Assess patient's tolerance to increase intensity of an exercise while being monitor for cardiac symptoms such as myocardial ischemia. Types of protocols include:  Trendmill Cycle ergometrer  UE's ergometer  Procedure typically   Progressive exercise with greater increments of work  This includes varying speed and resistance depending on the machine  Absolute termination of a the test include when   Systolic BP decreases by 10 mm Hg or less regardless of increased workload with myocardial symptoms  Moderate to severe angina 3/4 on the scale   Increased nervous symptoms  Signs of poor perfusion (circulation)  Cyanosis (blue skin)  Pallor (pale skin)  Constant ventricular tachycardia (without change) Signs when to maybe terminate test  Systolic BP decreased by or less regardless of increased workload without myocardial symptoms  Fatigue  SOB Wheezing Leg cramps  claudication  Increased chest pain  maybe signs of angina  maybe signs of ischemia  Hypertensive response  250/115 mm Hg  Signs of cardiac arrhythmias  Results  Negative low probability of coronary artery disease  Positive  High probability of coronary artery disease

Endurance exercise that involve large muscles through a repetitive and rhythmic motion.  Indications   When the patient has reduced cardiorepiratory endurance  Prevention of primary/secondary cardiovascular disease Precautions/contraindications  Known disease to minimize risks and maximize benefits  Procedure  Any exercise that can be done constantly with the goal to increase endurance as well  Components to prescription of exercise  Intensity  How hard or how much exercise the patient should perform based on a target heart rate (THR)  There are formulas to measure for this concept  To determine Heart rate max  HR max = 22 - age  To determine percent of HR max (highest to lowest point) Lowest THR = HR max x 55% Highest THR - HR max x 90% Second method using the karvonen formula also known as the heart rate reserve  Lowest THR = [(HR max - HR rest) x 40%] + HR rest  Highest THR = [(HR max - HR rest) x 85%] + HR rest  Duration  Depends on the intensity but is how long the exercise goes for  Typically 20-60 min session this also includes warm-up and cool down time  Types  High intensity Should be done for 20 minutes But can also be done longer if they are really fit  Moderate intensity  Long duration typically for adults who are not athletic  Low intensity  Activity should be done for > 30 minutes since intensity is low  Frequency  How many times a week/day the exercise is performed  Typically 3-5 days per week  Normal cardio responses  Acute response to exercise  Increased O2 consumption such as increased cardiac output and blood flow  Steady increase of systolic BP with increased workload (8-12 mm Hg)  No or slight change to diastolic BP during exercise  Increased RR and tidal volume during exercise  Chronic response yo exercise