Bruce Protocol

Bruce protocol
The Bruce protocol is a diagnostic test

used in the evaluation of cardiac function,
developed by Robert A. Bruce.
History
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 sometimes
used, but it was too strenuous for many
patients, and inadequate for the
assessment of respiratory and circulatory
function during varying amounts of
exercise. Most physicians relied upon
patients' complaints about exertion, and
examined them only at rest.
To address these problems, Bruce and his

colleagues began to develop a treadmill
exercise test. The test made extensive use
of relatively new technological
developments in electrocardiographs and
motorized treadmills. A Bruce exercise
test involved walking on a treadmill while
the heart was monitored by an
electrocardiograph with various electrodes
attached to the body. Ventilation volumes
and respiratory gas exchanges 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. 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
ailments.[1][2]
In 1950 Bruce joined the University of

Washington, where he continued research
on the single-stage test, particularly as a
predictor of the success of surgery for
valvular or congenital heart disease. Later
he developed the 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
detect signs of such conditions as angina
pectoris, a previous heart attack, or a
ventricular aneurysm. Bruce and
colleagues also demonstrated that
exercise testing was useful in screening
apparently healthy people for early signs
of coronary artery disease.
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 and Sub Maximal (more
practical with the majority of the non-
athletic or competitively athletic
population) efforts (see below).
%
Stage Minutes MPH min/mile km/h m
grade
1 3 10 1.7 35:18 2.7 22
2 3 12 2.5 24:00 4.0 1
3 3 14 3.4 17:39 5.5 1
4 3 16 4.2 14:17 6.8 8

5 3 18 5.0 12:00 8.0 7
6 3 20 5.5 10:55 8.9 6
7 3 22 6.0 10:00 9.7 6
Total Duration = 21 minutes

Modifications
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.
Results
The test score is the time taken on the

test, in minutes. This can also be
converted to an estimated VO2max
(maximal oxygen uptake) 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 give varying results. If possible, use
the one derived from a similar population
and which best suits your needs.
VO2max (ml/kg/min) = 14.76 - (1.379 ×

T) + (0.451 × T²) - (0.012 × T³)
Women: VO2max (ml/kg/min) = 2.94 x T
+ 3.74
Women: VO2max (ml/kg/min) = 4.38 × T
- 3.9
Men: VO2max (ml/kg/min) = 2.94 x T +
7.65
Young Men: VO2max (ml/kg/min) = 3.62
x T + 3.91
ref: ACSM's Health-Related Physical

Fitness Assessment Manual
Underlying Heart Rate

Formulas
Maximum heart rate (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).
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.
A diagnostician (e.g., personal trainer,

doctor, athletic trainer, nurse, medical
professional, dietitian, etc.) may be best
served to conduct the test twice using
both parameters and formulas.
Karvonen method
The Karvonen method factors in resting

heart rate (HRrest) to calculate target heart
rate (THR), using a range of 50–85%:
THR = ((HRmax − HRrest) × %Intensity) +

HRrest
Example for someone with a HRmax of 180

and a HRrest of 70:
50% intensity: ((180 − 70) × 0.50) + 70 =
125 bpm
85% intensity: ((180 − 70) × 0.85) + 70 =
163 bpm
References
1. Robert A. Bruce; Frank W. Lovejoy Jr.;
Raymond Pearson; Paul N. G. Yu; George B.
Brothers; Tulio Velasquez (November
1949). "Normal respiratory and circulatory
pathways of adaptation in exercise" . J.
Clin. Invest. 28 (6 Pt 2): 1423–1430.
doi:10.1172/JCI102207 . PMC 439698  .
PMID 15407661 .
2. Robert A. Bruce; Raymond Pearson;
Frank W. Lovejoy Jr.; Paul N. G. Yu; George
B. Brothers (November 1949). "Variability of
respiratory and circulatory performance
during standardized exercise" . J Clin
Invest. 28 (6 Pt 2): 1431–1438.
doi:10.1172/JCI102208 . PMC 439699  .
PMID 15395945 .
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Bruce protocol

The Bruce protocol is a diagnostic test

To address these problems, Bruce and his

In 1950 Bruce joined the University of

Typically during a Bruce Protocol, Heart

There are Bruce Protocol Tables available

4 3 16 4.2 14:17 6.8 8

Total Duration = 21 minutes

The Modiﬁed Bruce protocol starts at a

The test score is the time taken on the

VO2max (ml/kg/min) = 14.76 - (1.379 ×

ref: ACSM's Health-Related Physical

Underlying Heart Rate

Maximum heart rate (MHR) is often

A more accurate formula, offered in a

A diagnostician (e.g., personal trainer,

The Karvonen method factors in resting

THR = ((HRmax − HRrest) × %Intensity) +

Example for someone with a HRmax of 180

Last edited 20 days ago by an anon…

Content is available under CC BY-SA 3.0 unless

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