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Bruce protocol

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Typically during a Bruce Protocol, heart rate and rating of perceived exertion are taken every minute and blood pressure is taken at the end of each stage (every three minutes). There are Bruce protocol tables available for maximal (competitive athletes) and sub-maximal (non-athletic people) efforts.
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Fletcher, Gerald F.; Ades, Philip A.; Kligfield, Paul; Arena, Ross; Balady, Gary J.; Bittner, Vera A.; Coke, Lola A.; Fleg, Jerome L.; Forman, Daniel E.; Gerber, Thomas C.; Gulati, Martha; Madan, Kushal; Rhodes, Jonathan; Thompson, Paul D.; Williams, Mark A. (20 August 2013). "Exercise Standards for
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were also monitored before, during and after exercise. Because the treadmill speed and inclination could be adjusted, this physical activity was tolerated by most patients. Initial experiments involved a single-stage test, in which subjects walked for 10 minutes on the treadmill at a fixed workload.
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score using the calculator below and the following formulas, where the value "T" is the total time completed (expressed in minutes and fractions of a minute e.g. 9 minutes 15 seconds = 9.25 minutes). As with many exercise test equations, there have been many regression equations developed that may
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heart disease. Later he developed a multistage test, consisting of several stages of progressively greater workloads. It was this multistage test — a description of which was first published in 1963 — that became known as the Bruce Protocol. In the initial paper, Bruce reported that the test could
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According to the original Bruce protocol the patient walks on an uphill treadmill in a graded exercise test with electrodes on the chest to monitor. Every 3 min the speed & incline of the treadmill are increased. There are 7 such stages and only very fit athletes can complete all 7 stages. The
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The Modified Bruce protocol starts at a lower workload than the standard test and is typically used for elderly or sedentary patients. The first two stages of the Modified Bruce Test are performed at a 1.7 mph and 0% grade and 1.7 mph and 5% grade, and the third stage corresponds to the
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Exercise is performed on a treadmill. The leads of the ECG are placed on the chest wall. The treadmill is started at 2.74 km/h (1.7mph) & at an inclined gradient of 10%. After 3 min incline of the treadmill is increased by 2%, and the speed increases. Indications to terminate the test
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using a formula and the performance of the subject on a treadmill as the workload is increased. The test is easy to perform in a medical office setting, does not require extensive training or expensive equipment, and it has been validated as a strong predictor of clinical outcomes.
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Before the development of the Bruce protocol there was no safe, standardized protocol that could be used to monitor cardiac function in exercising patients. Master's two-step test was often used, but it was too strenuous for many patients, and inadequate for the assessment of
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A more accurate formula, offered in a study published in the journal, Medicine & Science in Sports & Exercise, is 206.9 - (0.67 x age) which can also be used to more accurately determine VO2 Max, but may produce significantly different results.
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A diagnostician (e.g., physical therapist, personal trainer, doctor, athletic trainer, nurse, medical professional, dietitian, etc.) may be best served to conduct the test twice using both parameters and formulas.
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Bruce's first reports on treadmill exercise tests, published in 1949, analyzed minute-by-minute changes in respiratory and circulatory function of normal adults and patients with heart or lung disease.
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modified Bruce Protocol is an alteration in the protocol so that the treadmill is initially horizontal rather than uphill, with the 1st few intervals increasing the treadmill slope only.
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Kelly, Jacob P.; Andonian, Brian J.; Patel, Mahesh J.; Huang, Zhen; Shaw, Linda K.; McGarrah, Robert W.; Borges-Neto, Salvador; Velazquez, Eric J.; Kraus, William E. (April 2019).
673:(MHR) is often calculated with the formula 220-age, which is quite inaccurate. The heart rate formula most often used for the Bruce is the Karvonen formula (below). 500:. Bruce and his colleagues also demonstrated that exercise testing was useful in screening apparently healthy people for early signs of coronary artery disease. 1130: 858:"Trends in Cardiorespiratory Fitness: The Evolution of Exercise Treadmill Testing at a Single Academic Medical Center from 1970 to 2012" 1839: 1165: 794:
Bruce, RA (December 1971). "Exercise testing of patients with coronary heart disease. Principles and normal standards for evaluation".
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Karvonen J, Vuorimaa T (May 1988). "Heart rate and exercise intensity during sports activities. Practical application".
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Robert A. Bruce; Frank W. Lovejoy Jr.; Raymond Pearson; Paul N. G. Yu; George B. Brothers; Tulio Velasquez (1949).
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give varying results. If possible, use the one derived from a similar population and which best suits your needs.
