Recommendations for objective cardiovascular assessment to inform clinical exercise prescription: An Exercise Physiologist and Physiotherapist expert consensus

Bethany Gower; Danielle Girard; Andrew Maiorana; Belinda Durey; David J Holland; Kade Davison

doi:10.1016/j.jsams.2023.07.004

Recommendations for objective cardiovascular assessment to inform clinical exercise prescription: An Exercise Physiologist and Physiotherapist expert consensus

J Sci Med Sport. 2023 Sep;26(9):454-458. doi: 10.1016/j.jsams.2023.07.004. Epub 2023 Jul 20.

Authors

Bethany Gower¹, Danielle Girard², Andrew Maiorana³, Belinda Durey², David J Holland⁴, Kade Davison²

Affiliations

¹ Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Australia. Electronic address: bethany.gower@mymail.unisa.edu.au.
² Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Australia.
³ School of Allied Health, Curtin University, Australia; Allied Health Department, Fiona Stanley Hospital, Australia.
⁴ Cardiology Department, Sunshine Coast University Hospital, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Australia; School of Medicine, Griffith University, Australia.

PMID: 37541866
DOI: 10.1016/j.jsams.2023.07.004

Abstract

Objectives: Exercise is beneficial in managing cardiovascular health. Objective assessments of cardiovascular function assist in identifying the presence or absence of exertional symptoms, and functional and physiological thresholds necessary to inform safe and effective exercise programmes. This study aimed to generate expert consensus on assessments of cardiovascular function to support clinical decision-making for professionals providing clinical exercise services.

Design: Three-round e-Delphi.

Methods: Expert Exercise Physiologists and Physiotherapists were recruited to participate in an e-Delphi. Experts were asked to list all objective cardiovascular assessments deemed necessary to inform safe and effective exercise prescription. In subsequent e-Delphi rounds, experts rated the importance of each item, provided a rationale to support their assertions, and reconsidered others' ratings and rationale to shift or reaffirm their position. These results were then translated into a clinical guidance document by the authors in consultation with a Cardiologist and an experienced Exercise Physiologist with expertise in cardiovascular assessment.

Results: Thirty-one experts participated in the e-Delphi and fourteen participants completed all three rounds. Forty objective assessments were initially suggested. Six items reached consensus by the end of Round 2 (resting and exercise heart rate, resting, exercise, and recovery blood pressure, and peak exercise-induced rating of perceived exertion). One additional item reached consensus in Round 3 (exercise oxygen saturation).

Conclusions: In the absence of research evidence, the collective experience and insights of an expert panel can inform an evidence gap. Further research is required to determine the feasibility of implementing these seven assessments in practice where CV assessment is indicated.

Keywords: Cardiovascular system; Clinical decision-making; Consensus; Evidence-based practice; Exercise.

MeSH terms

Consensus
Delphi Technique
Exercise
Humans
Physical Therapists*
Prescriptions