President Carter has not had a stress test since he began jogging last year, his physician, William M. Lukash, said yesterday.
Carter was forced to drop out of a 6.2 mile race near Camp David Saturday.
Cardiologists, exercise physiologists and others involved in sports medicine expressed surprise yesterday that the president had not taken the test, which is used to measure the heart's response to exercise.
The American Heart Association committee on exercise has recommended that a stress test be given anyone over the age of 35 returning to vigorous activity after a prolonged layoff.
President Carter was a member of the cross-country team when he was a student at the Naval Academy. According to Lukash, who is his occasional running partner as well as physician, Carter "had run as a governor. He had a nice road around the governor's mansion. So he started running out there and then got back into it" during the Camp David summit last fall.
"Obviously, when I play tennis with him all the time and I know how he runs and I do all his physicals, I'm well aware of his physical condition," Lukash said during a 45-minute interview at the White House.
"I am astonished that for a person who has access to so many things, and with so many statements on the subject in print, that these precautions (the stress test) apparently were not taken," said Dr. Herman Hellerstein, a vice president of the American Heart Association and professor of cardiology at Case Western Reserve Medical School in Cleveland.
Lukash said, "My general policy is that anyone that is in poor physical condition, anyone that has any potential risk factors, anyone that is 35 or older and hasn't had a physical exam, I recommend that they have a stress test."
An exercise tolerance (stress) test is an electrocardiogram taken with the subject running on a tread mill, which, Hellerstein explained, allows doctors to learn how "people respond to maximal exercise."
A standard, or resting, electrocardiogram was administered to President Carter shortly after he was forced to drop out of last Saturday's race at the four-mile mark. It showed no evidence of heart damage.
Dr. David L. Costill, director of the Human Performance Laboratory at Ball State University, said of EKGs in general, "You can be sitting in a chair and have the worst arteries in the world. If you place no stress, or demand, on the pump, it will look normal. It's like a Formula One race car, trying to evaluate how fast it will go while idling. That's what you're trying to do with a resting EKG."
"On the other side of the coin," Lukash said, "I can recall a recent New England Journal of Medicine article, indicating the confusion stress tests can cause."
According to Dr. Samuel Fox III, director of the cardiology exercise program at Georgetown University Hospital, the article in the New England Journal of Medicine suggested that in people without previous coronary symptoms, the stress test shows a relatively greater percentage of false, or incorrect, positive results.
Lukash said he considered the stress test "valuable" and might use it on another patient the president's age -- 54 -- if he had not been following the case, and if certain factors -- obesity, smoking, low level of physical activity -- were present.
Fox, who is consultant at the State Department exercise training center, suggested another reason the president might not have had the test: that a negative result might become public.
"If I was a doctor to a politician, I'd go on a little retreat, possibly under some nom de plume, and do the exercise test," Fox said.
"In the political world, the risk of a false response getting into the press must be recognized as a deterrent for getting the usual medical evaluations such as an exercise test. Clinical judgment should not be swayed by these considerations, neither for the individual subject, nor for the national interest."
Lukash also discussed the president's training regimen yesterday.
"He runs basically with his wife everyday," said Lukash, who sometimes fills in when Mrs. Carter is not in the mood.
"Some days, he'll give me a call and say, 'Have you run yet?' I usually run everyday at 3 p.m., it breaks up the day. He knows that and he'll call and say, 'Do you want to run this afternoon.'"
Lukash said the president "rarely does under three miles, depending on his schedule" and has gone as far as 12 miles. His longest run since Saturday's race has been three miles.
"He's built up, starting from eight or nine minutes a year ago to where he can do four to six miles at seven or 7 1/2 minutes (per mile), "Lukash said.
The president also is not into the loneliness of the long-distance runner and, even if he was, he would not have much choice. "His (Secret Service) agents are out there," Lukash said. "He never does anything alone."
In addition to keeping up with the president, the agents also time him, Lukash said.
"He has a need to be on his own," said Lukash. "He's surrounded by staff, by Secret Service. Running gives him a sense of freedom and a feeling being his own person. It apparently exhilarates him."
The president's exhilaration, however, is confined to the White House grounds.
"A president is so constrained at everything he does," Lukash said. "They're all aware, they don't want to disrupt anything, so he's obligated to run back here.
"There's a road there that's a quarter of a mile. That's the North Portico. And then on either side, he has the lawn, so he has several paths he can go on and he has them measured and he'll do a few. He doesn't like to go around the circle and draw a crowd."
Like most runners, Lukash said, the president is acutely aware of the miles he logs and the times he turns in.
"He's an engineer," Lukash said, "he knows. If he says he's done five miles, or 12 miles, he's done it."