Table 1:
Contraindications to exercise testing and training in patients with stable heart failure
| Absolute Contraindications |
| Early phase after acute coronary syndrome (within 2 days) |
| Ongoing unstable angina |
| Uncompensated heart failure |
| Acute thrombophlebitis or recent embolism (pulmonary or systemic) |
| Active endocarditis Acute myocarditis or pericarditis |
| Acute aortic dissection |
| Symptomatic severe aortic stenosis |
| Acute systemic illness or fever |
| Uncontrolled hypertension (≥180 mmHg systolic or ≥110mmHg diastolic blood pressure at rest) |
| Uncontrolled sinus tachycardiac (resting heart rate >120 beats.min–1) |
| Uncontrolled or life-threatening atrial or ventricular dysrhythmias (including new onset atrial fibrillation/flutter) |
| Third-degree atrioventricular block without pacemaker |
| Uncontrolled diabetes mellitus |
| Orthostatic drop in blood pressure (>20mmHg) with symptoms |
| Progressive worsening of exercise tolerance or dyspnea at rest or on exertion over previous 3–5 days |
| Significant ischemia at low work rates (<2 METs or 50 Watts) |
| Relative Contraindications (increased risk) |
| ≥1.8 kg or 3 lbs increase in body mass over previous 1–3 days |
| Concurrent continuous or intermittent dobutamine therapy |
| Decrease in systolic blood pressure with exercise |
| New York Heart Association Functional Class IV |
| Complex ventricular arrhythmias at rest or appearing with exertion |
| Supine resting heart rate ≥100 beats.min–1 |
| Pre-existing co-morbidities limiting exercise tolerance |
| Severe hypertrophic obstructive cardiomyopathy |
| Symptoms or indications of worsening heart failure |
| ≥1.8 kg or 3 lbs increase in body mass over previous 1–3 days |
| Worsening dyspnea (on exertion or rest) |
| Excessive fatigue, lack of energy |
| Swelling of legs, abdomen |
| Productive cough |
| Increased urination, particularly at night (nocturia) |
| Difficulty sleeping due to breathing problems (orthopnea) |
| Difficulty concentrating |
| Shock from an implantable cardiac defibrillator |