{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:32:29Z","timestamp":1790771549675,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T00:00:00Z","timestamp":1587945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Aerobic exercise is a core component of cardiac rehabilitation (CR). Leading organizations recommend that the exercise prescriptions should be based on a symptom limited baseline graded exercise test (GXT). However, recent evidence suggests that only ~30% of CR clinics perform baseline GXTs. Consequently, exercise prescriptions including exercise progression in CR are not following standard exercise prescription guidelines. Therefore, the purpose of this review is to provide clinicians with evidence-based techniques for prescribing exercise in the absence of a baseline GXT. Intensity indicators (e.g., heart rate, perceived exertion) are reviewed, along with special exercise considerations for various disease states (e.g., heart failure, peripheral artery disease, and coronary artery disease). Baseline exercise testing remains the gold standard approach for prescribing exercise among heart disease patients, however, clinicians must be prepared to safely develop and monitor patients when a baseline GXT is not performed.<\/jats:p>","DOI":"10.3390\/jcdd7020015","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T05:05:32Z","timestamp":1588050332000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Exercise Prescription Guidelines for Cardiovascular Disease Patients in the Absence of a Baseline Stress Test"],"prefix":"10.3390","volume":"7","author":[{"given":"Megan","family":"Mytinger","sequence":"first","affiliation":[{"name":"School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael K.","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah","family":"Zuhl","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1161\/01.CIR.0000024413.15949.ED","article-title":"Prediction of long-term prognosis in 12,169 men referred for cardiac rehabilitation","volume":"106","author":"Kavanagh","year":"2002","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1016\/j.jacc.2003.07.028","article-title":"Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation","volume":"42","author":"Kavanagh","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Martin, B.-J., Arena, R., Haykowsky, M., Hauer, T., Austford, L.D., Knudtson, M., Aggarwal, S., Stone, J.A., and Investigators, A. (2013). Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clinic Proceedings, Elsevier.","DOI":"10.1016\/j.mayocp.2013.02.013"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/S0735-1097(02)02164-2","article-title":"ACC\/AHA 2002 guideline update for exercise testing: Summary article: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines)","volume":"40","author":"Gibbons","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/HCR.0000000000000176","article-title":"Evolving role of exercise testing in contemporary cardiac rehabilitation","volume":"36","author":"Reeves","year":"2016","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/2047487312460484","article-title":"Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: A joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation","volume":"20","author":"Mezzani","year":"2013","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_7","first-page":"8","article-title":"Exercise Prescription Techniques in Cardiac Rehabilitation Centers in Midwest States","volume":"7","author":"Thomas","year":"2018","journal-title":"J. Clin. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s12471-013-0374-2","article-title":"Exercise training programs in Dutch cardiac rehabilitation centres","volume":"21","author":"Vromen","year":"2013","journal-title":"Neth. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.04.016","article-title":"Prescribing aerobic exercise intensity without a cardiopulmonary exercise test post stroke: Utility of the six-minute walk test","volume":"25","author":"Marzolini","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1161\/CIRCULATIONAHA.106.184461","article-title":"Assessment of functional capacity in clinical and research settings: A scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing","volume":"116","author":"Arena","year":"2007","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1177\/2047487316657669","article-title":"A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?","volume":"23","author":"Price","year":"2016","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_12","unstructured":"American College of Sports Medicine (2017). ACSM\u2019s Exercise Testing and Prescription, Lippincott Williams & Wilkins."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jchf.2013.09.002","article-title":"Cardiac rehabilitation exercise and self-care for chronic heart failure","volume":"1","author":"Ades","year":"2013","journal-title":"JACC Heart Fail."},{"key":"ref_14","unstructured":"American Association of Cardiovascular & Pulmonary Rehabilitation (2004). Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, Human Kinetics."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s00421-012-2421-x","article-title":"Associations between Borg\u2019s rating of perceived exertion and physiological measures of exercise intensity","volume":"113","author":"Scherr","year":"2013","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/occmed\/kqx063","article-title":"The Borg rating of perceived exertion (RPE) scale","volume":"67","author":"Williams","year":"2017","journal-title":"Occup. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Orlandi, G., Sofi, F., Moscarelli, L., Cirami, L., Mancini, S., and Stefani, L. (2020). Exercise Prescription in Renal Transplant Recipients: From Sports Medicine Toward Multidisciplinary Aspects: A Pilot Study. J. Funct. Morphol. Kinesiol., 5.","DOI":"10.3390\/jfmk5010010"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3390\/jfmk1010048","article-title":"Lifestyle intervention in surviving cancer patients","volume":"1","author":"Stefani","year":"2016","journal-title":"J. Funct. Morphol. Kinesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/00008483-200405000-00008","article-title":"Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation","volume":"24","author":"Joo","year":"2004","journal-title":"J. Cardiopulm. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.cjca.2017.01.022","article-title":"Performance of Fixed Heart Rate Increment Targets of 20 vs. 30 Beats per Minute for Exercise Rehabilitation Prescription in Outpatients with Heart Failure","volume":"33","author":"Reed","year":"2017","journal-title":"Can. