Risk Reduction
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2024 Clinical practice guidelines for Chronic heart failure
Galyavich, A. S., Tereshchenko, S. N., Uskach, T. M., Ageev, F. T., Aronov, D. M., Arutyunov, G. P., Begrambekova, Y. L., Belenkov, Y. N., Boytsov, S. A., Bubnova, M. G., et al. (2024) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2024-6162 · Cited by 251
2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation
Thomas, R. J., Balady, G. J., Banka, G., Beckie, T. M., Chiu, J. S., Gokak, S. Z., Ho, P. M., Keteyian, S. J., King, M. L., Lui, K., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.01.004 · Cited by 214
Kaminsky, L. A., Arena, R. A., MYERS, J. N., Peterman, J. E., Bonikowske, A. R., Harber, M. P., Medina‐Inojosa, J. R., Lavie, C. J., & Squires, R. W. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2021.08.020 · Cited by 201
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A review of telerehabilitation for cardiac patients
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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.”
Background2018 Guidelines for the Management of Dyslipidemia in Korea
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Cardiac Rehabilitation Exercise and Self-Care for Chronic Heart Failure
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Physical Activity Over the Lifecourse and Cardiovascular Disease
Perry, A., Dooley, E. E., Master, H., Spartano, N. L., Brittain, E. L., & Gabriel, K. P. (2023) · Circulation Research · doi:10.1161/circresaha.123.322121 · Cited by 215
The Acute Effect of High-Intensity Exercise on Executive Function: A Meta-Analysis
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Piotrowicz, E., Pencina, M. J., Opolski, G., Zaręba, W., Banach, M., Kowalik, I., Orzechowski, P., Szalewska, D., Pluta, S., Główczyńska, R., et al. (2019) · JAMA Cardiology · doi:10.1001/jamacardio.2019.5006 · Cited by 186
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Wohlford, G. F., Tassell, B. W. V., Billingsley, H., Kadariya, D., Canada, J. M., Carbone, S., Mihalick, V. L., Bonaventura, A., Vecchié, A., Chiabrando, J. G., et al. (2020) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000000931 · Cited by 184
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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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Recommendations for exercise in adolescents and adults with congenital heart disease
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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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“Exercise-based cardiac rehabilitation is effective in reducing total and CV mortality and hospital admissions in patients with a recent MI, and has been shown to have utility after revascularization.(14,134-142) Its utility in patients with chronic stable angina is less well documented.”
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“Aerobic interval training and high-intensity interval training cannot yet be broadly recommended until further data on safety and efficacy are available [266].”
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Exercise blood pressure: Clinical relevance and correct measurement
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“On anticoagulative therapy 6% (4) 7% (5) 0.”
Efficacy of Ranolazine in Patients With Symptomatic Hypertrophic Cardiomyopathy
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“Citing limited evidence on efficacy and safety, the American Heart Association has determined that, for patients with cardiovascular disease, HIIE “cannot yet be broadly recommended” (Fletcher et al., 2013, p. 915).”
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
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Exercise-Induced Cardiac Troponin I Increase and Incident Mortality and Cardiovascular Events
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Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19
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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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Metadata
- 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
- FWCI
- 241.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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