Exercise testing, monitoring and supervision for cardiac rehabilitation programs: A review of international guidelines
Bibliographic record
Abstract
Introduction: Cardiovascular disease (CVD) results in high rates of morbidity and mortality, with approximately 80% of all instances of CVD mortality occurring in individuals aged over 60 years (Mendis, Puska, & Norrving, 2011). Exercise-based cardiac rehabilitation programs are effective at reducing mortality following an acute cardiac event, however safety during exercise needs to be assured due to increased risk of subsequent events. Electrocardiograph (ECG)-monitored exercise testing prior to commencement of cardiac rehabilitation allows peak exercise capacity to be determined, while it is suggested ECG-monitoring during exercise testing provides increased self-confidence for participation and subsequent independent activity (American Association of Cardiovascular and Pulmonary Rehabilitation, 2013). This review sought to understand the type \nof supervision required and the recommended use of ECG during testing and monitoring of cardiac rehabilitation.\nMethods: National guidelines, position statements, and policy documents for outpatient cardiac rehabilitation available internationally in the English language were reviewed for exercise testing and monitoring recommendations, and compared to identify differences and/or consensus. \nResults: ECG-monitored exercise stress tests are recommended for all patients participating in cardiac rehabilitation in the United States (US), Canada, South America, mainland Europe, and Japan. In Australia, New Zealand, and countries of the United Kingdom, ECG-monitored pre-exercise testing is only recommended for high-risk patients or those participating in high-intensity exercise programs, with less intensive functional assessment preferred otherwise. Routine use of ECG during exercise rehabilitation is specified only in the US, Canada, South America, and Ireland, where guidelines incorporate progression from continuous to intermittent ECG monitoring along with a gradual reduction in the level of supervision as patient risk decreases. However, Belgium, France, Germany, the Netherlands, Japan, and the Europe-wide guidelines recommend ECG monitoring only for initial exercise sessions, high-risk patients, or when symptoms are present, instead relying on monitoring heart rate, blood pressure, and rating of perceived exertion. Typically, nations with more stringent exercise testing and monitoring recommendations suggest higher exercise rehabilitation intensities. \nConclusion: The recommendations for ECG monitoring of exercise testing and training sessions in cardiac rehabilitation programs differs considerably between nations and tends to be linked to the recommended intensity for exercise rehabilitation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".