NYC Gazette

People who can exercise adequately on a treadmill during cardiac stress testing have a reduced mortality risk, irrespective of their heart disease level, according to research led by Mount Sinai. The study's findings were published in Mayo Clinic Proceedings on February 19 and emphasize the life-saving benefits of physical fitness. Researchers encourage physicians to discuss these benefits with patients.

"Our data show that assessing a person’s ability to exercise during cardiac stress testing and their exercise capacity provides a stronger distinction between high- and low-risk patients than any other clinical risk factors evaluated at the time of cardiac stress testing," said Alan Rozanski, MD, Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai and lead author of the study. "Our results highlight the importance of evaluating patients’ exercise ability during testing and promoting physical activity or corrections to exercise limitations among those with limited exercise ability."

The study is considered the most comprehensive evaluation yet on how known risk factors such as hypertension, diabetes, smoking, and cardiac-related comorbidities affect mortality risk in patients undergoing cardiac stress tests. The team analyzed data from 15,562 patients over nearly seven years using SPECT myocardial perfusion imaging. This test assesses blood flow to the heart during both stress and rest phases to identify areas with reduced flow. Patients were categorized into those who could perform treadmill exercises and those who couldn't; the latter underwent medication-induced coronary artery dilation as an alternative for detecting blockages.

Researchers found that among those performing treadmill exercises, mortality was less than one percent per year regardless of coronary artery disease (CAD) risk factors or comorbidities. Conversely, participants tested pharmacologically had higher annual mortality rates that increased with more CAD risk factors and comorbidities.

"While these findings do not definitively establish causality due to the observational nature of our data, the magnitude of the results strongly suggest a highly protective role for physical fitness," noted Dr. Rozanski.

The study also highlighted the need for cardiac stress test reports to include comprehensive evidence about a patient's exercise capability at testing time. If an inability exists, it should prompt physicians to evaluate underlying reasons thoroughly as they can provide valuable insights into overall adverse event risks and appropriate interventions.

"This information should prompt doctors to have more meaningful conversations with patients about the importance of staying active," emphasized Dr. Rozanski. "Newer guidelines show that even small amounts of physical activity can improve health, and that short bursts of activity throughout the day can add up to significant cardio benefits."

Mount Sinai Fuster Heart Hospital ranks No. 4 nationally for cardiology, heart, and vascular surgery according to U.S. News & World Report, while ranking No. 1 in New York according to Newsweek’s “The World’s Best Specialized Hospitals.” It is part of Mount Sinai Health System—New York City's largest academic medical system—which includes eight hospitals, a leading medical school, and numerous ambulatory practices across New York City.

For more information about Mount Sinai Health System visit https://www.mountsinai.org or follow them on Facebook, Twitter and YouTube.