Beyond the Bruce Protocol: Advanced Exercise Testing for the Sports Cardiologist

Exercise testing is an important tool for determining baseline fitness as well as to diagnose limitations in performance. The Bruce protocol has become the standard for exercise testing protocol in many exercise physiology laboratories, but is rarely a suitable test for athletes who often have complex hemodynamic and metabolic demands during exercise required for practice and competition. We describe the approach for exercise testing beyond the Bruce protocol and focus on strategies to individualize the testing protocol to the metabolic demands of an athlete's sport.