What is GXT in exercise?
Aerobic exercise is a core component of cardiac rehabilitation (CR). Leading organizations recommend that the exercise prescriptions should be based on a symptom limited baseline graded exercise test (GXT). However, recent evidence suggests that only ~30% of CR clinics perform baseline GXTs. Consequ …
Do cardiac rehabilitation clinics perform baseline graded exercise tests?
Dec 24, 2014 · For GXT, the symptom limited method by modified Bruce protocol was used according to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) guidelines. GXT measures VO 2max , duration of exercise, and submaximal rate pressure product (RPP submax ).
Can a standard ett protocol improve cardiac rehabilitation testing?
Apr 24, 2019 · Cardiac Rehabilitation (CR) is an effective exercise-based lifestyle therapy for patients with cardiac disease. There are two common methods of exercise prescription, an effort based exercise prescription and target heart rate based exercise prescription.
Can stress tests guide exercise prescription in cardiac rehabilitation?
The answer is yes. Let's see how this can be done. Again, let's plug in the data from the GXT. (max Systolic BP - resting Systolic BP) x (.4 - .8 + (max METs/100)) + resting Systolic BP Training Exercise Blood Pressure (TEBP) = [ (180 - 120) x (.58)] + 120 TEBP = [ …
What are the goals of the cardiac exercise test?
First, the investigators want to know if an exercise test should be done near the beginning of cardiac rehabilitation. Second, the investigators want to understand what type of exercises should be recommend to patients.
What is CR exercise?
Cardiac Rehabilitation (CR) is an effective exercise-based lifestyle therapy for patients with cardiac disease. There are two common methods of exercise prescription, an effort based exercise prescription and target heart rate based exercise prescription. The purpose of this research study is to identify the best way to exercise in cardiac rehabilitation. There are three main goals of this study. First, the investigators want to know if an exercise test should be done near the beginning of cardiac rehabilitation. Second, the investigators want to understand what type of exercises should be recommend to patients. Third, the investigators want to understand if a personal heart rate monitor will improve adherence to a target heart rate for exercise. As part of this study, some patients will undergo an exercise stress test on a treadmill to determine a target heart rate. These patients will be given a heart rate goal to use when they exercise. Some patients will be given a personal heart rate monitor to improve adherence.
Do you need to wear a chest strap during cardiac rehabilitation?
Patients will be asked to wear both, the chest strap and the watch during cardiac rehabilitation. Ultimately, we hope that the use of HRM is not necessary, but it may be needed to assure that patients in the THHR are able to consistently know their HR and adjust their exercise prescription.
Why is exercise testing important for cardiac rehabilitation?
The increased practice of exercise testing before and after cardiac rehabilitation may help expedite the development of a standardized exercise tolerance protocol to optimize patient rehabilitation and recovery and document outcomes for both individual patients and the rehabilitation program as a whole.
When to do stress test after myocardial infarction?
In clinical settings, stress tests are often performed within the first few weeks after a myocardial infarction for diagnostic purposes (3). These stress tests, usually called graded exercise tests, commonly call for treadmill speed and incline to increase progressively throughout the stages of the test.
How long is the outpatient rehabilitation program?
The process consists of three phases: inpatient education, a 6-to 12-week outpatient supervised exercise program, and a maintenance phase of rehabilitation to promote heart health. Exercise physiologists and nurses typically supervise the 6-to 12-week outpatient program and prescribe exercise.
What is an ETT?
An ETT can identify the metabolic equivalents (METs) that a patient is capable of achieving. While one test may not be appropriate for all patients due to various physical issues, a physiological evaluation can be conducted in some capacity, regardless of the patient's condition.
Background
One of the well-established methods used to determine endurance training intensity for patients in outpatient cardiac rehabilitation (CR) is to take a percentage (70%–85%) of the maximal or peak heart rate (HRmax) from a recent postevent symptom-limited graded exercise test (GXT).
