Skip to main content
SpringerLink
Log in

Exercise Testing

  • Chapter
Cardiovascular Medicine

Abstract

Stress testing is a technique used primarily for the diagnostic, prognostic, and functional assessment of patients with known or suspected coronary artery disease (CAD).1 Exercise, or the ability to do work, when used as the stressor can reproduce symptoms and provide an objective estimate of functional capacity that is a general measure of cardiopulmonary and musculoskeletal reserve. Vagal tone is progressively withdrawn as dynamic exercise progresses and sympathetic discharge is increased. Cardiac output increases coincident with the increase in heart rate, stroke volume, and venous return. An estimate of an individual’s maximum heart rate can be calculated from the formula 220 minus age (years), assuming a standard deviation of 10 to 12 beats/min. Systolic blood pressure increases with progressive levels of work, and peak rate pressure product achieved (heart rate × systolic blood pressure) provides an estimate of myocardial oxygen demand at specific workloads.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing), 2002. American College of Cardiology Web site. Available at: www.acc.org/clinical/guidelines/exercise/dirIndex.htm.

    Google Scholar 

  2. Chaitman BR. Exercise stress testing. In: Libby P, Zipes D, Bonow R, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. Philadelphia: WB Saunders, 2005:153–177.

    Google Scholar 

  3. Porszasz J Casaburi R, Somfay A, Woodhouse LJ, Whipp B. A treadmill protocol using simultaneous changes in speed and grade. Med Sci Sports Exerc 2003;35:1596–1603.

    Article  PubMed  Google Scholar 

  4. Azarbal B, Hayes SW, Lewin HC, Hachamovitch R, Cohen I, Berman DS. The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality: superiority over 85% of maximal age-predicted heart rate. J Am Coll Cardiol 2004;44:423–430.

    Article  PubMed  Google Scholar 

  5. Vivekananthan DP, Blackstone EH, Potheir CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 2003;42:831–838.

    Article  PubMed  Google Scholar 

  6. Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation 1989;80:87–98.

    PubMed  CAS  Google Scholar 

  7. Froelicher VF, Fearon WF, Ferguson C, et al. Lessons learned from studies of the standard exercise ECG test. Chest 1999;116:1442–1451.

    Article  PubMed  CAS  Google Scholar 

  8. Morise AP, Diamond GA. Comparison of the sensitivity and specificity of exercise electrocardiography in biased and unbiased populations of men and women. Am Heart J 1995;130:741–747.

    Article  PubMed  CAS  Google Scholar 

  9. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002;346:793–801.

    Article  PubMed  Google Scholar 

  10. Mark DB, Hlatky MA, Harrell FE, et al. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987;106:793–800.

    PubMed  CAS  Google Scholar 

  11. Mark DB, Shaw L, Harrell FE, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991;325:849–853.

    Article  PubMed  CAS  Google Scholar 

  12. Kwok JMF, Miller TD, Hodge DO, Gibbons RJ. Prognostic value of the Duke treadmill score in the elderly. J Am Coll Cardiol 2002;39:1475–1481.

    Article  PubMed  Google Scholar 

  13. Alexander KP, Shaw LJ, DeLong ER, Mark DB, Peterson ED. Value of exercise treadmill testing in women. J Am Coll Cardiol 1998;32:1657–1664.

    Article  PubMed  CAS  Google Scholar 

  14. Morise AP, Jalisi F. Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease. J Am Coll Cardiol 2003;42:842–850.

    Article  PubMed  Google Scholar 

  15. Morise AP, Olson MB, Merz CNB, et al. Validation of the accuracy of pretest and exercise test scores in women with a low prevalence of coronary disease: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. Am Heart J 2004;147:1085–1092.

    Article  PubMed  Google Scholar 

  16. Aktas MK, Ozduran V, Pothier CE, Lang R, Lauer MS. Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA 2004;292:1462–1468.

    Article  PubMed  CAS  Google Scholar 

  17. Corra U, Mezzani A, Bosimini E, Giannuzzi P. Cardiopulmonary exercise testing and prognosis in chronic heart failure: a prognosticating algorithm for the individual patient. Chest 2004;126:942–950.

