Exercise Exercise

A comprehensive review of the patient’s medical history is paramount to safe and effective exercise prescription. For further information see the clinical history section.

This review should include:

  • Principal diagnosis
  • Past and current symptoms
  • Relevant investigations
  • Modifiable cardiovascular risk factors
  • Prescribed medications, particularly Cardiac medications that impact on exercise response
  • Co-morbidities and other pertinent medical history
  • Exercise habits past and present, including lifestyle physical activity
  • Personal exercise preferences
  • Barriers to exercise (time, anxiety level, depression, orthopaedic limitations, personal safety concerns, financial constraints, geography)
  • Enablers to exercise (things that make it easier to exercise or overcome barriers)
  • Social issues (family support, socioeconomics, transport)
  • Family medical history
  • Cognitive function

TIP: A patient’s interpretation of their illness, assessment or management may not always be accurate; always base risk stratification on documented evidence and interpretation of your assessment.

An assessment of general physical wellbeing includes consideration of the acute condition, as well as longer-term risks, and should include:

  • Resting heart rate (HR) and rhythm
  • Blood pressure (BP) – sitting and standing
  • Oxygen saturation
  • Body weight
  • Signs of fluid retention – orthopnoea, exertional dyspnoea, ankle oedema, bloating
  • Orthopaedic limitations
  • Mobility status, safety with ambulation – determine if further assessment is required regarding balance, falls risk, or other contributing factors
  • Anthropometric measurements; height, weight, body mass index (BMI) and waist girth
  • Physical activity measures – as appropriate (this may include accelerometers, pedometers, physical activity questionnaires)
  • Skin integrity – particularly diabetic feet
  • Supplementary assessments, as appropriate – blood glucose levels, balance testing, musculoskeletal assessment, respiratory auscultation
  • Sternal stability assessment and management in post-surgical patients

Determining the effectiveness of an intervention is an important component of any exercise program.

The choice of outcome measures is dependent upon:

  • Purpose of the program
  • Clinical presentation of the individual
  • Patient goals

The minimum standard for those attending a centre-based program is:

For some individuals, further assessment specific to the individual’s condition may be warranted. For example, a Timed Up and Go test (TUGT) or measures of strength, may be appropriate for frailer patients. For more detailed information see functional exercise tests.