Exercise Testing in Sports Medicine

Background: Bicycle and treadmill exercise tests are used in sports medicine and occupational medicine to detect latent disease, to monitor treatment, and to measure patients' physical performance ability and reserve. In this review, we describe the indications, contraindications, and manner of performance of these tests, along with the variables tested, criteria for evaluation, (sub) maximal stress, and the factors that affect these tests, including age, sex, and medications. Methods: This review is based on pertinent articles retrieved by a selective literature search and on the ergometry guidelines of four medical specialty societies. Results: The proper performance of ergometric stress tests calls for preparation and monitoring by qualified staff as well as standardized testing conditions. Ergometric studies are indispensable as a clinical diagnostic method for the early recognition of disease, for follow-up over time, and for individual counseling. The patient's maximal achievable performance is a predictor of morbidity and mortality. Among the variables that can be measured in the submaximal performance range, the respiratory rate, heart rate, and lactate performance curves are more accurate prognostic predictors than the so-called threshold values (physical working capacity, anaerobic-aerobic threshold). Ergometric stress tests can be used to detect (among other conditions) latent hypertension, pulmonary diseases (e.g., exertional asthma), pabnormal ECG changes, and cardiovascular disorders (e.g., ischemia, arrhythmia, congestive heart failure). The ergometric findings are influenced by the choice of stress-inducing protocol. They provide important information for the planning and monitoring of exercise training and for the treatment of persons suffering from diverse physical conditions, as well as for leisure-time athletes. They are less suitable for use in the design of training programs for high-performance athletes. Conclusion: Ergometric stress tests provide important data in clinical and preventive medicine. The findings are often difficult to interpret because of the wide range of normal findings, the use of different stress-inducing protocols, and the lack of generally accepted reference values. The establishment of a nationwide fitness and health registry for ergometric data would be very helpful for the individualized interpretation of test findings and for the monitoring of exercise training and therapy.