New kids on the CPET: age-appropriate outdoor cardiopulmonary exercise testing in preschoolers

Rottermann, Kathrin; Weigelt, Alexandra; Stäbler, T.; Ehrlich, Benedikt; Dittrich, Sven; Schöffl, Isabelle

doi:10.1007/s00421-021-04853-8

Cited by 9 publications

(11 citation statements)

References 37 publications

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“…We used the following physiological criteria for completion of a valid , two of which needed to be met for validation: (1) peak heart rate (peak HR) within 5% of the age-predicted maximum, (2) respiratory exchange ratio (RER) ≥ 1.0 and (3) volitional fatigue [ 30 , 31 ]. We chose a threshold of 1.00 RER for the completion of a valid as it is difficult to achieve higher RER values when performing CPET on a treadmill with children [ 32 ]. The peak oxygen uptake was put in relation to normal values from Kalden et al [ 33 ] for children below the age of 8 and from Bongers et al [ 34 ] for children between 9 and 16 years of age.…”

Section: Methodsmentioning

confidence: 99%

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

Schoeffl,

Raming,

Tratzky

et al. 2024

Eur J Pediatr

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Recently, the importance of post-COVID-19 in children has been recognized in surveys and retrospective chart analysis. However, objective data in the form of cardiopulmonary exercise test as performed in adults suffering from this condition are still lacking. This study aimed to investigate the cardiopulmonary effects of post-COVID-19 on children and adolescents. In this cross-sectional study (the FASCINATE study), children fulfilling the criteria of post-COVID-19 and an age- and sex-matched control group underwent cardiopulmonary exercise testing on a treadmill and completed a questionnaire with regard to physical activity before, during and after the infection with SARS-CoV-2. We were able to recruit 20 children suffering from post-COVID-19 (mean age 12.8 ± 2.4 years, 60% females) and 28 control children (mean age 11.7 ± 3.5 years, 50% females). All participants completed a maximal treadmill test with a significantly lower $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak in the post-COVID-19 group (37.4 ± 8.8 ml/kg/min vs. 43.0 ± 6.7 ml/kg/min. p = 0.019). This significance did not persist when comparing the achieved percentage of predicted $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak . There were no significant differences for oxygen pulse, heart rate, minute ventilation or breathing frequency. Conclusion: This is the first study to investigate post-COVID-19 in children using the cardiopulmonary exercise test. Although there was a significantly reduced $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak in the post-COVID-19 group, this was not true for the percent of predicted values. No pathological findings with respect to cardiac or pulmonary functions could be discerned. Deconditioning was the most plausible cause for the experienced symptoms. Trial registration: clinicaltrials.gov, NCT054445531, Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19—Full Text View—ClinicalTrials.gov. What is Known:• The persistence of symptoms after an infection with SARS-CoV 2, so-called post-COVID-19 exists also in children.• So far little research has been conducted to analyze this entity in the pediatric population. What is New:• This is the first study proving a significantly lower cardiopulmonary function in pediatric patients suffering from post-COVID-19 symptoms.• The cardiac and pulmonary function appear similar between children suffering from post-COVID-19 and those who don’t, but the peripheral muscles seem affected.

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Section: Methodsmentioning

confidence: 99%

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

Schoeffl,

Raming,

Tratzky

et al. 2024

Eur J Pediatr

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“…In clinical populations, differences between

and mode-specific

are likely to be small when appropriate quality control is applied ( 20 ). We therefore used the following physiological criteria for completion of a valid

, two of which needed to be met for validation: (1) peak HR within 5% of the age-predicted maximum, (2) respiratory exchange ratio (RER) ≥1.0, and (3) volitional fatigue ( 21 , 22 ). The first ventilatory threshold (VT1) is a marker of intensity that can be observed in a person's breathing at a point where lactate begins to accumulate in the blood.…”

Section: Methodsmentioning

confidence: 99%

Fitter Fontans for future—Impact of physical exercise on cardiopulmonary function in Fontan patients

