Current Practice of Exercise Stress Testing Among Pediatric Cardiology and Pulmonology Centers in the United States

Abstract

The objective of this study was to characterize current practice patterns for clinical exercise stress testing (EST) in children in the United States. We conducted a survey of 109 pediatric cardiology programs and 91 pediatric pulmonology programs at children's hospitals or university hospitals in the United States. A total of 115 programs from 88 hospitals responded (response rate, 58%). A higher percentage of cardiology programs (98.7%) have exercise laboratories compared with pulmonology programs (77.5%). Sixty-three percent of respondents have both a treadmill and a cycle ergometer. A larger proportion of respondents (76%) rely primarily or exclusively on treadmill, whereas a smaller number use cycle ergometer (24%). Sixty-seven percent of respondents reported that they include metabolic measurements in EST protocols. Respondents have varying minimum age criteria for EST, with 9% reporting < or = 4 years, 25% reporting 5 years, 31% reporting 6 years, 16% reporting 7 years, and 20% reporting > or =8 years. Programs using cycle ergometers tend to test children at a younger age and to measure metabolic parameters. Seventy-nine percent of respondents use Bruce and modified Bruce protocols. Institutional protocols are used by 14%. Ninety percent of respondents use technicians to perform EST and 8% use nurses, but 76% require physician presence during testing. The majority of respondents (57%) perform < 100 pediatric tests per year. There are wide variations in the current practice of EST among pediatric subspecialty programs in the United States. Treadmills are used more frequently than cycle ergometers, and Bruce and modified Bruce protocols are commonly used. Most survey respondents measure metabolic parameters during EST.

A meta-analysis of cardiopulmonary exercise testing in pre-pubertal healthy children produces new information

“…[2][3][4] Peak oxygen consumption (peak VO 2 ), a CPX measurement, is one of the indicators of a person's cardiorespiratory condition. Peak VO 2 deficits are associated with increased chances of developing other risk factors for cardiovascular disease in adulthood 5,6 and also helps screening ill pediatric patients, [7][8][9] responses to treatment [10][11][12][13][14] and prognostic factors.…”

Exercise limitation in patients with Fontan circulation: a review

“…Moreover, it is an important predictor of outcome and survival in patients with cardiovascular disease [6], as well as in healthy subjects [6,7]. Therefore, measurement of exercise capacity has become widespread in adult [8] and paediatric cardiology practice [9]. Several professional organisations have published guidelines for the performance and interpretation of maximal exercise tests in both adults [10][11][12] and children [13].…”

Statement on Exercise Testing in Cystic Fibrosis

“…Of the many protocols available for treadmill exercise testing, the Bruce protocol [66] is the most widely used in North America [29,67] and Europe [68,69]. Although originally used to assess functional aerobic impairment in cardiovascular disease [66], the Bruce treadmill protocol has also been used in patients with CF and a variety of other pulmonary diseases such as COPD [70,71], pulmonary artery hypertension [72] and lung transplantation [73,74].…”

“…Less than 10% of UK CF centers have access to facilities for full cardiopulmonary exercise testing (CPET) [28], while equipment for full CPET is available in more than 50% of German CF centers [1]. In the US, more than 60% of pediatric cardiology and pulmonary programs include gas exchange measures in exercise tests [29]. …”