Cardiovascular profiling.

As in all other medical evaluations, the evaluation of the cardiovascular system in the competitive athlete or the nonathlete wishing to exercise must begin with a carefully performed history and physical examination. Subsequent studies, including chest radiograph and electrocardiogram, may be waived in certain populations of young athletes, but in older individuals wishing to exercise, these should be included and an exercise stress test should also be done to assess the ability of the heart to withstand moderate levels of exercise without ischemia. The mainstay of evaluation of exercise performance is the graded exercise test on either a bicycle ergometer or a treadmill. These protocols are designed to provide increments in workload until the subject reaches maximal oxygen consumption or is symptom limited. Heart rate monitoring and blood pressure monitoring often are adequate to determine individual response to exercise and to provide appropriate exercise advice. When an absolute measure of physical fitness is required, maximal oxygen consumption should be measured. Following the guidelines of thorough medical evaluation plus stress testing, it is unlikely that an athlete or the exercising nonathlete will develop serious cardiovascular problems with exercise.