**2.1 Exercise testing**

Special considerations in patients suffering from DM for exercise testing needs to be undertaken are:

When initiating an exercise program of light-to-moderate intensity, exercise testing is usually not essential for people with DM or prediabetes who are asymptomatic for CVD and low risk (<10% risk of cardiac event over a 10-yr period using the Framingham risk calculator) [2].

Electrocardiogram (ECG) stress testing may be considered for individuals with DM, especially those who have been following sedentary lifestyle and desires to participate in vigorous intensity activities. If positive or nonspecific ECG changes in response to exercise are discovered or nonspecific ST and T wave changes at rest are observed, the client should undergo follow-up diagnostic testing. Thus, the cost-effectiveness and diagnostic value of such intensive investigations remains in question. Silent ischemia in patients with DM often follows the iceberg phenomenon; therefore, annual CVD risk factor assessments should be conducted [2].
