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Bruce protocol TMT normal values MET 19 ST depression aVR interpretation 20 year old male
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TMT (Treadmill Test) Report - Explained
Patient: AV Abhishek Katal | Age: 20 years | Male | Height: 174 cm | Weight: 70 kg
Date: 16-Jul-26 | Hospital: Military Hospital Jaipur | Protocol: Bruce
What is a TMT?
A TMT (Treadmill Test), also called an Exercise Stress Test, records your heart's ECG while you walk/run on a treadmill at progressively increasing speed and incline. It checks how your heart responds under physical stress - mainly to detect coronary artery disease, arrhythmias, or assess fitness.
Key Parameters - Explained One by One
1. Protocol: Bruce
The standard Bruce protocol has 7 stages, each 3 minutes long, with increasing speed and incline. It is the most commonly used stress test protocol worldwide.
2. Total Exercise Time: 21 minutes 0 seconds
- This patient completed all 7 stages of the Bruce protocol (Stage 1 through Stage 6 + Peak Ex at Stage 7).
- Normal healthy young adults usually last 8-12 minutes. 21 minutes is exceptional - this is elite athlete level fitness.
3. Max METs: 19.30
METs (Metabolic Equivalents) measure exercise capacity (1 MET = resting oxygen consumption).
| METs Score | Fitness Category |
|---|---|
| < 5 METs | Very Poor |
| 5-8 METs | Poor |
| 8-11 METs | Fair |
| 11-14 METs | Good |
| > 14 METs | Excellent |
19.30 METs is exceptional - well above excellent. For a 20-year-old male, this indicates outstanding cardiovascular fitness. Competitive athletes typically score in the 17-22 MET range.
4. Heart Rate Response
- Resting HR: 64 bpm (normal: 60-100 bpm) ✅
- Max HR achieved: 172 bpm (86% of predicted max HR)
- Predicted Max HR (Pr.MHR): 200 bpm (calculated as 220 - age = 220 - 20 = 200) ✅
- Target HR (THR): 180 bpm (90% of 200)
- The patient reached 86% of predicted max HR. Typically, a test is considered adequate if you reach ≥85% of predicted max HR. 86% is adequate. ✅
5. Blood Pressure Response
- Resting BP: 124/76 mmHg (normal) ✅
- Max BP: 144/86 mmHg
- A normal BP response during exercise is a gradual rise in systolic BP. A rise from 124 to 144 systolic is a modest, appropriate increase. ✅
- Danger signs (not present here): systolic >250 mmHg, or a drop in systolic BP during exercise.
6. ST Segment Changes (the most important ECG part)
This is where the report needs careful attention:
| Parameter | Value in Report | Significance |
|---|---|---|
| Max ST Level (at Peak Ex) | -4.67 aVR | In lead aVR |
| Recovery(1) | -5.52 aVR | |
| Recovery(2) | -5.52 aVR |
What do these mean?
The ST changes are reported in lead aVR, not in the standard chest leads (V1-V6). This is important:
- ST depression in aVR is actually a normal expected finding during exercise - aVR is a "mirror" lead and ST depression here is the reverse of ST elevation in other leads, not a sign of ischemia.
- Pathological ST depression (indicating ischemia) is looked for in leads V4-V6, II, or I - specifically horizontal or downsloping depression >1 mm (0.1 mV).
- The report shows no ST changes flagged in V4, V5, or V6 during exercise at concerning levels.
- The ST slope values (shown in V2, II, I, V3) are positive and increasing with exercise, which is normal.
The ST changes in aVR here are not indicative of ischemia. ✅
Stage-by-Stage Summary
| Stage | Speed | Grade | Heart Rate | BP | Comment |
|---|---|---|---|---|---|
| Resting (Supine) | 0 | 0 | 64 | 124/76 | Normal resting |
| Stage 1 | 1.7 mph | 10% | 79 | 128/76 | Normal warm-up |
| Stage 2 | 2.5 mph | 12% | 83 | 128/76 | Good |
| Stage 3 | 3.4 mph | 14% | 98 | 140/84 | Normal |
| Stage 4 | 4.2 mph | 16% | 118 | 142/84 | Normal |
| Stage 5 | 5.0 mph | 18% | 142 | 142/84 | High effort |
| Stage 6 | 5.5 mph | 20% | 151 | 142/84 | Very high effort |
| Peak Exercise | 6.0 mph | 22% | 172 | 144/86 | Max effort - excellent |
| Recovery (1-4) | Cooling down | - | Drops to 93 | 144/86 | Normal recovery |
The heart rate and BP both rise appropriately and recovery HR drops from 172 → 131 → 100 → 90 → 93, which is a normal recovery pattern. ✅
Overall Assessment: NORMAL - EXCELLENT FITNESS
Here is a summary of what is normal vs. what to note:
| Parameter | Value | Normal? |
|---|---|---|
| Exercise Duration | 21 minutes | ✅ Exceptional |
| Max METs | 19.30 | ✅ Excellent (well above 14) |
| Max Heart Rate | 172 (86% of max) | ✅ Adequate |
| Resting HR | 64 bpm | ✅ Normal |
| Resting BP | 124/76 | ✅ Normal |
| Max BP | 144/86 | ✅ Normal rise |
| BP drop during exercise | None | ✅ Good |
| Arrhythmias | None mentioned | ✅ |
| Significant ST depression (V leads) | None | ✅ No ischemia |
| Chest pain/angina | Not reported | ✅ |
One note: The report says (Summary Report edited by user) at the bottom. This means some data may have been manually edited, and the "Test Termination Criteria" field is left blank (normally this would say "voluntary fatigue" or similar). This doesn't change the clinical picture but is worth being aware of.
Bottom Line
For a 20-year-old male, this TMT is completely normal and outstanding. A Max MET of 19.30 and completing the full Bruce protocol for 21 minutes puts this person in the top tier of cardiovascular fitness - consistent with a trained military/athletic individual. There are no signs of cardiac ischemia, dangerous arrhythmias, or abnormal blood pressure response. This is a very good report.
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