Acsm's Guidelines for Exercise Testing and Prescription

by American College of Sports Medicine

ISBN13:

9780781727358

ISBN10:

0781727359

Format:

Paperback

Pub. Date:

2/1/1999

Publisher(s):

Lippincott Williams & Wilkins

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Summary

Recommended title for 2005 ACSM Certification Examinations!ACSM's Guidelines for Exercise Testing and Prescriptionbegan as a concise summary of recommendations for exercise testing and prescription primarily for cardiac patients; it has now become one of the single most internationally read and referenced texts of its kind. This reference is a virtual pharmacopoeia of exercise guidelines in a broad spectrum of patients. In this new edition there is heightened emphasis on preventing illness in apparently healthy persons and those "at risk", as well as treating patients with chronic disease. There are also two new chapters on methods for changing exercise behavior and legal issues.

Preface

vii

Note Bene

Contributors

Abbreviations

xviii

SECTION I. Health Appraisal, Risk Assessment, and Safety of Exercise

(32)

Benefits and Risks Associated with exercise

(19)

Public Health Perspective

(2)

Benefits of Regular Physical Activity and/or Exercise

(1)

Risks Associated With Exercise Testing

(4)

Risks Associated With Vigorous Exercise

(12)

Incidence of Cardiovascular Complications

(1)

Issues Regarding Preliminary Screening

(2)

Recommendations to Reduce the Incidence and Severity of Complications During Exercise

(7)

Health Screening and Risk Stratification

(11)

Preparticipation Health Screening

(3)

ACSM Risk Stratification

(2)

Risk Stratification for Cardiac Patients

(6)

Modifying Coronary Risk Status

(4)

SECTION II. Exercise Testing

(102)

Pretest Clinical Evaluation

(22)

Medical History, Physical Examination, and Laboratory Tests

(15)

Alternative Stress Tests

(2)

Blood Pressure

(1)

Cholesterol and Lipoproteins

(2)

Blood Profile Analyses

(2)

Pulmonary Function

(7)

Contraindications to Exercise Testing

(1)

Informed Consent

(6)

Patient Instructions

(5)

Physical Fitness Testing and Interpretation

(34)

Purposes of Fitness Testing

(1)

Basic Principles and Guidelines

(1)

Pretest Instructions

(1)

Test Order

(1)

Test Environment

(1)

Body Composition

(9)

Densitometry

(2)

Anthropometric Methods

(2)

Other Techniques

(4)

Cardiorespiratory Fitness

(12)

The Concept of Maximal Oxygen Uptake

(1)

Maximal versus Submaximal Exercise Testing

(1)

Modes of Testing

(7)

Cardiorespiratory Test Sequence and Measures

(3)

Test Termination Criteria

(1)

Muscular Fitness

(5)

Flexibility

(6)

Clinical Exercise Testing

(24)

Indications and Applications

(4)

Diagnostic Exercise Testing

(2)

Exercise Testing for Disease Severity and Prognosis

(1)

Exercise Testing After Myocardial Infarction

(1)

Functional Exercise Testing

(2)

Exercise Test Modalities

(2)

Exercise Protocols

(2)

Upper Body Exercise Testing

(1)

Testing for Return to Work

(2)

Weight Carrying Test

100

(1)

Repetitive Lifting Test

101

(1)

Measurements

101

(5)

Heart Rate and Blood Pressure

102

(1)

Expired Gases

103

(2)

Electrocardiographic Monitoring

105

(1)

Subjective Ratings

105

(1)

Postexercise Period

106

(1)

Indications for Exercise Test Termination

106

(1)

Exercise Testing With Imaging Modalities

107

(2)

Exercise Echocardiography

107

(1)

Exercise Nuclear Imaging

107

(1)

Pharmacologic Stress Testing

108

(1)

Considerations for Pulmonary Patients

109

(2)

Lung Function

109

(1)

Exercise Testing of Pulmonary Patients

110

(1)

Supervision of Exercise Stress Testing

111

(4)

Considerations Regarding Medical Supervision

111

(1)

Current Guidelines and Practices

111

(1)

Competency Considerations

112

(1)

Implications for Cost-Effectiveness

113

(2)

Interpretation of Clinical Test Data

115

(20)

Exercise Testing as a Screening Tool for Coronary Artery Disease

115

(1)

Interpretation of Responses to Graded Exercise Testing

116

(8)

Maximal Oxygen Uptake

117

(1)

Heart Rate Response

117

(1)

Blood Pressure Response

117

(3)

ECG Waveforms

120

(4)

Symptoms

124

(1)

Diagnostic Value of Exercise Testing

124

(6)

Sensitivity

125

(1)

Specificity

126

(1)

Predictive Value

126

(1)

Comparison With Imaging Stress Tests

127

(2)

Prognostic Applications of the Exercise Test

129

(1)

Interpretation of Exercise Tests in Pulmonary Patients

130

(5)

Specific Respiratory Diseases

130

(5)

SECTION III. Exercise Prescription

135

(100)

General Principles of Exercise Prescription

137

(28)

Principles of Training

138

(1)

Overview of the Exercise Prescription

139

(1)

