Statement on exercise testing in cystic fibrosis

Respiration

Volumn 90, Issue 4, 2015, Pages 332-351

  Hebestreit, Helge ^a   Arets, Hubertus G M ^b   Aurora, Paul ^c   Boas, Steve ^e   Cerny, Frank ^f   Hulzebos, Erik H J ^b   Karila, Chantal ⁱ   Lands, Larry C ^j   Lowman, John D ^g   Swisher, Anne ^h   Urquhart, Don S ^d  

^a UNIVERSITY HOSPITAL WÜRZBURG   (Germany)

^b UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^c UNIVERSITY COLLEGE LONDON   (United Kingdom)

^d ROYAL HOSPITAL FOR SICK CHILDREN   (United Kingdom)

^e NORTHWESTERN UNIVERSITY   (United States)

^f UNIVERSITY AT BUFFALO   (United States)

^g UNIVERSITY OF ALABAMA AT BIRMINGHAM   (United States)

^h WEST VIRGINIA UNIVERSITY   (United States)

ⁱ HÔPITAL NECKER ENFANTS MALADES   (France)

^j MONTREAL CHILDREN S HOSPITAL   (Canada)

more..

Author keywords

Cardiopulmonary exercise test; Clinical care; Cycle ergometry; Oxygen uptake; Treadmill

Indexed keywords

AEROBIC EXERCISE; BICYCLE ERGOMETER; COUNSELING; CYSTIC FIBROSIS; DELPHI STUDY; DISEASE COURSE; DISEASE SEVERITY; EXERCISE; FORCED EXPIRATORY VOLUME; HUMAN; LUNG CLEARANCE; LUNG FUNCTION; LUNG GAS EXCHANGE; LUNG TRANSPLANTATION; MUSCLE MASS; OXYGEN CONSUMPTION; OXYGEN SATURATION; PHYSICAL ACTIVITY; PRIORITY JOURNAL; PSEUDOMONAS INFECTION; PULSE OXIMETRY; QUALITY OF LIFE; REFERENCE VALUE; REVIEW; TREADMILL EXERCISE; EXERCISE TEST; PRACTICE GUIDELINE;

CYSTIC FIBROSIS; EXERCISE TEST; HUMANS;

EID: 84946489490     PISSN: 00257931     EISSN: 14230356     Source Type: Journal    
DOI: 10.1159/000439057     Document Type: Review

References (127)

