Recommendations for Standardization of Leads and of Specifications for Instruments in Electrocardiography and Vectorcardiography

Abstract

Exercise testing is a noninvasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercise. Exercise testing facilities range from the sophisticated research setting to more conventional equipment in the family practitioner’s or internist’s office. Regardless of the range of testing procedures performed in any given laboratory, basic equipment, personnel, and protocol criteria are necessary to conduct meaningful tests and ensure the comfort and safety of the patient. This statement provides a guide to initiating and maintaining a high quality clinical laboratory for administering graded exercise tests to adults. Pediatric testing is addressed separately.1 ### Environment Exercise testing equipment varies in size. The testing room should be large enough to accommodate all the equipment necessary, including emergency equipment and defibrillator, while maintaining walking areas and allowing adequate access to the patient in emergency situations. Compliance with local fire codes and with procedures for other types of emergencies (eg, earthquake, hurricane) is essential. The laboratory should be well lighted, clean, and well ventilated with temperature and humidity control. Including posters or pictures of outdoor scenes can reduce boredom and anxiety, particularly if the room has no windows. A wall-mounted clock with a “sweep” second hand or a digital counter is useful. The examining table should have space for towels, tape, and other items needed for patient preparation and testing. A curtain for privacy during patient preparation is useful. Minimizing interruptions and maintaining privacy allows the patient and laboratory personnel to concentrate on the testing procedure. To assess the level of effort, a large-print scale of perceived exertion2 (Table 1⇓) should be mounted on the wall in clear view of the patient. The same scale has been used to assess symptoms of fatigue, dyspnea, or leg fatigue/pain.3 Dyspnea can also be measured by means of …