We thank your correspondents for their critical comments.
In response to Professor Ulmer: as indicated in the title of our article, the article was directed primarily at predominantly sports focused doctors. As regards the importance of exercise testing in occupational/military medicine, the stress-strain concept, the use of professional simulators, and activity analyses, we refer our readers to the standard literature (1–3). The main focus of our article was on cardiorespiratory fitness and endurance (without any direct reference to the wide range of different professional/vocational fields). This has been not been assessed to a satisfactory degree in exercise testing in the outpatient or inpatient setting. In recent years, numerous studies have shown that physical fitness is of great prognostic importance with regard to disease and life expectancy.
Professor Kindermann touches on an important subject: the validity of the exercise ECG depends mainly on the prevalence, less on the pretest probability. The positive predictive value is much more reliable when considering the prevalence than the popular terms specificity and sensitivity.
Spiroergometry has a central role in scientific sports and exercise medicine/cardiology, but the method is rarely available in outpatient settings for sports medicine or general practice. Rather than discussing the well known criteria for peak performance once again, our focus is on the assessment of measured values in the submaximal range—as in our article. By doing so, pathological changes and training/therapy effects can be seen even in conditions of a far lower medical risk.
Training recommendations based on lactate thresholds have not been taken up in sports medicine practice. To cite Professor Ulmer (“Real professional or athletic performance can therefore not be measured by one single test ...).
At peak performance, the blood pressure values of healthy top athletes can easily rise above 210 mm Hg and even reach 300 mm Hg (4). Where pathological events are suspected, additional diagnostic evaluation should follow as a matter of course.
Professor Weisser confirms some of our critical wording and claims.
Depending on the research question, therapy/training applied, and individual, several appropriate stress protocols exist. A consensus for ergometric stress tests is highly desirable, which might even facilitate setting up a nationwide fitness and health registry. We comprehensively confirm/support the importance of blood pressure at 100 watts.
Prof. Dr. med. Herbert Löllgen
Johannes Gutenberg-Universität Mainz
Praxis für Kardiologie und Sportkardiologie
Prof. Dr. med. Dr. Sportwiss. Dieter Leyk
Institut für Physiologie und Anatomie, Deutsche Sporthochschule Köln
Institut für Präventivmedizin der Bundeswehr, Koblenz
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
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