A comparative analysis of four protocols for maximal treadmill stress testing.

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.