The safety of exercise testing

Although exercise testing is a safe activity for the vast majority of individuals being tested, complications during or soon after testing do occur, and safety is an extremely important consideration. In reviewing published rates of complications, it appears that complication rates around 5 per 10,000 tests and death rates around 0.5 per 10,000 tests might be expected. The rate of complications and deaths in our clinic is much lower than these published rates, but our population is, in general, a healthier population than those reported on in other studies. It is instructive to review the details of exercise tests in which complications have occurred, although sometimes it is impossible to predict that an untoward occurrence is imminent. Exercise testing soon after myocardial infarction or angioplasty can generally be conducted safely by knowledgeable professionals, although submaximal testing is recommended under these circumstances. Following accepted contraindications to testing and accepted indications for terminating an exercise test is still very important to ensure the safety of testing. If one desires to step outside these recognized guidelines, the anticipated benefits of testing must clearly outweigh the inherent risks. Any testing facility must have appropriate safety equipment, including a defibrillator, and personnel must be regularly drilled in responding to emergencies. In reviewing our experience at the Cooper Clinic, practical suggestions have been offered that should make exercise testing, which is already a very safe activity, even safer.