Exercise Testing and Prescription for Clinical Populations
Core concepts
Master the FITT-VP framework (Frequency, Intensity, Time, Type, Volume, Progression) and apply it across populations: cardiovascular disease, heart failure, diabetes, obesity, pulmonary disease, and older adults. Know the standard components of a clinical exercise test - informed consent, resting measures, monitoring, protocol selection, indications for stopping, and post-test observation - and the difference between maximal and submaximal testing. Understand intensity domains: percent of maximal HR, HR reserve (Karvonen), percent of VO2 reserve, RPE, and the talk test. Familiarize yourself with the exercise prescription sequence: assess, stratify risk, set goals, prescribe, and monitor.
Traps
Do not apply healthy-adult intensity targets to deconditioned or cardiac patients; start low and progress slowly. Watch for questions that mix up HRmax estimation (220 − age is a rough population estimate, not an individual truth) with measured values. Remember warm-up and cool-down are part of the prescription, not optional. Distinguish aerobic from resistance and flexibility recommendations, since frequency and intensity differ.
Rule of thumb
Karvonen target HR = [(HRmax − HRrest) × intensity%] + HRrest. Worked example: HRmax 180, HRrest 70, target 60% → [(180 − 70) × 0.60] + 70 = 66 + 70 = 136 bpm. For many clinical patients, begin near 40–60% of HR reserve and progress as tolerated.
Skills to practice
Writing a complete FITT-VP prescription for a given patient, selecting an appropriate testing modality, and justifying progression or regression based on signs and symptoms.