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Functional exercise testing (FET) assesses an individual's capacity to adapt to effort and identifies limiting factors, particularly dyspnea. It orients therapeutic choices, predicts the progression of chronic pathologies, and estimates preoperative risks, at times contraindicating surgery. The aim of this article is to provide a summary of the specific indications for functional exercise testing, test protocol selection, test equipment, appropriate personnel, and patient and test safety. This article is intended for healthcare professionals conducting or considering functional exercise testing., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular strength and endurance, as well as exercise tolerance, is therefore an important component of the evaluation of individuals with chronic respiratory failure. This evaluation can be made easier by using simple tools such as sit-to-stand tests. This review presents the main sit-to-stand tests that have been described and that can be used in everyday practice. The aim is to provide information to the clinician on the contribution of each test, and to identify the extent to which and the purpose for which these tests can be incorporated into a routine pulmonology and/or respiratory rehabilitation evaluation. Because of their inherently functional nature, these tests could help to identify the indications and/or the effects of respiratory rehabilitation., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Cardiopulmonary complications are the leading cause of mortality in patients with systemic sclerosis (SSc) requiring an early identification. A global and comprehensive approach is needed due to the complexity of the overlapping aetiologies of dyspnoea in SSc. Through its integrative approach of ventilatory, metabolic, cardiovascular, skeletal muscular and gas exchange findings, cardiopulmonary exercise testing (CPET) has been known to identify and sort competing mechanisms of exercise limitation in scleroderma patients presenting with dyspnoea. CPET may be used to screen for pulmonary arterial hypertension, suspect interstitial lung disease and guide therapeutic strategies including exercise rehabilitation. This review focuses on the clinical value of CPET in the decision-making processes for a more personalised diagnostic approach to SSc-related complications., (Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The GERS-P (Exercise Rehabilitation Sports Prevention Group of the French Society of Cardiology) has decided to update current guidelines regarding the practice of EKG stress tests. Since the last update dates from 1997, the GERS judged it necessary to integrate data from new works and advancements made in the last 20 years. Good clinical practices and safety conditions are better defined regarding the structure, location, material, staff competency, as well as convention with hospital structures. The diagnosis of coronary artery disease remains the principal indication for a stress test. Interpretation of the results is crucial - it must be multivariate and provide either a low, intermediate or strong probability of the existence of coronary lesions, taking into account the studied population (risk factors, age, sex and symptoms). We no longer have to talk about a "positive, negative or litigious" test. Several new indications for a stress test have been defined for the assessment of cardiac pathologies. With such indications, the use of gas expiration measurements is highly recommended in order to provide a precise prognosis for all the various cardiac pathologies : congenital, ischemic, valvular, cardiomyopathy, congestive heart failure, rhythm and conduction disorders, pacemaker fine-tuning, or pulmonary hypertension. Indications for stress tests and contraindications are defined according to different population subgroups, for instance : athletes, women, children, the elderly, asymptomatic patients, diabetics, hypertensive patients, peripheral arteritis disease patients, or in the context of a non-cardiac surgery pre-op visit. The new guidelines are considerably different from those dating from 1997 and further pinpoint the relevance and importance of an EKG stress test within the arsenal of complementary cardiologic exams. With the improvements made in providing diagnostic value in CAD, as well as better prognostic value for any underlying pathology, the indication for an EKG stress test has extended to all cardiovascular disease., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: Chronic dyspnoea that remains unexplained after resting pulmonary function and cardiovascular testing is a common problem in clinical practice. The aim of this study was to determine the utility of cardiopulmonary exercise testing (CPET) in the diagnosis of unexplained dyspnoea., Methods: This retrospective single-centre study included consecutive patients with dyspnoea who had normal resting cardiopulmonary examinations (including chest X-ray, electrocardiography, pulmonary function tests [PFTs], and cardiac ultrasound). CPET was performed using a cycle ergometer with analysis of blood gases. The results were interpreted as being most likely due to one of the six pathophysiological mechanisms shown below. Consensus required agreement between at least three of the authors., Results: Of the 194 patients included (median age 53 years, sex-ratio (M:F) 0.83, mean body mass index 27.3±5.36kg/m 2 ), 32% of the test profiles were compatible with deconditioning, 20% with inappropriate hyperventilation (without gas exchange abnormalities), 18% with disorders of gas exchange, 13% with sub-maximal CPET, 9% with cardiovascular anomalies, and 8% with normal CPET. Of the patients with gas exchange abnormalities, the most common causes were bronchiectasis (6), emphysema (6), recent pneumonia (2), and diffuse interstitial pneumonitis (2). Ten of the patients with cardiovascular abnormalities had chronotropic insufficiencies, 5 had excessive tension responses, and 3 had disorders of rhythm or repolarisation., Conclusions: CPET may greatly facilitate the diagnosis of unexplained dyspnoea. More than 50% of the dyspnoea cases examined here were due to deconditioning or hyperventilation syndrome and would benefit from a simple pulmonary rehabilitation program., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Physical activity is an important determinant of health in children and adults. Assessment of physical activity is therefore an important factor in the promotion of health and in several childhood and adulthood pathological situations. Physical activity can be estimated by various methods: pedometry, heart rate monitoring, questionnaires, the doubly labelled water method, and accelerometry. The choice of the type of device depends on the objectives of the clinician or researcher. Accelerometry currently represents the best objective method for measuring physical activity and is widely used in clinical or epidemiological studies. The purpose of this paper is to help practitioners and researchers to make better decisions when using accelerometry as a device for measuring physical activity measurement in order to obtain the most accurate and comparable information., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Dyspnea results from an imbalance between ventilatory demand (linked to CO 2 production, PaCO 2 set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. DLCO measurement, which evaluates both demand and capacity, depicts the best statistical correlation to dyspnea, for instance in obstructive and interstitial pulmonary diseases. Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Stress test is a useful diagnostic tool in patients with suspected angina pectoris with low sensitivity but high specificity. It is also very useful in the evaluation of the risk, of the effectiveness of treatment and it is a useful guidance on medical prescriptions after controlling the symptoms of ischemia. This study aims to analyze the contribution of stress test to the treatment of ischemic heart disease in the Department of Cardiology at the University Hospital CHU YO. We conducted a retrospective study of 60 patients who had undergone stress test from January 2012 to December 2013. Stress test was performed using a treadmill according to the modified Bruce protocol. Sixty patients underwent stress test during the study period. The average age of patients was 49± 10.8 years. Sex-ratio was 1.2. All patients underwent treadmill stress test. Twenty-two patients had a history of coronary artery disease. Estimating presence of coronary artery disease was the indication for stress test in 83% of cases. It was detected in 78% of cases. Stress test was stopped when maximal workload was reached in 46 cases (or 77%). Mean exercise duration was 11,7 mn ± 3,2. Ten percent of patients had a positive stress test and 10% a dubious test. Our study will also contribute to transfer knowledge on this diagnostic test which is still little prescribed in our environment and even among cardiologists. However, efforts should be made in order to improve the quality of stress test practice in the management of coronary artery disease in a context of countries with limited resources., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Previous studies showed that changes in peak of oxygen uptake value (VO 2peak ) with training were poorly related to changes in Maximal Tolerated Power output (MTP) among patients with cardiovascular disease. This result could be due to a difference between cardiopulmonary adaptation to training and the skeletal muscle conditioning., Objective: The aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters., Methods: Nine cardiac patients (64.0±3.1y, 172.9±4.8cm, 83.4±16.3kg, BMI: 27.8±4.5) performed an incremental cycling exercise test to determine MTP, VO 2peak and peak values of heart rate, before and after an aerobic training. Ventilatory thresholds were respectively determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (VT 1 ) and the point at which the ratio of minute ventilation to carbon dioxide output starts to increase (VT 2 ). EMG th1 and EMG th2 were defined as the first and the second breakpoints in the rms-EMG - power output relationship., Results: Short-term exercise training (23.7±8.8 days) induced a significant increase in VO 2peak (P=0.004), MTP (P=0.015), VT 1 (P=0.001) and VT 2 (P=0.001). Changes in VO 2peak only attained the survival criteria (3.5±2.9mLmin -1 kg -1 ). No significant differences (P>0.05) existed between mean power values of VT 1 and EMG th1 (60.5±4.1 vs. 59.2±9.6% of MTP, respectively), or between VT 2 and EMG th2 (78.3±5.7 vs. 80.2±5.2% of MTP). After training, EMG th1 occurred significantly before VT 1 (60.5±6.2 vs. 64.8±4.8% of MTP, P=0.049)., Conclusion: This might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Exercise prescription was generally based on the determination of ventilatory thresholds (VT 1 , VT 2 ) during cardiopulmonary exercise testing (CPX). Changes in surface electromyographic activity (EMG th1 , EMG th2 ) were also related to VT 1 and VT 2 in healthy subjects., Objective: To observe the occurrence of EMGt h1 and EMG th2 and whether these events accompany VT 1 and VT 2 during CPX in cardiac patients (CP)., Method: Thirty-four CP (62.1±7.3years, 172.1±6.3cm, 81.3±15.3kg, BMI: 27.3±4.1) performed a cycle CPX at a 60-rpm cadence. VT 1 was determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (V-slope method). VT 2 was defined as the point at which the ratio of minute ventilation to carbon dioxide output starts to increase. The root mean square of electromyogram (rms-EMG) was on-line calculated from the real time bipolar surface electromyographic signals recorded from the vastus lateralis. EMG th1 and EMG th2 were defined as the first and the second breakpoints in the rms-EMG-power output relationship., Results: Peak values of oxygen uptake (16.3±4.6mL·min -1 ·kg -1 ) and heart rate (106.7±13.8bpm) were reached at 112.9±38.5w (PMT). VT 1 and VT 2 occurred at 71.1±25.9w (62.5±5.5% PMT) and 87.9±28.6w (78.0±5.1% PMT). All subjects presented two breakpoints in the rms-EMG curve, EMG th1 at 68.0±24.7w and EMG th2 at 88.5±30.1w, i.e. 60.0±7.6 and 78.6±5.0% of PMT. EMG th1 occurred significantly before VT 1 (P=0.004, small effect size). No significant difference was observed between EMG th2 and VT 2 (P=0.13, small effect size)., Conclusion: The EMG th1 occurrence before VT 1 suggested a role of skeletal muscle conditioning on ventilatory responses, which should be taken into account in cardiac rehabilitation program prescription., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Aortic stenosis (AS) is the most common valvular heart disease in adults. The most frequent aetiology is now degenerative AS. There is general agreement that, in the absence of serious co-morbidity, surgery must be recommended for patients with symptomatic disease. The management of asymptomatic patients with severe aortic disease remains controversial for several reasons: sudden death in asymptomatic patients has been reported with an incidence < 1 % per year. In addition, operative mortality is significantly higher in symptomatic, when compared with asymptomatic, patients. Patients should be carefully educated about the importance of follow-up and reporting symptoms as soon as they develop. Echocardiography confirms the diagnosis and the severity of aortic stenosis. Exercise testing may be helpful when the patient is asymptomatic. If the patient develops symptoms during test, he should be referred for surgery. The management of patients with AS in everyday practice is based on the guidelines developed by ESC in October 2012.

