Is an Exercise Tolerance Test Indicated Before Beginning Regular Exercise? A Decision Analysis

ABSTRACT BACKGROUND AND OBJECTIVE The present study, using a decision analysis, evaluates whether an exercise tolerance test (ETT) is indicated before initiating regular physical activity to reduce the risk of sudden death during exercise training. DESIGN The study encompasses a decision tree, Monte...

Full description

Saved in:
Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2009-08, Vol.24 (8), p.934-938
Main Authors: Lahav, Dror, Leshno, Moshe, Brezis, Mayer
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular disease
Coronary Disease - complications
Coronary Disease - physiopathology
Coronary Disease - prevention & control
Coronary heart disease
Death, Sudden, Cardiac - prevention & control
Decision analysis
Decision Support Techniques
Exercise
Exercise - physiology
Exercise Test - methods
Exercise Test - statistics & numerical data
Exercise Tolerance - physiology
General aspects
Heart
Humans
Internal Medicine
Medical sciences
Medical screening
Medicine
Medicine & Public Health
Monte Carlo Method
Monte Carlo simulation
Mortality
Original
Original Article
Physical Fitness - physiology
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ABSTRACT BACKGROUND AND OBJECTIVE The present study, using a decision analysis, evaluates whether an exercise tolerance test (ETT) is indicated before initiating regular physical activity to reduce the risk of sudden death during exercise training. DESIGN The study encompasses a decision tree, Monte Carlo simulation, and utility analysis for adults at low to high risk for coronary disease, with a time horizon of five years, with or without routine ETT screening before initiating physical activity. MEASURES Mortality in Monte Carlo simulation; expected values in utility analysis. RESULTS Routine screening decreases mortality in intermediate to high-risk populations but not in low-risk persons. At all risk levels, the number of exercise-induced deaths prevented is less than the added number of deaths from angiography. Utility analysis indicates inferiority of routine screening, regardless of risk. Personal preferences (perceived stigma from having coronary disease and perceived benefit of regular exercise on quality of life) have a strong influence on the optimal choice. CONCLUSION Routine screening before initiating regular exercise is not recommended for the purpose of reducing the risk of sudden death during exercise training.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-009-1029-2