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. Consequently, exercise prescriptions including exercise progression in CR are not following standard exercise prescription guidelines. Therefore, the purpose of this review is to provide clinicians with evidence-based techniques for prescribing exercise in the absence of a baseline GXT. Intensity indicators (e.g., heart rate, perceived exertion) are reviewed, along with special exercise considerations for various disease states (e.g., heart failure, peripheral artery disease, and coronary artery disease). Baseline exercise testing remains the gold standard approach for prescribing exercise among heart disease patients, however, clinicians must be prepared to safely develop and monitor patients when a baseline GXT is not performed.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Defining time frames throughout cardiac rehabilitation (CR) to progress exercise workloads may lead to improve functional capacity outcomes. The purpose of this study was to investigate the role of exercise progression on functional capacity among cardiac patients enrolled in CR. This was a retrospective database analysis study. Extracted data included: Demographic, functional capacity (in METs), and exercise intensity during exercise sessions 2, 12, 24, and 36 of CR from 150 patients who completed a 36-session program. Progression of exercise was determined by calculating percent change in treadmill exercise workload within predefined time frames of CR. The time frames were percent change from exercise session 2 to 12 (“%ΔS2–S12), 12 to 24 (%ΔS12–S24), and 24 to 36 (%ΔS24–S36). A multiple linear regression model was developed to predict change in functional capacity (ΔMETs). A significant proportion (21%) of total variation in ΔMETs was predicted by %ΔS2–12, %ΔS12–24, %ΔS24–36, age, sex, and body mass index (BMI). Percent changes between sessions 12 to 24 (%ΔS12–24; β = 0.17, p = 0.03) and 24 to 36 (%ΔS24–36; β = 0.23, p < 0.01) were significant predictors. Progressing patients between sessions 12 to 24 and 24 to 36 predicted significant changes in functional capacity and reinforced the importance of exercise progression across all 36 sessions of CR.

Introduction: Although regular exercise is recommended during non-complicated pregnancies to promote maternal and fetal/infant health, estimates suggest that only 15% of expectant mothers achieve current exercise recommendations. Although lack of motivation and fear related to potential fetal injury are often cited as reasons for not engaging in regular physical activity/exercise during pregnancy, less is understood about individual attitudes and practice habits of obstetrician and gynecologists (OB/GYNs) regarding exercise recommendations that may influence patient engagement in exercise during pregnancy. Purpose: To describe the attitudes, knowledge, and clinical practice of OB/GYNs regarding exercise during pregnancy. Methods: Surveys were sent via U.S. mail to 950 practicing OB/GYNs identified via publicly available databases. The survey included 11 questions regarding demographic information, exercise physiology knowledge, as well as their attitudes and clinical practice recommendations regarding exercise during pregnancy. Results: One hundred thirty-nine completed surveys were returned (14.6% response rate). Ninety-four percent of physicians surveyed agreed that there are benefits of exercise during pregnancy and/or the benefits of exercise during pregnancy outweigh the risks. Ninety-eight percent of physicians surveyed reported that they (or their medical staff) routinely advise their patients to exercise during pregnancy and 46% reported discussing exercise guidelines related to time, intensity, and type of exercise. Only 13% of physicians surveyed reported taking a semester-long exercise physiology course, yet 27% of physicians surveyed reported developing personalized exercise prescriptions for all (6%) or some (21%) of their patients. Conclusions: Low exercise engagement among expectant mothers does not appear to be due to a lack of guidance or negative views of OB/GYNs regarding exercise during pregnancy.

Background: Graded exercise testing (GXT) is a fundamental component of the diagnosis/treatment of patients with suspected/known cardiovascular disease (CVD). Amid the current pandemic, patients must wear a facemask during GXTs, yet the impact of facemask use on peak values from a GXT has not been evaluated in individuals at increased risk of developing CVD. The objective is to examine potential differences in peak values obtained from a GXT performed under facemask versus no facemask conditions among adults at increased risk for CVD. Methods: Using a randomized, crossover study design, 16 adults at moderate risk for developing CVD completed 2 trials (facemask versus no facemask). Peak speed, grade, heart rate (HR), and rating of perceived exertion were recorded during a Modified Bruce Treadmill GXT for each trial. Peak speed and grade were used to estimate peak oxygen consumption (Vo₂peak) and peak metabolic equivalents of task (Vo₂peak/3.5). Results: Total exercise time (17:10 ± 2:04 versus 15:58 ± 1:51 minutes, P = 0.0005), peak HR (170 ± 11 versus 164 ± 11 b·min⁻¹, P = 0.01), estimated Vo₂peak (42.3 ± 8.9 versus 36.8 ± 6.6 mL·kg⁻¹·min⁻¹, P = 0.005), and peak metabolic equivalents of task (12.2 ± 2.6 versus 10.5 ± 1.9, P = 0.005) were higher during the no facemask versus the facemask trial. Peak rating of perceived exertion was similar between trials (18.1 ± 1.3 versus 18.3 ± 1.2, P = 0.84). Conclusion: Facemask use had a significant but modest clinical impact on hemodynamic responses during a GXT among moderate risk adults.