Title: A novel treadmill protocol for exercise testing in children: the British Columbia Children’s Hospital protocol
Abstract: <h3>Background</h3> 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. <h3>Aim</h3> To determine if our institutional protocol yields similar peak responses in minute ventilation (VE), oxygen consumption (VO<sub>2</sub>), carbon dioxide production (VCO<sub>2</sub>), respiratory exchange ratio (RER), metabolic equivalents (METS) and heart rate (HR) when compared with the traditional Bruce protocol. <h3>Methods</h3> 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. <h3>Results</h3> Physiological variables were similar between the two protocols (median (IQR); r<sub>s</sub>): VE (L/min) (BCCH=96.7 (72.0–110.2); Bruce=99.2 (75.6–120.0); r<sub>s</sub>=0.95), peak VO<sub>2</sub> (mL/min) (BCCH=2897 (2342–3807); Bruce=2901 (2427–3654); r<sub>s</sub>=0.94) and METS (BCCH=16.2 (14.8–17.7); Bruce=16.4 (14.7–17.9); r<sub>s</sub>=0.89). RERs were similar (BCCH=1.00 (0.96–1.02); Bruce=1.03 (0.99–1.07); r<sub>s</sub>=0.48). Total exercise time (in seconds) was longer for the BCCH protocol: BCCH=915 (829–1005); Bruce=810 (750-919); r<sub>s</sub>=0.67. <h3>Conclusion</h3> The BCCH protocol produces similar peak exercise responses to the Bruce protocol and provides an alternative for clinical exercise testing in children.