Diagnostic Testing: Exercise Testing In a subset of patients, exercise stress testing will be of additional value in determining optimal therapy. Because of the slow, insidious rate of progression of many valve lesions, patients may deny symptoms as they gradually limit their activity level over several years to match the gradual limitations imposed by the valve lesion. In patients with an equivocal history of symptoms, exercise testing helps identify those who are truly symptomatic.1,2 Exercise stress testing (ie, examining the exercise capacity and blood pres- sure response) is of prognostic value in patients with asymptomatic valve disease and provides further in- formation about the timing of a potential interven- It is important that exercise testing in patients with severe VHD always be performed by trained op- erators, with continuous monitoring of the ECG and blood pressure. 2.4. Basic Principles of Medical Therapy In patients being evaluated for VHD, standard GDMT for cardiac risk factors, including hypertension, diabetes mellitus, and hyperlipidemia, should not be neglected. Heart-healthy lifestyle factors (exercising, consuming a healthy diet, not smoking, and maintaining a normal body size) are no different for patients with VHD than for the general population. Many patients with asymp- tomatic VHD feel better with regular aerobic exercise to improve cardiovascular fitness.1 3 Although heavy iso- metric repetitive training might increase LV afterload, resistive training with small free weights or repetitive Table 4. 