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Cardiopulmonary exercise testing in children with cerebral palsy: Feasibility and the relationship between aerobic
Sevgi Esra Özdemir Tekeş1, Burak Kamil Turan1, Şehim Kutlay1
1Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey.
Introduction:
Children with cerebral palsy (CP) may exhibit reduced aerobic capacity. While the cardiopulmonary exercise test (CPET) is the gold standard for determining aerobic capacity, motor disorders and accompanying disturbances make its application challenging. The 6-minute walk test (6-MWT) may offer a practical alternative.
Objective:
To evaluate the feasibility of CPET, explore its relationship with the 6-MWT, and investigate the association between aerobic capacity and gross motor function in children with CP.
Methods:
Children aged 6-13 years with unilateral/bilateral spastic CP classified as Gross Motor Function Classification System Level II, who could follow instructions and walk on a treadmill without physical assistance, were included. The Gross Motor Function Measure-88 (GMFM-88), 6-MWT, and treadmill-based CPET were performed. CPET feasibility was evaluated by maximal exertion and termination reasons.
Results:
Eight participants (four males, four females; four spastic unilateral, four spastic bilateral) with a median age of 8.5 years were enrolled. The median (minimum-maximum) peak oxygen consumption (VO2peak), respiratory exchange ratio (RER), and maximum heart rate (HRmax) in CPET were 21 (17.1-30.6) mL/kg/min, 0.87 (0.81-1.00), and 145.5 (97-174) bpm, respectively. One participant achieved near-maximal exertion during CPET, while the others demonstrated submaximal effort. Reasons for CPET termination included lower limb fatigue (n = 5) and poor compliance (n = 3). The 6-minute walk distance (6MWD) was not significantly correlated with VO2peak (r = 0.000, p > .999). 6MWD was strongly correlated with the GMFM-88 total score (r = 0.790, p = .020). Moderate correlations, which were not statistically significant, were found between 6MWD and the GMFM-88 Dimensions D (r = 0.672, p = .068) and E (r = 0.695, p = .056). No significant correlations were observed between the GMFM-88 scores and VO2peak, RER, or HRmax.
Conclusion:
Treadmill-based CPET demonstrated limitations in reaching maximal aerobic capacity in this pilot sample of children with CP. The 6-MWT may offer a practical approach for evaluating functional performance, given its association with gross motor function.