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1152\/physiol.00012.2005","article-title":"Skeletal muscle glucose uptake during exercise: How is it regulated?","volume":"20","author":"Rose","year":"2005","journal-title":"Physiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/HCR.0000000000000049","article-title":"Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting","volume":"34","author":"Keteyian","year":"2014","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1016\/j.amjcard.2016.01.018","article-title":"Relationship between exercise workload during cardiac rehabilitation and outcomes in patients with coronary heart disease","volume":"117","author":"Brawner","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Haeny, T., Nelson, R., Ducharme, J., and Zuhl, M. (2019). The Influence of Exercise Workload Progression Across 36 Sessions of Cardiac Rehabilitation on Functional Capacity. J. Cardiovasc. Dev. Dis., 6.","DOI":"10.3390\/jcdd6030032"},{"key":"ref_25","unstructured":"Ehrman, J., Gordon, P., Visich, P., and Keteyian, S. (2018). Clinical Exercise Physiology, Human Kinetics. [4th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/HCR.0000000000000337","article-title":"Progression of exercise training in early outpatient cardiac rehabilitation","volume":"38","author":"Squires","year":"2018","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/OAJSM.S150596","article-title":"High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: A systematic review and meta-analysis","volume":"9","author":"Hannan","year":"2018","journal-title":"Open Access J. Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1177\/2047487317728370","article-title":"High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: A systematic review and meta-analysis","volume":"24","author":"Duraes","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.ijcard.2018.02.076","article-title":"High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis","volume":"261","author":"Neto","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_30","first-page":"e009305","article-title":"High-Intensity Interval Training for Patients with Cardiovascular Disease\u2014Is It Safe? A Systematic Review","volume":"7","author":"Wewege","year":"2018","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1016\/j.amjcard.2014.08.012","article-title":"Coronary atheroma regression and plaque characteristics assessed by grayscale and radiofrequency intravascular ultrasound after aerobic exercise","volume":"114","author":"Madssen","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"587","DOI":"10.2165\/11631910-000000000-00000","article-title":"High-intensity interval training in cardiac rehabilitation","volume":"42","author":"Guiraud","year":"2012","journal-title":"Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7","DOI":"10.15420\/cfr.2016:25:2","article-title":"Global public health burden of heart failure","volume":"3","author":"Savarese","year":"2017","journal-title":"Card. Fail. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1016\/j.jacc.2012.08.958","article-title":"Relation between volume of exercise and clinical outcomes in patients with heart failure","volume":"60","author":"Keteyian","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10741-007-9051-0","article-title":"Principles of exercise prescription for patients with chronic heart failure","volume":"13","author":"Myers","year":"2008","journal-title":"Heart Fail. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1038\/nrcardio.2016.179","article-title":"Peripheral artery disease: Epidemiology and global perspectives","volume":"14","author":"Fowkes","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/HCR.0000000000000343","article-title":"Exercise rehabilitation for peripheral artery disease: A review","volume":"38","author":"McDermott","year":"2018","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1001\/jama.1995.03530120067043","article-title":"Exercise rehabilitation programs for the treatment of claudication pain: A meta-analysis","volume":"274","author":"Gardner","year":"1995","journal-title":"JAMA"},{"key":"ref_39","unstructured":"Medicare, C.F., and Services, M. (2020, April 10). Decision Memo for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)(CAG-00449N), Available online: https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx.NCAId."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1161\/CIRCULATIONAHA.113.007003","article-title":"The treadmill is a better functional test than the 6-min walk test in therapeutic trials of patients with peripheral artery disease","volume":"130","author":"Hiatt","year":"2014","journal-title":"Circulation"},{"key":"ref_41","first-page":"113","article-title":"Beneficial effects of exercise beyond the pain threshold in intermittent claudication","volume":"4","author":"Carlon","year":"2003","journal-title":"Ital. Heart J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1177\/152660280701400520","article-title":"TASC II section F on revascularization in PAD","volume":"14","author":"Norgren","year":"2007","journal-title":"J. Endovasc. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e005375","DOI":"10.1161\/CIRCOUTCOMES.118.005375","article-title":"Mortality from Ischemic Heart Disease: Analysis of Data from the World Health Organization and Coronary Artery Disease Risk Factors from NCD Risk Factor Collaboration","volume":"12","author":"Nowbar","year":"2019","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics-2019 update: A report from the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","article-title":"Exercise standards for testing and training: A scientific statement from the American Heart Association","volume":"128","author":"Fletcher","year":"2013","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1002\/clc.22758","article-title":"Determination of ideal target exercise heart rate for cardiac patients suitable for rehabilitation","volume":"40","author":"Tan","year":"2017","journal-title":"Clin. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/7\/2\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:51:23Z","timestamp":1760363483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/7\/2\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,27]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["jcdd7020015"],"URL":"https:\/\/doi.org\/10.3390\/jcdd7020015","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,27]]}}}