Exercise testing in clinical medicine

Exercise-induced changes in the electrocardiogram have been used to identif y coronary artery disease for almost a century. Over the past decade, howev er, clinicians have increasingly focused on more expensive diagnostic tools believing them to offer improved diagnostic accuracy. In fact, by incorpor ating historical data, the simple exercise test can in most cases outperfor m the newer tests, The use of prediction equations and non-staged exercise protocols can improve the test still further, while advances In the use of the test for prognosis, with the discovery of novel risk factors and the ad dition of gas analysis, may in the future shift the primary emphasis away f rom diagnosis. Brief, inexpensive, and done in most cases without the prese nce of a cardiologist, the exercise test offers the highest value for predi ctive accuracy of any of the non-invasive tests for coronary artery disease .