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Overview of aerobic exercise testing in children and adolescents

Authors
James M Pivarnik, PhD
Dawn P Coe, PhD
Section Editors
Albert C Hergenroeder, MD
George B Mallory, MD
Deputy Editor
Carrie Armsby, MD, MPH

EXERCISE TESTING BASICS

Indications — Incremental aerobic exercise tests are performed in children and adolescents for a variety of reasons (table 1) [1]. The primary indication is to provide the clinician with information about a young patient's physical working capacity. The information gained from an aerobic exercise test is helpful in determining:

Whether a patient can perform daily activities within his or her functional capacity

Whether he or she is responding appropriately to an exercise intervention program

Whether chronic disease progression is affecting the patient's physical capacity

Contraindications — Exercise testing can be performed safely in most children. Absolute contraindications to exercise testing include:

                                  

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
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References
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  1. Paridon SM, Alpert BS, Boas 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.
  2. Blais S, Berbari J, Counil FP, Dallaire F. A Systematic Review of Reference Values in Pediatric Cardiopulmonary Exercise Testing. Pediatr Cardiol 2015; 36:1553.
  3. 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.
  4. Krahenbuhl GS, Skinner JS, Kohrt WM. Developmental aspects of maximal aerobic power in children. Exerc Sport Sci Rev 1985; 13:503.
  5. TAYLOR HL, BUSKIRK E, HENSCHEL A. Maximal oxygen intake as an objective measure of cardio-respiratory performance. J Appl Physiol 1955; 8:73.
  6. Welsman JR, Armstrong N. The measurement and interpretation of aerobic fitness in children: current issues. J R Soc Med 1996; 89:281P.
  7. Rowland TW. Does peak VO2 reflect VO2max in children?: evidence from supramaximal testing. Med Sci Sports Exerc 1993; 25:689.
  8. Hill AV. Muscular Activity, Tindall & Cox, London 1925.
  9. Hill AV, Long CN, Lupton H. Muscular exercise, lactic acid and the supply and utilization of oxygen. Part IV-VIII. Proc R Soc Lond 1924; B97:84.
  10. Gerstenblith G, Lakatta EG, Weisfeldt ML. Age changes in myocardial function and exercise response. Prog Cardiovasc Dis 1976; 19:1.
  11. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol 2001; 37:153.
  12. Peyer K, Pivarnik JM, Coe DP. The relationship among HRpeak, RERpeak, and VO2peak during treadmill testing in girls. Res Q Exerc Sport 2011; 82:685.
  13. Armstrong N, Welsman JR. Assessment and interpretation of aerobic fitness in children and adolescents. Exerc Sport Sci Rev 1994; 22:435.
  14. Atomi Y, Fukunaga T, Yamamoto Y, et al. Lactate threshold and VO2max of trained and untrained boys relative to muscle mass and composition. In: Children and exercise XII, Rutenfranz J, Mocellin R, Klimt F (Eds), Human Kinetics, Champaign, IL 1986. p.53.
  15. Tanaka H, Shindo M. Running velocity at blood lactate threshold of boys aged 6-15 years compared with untrained and trained young males. Int J Sports Med 1985; 6:90.
  16. Foster C, Schrager M, Snyder AC. Blood lactate and respiratory measurement of the capacity for sustained exercise. In: Physiological Assessment of Human Fitness, Maud PJ, Foster C (Eds), Human Kinetics, Champaign, IL 1995. p.57.
  17. Washington RL. Anaerobic threshold. In: Pediatric Laboratory Exercise Testing, Human Kinetics, Champaign, IL 1993. p.115.
