A comparative analysis of four protocols for maximal treadmill stress testing

Pollock, Michael L.; Bohannon, Richard L.; Cooper, Kenneth H.; Ayres, John J.; Ward, Ann; White, Steve R.; Linnerud, A.C.

doi:10.1016/s0002-8703(76)80401-2

Cited by 536Cardiovascular and exercise physiologyPhysical Activity and HealthCardiovascular Effects of Exercise

A comparative analysis of four protocols for maximal treadmill stress testing

Pollock, Michael L., Bohannon, Richard L., Cooper, Kenneth H., Ayres, John J., Ward, Ann, White, Steve R., Linnerud, A.C.·1976·American Heart Journal

DOI 10.1016/s0002-8703(76)80401-2

Open this paper in CoChat — free account

Abstract

The purpose of this investigation was to compare the results from four commonly used maximal treadmill stress tests: Balke, Bruce, Ellestad, and a continuous multistage running protocol. The results compared serial and maximal heart rate, metabolic demands, and ECG determinations. Fifty-one healthy men, 35 to 55 years of age, volunteered for this study and were dichotomized into trained and untrained subjects. Regression analyses showed all the tests to correlate highly. No significant differences were found between tests at maximum for V02, heart rate, and blood pressure, except for V02 for the Balke as compared to the running protocol (39 vs. 41 ml./Kg-min). The Balke protocol showed lower values at maximum in VE and RP than the other three tests as well as the most gradual rate of progression in MET cost (0.5 METS per minute). The increase for the Bruce and Ellestad tests was from 1 to 1.5 METS per minute, and a rapid initial increase (9 METS in the first 3 minutes) made the running test undesirable as a screening method. Although serial plots of heart rate and MET costs were similar to those previously reported for different population samples, the present data further refined these values. Finally, a nomograph comparing treadmill time and V02, max. for the Balke, Bruce, and Ellestad tests was developed from these data.

Integrity signals

Registry

Crossref · 10.1016/s0002-8703(76)80401-2

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

The fittest men and women had 43% and 53% lower risks of all-cause mortality and 47% and 70% lower risks of cardiovascular disease mortality, respectively, compared with the least fit peers.
“the fittest men and women had 43% and 53% lower risks of all-cause mortality and 47% and 70% lower risks of cardiovascular disease (CVD) mortality, respectively, compared with the least fit peers [45]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [45]

