Stress testing may hold older persons back from healthy exercise

The standard recommendation to get a stress test before starting to exercise may hinder efforts to keep older people active. According to a Yale study, a simple physical examination may be sufficient. After weighing the potential benefits and risks of exercise among persons age 75 years and older, researchers concluded that current guidelines for exercise stress testing are not applicable for the vast majority of older persons interested in starting an exercise program and may instead hold them back.

Thomas M. Gill, M.D., an associate professor of internal medicine and geriatrics, and his collaborators reported in the July 19 issue of The Journal of the American Medical Association that, “Based on a rigorous review of the available evidence, we found that the risk of myocardial infarction (MI) related to exercise among older persons may be overstated.” Current guidelines from the American Heart Association and American College of Sports Medicine recommend that older people undergo a stress test before beginning a moderately intense exercise program. The purpose of testing is to detect asymptomatic blockages to the heart’s arteries that could lead to MI. “The problem with a stress test,” said Gill, “is that most older people can’t complete it, so you have to go to more expensive, chemical tests to detect asymptomatic blockages to arteries.” Gill found no evidence that detecting these asymptomatic blockages is beneficial. “The risk of MI from exercise is very low.”

Instead, Gill and his colleagues recommend that older persons starting an exercise program skip the stress test and undergo a complete physical examination including a health history to identify potential risks of exercise. And all previously sedentary older persons without symptomatic cardiovascular disease should start with a low-intensity exercise program such as balance exercises, tai chi, self-paced walking and lower-extremity muscle strengthening.

The Yale researchers are following up on their study to learn more about the safest ways to get older adults into exercise programs. “We need more research on exercise and aging,” said Gill, “particularly now that the large baby boom population, who started the exercise movement, is growing older.”