Exercise testing in special populations: athletes, women, and the elderly

Exercise testing in special populations such as athletes, women, and the elderly requires additional considerations from the clinician. Different protocols, as well as special accommodations, may be necessary for performing the test. Symptomatic athletes may have a number of cardiac conditions that lead to ischemic changes on the exercise test. Asymptomatic athletes often use serial exercise testing to evaluate the efficacy of training programs. For women and the elderly, assessment of risk factors and evaluation of symptoms are important considerations before performing the exercise test. Negative exercise test findings suggest a low risk for future cardiovascular events. Positive exercise test findings must be interpreted in light of the individual's pre-test probability. Assessment of the needs of these patients allows the clinician to tailor the exercise test to produce useful information.