    Article  PubMed  Google Scholar 

  18. Osada N, Chaitman BR, Miller LW, et al. Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. J Am Coll Cardiol 1998;31:577–582.

    Article  PubMed  CAS  Google Scholar 

  19. Corra U, Mezzani A, Bosimini E, et al. Limited predicted value of cardiopulmonary exercise indices in patients with moderate chronic heart failure treated with carvedilol. Am Heart J 2004;147:553–560.

    Article  PubMed  CAS  Google Scholar 

  20. Myers J, Geiran O, Simonsen S, Ghuyoumi A, Gullestad L. Clinical and exercise test determinants of survival after cardiac transplantation. Chest 2003;124:2000–2005.

    Article  PubMed  Google Scholar 

  21. Fang JC, Rocco T, Jarcho J, Ganz P, Mudge GH. Noninvasive assessment of transplant-associated arteriosclerosis. Am Heart J 1998;135:980–987.

    Article  PubMed  CAS  Google Scholar 

  22. Erikssen G, Bodegard J, Bjornholt JV, Liestol K, Thelle DS, Erikssen J. Exercise testing of healthy men in a new perspective: from diagnosis to prognosis. Eur Heart J 2004;25:978–986.

    Article  PubMed  Google Scholar 

  23. Gibbons LW, Mitchell TL, Wei M, Blair SN, Cooper KH. Maximal exercise test as a predictor of risk for mortality from coronary heart disease in asymptomatic men. Am J Cardiol 2000;86:53–58.

    Article  PubMed  CAS  Google Scholar 

  24. Balady GJ, Larson MG, Vasan RS, Leip EP, O’Donnell CJ, Levy D. Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham Risk Score. Circulation 2004;110:1920–1925.

    Article  PubMed  Google Scholar 

  25. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham Score for risk prediction in asymptomatic individuals. JAMA 2004;291:210–215.

    Article  PubMed  CAS  Google Scholar 

  26. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women. The St. James Women Take Heart Project. Circulation 2003;108:1554–1559.

    Article  PubMed  Google Scholar 

  27. Mora S, Redberg RF, Cui Y, et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women. A 20-year follow-up of the Lipid Research Clinics Prevalence Study. JAMA 2003;290:1600–1607.

    Article  PubMed  CAS  Google Scholar 

  28. Topol EJ, Burek K, O’Neill WW, et al. A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion. N Engl J Med 1988;138:1083–1088.

    Article  Google Scholar 

  29. Grines CL, Marsalese DL, Brodie B, et al. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. J Am Coll Cardiol 1998;31:967–972.

    Article  PubMed  CAS  Google Scholar 

  30. De Luca G, Suryapranata H, van’t Hof AWJ, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004;109:2737–2743.

    Article  PubMed  Google Scholar 

  31. Newby LK, Eisenstein EL, Califf RM, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000;342:749–755.

    Article  PubMed  CAS  Google Scholar 

  32. Amsterdam EZ, Kirk JD, Diercks DB, Lewis WR, Turnipseed SD. Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain. J Am Coll Cardiol 2002;40:251–256.

    Article  PubMed  Google Scholar 

  33. Gibbons RJ, Hodge DO, Berman DS, et al. Long-term outcome of patients with intermediate-risk exercise electrocardiograms who do not have myocardial perfusion defects on radionuclide imaging. Circulation 1999;100:2140–2145.

    PubMed  CAS  Google Scholar 

  34. Jouven X, Zureik M, Desnos M, Courbon D, Ducimetiere P. Long-term outcome in asymptomatic men and exercise-induced premature ventricular depolarizations. N Engl J Med 2000;343:826–833.

    Article  PubMed  CAS  Google Scholar 

  35. Engel G, Beckerman JG, Froelicher VF, et al. Electrocardiographic arrhythmia risk testing. Curr Probl Cardiol 2004;29:365–432.

    Article  PubMed  Google Scholar 

  36. Partington S, Myers J, Cho S, Froelicher V, Chun S. Prevalence and prognostic value of exercise-induced ventricular arrhythmias. Am Heart J 2003;145:139–146.