Weigelt

Fritsch

Rottermann

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIn Fontans, exercise tolerance is poorer compared to their healthy peers. Higher V˙O2peak represents a strong predictor for mortality and morbidity in these patients. Cardiac rehabilitation programs have been shown to improve cardiopulmonary function in Fontans. More habitual physical activity should therefore lead to a better exercise tolerance.MethodsWe performed cardiopulmonary exercise testing in 24 Fontan patients who had engaged in physical activity for a minimum of 3 h per week over their lifetime. As a control we performed cardiopulmonary exercise testing in 20 Fontan patients who had undertaken no physical activity or <3 h per week in the past.ResultsA total of 44 Fontan patients was included (mean age 18.1 years). The mean parameters measured at peak exercise differed significantly between the active and inactive group (peak oxygen uptake [V˙O2peak] of 34.0 vs. 25.0 ml/min/kg, peak heart rate (HR) of 169.8/min vs. 139.8/min). Even though the O2pulse and the EF did not differ significantly between both groups, N-Terminal-Pro-B-Type Natriuretic Peptide (NT-pro BNP) was significantly higher in the inactive group. The two groups did not differ with respect to their cardiac function determined by magnetic resonance imaging (MRI). V˙O2peak was positively correlated with hours of sports performed by Fontans.ConclusionsV˙O2peak and maximum HR were significantly higher in Fontans who had been physically active compared to those who had been inactive. The values reported in this study were higher than in other studies and reached normal values for V˙O2peak for most Fontans in the physically active group. The positive correlation between V˙O2peak and physical activity is an indicator of the importance of incorporating physical exercise programs into the treatment of Fontan patients.

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“…Although the clinical significance of this difference remains unclear, the authors suggest that the low workload in the paediatric population may have dampened the second wind response. However, it is difficult to draw conclusions from such a small study, and the challenges of eliciting a true maximal exercise test in young subjects may also skew results 83,84 …”

Section: Exercise Testing In Iememmentioning

confidence: 99%

“…However, it is difficult to draw conclusions from such a small study, and the challenges of eliciting a true maximal exercise test in young subjects may also skew results. 83,84 Given the paucity of existing literature, the optimal CPET protocol for either diagnostic or monitoring purposes for children with McArdle disease has not yet been clearly defined. Similarly, the magnitude of the impairment in VO 2 peak, and the associated exercise limitations For patients with LC-FAOD, much of the existing literature on CPET describes single case or small cohort studies designed to assess the efficacy of dietary intervention, such as comparing higher carbohydrate with higher medium chain triglyceride (MCT) diets, or the use of ketones.…”

Section: Cpet In Iememmentioning

confidence: 99%

Exercise testing and prescription in patients with inborn errors of muscle energy metabolism

Batten

Bhattacharya

Simar

et al. 2023

J of Inher Metab Disea

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Skeletal muscle is a dynamic organ requiring tight regulation of energy metabolism in order to provide bursts of energy for effective function. Several inborn errors of muscle energy metabolism (IEMEM) affect skeletal muscle function and therefore the ability to initiate and sustain physical activity. Exercise testing can be valuable in supporting diagnosis, however its use remains limited due to the inconsistency in data to inform its application in IEMEM populations. While exercise testing is often used in adults with IEMEM, its use in children is far more limited. Once a physiological limitation has been identified and the aetiology defined, habitual exercise can assist with improving functional capacity, with reports supporting favourable adaptations in adult patients with IEMEM. Despite the potential benefits of structured exercise programs, data in paediatric populations remain limited. This review will focus on the utilisation and limitations of exercise testing and prescription for both adults and children, in the management of McArdle Disease, long chain fatty acid oxidation disorders, and primary mitochondrial myopathies.

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New kids on the CPET: age-appropriate outdoor cardiopulmonary exercise testing in preschoolers

Cited by 9 publications

References 37 publications

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

Fitter Fontans for future—Impact of physical exercise on cardiopulmonary function in Fontan patients

Exercise testing and prescription in patients with inborn errors of muscle energy metabolism

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