Cumming G R
Am J Cardiol. 1978 Oct;42(4):613-9. doi: 10.1016/0002-9149(78)90631-8.
Maximal treadmill tests following the Bruce protocol were performed by 830 children with heart defects and the endurance times compared with normal values from 327 children seen in the same clinic because of normal murmurs and from 388 normal children randomly selected and tested in the schools. When values in the normal clinic children were used as the reference, only 21 percent of the patients with heart defects had endurance times below the 10th percentile line. This line was 14 percent higher in the normal school children, and 47 percent of the patient group had values below the 10th percentile when values in the school children were used as the reference. Maximal heart rate in children with heart defects was almost always in the normal range (180 to 210 beats/min) except in patients with cyanosis or severe valve disease and, when encouraged to continue exercising, even these children had a mean maximal heart rate of 175 beats/min. When comparing the exercise capacity of children with heart defects with that of normal children, the source of the normal children is important; body build needs to be considered, as well as physical activity habits. Clinic patients without heart defects probably serve as a better normal control group than children obtained from the school system. Maximal exercise tests do not necessarily distinguish between children with mild or severe heart disease. Only children with lesions causing cyanosis or children with obviously severe disease have consistent reductions in exercise capacity.
830名患有心脏缺陷的儿童按照布鲁斯方案进行了极限跑步机测试，并将耐力时间与因正常杂音在同一诊所就诊的327名儿童以及在学校随机挑选并测试的388名正常儿童的正常值进行了比较。当以诊所正常儿童的值作为参考时，只有21%的心脏缺陷患者的耐力时间低于第10百分位线。这条线在正常学校儿童中要高出14%，当以学校儿童的值作为参考时，患者组中有47%的值低于第10百分位。患有心脏缺陷的儿童的最大心率几乎总是在正常范围内（180至210次/分钟），除了患有紫绀或严重瓣膜疾病的患者，而且当鼓励他们继续运动时，即使这些儿童的平均最大心率也为175次/分钟。在比较患有心脏缺陷的儿童与正常儿童的运动能力时，正常儿童的来源很重要；需要考虑体型以及体育活动习惯。没有心脏缺陷的诊所患者可能比从学校系统获得的儿童更适合作为正常对照组。极限运动测试不一定能区分轻度或重度心脏病儿童。只有患有导致紫绀的病变的儿童或患有明显严重疾病的儿童的运动能力会持续下降。
