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Exercise Capacity and Risk

Low Exercise Capacity Can Predict Risk

The level of a woman's ability to exercise has been shown to be an independent predictor of mortality.^64,90,91 In a study of 5721 asymptomatic women⁶⁴:

Metabolic equivalent (MET) levels <5 were associated with a 3.1-fold increase in the risk of death compared to levels >8.
MET levels of 5 to 8 were associated with a 1.9-fold increase in the risk of death compared to levels >8.
Every 1-MET increase in exercise capacity resulted in a 17% decrease in mortality risk.

Until recently, normative values of exercise capacity for age in women had not been established, making the extrapolation of risk from predicted and actual exercise levels more challenging.⁹⁰ In 2005, a new nomogram was introduced that can be used to calculate the percentage of a woman's age-predicted exercise capacity that she is actually able to reach (Figure 10).⁹⁰ Draw a line from the patient's age (left-side scale) to the MET level achieved (right-side scale). The point at which your line crosses the diagonal line on the chart shows the patient's percentage of age-predicted exercise capacity reached.

Figure 10. Nomogram for Calculating the Percentage of Women's Age-Predicted Exercise Capacity Attained⁹⁰

Defining Risk in Women

Exercise Capacity in Women

C-Reactive Protein

Atrial Fibrillation

Heart Failure

Fat Distribution and Heart Disease in Women

Fitness Levels

Rheumatoid Arthritis

Aging

Risk Prediction

Based on this nomogram, the risk of cardiac death among symptomatic women whose actual exercise capacity was <85% of their age-predicted capacity is twice that of women whose actual capacity is

85% of their age-predicted value.⁹⁰ In asymptomatic women, the risk of cardiac death was 2.44 times higher for those unable to reach 85% of their age-predicted value.⁹⁰ Incorporating this nomogram into the interpretation of exercise stress testing can provide additional prognostic information that can be used for risk stratification and to determine if additional diagnostic testing is required.