Fitness Testing

What is the Purpose of Fitness Testing?

One of the primary focuses of fitness testing is to highlight individuals at risk for exercise-related sudden death. This risk stratification involves several general categories, including the individual's age, medical conditions, coronary artery disease risk factors, and signs and/or symptoms of cardiovascular or pulmonary disease. Older age, greater than 45 years in men and greater than 55 years in women, is associated with increased risk. Women younger than 55 years, who have undergone menopause without hormone replacement therapy, are also at increased risk. Having an existing diagnosis of a cardiovascular, pulmonary, or metabolic disease can also increase one's risk of exercise-related sudden death. Pertinent cardiovascular diseases include heart disease, peripheral vascular disease, and coronary artery disease. Cystic fibrosis, chronic obstructive pulmonary disease (COPD), and asthma are among the pulmonary diseases associated with exercise-related sudden death. Common metabolic disorders associated with exercise-related sudden death include diabetes mellitus and thyroid disease.

Coronary artery disease risk factors are many. One coronary artery disease risk factor includes hypertension, either having a blood pressure >140/90 millimeters of mercury (mmHg) or taking an antihypertensive medication. Hypercholesterolemia, also a coronary artery disease risk factor, can consist of low-density lipoprotein (LDL) levels >130, high-density lipoprotein (HDL) levels <40, total cholesterol >200, or taking a lipid-lowering medication. An elevated HDL level (>60) is considered a negative [Page 535]risk factor. Another coronary artery disease risk factor is obesity, which can be defined as a body mass index (BMI) >30, a waist-to-hip ratio >0.95 in men and >0.86 in women, and a waist circumference >102 centimeters (cm) in men and >88 cm in women. A fasting blood glucose level of 100 or greater is a coronary artery disease risk factor, as is having a family history that includes acute myocardial infarction (MI) and sudden death in men <55 years old and in women <65 years old. The last two coronary artery disease risk factors are purely related to behavior—a sedentary lifestyle and smoking—currently or within the past 6 months.

Cardiovascular and pulmonary disease can also present with a variety of signs and symptoms. Cardiac symptoms include palpitations, heart murmur, chest pain, and other signs of myocardial infarction, such as jaw or arm pain. Shortness of breath with activity or at rest and unexplained fatigue can be symptoms of cardiac or pulmonary disease. Dizziness can be a symptom of cardiovascular insufficiency (i.e., inadequate blood flow), as can claudication (pain in the legs, associated with walking) and ankle edema (swelling in the ankles, related to poor blood return to the heart). Orthopnea, immediate difficulty breathing while lying flat, and paroxysmal nocturnal dyspnea, delayed difficulty breathing after lying flat, both relieved by sitting up, are also symptoms of cardiovascular disease, as the inadequate blood flow from the heart can cause fluid congestion in the lungs.

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