Reasons for terminating an exercise test provide independent prognostic information: 2014 apparently healthy men followed for 26 years

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Abstract
Aims We wanted to study whether reasons for terminating an exercise test might influence long-term mortality of healthy men, a previously unreported subject. Methods and results During 1972–75, 2014 men aged 40–59, free from somatic diseases and not using drugs, underwent an examination programme including case history, clinical examination, various blood tests, and a symptom limited exercise ECG-test. The following reasons for test termination were noted: impaired breathing, lower limb fatigue, exhaustion (=combined lower limb fatigue and impaired breathing), high heart rate, abnormal blood pressure response, heart arrhythmias, increasing chest pain during exercise, marked ST-depressions during the test, and refusal to continue. Follow-up was 26 years. When adjusting for age, men who stopped exercising exclusively because of impaired breathing (n=178) had a 1.86-fold increased risk (95% CI 1.34–2.60; P=0.0002) of dying from coronary heart disease (CHD), a 1.64-fold increased risk (95% CI 1.32–2.03; PPn=1376). After adjustment for age, smoking, total serum cholesterol, fasting blood glucose, systolic blood pressure, and physical fitness, impaired breathing remained significantly associated to an increased risk of dying from CHD, pulmonary disease, or any causes. Conclusion Healthy men who stop bicycle exercising only because of impaired breathing have a high long-term CHD-, pulmonary-, and total-mortality, and such men may need further diagnostic scrutiny and follow-up.