Practices And Procedures In Clinical Pediatric Exercise Laboratories In North America

Abstract

Inter-institutional differences in clinical pediatric exercise laboratory (CPEL) practices may affect consistency of patient care and efficacy of multi-center research. PURPOSE: To 1) describe current practices and procedures in CPELs; and 2) explore differences in CPELs that employ an exercise physiologist (ExP) to those that do not. METHODS: A survey (min 37, max 68 items) was distributed to CPELs in the U.S and Canada focusing on three domains: 1) staffing (min 6, max 12 items); 2) volumes, reporting, and interpretation (min 12, max 22 items); and 3) procedures/protocols (min 19, max 34 items). RESULTS: Of the n = 73 responses, n = 18 were excluded for being ineligible, not completing the survey, or were duplicated responses, producing a final sample of n = 55 responses. Most responses were from the U.S. (89%), represented a children’s hospital with university affiliation (85%), and reported to be cardiology specific (58%). ExPs are employed in 56% of CPELs (78% ExPs with master’s degree or higher). Physicians, cardiovascular techs, respiratory therapists, or nurses were responsible for conducting clinical exercise stress tests (ESTs) in CPELs without an ExP. Emergency life-support, professional, and clinical certifications were required in 92%, 27%, and 21% of CPELs, respectively. 9.6% of CPELS had no certification requirements. The median volume was 201-400 ESTs/yr. with 20% of the respondents performing >800 ESTs/yr. Treadmill and cycle were the primary modalities utilized for ESTs (80% and 10% of ESTs, respectively). Institution-specific exercise protocols were used in 20% of CPELs. 72% of CPELs provide services in addition to ESTs such as cardiac and/or pulmonary rehabilitation. Non-parametric testing found that those CPELS with an ExP perform a higher volume of ESTs (p = 0.004), are more likely to perform metabolic ESTs (p = 0.028), participate in more research (p < 0.001), and provide services in addition to ESTs (p = 0.001). CONCLUSIONS: Inter-institutional differences in CPELs staffing and operation may warrant efforts for standardization.