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To the Editor.

Richard A. Stein, MD
Arch Intern Med. 1985;145(11):2132. doi:10.1001/archinte.1985.00360110208053.
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—Drs Margulis and Katz raise a valid concern to studies that extrapolate cardiac response to exercises from those observed during a graded treadmill exercise electrocardiographic examination. Exercises that are different in posture (upright vs supine), extremities (leg vs arm) and type of work (high resistance vs low resistance) from treadmill exercise may produce markedly different heart rate and blood pressure responses at the same work or oxygen consumption levels. They also call attention to the differing heart rates and heart rate—blood pressure products during exercise in groups that differ in cardiovascular fitness, age, and the presence or absence of coronary heart disease.

The article by Bohlen et al1 presented data on heart rate, blood pressure, and oxygen consumption obtained from healthy young men during coitus in two positions (man on top, and woman on top) and during erotic stimulation with and without spouse assistance. The absolute heart rates and


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