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The test score is the time taken on the test, in minutes. This can also be converted to an estimated
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Robert A. Bruce; Raymond Pearson; Frank W. Lovejoy Jr.; Paul N. G. Yu; George B. Brothers (1949).
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Testing and Training: A Scientific Statement From the American Heart Association".
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any impairment in walking or pain, discomfort, numbness, or tiredness in the legs
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Sheffield, L.Thomas; Roitman, David (July 1976). "Stress testing methodology".
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Master, Arthur M. (April 1935). "The two-step test of myocardial function".
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To address these problems, Bruce and his colleagues began to develop a
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VO2max (ml/kg/min) = 14.76 - (1.379 × T) + (0.451 × T²) - (0.012 × T³)
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Treadmill for functional diagnostics for competitive athletes (1980)
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first stage of the Standard Bruce Test protocol as listed above.
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ref: ACSM's Health-Related Physical Fitness Assessment Manual
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Stages of the standard Bruce protocol are as follows:
735:85% intensity: ((180 − 70) × 0.85) + 70 = 163 bpm 732:50% intensity: ((180 − 70) × 0.50) + 70 = 125 bpm 903: 901: 752: 665: 1905: 1068: 820: 652:Young Women: VO2max (ml/kg/min) = 4.38 × T - 3.9 658:Young Men: VO2max (ml/kg/min) = 3.62 x T + 3.91 898: 753:Kennedy JW, Cobb LA, Samson WE (10 May 2005). 1124: 444:function during varying amounts of exercise. 649:Women: VO2max (ml/kg/min) = 2.94 x T + 3.74 16:Test of physical fitness and cardiac health 1166:Cardiology diagnostic tests and procedures 1131: 1117: 746: 701:(THR), using a range of 50–85% intensity: 27: 1262:Transcatheter pulmonary valve replacement 1045: 996: 937: 881: 770: 655:Men: VO2max (ml/kg/min) = 2.94 x T + 7.65 625:Learn how and when to remove this message 558:Learn how and when to remove this message 423:Learn how and when to remove this message 131: 1305:shunt from heart chamber to blood vessel 1405:shunt from blood vessel to blood vessel 1906: 943: 1535:Valve-sparing aortic root replacement 1274:enlargement of existing septal defect 1112: 793: 74:, developed by American cardiologist 1269:production of septal defect in heart 755:"Robert Arthur Bruce, MD: 1916–2004" 607:adding citations to reliable sources 578: 540:adding citations to reliable sources 511: 405:adding citations to reliable sources 376: 823:Progress in Cardiovascular Diseases 488:detect signs of such conditions as 85:The Bruce treadmill test estimates 13: 1366:transposition of the great vessels 1291:creation of septal defect in heart 772:10.1161/01.CIR.0000164274.41137.75 684: 14: 1930: 1666:Cardiac resynchronization therapy 693:factors in resting heart rate (HR 1890: 1889: 1083:10.2165/00007256-198805050-00002 583: 516: 507: 381: 107:, fatigue, shortness of breath, 101:impaired blood flow to the heart 1673:Left atrial appendage occlusion 594:needs additional citations for 527:needs additional citations for 392:needs additional citations for 1062: 1013: 964: 849: 814: 787: 666:Underlying Heart Rate Formulas 1: 1795:Radionuclide