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Exercise tolerance in children with cystic fibrosis undergoing lung transplantation assessment

¹ Cardiorespiratory and Critical Care Directorate, Great Ormond Street Hospital for Children, London, UK and ² Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK

CORRESPONDENCE: P. Aurora, Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. Fax: 44 2078298634

Keywords: children, cystic fibrosis, exercise, lung transplantation

Received: June 29, 2000
Accepted March 19, 2001

The aim of this study was to compare the 6-min walk test against the recently developed 3-min step test, as measures of exercise tolerance in children with moderate to severe cystic fibrosis (CF) lung disease referred for lung transplantation assessment.

Twenty-eight children with CF (16 girls, 12 boys), with a mean age of 13.7 yrs (range 7.2–17.8 yrs) and mean forced expiratory volume in one second of 34% predicted (range 17%–67%) were recruited. All subjects performed both the 6-min walk and 3-min step-tests. Outcome measures were maximum rise in heart rate (HR), and maximum fall in arterial oxygen saturation (S_a,O2).

There was no significant difference in resting HR or S_a,O2 prior to starting the two tests. Both step and walk tests produced significant rises in median HR (from 114–149 min^–1, p<0.0005, and 119–138 min^–1, p<0.0005, respectively) and significant falls in S_a,O2 (both from 94–92%, p<0.0005). The step test produced a significantly greater percentage rise in HR (30% versus 18%, p<0.0005) and a significantly greater percentage fall in S_a,O2 (4% versus 2%, p=0.002). Bland-Altman analysis gave wide 95% limits of agreement (10.7–29.3% for rise in HR, –2.1–4.6% for fall in S_a,O2). The step test was well tolerated.

The 3-min step test produced a greater fall in S_a,O2 and a greater rise in HR than the 6-min walk test in children with moderate to severe CF lung disease. It may be of value when assessing a child's suitability for lung transplantation.