Textbook of Work Physiology
Åstrand, P., & Rodahl, K. (1970) · Andalas University Repository (Andalas University) · Cited by 4,451 · see citing works
Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease
Bruce, R. A., Kusumi, F., & Hosmer, D. W. (1973) · American Heart Journal · doi:10.1016/0002-8703(73)90502-4 · Cited by 2,057 · see citing works
Maximal Oxygen Intake as an Objective Measure of Cardio-Respiratory Performance
TAYLOR, H. L., BUSKIRK, E. R., & Henschel, A. F. (1955) · Journal of Applied Physiology · doi:10.1152/jappl.1955.8.1.73 · Cited by 1,348 · see citing works
An experimental study of physical fitness of Air Force personnel.
Balke, B., & Ware, R. W. (1959) · PubMed · Cited by 878 · see citing works
Statistical Methods for the Behavioral Sciences.
Gold, D. A., & Edwards, A. L. (1955) · American Sociological Review · doi:10.2307/2092753 · Cited by 512 · see citing works
Elementary Statistics With Applications in Medicine and the Biological Sciences.
(1959) · Annals of Internal Medicine · doi:10.7326/0003-4819-51-5-1117_1 · Cited by 350 · see citing works
The Quantification of Endurance Training Programs
Pollock, M. L. (1973) · Exercise and Sport Sciences Reviews · doi:10.1249/00003677-197300010-00010 · Cited by 261 · see citing works
Self-citation
A simple field test for the assessment of physical fitness.
Balke, B. (1963) · ROSA P · Cited by 212 · see citing works
Exercise testing and exercise training in coronary heart disease
Naughton, J., Hellerstein, H. K., & Mohler, C. G. (1973) · Academic Press eBooks · Cited by 199 · see citing works
Maximal Treadmill Stress Testing for Cardiovascular Evaluation
Ellestad, M., Allen, W. E., Wan, M. K. C., et al. (1969) · Circulation · doi:10.1161/01.cir.39.4.517 · Cited by 172 · see citing works
Exercise and Sport Sciences Reviews
Williams, D. A. (1974) · Physical Therapy · doi:10.1093/ptj/54.8.913a · Cited by 169 · see citing works
Physical Training in Sedentary Middle-aged and Older Men III. Cardiac Output and Gas Exchange at Submaximal and Maximal Exercise
Hartley, L. H., Grimby, G., Kilbom, Å., Nilsson, N. J., Åstrand, I., BJURE, J., Ekblom, B. T., & Saltin, B. (1969) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.3109/00365516909080170 · Cited by 145 · see citing works
A Comparison of the Reproducibility and Physiologic Response to Three Maximal Treadmill Exercise Protocols
Froelicher, V. F., Brammell, H. L., Davis, G., Noguera, I., Stewart, A. J., & Lancaster, M. C. (1974) · CHEST Journal · doi:10.1378/chest.65.5.512 · Cited by 124 · see citing works
Guidelines for Graded Exercise Testing and Exercise Prescription
Carter, J. T. (1976) · Physical Therapy · doi:10.1093/ptj/56.2.240 · Cited by 115 · see citing works
Physical Training in Sedentary Middle-aged and Older Men I. Medical Evaluation
Kilbom, Å., Hartley, L. H., Saltin, B., BJURE, J., Grimby, G., & Åstrand, I. (1969) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.3109/00365516909080168 · Cited by 89 · see citing works
Statistical Methods for the Behavioral Sciences
Zubin, J. (1956) · American Journal of Psychiatry · doi:10.1176/ajp.112.10.862 · Cited by 85 · see citing works
World Standards of Cardiorespiratory Performance
Shephard, R. J. (1966) · Archives of Environmental Health An International Journal · doi:10.1080/00039896.1966.10664637 · Cited by 73 · see citing works
Effects of mode of training on cardiovascular function and body composition of adult men
Pollock, M. L., Dimmick, J. F., Miller, H. S., et al. (1975) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-197500720-00025 · Cited by 72 · see citing works
Self-citation
THE STANDARDIZATION AND INTERPRETATION OF SUBMAXIMAL AND MAXIMAL TESTS OF WORKING CAPACITY
TAYLOR, H. L., Wang, Y., Rowell, L. B., & Blomqvist, G. (1963) · PEDIATRICS · doi:10.1542/peds.32.4.703 · Cited by 62 · see citing works
Measurement in Exercise Electrocardiography.
Walker, W. J. (1971) · Archives of Internal Medicine · doi:10.1001/archinte.1971.00310140150035 · Cited by 42 · see citing works
Statistical Methods for the Behavioral Sciences.
Terry, M. E., & Edwards, A. L. (1956) · Journal of the American Statistical Association · doi:10.2307/2281359 · Cited by 42 · see citing works
Maximal exercise testing in assessing cardiovascular function.
McDonough, J. R., & Bruce, R. A. (1969) · PubMed · Cited by 41 · see citing works
Guidelines in the Management of the Exercising Patient
Cooper, K. H. (1970) · JAMA · doi:10.1001/jama.1970.03170100025004 · Cited by 31 · see citing works
Self-citation
Measurement in exercise electrocardiography
(1970) · American Heart Journal · doi:10.1016/0002-8703(70)90382-0 · Cited by 26 · see citing works
The application of electrocardiographic screening and exercise testing to preventive cardiology
Froelicher, V. F. (1973) · Preventive Medicine · doi:10.1016/0091-7435(73)90055-8 · Cited by 17 · see citing works
Multistage Treadmill Walking Performance and Associated Cardiorespiratory Responses of Middle-Aged Men
Adams, W. C., McHenry, M. M., & Bernauer, E. M. (1972) · Clinical Science · doi:10.1042/cs0420355 · Cited by 12 · see citing works