Objective
The purpose of this study was to determine if a target heart rate (THR) of 30% to 50% above RHR approximated a THR of 70% to 85% of the HRmax achieved on GXT (HRmax GXT) and provided equivalent exercise intensity based on ratings of perceived exertion (RPE) and metabolic equivalency thresholds (METs).
Methods
A retrospective chart review of 53 patients enrolled in CR and had documentation of postevent GXT was conducted to determine the patient’s mean exercise heart rate (HR) achieved at each session to percentage above RHR and percentage HRmax GXT.
Conclusion
In the observed population, a THR of 30% to 50% above RHR underestimated the THR range of 70% to 85% HRmax GXT but provided adequate exercise intensity for patients at the beginning of a CR program based on percentage HRmax GXT, RPE and MET levels.
What is a GXT for cardiology?
Current guidelines from the European Society of Cardiology and American Heart Association for CR programs strongly recommend a GXT, also commonly referred to as an exercise tolerance test (ETT) as the initial CR patient assessment . 5, 30 A GXT before starting CR provides assessment of ischemia (signs, symptoms, changes on electrocardiogram), arrhythmia, chronotropic responses, hemodynamics, and other safety parameters, as well as objective assessment of a patient's functional capacity, which is derived from treadmill or cycle protocols. 5 A GXT also helps characterize the subjective rated perceived exertion (RPE), 31 with an RPE of 13 to 14 often identified as a target intensity of training. The GTX is often applied as the basis of exercise prescription, usually relative to the peak heart rate but also in relation to an ischemic threshold, perceived exertion, or symptoms ( Table 1 ). Exercise prescription is then tailored to the goals and clinical circumstances for each patient.
What is GTX exercise?
The GTX is often applied as the basis of exercise prescription, usually relative to the peak heart rate but also in relation to an ischemic threshold, perceived exertion, or symptoms ( Table 1 ). Exercise prescription is then tailored to the goals and clinical circumstances for each patient.
What is CRF in GXT?
In standard GXT assessments, CRF is routinely reported as the number of METs achieved. METs are estimated using equations that incorporate a patient's exercise performance (on the basis of the speed, incline, and sex). Such calculations possess inherent inaccuracies as some key physiologic parameters (eg, weight) or differences in walking technique (eg, holding handrails) are not incorporated into the assessments. The GXT is also limited by its inability to assess other useful aspects of exercise performance, such as the anaerobic threshold, as well as insights regarding other factors limiting exercise performance (eg, pulmonary or skeletal muscle pathologies). In these respects, CPET is relatively advantageous.
What is the most recent condition approved by CMS for CR?
Heart failure is the most recent condition approved by the CMS for CR. 16, 17 Eligibility criteria of patients with heart failure (HF) for CR mirror the inclusion criteria used within HF-ACTION, a seminal trial that demonstrated safety and efficacy of exercise training for systolic HF. 18 Patients enrolled in the trial were chronic stable outpatients with HF with reduced left ventricular ejection fraction. Expert consensus and CMS policy call for a period of clinical stability before CR enrollment. 17, 19, 20
Is GXT better than CPET?
In these respects, CPET is relatively advantageous.
Can you do a symptom limited exercise test with a CPET?
Symptom-limited exercise testing can be performed with either GXT or CPET. Each provides a valuable assessment of cardiopulmonary exercise performance that can be used to guide safe exercise prescription. Completion of a maximal exercise test may also provide a patient with greater confidence in his or her ability to participate in an exercise training program, thus improving physical self-efficacy and adherence. Selection of the appropriate exercise testing protocol for functional capacity assessment is a key consideration for either GXT or CPET.
Does exercise test for CR?
Nonetheless, exercise testing has enduring value for CR, especially because it reveals dynamic physiological responses as well as ischemia, arrhythmias, and symptoms pertinent to exercise prescription and training and to overall stability and prognosis.