Appendix D: Contraindications to exercising


Box D.1 provides absolute and relative contraindications to exercising based on the Contraindications to Exercise Testing from the American Heart Association.1 Performing a pre-exercise screening and the careful review of a participant’s medical history will help identify potential contraindications.

Box D.1

Contraindications to exercising (adapted from a Scientific Statement by the American Heart Association)1

Absolute contraindications

  • • Acute myocardial infarction (MI), within 2 days
  • • Ongoing unstable angina
  • • Uncontrolled cardiac arrhythmia with haemodynamic compromise
  • • Active endocarditis
  • • Symptomatic severe aortic stenosis
  • • Decompensated heart failure
  • • Acute pulmonary embolism, pulmonary infarction or deep vein thrombosis
  • • Acute myocarditis or pericarditis
  • • Acute aortic dissection
  • • Physical disability that precludes safe exercise

Relative contraindications

  • • Known obstructive left main coronary artery stenosis
  • • Moderate-to-severe aortic stenosis with uncertain relation to symptoms
  • • Tachyarrhythmias with uncontrolled ventricular rates
  • • Acquired advanced or complete heart block
  • • Hypertrophic obstructive cardiomyopathy with severe resting gradient
  • • Recent stroke or transient ischaemic attack
  • • Mental impairment with limited ability to cooperate
  • • Resting hypertension with systolic or diastolic blood pressures > 200/110 mmHg
  • • Uncorrected medical conditions, such as significant anaemia, important electrolyte imbalance and hyperthyroidism

Reprinted with permission Circulation. 2013;128:873–934 ©2013 American Heart Association, Inc.

Absolute contraindications

An absolute contraindication is a reason or criterion that makes it inadvisable to exercise. Undertaking or continuing to exercise could place the participant at a higher risk of an untoward event (e.g. injury or medical condition) occurring as a result of exercising. Participants with absolute contraindications should not exercise until such conditions are stabilised or adequately treated.

Relative contraindications

A relative contraindication is a reason or criterion that needs to be considered in deciding whether to exercise. Factors such as the risk versus benefit and access to medical support need to be considered. Participants with relative contraindications should not exercise until the risks and benefits are carefully assessed.

Reference

1. Fletcher GF, Ades PA, Kligfield P, et al. On behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention. Exercise standards for testing and training. A scientific statement from the American Heart Association Circulation 2013;128: 873-934.