Pediatric Cardiology

, Volume 31, Issue 7, pp 1043–1048 | Cite as

Correlation of Subjective Questionnaires With Cardiac Function as Determined by Exercise Testing in a Pediatric Population

  • Rebekah Burns
  • Inger Olson
  • Jeffrey Kazmucha
  • Raymond Balise
  • Rita Chin
  • Clifford Chin
Original Article

Abstract

Background: Although exercise testing is an important objective method used to assess cardiopulmonary function, subjective assessment often is used as a proxy in the clinical setting. This study aimed to determine whether responses to a subjective functional capacity questionnaire administered to parents and patients in a pediatric exercise laboratory correlate with objective assessment of functional capacity, measured by peak oxygen consumption during maximal voluntary exercise testing. Methods: Subjective questionnaire responses and exercise test results collected over 10 years were retrospectively analyzed. Symptoms and physical capabilities were assessed using a 6-point Likert scale regarding the ability to attend school/work, walk, climb stairs, and run, as well as the frequency of fatigue, palpitations, and chest pain. Values of 0 to 3 were considered abnormal, whereas values of 4–5 were regarded as normal. Exercise testing was performed on a stationary cycle ergometer with a continuous ramping protocol. Heart rate and oxygen saturation were continuously monitored. Blood pressures and electrocardiograms (ECGs) were obtained at 2-min intervals. Metabolic gas analysis was performed using a breath-by-breath method. The results of the exercise testing were normalized for body size and expressed as a percentage of predicted peak oxygen consumption (%pVO2). Results: Very weak but statistically significant correlations (τ < 0.25; P < 0.05) between the scores of the school/work, walking, stair climbing, running, and fatigue items and %pVO2 were found using Kendall’s rank correlations. Conclusions: The subjective Likert scales used to assess basic physical capacity and cardiac-associated symptoms have limited ability to predict actual functional capacity as measured by %pVO2 achieved. The very weak rank-order correlation between %pVO2 achieved and the subjective reporting of the ability to attend school/work, walk, climb stairs, and run has low clinical significance and will not be useful in predicting functional capacity within the clinic setting.

Keywords

Exercise Pediatric Questionnaire 

References

  1. 1.
    Chang RK, Gurvitz M, Rodrigues S, Hong E, Klitzner TS (2006) Current practice of exercise stress testing among pediatric cardiology and pulmonology centers in the United States. Pediatr Cardiol 27:110–116CrossRefPubMedGoogle Scholar
  2. 2.
    Cooper DM, Weiler-Ravell D, Whipp BJ, Wasserman L (1984) Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol 56:628–634PubMedGoogle Scholar
  3. 3.
    Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC (2008) Chest pain: characteristics of children/adolescents. Pediatr Cardiol 29:775–781CrossRefPubMedGoogle Scholar
  4. 4.
    Davis JA, McBride MG, Christnat MRK, Patil SM, Hanna BD, Pardon SM (2006) Longitudinal assessment of cardiovascular exercise performance after pediatric heart transplantation. J Heart Lung Transplant 25:626–633CrossRefPubMedGoogle Scholar
  5. 5.
    Gratz A, Hess J, Hager A (2009) Self-estimated physical functioning poorly predicts actual exercise capacity in adolescents and adults with congenital heart disease. Eur Heart J 30:498–504CrossRefGoogle Scholar
  6. 6.
    Hager A, Hess J (2005) Comparison of health-related quality of life with cardiopulmonary exercise testing in adolescents and adults with congenital heart disease. Heart 91:517–520CrossRefPubMedGoogle Scholar
  7. 7.
    LeMura LM, von Duvillard SP, Cohen SL, Root CJ, Chelland SA, Andreacci J, Hoover J, Weatherford J (2001) Treadmill and cycle ergometry testing in 5- to 6-year-old children. Eur J Appl Physiol 85:472–478CrossRefPubMedGoogle Scholar
  8. 8.
    Macek M, Vavra J, Novosadova J (1976) Prolonged exercise in prepubetal boys: I. Cardiovascular and metabolic adjustment. Eur J Appl Physiol 35:291–298CrossRefGoogle Scholar
  9. 9.
    Massin MM, Bourgulgnont A, Coremans C, Comté L, Lepage P, Gérard P (2004) Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr 43:231–238CrossRefGoogle Scholar
  10. 10.
    Myers J, Do D, Herbert W, Ribisl P, Froelicher VF (1994) A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data. Am J Cardiol 73:591–596CrossRefPubMedGoogle Scholar
  11. 11.
    Myers J, Bader D, Madhavan R, Froelicher VF (2001) Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing. Am Heart J 132:1041–1046CrossRefGoogle Scholar
  12. 12.
    Paridon SM, Mitchell PD, Colan SD, Williams RV, Blaufox A, Li JS, Margossian R, Mital S, Russell J, Rhodes J (2008) A cross-sectional study of exercise performance during the first 2 decades of life after the Fontan operation. J Am Coll Cardiol 52:99–107CrossRefPubMedGoogle Scholar
  13. 13.
    Rankin SL, Briffa TG, Morton AR, Jung J (1996) A specific activity questionnaire to measure the functional capacity of cardiac patients. Am J Cardiol 77:1220–1223CrossRefPubMedGoogle Scholar
  14. 14.
    Rowland TW (1993) Does peak VO2 reflect PVO2 in children? Evidence from supramaximal testing. Med Sci Sports Excer 25:689–693Google Scholar
  15. 15.
    Salim MA, Alpert BS (1993) Indications and contraindications for exercise testing: children and adolescents. Prog Pediatr Cardiol 2:18–23CrossRefGoogle Scholar
  16. 16.
    Selbst SM, Ruddy RM, Clark BJ, Henretig FM, Santulli T (1988) Pediatric chest pain: a prospective study. Pediatrics 82:319–323PubMedGoogle Scholar
  17. 17.
    Wilson JR, Rayos G, Yeoh TK, Gothard P, Bak K (1995) Dissociation between exertional symptoms and circulatory function in patients with heart failure. Circulation 92:47–53PubMedGoogle Scholar
  18. 18.
    Zavaras-Angelidou KA, Weinhouse E, Nelson DB (1992) Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care 8:189–193CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rebekah Burns
    • 1
  • Inger Olson
    • 2
  • Jeffrey Kazmucha
    • 1
  • Raymond Balise
    • 3
  • Rita Chin
    • 1
  • Clifford Chin
    • 2
  1. 1.Lucile Packard Children’s HospitalPalo AltoUSA
  2. 2.Pediatric CardiologyStanford UniversityPalo AltoUSA
  3. 3.Health Reseach and PolicyStanford UniversityPalo AltoUSA

Personalised recommendations