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  • Title: [Does the modified Bruce protocol induce physiological stress equal to that of the Bruce protocol?].
    Author: Trabulo M, Mendes M, Mesquita A, Seabra-Gomes R.
    Journal: Rev Port Cardiol; 1994 Oct; 13(10):753-60; 735-6. PubMed ID: 7833062.
    Abstract:
    OBJECTIVE: To determine if the physiological stress induced by the modification of Bruce protocol used in our hospital is equivalent to the original protocol. DESIGN: Retrospective analysis of clinical history, physical examination and stress test of apparently healthy individuals submitted to cardiac check up. SETTING: Outpatient private cardiological clinical. PARTICIPANTS: Sequential sampling of 80 individuals apparently healthy, submitted to cardiac check-up between April 1988 and September 1992. MATERIAL AND METHODS: Comparison of heart rate, blood pressure and double product progression, as well as time of exercise of individuals studied by the Bruce protocol (group A: n = 51) with the same data of individuals tested by the modified Bruce protocol (group B: n = 29). MEASUREMENTS AND MAIN RESULTS: The first stage of group A protocol provokes a superior physiologic stress than group B protocol, since there are bigger increments on heart rate (28.8 +/- 9.9 vs. 20.2 +/- 11.2 bpm; p < 0.01), blood pressure (27.0 +/- 11.3 vs. 14.3 +/- 11.4 mmHg; p < 0.0001) and, consequently, higher double products. In submaximal stages with the same speed and grade on the treadmill the hemodynamical stress is similar in both groups. At peak exercise, group A attains higher values on systolic blood pressure (197.1 +/- 9.5 vs. 188.8 +/- 10.4 mmHg; p < 0.001), double product (34330.4 +/- 2191.8 vs. 33060.9 +/- 2049.8; p = 0.01) and corrected exercise time also higher than estimated (929 +/- 91 vs. 818 +/- 94 sec; p = 0.02). It could be found that more individuals on group A (76% vs. 48%; p = 0.02) could complete the stage of 6.8 Km/h x 16% (stage IV on Bruce protocol and V on modified Bruce protocol. CONCLUSIONS: Modified Bruce protocol has a lighter initial increment, but decreases moderately the capacity of peak exercise due to peripheral fatigue secondary to the first stage of low intensity. Bruce protocol has a higher initial increment but permits to attain higher peak exercise intensities. Bruce protocol seems more adequate to individuals with good physical capacity and the modified Bruce protocol to individuals moderately limited in their functional capacity due to bad physical fitness or illness.
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