Routine pre-exercise heart check often not needed

NEW YORK (Reuters Health) - Most generally healthy adults starting an exercise program do not need to see their doctor first, researchers say.

Routine medical screening before starting a regular exercise regimen with the goal of reducing the risk of sudden exercise-induced death is not recommended, the researchers wrote in a report published this month.

"Sudden death is a rare adverse effect of exercise," Dr. Mayer Brezis, of Hadassah Hebrew University Medical Center, Jerusalem, Israel, told Reuters Health in an interview.

"Medical screening before initiating regular exercise is often advised but without scientific basis," Brezis noted.

An exercise electrocardiogram -- a test that detects and records the heart's electrical activity -- is thought to help identify people at risk but the test yields "many" falsely positive and falsely negative test results, the researcher warned.

In a "simulation study," Brezis and colleagues found that routine screening decreases deaths in intermediate to high-risk people but not in those who are at low risk.

"Actually, medical screening may cause damage," Brezis said, "for instance because of labeling healthy people as sick or because of the side effects" of tests to check for heart disease.

"Medical screening may actually prevent the known benefit from exercise by diverting attention from the main goal: i.e., to have people exercise," Brezis said.

"Sedentary people should be encouraged to initiate exercise gradually and go to a physician if they feel chest discomfort or dizziness during exercise," Brezis said.

"Gyms should post boards explaining these warning signs. Exercise coaches should understand and explain these warning signs to customers," he added.

Still, Brezis emphasized that this advice does not apply to individuals with known heart disease. "These people should be referred to cardiac rehabilitation centers where they can resume physical activity under supervision."

SOURCE: Journal of General Internal Medicine, August 2009.