Patient Preparation

and Monitoring

Astri Kurniati Martiana., MD

Cardiovascular Prevention and Rehabilitation Division
Preparations and Precautions EST
Facilities and Equipment

• Electronic treadmill that ranges in speed between 1.6 km/h and

12.8 km/h and gradient range of 0% to 22%

• Treadmill should have have a front rail and at least one side rail for

safety and should be fited with emergency stop button

• A suitable electrocardiographic recording system capable of

continuous monitoring of heart rhythm, rate and iscahemic

changes

• Emergency trolley and defibrillator

 Preparations and Precautions EST
• Personel: appropriate healthcare professionals that capable of BCLS and ACLS & have competency for data

interpretations.

• Patient: Should not to eat, smoke, drink alchohol or caffeine at least 3 hours prior to the test, unusual

physical exertion should be avoided before testing, routine medications may be taken with small amounts

of water, comfortable walking shoes or footwear.

• Patient assessment: History taking, physical examination

• Indication and contraindication

• Informed concent
 Preparations and Precautions EST

Placement of the limb leads on the torso is necessary for reduction of noise
in the ECG during exercise, whereas precordial lead placement is unchanged.

Conditions known to interfere with ECG

interpretation

Gerald F. Fletcher. Circulation. Exercise Standards for Testing and Training, Volume: 104, Issue: 14, Pages: 1694-1740, DOI: (10.1161/hc3901.095960)
Patient monitoring
• Blood Pressure :
Prior to starting exercise as baseline reference. Once during every stage of
exercise, at peak exercise and at least twice in recovery or until blood
pressure has returned to values similar to exercise pressure.
• ECG :
Continuous ECG monitoring, should be easily viewed through a digital display
for entire duration of exercise.
• Monitoring of the patient should be continue for 6-8 minutes post exercise.
Indication for early termination of exercise stress testing
Parameters to be observed
during exercise stress test
6 Minutes Walking Test
 TECHNICAL ASPECTS: REQUIRED EQUIPMENT
1. Countdown timer (or stopwatch)
2. Mechanical lap counter
3. Two small cones to mark the turnaround points
4. A chair that can be easily moved along the walking course
5. Worksheets on a clipboard
6. A source of oxygen
7. Sphygmomanometer
8. Telephone
9. Automated electronic defibrillator
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. “ATS statement: guidelines for the six-minute walk test.” American journal of respiratory and critical care medicine
vol. 166,1 (2002): 111-7. doi:10.1164/ajrccm.166.1.at1102
 TECHNICAL ASPECTS: LOCATION

• The 6MWT should be performed indoors, along a long, flat, straight,

enclosed corridor with a hard surface that is seldom traveled.
• If the weather is comfortable, the test may be performed outdoors.
The walking course must be 30 m in length.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. “ATS statement: guidelines for the six-minute walk test.” American journal of respiratory and critical care medicine
vol. 166,1 (2002): 111-7. doi:10.1164/ajrccm.166.1.at1102
 TECHNICAL ASPECTS: LOCATION
• The length of the corridor should be marked
every 3 m. The turnaround points should be
marked with a cone (such as an orange traffic
cone).

• A starting line, which marks the beginning and

end of each 60-m lap, should be marked on the
floor using brightly colored tape.

ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. “ATS statement: guidelines for the six-minute walk test.” American journal of respiratory and critical care medicine
vol. 166,1 (2002): 111-7. doi:10.1164/ajrccm.166.1.at1102
 MEASUREMENTS
1. Repeat testing should be performed about the same time of day
2. A “warm-up” period before the test should not be performed.
3. The patient should sit at rest in a chair, located near the starting
position, for at least 10 minutes before the test starts.
4. Pulse oximetry is optional. If it is performed, measure and record
baseline heart rate and oxygen saturation (SpO2).
5. Have the patient stand and rate their baseline dyspnea and overall
fatigue using the Borg scale
6. Set the lap counter to zero and the timer to 6 minutes.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. “ATS statement: guidelines for the six-minute walk test.” American journal of respiratory and critical care medicine
vol. 166,1 (2002): 111-7. doi:10.1164/ajrccm.166.1.at1102
 MEASUREMENTS
8. Position the patient at the starting line.
9. Do not talk to anyone during the walk.
10. Post-test: Record the postwalk Borg dyspnea and fatigue levels.
11. If using a pulse oximeter, measure SpO2 and pulse rate from the
oximeter and then remove the sensor.
12. Record the number of laps from the counter (or tick marks on the
worksheet).
13. Record the additional distance covered
14. Congratulate the patient on good effort and offer a drink of water.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. “ATS statement: guidelines for the six-minute walk test.” American journal of respiratory and critical care medicine
vol. 166,1 (2002): 111-7. doi:10.1164/ajrccm.166.1.at1102
THANK YOU