What Is a Good METs Score for a Stress Test by Age?

A “good” METs score on a stress test depends heavily on your age and sex, because expected exercise capacity drops with each passing decade. Researchers have developed prediction formulas that set the benchmark: for men, the best-validated model estimates predicted METs as roughly 18 minus 0.15 times your age; for women, it is about 14.7 minus 0.13 times your age. Reaching or exceeding that predicted value generally signals healthy cardiovascular fitness, while falling well short of it raises a red flag. But the raw number alone does not tell the whole story, and some widely cited thresholds deserve more context than they usually get.

Predicted METs by Age and Sex

The most straightforward way to judge your stress test result is to compare it against what is predicted for someone of your age and sex. Two prediction formulas are commonly used in clinical practice. A large validation study found that for men, the formula with the strongest predictive accuracy came from a Veterans Affairs cohort: predicted METs equals 18 minus 0.15 times age. For women, the best-performing model came from the St. James Take Heart Project: predicted METs equals 14.7 minus 0.13 times age.¹ A separate formula sometimes used for men (14.7 minus 0.11 times age) produces somewhat lower targets, so the numbers you see can vary depending on which equation your cardiologist’s lab uses.²

Using the better-validated formulas, here is roughly what is predicted at various ages:

Age 30: about 13.5 METs for men, about 10.8 for women
Age 40: about 12 METs for men, about 9.5 for women
Age 50: about 10.5 METs for men, about 8.2 for women
Age 60: about 9 METs for men, about 6.9 for women
Age 70: about 7.5 METs for men, about 5.6 for women
Age 80: about 6 METs for men, about 4.3 for women

These are averages, not pass-fail cutoffs. Your cardiologist typically looks at how you performed relative to the predicted value for your demographics. Reaching 100 percent of your predicted METs means you performed exactly as expected; exceeding it is even better. Falling below about 85 percent of predicted generally starts raising concern, and the further below you fall, the stronger the association with future cardiac trouble.

What Actual Patients over 75 Achieve

Prediction formulas are useful, but real-world data from older adults undergoing the standard Bruce protocol treadmill test shows how wide the gap between predicted and achieved can be. A study of men and women over 75 found that men averaged about 7.7 METs while women averaged about 6.5 METs.³ Performance dropped as age increased beyond 75, and few participants made it past the second stage of the Bruce protocol. Most women (about 85 percent) and nearly all men (about 95 percent) completed the first stage, but only about a third of women and two-thirds of men completed the second stage. Getting into the third stage was uncommon for either sex at that age.

If you are in your late 70s or 80s and your doctor orders a treadmill stress test, reaching 6 to 8 METs is roughly in line with what most patients in that age range accomplish. That may sound modest compared to what a 40-year-old can do, but the clinical value comes from comparing your result to your peer group, not to a younger population.

Why the 10-MET Threshold Keeps Coming Up

You will often hear that reaching 10 METs on a stress test is the gold standard. There is real evidence behind this. A study that followed patients who hit 10 or more METs during exercise stress found that those patients had an excellent prognosis over several years of follow-up, regardless of the peak heart rate they reached. The researchers even questioned whether additional imaging added much diagnostic value for this group, because the outcomes were so favorable.⁴

That makes 10 METs a reassuring number to hear from your doctor. But here is the part that gets lost: by the formulas above, the average predicted capacity for a 60-year-old man is only 9 METs, and for a 60-year-old woman it is under 7. Holding everyone to a 10-MET standard regardless of age is not what the evidence actually supports. A 70-year-old woman who reaches 6 METs is performing right at her predicted level and should not feel she “failed” because she did not hit 10. The 10-MET threshold is more useful as a reassurance tool for younger and middle-aged patients than as a universal goal.

Every MET Matters for Survival

One of the clearest findings in exercise cardiology is that your MET score is a powerful predictor of how long you are likely to live, and this relationship holds across age groups. A landmark study of over 6,000 men referred for exercise testing found that each 1-MET increase in exercise capacity was linked to a roughly 12 percent improvement in survival.⁵ That is a surprisingly large effect for a single unit of measurement, and it means that even a modest improvement in fitness, say from 7 METs to 8, has meaningful implications for your long-term health.

Separate research looking at over 3,000 patients referred for clinical exercise testing confirmed that exercise capacity was the single strongest predictor of death among all the variables measured during the test, outperforming blood pressure response, heart rate patterns, and electrocardiogram changes.⁶ The message is consistent: how many METs you can reach matters more than almost anything else the stress test measures.

