Int J Sports Med 2010; 31(3): 202-206
DOI: 10.1055/s-0029-1243644
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Oxygen Uptake to Work Rate Slope in Children with a Heart, Lung or Muscle Disease

W. G. Groen1 , H. J. Hulzebos1 , P. J. Helders1 , T. Takken1
  • 1UMC Utrecht, Child Development & Exercise Centre, Utrecht, Netherlands
Further Information

Publication History

accepted after revision November 30, 2009

Publication Date:
15 February 2010 (online)

Abstract

The purposes of this study were all to determine if ΔVO2/ΔWR is dependent on age, body mass, height and fitness and if ΔVO2/ΔWR could discriminate between healthy children and children with a chronic disease that limits O2 delivery or utilization. Four groups were included: muscle disease (Juvenile Dermatomyositis; JDM; n=12), lung disease (Cystic Fibrosis; CF; n=13), Congenital Heart Disease (CHD; (n=13), and healthy children (n=44). All children performed a cardiopulmonary exercise test on a cycle ergometer with respiratory gas analysis. The ΔVO2/ΔWR was determined by linear regression using data from unloaded cycling to peak exercise. No associations were found between the ΔVO2/ΔWR and age, body mass and height in healthy children. ΔVO2/ΔWR was significantly correlated with VO2peak/kg (r=0.44; p<0.01). Children with JDM had lower ΔVO2/ΔWR values than healthy children (p=0.02), and ΔVO2/ΔWR tended to be lower in CHD and higher in CF (p=0.09 and p=0.08, respectively). ΔVO2/ΔWR may be more sensitive for conditions that are characterized by local hypo perfusion (as in JDM), than for conditions that are characterized by impaired oxygen delivery (i. e. CF or CHD).

