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August 24, 1957


JAMA. 1957;164(17):1868-1874. doi:10.1001/jama.1957.02980170008002

• The Master two-step test consists of a certain number of trips (approximately 20) over a set of two 9-in. (23-cm.) steps in 90 seconds. The exact number is determined for each subject according to his age and weight, and the score is determined by the time required for the subject's pulse and blood pressure to return to their preexercise levels. The calculated total work for the average subject (weighing 77.2 kg.) was 710 kg.-m. The work done per minute was 480 kg.-m. and corresponded to an oxygen consumption rate of 1,485 ml. per minute. This was found to be about 6.8 times the resting oxygen consumption of all subjects, regardless of age, weight, or health, and to fall between stair-climbing and deep knee-bends on a scale of severity for physical exercise. Comparisons were made between a group of 12 patients with rheumatic heart disease and 85 volunteer subjects classified as strictly normal. The latter were chosen from an initial group of 126 men; they had no known history of heart disease, gave normal electrocardiograms during rest and after exercise, had resting blood pressures of 140 mm. Hg or less systolic and 90 or less diastolic, and gave normal blood pressure responses to exercise. Comparisons were also made between a group of 31 patients with arteriosclerotic heart disease and 40 of the strictly normal subjects matched as to age and weight. The strictly normal subjects differed from the cardiac patients in being able to consume oxygen faster during the exercise period. The cardiac patients deferred a greater part of the oxygen demand to the recovery period. The promptness with which heart rate and blood pressure returned to preexercise levels combined with electrocardiographic changes afforded a better basis for discriminating between normal subjects and cardiac patients than did either the electrocardiogram or the ballistocardiogram alone. The Master two-step test was found to have a sound physiological basis, especially since the stress it imposes is comparable to the demands of the ordinary activities of life and is constant for patients of different ages and weights.