Positive exercise testing in athletes: What does that mean?

September 2, 2008,

Sudden cardiac death (SCD) during sports activity is an uncommon, but catastrophic event. Different efforts to reduce the risk of SCD related to sports have been undertaken. What is the role of the exercise test in this context? What does a positive exercise test mean?

Regular physical activity reduces cardiovascular risk factors and is associated with reduced cardiac mortality and morbidity. However, the risk for triggering cardiac events increases during vigorous physical activity, especially in individuals with underlying coronary artery disease (CAD). Several factors potentially contributing to oxygen depletion of the heart muscle (myocardial ischemia), may be specifically related to a high level of competition, such as release of stress hormones, increased risk for blood clot formation, thermal stress (heat/cold), altitude, dehydration and electrolyte disturbances.

Coronary artery disease is a very uncommon cause of SCD in young athletes, where underlying (most often unknown) inherited cardiovascular abnormalities are dominating causes. But, CAD is by far the most common cause of SCD in athletes >35 years of age. To reduce the incidence of SCD related to sports, the European Society of Cardiology (ESC) has proposed recommendations for cardiac screening of competitive athletes, consisting of family and personal history (including symptoms), physical examination and 12-lead electrocardiogram (ECG). If any abnormality is found during the screening, additional testing, including often a maximal exercise test, are undertaken to rule out/confirm the presence of an underlying cardiovascular abnormality.

In younger athletes (<35 years), an important indication for the exercise test clinically, is the suspicion of underlying cardiac arrhythmias and/or syncope. In athletes with underlying structural heart disease, such as hypertrophic obstructive cardiomyopathy, the exercise test may show a blood pressure drop or arrhythmias, giving important prognostic information.

The main role of the exercise test in athletes, however, is for the evaluation of "master" athletes (>35 years of age) with a high-risk profile. According to the ESC, the regular use of the exercise test in asymptomatic athletes with a low-risk profile for future cardiovascular events, <35 years of age (men) and <45 years of age (women), is not recommended.

But, in competitive athletes >35 years of age and with a high-risk profile for future cardiovascular events, the exercise test is mandatory to rule out/confirm the presence of (silent) underlying ischemic heart disease. For recreational sports/leisure-time activity, the exercise test today is recommended on an individual basis.

Exercise tests do have proven weaknesses, showing both false positive and false negative results, making additional testing necessary, especially in uncertain cases. If CAD is confirmed, athletes should be treated according to established protocols, and evaluated regarding eligibility for future sports competition, according to international recommendations.

To summarize, the exercise test is an important tool, used for:

-- cardiovascular evaluation of athletes with increased risk for underlying coronary artery disease or
-- on clinical suspicion of exercise-related arrhythmia, chest pain or syncope, or
-- risk stratification of athletes with different known cardiac abnormalities
-- A positive exercise test has to be complemented by additional testing, to confirm/ exclude the presence of underlying cardiovascular abnormality
-- When a final diagnosis has been made, the athlete must be treated according to established protocols and evaluated for future athletic eligibility according to existing international (ESC) recommendations

Source: European Society of Cardiology

Explore further: Researchers work to stop sudden cardiac death among young athletes

Related Stories

Researchers work to stop sudden cardiac death among young athletes

March 18, 2016
March Madness: It's a time of buzzer-beaters and bracket-busters, seed debates and the Sweet 16, as the 68-team NCAA men's basketball tournament hijacks our lives over a three-week stretch known as the Big Dance.

Manchester United's rising stars revolutionize heart health

January 28, 2015
A unique research project to identify the effects of exercise on young hearts has been announced today [Wednesday 28 January 2015]. Manchester United's Academy players are being put through their paces having their hearts ...

Population screening for SCD in young people: Feasible with basic screening program

May 8, 2014
Despite fears over cost, the wide-scale screening of young people to detect risk of sudden cardiac death (SCD) is feasible and cost effective, according to a study presented at EuroPRevent 2014. More than 12,000 people aged ...

Sudden death in hypertrophic cardiomyopathy rarely associated with exercise

August 28, 2016
Sudden death in patients with hypertrophic cardiomyopathy (HCM) is rarely associated with exercise, according to research presented at ESC Congress 2016 today by Dr Gherardo Finocchiaro, a cardiologist at St George's University ...

Study examines heart structure, function of NBA players

February 24, 2016
An analysis of the cardiac structure and function of more than 500 National Basketball Association (NBA) players provides information that can be incorporated into clinical assessments for the prevention of cardiac emergencies ...

New screening strategy to prevent cardiovascular complications in sports

December 13, 2013
Echocardiography with conventional M-mode and 2D modalities is a simple and cost effective way to increases the accuracy of pre-participation sports screening, according to research presented at EuroEcho-Imaging 2013 by Dr ...

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.