Exercise Testing and Exercise Training Prescription
Testing
A symptom-limited graded exercise test is preferred for prescribing, providing heart rate, blood pressure, ECG, symptom, and functional capacity data. Submaximal tests, the 6-minute walk test, and step tests are alternatives when maximal testing is not feasible. Know termination criteria and the effect of medications on the response.
Prescription
Apply the FITT framework. Aerobic: typically 3 to 5 days per week, 20 to 60 minutes of large-muscle activity, progressing from moderate intensity defined by a percentage of peak capacity, heart rate reserve, or perceived exertion around 11 to 14 on the 6 to 20 scale, supported by the talk test. Include 5 to 10 minutes of warm-up and cool-down. Resistance training: 2 to 3 days per week, 8 to 10 exercises, 1 to 3 sets of 10 to 15 repetitions at moderate load, with attention to breathing and avoidance of Valsalva maneuvers early in the program.
Worked example
Resting heart rate 70, peak heart rate 150. Heart rate reserve is 80. At 60% intensity: 70 + 0.6(80) = 118 beats per minute. Rule of thumb: heart rate reserve target = resting heart rate + (intensity fraction times the heart rate reserve), and when a beta-blocker blunts the chronotropic response, shift to perceived exertion and the talk test.
Exam traps
Predicted maximal heart rate formulas carry substantial error, and chronotropic incompetence or beta-blockade can make heart rate targets unreliable. Do not prescribe continuous high-intensity work for a newly enrolled, deconditioned patient.