This assessment tool may highlight any medical concerns, which require further assessment, prior to physical activity advice. Signpost your patient to the specific ‘safety considerations’ section, found at the end of each recommendation leaflet when providing advice. See FAQ to learn more about Physical activity guidelines.
Please note that vigorous (or high intensity) activity advice for currently inactive patients with chronic disease is beyond the scope of the Prescription for Exercise recommendations.
- History of Ischaemic Heart Disease?
An exercise tolerance test prior to any physical activity advice is needed for all high risk patients with coronary heart disease.*
Moderate intensity activities are safe for medically stable patients (based on history, examination and resting ECG) who can walk a mile in 25 minutes (that’s about 2.5 miles per hour). Deconditioned patients, who struggle to do this, and/or adults over 75 years old, should start with relatively low intensity activity and slowly increasing to relative moderate intensity exercise. 1
*Patients may be suspected to be high risk if:
- myocardial infarction is complicated by heart failure, cardiogenic shock and/or complex ventricular arrhythmias and/or
- angina or breathlessness occurs at a low level of sustained activity. 2
- Undiagnosed cardiovascular symptoms?
Symptoms of cardiovascular disease such as chest pain, palpitations, exertional shortness of breath, syncope or exertional syncope, postural hypotension need to be investigated first.
- Cardiovascular conditions that may be made worse on exertion?
A specialist cardiology opinion is needed before recommending physical activity for people with: Unstable Angina, severe aortic stenosis, uncontrolled cardiac arrhythmias, decompensated congestive heart failure and acute myocarditis.
- Current blood Pressure status?
- BP > 200/115mmHg – physical activity is not recommended until the BP is lowered.
- BP > 180/105mmHg – regular physical activity should not be resumed or started until the BP is lowered with medication
- Current disease status?
A management review or specialist opinion is advised for patients with unstable chronic conditions (e.g. uncontrolled diabetes, asthma, BP, angina, osteoarthritis) and acute illness/infection.
- Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease. S198 Appl. Physiol. Nutr Metab .Vol. 36, 2011 ↩
- SIGN (2002) Cardiac Rehabilitation (57). www.sign.ac.uk. This guideline is supported and endorsed by the British Association for Cardiac Rehabilitation (BACR) ↩