Exercise Prescription & Programming

I just created a 20-hour course for MedFit Classroom, Cardiac R.E.H.A.B. [Restore-Energy-Heartiness-Aspirations-Benchmarks] Fitness Specialist Course for coaches-trainers working in the NON-clinical setting, where they are catching high-risk clients in their assessments, and/or receiving referrals from primary care practitioners or Cardiac Rehab phases II-III.

MEDS and intensity are the gray areas regarding target HR ranges. In reality, a large percentage of clients are on Rx MEDS that affect HR response. Therefore RPE is more commonly utilized as an upper limit intensity marker, even though HR can be tracked.

I make reference to the ACSM GETP, 11th Edition, p. 149 Table 5.3 for some commonly used equations for ESTIMATING MxHR for those not on MEDS that affect exercise capacity.

For MEDS, see Appendix A, p. 470.

Chapter 8 specifically references the AHA and AACVPR guidelines.

Once again, guidelines are not rules and regulations.

For you CR clinical folks, develop a solid relationship with coaches and trainers working in the non-clinical setting who can pick up where you left off. In other words, share relevant work capacity [METS], exercise Rx and training session details upon discharge.

Good thread!

Dana- While ACSM's Guidelines for Exercise Testing & Prescription is a good resource and important for those taking an ACSM certification, it should not be considered the same as guideline statements that are published from professional organizations. Same thing for the AACVPR guidelines texts. Both ACSM and AACVPR guideline texts are written by individuals without a systematic process to review and evaluate data. Therefore, if 220-age works for your needs, stick with it.

As for using 220-age (or other) for exercise target HRs in patients participating in cardiac rehab, its not clear to me how this is useful. Equations to estimate maximum HR are for apparently healthy individuals and there is large inter-individual variability in HR response. Most equations have a standard deviation of 15+ beats. However, based on a recent study of cardiac rehab programs in the US, many programs are using equations like 220-age, so your program is not the only one that feel there is value in their use. https://journals.lww.com/jcrjournal/Abstract/2022/09000/Exercise_Prescription_Methods_and_Attitudes_in.10.aspx

We need more discussion and research on this topic. -Best wishes.

I guess I need to clarify that I work in cardiopulmonary rehab. We use target heart rates to help patients understand safe ranges and it has to be apart of documentation for certification. I understand it is not accurate and I don't hold this range as an exercise termination number. I am asking if with this change if anyone else is switching from the 220-age to the 207-(0.7xage) formula?

Hi Dana. I did my first exercise test about 32 years ago now and what I have realized is that no one person may fit any formula that is developed to estimate maximal heart rates. The only way would be to get someone to go through an actual maximum stress test, which is difficult to actually attain. Having at least a peak effort, so you can get an understanding of how hard the person is actually going to work would come in a close second.

Unless you are absolutely required to do so, I rarely ever prescribe exercise intensities by heart rates. What I do is give the person a session where we do some practical experience in how it should feel to them. I am not a fan of the subjective scales either due to inherit biases in them.

If the person can actually feel what is is like to perform the desired intensity, then you can give them objective information in how to progress such as speed, grade, resistance level, weight, etc.

The basics have never changed, in order to progress you must provide an overload to the muscle to improve. so regardless of heart rates, this can be done.

If this does not seem to make sense, let me know.

According to the new ACSM Guidelines for exercise testing. The formula 220-age was used but now no longer recommended. What is everyone using? Table 5.3 in the book shows commonly used equations for estimating maximal heart rates. Are people now using Gellish? What is the gold standard for the normal adult population?