Quantifying exertion level during exercise stress testing using percentage of age-predicted maximal heart rate, rate pressure product, and perceived exertion.
OBJECTIVE
To determine if the attainment of at least 85% of age-predicted maximal heart rate (APMHR), using the equation 220 - age, and/or at least 25,000 as the product of maximal heart rate and systolic blood pressure (rate pressure product, RPP) is an accurate indicator of exertion level during exercise stress testing.


METHODS
From May 1, 2009, to February 15, 2010, 238 patients (mean ± SD age, 49.3±11.9 years; 50% male) with symptoms suggestive of myocardial ischemia underwent an exercise stress test with the addition of ventilatory expired gas analysis and a myocardial perfusion study. Ventilatory expired gas analysis determined the peak respiratory exchange ratio (RER), which is considered a valid and reliable variable for quantifying a patient's exertion during exercise.


RESULTS
Of the patients, 207 (87%) attained a peak RER of 1.00 or more, and 123 (52%) attained a peak RER of 1.10 or more. An APMHR of 85% or more and peak RPP of 25,000 or more were both ineffective in identifying patients who put forth a maximal exercise effort (ie, peak RER, ≥1.10). Perceived exertion was a significant indicator (P=.04) of patient exertion, with a threshold of 15 (6-20 scale) being an optimal cut point. The percentage of equivocal myocardial perfusion study results was significantly higher in patients who demonstrated a submaximal exercise effort by peak RER (P≤.007).


CONCLUSIONS
Aerobic exercise testing is an integral component in the assessment of patients with suspected myocardial ischemia. Our findings indicate that the currently used percentage of APMHR and peak RPP thresholds are ineffective in quantifying a patient's level of exertion during exercise stress testing.
Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23140, USA.
Sherry
S
Pinkstaff
Mary Ann
MA
Peberdy
Michael C
MC
Kontos
Sheryl
S
Finucane
Ross
R
Arena
D001794:Blood Pressure / Q000502:physiology; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008448:Maximal Expiratory Flow Rate / Q000502:physiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology*