The potential contribution of the paramedical specialist to exercise testing is considered. Available statistics suggest that the incidence of cardiac catastrophes is no higher with paramedical than with medical supervision of stress tests. It is argued that a few hours of intensive training permit such specialists to make an effective interpretation of ancillary symptoms, and that although paramedics may halt a test at a lower intensity of effort, the reactions of the patient to low intensities of exercise have the greatest relevance for exercise prescription. In exceptional cases, the added expense of test supervision by an experienced sports cardiologist is justified by enhanced diagnostic yield, but in general medical supervision of exercise tests is neither cost effective nor necessary.