Cardiopulmonary Exercise Testing Techniques to Evaluate Exercise Intolerance
The use of exercise testing is an important tool for the pediatric pulmonologist. Physical stress often reveals cardiorespiratory abnormalities that are not apparent on conventional static tests. There is little doubt the information acquired from exercise tests have diagnostic and prognostic value, but exercise tests may also be critical to determine success or failure of treatment strategies. The purpose of this chapter is to provide the pediatric specialist with an overview of exercise evaluation that may assist in the diagnosis of and management of disease in pediatric and adolescent patients with physical activity intolerance, especially those with cardiorespiratory diseases. The specific aims of this chapter are to: (1) describe various exercise tests and the biomechanical and physiological principles of those tests necessary to assess patients; (2) discuss methods to assess the physical fitness profile of patients with cardiorespiratory diseases and physical limitations; (3) provide specific strategies for an exercise prescription based on the fitness and clinical profile of the patient and; (4) assist the provider in developing a center for exercise evaluation. Although each aim provides unique information, the overall goal of this chapter is to stimulate the pediatric pulmonologist to develop an understanding of indications for cardiopulmonary exercise testing (CPET) and implement strategies to systematically assess each patient’s fitness profile; to track patient’s disease or training progression or alternatively to monitor responses of medical interventions; and to prescribe a well-rounded exercise prescription to maximize functional ability and wellness of individual patients. This chapter is not intended to be an in depth review for exercise physiologists, but is designed to assist the practicing clinician in the logistics of developing a program and a comfort in interpreting studies.
KeywordsExercise testing Exercise evaluation Pediatric pulmonology Treatment strategies Cardiorespiratory disease Physical fitness profile Cardiovascular exercise testing
- 1.Cooper DM, Radom-Aizik S, Shin H, Nemet D. Exercise and lung function in child health and disease. Kendig and Chernick’s disorders of the respiratory tract in children. Saunders 2012; Chapter 13, pp. 234–50.Google Scholar
- 2.Wasserman K, et al. Principles of exercise testing and interpretation. Williams & Wilkins: Lippincott; 2012.Google Scholar
- 4.Pina IL, Balady GJ, Hanson P, Labovitz AJ, Madonna DW, Myers J. Guidelines for clinical exercise testing laboratories. A statement for healthcare professionals from the Committee on Exercise and Cardiac Rehabilitation, American Heart Association. Circulation. 1995;91(3):912–21. http://circ.ahajournals.org/content/91/3/912.full.PubMedCrossRefGoogle Scholar
- 5.Morton AR. Exercise physiology. In: Pediatric respiratory medicine. 2nd edn. Elsevier Inc. 2008; p. 89–99. http://dx.doi.org/10.1016/B978–0–323–04048–8.50012–8.
- 6.Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Joint Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2012;33(23):2917–27. http://www.ncbi.nlm.nih.gov/pubmed/22952138.PubMedCrossRefGoogle Scholar
- 7.Roca J. Exercise testing (chapter 10). In: Clinical respiratory medicine. 4th ed. Elsevier Inc. 2010;143–53. http://dx.doi.org/10.1016/B978–1–4557–0792–8.00010–6.
- 8.Teoh OH, Trachsel D, Mei-Zahav M, Selvadurai H. Exercise testing in children with lung diseases. Paediatr Respir Rev. 2009;10:99–104.Google Scholar
- 10.Han JC, Lawlor DA, Kimm SYS. Childhood obesity – 2010: progress and challenges. 2011;375(9727):1737–48.Google Scholar
- 15.DeHass DM. NCAA study of substance use of college student-athletes. National Collegiate Athletic Association. 2006.Google Scholar
- 16.Tomporowski PD. Cognitive and behavioral responses to acute exercise in youths: a review. Pediatr Exercise Sci. 2003;15(4):348–59. http://journals.humankinetics.com/pes-back-issues/pes-back-issues/cognitiveandbehavioralresponsestoacuteexerciseinyouthsareview.Google Scholar
- 17.Ramos RP, Alencar MCN, Treptow E, Arbex F, Ferreira EM V, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med. 2013;359021. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3666297&tool=pmcentrez&rendertype=abstract.
- 18.Ten Harkel ADJ, Takken T, Van Osch-Gevers M, Helbing WA. Normal values for cardiopulmonary exercise testing in children. Eur J Cardiovasc Prevent Rehabil. 2011;18:48–54.Google Scholar
- 23.Rowland TW. Oxygen uptake and endurance fitness in children: a developmental perspective. 1989.Google Scholar
- 24.Fisher M. Children and exercise: appropriate practices for grades K-6. JOPERD. 2009;80:18–23.Google Scholar
- 28.Walter LM, Foster AM, Patterson RR, Anderson V, Davey MJ, Nixon GM, et al. Cardiovascular variability during periodic leg movements in sleep in children. Sleep. 2009;32(8):1093–9. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2717200&tool=pmcentrez&rendertype=abstract.PubMedCentralPubMedGoogle Scholar
- 29.Sookan T, McKune AJ. Heart rate variability in physically active individuals: reliability and gender characteristics. Cardiovasc J Afr. 2012;23(2):67–72. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3721889&tool=pmcentrez&rendertype=abstract.PubMedCentralPubMedGoogle Scholar
- 31.Gui-Ling X, Jing-Hua W, Yan Z, Hui X, Jing-Hui S, Si-Rui Y. Association of high blood pressure with heart rate variability in children. Iran J Pediatr. 2013;23(1):37–44. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3574990&tool=pmcentrez&rendertype=abstract.PubMedGoogle Scholar
- 33.Yiallourou SR, Sands SA, Walker AM, Horne RSC. Maturation of heart rate and blood pressure variability during sleep in term-born infants. Sleep. 2012;35(2):177–86. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3250356&tool=pmcentrez&rendertype=abstract.PubMedCentralPubMedGoogle Scholar
- 37.Lau J, Engelen L, Bundy A. Parents’ perceptions of children’ s physical activity compared on two electronic diaries. Pediatr Exerc Sci. 2013;7:124–37.Google Scholar
- 38.Lau PWC, Fox KR, Cheung MWL. An analysis of sport identity as a predictor of children’ s participation in sport. Pediatr Exerc Sci. 2006;415–25.Google Scholar
- 39.Borg G. Borg’s perceived exertion and pain scales. Champaign: IL: Human Kinetics. 1998; 104. Available from The Free Library. http://www.thefreelibrary.com/Borg’s+Perceived+Exertion+and+Pain+Scales.-a053509933.Accessed 01 Sep 2014.