Health Testing FAQs

Pregnancy or recent childbirth

You are currently pregnant or have given birth within the last 6 months.

New unassessed health symptoms

You have new health symptoms that have not been assessed by a doctor. If you are experiencing these you should seek care via your GP or NHS 111, and in an emergency call 999 or attend your nearest emergency department.

This includes acid reflux, indigestion, persistent nausea, bloating, feeling tired all the time, dizziness, shortness of breath, and neurological symptoms.

Recent medical event or surgery

You have experienced a medical event or surgery within the last 6 months. For example, during recovery from a heart attack, stroke, pulmonary embolism, or major cardiovascular, abdominal, and orthopaedic surgery.

Active health conditions

You have an ‘active’ health condition. This means the condition is likely to get worse with maximal physical exertion and exercise, or you experience frequent, unpredictable increases in disease severity that impacts your normal activities or means you need medical care. This includes, but is not limited to:

• Active cancer undergoing treatment
• Active heart conditions: such as undiagnosed chest pain, unstable angina, coronary artery disease, heart failure, arrhythmias (irregular heartbeat), aortic stenosis, myocarditis, pericarditis, endocarditis
• Known aneurysm
• Uncontrolled blood pressure (a resting blood pressure that is consistently over 160 mmHg (systolic) or 100 mmHg (diastolic))
• Active respiratory conditions: such as acute pulmonary embolism (blood clot in the lung), or asthma / chronic lung diseases that interfere with your daily activities
• Active metabolic conditions: uncontrolled diabetes (e.g., recent ketosis or consistently very high/low blood sugar), or other uncontrolled metabolic diseases

Severe mental health symptoms

You are currently experiencing severe mental health symptoms. This includes current thoughts of suicide, current self-harm, active eating disorders, current uncontrolled use of substances or alcohol, and severe depression.

Why do VO2 Max tests have additional exclusions?

Performance testing to measure your maximal aerobic capacity (VO2 Max Testing) requires exercise at an increasing intensity until exhaustion.

The test is considered safe for individuals with low cardiovascular risk. However, the reaction of your heart, lungs, and blood vessels to such exercise cannot always be predicted. Although rare, there is a risk of the test exacerbating any existing medical conditions or causing abnormal changes during or following the test, which includes abnormal blood pressure, irregular, fast, or slow heart rhythm, breathing difficulties, vomiting, and in rare instances, medical events like fainting, a heart attack, stroke, or death.

To reduce these risks, you will be asked about your health and fitness, observations (heart rate, blood pressure, rating of perceived exertion) will be taken before and during the test, and emergency equipment and trained personnel are available to deal with emergency situations that may arise.

It is very important that you consider whether the benefit of the test outweighs any possible risks. You must read this list carefully — it is extensive but not exhaustive. You must disclose any medical information that may influence your ability and/or safety during an exercise test — please declare any historic or current medical condition that is not in this list but that may put you at risk if you were to proceed with the test.

Cardiovascular Exclusions

• Any recent cardiovascular finding for which there is ongoing investigation.
• Resting heart rate above 100 bpm.
• Blood pressure ≥ 160 mmHg (top number) or 100 mmHg (bottom number).
• Blood pressure < 90 mmHg (top number).
• Surgery on the heart or blood vessels.
• Previous cardiac arrest or myocardial embolism/infarction.
• Heart conditions; any cardiomyopathy, heart failure, coronary artery disease, angina, any heart valve disease (including aortic stenosis), endocarditis, myocarditis, pericarditis, ventricular aneurysm, undiagnosed and symptomatic heart murmurs.
• Electrical abnormalities of the heart e.g. atrial fibrillation or atrial flutter (inc. paroxysmal), tachy-brady syndrome, left bundle branch block, Wolf-Parkinson-White, 2nd and 3rd degree heart block (AV block), long QT syndrome, Brugada sign, any electrical abnormalities that you take medication for or attend medical check-ups for, any electrical abnormality that causes symptoms and/or impacts your exercise limits.
• Blood vessel conditions; carotid artery disease, transient ischemia attack (TIA) or stroke (of any kind), aneurysm with or without dissection (of any kind), deep vein thrombosis, inflamed leg veins (phlebitis)

Respiratory Exclusions

• Current infection (chest, throat, sinus).
• Cystic fibrosis.
• Pulmonary fibrosis.
• Chronic obstructive pulmonary disease (COPD).
• Lung cancer.
• Pulmonary hypertension.
• Pulmonary embolism/infarction.
• Any respiratory condition that may be exacerbated by exercise (e.g. exercise-induced asthma, long COVID).

Metabolic and MSK Exclusions

• HbA1c of ≥48 mmol/mol (≥6.5%).
• Fasting blood glucose of >11.0 mmol/L and/or signs of diabetic ketoacidosis.
• Current glucose <3.9 mmol/L (or clinical features of hypoglycaemia) or hypoglycaemia in the last 24 hours.
• Metabolic disease including but not limited to uncontrolled diabetes, thyrotoxicosis, chronic kidney disease (moderate and severe), clinical anaemia, and blood electrolyte abnormalities (e.g. hypokalaemia, hypomagnesaemia).
• Neuromuscular (examples include but are not limited to multiple sclerosis, motor neuron disease/ALS, myasthenia gravis), musculoskeletal, chronic infections, or rheumatoid disorders that may be exacerbated by exercise.
• Current cancer diagnosis and/or treatment
• Experiencing negative effects of a head injury

Medication Exclusions

• Pseudoephedrine cold cures (e.g. Sudafed).
• Beta-blockers (including systemic) e.g. atenolol, bisoprolol, propranolol.
• Digoxin
• Tricyclic anti-depressants
• Anti-arrhythmic therapy
• Any medication that is currently causing side-effects that make exercise testing inappropriate.

Relative Contraindications

You may be able to take part in a maximal aerobic capacity (VO2 Max) performance test if you have a relative contraindication. The benefits and risks of the test must be discussed first during a consultation with a medical doctor. Please contact membership@unbound.living if one of these apply to you.

• Resting heart rate under 40 bpm in athletes.
• Neurological conditions including epilepsy and seizures.
• Your risk of a heart attack or stroke in the next 10 years (QRISK3) is > 10%.
• You have previously undergone cardiac investigations
• You have had type 1 or type 2 diabetes for more than 10 years.
• You have type 1 or type 2 diabetes and are over 40 years old, or are under 40 with an additional cardiovascular risk factor (blood pressure ≥140 / 90 mmHg, HDL ratio ≥4, currently smoke cigarettes, microalbuminuria, nephropathy, retinopathy, neuropathy).

On the day

Please be aware that the Health Team will conduct final checks on the day of your assessment. If they view you as unfit to test (for example, you are unwell, injured, or you are experiencing symptoms like breathlessness), you will not be able to proceed and will need to reschedule your appointment.

You will need to postpone your VO2 max test if on the day you have:

• Pregnancy (all trimesters).
• Post-partum (6 months, or until you are cleared by the post-natal team for maximal exercise).
• Any current or chronic infection, operation, or health finding / condition for which medical advice still limits exercise or impacts general wellness and ability to exercise at a moderate-to-hard intensity level.
• Symptoms suggestive of cardiovascular disease or other acute health considerations:
  • Chest pain (at rest, during daily living or during exertion)
  • Shortness of breath
  • Dizziness/losing balance
  • Lost consciousness
  • Fainting
  • Palpitations
  • Excess sweating
  • Nausea