Using the exercise test to develop the exercise prescription in health and disease

The objective of an exercise program for persons with or without disease should be the development or maintenance of cardiorespiratory fitness, strength and muscular endurance, and flexibility. The basic principles of prescribing exercise--frequency, intensity, and duration of training--and the mode of activity as recommended by the ACSM for healthy adults are also appropriate for persons with disease. The difference in the exercise prescription for persons with disease is the manner in which these principles are applied. Usually, the more fragile the patient, the lower the intensity of exercise and the slower the progression of training. The role of cardiopulmonary exercise testing is to determine a safe and effective level of exercise for healthy persons as well as those with disease. GXT is useful in identifying individuals with disease and in providing information regarding the level of supervision needed during exercise training. In addition, exercise testing can be used to clear a person for participation in a resistance training program. Resistance training should be integrated as part of a well-rounded program, because of the importance of maintaining strength, muscle mass, and bone mineral density. Generally, the starting intensity for persons with disease is lower, the frequency and duration higher, and the progression of exercise slower to allow a more gradual adaptation to exercise training.