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Everything you need to know.

In sports and occupational medicine, exercise tests are used to detect underlying diseases, monitor treatment, or measure physical performance. Also called an exercise electrocardiogram (ECG), this test consists of recording the electrical activity of the heart by subjecting the person to physical exercise of increasing intensity in order to evaluate the heart's response(1).

The deaths of footballers Tim Nicot and Gregory Mertens have already raised questions about the effectiveness of exercise tests. In fact, in France, French Society of Cardiology The number of sudden deaths among athletes is estimated at about 1,000 cases annually. So, if it's perfectly possible to perform a stress and death test a few days after sudden death, what's the point of doing so?

Feel free to continue reading to clarify such questions and find answers to all your questions about stress testing.

Who is concerned? Who should take a stress test?

To stay physically active with peace of mind, an annual fitness checkup is essential for all sports and all ages. However, as a preventive measure and to evaluate health more comprehensively, a stress test is recommended.

Anyone, whether an athlete or not, can report a health incident at any time in their life. But a resting electrocardiogram (ECG) and then, if necessary, a cardiac stress test can rule out the vast majority of contraindications to exercise.

Tiana RaulSports and rehabilitation doctor in Noumea

Even if it is entirely possible to undergo stress testing since adolescence, Dr. Tiana Raul warns that stress tests are also highly recommended for athletes over 50 years of age. In fact, since this age we see an increase in cardiovascular accidents resulting from exercise.

Experts also recommend testing every 5 years. It is worth noting that urgent consultation is necessary if symptoms such as chest pain, heart palpitations, discomfort, difficulty breathing, or unusual fatigue appear during exercise.

“The indications are diverse… We can look for limitations in physical exercise. These limitations may be of cardiac or respiratory origin or due to deconditioning due to lack of physical activity. The stress test also allows the analysis of the physiological capabilities of the athlete…” – explains Dr. Raoul.

Furthermore, stress testing is recommended for those who want to resume physical and sporting activity, for people preparing for an intense physical event such as a marathon and for high-level athletes. It is also recommended for people with cardiovascular risk factors (high blood pressure, smoking, high cholesterol, family history of heart disease, etc.).

Do I need a prescription to take a stress test?

Dr. Tiana Raul confirms that a medical prescription is not mandatory to perform this examination. On the other hand, A Recovery At least partly via Social Security, in mainland France, or via CAFAT, in New Caledonia. “To perform a stress test, you can contact one of the relevant specialists: cardiologists, sports doctors or lung specialists, although any general practitioner trained in stress tests can perform this examination,” Says.

Do I need to be in good shape to take a stress test?

Dr. Raoul explains that it is not necessary to be particularly fit to perform a stress test as maximum exercise capabilities can be reached even if a person is feeling tired. In fact, you can stop when you feel overwhelmed, because the test adapts to each person's form. On the other hand, you should know that there are certain contraindications for an endurance test: inability to ride a bike, the need to live with oxygen or cardiac contraindications, among others. If in doubt, it is best to seek advice from your doctor.

Tiana Raul explains to us that there are two types of exercise tests: with gas exchange analysis and without. Generally, a cardiologist will perform exercise testing without gas exchange analysis only to look for heart failure. Below is an exercise test procedure with gas exchange analysis, i.e. oxygen consumption analysis.

“The stress test lasts between 8 and 14 minutes. The patient fit is precise: a sensor is fitted in the ear to analyze oxygen saturation, a cuff on the arm to measure blood pressure every two minutes, electrodes on the chest and back to monitor electrical cardiac activity and a mask on the face to measure oxygen consumption and release Carbon Dioxide.

She also says the patient rides a bike, treadmill, or rowing machine. He has three minutes to warm up, then the effort begins. Then the intensity of the effort increases little by little every two minutes. “Finally, the test stops when the person is completely exhausted, either because he no longer has the strength to press the pedals or because he is short of breath. The doctor can also stop the stress test if there are criteria for cardiac and respiratory arrest such as serious rhythm disturbances in a stress ECG or High blood pressure… – she explained.

Is stress testing dangerous?

Aside from mild discomfort and rhythm disturbances, complications during stress testing are rare. The numbers show a serious ventricular arrhythmia requiring electric shocks was reported in approximately 7,000 tests and one death in 70,000 tests.(2).

To reduce the risk of a heart attack during the test, the patient is monitored throughout the test. Moreover, Dr. Raoul says so The stress test is not dangerousBecause there are precise criteria for stopping stress testing. She explains that as soon as a serious heart rhythm disturbance appears on the stress ECG, the doctor stops the test and refers it to the relevant specialist for further examination.

Does a stress test prevent sudden death?

Unfortunately, even if we carry out a stress test, it seems that not all risks are excluded.

Sudden death during exercise often represents a manifestation of an underlying pathology, often of cardiovascular origin. A stress test that allows early detection of heart problems is supposed to prevent sudden death. On the other hand, many athletes still die every year due to this condition.

“Many sudden deaths could have already been avoided!”

“Many doctors issue medical certificates even though no resting ECG has been performed previously…”

Tiana Raul, MD, MPR

However, Dr. Tiana Raoul says soA large number of sudden deaths could have already been avoided Only using a resting electrocardiogram (ECG) when issuing the athlete's medical certificate. She also deplores the fact that many doctors issue medical certificates when a resting ECG has not been performed before. She advises, if there are clear abnormalities on this examination, to conduct further investigation through a stress test or contact a cardiologist to rule out any contraindications to exercise.

Please note that if in doubt, in addition to a stress test, doctors may suggest an ultrasound scan of the heart. Ultrasound, as a more sensitive guide, provides additional information to the electrocardiogram (ECG). It allows us to measure the size and function of the heart, monitor the thickness of the walls, valves, etc. But this technique is expensive, which is why it should not be performed on everyone except those with an abnormal EKG or family history.

Does stress testing help improve my performance?

There are more and more sports fans who decide to call sports doctors and undergo a stress test with the aim of monitoring the development of their figure.

In the same way, stress testing can be a very interesting tool for athletes, sports coaches or physical therapists. On the one hand, it is a test that warns of possible contraindications for physical exercise. On the other hand, it is a very complete assessment of a person's physical condition and provides information about important parameters when planning training.

“Thanks to the endurance test, training sessions will be completely adapted to suit their specific physical abilities.”

Tiana Raul, MD, MPR

“Stress testing makes it possible to analyze the physiological performance of an athlete and obtain VO2max as well as ventilation thresholds. VO2 max is the maximum amount of oxygen that the body can use per unit of time. Ventilation thresholds correspond to the phases of change where the athlete begins to hyperventilate significantly. Depending At ventilation thresholds, the athlete will be able to work at basic endurance (first ventilation threshold) or at intervals (second ventilation threshold) at the capacities and heart rates obtained at these thresholds. Likewise, the athlete can perform less strenuous sessions below the first ventilation threshold, In the recovery session, or conversely, very difficult interval sessions above the second ventilation threshold. – Dr. Raoul specifies.

In short, with the help of a stress test, we will be able to know the parameters that allow us to adapt training to our physical capabilities. Therefore, targeting our exercise sessions better will improve our performance or form.

Everything you need to know.

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