One Size Fits All? A New Protocol for Age-Appropriate Cardiopulmonary Exercise Testing in 8- to 10-Year-Old Children

 

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Background: High levels of physical activity in children are an essential part of a healthy lifestyle during childhood, adolescence, and later life. The most appropriate objective measurement of cardiorespiratory fitness is cardiopulmonary exercise testing (CPET). Still, knowledge about CPET in primary school kids is limited to a small number of studies. Generally, children are tested with the same increments for all age groups. They usually start at a walking pace which is difficult to handle for younger children. Furthermore, standard protocols involve an increase in gradient which represents a limitation for the underdeveloped knee-extensors in this age-group. This study strives to evaluate an age-appropriate CPET-protocol, derived from natural running speeds of 8- to 10-year-old children determined during outdoor testing and then transferred to a treadmill (TM).

Method: A group of 47 8- to 10-year-old healthy children was tested on a TM, using an age-appropriate CPET-protocol which was derived from natural running speeds measured during outdoor testing in this age group. The protocol consisted of a starting speed of 3 km/h, then 6 km/h, then 8 km/h and a further increase of 1 km/h for every further step. The inclination was set at 1% (wind factor) with a duration of 2 minutes for each step.

Results: All of the children except for 3 (26 males and 21 females, 9.22 ± 0.83 years) achieved sufficient exertion (RER = 1.07 ± 0.53). Cardiopulmonary exercise variables showed an age-appropriate VO2 peak (43.66 ± 6.11 mL/kg/min). The oxygen uptake efficiency slope (OUES, 1.61 ± 0.37) was positively correlated with VO2 peak Further emphasis was set on mean HR (193.57 ± 10.3/min), mean VEmax 4.21 ± 10.66 L/min), and mean O2pulse (7.06 ± 1.42 mL). Mean exercise time was 10.02 minutes (±2.25 min) with a mean peak velocity of 10.21 ± 1.08 km/h.

Conclusion: Based on physiological running speeds of 8- to 10-year-old children, we designed an age-appropriate TM protocol for CPET, achieving representative results for this age group. Without an inclination of the TM, it avoids the common problem of local leg fatigue. Initial running speeds correspond to natural running speeds and test duration is comparably short, thus resulting in a high grade of acceptance with the kids, an important factor in pediatric CPET. The OUES was positively correlated with VO2 peak, underlining its suitability as a submaximal parameter when maximal exertion cannot be achieved. This protocol could be a new alternative to standard CEPT protocols in this age-group.

Publication History

Article published online:
12 February 2022

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