2. Objectives
• Exercise electrocardiography Test
• Indication of exercise testing
• Patient preparation
• Types of maximal exercise test
• Treadmill test
Bruce protocol
Modified Bruce protocol
Balke protocol
3. • Exercise electrocardiographic testing is among the most
fundamental and widely used tests for the evaluation of
patients with Cardiovascular Disease
• It is easy to perform, and interpret; it is flexible and
adaptable; and it is reliable, inexpensive, and readily
available in hospital or cardiac rehabilitation practice
settings.
• The exercise test has been used by clinicians, cardiologist &
physiotherapist
4. Indication of exercise testing
• Elicit abnormalities not present at rest
• Estimate functional capacity
• Estimate prognosis of CAD like coronary artery disease
• Evaluation and management of patients with a wide variety of
cardiovascular conditions, including valvular heart disease, congenital
heart disease,arrhythmias, and peripheral arterial disease (PAD)
5. Contraindications to Exercise Testing
• A recent significant change in the resting ECG suggesting significant ischemia, recent
myocardial infarction (within 2 days)
• Acute cardiac event unstable angina
• Uncontrolled cardiac dysrhythmias
• Severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolism
• Acute myocarditis or pericarditis
• Acute systemic infection,
• Severe arterial hypertension (i.E., Systolic BP of >200 mm hg and/or a diastolic BP of >110
mm hg) at rest
6. Prior to performing an exercise test include
• Patient preparation
• Choosing a test type
• Choosing a test protocol
• Patient monitoring
• Reasons to terminate a test
• Post test monitoring
7. Patient preparation
• General medical history
• Physical examination
• Vital parameters
• Any history of light headed or fainted while exercising
should be asked
8. Preparation for exercise testing include the following-
• The subject should be instructed not to eat or smoke at least 2 hours
prior to the test .
• Specific questioning should determine which drugs are being taken.
• A written informed consent form should be taken from patient.
• The indication for the test should be known.
• The supervising doctor should be made aware of any recent
deterioration in the patient's clinical status.
• The test should not be performed on subjects who are markedly
hypertensive (e.g., blood pressure > 180/120 mm Hg) or who have
unexplained hypotension (e.g., systolic blood pressure < 80 mm Hg)
9. Types of maximal exercise test
1. Arm Ergometry
2. Bicycle Ergometry
3. Treadmill test
4. Walk Test
10. Bruce protocol
• The Bruce protocol is a standardized diagnostic test used in the evaluation
of cardiac function and physical fitness, developed by American
cardiologist Robert A Bruce.
• 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/ person can complete all 7
stages.
• The 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.
12. Modified Bruce protocol
• 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 first stage
of the Standard Bruce Test protocol as listed above
• Interpretation
VO2max (ml/kg/min) = 14.76 - (1.379 × T) + (0.451 × T²) - (0.012 × T³)
13. Balke protocol
• The Balke Treadmill Test was developed as a clinical test to
determine VO2 max in cardiac patients, though it can also be used to
estimate cardiovascular fitness in athletes. The test involves walking
on a treadmill to exhaustion, at a constant walking speed while
gradient/slope is increased every one or two minutes
14. • Purpose: To determine VO2 max particularly in cardiac patients.
• equipment required: treadmill, stopwatch, electrocardiograph
• pre-test: Explain the test procedures to the subject. Perform screening
of health risks and obtain informed consent. Prepare forms and record
basic information such as age, height, body weight, gender, test
conditions. Perform an appropriate warm-up.
15. • procedure: The athlete walks on a treadmill to exhaustion, at a constant
walking speed while gradient/slope is increased every one or two minutes.
The assistant starts the stopwatch at the beginning of the test and stops it
when the subject is unable to continue.
• The treadmill speed is set at 3.3 mph, with the gradient starting at 0%.
After 1 minute it is raised to 2%, then 1% each minute thereafter.
