Table 13. Comparison of major cycle ergometer protocols.

Protocol	Indications	Initial load	Load increase
Balke	Healthy children and adolescents *	25W	25W/2 minutes
Astrand 299	Children and adolescents	25W	25W/3 minutes
McMaster * 300	Children ** and adolescents ***	12.5W to 25W	5 increment modes, depending on height and sex, at a regular interval of 2 minutes
James * 301 , 302	Active children and adolescents *	33W	3 increment modes, depending on BSA, at a regular interval of 3 minutes
Godfrey * 303 , 304	Children * and adolescents	10W to 20W	3 increment modes, depending on height, at a regular interval of 1 minute
Rampa 297 , 305	All populations; ideal for athletes **	10W to 20W	5 to 20W/1 minute. Subdivide increment into equal amounts and increase at regular intervals (<60 seconds) ****

^*See Table 14 for a detailed description of each protocol.

^**Based on height, only for children aged 6 years and older.

^***Patients with heart, lung, or muscle diseases may require reductions in initial workload.

^****Example: ramp protocol with increment of 15 W/minute = increase load by 5W every 20 seconds.