References

  • 1 ATS/ACCP. . ATS/ACCP Statement on cardiopulmonary exercise testing.  Am J Respir Crit Care Med. 2003;  167 211-277
  • 2 Barstow TJ, Jones AM, Nguyen PH, Casaburi R. Influence of muscle fibre type and fitness on the oxygen uptake/power output slope during incremental exercise in humans.  Exp Physiol. 2000;  85 109-116
  • 3 Binkhorst RA, van’t Hof MA, Saris WHM. Maximale inspanning door kinderen; referentiewaarden voor 6–18 jarige meisjes en jongens. Maximal exercise in children; reference values girls and boys, 6-18 year of age.  Den-Haag: Nederlandse Hartstichting. 1992;  1-64
  • 4 Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts).  N Engl J Med. 1975;  292 403-407
  • 5 Caiozzo VJ, Davis JA, Ellis JF, Azus JL, Vandagriff R, Prietto CA, McMaster WC. A comparison of gas exchange indices used to detect the anaerobic threshold.  J Appl Physiol. 1982;  53 1184-1189
  • 6 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ:: Lawrence Erlbaum Associate Pub; 1988
  • 7 de Meer K, Gulmans VA, van Der Laag J. Peripheral muscle weakness and exercise capacity in children with cystic fibrosis.  Am J Respir Crit Care Med. 1999;  159 748-754
  • 8 Drinkard BE, Hicks J, Danoff J, Rider LG. Fitness as a determinant of the oxygen uptake/work rate slope in healthy children and children with inflammatory myopathy.  Can J Appl Physiol. 2003;  28 888-897
  • 9 Gaesser GA, Brooks GA. Muscular efficiency during steady-rate exercise: effects of speed and work rate.  J Appl Physiol. 1975;  38 1132-1139
  • 10 Godfrey S. Exercise Testing in Children. London: W.B. Saunders Company Ltd.; 1974: 1-168
  • 11 Hansen JE, Sue DY, Oren A, Wasserman K. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders.  Am J Cardiol. 1987;  59 669-674
  • 12 Harriss DJ, Atkinson G. International Journal of Sports Medicine – ethical standards in sport and exercise science research.  Int J Sports Med. 2009;  30 701-702
  • 13 Hebert CA, Byrnes TJ, Baethge BA, Wolf RE, Kinasewitz GT. Exercise limitation in patients with polymyositis.  Chest. 1990;  98 352-357
  • 14 Hjeltnes N, Stanghelle JK, Skyberg D. Pulmonary function and oxygen uptake during exercise in 16 year old boys with cystic fibrosis.  Acta Paediatr Scand. 1984;  73 548-553
  • 15 Jerusalem F, Rakusa M, Engel AG, MacDonald RD. Morphometric analysis of skeletal muscle capillary ultrastructure in inflammatory myopathies.  J Neurol Sci. 1974;  23 391-402
  • 16 Jones AM, Campbell IT, Pringle JS. Influence of muscle fibre type and pedal rate on the VO2-work rate slope during ramp exercise.  Eur J Appl Physiol. 2004;  91 238-245
  • 17 Lucía A, Rivero JLL, Pérez M. Determinants of O2 kinetics at high power outputs during a ramp exercise protocol.  Med Sci Sports Exerc. 2002;  34 326
  • 18 Mallory LA, Scheuermann BW, Hoelting BD, Weiss ML, McAllister RM, Barstow TJ. Influence of peak VO2 and muscle fiber type on the efficiency of moderate exercise.  Med Sci Sports Exerc. 2002;  34 1279-1287
  • 19 Moser C, Tirakitsoontorn P, Nussbaum E, Newcomb R, Cooper DM. Muscle size and cardiorespiratory response to exercise in cystic fibrosis.  Am J Respir Crit Care Med. 2000;  162 1823-1827
  • 20 Nagaraju K, Rider LG, Fan C, Chen YW, Mitsak M, Rawat R, Patterson K, Grundtman C, Miller FW, Plotz PH, Hoffman E, Lundberg IE. Endothelial cell activation and neovascularization are prominent in dermatomyositis.  J Autoimmune Dis. 2006;  3 2
  • 21 Nixon PA. Role of exercise in the evaluation and management of pulmonary disease in children and youth.  Med Sci Sports Exerc. 1996;  28 414-420
  • 22 O'Dochartaigh CS, Ong HY, Lovell SM, Riley MS, Patterson VH, Young IS, Nicholls DP. Oxygen consumption is increased relative to work rate in patients with McArdle's disease.  Eur J Clin Invest. 2004;  34 731-737
  • 23 Ohuchi H, Nakajima T, Kawade M, Matsuda M, Kamiya T. Measurement and validity of the ventilatory threshold in patients with congenital heart disease.  Pediatr Cardiol. 1996;  17 7-14
  • 24 Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, O'Donnell DE, Puente-Maestu L, Schols AM, Singh S, Whipp BJ. Recommendations on the use of exercise testing in clinical practice.  Eur Respir J. 2007;  29 185-209
  • 25 Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, Kimball TR, Knilans TK, Nixon PA, Rhodes J, Yetman AT. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth.  Circulation. 2006;  113 1905-1920
  • 26 Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise after repair of aortic coarctation.  J Pediatr. 1997;  131 210-214
  • 27 Rowland T, Goff D, Martel L, Ferrone L. Influence of cardiac functional capacity on gender differences in maximal oxygen uptake in children.  Chest. 2000;  117 629-635
  • 28 Scano G, Grazzini M, Stendardi L, Gigliotti F. Respiratory muscle energetics during exercise in healthy subjects and patients with COPD.  Respir Med. 2006;  100 1896-1906
  • 29 Stephens D. Exercise Testing and the Physiological Responses to Exercise in Young Patients with Chronic Chest Diseases.. In: Sport & Health Sciences. Exeter, Devon. U.K.: University of Exeter; 2009: 1-278
  • 30 Stromvall Larsson E, Eriksson BO. Haemodynamic adaptation during exercise in fontan patients at a long-term follow-up.  Scand Cardiovasc J. 2003;  37 107-112
  • 31 Takken T, Custers J, Visser G, Dorland L, Helders P, de Koning T. Prolonged exercise testing in two children with a mild Multiple Acyl-CoA-Dehydrogenase deficiency.  Nutr Metab (Lond). 2005;  2 12
  • 32 Takken T, Elst E, Van der Net J. Pathophysiological factors which determine the exercise intolerance in patients with juvenile dermatomyositis.  Curr Rheumatol Rev. 2005;  1 91-99
  • 33 Takken T, Henneken T, van de Putte E, Helders P, Engelbert R. Exercise testing in children and adolescents with chronic fatigue syndrome.  Int J Sports Med. 2007;  28 580-584
  • 34 Takken T, Spermon N, Helders PJ, Prakken AB, Van Der Net J. Aerobic exercise capacity in patients with juvenile dermatomyositis.  J Rheumatol. 2003;  30 1075-1080
  • 35 Takken T, Tacken MH, Blank AC, Hulzebos EH, Strengers JL, Helders PJ. Exercise limitation in patients with Fontan circulation: a review.  J Cardiovasc Med (Hagerstown). 2007;  8 775-781
  • 36 Takken T, van der Net J, Engelbert RH, Pater S, Helders PJ. Responsiveness of exercise parameters in children with inflammatory myositis.  Arthritis Rheum. 2008;  59 59-64
  • 37 Tanabe Y, Nakagawa I, Ito E, Suzuki K. Hemodynamic basis of the reduced oxygen uptake relative to work rate during incremental exercise in patients with chronic heart failure.  Int J Cardiol. 2002;  83 57-62
  • 38 Vanhees L, Lefevre J, Philippaerts R, Martens M, Huygens W, Troosters T, Beunen G. How to assess physical activity? How to assess physical fitness?.  Eur J Cardiovasc Prev Rehabil. 2005;  12 102-114
  • 39 Wessel HU, Paul MH. Exercise studies in tetralogy of Fallot: a review.  Pediatr Cardiol. 1999;  20 39-47
  • 40 Whipp BJ, Davis JA, Torres F, Wasserman K. A test to determine parameters of aerobic function during exercise.  J Appl Physiol. 1981;  50 217-221
  • 41 Whipp BJ, Wasserman K. Efficiency of muscular work.  J Appl Physiol. 1969;  26 644-648

Correspondence

Dr. Tim Takken

UMC Utrecht, Child Development & Exercise Centre

P O Box 85090

3088AB Utrecht

Netherlands

Phone: +31887554030

Fax: +31887555333

Email: t.takken@umcutrecht.nl