For citation purposes: Bongers BC, van Brussel M, Hulzebos HJ, Takken T. Paediatric exercise testing in clinics and classrooms: A comparative review of different assessments. OA Epidemiology 2013 Sep 01;1(2):14.

Critical review


Paediatric exercise testing in clinics and classrooms: a comparative review of different assessments

BC Bongers, M van Brussel, HJ Hulzebos, T Takken

Authors affiliations

Child Development & Exercise Center, Wilhelmina Children`s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands

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Physical fitness or aerobic capacity, is an important determinant of overall health. A higher aerobic capacity can lead to many health benefits. Paediatric exercise testing is important for identifying children and adolescents at risk for major public health diseases, as well as to be able to unravel the physiological mechanisms of a reduced aerobic capacity and to evaluate intervention effects. Aerobic capacity can be defined as the maximal capacity of the pulmonary and cardiovascular systems to take up and transport oxygen to the exercising muscles and of the exercising muscles to extract and utilize oxygen from the blood during progressive exercise with large muscle groups up to maximal exertion. Throughout progressive exercise, oxygen transport enlarges due to the integrative response of different physiological systems, resulting in an increase in cardiac output, minute ventilation and the arteriovenous oxygen difference. The aim of this critical review was to discuss the different assessments of paediatric exercise testing in clinics and classrooms.


Cardiopulmonary exercise testing is the gold standard for determining aerobic capacity as well as for examining the physiological response to exercise. However, this test is not always feasible to perform in a non-clinical setting in large population based studies. The steep ramp test and the 20 m shuttle run test are valid and reliable non-sophisticated alternatives for predicting aerobic capacity in children and adolescents in those studies. Nevertheless, prediction equations used to estimate aerobic capacity reached during cardiopulmonary exercise testing from steep ramp test or 20 m shuttle run test performance should be interpreted with caution. Additionally, these non-sophisticated tests should not be used as a substitute for performing regular cardiopulmonary exercise testing, as they are less accurate and do not provide diagnostic or prognostic information.

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