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This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom\u2010limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring \u2018myth\u2019 that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with \u2018methodological\u2019 recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short\u2010term risks posed by potential AAA rupture.<\/jats:p>","DOI":"10.1113\/ep090816","type":"journal-article","created":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T11:49:51Z","timestamp":1685101791000},"page":"1118-1131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Myths and methodologies: Cardiopulmonary exercise testing for surgical risk stratification in patients with an abdominal aortic aneurysm; balancing risk over benefit"],"prefix":"10.1113","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0498-7095","authenticated-orcid":false,"given":"Damian M.","family":"Bailey","sequence":"first","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Glamorgan UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Davies","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Glamorgan UK"},{"name":"Department of Anaesthetics University Hospital of Wales  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9598-6372","authenticated-orcid":false,"given":"George A.","family":"Rose","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Glamorgan UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Glamorgan UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Abd","family":"Aldayem","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery University Hospital of Wales  Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chistopher P.","family":"Twine","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Bristol  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wael","family":"Awad","sequence":"additional","affiliation":[{"name":"Neurovascular Research Laboratory, Faculty of Life Sciences and Education University of South Wales  Glamorgan UK"},{"name":"Department of Cardiothoracic Surgery Bart's Heart Centre, St Bartholomew's Hospital, Bart's Health NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matti","family":"Jubouri","sequence":"additional","affiliation":[{"name":"Hull York Medical School University of York  York UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idhrees","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Institute of Cardiac and Aortic Disorders SRM Institutes for Medical Science (SIMS Hospital)  Chennai Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos A.","family":"Mestres","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery University Hospital Z\u00fcrich  Z\u00fcrich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward P.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery Duke University Medical Center  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph S.","family":"Coselli","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Michael E. 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