Is an exercise tolerance test indicated before beginning regular exercise? A decision analysis

BACKGROUND AND OBJECTIVE: The present study, using a decision analysis, evaluates whether an exercise tolerance test (ETT) is indicated before initiating regular physical activity to reduce the risk of sudden death during exercise training. DESIGN: The study encompasses a decision tree, Monte Carlo simulation, and utility analysis for adults at low to high risk for coronary disease, with a time horizon of five years, with or without routine ETT screening before initiating physical activity. MEASURES: Mortality in Monte Carlo simulation; expected values in utility analysis. RESULTS: Routine screening decreases mortality in intermediate to high-risk populations but not in low-risk persons. At all risk levels, the number of exerciseinduced deaths prevented is less than the added number of deaths from angiography. Utility analysis indicates inferiority of routine screening, regardless of risk. Personal preferences (perceived stigma from having coronary disease and perceived benefit of regular exercise on quality of life) have a strong influence on the optimal choice. CONCLUSION: Routine screening before initiating regular exercise is not recommended for the purpose of reducing the risk of sudden death during exercise training.