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:

• Measure of exercise capacity (e.g., cardiopulmonary exercise test (CPET), 6-minute walk test (6MWT), incremental shuttle walk test (ISWT)
• Measure of quality of life

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. Combined measures may also prove useful such as the Short Physical Performance Battery (SPPB). For more detailed information see functional exercise tests.