Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values.
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ABSTRACT:
SUBMITTER: van der Cammen-van Zijp MH
PROVIDER: S-EPMC2799625 | biostudies-other | 2010 Jan
REPOSITORIES: biostudies-other
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Project description:INTRODUCTION:Cardiopulmonary exercise testing is an essential tool to assess cardiorespiratory fitness (CRF) in children. There is a paucity of adequate pediatric reference values that are independent of body size and pubertal stage. The purpose of this study is to provide Z score equations for several maximal and submaximal CRF parameters derived from a prospectively recruited sample of healthy children. METHODS:In this cross-sectional multicenter study, we prospectively recruited 228 healthy children 12 to 17 yr old in local schools. We performed a symptom-limited cardiopulmonary exercise testing progressive ramp protocol on an electronically braked cycle ergometer. Eighteen CRF parameters were analyzed. We tested several regression models to obtain prediction curves that minimized residual association with age, body size, and pubertal stage. Both the predicted mean and the predicted SD were modeled to account for heteroscedasticity. RESULTS:We identified nonlinear association of CRF parameters with body size and significant heteroscedasticity. To normalize CRF parameters, the use of a single body size variable was not sufficient. We therefore used multivariable models with various combination of height, corrected body mass, and age. Final prediction models yielded adjusted CRF parameters that were independent of age, sex, body mass, height, body mass index, and Tanner stages. CONCLUSIONS:We present Z score equations for several CRF parameters derived from a healthy pediatric population. These reference values provide updated predicted means and range of normality that are independent of sex and body size. Further testing is needed to assess if these reference values increase sensitivity and specificity to identify abnormal cardiorespiratory response in children with chronic diseases.
| S-EPMC6023574 | biostudies-literature
Project description:BackgroundGood hearing is a fundamental skill that allows children to develop properly, both socially and intellectually. In contrast to defects in inner ear function, however, auditory processing disorders (APDs)-which can affect up to 2-3% of school-children-are not easily identified with basic screening programs and must be diagnosed using special tests. Although such psychoacoustic tests are available, the scores achieved depend highly on the social, cultural, and linguistic characteristics of the population, and norms must be established for each population separately. Reference values are still lacking for the Polish population, especially for children in school-age, so that practitioners must interpret test scores themselves, often intuitively or using potentially biased thresholds from other countries.Materials and methodsWe investigated a sample of 94 Polish schoolchildren with normal hearing, divided into four age groups: from 7 years-olds to 10 years-olds. All children had no speech or language development disorder, learning problem, or symptom of APD. Participants were volunteers who had previously taken part in a large screening study. The group consisted of 56 girls (60%) and 38 boys (40%) with an average age of 8.6 years (SD = 1.1). The test battery included the Duration Pattern Test (DPT), Frequency Pattern Test (FPT), Time-Compressed Speech Test (CST), and Dichotic Digit Test (DDT).ResultsThe scores on all tests increased consistently with age. The difference between each age-group for DPT, CST, and left- and right-ear DDT tests was significant (Kruskal-Wallis test, p-values = 0.002, 0.006, 0.005, 0.020, respectively), but the effect of age on the FPT test was not (p-value = 0.143). The analysis showed a clear and significant separation between a merged group of ages 7 and 8 and another of ages 9 and 10. We, therefore, propose, for each test, separate reference values for these two particular age-groups. Using thresholds based on a 10% quantile, we offer the following reference values for ages 7-8 and 9-10 respectively: DPT, 28.5% and 53.8%; FPT, 18.5% and 27.5%; CST, 68.6% and 77.2%; left-ear DDT, 34.3% and 52.5%; right-ear DDT, 56% and 72.5%.ConclusionThe scores on psychoacoustic tests to diagnose APD differ between cultures and linguistic backgrounds. Clinicians should, therefore, use norms that have been designed for the population most similar to their patients. Here, we report the use of a test battery designed for the Polish language that accounts for various aspects of APD when screening school children. Together with a full methodology of those tests, we provide norms that can be used as cut-offs in clinical diagnosis. Practitioners are invited to use them to obtain more accurate, evidence-based decisions.