Flagged first, then by citations

Sorted by citations

Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women: A Meta-analysis
Kodama, S. (2009) · JAMA · doi:10.1001/jama.2009.681 · Cited by 3,035 · see citing works
Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association
Ross, R., Blair, S. N., Arena, R., Church, T. S., Després, J.-P., Franklin, B. A., Haskell, W. L., Kaminsky, L. A., Levine, B. D., Lavie, C. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000461 · Cited by 2,486 · see citing works
Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women
Blair, S. N. (1996) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1996.03540030039029 · Cited by 1,819 · see citing works
Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men
Wei, M. (1999) · JAMA · doi:10.1001/jama.282.16.1547 · Cited by 1,168 · see citing works
Association between muscular strength and mortality in men: prospective cohort study
Ruiz, J. R., Sui, X., Lobelo, F., Morrow, J. R., Jackson, A. W., Sjostrom, M., & Blair, S. N. (2008) · BMJ · doi:10.1136/bmj.a439 · Cited by 815 · see citing works
Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease Risk Factors
Carnethon, M. R. (2003) · JAMA · doi:10.1001/jama.290.23.3092 · Cited by 691 · see citing works
Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults
Sui, X., LaMonte, M. J., Laditka, J. N., Hardin, J. W., Chase, N., Hooker, S. P., & Blair, S. N. (2007) · JAMA · doi:10.1001/jama.298.21.2507 · Cited by 640 · see citing works
The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men
Wei, M., Gibbons, L. W., Mitchell, T. L., Kampert, J. B., Lee, C. D., & Blair, S. N. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-2-199901190-00002 · Cited by 472 · see citing works
Exercise capacity and body composition as predictors of mortality among men with diabetes
Church, T. S., Cheng, Y. J., Earnest, C. P., Barlow, C. E., Gibbons, L. W., Priest, E. L., & Blair, S. N. (2004) · Diabetes Care · doi:10.2337/diacare.27.1.83 · Cited by 469 · see citing works
Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes
Church, T. S., LaMonte, M. J., Barlow, C. E., & Blair, S. N. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.18.2114 · Cited by 445 · see citing works
Cardiorespiratory Fitness Attenuates the Effects of the Metabolic Syndrome on All-Cause and Cardiovascular Disease Mortality in Men
Katzmarzyk, P. T., Church, T. S., & Blair, S. N. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1092 · Cited by 408 · see citing works
Metabolic Syndrome, Obesity, and Mortality
Katzmarzyk, P. T., Church, T. S., Janssen, I., Ross, R., & Blair, S. N. (2005) · Diabetes Care · doi:10.2337/diacare.28.2.391 · Cited by 378 · see citing works
Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness
Jackson, A. S., Sui, X., Hébert, J. R., Church, T. S., & Blair, S. N. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.312 · Cited by 329 · see citing works
Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men.
Morris, C. K., Myers, J., Froelicher, V. F., Kawaguchi, T., Ueshima, K., & Hideg, A. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90832-l · Cited by 280 · see citing works
Association of Cardiorespiratory Fitness, Body Mass Index, and Waist Circumference to Nonalcoholic Fatty Liver Disease
Church, T. S., Kuk, J. L., Ross, R., Priest, E. L., Biltoff, E., & Blair, S. N. (2006) · Gastroenterology · doi:10.1053/j.gastro.2006.03.019 · Cited by 268 · see citing works
Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)
Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273 · see citing works
Heart rate recovery following maximal exercise testing as a predictor of cardiovascular disease and all-cause mortality in men with diabetes
Cheng, Y. J., Lauer, M. S., Earnest, C. P., Church, T. S., Kampert, J. B., Gibbons, L. W., & Blair, S. N. (2003) · Diabetes Care · doi:10.2337/diacare.26.7.2052 · Cited by 189 · see citing works
Maximal Estimated Cardiorespiratory Fitness, Cardiometabolic Risk Factors, and Metabolic Syndrome in the Aerobics Center Longitudinal Study
Earnest, C. P., Artero, E. G., Sui, X., Lee, D.-C., Church, T. S., & Blair, S. N. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.11.006 · Cited by 170 · see citing works
Associations of Cardiorespiratory Fitness and Obesity With Risks of Impaired Fasting Glucose and Type 2 Diabetes in Men
Lee, D.-C., Sui, X., Church, T. S., Lee, I.-M., & Blair, S. N. (2009) · Diabetes Care · doi:10.2337/dc08-1377 · Cited by 169 · see citing works
Validity of the revised Ekblom Bak cycle ergometer test in adults
Björkman, F., Ekblom-Bak, E., Ekblom, Ö., & Ekblom, B. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-016-3412-0 · Cited by 148 · see citing works
Physical fitness and risk for heart failure and coronary artery disease
Berry, J. D., Pandey, A., Gao, A., Leonard, D., Farzaneh-Far, R., Ayers, C., DeFina, L., & Willis, B. (2013) · Circulation: Heart Failure · doi:10.1161/circheartfailure.112.000054 · Cited by 149 · see citing works
The Association of Cardiorespiratory Fitness and Physical Activity With Incidence of Hypertension in Men
Chase, N. L., Sui, X., Lee, D.-C., & Blair, S. N. (2009) · American Journal of Hypertension · doi:10.1038/ajh.2009.6 · Cited by 143 · see citing works
Longitudinal Algorithms to Estimate Cardiorespiratory Fitness
Artero, E. G., Jackson, A. S., Sui, X., Lee, D.-C., O’Connor, D. P., Lavie, C. J., Church, T. S., & Blair, S. N. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.008 · Cited by 128 · see citing works
Maximal Aerobic Capacity Testing of Older Adults: A Critical Review
Huggett, D. L., Connelly, D. M., & Overend, T. J. (2005) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/60.1.57 · Cited by 117 · see citing works
Criterion-related validity of the short International Physical Activity Questionnaire against exercise capacity in young adults
Papathanasiou, G., Georgoudis, G., Georgakopoulos, D., Katsouras, C., Kalfakakou, V., & Evangelou, A. (2010) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e328333ede6 · Cited by 111 · see citing works
Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes: Findings From the Look AHEAD Trial
Patel, K. V., Bahnson, J. L., Gaussoin, S. A., Johnson, K. C., Pi-Sunyer, X., White, U., Olson, K. L., Bertoni, A. G., Kitzman, D. W., Berry, J. D., et al. (2020) · Circulation · doi:10.1161/circulationaha.120.050941 · Cited by 69 · see citing works
Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated?
Currie, K. D., Floras, J. S., La Gerche, A., & Goodman, J. M. (2018) · Sports Medicine · doi:10.1007/s40279-018-0900-x · Cited by 68 · see citing works
Association of midlife cardiorespiratory fitness with incident depression and cardiovascular death after depression in later life
Willis, B. L., Leonard, D., Barlow, C. E., Martin, S. B., DeFina, L. F., & Trivedi, M. H. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1467 · Cited by 62 · see citing works
Aerobic capacity and growth hormone deficiency after traumatic brain injury
Mossberg, K. A., Masel, B. E., Gilkison, C. R., & Urban, R. J. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0368 · Cited by 43 · see citing works
Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis
WHITAKER, K. M., INGRAM, K. H., APPIAH, D., NICHOLSON, W. K., BENNETT, W. L., LEWIS, C. E., REIS, J. P., SCHREINER, P. J., & GUNDERSON, E. P. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001600 · Cited by 24 · see citing works

