Every day we perform stress tests on our patients, and every day we report on how well they performed. I have always found it a little bit awkward to comment on my patients’ exercise tolerance with such simple qualifiers as “fair” or “very good for age.”
The truth is, if you have never actually performed an exercise test, you don’t really have a great context for judging others’ prowess.
The Bruce protocol was developed by Dr. Robert Bruce in 1963, and was only part of an impressive career, which has since defined him as the “Father of Exercise Cardiology.” His exercise protocol, which increases treadmill grade by 2 percent and speed by approximately 0.8 mph every three minutes, provides a pretty intense cardiac workout in a very short period of time.
Its value, in addition to gauging fitness, is in assessing one’s risk of having coronary artery disease, as well as predicting peri-operative and longer-term cardiac risk.
Back in the 1960’s, this was a very progressive approach to standardizing how doctors evaluated their patients. Dr. Bruce reportedly said, “You would never buy a used car without taking it out for a drive and seeing how the engine performed while it was running, and the same is true for evaluating the function of the heart.”
A few weeks ago, my cardiology office decided to take Dr. Bruce’s ideas to heart, and practice what we preach. Medical assistants, nurses and the rare physician jumped on the treadmill in turn, and we let the Bruce protocol do its thing.
I’m happy to report that we did pretty well overall. A few of our, um, younger employees completed the final stage — think competitive cyclists and sub-three hour marathoners. Our physicians, alas, weren’t quite as impressive, but at least we had age on our side… I was psyched to complete the fifth stage of the protocol, but was pretty wiped out for the rest of the afternoon (and the following afternoon, too). But it gave me new respect for what we put our patients through, and also gives me a better frame of reference to evaluate them.
One of the interesting “side effects” of formal exercise testing is that taking the test appears to motivate participants to make healthy changes in their own lives. One study reported that 63 percent of patients modified risky behaviors after being tested.
As for me, it inspired me to reach a new type of fitness goal — Stage 6, here I come!
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