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Updated: Jun 19, 2026

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Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values.

Monique H M van der Cammen-van Zijp1, Hanneke Ijsselstijn, Tim Takken

  • 1Department of Physical Therapy, Subdivision Pediatric Physical Therapy, Room Sk 0327, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands. m.vandercammen@erasmusmc.nl

European Journal of Applied Physiology
|October 13, 2009
PubMed
Summary

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Exercise Stress Test01:26

Exercise Stress Test

Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes

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New reference values for the original Bruce treadmill protocol in 4- and 5-year-olds are now available. Endurance times differ significantly between the original and half Bruce protocols, so they are not interchangeable for this age group.

Area of Science:

  • Pediatrics
  • Exercise Physiology
  • Cardiopulmonary Testing

Background:

  • The Bruce treadmill protocol is widely used for assessing exercise capacity in children and adults.
  • Existing normative data for young children (4-5 years) using this protocol are scarce and outdated.
  • The 'half Bruce' protocol is frequently employed for younger children due to the steep workload increases in the standard protocol.

Purpose of the Study:

  • To establish new reference values for the original Bruce treadmill protocol in healthy 4- and 5-year-old children.
  • To compare exercise capacity measurements between the original Bruce protocol and the 'half Bruce' protocol in this age group.

Main Methods:

  • A cross-sectional observational study involving 78 healthy Dutch children aged 4 and 5 years.

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  • Maximal endurance time was measured using both the original Bruce protocol and the 'half Bruce' protocol.
  • Reference centiles were calculated for the original Bruce protocol.

    • Main Results:

    • The mean endurance time for the original Bruce protocol was 10.2 (SD 1.5) minutes.
    • The mean endurance time for the 'half Bruce' protocol was 9.4 (SD 1.3) minutes.
    • A statistically significant mean difference of 50 seconds (95% CI: 29-71 s, P < 0.001) was observed between the two protocols.

    Conclusions:

    • Endurance times derived from the original and 'half Bruce' protocols are not interchangeable in 4- and 5-year-old children.
    • The newly established reference values are suitable for the original Bruce protocol in this pediatric population.
    • These findings highlight the importance of using age-appropriate and protocol-specific normative data for exercise testing in young children.