Physical fitness is an important determinant of global health in children and adolescents. Key components of physical fitness include cardiorespiratory fitness, flexibility, speed, and muscular and endurance strength. The school environment provides a great opportunity to assess the physical fitness level in children and adolescents. The french national program "Bouge... Une priorité pour ta santé! "(Move ... A priority for your health!) aims to assess the physical fitness of children and adolescents aged 6 to 18 years old in French schools. The aim of this paper is to describe the interest to assess different health-related physical fitness components. It presents the chosen tests within said battery for children and adolescents and explains how the battery was conceived. The health-related physical fitness tests included in "BOUGE" were chosen for their validity, reliability, low cost and feasibility for all schools.

Stress magnetic cardiac resonance imaging (MRI) development is in progress. Many cardiac imaging technics already known are completed by this safe radiation free exam with a short time acquisition (30minutes) and a good diagnostic performance in particular for patients with three vessels coronary artery diseases. Best indication concerns symptomatic patients unable to exercise with intermediate or high pretest probability. Pharmacological heart stress can be induced with vasodilatators or dobutamine to identify the presence and extent of myocardial ischemia, with high precision to guide coronary vessels revascularization. MRI gives many other interesting informations like heart anatomy, left ventricular function. Myocardial viability can be assessed with study of late gadolinium enhancement or analysis of contractile reserve with low dose of dobutamine., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Variable tests evaluate the cardio-respiratory working capacity of COPD patients. Stairclimbing testing has been less studied. Our hypothesis is that this functional exercise test represents a submaximal effort for these patients., Method: We compared in 10 COPD patients the main metabolic and ventilatory parameters at the end of an effort between stairclimbing and cycle ergometer test., Results: The following parameters studied (RER, V'CO2, lactates, V'E) are significantly lower for stair climbing. Nevertheless, in 8 patients, the V'O2 at the end of the stairclimbing testing is equal to the cycle ergometer test and in two patients superior. Concerning the evolution of some parameters during stairclimbing, 2 distinct profiles were observed: stabilization of the V'O2, HR, V'E and Vt (6/10 patients) or a constant increase of those parameters (4/10 patients)., Conclusion: Stairclimbing represents a submaximal effort for the majority of COPD patients combined with a high metabolic cost. However, some COPD patients execute a maximal effort like in the cycle ergometer test when climbing stairs. These two groups could not be differentiated with the rest lung function data. The hypothesis of different mechanical constraints and/or motivation is suggested., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

