What Do You Use Your Primary Care Physician For?

@TucsonBones Thanks for the explanation. I had no clue.

I have been walking hills only because I do not want to be as winded again as I was 11 years ago. The difference then at that moment I was very sick with my leg edema and I weighed a lot more.

To me, this is just one more reason to stretch and exercise. It will be nice to get somewhere over 10 minutes and pass this thing more comfortably than the first time. He put me up to ten minutes and saw nothing wrong the first time. The last hill I was on yesterday for 12 minutes was far easier.


There are so many reasons to continue physical conditioning, i.e., “keeping in shape”. Maintaining a healthy weight, controlling your blood sugar (I think you said your recent A1C was 7.0). Even if you have a blockage that needs to have a stent, your long term outcome will be significantly be better with the advantage of a healthy metabolism.
Nothing that I related above regarding the findings of a “stress test” should be read to mean that good physical conditioning and maintaining a healthy weight should not be the goal of all. In addition, I’d add optimal sleep, and stress reduction.
It sounds like you are taking advantage of modern preventative medicine, good luck and take care.


No, that reading would have been as many as five years ago. I have lost 40 pounds total since then.

We have no family history of heart disease. My weight currently is 210 which is 40 pounds overweight for me. I run circles around younger people I work with. Even the hardest workers I know move slower than I do. I stand as I am right now while online. That can be up to 12 hours working online per day. I move around my condo endlessly from the desk.

If I have a blockage I will get a stent. Deal with that if it is to happen.

I am expecting no problems.

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There are so many reasons to continue physical conditioning, i.e., “keeping in shape”.


In my instance…enough of a genetic predisposition that Righteous Lifestyle Choices didn’t prevent ASCVD…it’s probably what held the stent/CABG at bay. In trying to put the puzzle pieces together, I’m surmising that, along with that genetic gift of polygenic FH came a hefty dose of ability to build up a strong collateral circulation under the right circumstances. Thankfully, I unwittingly appear to have provided the “right circumstances”. YAY! for vanity.

In addition to a consistently athletic lifestyle since my early teens, over the past 2 decades+, I’ve had a gig as a group exercise instructor/personal trainer (Emeritus mode right now but still putting in the effort) Adding up the time spent in order to stay in shape for this venture, through my 50s and most of my 60s, I’ve invested well over 10 hrs a week on structured endurance and strength training. Consistently … which is the all important word.

Now I will say that, in this era of Bad Habits becoming increasingly the norm, the phenotype that this has presented alongside my “mildly elevated” LDL-C, appears to have bamboozled all and sundry into thinking it was an unimportant finding …except to my intervention cardiologist.

Oddly enough, I haven’t found a tremendous amount in the literature documenting the role of specific exercise prescriptions on building up collateral circulations…I guess it’s hard to study something so few are willing/able to do…so I am my own lab rat to a certain extent, with the approval of said cardiologist.

Here’s my anecdote on stress testing.

As documented elsewhere, shortly after our move to high altitude living, I had my first episode of Paroxysmal Afib. As a follow-up to that, along with various tests designed to find out “why” was a nuclear stress test. I was well familiar with the protocol as I’d actually done two VO2MAX tests but in spite of this I almost “failed” this as my cardiovascular conditioning was so high (my last VO2MAX just before my 60th b-day was 45 ml/kg/min and change) it was getting real hard to reach that arbitrary heart rate apparently/allegedly necessary to show the heart at work.

When we’d just about maxed out the speed/incline/time combo that the dude in charge was comfortable with he mentioned that we might have to go the pharmacology route. I think the idea that I’d have to sit and suffer the indignity of having drugs they used on sick old people to do the business alarmed me so much that burst of adrenaline gave me just the few more beats necessary to reach that predetermined goal.

Full confession…all this seemed like overkill at the time but at least I can be reassured that my Afib wasn’t a manifestation of a “silent” heart attack and a missed clue.

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I found out why the test last time was so uncomfortable. I read up on stress tests. The methodology is not that complex. The idea is to get to 85% of the heart rate for the age group.

I was 49 so under the 50 group. The test was supposed to get me up to 85% or a heart rate of 153 out of a max heart rate of 180.

I had edema in a bad way. The doctor put me up to 180. I could read the heart rate clearly as day. I was about 9 months before my birthday when they dropped to the target for the next decade.

The current max heart rate is 160. A much easier target than 180. The target of 85% is 136.

To think I incidentally put off the test for one year. I was 59. I need to watch these cardiologists carefully. :rofl: :stuck_out_tongue:

I just walked 2.1 miles at 3.35 miles per hour. Almost half up a steep hill for about 15 minutes. I was not winded. It will possibly take more to reach the 160. It won’t be hard.

Well, you’re highlighting another potential problem with using an arbitrary age-predicted, formula derived max heart rate. It might not be accurate for you.

There are umpteen different formulae out there that’ve come along since this Haskell-Fox 220-age came into being…all boasting superiority over that original, but none guaranteed to be totally accurate for any one individual.

One of many articles discussing the topic


My particular issue wasn’t the “wrong” max heart rate but rather, my training…i.e. I had a fair bit more than the average person undergoing a nuclear stress test.

