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May 11, 1964

Standardized or Unstandardized Stress?-Reply

JAMA. 1964;188(6):613. doi:10.1001/jama.1964.03060320132035

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It is to be emphasized that my recommendations, quoted above, refer specifically to crippled subjects who cannot manage the "two-step" test, and in whose case one is obliged to record an electrocardiogram during or after such stress as can be performed. My statement was not meant to endorse essentially randomized or unstandardized forms of stress, which, in my opinion, have not been nearly as rewarding diagnostically as the standardized Master "two-step" test. It is often very difficult to prescribe an amount of exercise "individualized and adjusted to the patient's condition." In the doctor's office, how would one tailor exercise for a patient who complains of chest pain only after sexual intercourse, or only for a short period in the early morning, or only under very special circumstances such as straining at stool? Patients rarely seek medical advice because of experiencing chest pain after doing knee bends!

In my opinion, the

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