VO2 max is nowadays an essential examination performed in the monitoring of heart failure. The nurse has a role to play during the test and in supporting the patient, although this test remains highly technical and complex.

Cardiorespiratory fitness (CF) is an important factor in treating various paediatric pathologies. As a consequence, assessing CF has widespread clinical application as part of paediatric intervention programs. Several methods have been developed for the purpose of measuring CF. The aim of this review is to describe and evaluate test procedures that are currently in use. Direct measurement in a laboratory setting has the advantage of high validity and reliability. The disadvantage, however, is that laboratory assessment of CF requires trained personnel, takes more time than field tests, and necessitates costly equipment. Conversely, field tests are easier to administer, require less time and utilise less expensive equipment. The choice of the test mode must take into account the age and health of the subject. The availability of a variety of tests makes it possible for the clinician/researcher to choose the most assessment that is most appropriate for the target population, study objectives, and available resources according to the research methods of the study.

Clinical presentation and symptoms of coronary artery disease may vary according to gender. This is not true to the same extent for acute coronary syndromes. The diagnosis is more complex in women because they show less often a typical clinical picture. In spite of these gender-related clinical differences, no diagnostic strategy in the detection of the coronary artery disease is recommended for women. Because "standard" treadmill or bicycle ECG stress test has a low specificity in women, non-invasive imaging (stress echocardiography, myocardial scintigraphy or cardiac magnetic resonance) should be preferred for the evaluation of myocardial ischemia in women.

Coronary disease can lead to very serious complications which sometimes may have dramatic consequences on the quality of life of our patients. In addition, it can also have numerous social repercussions including a significant increase in the health budget costs. Systematic evaluation adapted to each patient is crucial. Numerous diagnostic currently available tests when used in the appropriate manner can be of a precious help for the clinician and for the future of his patient.

This article examines the expected exercise-induced changes in the components of the oxygen transport system as described by the Fick equation with a view to enable a critical analysis of a standard incremental exercise test to identify normal and abnormal patterns of responses and generate hypotheses as to potential physiological and/or pathophysiological causes. The text reviews basic physiological principals and provides useful reminders of standard equations that serve to integrate circulatory, respiratory and skeletal muscle functions. More specifically, the article provides a conceptual and quantitative framework linking the exercise-induced increase in whole body oxygen uptake to central circulatory and peripheral circulatory factors with the view to establish the normalcy of response. Thus, the article reviews the exercise response to cardiac output determinants and provides qualitative and quantitative perspective bases for making assumptions on the peripheral circulatory factors and oxygen use. Finally, the article demonstrates the usefulness of exercise testing as an effective integrative physiological approach to develop clinical reasoning or verify pathophysiological outcomes., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To ascertain, through a national survey, whether the performance of the six-minute walk test (MW6) is in accordance with the recommendations of the American thoracic society (ATS)., Methods: An anonymous questionnaire was sent electronically to 206 departments of respiratory medicine (39 teaching hospitals and 167 general hospitals) and to respiratory rehabilitation departments provided by the Alveolar group of the SLPF (French language respiratory society), and then distributed on a discussion site specialising in respiratory physiotherapy and a professional information site for physiotherapists., Results: One hundred and eleven questionnaires were returned between October 2009 and April 2010, 105 from France. The response rate from hospitals was 30%. The MW6 was performed mainly by physiotherapists and nurses. In 48% there was no precise time for its performance. The site used was a corridor longer than 30 metres in 52% of cases. In 60% the patient was accompanied by the observer. In 35% a familiarisation test was performed, with a delay of 30 minutes or less between the two tests in 62% of these. In 40% encouragement was given. SpO(2) was monitored during the MW6 in 95%., Conclusion: For many items the recommendations of the ATS are not followed. The differences found were mainly due to constraints on the services (availability of operators and/or patients)., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