1. Barker M, Hebestreit A, Gruber W, Hebestreit H. Exercise testing and training in German CF centers. Pediatr Pulmonol 2004; 37: 351-355
2. Ruf K, Hebestreit H. Exercise-induced hypoxemia and cardiac arrhythmia in cystic fibrosis. J Cyst Fibros 2009; 8: 83-90
3. Urquhart D, Sell Z, Dhouieb E, Bell G, Oliver S, Black R, et al. Effects of a supervised, outpatient exercise and physiotherapy programme in children with cystic fibrosis. Pediatr Pulmonol 2012; 47: 1235-1241
4. Schneiderman-Walker J, Pollock SL, Corey M, Wilkes DD, Canny GJ, Pedder L, et al. A randomized controlled trial of a 3-year home exercise program in cystic fibrosis. J Pediatr 2000; 136: 304-310
5. Hebestreit H, Kieser S, Junge S, Ballmann M, Hebestreit A, Schindler C, et al. Long-term effects of a partially supervised conditioning programme in cystic fibrosis. Eur Respir J 2010; 35: 578-583
6. Moorcroft AJ, Dodd ME, Morris J, Webb AK. Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax 2004; 59: 1074-1080
7. Nixon PA, Orenstein DM, Kelsey SF, Doershuk CF. The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 1992; 327: 1785-1788
8. Ruter K, Staab D, Magdorf K, Bisson S, Wahn U, Paul K. The 12-min walk test as an assessment criterion for lung transplantation in subjects with cystic fibrosis. J Cyst Fibros 2003; 2: 8-13
9. Kadikar A, Maurer J, Kesten S. The six-minute walk test: a guide to assessment for lung transplantation. J Heart Lung Transplant 1997; 16: 313-319
10. Moorcroft AJ, Dodd ME, Webb AK. Exercise testing and prognosis in adult cystic fibrosis. Thorax 1997; 52: 291-293
11. Aurora P, Wade A, Whitmore P, Whitehead B. A model for predicting life expectancy of children with cystic fibrosis. Eur Respir J 2000; 16: 1056-1060
12. Pianosi P, Leblanc J, Almudevar A. Peak oxygen uptake and mortality in children with cystic fibrosis. Thorax 2005; 60: 50-54
13. van De Weert-van Leeuwen PB, Slieker MG, Hulzebos HJ, Kruitwagen CL, van Der Ent CK, Arets HG. Chronic infection and inflammation affect exercise capacity in cystic fibrosis. Eur Respir J 2012; 39: 893-898
14. Radtke T, Faro A, Wong J, Boehler A, Benden C. Exercise testing in pediatric lung transplant candidates with cystic fibrosis. Pediatr Transplant 2011; 15: 294-299
15. Tantisira KG, Systrom DM, Ginns LC. An elevated breathing reserve index at the lactate threshold is a predictor of mortality in patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med 2002; 165: 1629-1633
16. Orenstein DM, Nixon PA, Ross EA, Kaplan RM. The quality of well-being in cystic fibrosis. Chest 1989; 95: 344-347
17. Gruber W, Hebestreit A, Hebestreit H.E.V. ASiM Leitfaden Sport bei Mukoviszdise. Bonn, Mukoviszidose, 2004
18. Standards for the Clinical Care of Children and Adults with cystic Fibrosis in the UK, ed 2. London, CF Trust, 2011. https://www.cysticfibrosis. org.uk/media/82070/CD-Standards- of-Care-Dec-11.pdf
19. Cabrera ME, Lough MD, Doershuk CF, De-Rivera GA. Anaerobic performance assessed by the Wingate Test -in patients with cystic fibrosis. Pediatr Exerc Sci 1993; 5: 78-87
20. Boas SR, Danduran MJ, McColley SA. Energy metabolism during anaerobic exercise in children with cystic fibrosis and asthma. Med Sci Sports Exerc 1999; 31: 1242-1249
21. Hebestreit H, Kieser S, Rudiger S, Schenk T, Junge S, Hebestreit A, et al. Physical activity is independently related to aerobic capacity in cystic fibrosis. Eur Respir J 2006; 28: 734-739
22. Lands LC, Heigenhauser GJ, Jones NL. Analysis of factors limiting maximal exercise performance in cystic fibrosis. Clin Sci 1992; 83: 391-397
23. Klijn PH, Oudshoorn A, van Der Ent CK, van Der Net J, Kimpen JL, Helders PJ. Effects of anaerobic training in children with cystic fibrosis: a randomized controlled study. Chest 2004; 125: 1299-1305
24. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinicians guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122: 191-225
25. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167: 211-277
26. Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. ERS Task Force on Standardization of Clinical Exercise Testing. European Respiratory Society. Eur Respir J 1997; 10: 2662-2689
27. Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, et al. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation 2006; 113: 1905-1920
28. Stevens D, Oades PJ, Armstrong N, Williams CA. A survey of exercise testing and training in UK cystic fibrosis clinics. J Cyst Fibros 2010; 9: 302-306
29. Chang RK, Gurvitz M, Rodriguez S, Hong E, Klitzner TS. Current practice of exercise stress testing among pediatric cardiology and pulmonology centers in the United States. Pediatr Cardiol 2006; 27: 110-116
30. Barry SC, Gallagher CG. Corticosteroids and skeletal muscle function in cystic fibrosis. J Appl Physiol 2003; 95: 1379-1384
31. Hutler M, Schnabel D, Staab D, Tacke A, Wahn U, Boning D, et al. Effect of growth hormone on exercise tolerance in children with cystic fibrosis. Med Sci Sports Exerc 2002; 34: 567-572
32. Nixon PA. Role of exercise in the evaluation and management of pulmonary disease in children and youth. Med Sci Sports Exerc 1996; 28: 414-420
33. Selvadurai HC, McKay KO, Blimkie CJ, Cooper PJ, Mellis CM, Van Asperen PP. The relationship between genotype and exercise tolerance in children with cystic fibrosis. Am J Respir Crit Care Med 2002; 165: 762-765
34. Karila C, Gauthier R, Denjean A. Exercise testing in patients with cystic fibrosis (in French). Rev Pneumol Clin 2008; 64: 195-201
35. Arena R, Myers J, Guazzi M. The future of aerobic exercise testing in clinical practice: is it the ultimate vital sign?. Future Cardiol 2010; 6: 325-342
36. Baumgartner H, Bonhoeffer P, De Groot NM, De Haan F, Deanfield JE, Galie N, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915-2957
37. Webb GD, Williams RG. Care of the adult with congenital heart disease: introduction. J Am Coll Cardiol 2001; 37: 1166
38. Cropp GJ, Pullano TP, Cerny FJ, Nathanson IT. Exercise tolerance and cardiorespiratory adjustments at peak work capacity in cystic fibrosis. Am Rev Respir Dis 1982; 126: 211-216
39. Klijn PH, van Der Net J, Kimpen JL, Helders PJ, van Der Ent CK. Longitudinal determinants of peak aerobic performance in children with cystic fibrosis. Chest 2003; 124: 2215-2219
40. Pianosi P, Pelech A. Stroke volume during exercise in cystic fibrosis. Am J Respir Crit Care Med 1996; 153: 1105-1109
41. Henke KG, Orenstein DM. Oxygen saturation during exercise in cystic fibrosis. Am Rev Respir Dis 1984; 129: 708-711
42. Holland AE, Rasekaba T, Wilson JW, Button BM. Desaturation during the 3-min step test predicts impaired 12-month outcomes in adult patients with cystic fibrosis. Respir Care 2011; 56: 1137-1142
43. Keochkerian D, Chlif M, Delanaud S, Gauthier R, Maingourd Y, Ahmaidi S. Breathing pattern adopted by children with cystic fibrosis with mild to moderate pulmonary impairment during exercise. Respiration 2008; 75: 170-177
44. Dodd JD, Barry SC, Barry RB, Gallagher CG, Skehan SJ, Masterson JB. Thin-section CT in patients with cystic fibrosis: correlation with peak exercise capacity and body mass index. Radiology 2006; 240: 236-245
45. Cerny FJ. Day-to-Day Exercise and Cystic Fibrosis (CF). Bethesda, Cystic Fibrosis Foundation, 2009
46. Standards of Care and Good Clinical Practice for the Physiotherapy Management of Cystic Fibrosis, ed 2. London, CF Trust, 2011. http://www.cftrust.org.uk/aboutcf/publications/consensusdoc/Physio-standards-of-care. pdf
47. Diamond E. Developing a cardiopulmonary exercise testing laboratory. Chest 2007; 132: 2000-2007
48. Nixon PA, Orenstein DM, Curtis SE, Ross EA. Oxygen supplementation during exercise in cystic fibrosis. Am Rev Respir Dis 1990; 142: 807-811
49. Orenstein DM, Nixon PA. Exercise performance and breathing patterns in cystic fibrosis: male-female differences and influence of resting pulmonary function. Pediatr Pulmonol 1991; 10: 101-105
50. Godfrey S, Mearns M. Pulmonary function and response to exercise in cystic fibrosis. Arch Dis Child 1971; 46: 144-151
51. Orenstein DM, Hovell MF, Mulvihill M, Keating KK, Hofstetter CR, Kelsey S, et al. Strength vs aerobic training in children with cystic fibrosis: a randomized controlled trial. Chest 2004; 126: 1204-1214
52. Kriemler S, Kieser S, Junge S, Ballmann M, Hebestreit A, Schindler C, et al. Effect of supervised training on FEV1 in cystic fibrosis: a randomised controlled trial. J Cyst Fibros 2013; 12: 714-720
