Excellent article. Exactly what I try to communicate to patients every time I do a stress test. Thank you. It is the baseline and the rate of change over time.
Now, however, they want to do nuclear stress tests with medication, not you on a treadmill. How can that measure your fitness if you just lay there and let medication do all the work? I’ve had stress tests on a treadmill when I was younger. It was suggested to me that I have a nuclear stress test now, but no real reason as to why I might need one. I said no. I’m a 72 year old female who just had hip replacement surgery when it was discovered that it was a really bad hip, not my back, causing leg pain for two years. Even with that, prior to the hip surgery I managed mile walks with my dog using a Swedish all terrain rollator…just kept putting less and less weight on the bad ‘leg.’ I thought that adapting was my only choice. Once I’m fully recovered from my very successful hip transplant, I plan to be back to long walks and hikes like I was doing before the hip caused problems. I’ve always been physically active. I’m not plannng any marathons, just being able to walk without pain is a blessing, and walking/hiking is fine for me at this stage of life.
Nuclear stress testing is much more common in the US than other countries. However, we use non mechanical stress tests who may not be able to do a stress test eg hip pain. Most important thing is to keep moving as much as possible in a way that avoids injury. Keep it up.
Thank you for this article, I hadn't known about the value of measuring MET scores over time. I also wonder about the pros and cons of the nuclear stress test, which is being recommended for a family member as they have a mobility issue that impacts their ability to walk. I have also wondered if there are centres where exercise machines other than a treadmill can be used for a stress test, - example a bike, or rowing machine- for those for whom walking is the limiting factor.
Can one take too much exercise? Dr James O'Keeffe says "The fitness patterns for conferring longevity and robust lifelong cardiovascular health are distinctly different from the patterns that develop peak performance and marathon/superhuman endurance. Extreme endurance training and racing can take a toll on your long-term cardiovascular health. For the daily workout, it may be best to have more fun endure less suffering in order to attain ideal heart health."
This is great, and an important reminder for primary care docs regarding the METs reporting. Also good to be reminded that the majority of heart attacks occur suddenly in people with <70% stenosis... people are always shocked to hear me say that as I temper prognostic discussions after stress testing.
Excellent article. Exactly what I try to communicate to patients every time I do a stress test. Thank you. It is the baseline and the rate of change over time.
Great to see it communicated.
Thank you for this brilliant article, Dr. Barrett. As a patient, I'm thrilled to see my MET scores are at the high end!
Now, however, they want to do nuclear stress tests with medication, not you on a treadmill. How can that measure your fitness if you just lay there and let medication do all the work? I’ve had stress tests on a treadmill when I was younger. It was suggested to me that I have a nuclear stress test now, but no real reason as to why I might need one. I said no. I’m a 72 year old female who just had hip replacement surgery when it was discovered that it was a really bad hip, not my back, causing leg pain for two years. Even with that, prior to the hip surgery I managed mile walks with my dog using a Swedish all terrain rollator…just kept putting less and less weight on the bad ‘leg.’ I thought that adapting was my only choice. Once I’m fully recovered from my very successful hip transplant, I plan to be back to long walks and hikes like I was doing before the hip caused problems. I’ve always been physically active. I’m not plannng any marathons, just being able to walk without pain is a blessing, and walking/hiking is fine for me at this stage of life.
Nuclear stress testing is much more common in the US than other countries. However, we use non mechanical stress tests who may not be able to do a stress test eg hip pain. Most important thing is to keep moving as much as possible in a way that avoids injury. Keep it up.
Thank you for this article, I hadn't known about the value of measuring MET scores over time. I also wonder about the pros and cons of the nuclear stress test, which is being recommended for a family member as they have a mobility issue that impacts their ability to walk. I have also wondered if there are centres where exercise machines other than a treadmill can be used for a stress test, - example a bike, or rowing machine- for those for whom walking is the limiting factor.
It can be done on a bike but if the specific question is ischemia then a chemical stress test may be needed eg Nuclear or MRI perfusion.
Can one take too much exercise? Dr James O'Keeffe says "The fitness patterns for conferring longevity and robust lifelong cardiovascular health are distinctly different from the patterns that develop peak performance and marathon/superhuman endurance. Extreme endurance training and racing can take a toll on your long-term cardiovascular health. For the daily workout, it may be best to have more fun endure less suffering in order to attain ideal heart health."
Hi Declan. I have written about this before and I think that this is a very very small problem. Most people are a million miles away from exercising too much. When you look at the studies and the daily volumes achieved I suspect it's a rarefied group who will ever encounter this issue. https://paddybarrett.substack.com/p/is-too-much-exercise-harmful?utm_source=%2Fsearch%2Fexercise&utm_medium=reader2
This is great, and an important reminder for primary care docs regarding the METs reporting. Also good to be reminded that the majority of heart attacks occur suddenly in people with <70% stenosis... people are always shocked to hear me say that as I temper prognostic discussions after stress testing.
Bravo!