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Thomas M. Gill, MD; Loretta DiPietro, PhD, MPH; Harlan M. Krumholz, MD

JAMA. 2000;284:342-349.

While the benefits of physical activity and exercise among older persons are becoming increasingly clear, the role of exercise stress testing and safety monitoring for older persons who want to start an exercise program is unclear. Current guidelines regarding exercise stress testing likely are not applicable to the majority of persons aged 75 years or older who are interested in restoring or enhancing their physical function through a program of physical activity and exercise. In addition to being expensive and of unproven benefit, the current policy of routine exercise stress testing potentially could deter many older persons from participating in an exercise program. Research is needed to investigate current physician practices, evaluate the risk of adverse cardiac events, determine the role of pharmacological stress testing, and measure and compare absolute and relative exercise intensities. To assist clinicians, we offer a set of recommendations regarding precautions that can be taken to minimize the risk of adverse cardiac events among previously sedentary older persons who do not have symptomatic cardiovascular disease and are interested in starting an exercise program.

Author Affiliations: Departments of Medicine (Drs Gill and Krumholz) and Epidemiology and Public Health (Drs DiPietro and Krumholz), The John B. Pierce Laboratory (Dr DiPietro), Yale University School of Medicine, New Haven, Conn.

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