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Safety Issues Relating to Exercise Assessment

Before performing an exercise test, the coordinator should evaluate whether the patient should participate in exercise training based on:

  1. A review of the patient’s results from the Physical Activity Readiness Questionnaire (PAR-Q).
  2. An evaluation of the patient in relation to the contraindications and precautions identified below.

All patients should be evaluated for contraindications and precautions to exercise. Supervisory staff should be aware of the criteria for termination of a test, and other important safety issues.

Exercise Test Contraindications and Precautions

Unstable angina* or myocardial infarction during the previous month.
Resting heart rate > 120 beats / min after 10 minutes rest (relative contraindication).
Systolic blood pressure > 200 mmHg ± diastolic blood pressure > 100 mmHg (relative contraindication).
Resting pulse oximetry (SpO2)% < 88% on room air or while breathing the prescribed level of supplemental oxygen. The referring doctor should be notified and exercise assessment should not proceed.
Physical disability preventing safe performance.

*Note: Stable exertional angina is not an absolute contraindication to exercise, but the test should be performed after administration of anti-angina medication and with rescue nitrate available.

Exercise Test Termination Criteria

Onset of angina or angina-like symptoms.
Signs of poor perfusion including lightheadedness, confusion, ataxia, pallor, central cyanosis, nausea, cold clammy skin, sweating.
Patient requests to terminate test (e.g. intolerable dyspnoea, which is not relieved by rest and causes patient distress).
Physical or verbal manifestations of severe fatigue.
Development of an abnormal gait pattern (e.g. leg cramps, staggering).
Tachycardia (i.e. heart rate > 210 – 0.65age).  (This should be considered in conjunction with other signs or symptoms.
SpO2 < 85%*
Failure of heart rate to increase with exercise (unless the patient has a fixed rate pacemaker).

*Note: Depending on the experience of the supervising staff and on the patient’s clinical presentation, the test may continue even if SpO2 < 85%. If the test is stopped, recommence testing when the patient feels able or when SpO2 % approaches resting values. Alternatively, consider repeating the test with supplemental oxygen.

Safety Issues Associated With Exercise Testing

  • The health professionals supervising the exercise program will need to be trained in cardiopulmonary resuscitation.
  • Local area safety procedures should be reviewed during program set-up.
  • Where possible, “crash trolleys” and oxygen should be in the vicinity of the area designated for exercise.
  • Programs that are not run in a hospital environment (e.g. community programs) should ensure adequate emergency procedures are in place including a telephone to call an ambulance.
  • If the patient is on long-term oxygen therapy, the exercise tests should be carried out using the prescribed level of inspired oxygen.

Safety Monitoring During Walking Tests

During walking tests, the coordinator should ensure that:

  • Pulse oximetry is used to measure heart rate and oxygen saturation (i.e. the patient’s physiological response to exercise).
  • The breathless (Borg) score is used to measure the patient’s perception of dyspnoea during exercise.