New Reference Values for Cardiopulmonary Exercise Testing in Children.

Introduction: Cardiopulmonary exercise testing (CPET) 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 sub-maximal CRF parameters derived from a prospectively recruited sample of healthy children. Methods: In this cross-sectional multicenter study, we prospectively recruited 228 healthy children aged 12 to 17 years old in local schools. We performed a symptom-limited CPET progressive ramp protocol on an electronically-braked cycle ergometer. Eighteen CRF parameters were analysed. 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 standard deviation were modeled to account for heteroscedasticity. Results: We identified nonlinear association of CRF parameters with body size with 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. Conclusion: 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. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2018 American College of Sports Medicine

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