53. Orenstein DM, Franklin BA, Doershuk CF, Hellerstein HK, Germann KJ, Horowitz JG, et al. Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program. Chest 1981; 80: 392-398
54. Godfrey S, Davies CT, Wozniak E, Barnes CA. Cardio-respiratory response to exercise in normal children. Clin Sci 1971; 40: 419-431
55. Orenstein DM. Assessment of exercise pulmonary function; in Rowland TW (ed): Pediatric Laboratory Exercise Testing Clinical Guidelines. Champaign, Human Kinetics, 1993, pp 141-163
56. Moorcroft AJ, Dodd ME, Webb AK. Longterm change in exercise capacity, body mass, and pulmonary function in adults with cystic fibrosis. Chest 1997; 111: 338-343
57. De Meer K, Gulmans VA, van Der Laag J. Peripheral muscle weakness and exercise capacity in children with cystic fibrosis. Am J Respir Crit Care Med 1999; 159: 748-754
58. Alison JA, Regnis JA, Donnelly PM, Adams RD, Sullivan CE, Bye PT. End-expiratory lung volume during arm and leg exercise in normal subjects and patients with cystic fibrosis. Am J Respir Crit Care Med 1998; 158: 1450-1458
59. Hulzebos HJ, Werkman MS, van Brussel M, Takken T. Towards an individualized protocol for workload increments in cardiopulmonary exercise testing in children and adolescents with cystic fibrosis. J Cyst Fibros 2012; 11: 550-554
60. Binkhorst RA, Saris WHM, Noordeloos AM, vant Hof MA, De Haan AFJ. Maximal oxygen consumption of children (6-18 years) predicted from maximal and submaximal values in treadmill and bicycle tests; in Rutenfranz J, Mocellin R, Klimt F (eds): Children and Exercise XII. Champaign, Human Kinetics, 1986, pp 227-232
61. Ten Harkel AD, Takken T, Van Osch-Gevers M, Helbing WA. Normal values for cardiopulmonary exercise testing in children. Eur J Cardiovasc Prev Rehabil 2011; 18: 48-54
62. Jones NL, Makrides L, Hitchcock C, Chypchar T, McCartney N. Normal standards for an incremental progressive cycle ergometer test. Am Rev Respir Dis 1985; 131: 700-708
63. Werkman MS, Hulzebos EH, Helders PJ, Arets BG, Takken T. Estimating peak oxygen uptake in adolescents with cystic fibrosis. Arch Dis Child 2014; 99: 21-25
64. McKone EF, Barry SC, FitzGerald MX, Gallagher CG. Reproducibility of maximal exercise ergometer testing in patients with cystic fibrosis. Chest 1999; 116: 363-368
65. Gruber W, Orenstein DM, Braumann KM, Paul K, Huls G. Effects of an exercise program in children with cystic fibrosis: are there differences between females and males?. J Pediatr 2011; 158: 71-76
66. Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J 1973; 85: 546-562
67. Stuart RJ Jr, Ellestad MH. National survey of exercise stress testing facilities. Chest 1980; 77: 94-97
68. van Der Cammen-van Zijp MH, Ijsselstijn H, Takken T, Willemsen SP, Tibboel D, Stam HJ, et al. Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl Physiol 2010; 108: 393-399
69. van Der Cammen-van Zijp MH, van den Berg-Emons RJ, Willemsen SP, Stam HJ, Tibboel D, IJsselstijn H. Exercise capacity in Dutch children: new reference values for the Bruce treadmill protocol. Scand J Med Sci Sports 2010; 20: e130-e136
70. Terziyski KV, Marinov BI, Aliman OI, St Kostianev S. Oxygen uptake efficiency slope and chronotropic incompetence in chronic heart failure and chronic obstructive pulmonary disease. Folia Med (Plovdiv) 2009; 51: 18-24
71. Ganju AA, Fuladi AB, Tayade BO, Ganju NA. Cardiopulmonary exercise testing in evaluation of patients of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2011; 53: 87-91
72. Aggarwal P, Patial RK, Negi PC, Marwaha R. Oral tadalafil in pulmonary artery hypertension: a prospective study. Indian Heart J 2007; 59: 329-335
73. Grossman RF, Frost A, Zamel N, Patterson GA, Cooper JD, Myron PR, et al. Results of single-lung transplantation for bilateral pulmonary fibrosis. The Toronto Lung Transplant Group. N Engl J Med 1990; 322: 727-733
74. Snell GI, De Hoyos A, Winton T, Maurer JR. Lung transplantation in patients over the age of 50. Transplantation 1993; 55: 562-566
75. Pouliou E, Nanas S, Papamichalopoulos A, Kyprianou T, Perpati G, Mavrou I, et al. Prolonged oxygen kinetics during early recovery from maximal exercise in adult patients with cystic fibrosis. Chest 2001; 119: 1073-1078
