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Cardiovascular responses to treadmill and cycle

ergometer exercise in children and adults


KENNETH R. TURLEY AND JACK H. WILMORE
Human Performance Laboratory, Department of Kinesiology
and Health Education, The University of Texas at Austin, Austin, Texas 78712

Turley, Kenneth R., and Jack H. Wilmore. Cardiovascu- exercise in children and adults, only one used children
lar responses to treadmill and cycle ergometer exercise in with a mean age younger than 10 yr, and that study
children and adults. J. Appl. Physiol. 83(3): 948–957, 1997.— used only three boys with a mean age of 9.7 yr (19).
This study was conducted to determine whether submaximal Furthermore, all of these studies have used the cycle
cardiovascular responses at a given rate of work are different ergometer as the exercise modality. Whether cardiovas-
in children and adults, and, if different, what mechanisms are
involved and whether the differences are exercise-modality
cular response differences between children and adults
dependent. A total of 24 children, 7 to 9 yr old, and 24 adults, are attenuated, exacerbated, or the same on the tread-
18 to 26 yr old (12 males and 12 females in each group), mill is unknown. Finally, none of these studies has
participated in both submaximal and maximal exercise tests attempted to determine the mechanism behind the
on both the treadmill and cycle ergometer. With the use of differences that are generally reported between chil-
regression analysis, it was determined that cardiac output dren and adults. Only one study measured submaximal
(Q̇) was significantly lower (P # 0.05) at a given O2 consump- blood pressure (BP) (16), and none attempted to esti-

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tion level (V̇O2, l/min) in boys vs. men and in girls vs. women mate heart size to see whether differences may be
on both the treadmill and cycle ergometer. The lower Q̇ in the related to either peripheral resistance or differing heart
children was compensated for by a significantly higher (P # sizes of the subjects.
0.05) arterial-mixed venous O2 difference to achieve the same The present study investigated cardiovascular re-
or similar V̇O2. Furthermore, heart rate and total peripheral sponses to submaximal exercise using both the cycle
resistance were higher and stroke volume was lower in the
ergometer and treadmill with 7- to 9-yr-old children
children vs. in the adult groups on both exercise modalities.
Stroke volume at a given rate of work was closely related to
and young adults to determine the differences, if any, in
left ventricular mass, with correlation coefficients ranging responses between boys vs. men and girls vs. women
from r 5 0.89–0.92 and r 5 0.88–0.93 in the males and and to determine whether these relationships are af-
females, respectively. It was concluded that submaximal fected by the exercise modality. Left ventricular mass
cardiovascular responses are different in children and adults (LVM) and submaximal BP were measured to define
and that these differences are related to smaller hearts and a the mechanism for any differences that may exist.
smaller absolute amount of muscle doing a given rate of work
in the children. The differences were not exercise-modality METHODS
dependent.
Subjects. Twenty-four healthy 7- to 9-yr-old children (12
submaximal exercise; cardiac output; blood pressure; left
boys and 12 girls) and 24 healthy 19- to 26-yr-old adults (12
ventricular mass
men and 12 women) agreed to participate in this study. The
children were recruited from a local private school. To be
included, the children filled out an activity questionnaire to
ensure that they were active but not participating in formal
IT HAS BEEN REPORTED that both boys (2, 16, 30, 32, 42, training or organized sports. In addition, although pubertal
52) and girls (30, 32, 42, 52) have a lower cardiac output status was not assessed, parents of the children were asked
(Q̇) than adults at a given absolute submaximal rate of whether their child exhibited any overt signs of pubertal
work or O2 uptake (V̇O2). This lower Q̇ at a given onset (e.g., pubertal hair, breast development). If so, these
submaximal rate of work is attributed to a lower stroke children were excluded from participation (2 girls were
volume (SV), which is only partially compensated for by excluded based on this criterion). Adult subjects volunteered
a higher heart rate (HR). A higher arterial-mixed in response to flyers that were posted on the college campus.
Written informed consent was obtained from each of the
venous O2 difference (a-v)O2 in children then compen-
children and their parents and from each of the adult
sates for their lower Q̇ to achieve the same or similar subjects. After the children had completed all but their final
V̇O2 (2, 15, 32, 42). Although the majority of studies testing day, they were asked to sign a separate consent form
have reported a lower Q̇ in children vs. adults at a given specifically for a blood draw. A separate consent form for the
submaximal rate of work, others have reported similar blood draw in children was used so that they were not
Q̇ values for adults and children (17–19). discouraged from participating in the study solely based on
A close examination reveals a number of weaknesses their fear of having their blood drawn. The study design and
in these studies that have reported comparisons of consent forms had been previously approved by The Univer-
sity of Texas at Austin Institutional Review Board. All
cardiovascular responses to submaximal exercise in
subjects, both adults and children, were active but not
children vs. adults. First, many of the studies did not participating in formal training or organized sports.
collect data on adults but instead have compared data Study design. All testing was conducted in the Human
on children with adult values reported elsewhere (2, Performance Laboratory at The University of Texas at Aus-
16–18, 30). In addition, of all the studies that have tin. Each subject visited the laboratory six times. During the
compared submaximal cardiovascular responses with first visit maximal O2 consumption (V̇O2 max) was determined

