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Pediatric Cardiopulmonary Exercise Physiology Laboratory

The Pediatric Cardiopulmonary Exercise Physiology Department at NewYork-Presbyterian Morgan Stanley Children's Hospital administers over 1,200 exercise tests per year. The Department consists of professionally trained physicians, physiologists and technicians. The exercise lab has state-of-the-art equipment in order to ensure accurate and reproducible clinical data. The cardiopulmonary test results are used to determine the cause of chest pain, evaluate fitness, heart function and the effectiveness of drug therapies.

The majority of our testing is supervised by a physician in the laboratory. Because many times the patient's symptoms do not occur during rest, exercise testing allows the assessment of the cardio-pulmonary system during heavy exertion. The test also helps determine the patient's true capacity to perform during physical activities. Exercise Tests

Exercise testing provides a non-invasive assessment of the heart, lungs and muscle interactions during physical activity. There are different types of exercise tests that are performed. The specific type of test performed is based on each individual's needs. The tests include a

• Cardiovascular Stress Test
• Cardio-Pulmonary Exercise Test (CPET)
• an Exercise-Induced Asthma Challenge, and
• a Six-Minute Walk Test

In preparation for an exercise test, patients should wear loose fitting clothing and sneakers and refrain from eating two hours before the test.

Cardiovascular Stress Test (Stress EKG)

A Cardiovascular Stress Test measures how well the heart works while exercising. This test may be ordered for people with shortness of breath, chest discomfort, lack of energy, known arrhythmias, known structural heart disease, or prior to or after an operative procedure. The test is done to find out how well the heart pumps blood and oxygen to muscles, how well current medicines are working and to set a safe level of exercise. How is the test done?

Small adhesive pads called electrodes are placed on the chest and attached to an electrocardiogram (EKG) machine. A blood pressure cuff is placed on the arm so that pressure can be monitored during the test. The patient walks and eventually jogs on a treadmill as the speed and incline are gradually increased to make it harder. While exercising, heart rate and rhythm and blood pressure are recorded, and the patient is constantly monitored during the test.

Patients are closely watched for any complications. Emergency equipment and trained staff are on hand if complications occur. Staff should be alerted if the patient has chest discomfort, headache, nausea, anxiety, dizziness, heart palpations, shortness of breath or tired legs.

THERE ARE NO NEEDLES OR BLOOD TESTS!

The total test time takes about one hour from start to finish. The exercise portion lasts from 12-15 minutes after which blood pressure and EKG are monitored while the patient rests for 10 minutes.

In some cases a doctor may want to examine the patient's lungs after exercise, and will perform a breathing test after exercise.

The Pediatric Cardiopulmonary Exercise Physiology Laboratory does not perform cold air challenges.

Cardiopulmonary Exercise Test (CPET)

A cardiopulmonary exercise test measures how well the heart and lungs work while the person exercises.

This test may be ordered for people with shortness of breath, chest discomfort, lack of energy, low blood oxygen levels, known heart or lung problems or before an organ transplant. The test is done to find out how well the heart pumps blood and oxygen to muscles, how breath is held during exercise, how well current medicines are working and to set a safe level of exercise for the patient. How is the test done?

Three breathing tests are done to measure baseline lung function. After the breathing tests are completed, small adhesive pads called electrodes are placed on the chest and attached to an electrocardiogram (EKG) machine. A pulse oximeter (a small plastic clip) is put on the ear to monitor oxygen levels in the blood. Another clip is placed on the nose to keep air from leaking out during exercise. A mouthpiece is placed between the lips and teeth to monitor the air that is expired. Finally, a blood pressure cuff is placed on the arm so that pressures can be monitored during the test.

The patient pedals on a stationary bike or walks on a treadmill while breathing through the mouthpiece into the monitor. While on the bike, the resistance will be slowly and steadily increased as the patient pedals to make the walk harder. While on the treadmill, the speed and the incline are also gradually increased to make walking more difficult.

While exercising, the amount of oxygen and carbon dioxide in the air while exhaling (breathe out) is measured. Heart rate and rhythm and blood pressure are recorded and the patient is constantly monitored during the test for any complications. Emergency equipment and trained staff are on hand if complications occur. Staff should be alerted if the patient experiences any chest discomfort, headache, nausea, anxiety, dizziness, heart palpitations, shortness of breath or tired legs.

THERE ARE NO NEEDLES OR BLOOD TESTS!

The total test time takes about one and a half hours from start to finish. The exercise portion lasts from 12-15 minutes. When the exercise portion is finished, blood pressure and EKG will be monitored while the patient rests for 10 minutes.

In some cases a doctor may want to examine the the patient's lungs after exercise, and perform a breathing test after exercise.

Exercise-Induced Asthma Challenge (Exercise-Induced Bronchospasm or Asthma Challenge)

A bronchial challenge measures lung function before and after exercise. It helps the doctor determine if the patient has exercise-induced asthma. This test may be ordered for people who experience shortness of breath, chest discomfort or dizziness after exercise. It may also be used on known asthmatics to see if exercise provokes bronchospasm. The test is done to find out how well lungs function before and after exercise, and/or how well current medicines are working and to set a safe level of exercise for the patient. How is the test done?

