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A novel treadmill protocol for exercise testing in children: the British Columbia Children's Hospital protocol
D Kathryn Duff1,2, Astrid M De Souza3, Derek G Human3
1Department of Sport Science, Douglas College, New Westminster, British Columbia, Canada.
Insights
The British Columbia Children's Hospital (BCCH) protocol shows similar peak exercise responses to the Bruce protocol in children. This new protocol offers a viable alternative for pediatric clinical exercise testing.
Area of Science:
- Pediatric Exercise Physiology
- Cardiopulmonary Exercise Testing
Background:
- Exercise testing is crucial for children's health assessment.
- The traditional Bruce protocol presents practical challenges for pediatric populations.
- A novel British Columbia Children's Hospital (BCCH) protocol was developed for improved utility in children.
Purpose of the Study:
- To compare peak exercise responses between the BCCH and Bruce protocols in children.
- To evaluate key physiological parameters including ventilation, oxygen consumption, and heart rate.
Main Methods:
- Seventy children (aged 10-18 years) underwent treadmill testing using both BCCH and Bruce protocols on separate occasions.
- Metabolic gas exchange and heart rate were continuously monitored during exercise.
Main Results:
- Both protocols yielded similar peak oxygen consumption (VO2), minute ventilation (VE), and metabolic equivalents (METS).
- Respiratory exchange ratio (RER) values were also comparable between the BCCH and Bruce protocols.
- The BCCH protocol resulted in a longer total exercise duration compared to the Bruce protocol.
Conclusions:
- The BCCH protocol is a suitable alternative for clinical exercise testing in children.
- It demonstrates comparable peak physiological responses to the established Bruce protocol.
- This offers a potentially more practical option for pediatric exercise assessments.
Background:
Exercise testing in children is widely recommended for a number of clinical and prescriptive reasons. Many institutions continue to use the Bruce protocol for treadmill testing; however, with its incremental changes in speed and grade, it has challenges for practical application in children. We have developed a novel institutional protocol (British Columbia Children's Hospital (BCCH)), which may have better utility in paediatric populations.
Aim:
To determine if our institutional protocol yields similar peak responses in minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), metabolic equivalents (METS) and heart rate (HR) when compared with the traditional Bruce protocol.
Methods:
On two different occasions, 70 children (boys=33; girls=37) aged 10-18 years completed an exercise test on a treadmill using each of the protocols. During each test, metabolic gas exchange parameters were measured. HR was monitored continuously during exercise using an HR monitor.
Results:
Physiological variables were similar between the two protocols (median (IQR); rs): VE (L/min) (BCCH=96.7 (72.0-110.2); Bruce=99.2 (75.6-120.0); rs=0.95), peak VO2 (mL/min) (BCCH=2897 (2342-3807); Bruce=2901 (2427-3654); rs=0.94) and METS (BCCH=16.2 (14.8-17.7); Bruce=16.4 (14.7-17.9); rs=0.89). RERs were similar (BCCH=1.00 (0.96-1.02); Bruce=1.03 (0.99-1.07); rs=0.48). Total exercise time (in seconds) was longer for the BCCH protocol: BCCH=915 (829-1005); Bruce=810 (750-919); rs=0.67.
Conclusion:
The BCCH protocol produces similar peak exercise responses to the Bruce protocol and provides an alternative for clinical exercise testing in children.
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