Is an Exercise Tolerance Test Indicated Before Beginning Regular Exercise? A Decision Analysis

Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation

“…An orientation to the theoretical heart rate (HR) max , for example reaching at least 85% of the HR max , may be misleading because of individual variations of HR max not related to age. Although the routine use of maximal exercise ECG in healthy asymptomatic individuals with a low risk of cardiovascular events, has low positive predictive value, 37,38,68 in populations with risk factors for CAD, a positive exercise test has been shown to identify individuals with an increased risk of subsequent coronary events. 69,70 Indeed, in the Seattle Heart Watch Study, asymptomatic men with more than one coronary risk factor and more than two abnormal findings on the exercise test, had a 30 times higher risk for cardiac events during the 5-year follow-up period.…”

“…Although the routine use of maximal exercise ECG in healthy asymptomatic individuals with a low risk of cardiovascular events, has low positive predictive value, 37,38,68 in populations with risk factors for CAD, a positive exercise test has been shown to identify individuals with an increased risk of subsequent coronary events. The exercise test should be conducted until volitional fatigue (or a clinical indication for stopping).…”

ACSM’s New Preparticipation Health Screening Recommendations from ACSM’s Guidelines for Exercise Testing and Prescription, Ninth Edition

“…Furthermore there is lack of consensus regarding the extent of the medical evaluation (i.e., medical examination and stress testing) needed as part of the preparticipation health screening process prior to initiating an exercise program even if it is of vigorous intensity (1, 5,15). There is also evidence from decision analysis modeling that routine screening using exercise testing prior to initiating an exercise program is not warranted regardless of baseline individual risk (7). These considerations form the basis for the new ACSM preparticipation health screening recommendations that follows (10).…”

Leisure sport activity as a trigger for acute coronary events in men without known coronary artery disease

“…When applying the PROCAM risk score® for this cohort, there was a low 10-year probability risk for AMI of 7.8% [2]. Although the routine use of maximal exercise electrocardiogram in healthy asymptomatic individuals with a low risk of CV events has a low positive predictive value [17], in populations with risk factors for CAD, a positive exercise test has been shown to identify individuals with an increased risk of subsequent coronary events [19,25]. A recent publication indicates that the exercise test may be superior to the resting electrocardiogram for identifying underlying CV abnormalities [32].…”

“…The mean hospital stay was 14 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), while the revenue from diagnosis-related groups was 9884 €±11,629 € (4087-46,000) (. Tab.…”