Which scenario would prompt medical clearance before performing a symptom-limited exercise test?

• A. Systolic blood pressure 180/70 at rest.
• B. Systolic blood pressure 210/70 at rest.
• C. Heart rate at rest 60.
• D. No prior history of cardiovascular disease.

Answer: (B)

Resting blood pressure values are checked before a symptom-limited exercise test to ensure safety. Medical clearance is typically required when resting blood pressure is severely elevated, such as a systolic value of 200 mmHg or higher (or a diastolic value of 110 mmHg or higher), because exercising under those conditions can trigger dangerous cardiovascular events.

In this scenario, the resting systolic pressure is 210 mmHg with a diastolic of 70 mmHg. The very high systolic value meets that threshold, signaling severe hypertension at rest and warranting medical clearance before proceeding with the test. The other readings—systolic 180 with a normal diastolic, a normal resting heart rate, and no prior cardiovascular disease—do not by themselves mandate clearance.