In the past decade, cardiovascular magnetic resonance (CMR) has evolved considerably. Its clinical applications enable the diagnosis and prognostic assessment of patients with ischemic heart disease. CMR is safe, with absence of any ionizing radiation, and offers the greatest information from a single test, allowing the assessment of myocardial morphology, myocardial function and viability. Stress-CMR can be used for detection and quantification of ischemia. This article analyses the technical approach, the limits and reviews the available literature about diagnostic performance of stress CMR testing and its results in the prognostication of cardiac patients. With further improvements in CMR techniques and the establishment of a standardized study protocol, stress-CMR will play a pivotal role in managing patients with ischemic heart disease., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: Isokinetic assessment is currently the reference method for measuring dynamic muscle strength. We have sought to evaluate the reproducibility over time of isokinetic testing of the hip flexor (FI) and extensor (Ext) muscles and to establish whether there is a significant difference in peak torque (PT) between the left and right hips., Patients and Methods: Ten adults were tested once a week for 3 weeks by the same investigator and according to the same protocol, with two velocities (60 degrees /s and 180 degrees /s) for the hip FI and Ext in concentric tests and one velocity (30 degrees /s) for the Ext only in eccentric tests. The reproducibility of the measured PT was analyzed by using the intraclass correlation coefficient (ICC) and a Bland and Altman plot. The difference in PT between the right and left hips was tested using Student's T test., Results: The ICC for the observed PT values revealed very good reproducibility (with a value of between 0.75 and 0.96) for the hip FI and Ext measurements (regardless of the body side, test velocity or contraction mode). We did not observe any significant PT differences between the right and left hips., Conclusion: The isokinetic assessment of the concentric and eccentric PT values generated by the hip FI and Ext is highly reproducible. There is no difference between dominant and nondominant body sides, which enables the use of the contralateral limb as a reference., (2010. Published by Elsevier Masson SAS.)

Patients suffering from Chronic Obstructive Pulmonary Disease (COPD) are usually evaluated for cardio-respiratory capacity on a flat surface even though these patients generally encounter discomfort only when climbing stairs or ascending a slope. The purpose of this study was to describe the cardio-respiratory evaluation of these patients on climbing stairs. A staircase test was carried out and compared to the 6-min walking test. The maximum duration of ascent was 2 min, covering a maximum of four flights of stairs. The conditions of the staircase test and the instructions given to the patients regarding walking were designed to be consistent with the activities of daily life. We recorded the height reached and the distance covered; we also recorded dyspnoea, oxygen saturation (SpO2) and heart rate (HR); we estimated the maximal oxygen consumption (VO2max) and the physiological cost index (PCI) during each test. The statistical analysis of the results was surprising: it showed that there was no significant difference between the 6-min walking test and the stair climbing test on the following criteria: estimated VO2max, SpO2, and variation in heart rate between rest and effort (DeltaHR); it also showed that these two tests correlated well for dyspnoea (p<0.0001). It appears that the PCI of stair climbing is much higher than the PCI of walking on a level surface. These results may be explained partly by the anaerobic metabolic pathway used predominantly by patients with COPD in brief periods of exertion and partly by the muscular dysfunction which also accompanies brief exertion. The use of the PCI adds greater precision to the interpretation of the results of cardio-respiratory evaluation of COPD patients. The value of this index is proportional to the incapacity described by these patients. The staircase test is complementary to the 6-min walking test, making it possible to evaluate restriction of activity in COPD patients. Its implementation is simple and accessible.

The hyperventilation syndrome is a disease affecting children as well as adults. It predominates in female and may be debilitating. It is frequently associated with anxiety. The diagnosis, that is unfortunately often belated, is a diagnosis of exclusion and relies on the anamnesis, various non specific signs, on the Nijmegens score and on a hyperventilation provocation test. A specialized treatment allows, in most cases, a good control of ventilation and the disappearance of symptoms.

