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Table 1 Characteristics and benefits of the varying exercise modalities used in exercise CMR

From: Exercise cardiovascular magnetic resonance: development, current utility and future applications

Exercise type Treadmill Upright cycle ergometer Supine Cycle ergometer Supine stepper ergometer Prone exercise Isometric Handgrip
Outside MR scanner Inside MR scanner
Dynamic Dynamic Dynamic Dynamic Dynamic Static
Common applications Ischaemia testing
(Regional wall motion & perfusion)
Aortic/Pulmonary Flow Ventricular volumes
Aortic/pulmonary flow
Ventricular volumes
Aortic/pulmonary flow
Spectroscopy Spectroscopy
Coronary endothelial function
Max exercise intensitya Maximal Light Maximal Submaximal/ Vigorous Light-Moderate Very-light
Benefits -Patients more readily achieve maximal intensity exercise
-Diagnostic 12 lead ECG performed during exercise
-Treadmill test provides separate prognostic data
- Maximal oxygen uptake during exercise on CMR adjacent treadmill feasible
-Most natural and tolerated form of exercise
Allows imaging during exercise
Allows imaging at multpile exercise levels
-Only modality with upright in-scanner exercise
-Less claustrophobia in open magnet scanner
-Can be performed to maximal exercise intensity in MR bore. -Less leg restriction than cycle ergometer   -Stable stress heart rate
-Minimal movement
-No magnet bore restriction
Weaknesses - Post stress imaging allows heart rate recovery before imaging
- Logistically difficult to image at multiple exercise intensities
Unable to perform 12 lead ECG or accurate ST segment monitoring during in-scanner exercise
-Uses open magnet scanner – low field strength (low SNR), limited availability, CMR feasible but non-standard.
-Only published in minimal studies to light intensity exercise.
-Cycling can be restricted by magnet bore diameter - Lower intensity exercise than cycle ergometer - Uncomfortable form of exercise
- Modest exercise feasible
- Logistically difficult to increase resistance
-Atypical form of exercise
- Limited increase in heart rate
  1. aHighest exercise intensity achieved in published research, with intensities defined by American College of sports medicines guidelines [32]. SNR = signal-to-noise ratio