Pediatric Exercise Testing: Value and Implications of Peak Oxygen Uptake

Abstract

Peak oxygen uptake (peakV˙O2) measured by clinical exercise testing is the benchmark for aerobic fitness. Aerobic fitness, estimated from maximal treadmill exercise, is a predictor of mortality in adults. PeakV˙O2 was shown to predict longevity in patients aged 7–35 years with cystic fibrosis over 25 years ago. A surge of exercise studies in young adults with congenital heart disease over the past decade has revealed significant prognostic information. Three years ago, the first clinical trial in children with pulmonary arterial hypertension used peakV˙O2 as an endpoint that likewise delivered clinically relevant data. Cardiopulmonary exercise testing provides clinicians with biomarkers and clinical outcomes, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response hidden at rest. Momentum from these pioneering observations in multiple disease states should impel clinicians to employ similar methods in other patient populations; e.g., sickle cell disease. Advances in pediatric exercise science will elucidate new pathways that may identify novel biomarkers. Our initial aim of this essay is to highlight the clinical relevance of exercise testing to determine peakV˙O2, and thereby convince clinicians of its merit, stimulating future clinical investigators to broaden the application of exercise testing in pediatrics.

The Amsterdam Growth and Health Longitudinal Study: how important is physical activity in youth for later health? (ELS 33)

“…[3][4][5] Aerobic fitness was measured with a maximal running test on a treadmill with continuous measurement of oxygen uptake (VO 2 peak ). 6 There after a six-minute sub-maximal running test at a speed of 8 km/h and increasing slope of 0, 2.5 and 5% was recorded. After a short rest, running was continued at the same constant speed of 8 km/h while the slope was increased every two minutes by 2.5 or 5%, depending on the heart rate.…”

Small effort, high impact: Focus on physical activity improves oxygen uptake (VO2peak), quality of life, and mental health after pediatric renal transplantation

“…Peak oxygen uptake (VO 2 peak ) is a validated method to measure cardiorespiratory fitness and inactivity generally results in low VO 2 peak . In our previous study, the HENT 1 (HEalth after kidNey Transplantation) performed 2008‐2009, and we showed that children with a renal transplant had a significantly lower VO 2 peak than healthy children .…”

Ergospirometrische Belastungsuntersuchungen in der Pädiatrie

“…Neben der subjektiven Einschätzung der körperlichen Belastbarkeit durch Patienten oder deren Eltern gibt es wenige objektive Diagnoseverfahren, um eine umfassende Zustandsbeschreibung von Herz-, Kreislauf-und Atmungssystem eines Patienten, Probanden zu erhalten. Die ergospirometrische Belastungsuntersuchung (englisch: cardio-pulmonary-exercise-test = CPET) ist eines der am besten standardisierten Verfahren für die objektive Einschätzung der Funktion des Respirationstraktes, des Herz-Kreislaufsystems, der neuromuskulären Balance sowie des metabolischen Zustandes in Ruhe und unter Maximalbelastung [7].…”