Exercise training is currently including in the treatment of coronary arterial disease patients, in patients with left ventricular dysfunction as well as in patients who underwent cardiac transplantation or cardiac surgery. However methods of prescribing exercise-training programs are difficult to determine and must be adapted for each patient Exercise test with gas analysis through the determination of anaerobic threshold may help to understand the physiopathological mechanism related to exercise limitation in these patients. Exercise test may help to precise exercise intensity during cardiac rehabilitation and may assess the benefits on exercise tolerance.

Exercise testing provides information on physical capacity during exercise in addition to spirometric measures of lung function or assessment on treadmills or ergonomic cycle. The "gold standard" assessment of exercise tolerance is measured in the laboratory using treadmills or ergonomic cycle but the necessary equipment is expensive and may not be readily accessible; such tests require people used to work with children. Walking tests are field tests providing a valid and easily accessible method of measuring function-limited exercise tolerance in patients with respiratory or cardiac chronic diseases. These walking tests are non-threatening, inexpensive, easy to perform and to understand for children. Walking tests performed in daily practice are the following: "time-based" tests (2-, 6- or 12-min walking test), 3-min step test (on a step) and the shuttle walking test. It may be a useful measure to assess therapeutic intervention and provide information on the prognosis. They are simple and safe methods to evaluate quality of life in these patients.

The symptom-limited exercise test is nowadays the gold standard to assess the exercise tolerance and the effects of different treatments in patients with chronic heart failure (CHF). A simpler alternative to this test is the 6-minute walk test. The 6-minute walk test is easy to realize and well-tolerated. Moreover, it is reliable just after one familiarization practice and requires standardization. Indeed, its conduction, which is submitted to some security precautions, can be altered by variation factors. The distance walked during the 6 minutes was the only parameter studied during the test. This parameter could allow judging the CHF severity and prognostic. The analyse of cardiorespiratory parameters has shown that the 6-minute walk test relative intensity is near to the peak individual values. Moreover, the cardiac and ventilatory adaptation of patient during this test depends to his own functional capacity. Lastly, the 6-minute walk test is a submaximal constant-load exercise, which should be performed in complement to the symptom-limited exercise test in cardiac patients.

Heart failure is associated with modifications of skeletal muscle cells, which could participate in the exercise limitation of the patients. However, the mechanical efficiency of the skeletal muscle has not been fully evaluated in these patients. We therefore measured VO2 during prolonged exercise (15 min) at constant load to obtain stable conditions. Load was chosen after maximal stress test as 35% and 65% of load at anaerobic threshold. VO2 during assisted cycling was subtracted from that during constant load to evaluate the relationship between VO2 and Watt. Twenty CHF patients (peak VO2 17.6 ml/kg/min, LVEF <35%) have been compared to 11 controls (peak VO2 40.2 ml/ml/kg). VO2 was similar in the two groups at rest and during assisted cycling. Ventilation on contrary was higher in CHF patients. The relationship between VO2 and Watt was similar in the two populations, indicating that skeletal muscle mechanical efficiency was not altered in CHF patients. In conclusion, histological modifications present in skeletal muscle of CHF patients do not translate into altered skeletal muscle efficiency.

Introduction: Exercise testing is useful in the respiratory evaluation of patients with cystic fibrosis. The shuttle walk test (SWT) is a progressive, externally paced, exercise test requiring the subject to walk/run back and forth between two fixed points. The aim is to assess the reproductibility of the SWT in paediatric patients with cystic fibrosis., Methods: This prospective study recruited 31 children with stable disease. The patients performed two SWT one day (SWT 1 and 2) and two others (SWT 3 and 4) within 15 days. Only SWT 2 and 4 were assessed for reproducibility., Results: 61% were boys, median age (range): 12.9 (7-18.9) years, median Shwachman score (range): 80 (65-100), median values for FEV1 and FVC (range): 92 (55-154) and 92 (64-140)% predicted, respectively. Median distance for SWT 2-4 (range): 910 (580-1020) and 925 (540-1020) metres. Reproducibility for SWT distance and physical activity measured by an accelerometer is very good (intra-class correlation coefficient=0.90 and 0.92, respectively). SWT distance correlated with physical activity (p=3.10(-4)) and weight (p=0.03). SWT distance was independent of the following parameters: height, weight-for-age Z-score, FEV1, FVC, Shwachman score, colonisation with Pseudomonas aeruginosa., Conclusions: The SWT is reproducible in paediatric patients with cystic fibrosis and provides assessment of respiratory performance that complements spirometric measures of lung function.