  18. Wilmore JH, Costill DL. Physiology of Sport and Exercise, Human Kinetics, Champaign, IL 1994. p.215.
  19. Payne VG, Morrow JR Jr. Exercise and VO2 max in children: a meta-analysis. Res Q Exerc Sport 1993; 64:305.
  20. Mandigout S, Lecoq AM, Courteix D, et al. Effect of gender in response to an aerobic training programme in prepubertal children. Acta Paediatr 2001; 90:9.
  21. Rowland TW, Boyajian A. Aerobic response to endurance exercise training in children. Pediatrics 1995; 96:654.
  22. Rowland TW. Aerobic response to endurance training in prepubescent children: a critical analysis. Med Sci Sports Exerc 1985; 17:493.
  23. Mandigout S, Melin A, Lecoq AM, et al. Effect of two aerobic training regimens on the cardiorespiratory response of prepubertal boys and girls. Acta Paediatr 2002; 91:403.
  24. Katch VL. Physical conditioning of children. J Adolesc Health Care 1983; 3:241.
  25. Rowland TW. The Plasticity of Aerobic Fitness. In: Developmental Exercise Physiology, Human Kinetics, Champaign, IL 1996. p.97.
  26. Nottin S, Vinet A, Stecken F, et al. Central and peripheral cardiovascular adaptations to exercise in endurance-trained children. Acta Physiol Scand 2002; 175:85.
  27. Bouchard C, Lesage R, Lortie G, et al. Aerobic performance in brothers, dizygotic and monozygotic twins. Med Sci Sports Exerc 1986; 18:639.
  28. Bar-Or O. Pathophysiological factors which limit the exercise capacity of the sick child. Med Sci Sports Exerc 1986; 18:276.
  29. McFadden ER Jr, Gilbert IA. Exercise-induced asthma. N Engl J Med 1994; 330:1362.
  30. Nixon PA. Role of exercise in the evaluation and management of pulmonary disease in children and youth. Med Sci Sports Exerc 1996; 28:414.
  31. Haby MM, Anderson SD, Peat JK, et al. An exercise challenge protocol for epidemiological studies of asthma in children: comparison with histamine challenge. Eur Respir J 1994; 7:43.
  32. Hallstrand TS, Curtis JR, Koepsell TD, et al. Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. J Pediatr 2002; 141:343.
  33. Abu-Hasan M, Tannous B, Weinberger M. Exercise-induced dyspnea in children and adolescents: if not asthma then what? Ann Allergy Asthma Immunol 2005; 94:366.
  34. Seear M, Wensley D, West N. How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren? Arch Dis Child 2005; 90:898.
  35. Baba R, Nagashima M, Tauchi N, et al. Cardiorespiratory response to exercise in patients with exercise-induced bronchial obstruction. J Sports Med Phys Fitness 1997; 37:182.
  36. Zach M, Oberwaldner B, Häusler F. Cystic fibrosis: physical exercise versus chest physiotherapy. Arch Dis Child 1982; 57:587.
  37. Radtke T, Stevens D, Benden C, Williams CA. Clinical exercise testing in children and adolescents with cystic fibrosis. Pediatr Phys Ther 2009; 21:275.
  38. Bongers BC, Werkman MS, Arets HG, et al. A possible alternative exercise test for youths with cystic fibrosis: the steep ramp test. Med Sci Sports Exerc 2015; 47:485.
  39. Loutzenhiser JK, Clark R. Physical activity and exercise in children with cystic fibrosis. J Pediatr Nurs 1993; 8:112.
  40. 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.
  41. Javadpour SM, Selvadurai H, Wilkes DL, et al. Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis? Arch Dis Child 2005; 90:792.
  42. Sawyer EH, Clanton TL. Improved pulmonary function and exercise tolerance with inspiratory muscle conditioning in children with cystic fibrosis. Chest 1993; 104:1490.
  43. Orenstein DM, Franklin BA, Doershuk CF, et al. Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program. Chest 1981; 80:392.
