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

### 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 movement, primarily provides a volume load to the left ventricle, and the response is proportional to the size of the working muscle mass and the intensity of exercise. Isometric exercise is defined as a muscular contraction without movement (eg, handgrip) and imposes greater pressure than volume …

Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association

Exercise Standards for Testing and Training A Statement for Healthcare Professionals From the American Heart Association

The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals free from clinical manifestations of cardiovascular disease as well as those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in the regular exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association in Circulation (1992;86:340-344). 

These guidelines are a revision of the 1990 standards1 of the AHA that addressed the issues of exercise testing and training. An update of background, scientific rationale, and selected references are provided, and current issues of practical importance in the clinical use of these standards are considered. 

### The Cardiovascular Response to Exercise 

Exercise, a common physiological stress, can elicit cardiovascular abnormalities not present at rest and 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 resistive (a combination of isometric and isotonic).2 3 Isometric exercise, defined as a muscular contraction without movement (eg, handgrip), imposes greater pressure than volume load on the left ventricle in relation to the body’s ability to supply oxygen. The cardiovascular response to isometric exercise is difficult to grade. In addition, cardiac output is not increased as much as in isotonic exercise because increased resistance in active muscle groups limits blood flow. Isotonic exercise, defined as muscular contraction resulting in movement, primarily …

Exercise standards. A statement for health professionals from the American Heart Association.

Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review

Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group.

Neurologic impairment remains a serious consequence of cardiac arrest. While current investigations are difficult to compare due to their lack of standardization, our understanding of the pathophysiology of CNS ischemia has been greatly increased. Ion fluxes, especially K and Ca, may contribute to injury by initiating a cascade of events culminating in free fatty acid, prostaglandin, and free radical formation, with their related pathogenetic potential. Treatment measures currently consist of CPR (although disagreement exists as to which form of CPR), standard supportive measures, and attention to intracranial pressure control. There is some experimental evidence to support the use of calcium channel-blockers, phenytoin, prostaglandin inhibitors, and free-radical scavengers or inhibitors; however, no human trials have been performed. Steroids and barbiturates have been investigated in human trials and do not appear to be efficacious in ameliorating CNS injury after cardiac arrest.

Cerebral function and preservation during cardiac arrest.

The value of standardized exercise testing in the noninvasive evaluation of mitral stenosis.

Aberrant origin of coronary arteries is a not uncommon entity found on cardiac catheterization, at the time of surgery, and on post mortem examination. We present two cases of origin of a right ventricular (or atypical large conus) branch of the right coronary artery originating from a separate ostium in the right coronary cusp, which to our knowledge has been only rarely previously described. We feel that this may be a relatively frequent coronary varient that has important implications regarding patient assessment and care.

Aberrant origin of the right ventricular coronary artery: a report of two cases.

Emergency coronary bypass surgery for intractable cardiovascular collapse associated with severe left main coronary artery stenosis.

Apical hypertrophic cardiomyopathy in American patients

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