Gardner Treadmill Protocol

Gardner Treadmill Protocol

Gardner Treadmill Protocol, also known as Gardner-Skinner Protocol was described in 1991 [1]. It is used mainly in the evaluation of peripheral arterial disease. The seminal article evaluated the effect of handrail support on claudication distance. Handrail support reduces energy cost of treadmill walking, and can affect claudication distance and hemodynamic responses in persons with peripheral vascular disease. Reliability of tests may also be reduced unless same pressure is applied to the handrails over repeated tests.

Gardner treadmill protocol is a symptom limited one with progressive graded workload having constant speed of 2 miles per hour (3.2 km/h) and 2% increase in gradient every two minutes, from 0 to 12% [2]. Stage 1 needs 2.5 METS and stage 7 needs 5.4 METS of energy expenditure approximately.

A modified Gardner-Skinner Protocol has also been mentioned like the modified Bruce protocol. In the modified Gardner-Skinner Protocol, stage 4 is equivalent to the stage 1 of standard Gardner-Skinner Protocol. In the initial four stages, the gradient is zero. In stage 1 the speed is 0.5 mph, 1 mph in stage 2 and 1.5 mph in stage 3.

As Gardner-Skinner Protocol is more popular in the evaluation of peripheral arterial disease, in addition to the routine monitoring like ECG, heart rate and blood pressure, foot transcutaneous oxygen tension (SPO2), ankle systolic pressure and ankle/brachial systolic pressure ratio (ABI) are also checked [1]. As PAD is often associated with other atherosclerotic diseases like coronary artery disease, monitoring for ST shift during initial evaluation with Gardner treadmill protocol is of paramount importance [3].

References

1. Gardner AW, Skinner JS, Smith LK. Effects of handrail support on claudication and hemodynamic responses to single-stage and progressive treadmill protocols in peripheral vascular occlusive disease. Am J Cardiol. 1991 Jul 1;68(1):99-105. doi: 10.1016/0002-9149(91)90719-2. PMID: 2058566 [Free Full Text].
2. Arao K, Yasu T, Endo Y, Funazaki T, Ota Y, Shimada K, Tokutake E, Naito N, Takase B, Wake M, Ikeda N, Horie Y, Sugimura H, Momomura SI, Kawakami M; Investigators of the Anti-Arteriosclerosis and Lipid Lowering with Pitavastatin Evaluation Study in Nippon (ALPEN). Effects of pitavastatin on walking capacity and CD34⁺/133⁺ cell number in patients with peripheral artery disease. Heart Vessels. 2017 Oct;32(10):1186-1194. doi: 10.1007/s00380-017-0988-1. Epub 2017 May 2. PMID: 28466409; PMCID: PMC5614906.
3. Yasu T. Comprehensive cardiac rehabilitation program for peripheral arterial diseases. J Cardiol. 2022 Oct;80(4):303-305. doi: 10.1016/j.jjcc.2021.11.011. Epub 2021 Nov 29. PMID: 34857431.