Exercise Testing

1. Key Reference

The key reference for exercise testing is the text Guidelines for Exercise Testing and Prescription, a publication of the American College of Sports Medicine, now in its eighth edition, 2010. It is published by Lippincott Williams and Wilkins; ISBN=978-0-7817-6903-7. This text is written for professionals in the field. This material is abstracted from Chapter Two.

2. Risk Stratification.

a. Mimimum Risk. Individuals classified as minimum risk are those who do not have signs/symptoms of, and have not been diagnosed with, cardiovascular, pulmonary and/or metabolic disease. They have no more than one cardiovascular disease risk factor – see section 4. The risk of an acute cardiovascular event in this population is low, and a physical activity /exercise program may be pursued safely without the necessity for medical examination and clearance.

b. Moderate Risk. Individuals classified as moderate risk do not have signs/symptoms of, and have not been diagnosed with, diagnosed cardiovascular, pulmonary and/or metabolic disease but have two or more cardiovascular disease risk factors.

c. Maximum Risk. Individuals classified as maximum risk are those who have one or more signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease.

3. Participation in Science Fair Projects

a. Only individuals classified as Minimum Risk may participate in science fair projects.
b. Individuals classified as Moderate or Maximum Risk may NOT participate in science fair projects.

4. Artherosclerotic Cardiovascular Disease Risk Factor Thresholds

Positive Risk Factors	Defining Criteria
Age	Men: ≥ 45 years; Women: ≥ 55 years
Family History	Myocardial Infarction, coronary revascularization or sudden death before 55 years in the father or other first degree male relative, or before 65 years old in the mother or other first degree female relative.
Cigarette Smoking	Current cigarette smoker, or those who have quit within the last 6 months or those exposed to tobacco smoke.
Sedentary Life Style	Not participating in at least 30 minutes of moderate intensity physical activity on at least three days a week for at least three months.
Obesity	Body mass index ≥ 30 kg.m2 or waist girth > 102 cm for men and > 88 cm for women.
Hypertension	Systolic Blood Pressure > 140 mm Hg and / or diastolic blood pressure > 90 mm Hg confirmed by a minimum of two measurements taken at least 24 hours apart. Or on antihypertensive medication.
Dylipidemia	Low density lipoprotein (LDL-C) cholesterol ≥ 130 mg∙dL-1or high-density lipoprotein (HDL-C) < 40 mg∙dL-1 or or on lipid-lowering medication. See the text above for further details
Prediabetes	Impaired fasting glucose (IFG) = fasting plasma glucose ≥ 100 mg∙dL-1 See the text above for further details.

5. The Physical Activity Readiness Questionnaire – PAR-Q

This Canadian Questionnaire can be downloaded here: http://www.csep.ca/english/view.asp?x=698 Those doing a science fair project may use it as part of their Informed Consent form to ensure that all the participants are Minimum Risk.

6. Risk Stratification

Minimum Risk Allowed Asymptomatic ≤ 1 Risk Factor	Moderate Risk Not Allowed Asymptomatic ≥ 2 Risk Factors	Maximum Risk Not Allowed Symptomatic, or known cardiac, pulmonary or metabolic disease
Medical Exam & Graded Exercise Testing before Exercise Moderate Exercise: Not Necessary Vigorous Exercise: Not Necessary	Medical Exam & Graded Exercise Testing before Exercise Moderate Exercise: Not Necessary Vigorous Exercise: Recommended	Medical Exam & Graded Exercise Testing before Exercise Moderate Exercise Recommended Vigorous Exercise: Recommended
MD Supervision of Exercise Test Sub maximum: Not necessary Maximum: not necessary	MD Supervision of Exercise Test Sub maximum: Not necessary Maximum: recommended	MD Supervision of Exercise Test Sub maximum: recommended Maximum: recommended

a. Moderate Exercise: Moderate intensity exercise; 40 -60% of VO_{2 max} ; 3-6 METs’ [i]“an intensity well within the individuals capacity, one which can be comfortably sustained for a prolonged period of time (45 minutes).

b. Vigorous Exercise: Vigorous Intensity Exercise; > 60% of VO_{2 max} ; > 6 METs; “exercise intense enough to represent a substantial cardiorespiratory challenge”.

c. Not Necessary: reflects the notion that a medical examination, exercise test, and physician supervision f exercise testing would not be essential in the pre-participation screening, however they should not be viewed as inappropriate.

d. Recommended: when MD supervision of exercise testing is “Recommended” the MD should be in close proximity and readily available should there be an emergent need.