青春早期前兒童在Bruce及Bruce Ramp兩種運動測試中運動反應和最大攝氧量的比較

Comparison of the Bruce and Bruce Ramp Protocols in Exercise Response and Maximal Oxygen Consumption in Children before Early Pubertal Stage

運動測試是評估受測者運動能力及心肺耐力的標準實驗室方法，一般採多階漸進的方式進行，直到受測者不能繼續為止，臨床上有多種測試程式(testing protocol)。Bruce運動程式是每三分鐘增加速度及坡度，對青春早期之前兒童有提早停止測試之虞，Bruce Ramp之測試程式的運動量則採斜坡漸進方式增加速度及坡度。本研究的目的在比較青春早期之前兒童在Bruce及Bruce Ramp運動測試中運動反應和最大攝氧量。本研究包括15名（10男5女）青春早期之前的國小兒童，平均年齡為9.6±1.4歲，在獲得監護人同意書後，依序測量他們的身高、體重，且間隔一星期進行二次最大運動測試，二次分別以隨機方式採Bruce和Bruce Ramp運動程式進行，收集每口呼吸進行最大攝氧量的測量，運動測試中每三分鐘和最大運動時記錄自覺用力係數及兒童圖表自覺用力係數。所有受測者資料以敘述性統計呈現，二次運動測試結果以成對t檢定分析，α訂為0.05，自覺用力係數及兒童圖表自覺用力係數以重複量數二因子變異數分析。結果完成Bruce最大運動測試的時間較Bruce Ramp短（9.5±1.8 vs.10.7±1.7分鐘），第3、6、9分鐘的一分鐘平均攝氧量及最大攝氧量(36.7±6.8 vs. 32.6±8.2 mL‧kg^(-1)‧min^(-1), p<0.05)較高，兩種運動程式在最大運動時的自覺用力係數和兒童圖表自覺用力係數則無統計上差異。結論：兩種程式均可在學者所建議的12分鐘內完成，但Bruce運動測試程式可以在較短時間完成、且可達到較大的最大攝氧量，建議以Bruce運動測試程式進行健康青春早期之前兒童的最大運動測試。本研究結果可提供學者對青春早期前健康兒童進行最大運動測試程式選擇的參考。

Exercise test is indicated to measure exercise capacity and assess exercise-related symptoms. Bruce protocol is commonly used that increases speed and grade every 3 minutes, while the Bruce Ramp protocol has gradual increase in intensity usually every 15 seconds. The purpose of this study was to compare the exercise responses and maximal oxygen consumption by using Bruce and Bruce Ramp protocols in children before early pubertal stage. We also compared the rating of perceived exertion (RPE) and pictorial children's effort rating table (PCERT) during two exercise tests. Fifteen children were recruited and completed the study. The testing order was randomly assigned and the two tests completed within one week. Paired t-test was performed to compare the differences of the cardiopulmonary responses and maximal oxygen consumption between two test protocols, while two-way repeated measure ANOVA was used to analyze subjects’ perception of exertion by RPE and PCERT. The result revealed that the duration of exercise testing for Bruce protocol was shorter than the Bruce Ramp protocol (9.5±1.8 vs.10.7±1.7 minutes). Subjects achieved higher oxygen consumption in the 3rd, 6th, 9th minutes and maximal oxygen consumption (36.7±6.8 vs. 32.6±8.2 mL‧kg^(-1)‧min^(-1), p<0.05) by using Bruce protocol compared to the Bruce Ramp protocol. There were no differences between RPE and PCERT either by Bruce or Bruce Ramp exercise testing protocol. In conclusion, both protocols produced test durations between 8-12 minutes that was recommended for an exercise test. Maximal oxygen consumption measured by Bruce protocol was higher and the test duration was shorter compared with the Bruce Ramp protocol in our subjects. Bruce protocol is recommended for healthy children before early pubertal stage in exercise test.