Cardiopulmonary exercise testing in children: application and interpretation challenges

Abstract Cardiopulmonary exercise testing (CPET) is a complex functional test that allows for dynamic monitoring of the cardiovascular and respiratory systems during progressive incremental physical activity. CPET is well-established in adult patients, as it provides diagnostic and prognostic value. Pediatric CPET proves informative, although it entails numerous challenges, stemming from the developmental characteristics of children, as well as factors regarding test conduction and interpretation. Pediatric CPET applicability ranges from estimating exercise capacity in healthy and athletic children to diagnosis and prognosis in cases of chronic disease, such as respiratory or cardiovascular conditions. It can be used as a basis for the assessment of functional capacity in cases of asthma and cystic fibrosis, as well as quality of life scoring in kids with chronic heart failure. Furthermore, exercise testing is used as part of the indirect bronchoprovocation procedures for pulmonary function testing. Main challenges include the lack of standardized reference values, protocol selection, and the need for special pediatric equipment, as well as the high cost associated with the test. CPET represents a valuable and increasingly utilized tool for assessment of the pediatric population. Future studies should focus on establishing normative datasets and improving methodological standardization.