Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-25T06:59:32.169Z Has data issue: false hasContentIssue false
  • English
  • Français

Open field stress testing: finally an optimal method in young children? Reference values for mobile cardiopulmonary exercise testing in healthy children aged 4–8 years

Part of: Metabolic

Published online by Cambridge University Press:  10 December 2021

Philipp Kalden Open the ORCID record for Philipp Kalden [Opens in a new window] ,
Isabelle Schoeffl ,
Kathrin Rottermann ,
Florian Loeffelbein ,
Anna Michaelis ,
Franziska Markel ,
Susann Brosig ,
Roman Antonin Gebauer ,
Ingo Daehnert  and
Christian Paech Open the ORCID record for Christian Paech [Opens in a new window]
Philipp Kalden*
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Isabelle Schoeffl
Affiliation:
Department for Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Kathrin Rottermann
Affiliation:
Department for Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
Florian Loeffelbein
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Anna Michaelis
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Franziska Markel
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Susann Brosig
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Roman Antonin Gebauer
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Ingo Daehnert
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
Christian Paech
Affiliation:
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
*
Author for correspondence: P. Kalden, Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289Leipzig, Germany. Tel: +49-341-8651036; Fax: +49-341-8651143. E-mail: Philipp.Kalden@helios-gesundheit.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Cardiopulmonary exercise testing represents the diagnostic tool for determining cardiopulmonary function. Especially in small children, exercise testing is extremely challenging. To address this problem, field testing has been implemented using small mobile devices. This study aims at using this protocol for developing normal values for cardiopulmonary exercise testing in very young children.

Material and methods:

Healthy children aged 4–8 years were recruited. All children were tested according to an outdoor protocol, in which they were instructed to walk, then run slowly, then a little harder and at last run at full speed. Each step lasted for 2 minutes, except the last step, in which the children were instructed to maintain as long as possible.

Results:

A total of 104 children (64 female/35 male, mean age 6.6 years) performed outdoor cardiopulmonary exercise testing using a mobile device. Almost all tests were completed successfully (95%). Despite a predominance of female study subjects, anthropometric values did not differ between boys and girls. V̇O2peak/kg, respiratory exchange ratio, VT1, heart rate at VT1, and time of exercise were also comparable between sexes. Generally, a tendency of higher maximal oxygen uptake could be observed in older children.

Conclusion:

Open field mobile cardiopulmonary exercise testing represents a novel approach in very young children. In this study, we were able to determine normal values of maximal oxygen uptake and OUES/kg for 4–8-year-old children. The method is easy to achieve and safe.

Keywords

CHDopen field stress testingexercise testing
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1598 - 1602
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Philipp Kalden and Isabelle Schoeffl contributed equally to this publication.