The Art of Exercise Prescription

139

(1)

Components of the Training Session

140

(3)

Warm-up

141

(1)

Endurance Phase

142

(1)

Recreational Activities

142

(1)

Cool-down

143

(1)

Cardiorespiratory Fitness

143

(8)

Mode of Exercise

143

(2)

Exercise Intensity

145

(5)

Exercise Duration

150

(1)

Exercise Frequency

151

(1)

Energy Expenditure Goals

151

(3)

Rate of Progression

154

(2)

Initial Conditioning Stage

154

(1)

Improvement Stage

155

(1)

Maintenance Stage

155

(1)

Training Specificity

156

(1)

Musculoskeletal Flexibility

156

(3)

Muscular Fitness

159

(1)

Maintenance of the Training Effect

160

(1)

Program Supervision

161

(4)

Exercise Prescription for Cardiac Patients

165

(35)

Inpatient Programs

166

(3)

Outpatient Programs

169

(6)

Intensity

170

(1)

Frequency

171

(1)

Duration

172

(1)

Outpatient Rate of Progression

172

(2)

Types of Outpatient Programs

174

(1)

Exercise Prescription Without a Preliminary Exercise Test

175

(1)

Resistance Training

176

(5)

Eligibility and Exclusion Criteria

177

(1)

Time Course to Resistance Training

178

(1)

Prescriptive Guidelines

178

(3)

Arm Exercise Prescription

181

(1)

Arm Exercise Training Heart Rate

181

(1)

Work Rates for Arm Training

181

(1)

Arm Exercise Equipment and Training Modalities

182

(1)

Exercise Training for Return to Work

182

(1)

Optimal Exercise Dosage? Pathophysiologic Considerations

183

(2)

Special Patient Populations

185

(8)

Angina or Silent Ischemia

185

(1)

Congestive Heart Failure

186

(3)

Pacemaker and Implantable Cardioverter Defibrillators

189

(2)

Cardiac Transplant

191

(2)

Exercise: An Integral Component of a Comprehensive Treatment Approach

193

(7)

Exercise Prescription for Pulmonary Patients

200

(6)

Exercise Prescription

200

(2)

Mode of Exercise

200

(1)

Frequency

200

(1)

Intensity

201

(1)

Duration

201

(1)

Special Considerations

202

(1)

Pursed-Lips Breathing

202

(1)

Supplemental Oxygen

202

(1)

Alternative Modes of Exercise Training

202

(2)

Continuous Positive Airway Pressure

203

(1)

Upper Body Resistance Training

203

(1)

Ventilatory Muscle Training

203

(1)

Program Design and Supervision

204

(2)

Monitoring Exercise Training Intensity

204

(2)

Other Clinical Conditions Influencing Exercise Prescription

206

(11)

Hypertension

206

(2)

Lower-Extremity Peripheral Vascular Disease

208

(4)

Diabetes Mellitus

212

(2)

Obesity

214

(3)

Programs for Reducing Body Fatness

214

(3)

Exercise Testing and Prescription for Children, the Elderly, and Pregnant Women

217

(18)

Children

217

(6)

Fitness Testing

217

(1)

Clinical Exercise Testing

218

(1)

Exercise Prescription

219

(4)

The Elderly

223

(7)

Exercise Testing

223

(2)

Exercise Prescription

225

(5)

Pregnant Women

230

(5)

SECTION IV. Special Considerations

235

(36)

Methods for Changing Exercising Behaviors

237

(21)

Exercise Compliance

237

(2)

Adult Learning

239

(2)

Psychological Components of Successful Behavior Change

241

(1)

Strategies to Improve Behavioral Change Outcomes

242

(7)

Practical Recommendations to Enhance Exercise Adherence

245

(4)

Population-Specific Barriers to Physical Activity

249

(1)

Program Models: Group versus Home-Based Exercise Therapy

249

(2)

Other Targets for Health Behavior Change

251

(7)

Smoking Cessation

252

(1)

Weight Management

252

(1)

Dietary Modification

253

(1)

Stress Management

254

(4)

Legal Issues

258

(13)

Contracts, Informed Consent, and Torts

259

(2)

Contract Law

259

(1)

Informed Consent

260

(1)

Torts

261

(1)

Negligence and/or Malpractice

261

(3)

Defenses to Negligence and/or Malpractice Actions

263

(1)

Liability Insurance

264

(1)

Standards of Care

264

(3)

Policies, Protocols, Forms, and Fulfillment

266

(1)

Legal Concerns and the Roles of Licensed and Nonlicensed Exercise Professionals

267

(2)

Summary

269

(2)

SECTION V. Appendices

271

(82)

Appendix A. Common Medications

273

(10)

Appendix B. Emergency Management

283

(10)

Appendix C. Electrocardiogram (ECG) Interpretation

293

(7)

Appendix D. Metabolic Calculations

300

(13)

Appendix E. Environmental Considerations

313

(9)

Appendix F. American College of Sports Medicine Certifications

322

(31)

Index

353

Acsm's Guidelines for Exercise Testing and Prescription

9780781727358

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Table of Contents