For people with existing heart failure, the picture shifts slightly. A study from the Henry Ford Exercise Testing Project found that in patients with heart failure, each additional MET achieved was associated with about an 11 percent lower risk of dying (a hazard ratio of 0.89 per MET). Body mass index, by contrast, was not independently associated with mortality once exercise capacity was accounted for.⁷ That finding reinforces the idea that your fitness level matters more than your weight when it comes to predicting outcomes.

The Protocol Changes the Number

One detail that most patients never think about: the specific treadmill protocol your lab uses can change your MET score. The Bruce protocol, the most common in the United States, ramps up speed and incline aggressively every three minutes. Modified Bruce, Naughton, and Cornell protocols use gentler progressions. A large registry study of over 120,000 patients found that while higher METs were associated with lower mortality across all protocols, the same MET value did not carry the same prognosis from one protocol to another. Patients who achieved a given number of METs on a less-demanding protocol actually had worse outcomes than patients who hit the same number on a more demanding one.⁸

The takeaway is that MET scores are not perfectly interchangeable between protocols. If your stress test used a modified Bruce or Naughton protocol, you should not directly compare your number to a benchmark derived from the standard Bruce. Ask your doctor which protocol was used if the report does not make it clear.

Treadmill Versus Stationary Bike

A similar issue arises with the type of equipment. Most stress test benchmarks come from treadmill testing, but some labs, especially in Europe, use cycle ergometers instead. Treadmill testing generally produces higher MET values because it engages more muscle mass and allows for a higher peak oxygen consumption. Studies in both athletes and clinical populations consistently show significantly higher oxygen uptake on a treadmill compared with a bike.⁹ Research comparing the two modalities in young healthy adults also found that peak oxygen uptake was lower during cycling, which means MET estimates derived from cycle tests tend to be lower as well.¹⁰

If your stress test was performed on a bike rather than a treadmill, your MET score may be a point or two lower than it would have been on a treadmill, simply because of equipment differences. This is worth keeping in mind before you compare your number against published treadmill-based norms.

Handrail Holding Inflates Your Score

Here is a common scenario: the treadmill picks up speed and incline, you start feeling unsteady, and you grab the handrails. It feels like a small thing, but it can meaningfully distort your results. Research has shown that holding onto the handrails during treadmill testing blunts the heart rate and oxygen consumption responses at a given speed and grade, which leads to longer exercise time and an artificially inflated estimate of aerobic capacity.¹¹

An older but widely cited study quantified the gap: holding the handrails increased the estimated peak oxygen uptake from about 32.7 to 37.9 mL/kg/min, while the actual measured oxygen consumption barely changed.¹² In MET terms, that gap is roughly 1 to 1.5 METs, which is clinically significant given the survival data described above. If you held onto the rails during your test, your reported MET score may overestimate your true fitness. Most exercise physiologists will note this in the report, but it is worth asking if it was documented.

Beta-Blockers and Other Medications

If you take a beta-blocker for blood pressure, heart rhythm, or anxiety, it will almost certainly affect your stress test performance. Beta-blockers slow the heart rate, which limits how high your cardiovascular system can ramp up during exercise. Data from the Henry Ford Exercise Testing Project found that patients on beta-blocker therapy achieved about 8 percent lower peak heart rates compared to those not taking the medication.¹³ A capped heart rate typically means you will fatigue sooner and stop at a lower MET level than you otherwise would.

Your cardiologist already knows this and will factor it in when reading the results. Some doctors will ask you to hold your beta-blocker the day before the test, but this depends on the reason for the medication and cannot be done safely in all patients. If you were on a beta-blocker during your stress test and your MET score seems lower than expected, the medication is a likely contributor. Other drugs that can affect exercise performance include certain calcium channel blockers, antiarrhythmics, and even some antidepressants, though their effects on stress test results are generally smaller.

Heart Rate Recovery and the Chronotropic Response

While METs get the most attention, two other variables from the stress test carry independent prognostic weight. The first is heart rate recovery: how quickly your heart rate drops in the first minute after you stop exercising. A slow drop (generally less than 12 beats per minute in the first minute) has been repeatedly linked to higher mortality risk, independent of how many METs you reached.

The second is the chronotropic response, which is just a clinical term for whether your heart rate climbed appropriately during exercise. Patients who fail to reach their target heart rate during a stress test tend to have lower exercise capacity and worse outcomes. A large study found that the chronotropic index (a measure of how well the heart rate increased relative to what was predicted) was dramatically lower in patients who could not reach their target heart rate, at 0.55 versus 0.97.¹⁴ A poor chronotropic response is not the same as a low MET score, though the two often travel together. It tells the doctor something specific about the heart’s electrical and autonomic function that METs alone do not capture.