948 0161-7567/97 $5.00 Copyright r 1997 the American Physiological Society http://www.jap.org
CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE 949

(random draw of either treadmill or cycle ergometry), Submaximal exercise tests. Submaximal exercise tests on
anthropometric measurements were obtained, and a 10-min the treadmill were at 3.0, 4.0, and 5.0 mph for children and at
accommodation period on the treadmill [5 min at both 3.0 and 3.0 and 5.0 mph and ,60% of V̇O2 max for the adults. A relative
5.0 miles/h (mph)] was provided. On the second visit for work rate was used in adults so that a similar physiological
children, a submaximal steady-state 4.0-mph walk on the stress was experienced by both the children and adults, thus
treadmill and a second maximal test on the ergometer also allowing comparison of cardiovascular responses at
(whichever was not used in the first test) were conducted, similar relative rates of work and increasing the range of V̇O2
with the tests being separated by 20–30 min. On the second values from which regression lines were developed. From the
visit for adults, only the second maximal test was conducted. results of pilot work, we found that children were just able to
On each of the next four visits, one of four randomized complete steady-state cardiovascular measurements on the
submaximal steady-state exercise tests was conducted (2 treadmill when they exercised at both 3.0 and 5.0 mph on the
cycle and 2 treadmill tests). Both children and adults exer- same day. Hence, the children completed the 4.0-mph portion
cised at three different submaximal rates of work on each of their submaximal treadmill test on their second visit, as
ergometer so that accurate regression lines could be devel- described above. Children completed the 4.0-mph work rate
oped through as wide a range of V̇O2 values as possible. only once. One boy did not do the 4.0-mph work rate.
On the last visit, M-mode echocardiography was used to On the cycle, children exercised at 20, 40, and 60 W,
determine the subject’s left ventricular dimensions at rest, whereas adults exercised at 40 and 60 W and at ,60% of
just before exercise, and a blood sample was drawn immedi- V̇O2 max, both groups cycling at 65 6 5 rpm. One girl
ately after exercise (optional for the children) to determine was not able to complete the 60-W work rate. As with the
hemoglobin concentration ([Hb]) for use in the calculation of treadmill, a relative work rate was used in adults to in-
Q̇. Testing for each subject was conducted within a 2- to 4-wk crease the range of V̇O2 values from which regression lines
were developed.