Overview: Arterial hypotension during stress echocardiography with Dobutamine (ESD) is an occasional complication with no prognostic value, but it sometimes necessitates termination of the investigation. The present study had the aim of elucidating the mechanism responsible for hypotension during ESD and proposing one or several markers for patients at risk for this complication., Method: One hundred and twenty consecutive patients referred for stress echocardiography (Dobutamine or cycloergometrine) were analysed. Arterial hypotension induced by Dobutamine was defined as a fall of more than 30 mmHg compared to the arterial pressure before the test or following the preceding level of Dobutamine. Concentric left ventricular hypertrophy (LVH) was defined as a left ventricular mass > 125 g/m2., Results: Among the 89 patients undergoing ESD, 32 (35%) had LVH, 9 of whom (28%) had arterial hypotension, prompting termination of the examination in 4 patients. Among the 57 patients (65%) without LVH, only 2 (3%) had hypotension. All patients with LVH had normal left ventricular function at rest and excellent contractility under stress, with no sign of ischaemia. None of the 31 patients, 5 of whom had LVH, who underwent the test with cycloergometrine had hypotension., Conclusion: Hypotension occurring during ESD affects patients more often with LVH (p < 0.001) and excellent systolic function. We postulate that the vigorous contraction of the left ventricle with Dobutamine produces excessive stimulation of the cardiac mechanoreceptors inducing a reflex hypotension. LVH is therefore a marker for patients at risk of hypotension and effort echocardiography is an excellent alternative to this investigation.

Exercise tests are routinely used in children to assess cardio-respiratory and muscular adaptations to exercise. However these tests are of relatively recent use, and there is a lack of standardization and of relevant data in large groups in this population. The aim of this paper was to specify the common medical indications of exercise tests in children, to propose standardized protocols of these tests in some of the most common pathological situations as: exercise-induced asthma, chronic respiratory diseases (bronchopulmonary dysplasia, cystic fibrosis), muscular diseases. These tests can provide clinically relevant parameters only when they are used in strict conditions of standardization.

Exercise tolerance tests in athletes are usually performed to evaluate aerobic exertion capacity and to plan training. They are based on simultaneous measurement of expired gases (determination of ventilation threshold and of VO2max). They can also be used to seek a possible cardiovascular anomaly, particularly in case of clinical symptoms or anomalies on auscultation; findings based on electrocardiography (rhythm, repolarisation, etc.) and on blood pressure readings, however, can lead to suspicion of an early anomaly and direct complementary investigation.

The athlete's heart syndrome concerns only high level trained subjects. The classical electrocardiographic features of this syndrome are hypokinetic arrhythmia as bradycardia, low level of atrioventricular and of right bundle branch block and electrocardiographic T wave alterations. Sometimes, marked ventricular repolarisation alterations can suggest the presence of heart disease. These electrocardiographic patterns seem linked to the alterations of the two drive of autonomic nervous system (sympathetic and parasympathetic) and to cardiac hypertrophy. In all cases, it must be kept in mind that the athlete must be free of clinical symptoms and that these electrocardiographic alterations must disappear during exercise and in case of physical training cessation. In case of doubt a cardiologist judgement must be performed.

Dobutamine stress echocardiography (DSE) and exercise stress echocardiography (ESE) are widely used for diagnosis of coronary artery disease. Each of these methods has limitations: secondary effects of Dobutamine, poor imaging quality, difficulty in attaining the maximal heart rate. The authors evaluated a test associating pedalling exercise at a constant low load (30-60 watts) with Dobutamine infusion (10-20-30-40 j/Kg/min +/- Atropine) (DES + E) in 42 patients referred for suspected coronary artery disease. All patients underwent coronary angiography on Day 1. There was significant coronary disease (> 50% stenosis) in 19 of the 42 patients. Sensitivity, specificity, negative predictive value, positive predictive value and overall diagnosis value were respectively 84, 87, 84, 87 and 86%. In the first 20 patients, the DES + E was compared directly with DES: There was only one undesirable side effect (hypertension) with DES + E compared with 5 with DES alone. The target heart rate was attained with lower doses of Dobutamine with DES + E (32.35 vs 39.42 j/Kg/min, p = 0.05). DES + E therefore seems to be a promising technique which is better tolerated than DES alone with very satisfactory diagnostic performances. However, these results require further confirmation in larger numbers of patients.

