Author + information
- Marieke Nederenda,b,
- Michael Ackermana,b,
- Jonathan Johnsona,b,
- Brandon Morricala,b,
- A.D.J. ten Harkela,b and
- Thomas Allisona,b
Background: Exercise testing is commonly performed in children, but protocols and guidelines are optimized for the adult population. Our aim was to identify factors that may influence the objective versus subjective effort on exercise tests in children, as indicated by the peak respiratory exchange ratio (RER) and highest rating of perceived exertion (RPE).
Methods: We retrospectively analyzed all cardiopulmonary tests performed on patients ≤ 18 years from January 2011 through July 2016 at the Mayo Integrated Stress Center, Rochester, MN. Patients were classified according to structural or arrhythmogenic heart disease and compared to patients without identified heart disease or only minor abnormalities. A second comparison was performed against adults with similar referral diagnoses tested in the same time frame. If more than one test was performed during the study period, we chose the most recent for analysis. Differences between groups were assessed by analysis of variance according to the General Linear model with adjustment for covariates.
Results: 840 pediatric and 5827 adult patients were analyzed. Average peak RER was 0.99 ± 0.09, 1.06 ± 0.09, 1.14 ± 0.10, in children 5-9, 10-14, and 15-18 years of age respectively, which was lower compared to adults (1.16 ± 0.11) (p<.001). The percentage of patients achieving maximal effort (achieving a peak RER > 1.15) was significantly related to age: 5%, 13%, 44% in the three groups, respectively and 54% in adults (p<.001). The highest RPE did not mirror the age effect of RER (18.0 ± 1.6, 18.2 ± 1.4, 18.3 ± 1.1, 18.2 ± 1.1, respectively; P = .11). Within the 3 pediatric groups, peak RER was not significantly affected by the presence of structural (N=168) or arrhythmogenic heart disease (N=502), sex, patient being on a HR-lowering drug (N=330), the presence of AICD (N=50), or history of a prior exercise test (N=264).
Conclusions: Test effort as determined by peak RER is impaired in pediatric patients and is inversely proportional to age. Subjective RPE did not identify this impairment. The type of heart disease and the presence of AICD do not appear to affect peak effort. These data suggest that separate protocols for pediatric patients are needed to optimize test performance.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Improving Outcomes in the Athlete With Cardiovascular Disease
Abstract Category: 7. Arrhythmias and Clinical EP: Sports and Exercise
Presentation Number: 1111-111
- 2017 American College of Cardiology Foundation