Exercise Testing for the Symptomatic Athlete

  • Karl B. Fields

Many physicians consider exercise tolerance testing for athletes to be counterintuitive in that these individuals routinely perform high-level activity that would stress the cardiovascular system. However, numerous case reports of high-level athletes experiencing cardiac death have underscored the importance of identifying the athlete with symptoms that warrant evaluation. An additional challenge of deciding who merits testing is the labeling of individuals as athletes and the differentiation between symptoms of physiologic stress and pathophysiology.


Heart Rate Recovery Pretest Probability Complete Heart Block Right Bundle Branch Block Teaching Point 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American College of Sports Medicine. Guidelines for Exercise Testing and Prescription, 6th ed. Lea and Febiger, eds. Philadelphia: Lippincott, Williams & Wilkins, 2000.Google Scholar
  2. 2.
    Garber AM, Hlatky MA. Stress testing for the diagnosis of coronary heart disease. In: UpToDate Version 15.1, 2007.Google Scholar
  3. 3.
    Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;106:1883.PubMedCrossRefGoogle Scholar
  4. 4.
    Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. NEJM 2002;346:793–801.PubMedCrossRefGoogle Scholar
  5. 5.
    Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 2000;284(11):1392–1398.PubMedCrossRefGoogle Scholar
  6. 6.
    Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, Dat D, Myers J. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 2001;38(7):1980–1987.PubMedCrossRefGoogle Scholar
  7. 7.
    Mora S, Redberg RF, Sharrett AR, Blumenthal RS. Enhanced risk assessment in asymptomatic individuals with exercise testing and Framingham risk scores. Circulation 2005;112(11):1566–1572.PubMedCrossRefGoogle Scholar
  8. 8.
    Biffi A, Pelliccia A, Verdile L, Fernando F, Spataro A, Caselli S, Santini M, Maron BJ. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2002;40(3):446–452.PubMedCrossRefGoogle Scholar
  9. 9.
    Olshansky B. Neurocardiogenic (vasovagal) syncope and carotid sinus hypersensitivity. In: Rose BD, ed. UpToDate. Waltham, MA: Version 15.1, 2007.Google Scholar
  10. 10.
    Arnsdorf MF. Congenital third degree (complete) atrioventricular block. In: Rose BD, ed. UpToDate. Waltham, MA: Version 15.1, 2007.Google Scholar
  11. 11.
    Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor of death [erratum appears in N Engl J Med 2003;348(15):1508]. N Engl J Med 2003;348(9):781–790.PubMedCrossRefGoogle Scholar
  12. 12.
    Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ 1998;316:1784–1785.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Karl B. Fields
    • 1
    • 2
  1. 1.Moses Cone Health SystemGreensboro
  2. 2.Department of Family MedicineUniversity of North Carolina at Chapel HillGreensboroUSA

Personalised recommendations