76. Robinson PD, Cooper P, Van Asperen P, Fitzgerald D, Selvadurai H. Using index of ventilation to assess response to treatment for acute pulmonary exacerbation in children with cystic fibrosis. Pediatr Pulmonol 2009; 44: 733-742
77. Selvadurai HC, Blimkie CJ, Meyers N, Mellis CM, Cooper PJ, Van Asperen PP. Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Pediatr Pulmonol 2002; 33: 194-200
78. Selvadurai HC, Cooper PJ, Meyers N, Blimkie CJ, Smith L, Mellis CM, et al. Validation of shuttle tests in children with cystic fibrosis. Pediatr Pulmonol 2003; 35: 133-138
79. Sawyer EH, Clanton TL. Improved pulmonary function and exercise tolerance with inspiratory muscle conditioning in children with cystic fibrosis. Chest 1993; 104: 1490-1497
80. Pollock ML, Foster C, Schmidt D, Hellman C, Linnerud AC, Ward A. Comparative analysis of physiologic responses to three different maximal graded exercise test protocols in healthy women. Am Heart J 1982; 103: 363-373
81. Foster C, Jackson AS, Pollock ML, Taylor MM, Hare J, Sennett SM, et al. Generalized equations for predicting functional capacity from treadmill performance. Am Heart J 1984; 107: 1229-1234
82. Coffey MJ, FitzGerald MX, McNicholas WT. Comparison of oxygen desaturation during sleep and exercise in patients with cystic fibrosis. Chest 1991; 100: 659-662
83. Wasserman K, Hansen JE, Sue DY, Stringer W, Whipp BJ. Clinical Exercise Testing. Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications, ed 4. Philadelphia, Lippincott Williams and Wilkins, 2005
84. Cumming GR, Everatt D, Hastman L. Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol 1978; 41: 69-75
85. Wessel HU, Strasburger JF, Mitchell BM. New standards for the Bruce treadmill protocol in children and adolescents. Pediatr Exerc Sci 2001; 13: 392-401
86. Thompson WR, Gordon NF, Pescatello LS (eds): ACSMs Guidelines for Exercise Testing and Prescription, ed 8. Philadelphia, Lippincott Williams and Wilkins, 2010
87. Fielding RA, Frontera WR, Hughes VA, Fisher EC, Evans WJ. The reproducibility of the Bruce protocol exercise test for the determination of aerobic capacity in older women. Med Sci Sports Exerc 1997; 29: 1109-1113
88. Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, et al. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infect Control Hosp Epidemiol 2014; 35(suppl 1): S1-S67
89. Flume PA, Mogayzel PJ Jr, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC, et al. Cystic fibrosis pulmonary guidelines: pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med 2010; 182: 298-306
90. Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation 2009; 119: 3144-3161
91. Mahler DA. The measurement of dyspnea during exercise in patients with lung disease. Chest 1992; 101: 242S-247S
92. Borg E, Kaijser L. A comparison between three rating scales for perceived exertion and two different work tests. Scand J Med Sci Sports 2006; 16: 57-69
93. Rowland TW. Developmental Exercise Physiology. Champaign, Human Kinetics, 1996
94. Fairbarn MS, Blackie SP, McElvaney NG, Wiggs BR, Pare PD, Pardy RL. Prediction of heart rate and oxygen uptake during incremental and maximal exercise in healthy adults. Chest 1994; 105: 1365-1369
95. Nes BM, Janszky I, Wisloff U, Stoylen A, Karlsen T. Age-predicted maximal heart rate in healthy subjects: the HUNT fitness study. Scand J Med Sci Sports 2013; 23: 697-704
96. Legrand R, Ahmaidi S, Moalla W, Chocquet D, Marles A, Prieur F, et al. O 2 arterial desaturation in endurance athletes increases muscle deoxygenation. Med Sci Sports Exerc 2005; 37: 782-788
97. Rowland TW, Cunningham LN. Development of ventilatory responses to exercise in normal white children. A longitudinal study. Chest 1997; 111: 327-332
98. Armstrong N, Kirby BJ, McManus AM, Welsman JR. Prepubescents ventilatory responses to exercise with reference to sex and body size. Chest 1997; 112: 1554-1560
99. Neder JA, Nery LE, Peres C, Whipp BJ. Reference values for dynamic responses to incremental cycle ergometry in males and females aged 20-80. Am J Respir Crit Care Med 2001; 164: 1481-1486