| S-EPMC6713444 | biostudies-literature
Project description:Background/Hypothesis: Cardiopulmonary exercise testing (CPET) is used in the assessment of function and prognosis of cardiopulmonary health in children with cardiac and pulmonary diseases. Techniques, such as cardiac MRi, and PET-scan, can be performed simultaneously with exercise testing. Thus, it is desirable to have a broader knowledge about children's normal cardiopulmonary function in different body postures and exercise modalities. The aim of this study was to investigate the effect of different body positions on cardiopulmonary function in healthy subjects performing CPETs. Materials and Methods: Thirty-one healthy children aged 9, 12, and 15 years did four CPETs: one treadmill test with a modified Bruce protocol and three different bicycle tests with different body postures, sitting, tilted 45°, and lying flat (0°). For the bicycle tests, a 20-watt ramp protocol with a pedal frequency of 60 ± 5 rotations per minute was used. Continous ECG and breath-by-breath V . O 2 measurements was done throughout the tests. Cardiac structure and function including aortic diameter were evaluated by transthoracic echocardiography prior to the tests. Doppler measurements of the blood velocity in the ascending aorta were measured prior to and during the test. Prior to every test, the participants performed pulmonary function tests with maximum voluntary ventilation test. Results: There is a significantly (p < 0.05) lower peak V . O 2 in all bicycle tests compared with the treadmill test. There is lower corrected peak V . O 2 (ml kg-0.67 min-1), but not relative peak V . O 2 (ml kg-1 min-1), in the supine compared with the upright bicycle test. There are no differences in peak stroke volume or cardiac output between the bicycle modalities when calculated from aortic blood flow. Peak heart rate decreases from both treadmill to upright bicycle and from upright bicycle to the supine test (0°). Conclusion: There are no differences in peak cardiac output between the upright bicycle test and supine bicycle tests. Heart rate and corrected peak V . O 2 are lower in the supine test (0°) than the upright bicycle test. In the treadmill test, it is a higher absolute and relative peak V . O 2 . Despite the latter differences, we are convinced that both upright and supine bicycle tests are apt in the clinical setting when needed.
| S-EPMC6897055 | biostudies-literature
Project description:ObjectivesThe purpose of this study was to estimate the frequency and results of downstream testing after exercise treadmill tests (ETTs).BackgroundThe utility of additional diagnostic testing after ETT is not well characterized.MethodsWe followed consecutive individuals without known coronary artery disease referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within 6 months of ETT and the combined endpoint of survival free from cardiovascular death, myocardial infarction, and coronary revascularization.ResultsAmong 3,656 consecutive subjects who were followed for a mean of 2.5 ± 1.1 years, 332 (9.0%) underwent noninvasive imaging and 84 (2.3%) were referred directly to invasive angiography after ETT. The combined endpoint occurred in 76 (2.2%) patients. The annual incidence of the combined endpoint after negative, inconclusive, and positive ETT was 0.2%, 1.3%, and 12.4%, respectively (p < 0.001). Rapid recovery of electrocardiography (ECG) changes during ETT was associated with negative downstream test results and excellent prognosis, whereas typical angina despite negative ECG was associated with positive downstream tests and adverse prognosis (p < 0.001). Younger age, female sex, higher metabolic equivalents of task achieved, and rapid recovery of ECG changes were predictors of negative downstream tests.ConclusionsAmong patients referred for additional testing after ETT, the lowest yield was observed among individuals with rapid recovery of ECG changes or negative ETT, whereas the highest yield was observed among those with typical angina despite negative ECG or a positive ETT. These findings may be used to identify patients who are most and least likely to benefit from additional testing.
| S-EPMC4033667 | biostudies-literature
Project description:BackgroundExercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke.Methods20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability.ResultsPeak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC?=0.82), relative peak oxygen uptake (ICC?=0.72), peak work rate (ICC?=0.91), peak heart rate (ICC?=0.80), absolute gas exchange threshold (ICC?=0.91), relative gas exchange threshold (ICC?=0.88), oxygen cost of work (ICC?=0.87), oxygen pulse at peak oxygen uptake (ICC?=0.92), ventilation rate versus carbon dioxide output slope (ICC?=0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied.ConclusionsThis study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.
| S-EPMC4271449 | biostudies-literature
Project description:ImportanceAdverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness.ObjectiveTo assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing.Design, setting, and participantsThis retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (?97.7th percentile).ExposuresCardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing.Main outcomes and measuresAll-cause mortality.ResultsThe study population included 122?007 patients (mean [SD] age, 53.4?[12.6] years; 72 173 [59.2%] male). Death occurred in 13?637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P?<?.001; elite vs high: adjusted HR, 0.77; 95% CI, 0.63-0.95; P?=?.02). The increase in all-cause mortality associated with reduced cardiorespiratory fitness (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P?<?.001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P?<?.001) was comparable to or greater than traditional clinical risk factors (coronary artery disease: adjusted HR, 1.29; 95% CI, 1.24-1.35; P?<?.001; smoking: adjusted HR, 1.41; 95% CI, 1.36-1.46; P?<?.001; diabetes: adjusted HR, 1.40; 95% CI, 1.34-1.46; P?<?.001). In subgroup analysis, the benefit of elite over high performance was present in patients 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P?=?.04) and patients with hypertension (adjusted HR, 0.70; 95% CI, 0.50-0.99; P?=?.05). Extreme cardiorespiratory fitness (?2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups.Conclusions and relevanceCardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.
