Integrated cardiopulmonary approach to exercise testing in pediatrics.

In the pediatric age groups exercise evaluation of cardiac and pulmonary disease has had a lesser impact on clinical care than in adults. Exercise evaluation complements clinical information, echocardiography, hemodynamics and lung function studies at rest to provide reproducible, quantitative information to answer questions of capacity for physical work, employment, insurability and participation in recreation and sports. To ensure serial studies in children measurements should be noninvasive and minimize demands of patient cooperation. Exercise evaluation should include evaluation of lung function at rest to exclude pulmonary limitations of exercise. Because of the close link of cardiovascular and pulmonary responses to exercise, assessment of ventilation and pulmonary gas exchange should be an integral part of exercise evaluation. Computerized systems can enhance the accuracy and precision of such measurements and can provide a data base for evaluation of individual patients and the natural history of treated congenital cardiac defects and pulmonary disease.