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METs Functional Capacity

Estimates functional capacity in metabolic equivalents

When to Use

  • Step 3 of the ACC/AHA perioperative cardiac risk assessment algorithm
  • Patients with RCRI >= 1 who need functional capacity assessment
  • Quick bedside estimation without formal exercise testing

When NOT to Use

  • Cannot be assessed in bedbound or wheelchair-bound patients (assume < 4 METs)
  • Does not replace formal exercise tolerance testing when indicated
  • Self-reported METs overestimates actual capacity in ~40% of patients (METS study, Wijeysundera 2018)
What is the highest level of activity you can perform?

METs Activity Reference Scale

1
Eating, dressing, using the toilet
2
Walking around the house, cooking
3
Walking 1-2 blocks on level ground (3-4 km/h)
4
Climbing a flight of stairs, walking uphill, light yard work
5-6
Short-distance running, cycling, golf without cart, heavy housework
7-8
Walking 4 mph (6.4 km/h), singles tennis, carrying heavy groceries upstairs
9-10
Jumping rope, vigorous cycling, swimming laps
>10
Competitive sports, running long distances

Evidence & References

  • Fleisher LA, Fleischmann KE, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. J Am Coll Cardiol. 2014;64(22):e77-e137.PMID: 25091544
  • Wijeysundera DN, Pearse RM, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study (METS). Lancet. 2018;391(10140):2631-2640.PMID: 30070222
Disclaimer: This calculator is a clinical decision aid and does not replace clinical judgment. Always consider the full clinical context when making patient care decisions.