ventriculography 958:10.1016/S0002-8703(35)90218-6 739: 720:Example for someone with a HR 99:include signs or symptoms of 1780:Myocardial perfusion imaging 923:10.1161/CIR.0b013e31829b5b44 835:10.1016/0033-0620(76)90007-4 369:Total Duration = 21 minutes 93: 7: 796:Annals of Clinical Research 453:electrocardiograph machines 10: 1935: 1387:for univentricular defect 574: 372: 66:used in the evaluation of 1887: 1866: 1838: 1727:Implantable loop recorder 1695: 1550: 1446: 1371:Arterial switch operation 1186: 1179: 1161:Interventional cardiology 1151: 874:10.1016/j.ahj.2019.01.001 475:In 1950 Bruce joined the 118: 46: 42:evaluate cardiac function 38: 26: 21: 1806:Coronary catheterization 1296:Blalock–Hanlon procedure 1257:Mitral valve replacement 1240:Aortic valve replacement 477:University of Washington 467:volumes and respiratory 1802:Cardiac catheterization 1744:Electrophysiology study 1644:Radiofrequency ablation 1609:Alcohol septal ablation 1848:Impedance cardiography 1470:Coronary artery bypass 946:American Heart Journal 862:American Heart Journal 463:attached to the body. 105:irregular heart rhythm 1914:Diagnostic cardiology 1879:Transcutaneous pacing 1683:Heart transplantation 1604:Ventricular reduction 1420:Blalock–Taussig shunt 639:maximal oxygen uptake 87:maximum oxygen uptake 1853:Ballistocardiography 1410:systemic circulation 713:) × %Intensity) + HR 603:improve this article 536:improve this article 401:improve this article 1919:Exercise physiology 1732:Cardiac stress test 1710:Electrocardiography 1649:Pacemaker insertion 1396:Kawashima procedure 1360:compound procedures 1235:Aortic valve repair 1208:Mitral valve repair 983:(6 Pt 2): 1423–30. 496:, or a ventricular 449:cardiac stress test 51:Cardiac stress test 1785:Cardiovascular MRI 1715:Vectorcardiography 1570:Pericardial window 1565:Pericardiocentesis 1506:Drug-eluting stent 1335:Rastelli procedure 1284:Balloon septostomy 1032:(6 Pt 2): 1431–8. 671:Maximum heart rate 62:is a standardized 1901: 1900: 1758:Angiocardiography 1704:Electrophysiology 1691: 1690: 1634:Catheter ablation 1617:Conduction system 1542:LeCompte maneuver 1530:Bentall procedure 1391:Norwood procedure 1381:Senning procedure 1376:Mustard procedure 1279:Atrial septostomy 1230:Valve replacement 1038:10.1172/JCI102208 989:10.1172/JCI102207 765:(18): 2410–2411. 699:target heart rate 635: 634: 627: 568: 567: 560: 433: 432: 425: 367: 366: 111:, leg cramps, or 56: 55: 1926: 1893: 1892: 1858:Cardiotocography 1826: 1790:Ventriculography 1763:Echocardiography 1754: 1706: 1622:Maze procedure ( 1619: 1585: 1561: 1514: 1513:Obstacle removal 1501:Bare-metal stent 1497: 1457: 1414:pulmonary artery 1406: 1361: 1346:pulmonary artery 1319:Fontan procedure 1314:pulmonary artery 1306: 1270: 1184: 1183: 1133: 1126: 1119: 1110: 1109: 1103: 1102: 1066: 1060: 1059: 1049: 1017: 1011: 1010: 1000: 968: 962: 961: 941: 935: 934: 905: 896: 895: 885: 853: 847: 846: 818: 812: 811: 791: 785: 784: 774: 750: 630: 623: 619: 616: 610: 587: 579: 563: 556: 552: 549: 543: 520: 512: 428: 421: 417: 414: 408: 385: 377: 126: 125: 72:physical fitness 31: 19: 18: 1934: 1933: 1929: 1928: 1927: 1925: 1924: 1923: 1904: 1903: 1902: 1897: 1883: 1862: 1834: 1830:Phonocardiogram 1822: 1752:Cardiac imaging 1750: 1702: 1687: 1615: 1599:Septal myectomy 1589:Cardiomyoplasty 1581: 1575:Pericardiectomy 1557: 1546: 1512: 1493: 1453: 1447:Cardiac vessels 1442: 1436:Glenn procedure 1404: 1359: 1342:right ventricle 1304: 1268: 1190: 1175: 1171:Cardiac imaging 1156:Cardiac surgery 1147: 1137: 1107: 1106: 