I have attached an article below gives a definition of METS and some insight into treadmill testing, and also a link to an article on treadmill testing.
But basically most stress testing follows the "Bruce" protocols. There is no specified exact time the test takes. They start you off walking and every 2 or 3 minutes they increase the difficulty of the test by changing the elevation of the treadmill or resistence of the stationary bike. They stop the test if you develop bad signs like dizziness or if the EKG you are hooked up to shows abnormal rhythms....or when you achieve 85% of your predicted maximal heart rate.
So basically take about 10-12 minutes to work up to a good running pace on a treadmill, then give it your maximal effort - all you can for a minute or two- at your maximal effort you should be around your 85% predicted maximal heart rate-and at that time note what your heart rate is and what your maximal MET performance was (mine is about 17 METS when I am really kicking it). Then hop off the treadmill and rest for 2 minutes. Then check your pulse again - this is hard to do at the gym since you have to get back on the machine and pedal again to get the machine working so you can check your pulse, and by pedalling again you are elevating your heart rate. So it is better to check your pulse manually after the maximal exertion - take your pulse for 10 seconds and multiply by 6 or take your pulse for 15 seconds and multiply times 4 etc.
But you don't want to end up doing 45 minutes of cardio or something before giving your maximal effort because you will have accrued some oxygen debt and your heart rate will take longer to return to normal because of that. 20 minutes total of testing is more than enough - you really can get a good idea in 15 minutes.
no matter what your results are you can improve them - have no doubt about that. Risk for heart disease is a fluctuating thing - in fact it fluctuates day by day and hour by hour (not trying to be scarey) - statistics show that most heart attacks occur around 5-7 AM and more often on Monday mornings - the point being that risk factors are modifiable. Research indicates that for every one MET improvement in treadmill performance there is a 12% increase in survival. The best way to improve treadmill performance is getting on a treadmill regularly. Cardio exercise reduces cardiac risk regardless - that is why cardio rehab is so important to a patient after they have a heart attack. So even if you have a dismal set of risk factors today, literally in a number of weeks or months you could alter the course of your life and have a very favorable profile
Link :
http://www.heartsite.com/html/regular_stress.html
Article:
GIBBONS ET AL., 2002 GUIDELINE UPDATE FOR EXERCISE TESTING
Circulation 2002;106:1883-1892
ACC/AHA 2002 Guideline Update for Exercise Testing—Summary Article
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Excercise Testing Guidelines)
Modification III
This revised text incorporates new published evidence on elderly patients, heart-rate responses during and after exercise, and systolic blood pressure responses during and after exercise. It replaces material in the original text that appeared under the major heading "Risk Stratification" and the subheading "Nonacute Coronary Artery Disease" beginning on page 278 (second column).
The value of exercise treadmill testing for prognostic assessment in elderly subjects has been described in the Olmstead County, Minnesota, cohort followed by the Mayo Clinic.14 As expected, the elderly patients (aged greater than or equal to 65 years) had more comorbidity and achieved a lower workload than their younger counterparts. They also had a significantly worse unadjusted survival. Workload expressed as metabolic equivalents (METs) was the only treadmill variable associated with all-cause mortality in both groups (adjusting for clinical prognostic variables), whereas both workload and exercise angina were associated with cardiac events (death plus myocardial infarction) in both groups. A positive ST response was not prognostic in the older patients when tested as a binary variable. Quantitative ST-segment deviation with exercise was apparently not available in this cohort, and the Duke Treadmill Score was not computed in this study.
Morrow and colleagues15 developed a prognostic score using data from 2546 patients from Long Beach Veterans Administration Hospital. This score includes 2 variables in common with the Duke treadmill score (exercise duration or the MET equivalent and millimeters of ST changes) and 2 different variables (drop in exercise systolic blood pressure below resting value and history of congestive heart failure [CHF] or use of digoxin [Dig]). The score is calculated as follows:
5 × (CHF/Dig [yes = 1; no=0]) + exercise-induced ST depression in millimeters + change in systolic blood pressure score - METs,
where systolic blood pressure_0 for an increase greater than 40 mm Hg, 1 for an increase of 31 to 40 mm Hg, 2 for an increase of 21 to 30 mm Hg, 4 for an increase of 0 to 11 mm Hg, and 5 for a reduction below standing systolic preexercise blood pressure. With this score, 77% of the Long Beach Veterans Administration Hospital population were at low risk (with less than 2% average annual mortality), 18% were at moderate risk (average annual mortality, 7%), and 6% were at high risk (average annual mortality, 15%).
Several studies have highlighted the prognostic importance of other parameters from the exercise test. Chronotropic incompetence, defined as either failure to achieve 80% to 85% of the age-predicted maximum exercise heart rate or a low chronotropic index (heart rate adjusted to MET level), was associated with an 84% increase in the risk of all-cause mortality over a 2-year follow-up in 1877 men and 1076 women who were referred to the Cleveland Clinic for symptom-limited thallium treadmill testing.16,17 The Cleveland Clinic investigators have also demonstrated the prognostic importance of an abnormal heart rate recovery pattern after exercise testing. Defined as a change from peak exercise heart rate to heart rate measured 2 minutes later of less than or equal to 12 beats per minute, an abnormal heart rate recovery was strongly predictive of all-cause mortality at 6 years in 2428 patients referred for thallium exercise testing.18 Similar trends have been suggested for a delayed systolic blood pressure response after exercise, defined as a value greater than 1 for systolic blood pressure at 3 minutes of recovery divided by systolic blood pressure at 1 minute of recovery. This finding was associated with severe CAD in a study of 493 patients at the Cleveland Clinic who had both symptomlimited exercise testing and coronary angiography (within 90 days). In a study of 9454 consecutive patients, most of whom were asymptomatic, the Cleveland Clinic investigators reported that abnormal heart rate recovery and the Duke treadmill score were independent predictors of mortality.20 Further work is needed to define the role of chronotropic incompetence, abnormal heart rate recovery, and delayed blood pressure response in the risk stratification of symptomatic patients relative to other well-validated treadmill test parameters.
In patients who are classified as low risk on the basis of clinical and exercise testing information, there is no compelling evidence that an imaging modality adds significant new prognostic information to a standard exercise test. In this regard, a distinction should be made between studies that show a statistical advantage of imaging studies over exercise ECG alone and studies that demonstrate that the imaging data would change practice (eg, by shifting patients from moderate- to low- or high-risk categories). Because of its simplicity, lower cost, and widespread familiarity in its performance and interpretation, the standard treadmill ECG is the most reasonable exercise test to select in men with a normal resting ECG who are able to exercise. In patients with an intermediate-risk treadmill score, myocardial perfusion imaging appears to be of value for further risk stratification. Patients with an intermediate-risk treadmill score and normal or near-normal exercise myocardial perfusion images and normal cardiac size are at low risk for future cardiac death and can be managed medically.
© 2002 by the American College of Cardiology Foundation and the American Heart Association, Inc.
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