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A Journal on Sports Medicine

Official Journal of the Italian Sports Medicine Federation
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Medicina dello Sport 1998 March;51(1):91-6

language: Italian

Use of maximal effort test to grant the agonistic certificate to middle and advanced age athletes

Cecchetti F., Nardi P., Bianchi G., Iavazzo R., Gaudino S., Parisi A.

Istituto di Medicina dello Sport di Roma - CONI-FMSI, Roma


The most frequent cardiovascular accident in athletes, older than 35, is the Ischemic Cardiopathy. Therefore, at the Sport’s Medicine Institute in Rome, athletes who have passed this age have to undergo not only the normal step test and clinical visit (D.M. 18/2/1982), but also a maximal effort test (ergometric cycle or treadmill).
Starting from September 1994 until September 1997, 505 athletes have undergone the maximal effort test; they had to use gradually heavier weights, proportionally to the level of training. The training lasted, except particular situations, until exhaustion.
In most tests the results where fortunately negative. Only in a few cases there where found: arrhythmias (a slightly higher percentage than with the step test), a slight pressure increase in subjects with normal resting pressure and ventricular repolarization anomalies, suggesting ischemic cardiopathy.
Of the 8 athletes with tests suggesting ischemia, 7 where absolutely asymptomatic and three were athletes of a discrete level. Only five continued the medical examinations and were found positive to the coronaric scintigraphy; one had to be operated.
The step test never identified alterations that could suggest an ischemic cardiopathy; it was possible to suspect it only after the maximal effort test.
Even though “positive” subjects are only very rarely found, we think that the maximal effort test should always be used to grant an agonistic certificate to people above the age of 50, considering the legal responsability doctors, specialized in Sport’s Medicine in Italy, have.

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