PHYS THER
Vol. 89, No. 7, July 2009, pp. 679-687
DOI: 10.2522/ptj.20080328
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Research Reports

Treadmill Testing of Children Who Have Spina Bifida and Are Ambulatory: Does Peak Oxygen Uptake Reflect Maximum Oxygen Uptake?

Janke Frederike de Groot, Tim Takken, Sanna de Graaff, Rob H.J.M. Gooskens, Paul J.M. Helders and Luc Vanhees

J.F. de Groot, PT, MSc, is Researcher, Research Group Lifestyle and Health, University of Applied Sciences, Utrecht, the Netherlands, and Department of Pediatric Physical Therapy and Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room kb.02.056.0, PO Box 85090, 3508 AB Utrecht, the Netherlands.
T. Takken, PhD, is Medical Physiologist, Department of Pediatric Physical Therapy and Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht.
S. de Graaff, MSc, was a medical student, Faculty of Medicine, University Medical Center Utrecht, at the time of the study.
R.H.J.M. Gooskens, is Professor and Child Neurologist, Department of Pediatric Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht.
P.J.M. Helders, PT, PhD, PCS, is Professor, Department of Pediatric Physical Therapy and Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht.
L. Vanhees is Professor, Research Group Lifestyle and Health, University of Applied Sciences, Utrecht, the Netherlands, and Department of Rehabilitation Sciences, Catholic University, Leuven, Belgium.

Address all correspondence to Mrs de Groot at: J.F.deGroot-16{at}umcutrecht.nl

Background: Earlier studies have demonstrated low peak oxygen uptake (VO2peak) in children with spina bifida. Low peak heart rate and low peak respiratory exchange ratio in these studies raised questions regarding the true maximal character of VO2peak values obtained with treadmill testing.

Objective: The aim of this study was to determine whether the VO2peak measured during an incremental treadmill test is a true reflection of the maximum oxygen uptake (VO2max) in children who have spina bifida and are ambulatory.

Design: A cross-sectional design was used for this study.

Methods: Twenty children who had spina bifida and were ambulatory participated. The VO2peak was measured during a graded treadmill exercise test. The validity of VO2peak measurements was evaluated by use of previously described guidelines for maximum exercise testing in children who are healthy, as well as differences between VO2peak and VO2 during a supramaximal protocol (VO2supramaximal).

Results: The average values for VO2peak and normalized VO2peak were, respectively, 1.23 L/min (SD=0.6) and 34.1 mL/kg/min (SD=8.3). Fifteen children met at least 2 of the 3 previously described criteria; one child failed to meet any criteria. Although there were no significant differences between VO2peak and VO2supramaximal, 5 children did show improvement during supramaximal testing.

Limitations: These results apply to children who have spina bifida and are at least community ambulatory.

Conclusions: The VO2peak measured during an incremental treadmill test seems to reflect the true VO2max in children who have spina bifida and are ambulatory, validating the use of a treadmill test for these children. When confirmation of maximal effort is needed, the addition of supramaximal testing of children with disability is an easy and well-tolerated method.


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