Comparison of ramp versus step protocols for exercise testing in patients ≥60 years of age

• Published in: The American journal of cardiology Vol. 83; no. 1; pp. 11 - 14
• Main Authors: Bader, David S, Maguire, Thomas E, Balady, Gary J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 1999; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood Pressure; Cardiology. Vascular system; Coronary Disease - diagnosis; Coronary Disease - metabolism; Coronary Disease - physiopathology; Coronary heart disease; Exercise Test - methods; Female; Heart; Heart Function Tests; Heart Rate; Humans; Linear Models; Male; Medical sciences; Middle Aged; Oxygen Consumption; Predictive Value of Tests; Respiratory Function Tests; Surveys and Questionnaires; Systole; Human; Treadmill exercise; Device; Cardiovascular disease; Cardiopulmonary; Oxygen consumption; Exercise tolerance test; Exploration; Technique; Coronary heart disease; Elderly; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00774-7

To evaluate whether individualized ramp protocols may be better than step protocols in patients ≥60 years of age referred for exercise testing, peak cardiopulmonary responses and accuracy in prediction of oxygen uptake (VO 2) for individualized ramp and step protocols (Bruce or modified Bruce) were compared. Twenty-four subjects (67 ± 3 years) with known or suspected coronary artery disease performed both tests in random order. Protocols were selected based on estimated exercise capacity using a pretest activity questionnaire. No differences were observed between peak VO 2 (19.3 ± 6.3 and 19.1 ± 6.4 ml/kg/min), heart rate (127 ± 15 and 126 ± 16 beats/min), rate–pressure product (24.0 ± 4.8 and 23.4 ± 4.9 beats/min × mm Hg × 10 3) and anaerobic threshold (16.6 ± 3.7 and 16.0 ± 4.7 ml/kg/min) for the ramp and step protocols, respectively. The relation between measured submaximal VO 2 and American College of Sports Medicine (ACSM)-predicted VO 2 during the ramp protocol is demonstrated by the regression coefficient (β), where β = 0.92 (95% confidence intervals [CI] 0.85 to 0.99) and for the step protocols where β = 1.02 (95% CI 0.84 to 1.20). Peak cardiopulmonary responses in the elderly are similar during individualized ramp and step protocols when appropriately selected based on a pretest activity questionnaire. Both protocols appear to provide clinically reasonable estimates of VO 2 when gas exchange analysis is not used.