| Protocol |
Modified Bruce Treadmill Test (MBTT) |
Symptom-limited cycle ergometer incremental load test (ILT) |
Cycle-ergometer constant load test (CLT) |
Six-Minute Walk Test (6MWT) |
Cardiopulmonary exercise testing (CPET) |
| Authors & date |
Bruce RA et al.(1973) |
Neder JR et al. (2003) |
Neder JR et al. (2003) |
Iwama et al. (2009) (ERS/ATS guidelines). |
American Thoracic Society in 2003 |
| Patients |
Coronary heart diseases, cardiac patients, lung function and heart surgery |
Patients with disorders of cardiopulmonary, cardiac, asthma, COPD |
Chronic respiratory patients, cardiac patients. |
Cardiac and respiratory patients with severe situation. |
Respiratory diseases, cardiovascular, haemopoietic, neuropsychological, skeletal systems and metabolic syndrome. |
| Propose |
Evaluation of improvement of pulmonary patients especially COPD in long time of rehabilitation program |
Intensity of exercise in this test is increasing step by step for evaluation of VO2max. |
Maximum tolerance in patients. |
Maximum clinical practice in respiratory and cardiac patients in time and distance. |
Gold standard assessment (validity and reliability) in patients with limited level of exercise and evaluate improvement of patients before and after rehabilitation protocol. |
| Measurement |
Starts at 1.7 mph at a grade of 10%, the modified test has a zero stage (1.7 mph at 0% grade) and a one-half-stage (1.7 mph at 5% grade). |
Cycle ergometer pedal at 60 rpm is used with standard vocal encouragements. (Borg>7), SpO2 < 80%, reach the maximum HR and cannot continue, it automatically stops.
1-minute warm-up period at minimal cycle ergometer load (15 W), with 5- to 10-W increases every 2 minutes that are individually selected to maintain the period of load increase in the 8-to-12 -minute range.
One-minute active recovery using minimal cycle ergometer and followed by a 6-minute. |
In this test patients are instructed to pedal at 60 rpm and given standard vocal encouragements every minute. Workload of 70% of the maximum intensity and so in this protocol maximum tolerance time for each sample will be measured. Maximum tolerated time and subsequent analysis of VO2 and HR on-kinetics. Initial minimal load of 15 W is used for 1 minute during the warm-up and cool-down phases and 6-minute passive recovery period. |
The therapist should pay attention to patients and if they have fatigue or dyspnea, they must rapidly stop the test and go to rest on a chair or bed. It is performed on a 30-meter-long flat hallway twice daily with a 30-minute interval between each session; the largest value of distance traveled will be selected for analysis. The patients will be instructed and encouraged to walk as fast as possible for 6 minutes, using standardized phrases every minute of the self-paced tests. [Distance traveled at 6MWT/predicted distance×100]. |
GloecklR et al. (2013) stated that the 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests by ergo cycling system. Interpretation of CPET involves a systematic review of the indices of the exercise capacity [peak oxygen uptake (VO2 peak), max work rate], cardiovascular response, and Ventilatory response and gas exchange. |
| Other explanations |
Bruce test is one of best tests mostly used in healthy persons and cardiorespiratory patients in all clinical trials. |
The patients will be monitored by pulse oximetry throughout the entire test. HR will be measured using a heart rate monitor, and dyspnea and lower limb fatigue are assessed using the CR [Category Ratio]-10 modified Borg scale. |
SpO2, HR, BP, feelings of dyspnea and lower limb fatigue at rest and peak exercise in maximum tolerance will be recorded. The electrocardiographic tracing is monitored throughout the entire test. |
SpO2 during exercise will be measured lightweight portable pulse oximeter. The longest 6MWD of two tests (per-formed the same day and separated by 20 min) will be the primary outcome measure. Dyspnea will be measured the Borg scale.(Formula HR max = 220 – age). |
The response pattern in respiratory patients is exampled by (1) decreased VO2 peak (2), decreased or normal AT (3), decreased HR peak (4), normal or decreased O2 pulse and (5) increased in VE / MVV, VE/VCO2 parameters. |
| Type exercise |
Training test |
Training test |
Training test |
Assessment test |
Assessment test |
