Holland JL;  Radcliffe Department of Medicine, University of Oxford, Oxford, UK.&
Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
Cowie P; Gardner L; Mulae J; Richards S; Holdsworth DA

BMJ Military Health. 172(2):140-147, 2026 Mar 20.

INTRODUCTION: Abnormal cardiorespiratory symptoms and investigative
findings in service personnel typically result in prolonged investigation
and occupational restriction. This analysis aimed to assess the impact of
the Oxford Military Cardiopulmonary Exercise Testing Clinic (OMEC), which
investigates such symptoms and findings, on occupational recommendations.

METHODS: A service evaluation was conducted on all OMEC attendances over
a 5-year period. Referral indication and occupational grading,
demographics, exercise testing parameters, clinical diagnosis and
occupational recommendation were recorded.

RESULTS: 141 individuals were reviewed. Mean age was 36 (+/-11.3) years,
and 91% were male. Median waiting time for an appointment was 14.4 weeks
(cf NHS 17.4 weeks). Individuals were referred for dyspnoea (22.1%),
syncope (11.4%), chest pain (8.1%) (referred to as ‘higher risk’ symptom
group), and pre-syncope (8.1%), palpitations (8.1%), and fatigue and/or
exercise intolerance (6.0%) (referred to as ‘lower risk’ symptom group).
34% were asymptomatic with incidental findings on cardiac screening
investigations. Reduced exercise capacity was rare, affecting only 11% of
individuals, which was borderline/mild at worst.Median peak VO2 (as a
percentage of the predicted peak) was lower in the higher-risk symptom
group than in the lower-risk symptom group (97.8% vs 121%; p<0.001). This
was also seen for median workload as %PP (82.6% vs 98.0%; p<0.001). 80.5%
of patients were given an immediate occupational recommendation; 78% of
which were favourable outcomes (ie, a recommended occupational upgrade
(72%) or to remain fully deployable (6%)).

CONCLUSION: OMEC is tailored to the unique needs of the military
population, providing outcomes that support operational requirements.
Despite geographical distribution and operational commitments, OMEC
waiting time is equivalent to the NHS, with the great majority of patients
upgraded after attendance. These findings establish OMEC as a benchmark
for military-specific clinical services based in public (NHS) hospitals,
highlighting its role in facilitating rapid and effective occupational
management.