100. Stein R, Selvadurai H, Coates A, Wilkes DL, Schneiderman-Walker J, Corey M. Determination of maximal voluntary ventilation in children with cystic fibrosis. Pediatr Pulmonol 2003; 35: 467-471
101. Cooper DM, Weiler-Ravell D, Whipp BJ, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol 1984; 56: 628-634
102. Force ERST, Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007; 29: 185-209
103. Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011; 123: 668-680
104. Sheehan JM, Rowland TW, Burke EJ. A comparison of four treadmill protocols for determination of maximum oxygen uptake in 10-to 12-year-old boys. Int J Sports Med 1987; 8: 31-34
105. Gulmans VA, van Veldhoven NH, De Meer K, Helders PJ. The six-minute walking test in children with cystic fibrosis: reliability and validity. Pediatr Pulmonol 1996; 22: 85-89
106. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384-1387
107. Geiger R, Strasak A, Treml B, Gasser K, Kleinsasser A, Fischer V, et al. Six-min walk test in children and adolescents. J Pediatr 2007; 150: 395-399.e1-e2
108. Lammers AE, Hislop AA, Flynn Y, Haworth SG. The 6-min walk test: normal values for children of 4-11 years of age. Arch Dis Child 2008; 93: 464-468
109. Beriault K, Carpentier AC, Gagnon C, Menard J, Baillargeon JP, Ardilouze JL, et al. Reproducibility of the 6-min walk test in obese adults. Int J Sports Med 2009; 30: 725-727
110. Morinder G, Mattsson E, Sollander C, Marcus C, Larsson UE. Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiother Res Int 2009; 14: 91-104
111. Nixon PA, Joswiak ML, Fricker FJ. A sixminute walk test for assessing exercise tolerance in severely ill children. J Pediatr 1996; 129: 362-366
112. Gruber W, Orenstein DM, Braumann KM, Huls G. Health-related fitness and trainability in children with cystic fibrosis. Pediatr Pulmonol 2008; 43: 953-964
113. Lesser DJ, Fleming MM, Maher CA, Kim SB, Woo MS, Keens TG. Does the 6-min walk test correlate with the exercise stress test in children?. Pediatr Pulmonol 2010; 45: 135-140
114. Leger LA, Lambert J. A maximal multistage 20-m shuttle run test to predict V O 2 max . Eur J Appl Physiol 1982; 49: 1-12
115. Ortega FB, Artero EG, Ruiz JR, Espana-Romero V, Jimenez-Pavon D, Vicente-Rodriguez G, et al. Physical fitness levels among European adolescents: the HELENA study. Br J Sports Med 2011; 45: 20-29
116. Silva G, Aires L, Mota J, Oliveira J, Ribeiro JC. Normative and criterion-related standards for shuttle run performance in youth. Pediatr Exerc Sci 2012; 24: 157-169
117. Leger L, Gadoury C. Validity of the 20 m shuttle run test with 1 min stages to predict V O 2 max in adults. Can J Sports Sci 1989; 14: 21-26
118. Stickland MK, Petersen SR, Bouffard M. Prediction of maximal aerobic power from the 20-m multi-stage shuttle run test. Can J Sports Sci 2003; 28: 272-282
119. Lamb KL, Rogers L. A re-appraisal of the reliability of the 20 m multi-stage shuttle run test. Eur J Appl Physiol 2007; 100: 287-292
120. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47: 1019-1024
121. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Goncalves CG, et al. Reference values for the incremental shuttle walking test. Respir Med 2012; 106: 243-248
122. Bradley J, Howard J, Wallace E, Elborn S. Validity of a modified shuttle test in adult cystic fibrosis. Thorax 1999; 54: 437-439
123. Elkins MR, Dentice RL, Bye PT. Validation of the MST-25: an extension of the modified shuttle test (MST). J Cyst Fibros 2009; 8: S70
124. Bradley J, Howard J, Wallace E, Elborn S. Reliability, repeatability, and sensitivity of the modified shuttle test in adult cystic fibrosis. Chest 2000; 117: 1666-1671
125. Balfour-Lynn IM, Prasad SA, Laverty A, Whitehead BF, Dinwiddie R. A step in the right direction: assessing exercise tolerance in cystic fibrosis. Pediatr Pulmonol 1998; 25: 278-284
126. Aurora P, Prasad SA, Balfour-Lynn IM, Slade G, Whitehead B, Dinwiddie R. Exercise tolerance in children with cystic fibrosis undergoing lung transplantation assessment. Eur Respir J 2001; 18: 293-297
127. Narang I, Pike S, Rosenthal M, Balfour-Lynn IM, Bush A. Three-minute step test to assess exercise capacity in children with cystic fibrosis with mild lung disease. Pediatr Pulmonol 2003; 35: 108-113