Bicycle spiroergometry: comparison of standardized examination protocols for adolescents: is it necessary to define own standard values for each protocol?

Jana Windhaber,Georg Singer,Annemarie Wieland,Christoph Castellani,Peter Schober,Regina Riedl,Monica Steinbauer,Kristina Kogler,Magdalena Holter,Holger Till

doi:10.1007/s00421-021-04601-y

Jana Windhaber, Georg Singer + Show 8 more

Open Access

https://doi.org/10.1007/s00421-021-04601-y

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Abstract

PurposeTo compare performance data of adolescents collected with five different bicycle spiroergometry protocols and to assess the necessity for establishing standard values for each protocol.MethodsOne-hundred-twenty adolescents completed two bicycle spiroergometries within 14 days. One of the two tests was performed based on our institutional weight-adapted protocol (P0). The other test was performed based on one out of four exercise protocols widely used for children and adolescents (P1, 2, 3 or 4) with 30 persons each. The two tests were performed in a random order. Routine parameters of cardiopulmonary exercise tests (CPET) such as VO2peak, maximum power, O2 pulse, OUES, VE/VCO2 slope as well as ventilatory and lactate thresholds were investigated. Agreement between protocols was evaluated by Bland–Altman analysis, coefficients of variation (CV) and intra-class correlation coefficients (ICC).ResultsNone of the CPET parameters were significantly different between P0 and P1, 2, 3 or 4. For most of the parameters, low biases between P0 and P1–P4 were found and 95% confidence intervalls were narrow. CV and ICC values largely corresponded to well-defined analytical goals (CV < 10% and ICC > 0.9). Only maximal power (Pmax) showed differences in size and drift of the bias depending on the length of the step duration of the protocols.ConclusionComparability between examination protocols has been shown for CPET parameters independent on step duration. Protocol-dependent standard values do not appear to be necessary. Only Pmax is dependent on the step duration, but in most cases, this has no significant influence on the fitness assessment.

Highlights

Cardiopulmonary exercise testing (CPET) is the gold standard for determining aerobic fitness in medicine
The other test was performed applying one of the exercise protocols widely used for children and adolescents [Godfrey–Protocol (P1) cited in Hebestreit (Hebestreit et al 2002)], stress protocols recommended by the sports association (P2 and P3) or the protocol of Rost and Hollmann (P4) cited in Hebestreit (Hebestreit et al 2002)
Agreement between different protocols was evaluated by Bland–Altman analysis, coefficients of variation (CV) and intra-class correlation coefficients (ICC) for every group separately

Summary

Introduction

Cardiopulmonary exercise testing (CPET) is the gold standard for determining aerobic fitness in medicine. It provides information describing the function of respiratory, cardiocirculatory, neuromuscular, blood, and metabolic systems, as well as limits of exercise tolerance and is useful in the diagnosis, management, and prognosis of diseases and sports medicine issues (Cooper et al 2014). Since the physiological responses to exercise change during growth and development, appropriate pediatric reference values seem essential for adequate interpretation of CPET. Two recent reviews have described significant heterogeneity between examination protocols (e.g., step duration and increment) and suggested adjustment for body size or weight (Blais et al 2015; Pianosi et al 2017). Recommendations conclude that each protocol needs its own set of reference values (Paridon et al 2006)

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