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September 4, 1972

Exercise Tests

Author Affiliations

Birmingham, Ala

JAMA. 1972;221(10):1165. doi:10.1001/jama.1972.03200230051023

To the Editor.—  Cohn et al (220:501, 1972), in examining the diagnostic accuracy of the two-step test have really combined two different types of e'xercise tests: (1) the standard double Master's two-step test, and (2) submaximal exercise testing graded by heart rate. They employ the principle of heart rate response in the form of a criterion to identify and eliminate 20% of the test procedures which were unsatisfactory due to low heart rate response to the exercise specified by the two-step trip tables. If the trip tables systematically lead to uninterpretable results in one patient out of five, and retrospective employment of the principle of heart rate response correctly identifies this uninterpretable group, one might take this as evidence favoring prospective use of heart rate response in governing the amount of exercise employed, rather than trip tables. Their data suggest that the sensitivity of the test increases (from 66% to