Supervision of Exercise Testing by Nonphysicians

exercise test; physical exertion; physician's roleThe standard exercise test is a well-established procedure that has been widely used in cardiovascular medicine for many decades, with staffing issues that have changed over time.The test is frequently considered the "gatekeeper" to more expensive and/or invasive procedures since it is often the first diagnostic evaluation when coronary artery disease (CAD) is suspected.Thus, it is used to help guide decisions regarding diagnosis and/or medical and interventional management.Moreover, the prognostic value of aerobic capacity and other variables obtained during exercise is firmly established in those who are apparently healthy and in virtually all patient populations. 1,2Generally, peak or symptomlimited exercise testing is used to detect signs or symptoms of myocardial ischemia and to discern fundamental information on exercise capacity, exercise hemodynamics, dysrhythmias, oxygenation, neuroautonomic health, symptoms, and other physiological responses.In most instances, peak effort entails at least brief periods of high-intensity † Significant.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.