    Article  PubMed  Google Scholar 

  37. Morshedi-Meibodi A, Evans JC, Levy D, Larson MG, Vasan RS. Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community: the Framingham Heart Study. Circulation 2004;109:2417–2422.

    Article  PubMed  Google Scholar 

  38. Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor of death. N Engl J Med 2003;348:781–790.

    Article  PubMed  Google Scholar 

  39. O’Neill JO, Young JB, Pothier CE, Lauer MS. Severe frequent ventricular ectopy after exercise as a predictor of death in patients with heart failure. J Am Coll Cardiol 2004;44:820–826.

    Article  PubMed  Google Scholar 

  40. Bunch TJ, Chadrasekaran K, Gersh BJ, et al. The prognostic significance of exercise-induced atrial arrhythmias. J Am Coll Cardiol 2004;43:1236–1240.

    Article  PubMed  Google Scholar 

  41. Jeger RV, Zellweger MJ, Kaiser C. Prognostic value of stress testing in patients over 75 years of age with chronic angina. Chest 2004;125:1124–1131.

    Article  PubMed  Google Scholar 

  42. Lai S, Kaykha A, Yamazaki T, et al. Treadmill scores in elderly men. J Am Coll Cardiol 2004;43:606–615.

    Article  PubMed  Google Scholar 

  43. Messinger-Rapport B, Pothier Snader CE, Blackstone EH, Yu D, Lauer MS. Value of exercise capacity and heart rate recovery in older people. J Am Geriatr Soc 2003;51:63–68.

    Article  PubMed  Google Scholar 

  44. Krone RJ, Hardison RM, Chaitman BR, et al. Risk stratification after successful coronary revascularization: the lack of a role for routine exercise testing. J Am Coll Cardiol 2001;38:136–142.

    Article  PubMed  CAS  Google Scholar 

  45. Sellier P, Chatellier G, D’Agrosa-Boiteux MC, et al. Use of noninvasive cardiac investigations to predict clinical endpoints after coronary bypass graftsurgery in coronary artery disease patients: results from the prognosis and evaluation of risk in the coronary operated patient (PERISCOP) study. Eur Heart J 2003;24:916–926.

    Article  PubMed  Google Scholar 

  46. Roffi M, Wenaweser P, Windecker S, et al. Early exercise after coronary stenting is safe. J Am Coll Cardiol 2003;42:1569–1573.

    Article  PubMed  Google Scholar 

  47. Weisman IM, Marciniuk D, Martinez FJ, et al. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211–277.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Research Division of Cardiology, Saint Louis University School of Medicine, St. Louis, MO, USA

    Bernard R. Chaitman MD

  2. Department of Cardiology, Wright State University, Dayton, OH, USA

    Masarrath J. Moinuddin MD, MPH

  3. Division of Cardiology, St. Louis University School of Medicine, St. Louis, MO, USA

    Junko Sano MD

Authors
  1. Bernard R. Chaitman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masarrath J. Moinuddin MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junko Sano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The University of Texas Health Science Center in Houston, Houston

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  2. Texas Heart Institute, Houston, TX, USA

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  3. Department of Cardiology, University of Maastricht, Masstricht, The Netherlands

    Hein J. J. Wellens MD (Emeritus Professor) (Emeritus Professor)

  4. Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA

    Jay N. Cohn MD (Professor of Medicine and Director) (Professor of Medicine and Director)

  5. Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    David R. Holmes Jr. MD (Consultant, Professor of Medicine and Scripps Professor) (Consultant, Professor of Medicine and Scripps Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag London Limited

About this chapter

Cite this chapter

Chaitman, B.R., Moinuddin, M.J., Sano, J. (2007). Exercise Testing. In: Willerson, J.T., Wellens, H.J.J., Cohn, J.N., Holmes, D.R. (eds) Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-84628-715-2_34

Download citation

  • DOI: https://doi.org/10.1007/978-1-84628-715-2_34

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-188-4

  • Online ISBN: 978-1-84628-715-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation