The Selection of Exercise Testing Protocols in Cardiovascular Rehabilitation Centres: A Pan-Canadian Survey

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.