Andersons pediatric cardiology 587
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CardiopulmonaryExerciseTesting
PaulStephensJr,MichaelG.Mcbride,AlexanderR.Opotowsky,StephenM.
Paridon
Abstract
Regularexerciseisanimportantpartofahealthylifestyle.Healthylevels
ofphysicalfitnessrequireregularparticipationinactivitiesthatgenerate
energyexpendituressignificantlyabovetherestinglevel.Exercisetesting
hasbecomeanintegralpartoftheevaluationofchildrenandadultswith
congenitalandacquiredcardiovasculardisease.Thecardiopulmonary
exercisetestisuniqueamongcardiactestswhicharetypicallyperformed
whenthepatientisatrest.Theevaluationofthepatientintheexercise
physiologylaboratoryallowsthecliniciantoassessthecardiovascular
systeminastatethatismorelikelytoreflectthatofthenormaldaily
physicalactivities.
Keywords
Isomerism;heterotaxy;asplenia;polysplenia;functionallyuniventricular;
kawashima;fontan;Glenn;ciliarydyskinesia
Regularexerciseisanimportantpartofahealthylifestyle.Physicalactivityin
somedevelopedcountrieshasdiminishedforavarietyofreasonsassocietyhas
trendedawayfromoutdooractivitiestowardothertypesofactivities,suchas
computergamesandtelevision,andjobshavebecomemoresedentary.Healthy
levelsofphysicalfitnessrequireregularparticipationinactivitiesthatgenerate
energyexpendituressignificantlyabovetherestinglevel.1
Exercisetestinghasbecomeanintegralpartoftheevaluationofchildrenand
adultswithcongenitalandacquiredcardiovasculardisease.Althoughchildren
areseldomsittingorlyingquietlyduringwakinghours,mostofthetesting
availabletothecardiovascularspecialistisperformedinsucharestingstateand
sometimesinasedatedstate.Theevaluationofthepatientintheexercise
physiologylaboratoryallowsthecliniciantoassessthecardiovascularsystemin
astatethatismorelikelytoreflectthatofthenormaldailyphysicalactivities.
Optimalexerciseperformancerequirescontinuouscoordinatedinteraction
betweenmultipleorgansystems.2Therolesoftheheartandlungsaretoprovide
adequateenergysubstratestoworkingskeletalmuscleandtoremovetheend
productsofaerobicandanaerobicmetabolismduringexercise.Mostofthe
childrenwhomweencounterintheexercisephysiologylaboratoryhave,orare