| S-EPMC6324439 | biostudies-literature
Project description:The supragingival plaque microbiota of pre-school children.
| PRJNA555320 | ENA
Project description:Cardiac amyloidosis (CA) is a myocardial disease characterized by extracellular amyloid infiltration throughout the heart, resulting in increased myocardial stiffness, and restrictive heart wall chamber behavior. Its diagnosis among patients hospitalized for cardiovascular diseases is becoming increasingly frequent, suggesting improved disease awareness, and higher diagnostic capacities. One predominant functional manifestation of patients with CA is exercise intolerance, objectified by reduced peak oxygen uptake (VO2 peak), and assessed by metabolic cart during cardiopulmonary exercise testing (CPET). Hemodynamic adaptation to exercise in patients with CA is characterized by low myocardial contractile reserve and impaired myocardial efficiency. Rapid shallow breathing and hyperventilation, in the absence of ventilatory limitation, are also typically observed in response to exercise. Ventilatory inefficiency is further suggested by an increased VE-VCO2 slope, which has been attributed to excessive sympathoexcitation and a high physiological dead space (VD/VT) ratio during exercise. Growing evidence now suggests that, in addition to well-established biomarker risk models, a reduced VO2 peak is potentially a strong and independent predictive factor of adverse patient outcomes, both for monoclonal immunoglobulin light chain (AL) or transthyretin (ATTR) CA. Besides generating prognostic information, CPET can be used for the evaluation of the impact of therapeutic interventions in patients with CA.
| S-EPMC9207317 | biostudies-literature
Project description:AimsTo generate reference values for two inspiratory muscle endurance (IME) protocols in healthy children and adolescents.Materials and methodsThis is an observational, cross-sectional study, in healthy children and adolescents from 4 to 18 years of age. Weight, height, maximal inspiratory pressure (MIP) and IME were measured using two protocols. A fixed load of 30% of MIP with a 10% increment every 2 minutes was used in the incremental threshold loading protocol. As for the maximal loading protocol, a fixed load of 70% of MIP was used and the time limit (Tlim) achieved until fatigue was measured.ResultsA total of 462 participants were included, 281 corresponding to the incremental loading protocol and 181 to maximal loading. There were moderate and positive correlations between IME and age, MIP, weight and height in the incremental threshold loading. However, the regression model demonstrated that MIP and age were the best variables to predict the IME. Otherwise, weak and positive correlations with age, weight and height were found in the maximal loading. Only age and height influenced endurance in the regression model. The predictive power (r2) of the incremental threshold loading protocol was 0.65, while the maximal loading was 0.15. The reproducibility measured by the intraclass correlation coefficient (ICC) was higher in the incremental loading (0.96) compared to the maximal loading test (0.69).ConclusionIME in healthy children and adolescents can be explained by age, height and MIP. The incremental threshold loading protocol showed more reliable results and should be the model of choice to evaluate IME in the pediatric age group.
| S-EPMC5266249 | biostudies-literature
Project description:There is an increasing need for suitable tools to evaluate body composition in paediatrics. The Body Composition Monitor (BCM) shows promise as a method, but reference values in children are lacking. Twenty children were included and measured twice by 4 different raters to asses inter- and intra-rater reproducibility of the BCM. Reliability was assessed using the Bland-Altman method and by calculating intraclass correlation coefficients (ICCs). The intra-rater ICCs were high (≥ 0.97) for all parameters measured by BCM as were the inter-rater ICCs for all parameters (≥ 0.98) except for overhydration (0.76). Consequently, a study was set up in which BCM measurements were performed in 2058 healthy children aged 3-18.5 years. The age- and gender-specific percentile values and reference curves for body composition (BMI, waist circumference, fat mass and lean tissue mass) and fluid status (extracellular and intracellular water and total body water) relative to age were produced using the GAMLSS method for growth curves.Conclusion: A high reproducibility of BCM measurements was found for fat mass, lean tissue mass, extracellular water and total body water. Reference values for these BCM parameters were calculated in over 2000 children and adolescents aged 3 to 18 years. What is Known • The 4-compartment model is regarded as the 'gold standard' of body composition methods, but is inappropriate for regular follow-up or screening of large groups, because of associated limitations. • Body Composition Monitor® is an inexpensive field method that has the potential to be an adequate monitoring tool. What is New • Good reproducibility of BCM measurements in children provides evidence to use the device in longitudinal follow-up, multicentre and comparative studies. • Paediatric reference values relative to age and sex for the various compartments of the body are provided.
| S-EPMC8105252 | biostudies-literature