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Cardiac Stress Testing:

Seek approval by the primary physician prior to starting an exercise program. Stress testing should be conducted in any patient with the following conditions (139,140):

• Suspected or known coronary artery disease
• Typical and atypical angina
• Prior heart attack
• Evaluation of exercise capacity in patients with heart disease involving one or more of the valves of the heart, those with heart rhythm disorders, and those with pacemakers.
• Relatively healthy individuals without symptoms should have stress testing prior to exercising if they have multiple risk factors of heart disease such as:
  • High cholesterol
  • High BP
  • Family history of heart problems
  • Obesity
  • Diabetes mellitus
  • Other chronic diseases
  • Those in high-risk occupations such as pilots, firefighters, law enforcement officers, and transit operators
  • Men over age 40 and women over age 50 who have been inactive but plan to start vigorous exercise.

American College of Sports Medicine (ACSM) Cardiorespiratory Training Guidelines:

After approval from the physician is obtained, training guidelines should be followed. The main components of an exercise session per ACSM include warm-up, conditioning stimulus, and cool down. Warm-up before the session and cool down after the session of exercise consists of 5-15 minutes of activity at 50% training intensity of the conditioning activity planned. One should be easily able to hold conversation at 50% intensity.