Weight Carrying Versus Handgrip Exercise Testing in Men with Coronary Artery Disease Nancy A. Wilke, BS, Lois M. Sheldahl, PhD, Scot G. Levandoski, MS, Martin D. Hoffman, MD, and Felix E. Tristani, MD The clinkal merits of handgrip and weight carrying tests were compared in 30 patients with document- ed coronary ariery dlsease. The statk loads in the 2 tests were matched by percentage of maximal statkeffortand~spondedt029and45560f maxbnal vohmtary hand&p contraction and 29 and 4S% of maximal l-hand lift capacity. Each static toad in both tests was contid for 13 min- utes. At the 29% maximal effort stage, 93 and 90% of patients were able to complete 3 minutes of handgrip and weight carrying, respectively. Only 13 and 10% were able to complete 3 minutes at the 45% maximal effort stage with handgrip and weight carrying, mpectively. Am fatigue and an increase in dkstolk blood pressure >120 mm Hg were the predeminant endpoints. Weight carrying resulted in significantly higher (p <0.09) heart rate, w-- pressmq pressure-rate product, ventiia8on and oxygen consumption compared to handgrip. Diastolk blood pressure responses did notdifferbetweenthetests.Noneofthepatients demonstrated ischemii responses to either hand- grip or weight carrying and the incidence of ar- rhythmias was rare. The diastolic blood pressure respome to static effort is equally evaluated by handgrip and weight cafrying tests. However, the greater myocardial oxygen demand, reflected by the m-rate product, in addition to the groat- er total body oxygen consumption, imposed by weight carrying, enhances the clinical application of the! weight carrying test. (Am J Cardiol1989;64:739-740) From the Cardiac Rehabilitation Center, Zablocki Veterans Adminis- tration Medical Center, and the Departments of Physiologyand Medi- cine, The Medical College of Wisconsin, Milwaukee, Wisconsin. Man- uscript received April 17, 1989;revised manuscript received June 20, 1989,and acceptedJane 21. Address for reprints: Loi M. Sheldahl, PhD, Cardiac Rehabilita- tion Center/l 1lR, Veterans Administration Medical Center, Milwau- kee, Wisconsin53295. 736 THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 64 M any activities of daily living require a significant component of static muscular contraction. Static exercise is known to induce a greater pressor response than occurswith dynamic exercise, and previous studies 1*2 have shown that some patients with coronary artery disease experiencean increasein blood pressureabove normally acceptedlevels3 with static or static-dynamic exercise. The different hemodynamic responses to static and dynamic exercise may cause difficulties in advising somepatients on work resumption after a cardiac event based only on dynamic exercise testing results. This is especially true for patients whosework requires a heavy component of static effort. To enhance activity guide- lines for these patients, static exercise testing has been suggested. Handgrip4v5and weight carrying1y6are 2 commonly recommended tests.This study compares the hemodynamic and metabolic responses to similar rela- tive static workloads with handgrip and weight carrying and evaluates the clinical merits of handgrip and weight carrying responses for advising cardiac patients on the resumption of common static and static-dynamic activi- ties of daily living. METHODS Patient population: The study population consisted of 30 men with documentedcoronary artery disease. A history of myocardial infarction was present in 18 sub- jects (7 anterior, 8 inferior, 3 non-Q-wave), 18 had un- dergonecoronary artery bypasssurgery, 8 had percuta- neoustransluminal coronary angioplasty and 1 had ven- tricular aneurysectomy.Patients with clinical evidence of congestiveheart failure, recent (<6 weeks) myocar- dial infarction or coronary artery bypasssurgery, unsta- ble angina pectoris or any physical limitation that re- stricted upper or lower extremity effort were excluded from the study. The mean age of the group was 61 f 6 years (range 40 to 70). Prescribed medications re- mained constant throughout the testing period and in- cluded p blockers for 10 subjects, calcium antagonists for 10, antihypertensives for 7, digoxin for 5, antiar- rhythmic-sfor 4, diuretics for 2 and nitrates for 1. None of the subjectswas currently enrolled in cardiac reha- bilitation. Each subject signed an informed consent ap proved by the Human ResearchReview Committee. Testing proeedwer: All subjectsinitially underwent a physical examination and a symptom-limited leg cycle ergometer graded exercisetest with 1Zlead electrocar- diographic monitoring. On 2 subsequent days, the sub- jects underwent a weight carrying test and handgrip test. At least 24 hours separatedall exercise tests, and