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Heart rate is arguably a very easy cardiovascular measurement, especially in comparison to the invasive or noninvasive procedures used to estimate stroke volume and cardiac output. Consequently, measurement of heart rate is routinely used to assess the response of the heart to exercise, or the recovery from exercise, as well as to prescribe exercise intensities . Given that the increase in heart rate during incremental exercise mirrors the increase in cardiac output, maximal heart rate is often interpreted as the upper ceiling for an increase in central cardiovascular function. Indeed, research for the last 100 years has demonstrated that heart rate does in fact have a maximal value; one that cannot be surpassed despite continued increases in exercise intensity or training adaptations.
[From the link provided]

The real question is: can age-predicted max heart rate provide an induction test that will provide high predictability in myocardial perfusion studies?

Not sure in my case that is the appropriate question. The cardiologist thinks I have no problems.

The bigger problem for doctors is when the doctor thinks there is a problem when there is not a problem.

Do you mean is it adequate for the purpose, given its relative lack of accuracy for the individual… are you wondering if there’s a better option?

The 220-age formula seems to be the default which may be simply historical and perceived to be the “safest” as well as adequate, since it was originally devised for use in cardiac rehab and studied on this demographic. Mind you, since the imaging technology used for perfusion studies has come along since its origin, maybe that’s faulty reasoning. Like I always say…there’s a reason heart disease is still the world’s #1killer.

Your snippet (“from provided link”?) refers to measured maximum heart rate. I find myself wondering where it came from given the opening sentence. I doubt the author is writing from the experience of a VO2MAX test to perform this measurement since there’s rarely any argument about it being easy.

No, it was originally described by Dr. Bruce for use in the Bruce protocol treadmill test.

Are you implying that because (in your opinion) the age associated predicted HR is faulty, that is the reason that Heart Disease is still the number one cause leading to death?

What test in your opinion would be more effective in risk stratification for underlying CAD? Before stress testing became the mainstay in clinical cardiology, patients would just present with angina or a heart attack (myocardial infarction). Some patient never even experience angina, especially diabetics.

That would be beats per minute.

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Nope. The disparity between age predicted, formula-derived Max HR being a reality on an individual basis rather than my opinion (I imagine anyone curious enough will already have googled the accuracy of APMHR formulae vs. individual measurement), I was speculating on whether being spot on with %MaxHR was mandatory for precision in perfusion studies.

If not, measured on an individual basis vs. formula derived would be irrelevant. Close enough would be good enough, right?

Conversly, if it is important to have, say, that extra 5 beats or more that might be missing if measured MaxHR (one’s personal max) is higher than the age predicted formula (which is an average) there “on the clock” for the workload to be challenging enough to show up any underperfused tissue, then folk might just be getting results that show they’ve “passed” their test and perceive they’re in good cardiovascular shape because their working heart rate (bpm or %max) was, in reality, a bit too low during the test…but, in fact, they’re potentially at serious risk.

I rather suspect that absolute accuracy isn’t as important as it might appear. At the time of my nuclear stress test, I was 64. My most recent VO2MAX test was when I was just coming up to 60. My measured MaxHR was 180 bpm then…and, as your link suggested, didn’t increase with the further work necessary to reach VO2MAX. It’d be a bit of a stretch to imagine that my real, very own, all mine MaxHR had dropped sufficiently in the intervening years to make it anywhere close to the formula derived average. In fact, when they were suggesting using the sick old folks’ method, I asked if it wasn’t a decent enough diagnostic that I could work as hard as I was in actual workload (speed and incline) and still natter away in complete sentences that I was too fit for their test? I was barely out of Zone 2…per bpm and perceived exertion.

The statistical structure is not you, VeeEnn. The statistical structure remains.

The accuracy is not the point. The test outcome is the point.

In my own case I am expecting the test to show no problems. I was just so uncomfortable last time I dread doing this. Climbing hills has relieved the worries of being ultra uncomfortable.

Indeed…and it’s a crying shame that I didn’t mention that absolute accuracy probably isn’t that important in order for the test to “work”. That is, to demo areas of ischaemia…either from changes on ekg or images derived from a PET scan and radioactive tracer (such as I had) and any other relevant info.

It’s my opinion that this is the case based upon a couple of decades of heart rate monitor usage for my own heart rate monitored training purposes plus teaching others how to do it right. Shame the Running Fools board is no l Ionger up and running as, over the years, this topic came up quite frequently.

My reason for mentioning measured, personal heart rate vs. average formula derived number was a response to your comment on how miserable a test it was on your last go-around. See, 85% of a person’s actual MaxHR is hard…not the sort of intensity one would want to hold for an hour or so…but not so uncomfortable over the short term. Like, say, for the limited amount of time you are spending there towards the very end of a stress test. One possibility for this might be that your actual MaxHR heart rate really is lower than average …or your level of conditioning is so bad that even a stress test was beyond your level of fitness.

The reason why conditions like COPD etc require the pharma route is mainly because the heart rate response to a given workload is exaggerated as compared to the work being done so the myocardium doesn’t actually get an adequate challenge in order to be sure of the degree of perfusion.

Did it occur to you that it might have something to do with COPD V̇/Q̇ Mismatch?

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Well, tomorrow is the big day. I am at peace with it. I will stretch well tomorrow morning. Get a few things done during the first half of the day and report to the doctor’s office early afternoon. I will have a salad for lunch.


happy landings!

d fb

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Let me Google the answer to that and find a link to quote from :innocent:

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Good luck…no need to say any more but for the TMF 20 characters tomfoolery.

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Good luck @Leap1. I also have to do a stress test sometime soon. But I am delaying it because I couldn’t properly exercise for 9 months while my shoulder healed.

Is it a fasting type test, or can you eat breakfast?

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