Contraindications to testing

Contraindications to exercise ECG and cardiovascular performance testing

You will not be able to have the exercise ECG test if you have any of a list of specific conditions or symptoms, which are absolute contraindications to this test. These will be considered by your Health Assessment Doctor and will be based on results and information available at the time of discussion. 

This list is extensive but not exhaustive and we ask that you declare any historic or current medical consideration that is not in the list below, but that may put you or your clinician at risk if you were to proceed with the test.

1. Wellness

Symptoms suggestive of acute cardiovascular disease or other acute health considerations:

  • chest pain (at rest, during daily living or during exertion) 
  • shortness of breath 
  • dizziness 
  • fainting 
  • palpitations 
  • excess sweating 
  • nausea.

2. Cardiovascular Event 

Any current or recent cardiovascular event or surgery. Recent is still under care and/or care advice that limits moderate to hard exercise. Includes but not limited to:

  • Heart or vascular surgery (of any kind)
  • Cardiac arrest
  • Stroke (of any kind)
  • Deep vein thrombosis
  • Myocardial embolism/infarction
  • Aneurysm dissection (of any kind)
  • Transient ischemia attack (TIA)
  • Pulmonary embolism/infarction.

3. Other Cardiovascular

  • Aneurysm (of any kind)
  • Cardiomyopathy (of any kind)
  • Heart failure (controlled and uncontrolled)
  • Coronary artery disease
  • Carditis (of any kind)
  • Blood pressure ≥ 160 mmHg systolic
  • Blood pressure < 90 mmHg
  • Tachybrady syndrome
  • Angina (stable and unstable)
  • Heart valve disease (of any kind)
  • Inflamed leg veins (phlebitis)
  • Carotid artery disease
  • Symptomatic heart murmur
  • ≥ 100 mmHg diastolic
  • Pulmonary hypertension
  • Any other recent cardiovascular finding for which there is ongoing investigation.

4. Resting ECG (existing diagnosis OR noted during health assessment)

  • Evidence of ischemia
  • Left bundle branch block
  • Atrial fibrillation (inc. paroxysmal)
  • Brugada sign
  • Resting heart rate >100 bpm
  • Resting heart rate <40bpm (excluding very cardiovascular fit clients)
  • Wolf-parkinson-white
  • 2nd and 3rd degree heart block
  • Atrial flutter (inc. paroxysmal)
  • Long QT syndrome
  • Any cardiac arrhythmias causing symptoms
  • Any other ECG findings that require further investigation prior to exercise testing.

5. Respiratory

  • Cystic fibrosis
  • Pulmonary fibrosis
  • Chronic obstructive pulmonary disease
  • Lung cancer
  • Any respiratory condition that may be exacerbated by exercise (e.g. asthma, long COVID)
  • Current respiratory infection (excluding minor colds).

6. Medication

  • Digoxin
  • Pseudoephedrine cold cures
  • Tricyclic anti-depressants
  • Beta-blockers (including systemic beta-blockers)
  • Anti-arrhythmic therapy
  • Any medication that is currently causing side effects that make exercise testing inappropriate.

7. Other

  • Fasting blood glucose of >11.0 mmol/L and/or signs of diabetic ketoacidosis 
  • Current glucose <3.9 mmol/L (or clinical features of hypoglycaemia) or hypoglycaemia in the last 24 hours 
  • Chronic kidney disease (moderate and severe) 
  • Clinical anaemia 
  • Any operation or recent health finding for which Consultant advice still limits moderate to hard exercise 
  • Pregnancy 2nd and 3rd trimester 
  • Pregnancy 6-weeks post-partum for uncomplicated birth 
  • Pregnancy post-partum complicated birth, until the individual is cleared by the post-natal team 
  • The Wattbike has a weight limit of 150 kg and a minimum height of 150 cm
  • Any results or medical/lifestyle finding or combination of findings that the health assessment Doctor deems exercise testing is currently inappropriate .

8. Relative Contraindications

 Will be considered at the discretion of the Health Assessment Doctor: 

  • Pregnancy 1st trimester  
  • Electrolyte abnormalities including by not limited to hypokalaemia, hypomagnesaemia 
  • Neuromuscular (examples include but are not limited to multiple sclerosis, motor neuron disease/ALS, myasthenia gravis), musculoskeletal, or rheumatoid disorders that are exacerbated by exercise) 
  • Uncontrolled metabolic disease including by not limited to diabetes, thyrotoxicosis, myxedema 
  • Any current or chronic infections or conditions impacting general wellness and ability to exercise at moderate to hard intensity  
  • Client has previously undergone cardiac investigations 
  • Current cancer diagnosis and/or treatment 
  • Neurological conditions including epilepsy and seizures 
  • Experiencing negative effects of a head injury.

Contra-indications to Aerobic Capacity and PATH Fitness Module testing

The presentation of an absolute contraindications is considered an exclusion criteria and will result in the exercise test (known as the Aerobic Capacity Test) not being conducted. This list is extensive but not exhaustive and we ask that you declare any historic or current medical condition that is not in the list below, but that may put you or your clinician at risk if you were to proceed with the test.

There are a series of relative contraindications for which the aerobic capacity test may be able to proceed however you will require a Doctor consultation first to discuss the medical benefits vs. risks of performing the test. Please provide us with advance notice if this applies and we will organise for this consultation to take place with one of our health assessment Doctors, depending on operational capabilities. 

