Cardiac Exercise Stress Testing: A Safe Tool to Design an Individualized Physical Exercise Training Plan for Older Adults
Authors: Zemljic‐Harpf Alice E. , Traninger Heimo , Harpf Hanns H. 
Published: June 2021

Introduction

In the United States about 10% of premature mortality is associated with insufficient physical activity. New 2018 Physical Activity Guidelines (PAG) were announced recently but it is unclear how these guidelines will be implemented in the general population. Recommending an individualized training plan in elderly patients is challenging. Cardiac stress tests are primarily used to evaluate potential underlying cardiovascular disease but can also be used to assess cardiorespiratory fitness (CRT). We hypothesized that treadmill cardiac exercise stress testing in older adults will be safe and useful to initiate an exercise training plan.

Methods

We retrospectively investigated ECG treadmill test results conducted at the Center for Ambulatory Rehabilitation Graz (ZARG), Austria. The Austrian cardiac rehabilitation program consists of three phases; phase I begins during the hospital stay, and phase II (6 weeks, 4 times/week) as well as phase III (up to 13 months, 2 times/week) are conducted in ambulatory cardiac rehabilitation centers and a home‐based training recommended every day of the week. Patients participating in phase II and phase III rehabilitation underwent initial screening and subjects with aortic stenosis, low systolic output (EF% < 45), and dyspnea at rest (NYHA Class IV) were excluded. Male and female patients age 65y–75y (n= 3006) and 75y–90y (n= 2493) were included. The ECG stress test training protocol was conducted, heart rate (HR) monitored continuously, and the HR threshold (HRT) calculated from the whole HR curve over time. We further documented body weight, height, body mass index, resting HR, maximal HR, resting/baseline as well as maximal systolic and diastolic blood pressure, calculated VO2Max, 50Watt HR, 100‐Watt HR, max Watt, and Watt/kg.

Results

Baseline bicycle ergometer exercise was performed until perceived exertion. Protocols used were 10W/10W increments per min (~90% of patients) or 20W/20W/1min (~10% of patients). Treadmill exercise tolerance testing was well tolerated by male and female patients of all ages (total n=5499). No differences between “maximal training capacity (Max Watt)” were found in male and female patients. Further, no difference in exercise capacity was found between the 65–75‐year (n= 3006) and 75–90‐year (n= 2493) age groups due to a wide range of individual exercise capacity amongst all participants. A personal training plan was compiled based on 70% of maximal performance. Patients were encouraged to achieve optimal training heart rates for 30 minutes daily and advised to perform muscle strengthening twice per week.

Conclusion

Treadmill exercise stress testing in older adults is safe and of great value to implement a home‐based personalized endurance exercise program. Since a direct link between CRT and early mortality has been shown, our data suggest that cardiac exercise stress testing should be routinely performed, not only to document and monitor cardiovascular disease, but also to prescribe a detailed, safe, individual, and home‐based exercise plan to achieve the new 2018 PAG.

Support or Funding Information

None

This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.