Standardization of a Continuous Ramp Ergometer Protocol for Clinical Exercise Testing in Children

Developing a standardized protocol for pediatric exercise laboratories is challenging. Our objective was to report normal pediatric values for a continuous non-steady state cycle ergometer ramp protocol to achieve 8–10 min of exercise based on sex and weight. One hundred seventeen patients (117) [mean age 13 ± 2.8 years, range 7–18 years (51% male)] referred for chest pain with normal cardiac evaluation underwent cardiopulmonary testing on a cycle ergometer. Patients entered one of the four continuous ramp protocols (10, 15, 20, and 25 W/min ramp) to achieve an expected peak workload of 3 W/kg at an increase of 0.3 to 0.35 W/kg/min. Exercise test outcomes measured included duration, peak heart rate, work, respiratory exchange ratio, peak oxygen consumption, peak blood pressure, and ventilatory anaerobic threshold. An exercise duration of 8–10 min was achieved in a majority of the study population; however, interactions with age (older, longer duration) and sex (males, longer duration) were present. Using our algorithm (0.3–0.35 W/kg × weight), we demonstrated four non-steady state ramp bike ergometer protocols (10, 15, 20, and 25 W/min) that can be applied to males and females of different ages and weights to achieve an exercise duration of 8–10 min.