1071:Sports Medicine 1067: 1063: 1018: 1014: 969: 965: 942: 938: 906: 899: 854: 850: 819: 815: 792: 788: 751: 747: 742: 727: 724:of 180 and a HR 723: 716: 712: 708: 697:) to calculate 696: 691:Karvonen method 687: 685:Karvonen method 668: 631: 620: 614: 611: 600: 588: 577: 564: 553: 547: 544: 533: 521: 510: 490:angina pectoris 429: 418: 412: 409: 398: 386: 375: 121: 96: 76:Robert A. Bruce 64:diagnostic test 34: 17: 12: 11: 5: 1932: 1922: 1921: 1916: 1899: 1898: 1888: 1885: 1884: 1882: 1881: 1876: 1870: 1868: 1864: 1863: 1861: 1860: 1855: 1850: 1844: 1842: 1840:Function tests 1836: 1835: 1833: 1832: 1827: 1819: 1818: 1813: 1808: 1799: 1798: 1797: 1787: 1782: 1777: 1776: 1775: 1770: 1760: 1755: 1747: 1746: 1741: 1740: 1739: 1737:Bruce protocol 1729: 1724: 1722:Holter monitor 1719: 1718: 1717: 1707: 1699: 1697: 1693: 1692: 1689: 1688: 1686: 1685: 1680: 1675: 1669: 1668: 1663: 1657: 1651: 1646: 1641: 1636: 1631: 1620: 1612: 1611: 1606: 1601: 1596: 1591: 1586: 1578: 1577: 1572: 1567: 1562: 1554: 1552: 1548: 1547: 1545: 1544: 1538: 1537: 1532: 1526: 1525: 1520: 1518:Endarterectomy 1515: 1509: 1508: 1503: 1498: 1495:Coronary stent 1490: 1489: 1488: 1487: 1482: 1477: 1463: 1458: 1450: 1448: 1444: 1443: 1441: 1440: 1439: 1438: 1424: 1423: 1422: 1407: 1401: 1400: 1399: 1398: 1393: 1385: 1384: 1383: 1378: 1373: 1362: 1356: 1355: 1354: 1353: 1339: 1338: 1337: 1326:left ventricle 1323: 1322: 1321: 1307: 1301: 1300: 1299: 1298: 1288: 1287: 1286: 1281: 1271: 1265: 1264: 1259: 1254: 1253: 1252: 1247: 1245:Ross procedure 1237: 1232: 1227: 1226: 1225: 1220: 1210: 1205: 1200: 1194: 1192: 1181: 1177: 1176: 1174: 1173: 1168: 1163: 1158: 1152: 1149: 1148: 1143:involving the 1136: 1135: 1128: 1121: 1113: 1105: 1104: 1061: 1012: 963: 952:(4): 495–510. 936: 917:(8): 873–934. 897: 848: 813: 786: 744: 743: 741: 738: 737: 736: 733: 725: 721: 718: 717: 714: 710: 706: 694: 686: 683: 667: 664: 660: 659: 656: 653: 650: 647: 633: 632: 591: 589: 582: 576: 573: 566: 565: 524: 522: 515: 509: 506: 455:and motorized 431: 430: 389: 387: 380: 374: 371: 365: 364: 361: 358: 355: 352: 349: 346: 343: 340: 336: 335: 332: 329: 326: 323: 320: 317: 314: 311: 307: 306: 303: 300: 297: 294: 291: 288: 285: 282: 278: 277: 274: 271: 268: 265: 262: 259: 256: 253: 249: 248: 245: 242: 239: 236: 233: 230: 227: 224: 220: 219: 216: 213: 210: 207: 204: 201: 198: 195: 191: 190: 187: 184: 181: 178: 175: 172: 169: 166: 162: 161: 158: 152: 149: 144: 141: 138: 133: 130: 120: 117: 95: 92: 60:Bruce protocol 54: 53: 48: 44: 43: 40: 36: 35: 32: 24: 23: 22:Bruce protocol 15: 9: 6: 4: 3: 2: 1931: 1920: 1917: 1915: 1912: 1911: 1909: 1896: 1886: 1880: 1877: 1875: 1874:Cardioversion 1872: 1871: 1869: 1865: 1859: 1856: 1854: 1851: 1849: 1846: 1845: 1843: 1841: 1837: 1831: 1828: 1825: 1821: 1820: 1817: 1814: 1812: 1809: 1807: 1803: 1800: 1796: 1793: 1792: 1791: 1788: 1786: 1783: 1781: 1778: 1774: 1771: 1769: 1766: 1765: 1764: 1761: 1759: 1756: 1753: 1749: 1748: 1745: 1742: 1738: 1735: 1734: 1733: 1730: 1728: 1725: 1723: 1720: 1716: 1713: 1712: 1711: 1708: 1705: 1701: 1700: 1698: 1694: 1684: 1681: 1679: 1676: 1674: 1671: 1670: 1667: 1664: 1661: 1658: 1655: 1652: 1650: 1647: 1645: 1642: 1640: 1637: 1635: 1632: 1629: 1625: 1621: 1618: 1614: 1613: 1610: 1607: 1605: 1602: 1600: 1597: 1595: 1594:Dor procedure 1592: 1590: 1587: 1584: 1580: 1579: 1576: 1573: 1571: 1568: 1566: 1563: 1560: 1556: 1555: 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1114: 1111: 1100: 1096: 1092: 1088: 1084: 1080: 1077:(5): 303–11. 