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Circulation. 2001;104:1694-1740
doi: 10.1161/hc3901.095960
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(Circulation. 2001;104:1694.)
© 2001 American Heart Association, Inc.


AHA Scientific Statement

Exercise Standards for Testing and Training

A Statement for Healthcare Professionals From the American Heart Association

Gerald F. Fletcher, MD, Chair; Gary J. Balady, MD, Vice Chair; Ezra A. Amsterdam, MD; Bernard Chaitman, MD; Robert Eckel, MD; Jerome Fleg, MD; Victor F. Froelicher, MD; Arthur S. Leon, MD; Ileana L. Piña, MD; Roxanne Rodney, MD; Denise A. Simons-Morton, MD, PhD; Mark A. Williams, PhD; Terry Bazzarre, PhD

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee in June 2001. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0210. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or e-mail pubauth@heart.org. To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400.


Key Words: AHA Scientific Statements • exercise • oxygen • coronary disease • risk factors • stress


*    Introduction
 
The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals who are free from clinical manifestations of cardiovascular disease and those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. This report is in accord with the "Statement on Exercise" published by the American Heart Association (AHA).1

These guidelines are a revision of the 1995 standards of the AHA that addressed the issues of exercise testing and training.2 An update of background, scientific rationale, and selected references is provided, and current issues of practical importance in the clinical use of these standards are considered. These guidelines are in accord with the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.3


*    Exercise Testing
 
The Cardiovascular Response to Exercise
Exercise, a common physiological stress, can elicit cardiovascular abnormalities that are not present at rest, and it can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a "stress test." This is particularly relevant considering the increased use of nonexercise stress tests.

Types of Exercise
Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistance (a combination of isometric and isotonic).4,5 Isotonic exercise, which is defined as a muscular contraction resulting in . . . [Full Text of this Article]




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Cardiovasc ResHome page
K. Yoshinari, H. Yaoita, K. Maehara, and Y. Maruyama
Different therapeutic responses to treadmill exercise of heart failure due to ischemia and infarction in rats
Cardiovasc Res, February 1, 2005; 65(2): 457 - 468.
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CirculationHome page
A. S. Leon, B. A. Franklin, F. Costa, G. J. Balady, K. A. Berra, K. J. Stewart, P. D. Thompson, M. A. Williams, and M. S. Lauer
Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An American Heart Association Scientific Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in Collaboration With the American Association of Cardiovascular and Pulmonary Rehabilitation
Circulation, January 25, 2005; 111(3): 369 - 376.
[Abstract] [Full Text] [PDF]