References

Guirgis, L, Khraiche, D, Ladouceur, M, Iserin, L, Bonnet, D, Legendre, A. Cardiac performance assessment during cardiopulmonary exercise test can improve the management of children with repaired congenital heart disease. Int J Cardiol 2020; 300: 121–126. DOI 10.1016/j.ijcard.2019.10.032.CrossRefGoogle ScholarPubMed
Goldberg, DJ, Zak, V, McCrindle, BW, et al. Exercise capacity and predictors of performance after Fontan: results from the pediatric heart network Fontan 3 study. Pediatr Cardiol 2021; 42: 158–168. DOI 10.1007/s00246-020-02465-1.CrossRefGoogle ScholarPubMed
Goldberg, DJ, Zak, V, Goldstein, BH, et al. Results of the FUEL trial. Circulation 2020; 141: 641–651. DOI 10.1161/CIRCULATIONAHA.119.044352.CrossRefGoogle ScholarPubMed
Sanz-Santiago, V, Diez-Vega, I, Donadio, MVF, et al. Comparison of physical fitness between healthy and mild-to-moderate asthmatic children with exercise symptoms: a cross-sectional study. Pediatr Pulmonol 2021; 56: 2512–2521. DOI 10.1002/ppul.25506.CrossRefGoogle ScholarPubMed
Nixon, PA, Orenstein, DM, Kelsey, SF, Doershuk, CF. The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 1992; 327: 1785–1788. DOI 10.1056/NEJM199212173272504.CrossRefGoogle ScholarPubMed
Hebestreit, H, Hulzebos, EHJ, Schneiderman, JE, et al. Cardiopulmonary exercise testing provides additional prognostic information in cystic fibrosis, prognostic value of CPET in CF study group. Am J Respir Crit Care Med 2019; 199: 987–995. DOI 10.1164/rccm.201806-1110OC.CrossRefGoogle Scholar
Baba, R, Nagashima, M, Goto, M, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol 1996; 28: 1567–1572. DOI 10.1016/s0735-1097(96)00412-3.CrossRefGoogle ScholarPubMed
Baba, R, Nagashima, M, Nagano, Y, Ikoma, M, Nishibata, K. Role of the oxygen uptake efficiency slope in evaluating exercise tolerance. Arch Dis Child 1999; 81: 73–75. DOI 10.1136/adc.81.1.73.CrossRefGoogle ScholarPubMed
Hollenberg, M, Tager, IB. Oxygen uptake efficiency slope: an index of exercise performance and cardiopulmonary reserve requiring only submaximal exercise. J Am Coll Cardiol 2000; 36: 194–201. DOI 10.1016/s0735-1097(00)00691-4.CrossRefGoogle ScholarPubMed
Akkerman, M, van Brussel, M, Bongers, BC, Hulzebos, EHJ, Helders, PJM, Takken, T. Oxygen uptake efficiency slope in healthy children. Pediatr Exerc Sci 2010; 22: 431–441. DOI 10.1123/pes.22.3.431.CrossRefGoogle ScholarPubMed
Hossri, CA, Souza, IPA, de Oliveira, JS, Mastrocola, LE. Assessment of oxygen-uptake efficiency slope in healthy children and children with heart disease: generation of appropriate reference values for the OUES variable. Eur J Prev Cardiol 2019; 26: 177–184. DOI 10.1177/2047487318807977.CrossRefGoogle ScholarPubMed
Gavotto, A, Vandenberghe, D, Abassi, H, et al. Oxygen uptake efficiency slope: a reliable surrogate parameter for exercise capacity in healthy and cardiac children? Arch Dis Child 2020; 105: 1167–1174. DOI 10.1136/archdischild-2019-317724.CrossRefGoogle ScholarPubMed
van der Cammen-van Zijp, MH, Ijsselstijn, H, Takken, T, et al. Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl Physiol 2010; 108: 393–399. DOI 10.1007/s00421-009-1236-x.CrossRefGoogle ScholarPubMed
Armstrong, N, Williams, J, Balding, J, Gentle, P, Kirby, B. The peak oxygen uptake of British children with reference to age, sex and sexual maturity. Eur J Appl Physiol Occup Physiol 1991; 62: 369–375. DOI 10.1007/BF00634975.CrossRefGoogle ScholarPubMed
Dubowy, KO, Baden, W, Bernitzki, S, Peters, B. A practical and transferable new protocol for treadmill testing of children and adults. Cardiol Young 2008; 18: 615–623. DOI 10.1017/S1047951108003181.CrossRefGoogle ScholarPubMed
Schöffl, I, Ehrlich, B, Stanger, S, Rottermann, K, Dittrich, S, Schöffl, V. Exercise field testing in children: a new approach for age-appropriate evaluation of cardiopulmonary function. Pediatr Cardiol 2020; 41: 1099–1106. DOI 10.1007/s00246-020-02359-2.CrossRefGoogle ScholarPubMed
LeMura, LM, von Duvillard, SP, Cohen, SL, et al. Treadmill and cycle ergometry testing in 5- to 6-year-old children. Eur J Appl Physiol 2001; 85: 472–478. DOI 10.1007/s004210100461.CrossRefGoogle ScholarPubMed
Duff, D K, De Souza, AM, Human, DG, Potts, JE, Harris, KC. A novel treadmill protocol for exercise testing in children: the British Columbia Children’s Hospital protocol. BMJ Open Sport Exerc Med 2017; 3: e000197. DOI 10.1136/bmjsem-2016-000197.CrossRefGoogle ScholarPubMed
Blais, S, Berbari, J, Counil, F-P, Dallaire, F. A systematic review of reference values in pediatric cardiopulmonary exercise testing. Pediatr Cardiol 2015; 36: 1553–1564. DOI 10.1007/s00246-015-1205-6.CrossRefGoogle ScholarPubMed
Beaver, WL, Wasserman, KWL, Whipp, BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol (1985) 1986; 60: 2020–2027. DOI 10.1152/jappl.1986.60.6.2020.CrossRefGoogle ScholarPubMed
Binder, RK, Wonisch, M, Corra, U, et al. Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. Eur J Cardiovasc Prev Rehabil 2008; 15: 726–734. DOI 10.1097/HJR.0b013e328304fed4.CrossRefGoogle Scholar
Rowland, TW. Does peak VO2 reflect VO2max in children?: evidence from supramaximal testing. Med Sci Sports Exerc 1993; 25: 689–693.CrossRefGoogle ScholarPubMed
Sawilowsky, SS, Blair, RC. A more realistic look at the robustness and Type II error properties of the t test to departures from population normality. Psychol Bull 1992; 111: 352–360. DOI 10.1037/0033-2909.111.2.352.CrossRefGoogle Scholar
Kromeyer-Hauschild, K, Wabitsch, M, Kunze, D, et al. Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001; 149: 807–818. DOI 10.1007/s001120170107.CrossRefGoogle Scholar
Armstrong, N, Kirby, BJ, McManus, AM, Welsman, JR. Aerobic fitness of prepubescent children. Ann Hum Biol 1995; 22: 427–441. DOI 10.1080/03014469500004102.CrossRefGoogle ScholarPubMed
Rowland, T, Goff, D, Martel, L, Ferrone, L. Influence of cardiac functional capacity on gender differences in maximal oxygen uptake in children. Chest 2000; 117: 629–635. DOI 10.1378/chest.117.3.629.CrossRefGoogle ScholarPubMed
Winsley, RJ, Fulford, J, Roberts, AC, Welsman, JR, Armstrong, N. Sex difference in peak oxygen uptake in prepubertal children. J Sci Med Sport 2009; 12: 647–651. DOI 10.1016/j.jsams.2008.05.006.CrossRefGoogle ScholarPubMed