Do You Need a Stress Test?

Exercise is clearly one of the most important activities anyone can do to improve and sustain great health, well-being, and slow or even prevent aging. There are risks associated with a high-intensity exercise program, however, and these not only include injuries to muscles and tendons but also can include injuries to your heart-by far the most serious. Heart disease is the number one killer in our nation!

To prevent cardiac events from happening while exercising, the American Heart Association and the American College of Sports Medicine now recommend that all men over the age of 40 and women over the age of 50 undergo stress testing before starting a rigorous exercise program. If your heart has any blockages in the coronary arteries (the arteries that supply your heart muscle with all of it's blood) the heart muscle (myocardium) won't get enough of the oxygen-rich blood it needs and this will cause ischemia. Ischemia may or may not cause chest pain (angina). When ischemia from heart disease doesn't cause any pain it is called silent heart disease. Even if silent heart disease is present, it will cause changes in the electrical activity of the heart that can be picked up on an electrocardiogram (EKG). This, I believe, is the real value of a stress test -it is done under very close medical supervision with very sensitive electronic monitoring and can frequently pick up problems with your heart that you don't know you have. And, if serious problems should develop, well-trained medical personnel can successfully and efficiently deal with them immediately.

Another plus for stress testing is that it assesses one's capacity for exercise, as determined by how long he or she can stay on the treadmill until exhaustion, and this is a powerful predictor of cardiac risk. There is a down side to stress testing, however, and that is it sometimes misses exercise-induced heart problems and at other times it can falsely suggest that an individual has a heart problem, when in fact they don't. 

So what should you do? Clearly, if you have a family history of heart disease or you have had a previous heart attack, or smoke, or have high blood pressure, congestive heart failure, high cholesterol levels, abnormal heart rhythms, obesity, or any other major cardiac risk factor you definitely need a comprehensive medical evaluation. I think this evaluation should also include a stress test. When you do go for your stress test, be sure to get the most sensitive test you can, one that uses nuclear imaging or echocardiography. 

If you don't fall into any of the risk categories I mentioned above and you are healthy, your doctor may advise you to forego the stress test and go with just a good general checkup. I must tell you, however, that all of the cardiologists I know strongly advise that every male over 40 and every female over 50 get a stress test if they are going to exercise vigorously.

Regardless of whether or not you get a stress test, you must always be sure to "listen" carefully to your body when you are exercising (as well as at all other times for that matter) and if you experience any pressure or pain in your chest, neck, arm, or jaw, or get indigestion, extreme shortness of breath, an erratic pulse, or dizziness you must stop immediately, chew and swallow two aspirins if you are not allergic to them, and go to your nearest emergency room. 

Finally, be sure you get into shape gradually. Remember, Rome wasn't built in a day and this is not just an exercise program-it's a new lifestyle for you that will become an essential part of each and every day of the rest of your life, so take your time and do it right!