A comprehensive review of the patient’s medical history is paramount to safe and effective exercise prescription. For further information see the Treatment and Management 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
• 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
• Psychosocial health (depression and anxiety)

Reducing sedentary behaviour and promoting lifelong physical activity is an important component of all cardiac rehabilitation and HF management programs. Assessment of physical activity is thus important for all patients and can be undertaken in the following ways:

• Pedometers (often found in smartphone apps) – provide measure of step count
• Accelerometers – (wearables and some smart phone apps) - provides step count + measure of exercise intensity thus allowing overall measure of volume of moderate-vigorous physical activity per week
• Inclinometers – measure postural changes including lying, sitting and standing time. Provide accurate measures of sedentary time
• Physical activity questionnaires (eg Long-format Physical Activity Questionnaire, Active Australia Survey)
• Physical activity diaries

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

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

The choice of outcome measures is dependent upon:

• Clinical presentation of the individual
• Patient goals
• Mode of program delivery (eg centre-based versus home based)

Outcome measures should reflect the type of exercise training and expectations of outcome change.  For example, if it is intended that resistance training be included in the patient’s program for the purpose of improving muscle strength, inclusion of a measure of strength would be appropriate. For frail patients, additional functional exercise tests should be considered. Combined measures may also prove useful such as the Short Physical Performance Battery (SPPB).

Following completion of the assessment, communication with relevant health care providers is essential to communicate the exercise plan and to optimise patient outcomes.

Where possible, assessments for people participating in home-based exercise training programs should be undertaken in-person at the health facility.  This allows for ease of performance of outcome measures such as the six minute walk test, standardisation of assessment conditions, availability of staff for safety purposes and availability of equipment for monitoring. 

In some cases, attendance at the heath facility may not be possible and whilst there is currently limited evidence for remote assessment of exercise capacity, clinical consensus suggests that there is potential to adapt some elements of the assessment. Specific considerations include:

• The patient’s clinical condition (eg falls risk, cognition, vision, hearing)
• The patient’s availability and familiarity with technology
• Access to blood pressure and heart rate monitoring (either own equipment or potential for loaning/ distributing equipment from the health service)
• Appropriateness of outcome measures. As assessment of exercise capacity using a six minute walk test may not be feasible, alternative measures such as a one minute sit to stand test, may be preferable.