ONE METHOD ON LODA OF PHYSICAL EXERCISE AT THE DEFINED HEART RATE
Nakano, S., Yoshioka, T., Narusawa, M., et al. (1977) · 体力科學 · doi:10.7600/jspfsm1949.26.96
The Normal Heart Rate Response to Treadmill Exercise
Fitzgerald, B., Weldon, A., & Scalia, G. M. (2016) · Heart Lung and Circulation · doi:10.1016/j.hlc.2016.06.655 · Cited by 1 · see citing works
Comparison of Bruce Treadmill Exercise Test Protocols: Is Ramped Bruce Equal or Superior to Standard Bruce in Producing Clinically Valid Studies for Patients Presenting for Evaluation of Cardiac Ischemia or Arrhythmia with Body Mass Index Equal to or Greater Than 30?
Bires, A. M., Lawson, D., Wasser, T., & Raber-Baer, D. (2013) · Journal of Nuclear Medicine Technology · doi:10.2967/jnmt.113.124727 · Cited by 26 · see citing works
A modified treadmill exercise protocol for computer-assisted analysis of the ST segment/heart rate slope: Methods and reproducibility
Okin, P. M., Ameisen, O., & Kligfield, P. (1986) · Journal of Electrocardiology · doi:10.1016/s0022-0736(86)81058-5 · Cited by 131 · see citing works
Treadmill Exercise Test Performance Index
Miller, A. J., & Grais, I. M. (1986) · CHEST Journal · doi:10.1378/chest.89.4.617a · Cited by 2 · see citing works

Authors: Pollock, M. L., Bohannon, R. L., Cooper, K. H., Ayres, J. J., Ward, A., White, S. R., & Linnerud, A. C.
Corresponding author: Pollock, Michael L.
Venue: American Heart Journal
Publisher: Elsevier BV
Published: 1976-07
Volume: 92
Issue: 1
Pages: 39-46
ISSN: 0002-8703 (ISSN-L)
DOI: 10.1016/s0002-8703(76)80401-2
OpenAlex: W1990558893
Cited by: 536
References: 26
Citations by year: 2026: 13 · 2025: 13 · 2024: 15 · 2023: 22 · 2022: 8 · 2021: 15 · 2020: 14 · 2019: 13 · 2018: 15 · 2017: 9 · 2016: 21 · 2015: 26 · 2014: 25 · 2013: 22 · 2012: 21
FWCI: 11.24
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Heart Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords: Bruce protocol, VO2max, heart rate response, blood pressure response, respiratory exchange ratio, trained vs untrained subjects, nomogram, exercise screening
MeSH terms: Adult, Blood Pressure, Physical Exertion, Heart Function Tests, Heart Rate, Humans, Male, Middle Aged, Oxygen Consumption

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

A comparative analysis of four protocols for maximal treadmill stress testing

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks