The core of exercise risk assessment includes: standard operating procedures for exercise stress testing, termination criteria, and medical exclusion.

Exercise stress testing involves recording various bodily responses under specific exercise load conditions using instruments to assess health status and test exercise capacity. It is a necessary condition for designing exercise prescriptions. Commonly used tests include exercise electrocardiography (ECG), and maximum oxygen uptake (VO2 max) measurement is essentially a type of exercise stress test.

A detailed medical history, physical examination, and certain medical tests are required before the test. The initial load and the degree of increase are determined based on gender, age, health status, and ability. To reduce costs, the step method can be used, with Level 1 consisting of 15 steps up and down the stairs per minute for 2 minutes, and Level 2 consisting of 30 steps per minute, which generally meets the requirements. Exercise stress testing involves progressively increasing intensity exercise, which poses certain risks to patients with cardiovascular disease.

Contraindications include: significant abnormalities on resting electrocardiogram, history of angina pectoris within the past two weeks, severe hypertension, severe hyperthyroidism, mid-to-late pregnancy, and diabetes mellitus complicated with acidosis. Termination of the trial is based on: the occurrence of arrhythmia or ST-segment depression, abnormally high or low blood pressure, chest pain or tightness, reaching sublimit heart rate, and the subject's request to stop.

During the experiment, subjects' facial expressions must be closely observed by designated personnel, and electrocardiograms and blood pressure measurements must be recorded. The increase in workload should follow a gradual approach. If patients with cardiovascular disease insist on participating, the initial workload should be extremely low, starting at 2 km/h on the treadmill. The laboratory should be equipped with resuscitation equipment and medications, and a cardiologist should be present. After the experiment, subjects should be observed for at least 30 minutes, and a resting electrocardiogram should be recorded before they leave.

A normal resting electrocardiogram (ECG) does not necessarily indicate normal heart function. Coronary artery stenosis may not show any abnormalities at rest, but when exercise increases myocardial oxygen demand, the imbalance between supply and demand will cause ECG changes. This test can not only rule out exercise risks but also determine at what intensity an ECG abnormality will occur, providing a basis for determining the upper limit of safe exercise intensity.

Progressive exercise stress testing is the most crucial step in exercise risk assessment, as over 95% of exercise-induced sudden death occurs in patients with coronary heart disease and myocarditis. Determining an appropriate intensity through this testing ensures both safety and that exercise occurs within the range of highest fat oxidation rates.

Because obese patients often experience impaired diastolic function due to fat accumulation around the heart, they can only tolerate lower intensity exercise, resulting in a faster rise in heart rate. Load testing to understand responses to different intensities provides a scientific basis for developing individualized exercise prescriptions. Exercise safety is always paramount; only with safety can health be effectively promoted.