Contraindications to Exercise Testing
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Some conditions make a maximal/exercise test unsafe right now — absolute contraindications mean don't test until resolved; relative ones mean test only with caution, clearance, or a modified protocol.
Detail
Before administering an exercise test (especially maximal or graded exercise tests), screen for contraindications. ACSM/AHA classify these as absolute (do not test) and relative (test only if benefits outweigh risks, often with physician oversight and lower intensity).
Absolute contraindications (do not test):
- Recent significant change in resting ECG suggesting ischemia, recent myocardial infarction (within ~2 days), or other acute cardiac event.
- Unstable angina.
- Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise.
- Symptomatic severe aortic stenosis.
- Decompensated heart failure.
- Acute pulmonary embolism or pulmonary infarction / deep vein thrombosis.
- Acute myocarditis or pericarditis.
- Acute aortic dissection.
- Acute systemic infection with fever, body aches, or swollen lymph nodes.
Relative contraindications (test with caution / clearance):
- Known obstructive left main coronary stenosis.
- Moderate-to-severe aortic stenosis with uncertain symptoms.
- Tachy-/bradyarrhythmias.
- Acquired or complete heart block.
- Hypertrophic cardiomyopathy.
- Uncontrolled hypertension (e.g., resting SBP >200 or DBP >110 mmHg). (exact mmHg threshold per current edition)
- Significant electrolyte abnormalities.
- Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis).
- Mental/physical impairment limiting safe, adequate exertion.
For field and submaximal fitness tests in apparently healthy people, the same red flags apply but the overall risk is lower; still, never test someone showing acute signs/symptoms.
Key facts
- Two tiers: absolute (do not test) and relative (test with caution/clearance).
- Absolute examples: recent MI (~within 2 days), unstable angina, decompensated HF, acute PE/DVT, acute myo-/pericarditis, severe symptomatic aortic stenosis, acute febrile illness.
- Relative examples: uncontrolled HTN (~SBP >200/DBP >110), HCM, significant arrhythmias, electrolyte/metabolic derangement.
- Acute febrile illness alone is enough to postpone testing.
Connections
- Signs & Symptoms Suggestive of Cardiovascular/Metabolic/Renal Disease — overlapping red-flag list.
- Reasons to Stop an Exercise Test — when to stop a test already underway.
- Medical Clearance — When to Seek It — relative contraindications usually need it.
Sources
Keep this lesson, or ask how it applies to you.
Educational content only — not medical advice. Always consult a qualified professional for individualized guidance, especially around injury, pregnancy, or medical conditions.