Exercise transiently increases the relative risk of CV events anywhere from 2- to 56-fold above what is expected at rest by chance alone | II or III |
There is evidence for greater risk with PA in the following patients or circumstances: when performing increasingly vigorous intensity (≥ 6 METs); in men, especially with limited previous PA history; and in older individuals | II or III |
Symptoms of dizziness or syncope, chest discomfort, and unexplained shortness of breath during or following PA are associated with nonfatal CV events or SCD and should be followed up. However, in most cases of SCD, death is the first clinical event, thus underlying pathology is not recognized. Despite the limitations of written or verbal screening alone (without ECG) for the detection of cardiac disease in apparently healthy individuals, efforts to identify those at higher risk using this approach are warranted; arguments in support of this method of screening are the low risk of adverse events in this population, the consequences of false-positive or false-negative results, and the costs of nonessential advanced screening technologies | III |
Most events in individuals older than 35 to 40 y are secondary to coronary artery disease; by far most cases in those younger than 30 to 35 y are linked to undetected congenital or inherited heart conditions related to conduction or myocardial and vessel structure. In both cases, adverse events are likely triggered by various malignant substrates related to the physiologic stress of exercise in the presence of disease | III |
The routine use of exercise testing in apparently healthy individuals is relatively safe and the risks of testing have been overstated by 20% to 50%, based on limited data from individuals with and without cardiac disease. The estimated risk of a fatal event during maximal exercise testing ranges from 0.3 to 0.8 per 10 000 tests (rather than 1 per 10 000 tests). Approximately 1.4 nonfatal events occur per 10 000 tests | III |
The risk of an adverse CV response during PA is extremely low for apparently healthy adults and adolescents; the risk of participation is outweighed by substantial health benefits conferred by PA | II |