Actually in South Africa, over the age of forty, you have to do a stress ECG each year for a Class I renewal. This means running on a treadmill for a minimum of eight minutes. A lifetime of pure sinful excess means that this ordeal is very much a fitness test. The medical examiner in South Africa is well within his rights to make a notation to the effect that the candidate is physically lacking in endurance. The medical forms pass through the Military Medical Institute (MMI) for final approval. You can be passed as fit with the requirement that you are considerably fitter next time you apply for a renewal. This of course is all good for the blood pressure!