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A comparative analysis of four protocols for maximal treadmill stress testing
Insights
This study compared four maximal treadmill stress tests, finding no significant differences in maximal oxygen uptake (V02 max) or heart rate. The Balke protocol offered a more gradual increase in metabolic cost, making it suitable for screening.
Area of Science:
- Exercise Physiology
- Cardiovascular Diagnostics
- Sports Medicine
Background:
- Maximal treadmill stress tests are crucial for assessing cardiovascular fitness and diagnosing conditions.
- Common protocols include Balke, Bruce, Ellestad, and continuous running tests, each with unique progression schemes.
- Understanding comparative performance is vital for selecting appropriate testing methods.
Purpose of the Study:
- To compare the physiological responses and effectiveness of four maximal treadmill stress tests.
- To evaluate serial and maximal heart rate, metabolic demands (V02, METs), and ECG parameters.
- To determine the suitability of each protocol for screening healthy adult men.
Main Methods:
- Fifty-one healthy men (35-55 years) were divided into trained and untrained groups.
- Participants underwent four maximal treadmill tests: Balke, Bruce, Ellestad, and a continuous running protocol.
- Data analyzed included maximal heart rate, V02, blood pressure, ventilation (VE), and respiratory parameters (RP).
Main Results:
- All tests showed high correlations, with no significant differences in maximal V02, heart rate, or blood pressure.
- The Balke protocol exhibited lower maximal VE and RP, with a more gradual MET cost progression (0.5 METs/min).
- The continuous running test's rapid initial MET increase (9 METs in 3 min) deemed it less suitable for screening.
Conclusions:
- The Balke, Bruce, and Ellestad treadmill tests are comparable in eliciting maximal physiological responses in healthy men.
- The Balke protocol's gradual progression makes it a potentially superior choice for screening.
- A nomograph was developed to estimate V02 max from treadmill time for the Balke, Bruce, and Ellestad tests.
Abstract:
The purpose of this investigation was to compare the results from four commonly used maximal treadmill stress tests: Balke, Bruce, Ellestad, and a continuous multistage running protocol. The results compared serial and maximal heart rate, metabolic demands, and ECG determinations. Fifty-one healthy men, 35 to 55 years of age, volunteered for this study and were dichotomized into trained and untrained subjects. Regression analyses showed all the tests to correlate highly. No significant differences were found between tests at maximum for V02, heart rate, and blood pressure, except for V02 for the Balke as compared to the running protocol (39 vs. 41 ml./Kg-min). The Balke protocol showed lower values at maximum in VE and RP than the other three tests as well as the most gradual rate of progression in MET cost (0.5 METS per minute). The increase for the Bruce and Ellestad tests was from 1 to 1.5 METS per minute, and a rapid initial increase (9 METS in the first 3 minutes) made the running test undesirable as a screening method. Although serial plots of heart rate and MET costs were similar to those previously reported for different population samples, the present data further refined these values. Finally, a nomograph comparing treadmill time and V02, max. for the Balke, Bruce, and Ellestad tests was developed from these data.