Treadmill Stress Test Protocols

The most common treadmill protocol used is the Bruce (Table 6) protocol; however, due to its large and uneven load increments, it is preferred for individuals with a good predicted functional capacity [15].



Abbreviations: Km/h—kilometers per hour; METS—multiples of resting metabolic equivalent; Source: Adapted from [15].

The modified Bruce protocol was designed for individuals who cannot exercise vigorously (Table 7). It includes two lower workload stages at the beginning of the standard Bruce protocol.


**Table 7.** Modified Bruce protocol.

Abbreviations: Km/h—kilometers per hour; METS—multiples of resting metabolic equivalent; Source: Adapted from [2].

The Naughton protocol increases the load by approximately 1 MET in 2 min stages and is recommended for use in patients who have a low predicted functional capacity (Table 8).


**Table 8.** Naughton protocol [2].

Abbreviations: Km/h—kilometers per hour; METS—multiples of resting metabolic equivalent; Source: Adapted from [2].

There are many available ramp treadmill protocols—e.g., the Bruce protocol (Table 9).


**Table 9.** Bruce Ramp Stress Test protocol [2].

Abbreviations: Km/h—kilometers per hour; METS—multiples of resting metabolic equivalent; Source: Adapted from [2].

Underutilized individualized ramp test protocols allow for precise test termination after 8 to 12 min but are still underexploited [16].