A resting breathing test is performed to obtain baseline breathing measurements. Small adhesive pads called electrodes are placed on the chest and attached to an electrocardiogram (EKG) machine. A blood pressure cuff is placed on the patient's arm so that pressures can be monitored during the test. A mouthpiece will be placed between the lips and teeth and a nose clip will be placed on the nose to prevent leaks. The patient will be breathing dry air through the mouthpiece.

The patient runs on a treadmill with no incline for approximately 6-8 minutes. While exercising, the heart rate and rhythm and blood pressure are recorded and the patient is constantly monitored for any complications. Trained staff with emergency equipment are on hand if complications arise. Staff should be alerted if the patient experiences chest discomfort, headache, nausea, anxiety, dizziness, heart palpitations, shortness of breath or tired legs.

THERE ARE NO NEEDLES OR BLOOD TESTS!

Total test time takes about one and a half hours from start to finish. The exercise portion lasts from 6-8 minutes. When the exercise portion is finished, blood pressure and EKG will be monitored while the patient rests for 10 minutes. Breathing tests will be administered 3 minutes, 5 minutes, and 15 minutes after the running portion of the test.

Six-Minute Walk Test

A six-minute walk test measures how much distance an individual can walk over the allowed time. Oxygen levels and heart rate are measured before and after the test, which may be ordered for people with shortness of breath, known structural heart disease, or those individuals who may be participating in a clinical drug trial. The test is done to find out how far one can walk for 6 minutes and how heart rate and oxygen levels respond to exercise. How is the test done?

A probe is placed on the finger to measure oxygen levels and heart rate. The patient walks at his or her own pace for six minutes without the probe. Staff will inform the patient when he or she has reached the 2-minute mark and 4-minute mark. At the 6-minute mark, the patient will be asked to stop. At the end of 6 minutes, the patient will be shown a scale and asked to rate the degree of shortness of breath. Once a rating is obtained, staff will use the probe to measure heart rate and oxygen. The patient is allowed to take as many rests as needed during the test.

The patient is closely watched for any complications. Emergency equipment and trained staff are on hand if complications occur. Staff should be alerted if the patient experiences chest discomfort, headache, nausea, anxiety, dizziness, heart palpitations, shortness of breath or tired legs.

THERE ARE NO NEEDLES OR BLOOD TESTS!

Frequently Asked Questions

Why would an exercise test be beneficial?
Exercise testing examines the interactions of the heart and lungs during exercise. There are many different exercise tests that can be performed: Cardiovascular Stress Test, Progressive Exercise Test and an Exercise-Induced Asthma Challenge. The information provided by these tests will help evaluate the symptoms.

What does my child need to wear to an exercise test?
Subjects should wear loose fitting clothing (we recommend patients bring shorts or sweatpants) and sneakers (a patient without proper clothing will not be tested). All meals should be eaten at least two hours before any exercise test. A suggested meal would include: cereal with low fat milk or a plain bagel with jelly or cream cheese. Please do not let your child have caffeine before the test.

How can I describe this test to my child?
Please inform your child that he or she will be taking a test that will require him or her to either ride a bike, walk up a hill or run on a treadmill (depending on the test). He or she will be breathing through a mouthpiece (like a snorkel) with a nose clip. The patient should continue exercising for as long as possible. When he or she cannot do anymore, then the test will end. The patient's job is to do the best he or she can. There are no needles or blood tests involved and no pass or fail.

What does an exercise test consist of?
Depending on which exercise test is being performed, some of the components may be slightly different but the major components are:(1) breathing on a mouthpiece with a nose clip pinching the nose, (2) skin monitoring (10 stickers), and (3) blood pressure monitoring.

Are there any risks associated with an exercise test?
The exercise laboratory offers provocative tests; we try to reproduce the patient's symptoms whether it be early fatigue or replicating chest pain. The risks involved in these tests are no different than regular high-intensity exercise (soccer, basketball, lacrosse, etc.) Please make sure to speak to your child's physician or e-mail the exercise physiology department if there are any specific concerns or questions. The exercise lab is equipped with all the necessary testing apparatus needed to monitor your child. Please understand that your child is perfectly safe in the lab.

How long will the test take?
The length of tests vary between one another, but each takes approximately an hour to an hour and a half. The actual exercise portion of the test is only 10 to 20 minutes.

Who will be present during an exercise test?
The test will be covered by professionally trained physicians, physiologists and technicians. All staff are trained in CPR and advanced life support. Parents may also be present at all times during the test.

When will I find out the test results?
The results of the test need to be reviewed and officially interpreted by a physician. Due to the nature of the volume of data collected during the test, it will take 1 to 2 weeks for the results to be available.

Is the test covered by my insurance?
Morgan Stanley Children's Hospital participates in various plans. It is your responsibility to check with your insurance carrier for coverage or you will be asked to incur the costs of the test.

Our Team

Robert Garofano, PhD, Director
[email protected]

Melissa Kessler, Supervisor
[email protected]

Siwat Siengsanaoh, Lab Technician
[email protected]

Judilisa Valdez, Lab Technician
[email protected]

Jasmine Haque, Lab Technician
[email protected]

Contact: To learn more about the Pediatric Cardiopulmonary Exercise Physiology Laboratory at Morgan Stanley Children's Hospital, please call (212) 305-4226.