The quest for an “optimal” test for assessing electrocardiographic and/or gas exchange responses to exercise spans 7 decades. Several protocols have evolved that have become common, and while the treadmill is the most frequently used mode in the United States, the cycle ergometer remains popular in Europe. Advantages and disadvantages of various exercise modes and protocols have been discussed at length. An ideal protocol should consider the following: (1) the purpose of the test; and (2) the subject tested. For most exercise tests, however, the choice of protocol is dictated by tradition, equipment, or convenience. For example, of the treadmill protocols, more than half the laboratories in North America employ the standard Bruce test, even though its large increments in work make it inappropriate for many patients with cardiovascular diseases.
A number of investigators have suggested individualizing tests rather than employing a standardized protocol for every patient. Redwood et al demonstrated that such tests were superior for the evaluation of pharmacologic treatment effects; protocols placing heavy or abrupt demands on patients with angina appeared to mask the salutory effect of nitroglycerin. Buchfuhrer and associates reported that the highest values for maximal oxygen uptake were observed in tests individualized to last approximately 10 min.