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Indications and Contraindications for Exercise Testing FREE

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This report is not intended to serve as a standard of medical care; standards of medical care, which are determined locally and are constantly subject to change, are established on the basis of all the several facts of the individual case.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (Rogers J. Smith, MD).


JAMA. 1981;246(9):1015-1018. doi:10.1001/jama.1981.03320090065037
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EXERCISE testing has long provided a means to measure cardiovascular and physical fitness and was improved by the relatively recent addition of the ECG response to exertion. The Master's two-step test was accepted 35 years ago but today has been replaced by the treadmill or the bicycle ergometer, which uses a progression of mild to strenuous exercise. Safe protocols to be used for a progressive exercise test have been established,1,2 and the testing of cardiac fitness, both in normal and healthy subjects and patients, has become routine. Only recently, however, have data become available that allow comparison of coronary arteriography with the results of exercise testing in substantial numbers of asymptomatic subjects. This has shown a disturbingly high prevalence of both false-positive and false-negative test results, so that the value of such testing has recently been challenged.3 As a consequence, the Council on Scientific Affairs has requested several expert

REFERENCES

Kattus AA, Brock LL, Bruce RA, et al: Exercise Testing and Training of Apparently Healthy Individuals: A Handbook for Physicians , The Committee on Exercise. New York, American Heart Association, 1972;.
Kattus AA, Brock LL, Bruce RA, et al: Exercise Testing and Training of Individuals with Heart Disease or at High Risk for Its Development: A Handbook for Physicians , The Committee on Exercise. New York, American Heart Association, 1975;.
Epstein SE:  Value and limitations of the electrocardiographic response to exercise in the assessment of patients with coronary artery disease . Am J Cardiol 1978;;42:667-673.
Morris SN, Phillips JF, Jordan JW, et al:  Incidence and significance of decreases in systolic blood pressure during graded treadmill exercise testing . Am J Cardiol 1978;;41:221-226.
Bruce RA:  Exercise testing for evaluation of ventricular function . N Engl J Med 1977;; 296:671.
Ellestad MH, Wan MK: Stress Testing— Principles and Practices . Philadelphia, FA Davis Co, 1975;.
Chahine RA, Raizner AE, Ishimori T:  The clinical significance of exercise-induced ST-segment elevation . Circulation 1976;;54:209-213.
Weiner DA, Ryan TJ, McCabe CH, et al:  Exercise stress testing: Correlations among history of angina, ST-segment response and prevalence of coronary artery disease in the coronary artery surgery study (CASS) . N Engl J Med 1979;;301:230-235.
Patterson J, Naughton J, Pietras R, et al:  Treadmill exercise in assessment of the functional capacity of patients with cardiac disease . Am J Cardiol 1972;;30:757-762.
Froelicher VF, Brammel H, Davis G, et al:  A comparison of the reproducibility and physiologic response to three treadmill protocols . Chest 1974;;65:512-517.
Goldschlager N, Selzer A, Cohn K:  Treadmill stress tests as indicators of presence and severity of coronary artery disease . Ann Intern Med 1976;;85:277-286.
Froelicher VF:  Screening asymptomatic men for coronary disease . Annu Rev Med 1977;; 28:1-20.

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Kattus AA, Brock LL, Bruce RA, et al: Exercise Testing and Training of Apparently Healthy Individuals: A Handbook for Physicians , The Committee on Exercise. New York, American Heart Association, 1972;.
Kattus AA, Brock LL, Bruce RA, et al: Exercise Testing and Training of Individuals with Heart Disease or at High Risk for Its Development: A Handbook for Physicians , The Committee on Exercise. New York, American Heart Association, 1975;.
Epstein SE:  Value and limitations of the electrocardiographic response to exercise in the assessment of patients with coronary artery disease . Am J Cardiol 1978;;42:667-673.
Morris SN, Phillips JF, Jordan JW, et al:  Incidence and significance of decreases in systolic blood pressure during graded treadmill exercise testing . Am J Cardiol 1978;;41:221-226.
Bruce RA:  Exercise testing for evaluation of ventricular function . N Engl J Med 1977;; 296:671.
Ellestad MH, Wan MK: Stress Testing— Principles and Practices . Philadelphia, FA Davis Co, 1975;.
Chahine RA, Raizner AE, Ishimori T:  The clinical significance of exercise-induced ST-segment elevation . Circulation 1976;;54:209-213.
Weiner DA, Ryan TJ, McCabe CH, et al:  Exercise stress testing: Correlations among history of angina, ST-segment response and prevalence of coronary artery disease in the coronary artery surgery study (CASS) . N Engl J Med 1979;;301:230-235.
Patterson J, Naughton J, Pietras R, et al:  Treadmill exercise in assessment of the functional capacity of patients with cardiac disease . Am J Cardiol 1972;;30:757-762.
Froelicher VF, Brammel H, Davis G, et al:  A comparison of the reproducibility and physiologic response to three treadmill protocols . Chest 1974;;65:512-517.
Goldschlager N, Selzer A, Cohn K:  Treadmill stress tests as indicators of presence and severity of coronary artery disease . Ann Intern Med 1976;;85:277-286.
Froelicher VF:  Screening asymptomatic men for coronary disease . Annu Rev Med 1977;; 28:1-20.
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