1076: 1072: 1065: 1057: 1053: 1048: 1043: 1039: 1035: 1031: 1027: 1026:J Clin Invest 1023: 1016: 1008: 1004: 999: 994: 990: 986: 982: 978: 977:J Clin Invest 974: 967: 959: 955: 951: 947: 940: 932: 928: 924: 920: 916: 912: 904: 902: 893: 889: 884: 879: 875: 871: 867: 863: 859: 852: 844: 840: 836: 832: 828: 824: 817: 809: 805: 802:(6): 323–32. 801: 797: 790: 782: 778: 773: 768: 764: 760: 756: 749: 745: 734: 731: 730: 729: 704: 703: 702: 700: 692: 682: 678: 674: 672: 663: 657: 654: 651: 648: 645: 644: 643: 640: 629: 626: 618: 608: 604: 598: 597: 592:This section 590: 586: 581: 580: 572: 562: 559: 551: 541: 537: 531: 530: 525:This section 523: 519: 514: 513: 508:Modifications 505: 501: 499: 495: 492:, a previous 491: 486: 482: 478: 473: 470: 466: 462: 458: 454: 450: 445: 443: 439: 427: 424: 416: 406: 402: 396: 395: 390:This section 388: 384: 379: 378: 370: 362: 359: 356: 353: 350: 347: 344: 341: 338: 337: 333: 330: 327: 324: 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57: 47:Test of 1816:Cardiac PET 1559:Pericardium 1523:Atherectomy 1461:Angioplasty 1203:Valvulotomy 911:Circulation 759:Circulation 615:August 2023 548:August 2023 442:circulatory 438:respiratory 413:August 2023 1908:Categories 1811:Cardiac CT 1678:Cardiotomy 1583:Myocardium 1351:Sano shunt 1141:procedures 1139:Tests and 740:References 705:THR = ((HR 485:congenital 461:electrodes 457:treadmills 1191:and septa 868:: 88–97. 465:Breathing 143:min/mile 94:Procedure 1895:Category 1628:minimaze 1624:Cox maze 1099:42982362 1056:15395945 1007:15407661 931:23877260 892:30743212 781:16389672 498:aneurysm 481:valvular 132:Minutes 109:wheezing 1180:Surgery 1091:3387734 883:6441626 808:5156892 728:of 70: 575:Results 373:History 151:min/km 136:% grade 68:cardiac 39:Purpose 1867:Pacing 1475:MIDCAB 1466:Bypass 1416:shunt 1310:atrium 1223:mitral 1218:aortic 1097:  1089:  1054:  1047:439699 1044:  1005:  998:439698 995:  929:  890:  880:  843:785541 841:  806:  779:  129:Stage 119:Stages 1824:sound 1696:Tests 1654:S-ICD 1551:Other 1485:TECAB 1330:aorta 1145:heart 1095:S2CID 363:2.69 351:10:00 334:2.47 322:10:55 305:2.22 293:12:00 276:1.89 264:14:17 247:1.52 241:10:55 235:17:39 218:1.11 212:15:00 206:24:00 189:0.75 183:22:13 177:35:18 1626:and 1364:for 1087:PMID 1052:PMID 1003:PMID 927:PMID 888:PMID 839:PMID 804:PMID 777:PMID 726:rest 715:rest 711:rest 709:− HR 695:rest 689:The 440:and 357:6:11 354:9.7 348:6.0 328:6:44 325:8.9 319:5.5 299:7:30 296:8.0 290:5.0 270:8:49 267:6.8 261:4.2 238:5.5 232:3.4 215:4-5 209:4.0 203:2.5 180:2.7 174:1.7 160:m/s 147:km/h 140:MPH 58:The 1773:TEE 1768:TTE 1660:ICD 1455:CHD 1427:SVC 1412:to 1344:to 1328:to 1312:to 1079:doi 1042:PMC 1034:doi 993:PMC 985:doi 954:doi 919:doi 915:128 878:PMC 870:doi 866:210 831:doi 767:doi 763:111 722:max 707:max 605:by 538:by 483:or 403:by 360:21 331:17 302:14 273:10 155:MET 1910:: 1431:PA 1093:. 1085:. 1073:. 1050:. 1040:. 1030:28 1028:. 1024:. 1001:. 991:. 981:28 979:. 975:. 950:10 948:. 925:. 913:. 900:^ 886:. 876:. 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Index


Cardiac stress test
diagnostic test
cardiac
physical fitness
Robert A. Bruce
maximum oxygen uptake
impaired blood flow to the heart
irregular heart rhythm
wheezing
any impairment in walking or pain, discomfort, numbness, or tiredness in the legs
% grade
km/h
MET

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respiratory
circulatory
cardiac stress test
electrocardiograph machines
treadmills
electrodes
Breathing
gas exchange
University of Washington
valvular
congenital

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