Several of the older patients in your practice intend to pursue exercise programs. They have no cardiac symptoms, but some do have vascular risk factors such as diabetes or hypertension. In these patients, which of the following is true about exercise electrocardiography?

Exercise electrocardiography represents an increasingly popular noninvasive method for early detection of latent ischemic heart disease. As with other diagnostic tests, the exercise ECG is of most clinical value when the pretest probability of disease is moderate (i.e., 30-70%). In men over 40 and women over 50 who plan to start vigorous exercise, use of exercise ECG is possibly, but not definitely, supported by the evidence (class IIb).