Exercise Capacity Versus Peak Oxygen Intake in Cardiac Rehab Patients

For people entering cardiac rehabilitation after a heart attack, bypass surgery, or heart failure diagnosis, the clinical context shifts. Stress tests in cardiac rehab are often used to set safe exercise intensity rather than to diagnose new disease. A study tracking over 12,000 men in cardiac rehabilitation found that measured peak oxygen intake was a powerful predictor of both cardiac and all-cause death. Men with peak oxygen consumption above 22 mL/kg/min (roughly 6.3 METs) had about 60 percent lower cardiac mortality and 55 percent lower all-cause mortality compared to those below 15 mL/kg/min (roughly 4.3 METs).¹⁵

Those thresholds are considerably lower than what you would expect from a healthy person of the same age, which makes sense: these are patients recovering from major cardiac events. If you are in cardiac rehab, the goal posts are different from a routine screening stress test. Reaching even a modest number of METs has real significance for long-term survival in this setting, and improvements over time track closely with reduced risk.

Body Weight, the Obesity Paradox, and MET Interpretation

METs are calculated per kilogram of body weight, which means the formula already accounts for body size to some degree. But the relationship between weight and stress test outcomes is not straightforward. Among heart failure patients in the Henry Ford project, higher BMI was associated with better survival only in those with exercise capacity below 4 METs. Once exercise capacity reached 4 METs or above, the apparent protective effect of higher weight disappeared entirely.⁷

This is a version of what researchers call the obesity paradox: in some heart disease populations, heavier patients seem to do better, which runs against the general public health message about weight. But the data suggest that this paradox dissolves once you account for fitness. If you can exercise to a reasonable capacity, your weight matters much less for predicting survival. The practical implication is that improving your exercise capacity, even without losing weight, is one of the most impactful things you can do for your prognosis.

How to Improve Your MET Capacity

Since each additional MET carries measurable survival benefit, raising your exercise capacity is one of the clearest return-on-investment health moves available. The good news is that exercise capacity is highly trainable at any age. Even modest increases in regular aerobic activity, from sedentary to walking 20 to 30 minutes most days, can shift your MET level meaningfully within weeks to months.

For someone starting from a low fitness base (say, 5 to 6 METs), a structured walking program that progressively increases pace and duration is usually the first step. Interval training, where you alternate between harder and easier effort, tends to produce faster gains in peak exercise capacity than steady-state walking alone, though either approach works. Resistance training does not directly raise your MET score on a treadmill test in the same way cardio does, but it helps with the muscular endurance and balance that let you keep moving at higher treadmill inclines without grabbing the rails.

If you have known heart disease, cardiac rehab programs are specifically designed to raise exercise capacity in a monitored setting. These programs typically produce improvements of 1 to 2 METs over 12 weeks, which, given the survival data, translates to a meaningful reduction in risk. The key variable, as with all exercise, is consistency. Gains in MET capacity fade within a few months of stopping regular activity, so the goal is building a sustainable routine rather than cramming before your next stress test.

1
PubMed. External prognostic validations and comparisons of age- and gender-adjusted exercise capacity predictions
2
JAMA Internal Medicine. Association of Exercise Capacity on Treadmill With Future Cardiac Events in Patients Referred for Exercise Testing
3
PubMed Central. Average Exercise Capacity in Men and Women >75 Years of Age Undergoing a Bruce Protocol Exercise Stress Test
4
PubMed Central. Prognosis in patients achieving ≥10 METS on exercise stress testing: Was SPECT imaging useful?
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PubMed. Exercise capacity and mortality among men referred for exercise testing
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PubMed. Exercise capacity and mortality – a follow-up study of 3033 subjects referred to clinical exercise testing
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8
PubMed Central. Prognostic Value of Functional Capacity in Different Exercise Protocols
9
PubMed Central. Differences between Treadmill and Cycle Ergometer Cardiopulmonary Exercise Testing Results in Triathletes and Their Association with Body Composition and Body Mass Index
10
PubMed. Comparing the systolic blood pressure per metabolic equivalent response during treadmill and cycle ergometer exercise testing: implications for translating risk cut-offs
11
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12
The American Journal of Cardiology. Method Factors influencing estimated oxygen uptake during exercise testing soon after myocardial infarction
13
PubMed Central. Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival
14
JAMA. Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
15
PubMed. Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation