Cardiac exercise programs: role of continuous electrocardiographic monitoring

The purpose of the present study was to determine the value of telemetry monitoring for detection of new and significant electrocardiographic (ECG) or blood pressure abnormalities during outpatient cardiac exercise therapy. Following preliminary graded exercise testing, 177 cardiac patients underwent a four-week monitored exercise program three days per week. During 2248 training sessions, 12 of the 177 patients (7%) showed significant ECG or blood pressure abnormalities not evident on initial exercise testing, eight (5%) requiring change in medical therapy. Abnormalities included significant (greater than 2mm) ST-T displacement (two patients), ventricular arrhythmias (seven patients), and hypertensive exercise response (three patients). Eleven of the abnormalities (92%) appeared during the first three weeks of the program. Results indicated that continuous ECG and blood pressure monitoring offered a small but significant diagnostic yield not evident on preliminary graded exercise testing. One-year experience suggested that short-term (four weeks) exercise monitoring may be adequate for cardiac patients who undergo careful preliminary screening.