Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation

Eur J Prev Cardiol. 2013 Jun;20(3):442-67. doi: 10.1177/2047487312460484. Epub 2012 Oct 26.


Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

Keywords: Aerobic training; cardiac rehabilitation; energy expenditure; peak VO2; ventilatory thresholds.

Publication types

  • Practice Guideline

MeSH terms

  • Canada
  • Europe
  • Exercise Test / standards
  • Exercise Therapy / standards*
  • Exercise Tolerance
  • Heart Diseases / diagnosis
  • Heart Diseases / physiopathology
  • Heart Diseases / rehabilitation*
  • Humans
  • Predictive Value of Tests
  • Recovery of Function
  • Societies, Medical / standards*
  • Time Factors
  • Treatment Outcome
  • United States