Sports Medicine: Just the Facts

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20 EXERCISE TESTING

David E Price, MD

Kevin Elder, MD

Russell D White, MD

INTRODUCTION

•Various anatomic, electric, and physiologic tests are
used in evaluation of the heart. The exercise stress
test(EST) endures as one of the few valuable and

practical physiologic tools to evaluate cardiac perfu-

sion and function under controlled conditions. Many

primary care physicians have moved away from this

traditional physiologic test thinking it less practical

with the advent of newer cardiovascular imaging

techniques. But numerous evidence-based guidelines

as established by the American College of Cardio-

logy (ACC) as well as the American College of

Sports Medicine (ACSM) have shown that many of

the new technologies do not necessarily have better

diagnostic characteristics than the standard exercise

test (Froelicher et al, 1999).

• EST is useful for diagnosis of ischemia (sensitivity of
  50–70%, specificity 80–90%), prognosis of known
  cardiac disease, and exercise prescription (Froelicher
  et al, 1999; Evans and Karunarante, 1992a).


• When performing an EST, one should understand its
  physiology, indications, contraindications, and inter-
  pretation, with special consideration given to athletes
  whose abnormal responses may, in fact, be normal
  variations.

EXERCISE TEST TERMINOLOGY

• It is essential to understand the basic EST terminol-
  ogy prior to performing the test (Fig. 20-1):


• PR segment:The isoelectric line from which the ST
  segment and the J point are measured at rest. With

118 SECTION 2 • EVALUATION OF THE INJURED ATHLETE

FIG. 20-1 Exercise stress test terminology.