Abstract Both treadmill exercise and arm exercise are used for evaluating coronary artery disease, but arm exercise has lower diagnostic sensitivity. We compared the two exercise modalities with respect to the rate‐pressure product at 85% predicted maximal heart rate, a parameter frequently used to denote performance of sufficient exercise to derive clinical conclusions. At this heart rate, treadmill exercise resulted in a significantly greater systemic oxygen consumption (2.7±.8 vs. 2.1±.6 l/min) and rate‐pressure product (30.6±4.4x10 3 vs. 28±3.3x10 3 ) than arm ergometry. An inability to generate sufficient imbalance of myocardial oxygen supply and demand may account for the relatively higher incidence of false negative exercise tests seen with arm ergometry, especially if the exercise test is stopped when the patient attains 85% predicted maximal heart rate.
Exercise prescription is frequently based on the premise that an equivalent oxygen consumption achieved on different exercise modalities will result in a similar cardiovascular response. To test this, a comparison was made of the rate pressure product occurring at an equivalent systemic oxygen consumption (VO2) while exercising on different modalities. Subjects (n = 20) performed maximal exercise tests at random over a 2-week period on nonconsecutive days on a treadmill, bicycle, rowing, and arm ergometers with an intermittent/incremental protocol and continuous ventilatory measurements. The heart rate and systolic blood pressure at equivalent VO2 on each exercise modality for each subject was determined from highly significant regression formulas based on the measures made during the tests. Rate pressure product was significantly higher (P < .01) during arm ergometry compared with other modalities at all intensities. Bicycle exercise resulted in a higher rate pressure product than treadmill exercise at high VO2 (P < .01), but did not differ significantly at lower intensities. Rowing elicited a lower rate pressure product at low VO2 (P < .01), but did not differ significantly from treadmill exercise at higher intensities. The results were gender independent. Different exercise modalities may result in a significantly different rate pressure product at an equivalent VO2. This should be considered when formulating an exercise prescription.
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