Key result
Canadian cardiovascular rehab centers use the Bruce protocol for 86% of maximal tests alongside 6MWT.
Why the study?
Cardiorespiratory fitness is routinely assessed in cardiovascular rehabilitation using various exercise test protocols, but protocol selection and guiding decision-making processes across centres remain unclear.
Exercise testing practices in Canadian cardiovascular rehabilitation centres vary widely, with submaximal protocols like the 6-minute walk test and maximal protocols like the Bruce treadmill test dominating current practice.
Wide CR exercise testing variation warrants caution comparing program outcomes; leaves open optimal protocols pending comparative effectiveness research.
Background: Cardiorespiratory fitness (CRF) is a strong independent predictor of mortality and is routinely assessed in cardiovascular rehabilitation (CR) using exercise tests.There are several protocols for measuring CRF, however, their selection in CR centres and the decision-making processes guiding these choices remain unclear.This study aimed to identify (i) the most frequently used maximal and submaximal exercise testing protocols in Canadian CR centres, and (ii) the number of protocols used, annual testing volumes, decision-makers, and criteria guiding protocol selection.Methods: This observational pan-Canadian survey was distributed electronically to all identified CR centres to capture their exercise testing practices, annual testing volumes, protocol frequency, and decision-making criteria.Results: Of 196 centres identified and contacted, 118 completed the survey.Among these, 87 centres (74%) performed exercise testing: 15% used only maximal tests, 47% used only submaximal, and 30% used both.The Bruce treadmill protocol was the most used maximal test (86%), while the 6-minute walk test (6MWT) was the most used submaximal test (77%).Approximately 5,575 maximal and 20,105 submaximal tests were performed annually.Physicians were the primary decision-makers in 54% of centres, followed by exercise physiologists (38%).Common selection criteria included staff clinical judgement, patient-specific factors, and standardized centre procedures. Conclusion: Exercise testing practices in Canadian CR centres vary widely, with submaximal protocols favoured.The Bruce and 6MWT protocols dominate current practice, yet variability in protocol selection underscores the need for standardized guidelines.Future research should explore outcomes associated with different protocols to optimize CRF assessment and exercise prescription.
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Wong et al. (2026) studied this question. Canadian cardiovascular rehabilitation centres predominantly use the Bruce treadmill protocol (86%) and 6-minute walk test (77%) for maximal and submaximal exercise testing, respectively.
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