Recent cohort studies such as the European Surgical Outcomes Study (EuSOS) have highlighted that elective surgery is associated with significant risk. In this audit of 46,539 surgical patients, the reported hospital mortality rate of 3.6 per cent was higher than had previously been estimated. Cardiopulmonary exercise testing (CPET) is a good pre-operative risk assessment tool because it provides an objective global assessment of the integrative responses of the pulmonary, cardiovascular, and haematological systems rather than evaluating individual organ systems' function in isolation. Physical fitness levels in abdominal aortic aneurysm (AAA) patients are poor as a consequence of co-morbid disease processes, sedentary lifestyle, and age. Morbidity and mortality after surgery for vascular disease are generally high. The endovascular aneurysm repair (EVAR 2) and the National Quality Improvement Programme strongly advocate the optimisation of preoperative-patient fitness with the aim of improving overall outcomes.