Please note there is an alternative to the Aerobic Capacity Test called the Polar Fitness Test. This is a non-exercise test that predicts maximal aerobic power (maximal oxygen uptake, VO2max) and can be selected, at any point, as the VO2max collection method of choice for the Health Assessment. 

1. Wellness 

Any current or chronic infections or conditions impacting general wellness and ability to exercise at a moderate-to-hard intensity level 

Any operation or recent health finding for which Consultant/GP advice still limits moderate-to-hard intensity exercise 

Symptoms suggestive of cardiovascular disease or other acute health considerations: 

  • chest pain (at rest, during daily living or during exertion) 
  • shortness of breath 
  • dizziness/losing balance 
  • lost consciousness 
  • fainting 
  • palpitations 
  • excess sweating 
  • nausea.

2. Cardiovascular Event 

Any current or recent cardiovascular event or surgery. Recent is still under care and/or care advice that limits moderate to hard exercise. Includes but not limited to:

  • Heart or vascular surgery (of any kind)
  • Cardiac arrest
  • Stroke (of any kind)
  • Deep vein thrombosis
  • Myocardial embolism/infarction
  • Aneurysm dissection (of any kind)
  • Transient ischemia attack (TIA)
  • Pulmonary embolism/infarction.

3. Other Cardiovascular

  • Aneurysm (of any kind)
  • Cardiomyopathy (of any kind)
  • Heart failure (controlled and uncontrolled)
  • Coronary artery disease
  • Carditis (of any kind)
  • Blood pressure ≥ 160 mmHg systolic
  • Blood pressure < 90 mmHg
  • Tachybrady syndrome
  • Angina (stable and unstable)
  • Heart valve disease (of any kind)
  • Inflamed leg veins (phlebitis)
  • Carotid artery disease
  • Symptomatic heart murmur
  • ≥ 100 mmHg diastolic.

4. Resting ECG (existing diagnosis OR noted during health assessment)

  • Evidence of ischemia
  • Left bundle branch block
  • Atrial fibrillation (inc. paroxysmal)
  • Brugada sign
  • Resting heart rate >100 bpm
  • Resting heart rate <40bpm (excluding very cardiovascular fit clients)
  • Wolf-parkinson-white
  • 2nd and 3rd degree heart block
  • Atrial flutter (inc. paroxysmal)
  • Long QT syndrome
  • Any other cardiac electrical abnormality that:
    • You take medication for 
    • You attend medical check-ups for 
    • Causes symptoms and/or impacts your exercise limits.

5. Respiratory

  • Cystic fibrosis
  • Pulmonary fibrosis
  • Chronic obstructive pulmonary disease
  • Lung cancer
  • Any respiratory condition that may be exacerbated by exercise (e.g. asthma, long COVID)
  • Current respiratory infection (excluding minor colds).

6. Medication

  • Digoxin
  • Pseudoephedrine cold cures
  • Tricyclic anti-depressants
  • Beta-blockers (including systemic beta-blockers)
  • Anti-arrhythmic therapy
  • Any medication that is currently causing side effects that make exercise testing inappropriate.

7. Other  

  • ≥48 mmol/mol (≥6.5%) 
  • Fasting blood glucose of >11.0 mmol/L and/or signs of diabetic ketoacidosis 
  • Current glucose <3.9 mmol/L (or clinical features of hypoglycaemia) or hypoglycaemia in the last 24 hours 
  • Neuromuscular (examples include but are not limited to multiple sclerosis, motor neuron disease/ALS, myasthenia gravis), musculoskeletal, or rheumatoid disorders that are exacerbated by exercise 
  • Chronic kidney disease (moderate and severe) 
  • Clinical anaemia 
  • Any operation or recent health finding for which Consultant advice still limits moderate to hard exercise 
  • Pregnancy (all trimesters) 
  • Pregnancy 6-weeks post-partum for uncomplicated birth 
  • Pregnancy post-partum complicated birth, until the individual is cleared by the post-natal team 
  • Blood electrolyte abnormalities including by not limited to hypokalaemia, hypomagnesaemia 
  • Uncontrolled metabolic disease including but not limited to diabetes, thyrotoxicosis, myxedema.

8. Relative Contraindications 

There are a series of relative contraindications for which your aerobic capacity test can proceed but first requires a Doctor consultation for consideration of your benefit vs. risk of performing the test. 

  • Previous cardiac investigations  
  • Any current or chronic infections or conditions impacting general wellness and ability to exercise (including but not limited to cancer, neurological conditions and head injury) 
  • Neuromuscular (examples include but are not limited to multiple sclerosis, motor neuron disease/ALS, myasthenia gravis), musculoskeletal, rheumatoid disorders or injuries that may be exacerbated by exercise  
  • Controlled diabetes in addition to one of the following:  
    • Age 40 years or older, with or without CVD risk factors other than diabetes 
    • Age 30 years or older and Type 1 or type 2 diabetes of 10 years in duration 
    • Hypertension (systolic blood pressure ≥140 diastolic blood pressure ≥90) 
    • Cigarette smoking 
    • Dyslipidaemia (total/HDL ratio ≥4) 
    • Proliferative or pre-proliferative retinopathy 
    • Nephropathy including microalbuminuria 
    • Autonomic neuropathy.