Abstract
Cardiopulmonary exercise testing (CPET) in paediatric cardiology differs in many aspects from the tests as performed in adult cardiology. Children's cardiovascular responses during exercise testing present different characteristics, particularly oxygen uptake, heart rate and blood pressure response, which are essential in interpreting haemodynamic data. Diseases that are associated with myocardial ischaemia are very rare in children. The main indications for CPET in children are evaluation of exercise capacity and the identification of exercise-induced arrhythmias. In this article we will review exercise equipment and test protocols for CPET in children with congenital heart disease. (Neth Heart J 2009;17:339–44.)
Similar content being viewed by others
References
Connuck DM. The role of exercise stress testing in pediatric patients with heart disease. Prog Pediatr Cardiol 2005;20:45–52.
Bar-Or O. Pathophysiological factors which limit the exercise capacity of the sick child. Med Sci Sports Exerc 1986;18:276–82.
Lunt D, Briffa T, Briffa NK, Ramsay J. Physical activity levels of adolescents with congenital heart disease. Aust J Physiother 2003; 49:43–50.
Rich MW. Heart failure disease management: a critical review. J Card Fail. 1999;5:64–75.
James FW, Blomqvist CG, Freed MD, Miller WW, Moller JH, Nugent EW, et al. Standards for exercise testing in the pediatric age group. American Heart Association Council on Cardiovascular Disease in the Young. Ad hoc committee on exercise testing. Circulation. 1982;66:1377A–97A.
Rowland TW. Aerobic exercise testing protocols. In: Rowland TW, editor. Pediatric Laboratory Exercise Testing: Clinical Guidelines. Champaign, Ill: Human Kinetics; 1993. p. 19–41.
Stephens P Jr, Paridon SM. Exercise testing in Pediatrics. Pediatr Clin North Am. 2004;51:1569–87, viii.
Macfarlane DJ. Automated metabolic gas analysis systems: a review. Sports Med. 2001;31:841–61.
Lightfoot JT. Can blood pressure be measured during exercise? A review. Sports Med. 1991;12:290–301.
Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA. Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing. Blood Press Monit. 2004;9:269–75.
Chang RK, Gurvitz M, Rodriguez S, Hong E, Klitzner TS. Current practice of exercise stress testing among pediatric cardiology and pulmonology centers in the United States. Pediatr Cardiol. 2006;27:110–6.
Balke B, Ware RW. An experimental study of “physical fitness” of air force personnel. U S Armed Forces Med J. 1959;10:675–88.
Ellestad M. Stress Testing. Oxford: Oxford University Press; 2003.
Bar-Or O, Rowland TW. Pediatric Exercise Medicine. From Physiologic principles to healthcare Application. Champaign, IL: Human Kinetics; 2004.
James FW, Kaplan S, Glueck CJ, Tsay JY, Knight MJ, Sarwar CJ. Responses of normal children and young adults to controlled bicycle exercise. Circulation. 1980;61:902–12.
Godfrey S. Exercise testing in children. London: W.B. Saunders Company Ltd; 1974.
Karila C, de Blic J, Waernessyckle S, Benoist MR, Scheinmann P. Cardiopulmonary exercise testing in children: an individualized protocol for workload increase. Chest. 2001;120:81–7.
Hebestreit H. Exercise testing in children - What works, what doesn't, and where to go to? Paediatr Respir Rev. 2004;5:S11–S4.
Buchfuhrer MJ, Hansen JE, Robinson TE, Sue DY, Wasserman K, Whipp BJ. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol. 1983;55:1558–64.
Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardiorespiratory performance. J Appl Physiol. 1955;8:73–80.
Mitchell JH, Blomqvist G. Maximal oxygen uptake. N Engl J Med. 1971;284:1018–22.
Will PM, Walter JD. Exercise testing: improving performance with a ramped Bruce protocol. Am Heart J. 1999;138:1033–7.
Myers J, Buchanan N, Walsh D, Kraemer M, McAuley P, Hamilton-Wessler M, et al. Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol. 1991;17:1334–42.
Whipp BJ, Davis JA, Torres F, Wasserman K. A test to determine parameters of aerobic function during exercise. J Appl Physiol. 1981;50:217–21.
Hill AV, Long CNH, Lupton H. Muscular exercise, lactic acid and the supply and use of oxygen. Parts I-III. Proc R Soc Biol. 1924;96:438–75.
Bruce RA. Exercise testing for evaluation of ventricular function. New Engl J Med. 1977;296:671–5.
Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, et al. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation. 2006; 113:1905–20.
Bruce RA, Blackmon JR, Jones JW, Strait G. Exercise testing in adult normal subjects and cardiac patients. Pediatrics. 1963;32: Suppl-56.
American College of Sports M. Guidelines for exercise testing and prescription. Philadelphia: Lea and Febiger;. 1991.
McInnis K, Balady G, Weiner D, Ryan T. Comparison of ischaemic and physiologic responses during exercise tests in men using the standard and modified Bruce protocols. Am J Cardiol.. 1992;69: 84–9.
Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104:1694–740.
Barber G. Pediatric exercise testing: methodology, equipment and normal values. Prog Pediatr Cardiol. 1993;2:4–10.
Balke B. [Optimum physical working capacity, its measurement and change as a result of the working fatigue]. Arbeitsphysiologie. 1954;15:311–23.
Balke B, Ware RW. An experimental study of physical fitness of Air Force personnel. U S Armed Forces Med J. 1959;10:675–88.
Rowland TW. Crusading for the Balke protocol. Pediatr Exer Sci. 1999;11:189–92.
Buchfuhrer M, Hansen J, Robinson T, Sue D, Wasserman K, Whipp B. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol. 1983;55:1558–64.
Benedict FG, Cady WG. A bicycle ergometer with an electric brake. Washington DC: Carnegie Institute of Washington; 1912. Report No: Publication no. 167.
Krogh A. A bicycle ergometer and respiration apparatus for the experimental study of muscular work. Scand Arch Physiol. 1913;33:375–80.
Kuipers H, Verstappen FT, Keizer HA, Geurten P, van Kranenburg G. Variability of aerobic performance in the laboratory and its physiologic correlates. Int J Sports Med. 1985;6:197–201.
Astrand P, Rodahl K. Textbook of work physiology, physiological bases of exercise. New York: McGraw-Hill Book Company; 1986.
Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of Exercise Testing and Interpretation. Baltimore, MD: Lippincott, Williams and Wilkins; 1999.
Tanner CS, Heise CT, Barber G. Correlation of the physiologic parameters of a continuous ramp versus an incremental James exercise protocol in normal children. Am J Cardiol.. 1991;67: 309–12.
Barber G. Pediatric exercise testing: methodology, equipment and normal values. Progr Pediatr Cardiol. 1993;2:4–10.
Bar-Or O. Pediatric sports medicine for the practitioner. New York: Springer-Verlag; 1983.
Author information
Authors and Affiliations
Corresponding author
Additional information
Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
T. Takken Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KB02.056.0, PO Box 85090, 3508 AB Utrecht, the Netherlands
Rights and permissions
About this article
Cite this article
Takken, T., Blank, A.C., Hulzebos, E.H. et al. Cardiopulmonary exercise testing in congenital heart disease: equipment and test protocols. NHJL 17, 339–344 (2009). https://doi.org/10.1007/BF03086280
Issue Date:
DOI: https://doi.org/10.1007/BF03086280