Exercise testing in pediatrics
Section snippets
Changes in the cardiovascular and pulmonary systems in the normal patient during dynamic exercise
In the healthy individual, cardiac output may increase fivefold during exercise as a result of an increase in stroke volume and heart rate. This increased output is not evenly distributed. The muscles, heart, and skin (to effectuate proper cooling) are the primary recipients of this increased blood flow. Other vital organs such as the gut, kidneys, and central nervous system see no significant changes in blood flow during exercise. Therefore, exercise can be thought of as the state of increased
Indications for exercise stress testing
Most pediatric patients undergo exercise testing for evaluation of nonischemic heart disease. The most common reason is the evaluation of exercise performance in preoperative or postoperative congenital heart defects. Other common indications include cardiomyopathies, exercise-induced symptoms including palpitations or syncope, possible arrhythmias during exercise, and suspected pulmonary disorders such as exercise-induced bronchospasm (Box 1) [3].
Risk to the patient and contraindications to exercise testing
The actual risk of exercise testing in the pediatric population is believed to be quite low. Indeed, in adults, exercise entails a small risk: data confirm up to 1 myocardial infarction or death per 2500 tests [5]. Given that ischemic heart disease is rare in the pediatric population, the authors estimate the risk is far less than in adults.
Exercise physiologists generally agree that there are absolute and relative contraindications to graded exercise testing (Box 2). Before the test, all
Laboratory equipment, staff, and procedures
All laboratories should have basic equipment, which includes an automated blood pressure monitoring system with manual override, a cycle ergometer, a treadmill, high-quality ECG recording systems and writers, spirometers, and pulse oximeters. In most pediatric laboratories, metabolic carts with gas analyzers, which can assess ventilation and cardiac output, are typically in place. Qualified technicians, physicians, and emergency equipment and supplies in the event of respiratory or cardiac
Types of protocols and choice of test
The choice of treadmill testing or cycle ergometry depends on the type of information desired. The cycle ergometer has practical advantages over treadmill testing: it is less expensive to purchase and maintain, is safer, and is less intimidating to exercising subjects. One of the most important advantages of cycle ergometry is decreased artifact when measuring ECG and blood pressure data. Physical working capacity can be easily assessed with modern electronically braked cycle ergometers but is
Assessment of aerobic fitness
Assessing aerobic fitness has been the topic of many publications. Space does not allow an in-depth analysis of how fitness is assessed. Numerous studies have examined heart rate, ratings of perceived exertion by the subject or examiner, oxygen consumption, working capacity, and endurance times, alone or in combination, as a way of assessing whether the test was maximally strenuous. The advantages and disadvantages of these indices are discussed briefly here, and then the authors discuss their
Congenital heart disease
More formal exercise studies have been performed more in children with congenital heart disease than in any other pediatric group. Exercise testing in patients with congenital lesions can aid the decision-making process as to whether an intervention such as surgery is needed or can help in assessing the success of an intervention.
Summary
State-of-the-art stress testing laboratories can provide a myriad of useful physiologic data on patients with congenital malformations or suspected of having acquired disorders. Unlike most medical tests, which are performed on resting subjects, exercise stress testing can assess the functional capacity of the individual and can provide a more complete understanding of the patient's physical abilities and limitations.
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Principals of exercise testing and interpretation
Cited by (36)
Normative Values for Cardiopulmonary Exercise Stress Testing Using Ramp Cycle Ergometry in Children and Adolescents
2021, Journal of PediatricsCitation Excerpt :MVV was directly measured over a 10-second interval and multiplied by 6 to provide the MVV over 1 minute. The measured MVV was used to calculate the breathing reserve at peak exercise using a standard formula.11 Owing to potential error in measuring MVV in pediatric patients owing to poor technical effort, an alternative estimate of MVV is also calculated using the formulate forced expiratory volume at 1 second × 40 to provide an estimated breathing reserve.
Exercise stress testing: A valuable tool to predict risk and prognosis
2019, Progress in Pediatric CardiologyCitation Excerpt :Additionally, any musculoskeletal or neurological impairment will impact exercise performance. Thus, EST can help evaluate a patient's complex physiologic response to exercise and determine why exercise limitations may occur, as well as risk stratify patients [7,8]. Modern exercise laboratories typically measure maximal oxygen consumption (VO2), carbon dioxide production (VCO2), heart rate and calculate oxygen pulse (VO2/HR), the latter surrogate of stroke volume.
Pulmonary function tests and polysomnography in infants and children: Practical aspects
2015, Journal de Pediatrie et de PuericultureCardiopulmonary stress testing
2010, Paediatric CardiologyAssessment of exercise capacity in congenital heart disease
2016, Archivos de Cardiologia de MexicoPhysical exercise and cardiovascular response: design and implementation of a pediatric CMR cohort study
2023, International Journal of Cardiovascular Imaging