Purpose of the Study: The purpose of this study was to present a new treadmill proposed for evaluating gait in children. We analysed differences in ground reaction forces between boys and girls, and we calculated the symmetry index in healthy children., Material and Method: Time and ground reaction forces of about 30 steps were measured using a new treadmill. The apparatus consists of 2 walking belts which function as two independent treadmills placed side by side, separated by 4 mm. The 2 treadmills were mechanically separated in order to allow independent measurement of the ground reaction forces induced by each lower limb during stance phase. The children (28 boys and 29 girls), all clinically healthy, were divided into three groups according to their height (between 105 and 150 cm). They walked at three different velocities (2.7 km/h, 3.6 km/h and 4.5 km/h according to their height). The graphs representing the subject's measurements were composed of fore-aft, medial-lateral, and vertical parameters. The analysis of these graphs considered stride, stance, double stance and nine specific points. We also calculated the symmetry index of each child., Results: We determined the values of the symmetry index in healthy children. We did not find any significant difference in gait between girls and boys, except for Fz3 at 2.7 kg/h, where Fz3 was higher in girls than in boys., Discussion: We compared our results with those reported in the literature and found that ADAL has a very important advantage in gait analysis in children because it is simple and easily accepted by children.

The development of stress echocardiography on an ergometric table has increased the number of stress tests in the decubitus position, whereas most of the information currently available concerns stress tests in the sitting position or on the treadmill. In order to study the influence of this position of stress testing, the authors compared the results obtained in a series of 15 patients without cardiac disease (Group I) and another series of 15 coronary patients (Group II) undergoing the two types of stress testing, in the vertical position on a bicycle ergometer and in the lateral decubitus position on the ergometric table. Effort tolerance on the bicycle ergometer was significantly greater in terms of work load (202 +/- 35 vs 180 +/- 36 watts (p < 0.001) in the controls, and 120 +/- 32 vs 106 +/- 22 watts (p < 0.05) in the coronary group), of duration of effort (19 +/- 3 vs 16 +/- 3 minutes (p < 0.001) in the controls and 10 +/- 3 vs 8 +/- 2 minutes (p < 0.05) in the coronary patients), of heart rate (190 +/- 10 vs 172 +/- 21 beats/min (p < 0.005) in controls and 118 +/- 19 vs 111 +/- 14 beats/min (p < 0.05) in the coronary patients). On the other hand, blood pressure and O2 saturation tended to be greater during exercise in the decubitus position: SBP 200 +/- 23 vs 196 +/- 27 mmHg (NS) in the controls and 158 +/- 21 vs 166 +/- 23 mmHg (NS) in the coronary patients; DBP 97 +/- 10 vs 102 +/- 27 mmHg (NS) in the controls and 85 +/- 6 vs 90 +/- 10 mmHg (NS) in the coronary patients; O2 sat 96.8 +/- 1 vs 97.6 +/- 0.8% (p < 0.05) in the coronary patients. The anaerobic threshold and peak VO2 were much higher during exercise in the sitting position: oxygen consumption at the threshold 14.8 +/- 3.8 vs 12.6 +/- 2.3 ml.kg-1.min-1 (p < 0.01), peak VO2 22.2 +/- 5.9 vs 18.8 +/- 4.7 ml.kg-1.min-1 (p < 0.01) in the coronary patients. The results of this study show that the cardiovascular stimulation obtained in the decubitus position is not identical to that obtained by traditional exercise stress testing, particularly in coronary patients.

Dyspnea may be easily appreciated during exercise with dyspneic scales, but methodological standardisation still needs to be specified. Authors review the basic physiological mechanism relating dyspnea to indices obtained during a stress test. They propose to use the dyspnea/VE relationship. With the concept of dyspneic threshold (close to the ventilatory threshold) and the ramp that both could be modified (for instance by rehabilitation programmes including exercise training). Interpretation of dyspnea during an exercise test obviously needs to be integrated with other parameters studied during exercise.

P. carinii pneumonia is one of the most frequent opportunistic infections in HIV-infected patients. Clinical and radiological manifestations are non-specific and reference diagnostic procedure remains broncho-alveolar lavage which is costly and invasive. Alternative diagnostic strategies have been proposed. We report here our experience as well as literature date in this field with the purpose to show the usefulness of decision analysis techniques in choosing an optimal cost-effective strategy.