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ChestHome page
C. J. Lavie, T. Kuruvanka, R. V. Milani, A. Prasad, and H. O. Ventura
Exercise Capacity in Adult African-Americans Referred for Exercise Stress Testing: Is Fitness Affected by Race?
Chest, December 1, 2004; 126(6): 1962 - 1968.
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HypertensionHome page
J. A. Laukkanen, S. Kurl, R. Salonen, T. A. Lakka, R. Rauramaa, and J. T. Salonen
Systolic Blood Pressure During Recovery From Exercise and the Risk of Acute Myocardial Infarction in Middle-Aged Men
Hypertension, December 1, 2004; 44(6): 820 - 825.
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CirculationHome page
G. J. Balady, M. G. Larson, R. S. Vasan, E. P. Leip, C. J. O'Donnell, and D. Levy
Usefulness of Exercise Testing in the Prediction of Coronary Disease Risk Among Asymptomatic Persons as a Function of the Framingham Risk Score
Circulation, October 5, 2004; 110(14): 1920 - 1925.
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J. Clin. Endocrinol. Metab.Home page
P. Wellhoener, J. Born, H. L. Fehm, and C. Dodt
Elevated Resting and Exercise-Induced Cortisol Levels after Mineralocorticoid Receptor Blockade with Canrenoate in Healthy Humans
J. Clin. Endocrinol. Metab., October 1, 2004; 89(10): 5048 - 5052.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
F. X. Kleber
The predictive value of cardiorespiratory fitness
Eur. Heart J., August 2, 2004; 25(16): 1374 - 1375.
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Eur Heart JHome page
J. A. Laukkanen, S. Kurl, R. Salonen, R. Rauramaa, and J. T. Salonen
The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study
Eur. Heart J., August 2, 2004; 25(16): 1428 - 1437.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
S. Klein, N. F Sheard, X. Pi-Sunyer, A. Daly, J. Wylie-Rosett, K. Kulkarni, and N. G Clark
Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Am. J. Clinical Nutrition, August 1, 2004; 80(2): 257 - 263.
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ChestHome page
H. Amital, M. Glikson, M. Burstein, A. Afek, R. Sinnreich, Y. Weiss, and V. Israeli
Clinical Characteristics of Unexpected Death Among Young Enlisted Military Personnel: Results of a Three-Decade Retrospective Surveillance
Chest, August 1, 2004; 126(2): 528 - 533.
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Diabetes CareHome page
S. Klein, N. F. Sheard, X. Pi-Sunyer, A. Daly, J. Wylie-Rosett, K. Kulkarni, and N. G. Clark
Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies: A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Diabetes Care, August 1, 2004; 27(8): 2067 - 2073.
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StrokeHome page
N. F. Gordon, M. Gulanick, F. Costa, G. Fletcher, B. A. Franklin, E. J. Roth, and T. Shephard
Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council
Stroke, May 1, 2004; 35(5): 1230 - 1240.
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CirculationHome page
N. F. Gordon, M. Gulanick, F. Costa, G. Fletcher, B. A. Franklin, E. J. Roth, and T. Shephard
Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council
Circulation, April 27, 2004; 109(16): 2031 - 2041.
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NEJMHome page
J. Ako, Y. Honda, P. J. Fitzgerald, I. A. Andrianakis, E. D. Papadomichelakis, A. N. Kotanidou, T. O. Cheng, E. Fossum, K. Nils-Einar, A. Mangschau, et al.
Conditions Associated with ST-Segment Elevation
N. Engl. J. Med., March 11, 2004; 350(11): 1152 - 1155.
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J Am Coll CardiolHome page
T. Kavanagh, D. J. Mertens, L. F. Hamm, J. Beyene, J. Kennedy, P. Corey, and R. J. Shephard
Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2139 - 2143.
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NEJMHome page
K. Wang, R. W. Asinger, and H. J.L. Marriott
ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction
N. Engl. J. Med., November 27, 2003; 349(22): 2128 - 2135.
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CirculationHome page
M. Gulati, D. K. Pandey, M. F. Arnsdorf, D. S. Lauderdale, R. A. Thisted, R. H. Wicklund, A. J. Al-Hani, and H. R. Black
Exercise Capacity and the Risk of Death in Women: The St James Women Take Heart Project
Circulation, September 30, 2003; 108(13): 1554 - 1559.
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Arterioscler. Thromb. Vasc. Bio.Home page
P. D. Thompson, D. Buchner, I. L. Pina, G. J. Balady, M. A. Williams, B. H. Marcus, K. Berra, S. N. Blair, F. Costa, B. Franklin, et al.
Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)
Arterioscler Thromb Vasc Biol, August 1, 2003; 23(8): e42 - 49.
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Eur Heart JHome page
P. Giannuzzi, H. Saner, H. Bjornstad, P. Fioretti, M. Mendes, A. Cohen-Solal, L. Dugmore, R. Hambrecht, I. Hellemans, H. McGee, et al.
Secondary Prevention Through Cardiac Rehabilitation: Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology
Eur. Heart J., July 1, 2003; 24(13): 1273 - 1278.
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CirculationHome page
P. D. Thompson, D. Buchner, I. L. Pina, G. J. Balady, M. A. Williams, B. H. Marcus, K. Berra, S. N. Blair, F. Costa, B. Franklin, et al.
Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)
Circulation, June 24, 2003; 107(24): 3109 - 3116.
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CirculationHome page
J. Myers, J. E. Atwood, and V. Froelicher
Active Lifestyle and Diabetes
Circulation, May 20, 2003; 107(19): 2392 - 2394.
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JCOHome page
K. S. Courneya, J. R. Mackey, G. J. Bell, L. W. Jones, C. J. Field, and A. S. Fairey
Randomized Controlled Trial of Exercise Training in Postmenopausal Breast Cancer Survivors: Cardiopulmonary and Quality of Life Outcomes
J. Clin. Oncol., May 1, 2003; 21(9): 1660 - 1668.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. Bogaty, P. Poirier, L. Boyer, J. Jobin, and G. R. Dagenais
What Induces the Warm-Up Ischemia/Angina Phenomenon: Exercise or Myocardial Ischemia?
Circulation, April 15, 2003; 107(14): 1858 - 1863.
[Abstract] [Full Text] [PDF]


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CirculationHome page
I. L. Pina, C. S. Apstein, G. J. Balady, R. Belardinelli, B. R. Chaitman, B. D. Duscha, B. J. Fletcher, J. L. Fleg, J. N. Myers, and M. J. Sullivan
Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention
Circulation, March 4, 2003; 107(8): 1210 - 1225.
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CirculationHome page
J. Myers
Exercise and Cardiovascular Health
Circulation, January 7, 2003; 107 (1): e2 - e5.
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CirculationHome page
T. Kavanagh, D. J. Mertens, L. F. Hamm, J. Beyene, J. Kennedy, P. Corey, and R. J. Shephard
Prediction of Long-Term Prognosis in 12 169 Men Referred for Cardiac Rehabilitation
Circulation, August 6, 2002; 106(6): 666 - 671.
[Abstract] [Full Text] [PDF]


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NEJMHome page
G. J. Balady
Survival of the Fittest -- More Evidence
N. Engl. J. Med., March 14, 2002; 346(11): 852 - 854.
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CMAJHome page
M. A. Mittleman
The double-edged blade of recreational hockey
Can. Med. Assoc. J., February 1, 2002; 166(3): 331 - 332.
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