  44. Selvadurai HC, Blimkie CJ, Meyers N, et al. Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Pediatr Pulmonol 2002; 33:194.
  45. Schneiderman-Walker J, Pollock SL, Corey M, et al. A randomized controlled trial of a 3-year home exercise program in cystic fibrosis. J Pediatr 2000; 136:304.
  46. Gruber W, Orenstein DM, Braumann KM, Hüls G. Health-related fitness and trainability in children with cystic fibrosis. Pediatr Pulmonol 2008; 43:953.
  47. Brundage BH. Exercise testing in primary pulmonary hypertension: a valuable diagnostic tool. J Am Coll Cardiol 1991; 18:1745.
  48. Rhodes J, Barst RJ, Garofano RP, et al. Hemodynamic correlates of exercise function in patients with primary pulmonary hypertension. J Am Coll Cardiol 1991; 18:1738.
  49. Garofano RP, Barst RJ. Exercise testing in children with primary pulmonary hypertension. Pediatr Cardiol 1999; 20:61.
  50. Barst RJ. Diagnosis and treatment of pulmonary artery hypertension. Curr Opin Pediatr 1996; 8:512.
  51. Buckler JM. Plasma growth hormone response to exercise as diagnostic aid. Arch Dis Child 1973; 48:565.
  52. Donaubauer J, Kratzsch J, Fritzsch C, et al. The treadmill exhausting test is not suitable for screening of growth hormone deficiency! Horm Res 2001; 55:137.
  53. Palayew K, Crock P, Pianosi P, et al. Growth hormone response in very short children. Clin Invest Med 1991; 14:331.
  54. Keyser RE, Peralta L, Cade WT, et al. Functional aerobic impairment in adolescents seropositive for HIV: a quasiexperimental analysis. Arch Phys Med Rehabil 2000; 81:1479.
  55. Pihkala J, Happonen JM, Virtanen K, et al. Cardiopulmonary evaluation of exercise tolerance after chest irradiation and anticancer chemotherapy in children and adolescents. Pediatrics 1995; 95:722.
  56. De Caro E, Fioredda F, Calevo MG, et al. Exercise capacity in apparently healthy survivors of cancer. Arch Dis Child 2006; 91:47.
  57. Zaccara A, Turchetta A, Calzolari A, et al. Maximal oxygen consumption and stress performance in children operated on for congenital diaphragmatic hernia. J Pediatr Surg 1996; 31:1092.
  58. Pastore E, Marino B, Calzolari A, et al. Clinical and cardiorespiratory assessment in children with Down syndrome without congenital heart disease. Arch Pediatr Adolesc Med 2000; 154:408.
  59. Wee SO, Pitetti KH, Goulopoulou S, et al. Impact of obesity and Down syndrome on peak heart rate and aerobic capacity in youth and adults. Res Dev Disabil 2014; 36C:198.
  60. Broström E, Nordlund MM, Cresswell AG. Plantar- and dorsiflexor strength in prepubertal girls with juvenile idiopathic arthritis. Arch Phys Med Rehabil 2004; 85:1224.
  61. Giannini MJ, Protas EJ. Aerobic capacity in juvenile rheumatoid arthritis patients and healthy children. Arthritis Care Res 1991; 4:131.
  62. van Brussel M, Lelieveld OT, van der Net J, et al. Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57:891.
  63. Bar-Or O. Role of exercise in the assessment and management of neuromuscular disease in children. Med Sci Sports Exerc 1996; 28:421.
  64. Lundberg A. Longitudinal study of physical working capacity of young people with spastic cerebral palsy. Dev Med Child Neurol 1984; 26:328.
  65. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994; 121:953.
  66. Fulcher KY, White PD. Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 2000; 69:302.
  67. Hergenroeder AC, personal communication.
  68. Takken T, Henneken T, van de Putte E, et al. Exercise testing in children and adolescents with chronic fatigue syndrome. Int J Sports Med 2007; 28:580.
  69. Riley MS, O'Brien CJ, McCluskey DR, et al. Aerobic work capacity in patients with chronic fatigue syndrome. BMJ 1990; 301:953.