Assessing the Risk of a Cardiac Event Before Initiating Aerobic Exercise: A Scoping Review

Purpose: Assessing the potential risk of major adverse cardiac events (MACE) before initiating aerobic exercise is increasingly more important given direct access to physical therapy (PT). This scoping review aimed to 1) identify and synthesize methods to assess risk of MACE and 2) define levels of cardiac risk providing statistical data when available, on the likelihood of MACE. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping review reporting guideline was used to conduct this scoping review. Four online databases were used to identify records that fit the criteria. A two-round screening process was performed independently by 2 researchers, with conflict resolution provided by a third. Data extraction was completed independently by all 3 parties. Methods of risk assessment that were deemed similar were compared. Results: The search yielded 1764 records from 4 databases; 38 records were included. Twelve articles used cardiac risk factor assessment, 10 articles used exercise testing with an electrocardiogram, and the remaining articles reported different methods including questionnaires, risk calculators, and physical examination assessments. Risk factor assessment yielded the most statistical information regarding relative risk of a MACE; however, the risk calculators provided a clearer assessment of risk level in low-, medium-, and high-risk categories. Conclusions: Physical therapies have several options for assessing cardiac risk. The use of a questionnaire, risk factor assessment, or risk calculator could be used to identify the level of risk. Patients who are considered intermediate or high risk should participate in an exercise assessment to gauge appropriate cardiovascular response.