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period, with a minimum of 24 h between tests.
Maximal-exercise tests. Before the commencement of the Before the commencement of both the treadmill and cycle
ergometer submaximal tests, the children and adults were
maximal tests on the motor-driven treadmill (Quinton Q65),
allowed a 3–5 min warm-up period. The treadmill was
both children and adults practiced walking and running for
calibrated at each speed during each submaximal test to
3–5 min, after which the protocol began. For children, the
ensure that the appropriate speed was maintained, and the
protocol began with walking at 3.0 mph at 0% grade for 1 min,
cycle ergometer was calibrated daily. Although the electroni-
with a 2.5% increase in grade at the beginning of both minute
cally braked cycle ergometer used in this study maintained
2 and minute 3. At the start of minute 4, the speed was
the work rate independent of rpm, rpm during submaximal
increased to 5.0 mph, with an additional increase to 5.5 mph
testing was the same for both children and adults (65 6 5) to
at the beginning of minute 5. Grade was then increased 2.5%
eliminate the possible effects that different pedaling speeds
at the start of both minutes 6 and 7, after which the speed was
might have on their metabolic and cardiovascular responses
increased 0.5 mph each minute until exhaustion. For safety
(49). During all submaximal tests, subjects were allowed to
purposes, a spotter was positioned behind the children during
drink water ad libitum, and a fan was used for cooling at an
maximal treadmill testing. The adult protocol began with airflow rate of ,2.0–3.0 m/s.
walking at 3.0 mph for 1 min, with a subsequent 0.5 mph Submaximal cardiovascular and metabolic data were col-
increase in speed at the beginning of every minute up to lected during steady-state exercise. Steady state for all
6.5–7.5 mph, dependent on the fitness level of the subject. subjects was defined as a HR response within 65 beats/min,
Once maximal speed was reached, grade was subsequently and three consecutive 20-s values for both V̇O2 and CO2
increased 2.5% at the start of every minute until exhaustion. production (V̇CO2) within 610%. On average, both children
Maximal tests on the electronically braked cycle ergometer and adults exercised for ,3–6 min before steady state was
(Ergoline 800S, SensorMedics) used different continuous achieved, and each steady-state work rate lasted ,14–18
incremental protocols for children and adults. The children min. Once steady state had been achieved, Q̇, HR, V̇O2, and
performed unloaded cycling at 65–75 revolutions/min (rpm) BP measurements were obtained in duplicate. For children, a
for the first minute, after which the work rate was increased 3- to 5-min rest period was allowed between each work rate
to 20 W for the second minute, and then increased by 15-W and between duplicate measurements at the highest work
increments at the start of every minute until exhaustion. The rate when necessary. For adults, a 3- to 5-min rest period was
adults pedaled at 65–75 rpm at 50 W for the first minute, given between the two highest work rates.
after which the work rate was increased by 25 W at the Before the start of the submaximal treadmill and cycle
beginning of every minute until exhaustion. The cycle ergom- tests, subjects were connected to a Colin model STBP-780
eter was calibrated daily. semiautomated BP-measurement device (Colin Medical In-
During maximal tests, the subjects exercised to volitional struments, San Antonio, TX). The BP cuff was selected so that
fatigue. Tests were considered maximal in children when at the cuff bladder width was ,40% of the subject’s upper arm
least two of the following criteria were achieved: 1) failure circumference measured at midbicep (20, 26).
to maintain the work rate, 2) respiratory exchange ratio Once steady state was achieved, a BP measurement was
(RER) $1.00, and 3) maximal HR $95% of age-predicted taken, followed by measurements of HR, V̇CO2, and V̇O2. The
maximum. Because it has recently been reported that a HR and V̇O2 (collected as the rolling average of 3 consecutive
plateau in V̇O2 is seldom achieved in children (45, 46) or 20-s intervals) used as steady-state values were a 1-min
adolescents (41), attainment of a plateau was not used as a average taken just before the CO2-rebreathing maneuver.
criterion for V̇O2 max in children. For adults, a test was Once these steady-state values had been attained, end-tidal
considered a valid maximal test when at least two of the CO2 pressure (PETCO2) values were collected and a CO2-
following criteria were achieved: 1) failure to maintain the rebreathing Q̇ measurement was performed.
work rate, 2) RER $1.10, 3) maximal HR $ age-predicted Measurements. Height, weight, and skinfold thicknesses
maximum, and 4) an increase in work rate with no further were measured during the subject’s first visit to the labora-
increase in V̇O2. If two or more of these criteria were not tory. Relative body fat in children was estimated from triceps
achieved, a second maximal test was performed. and subscapular skinfold thicknesses by using the equations
950 CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE

of Slaughter et al. (see Ref. 25). For adult men, abdominal, Left ventricular dimensions were measured from standard
chest, and thigh skinfolds were used to estimate body density M-mode echocardiography obtained with a Johnson & Johnson
via the Jackson and Pollock equation (23), and the Brozek et Ultrasound Imaging System with the use of a 3.0-mHz trans-
al. equation (6) was used to estimate relative body fat from ducer. The subjects were measured in the left lateral decubi-
body density. Body density of the women was estimated from tus position. M-mode tracings were obtained at the level just
the Jackson, Pollock, and Ward equation (24) by using the above the papillary muscle and recorded onto a standard
triceps, abdominal, suprailium, and thigh skinfolds. The videocassette recorder tape for off-line measurements.
Lohman equation (37) was then used to determine relative fat Left ventricle dimensions were measured off-line with a
in women. Fat mass (FM) was determined by relative body fat digital imaging-acquisition system (Freeland Prism) accord-
(%) times body weight (kg) divided by 100. Fat-free mass ing to the American Society of Echocardiography (47) and
(FFM) was determined by body weight (kg) minus FM. using leading edge-to-leading edge methodology. The intraven-
Relative body fat was estimated on two separate occasions in tricular septal wall thickness, left ventricular internal diam-
six subjects of each group (boys, girls, men, and women) to eter (LVIDd and LVIDs ), and left ventricular posterior wall
determine reliability of the measurement. Body surface area thickness were measured in both diastole (d) and systole (s),
(BSA, m2 ) was calculated by using the Haycock et al. formula respectively. Each dimension was measured from three differ-
(21). Body mass index (BMI) was calculated by dividing body ent cardiac cycles, and the average value was used. All
weight (kg) by stature squared (m2 ). M-mode tracings and dimensions were measured by the
Expired gases during both the maximal and submaximal same technologist. M-mode tracings of 17 subjects were read
tests were collected and analyzed by using a SensorMedics twice, once on each of two separate days to assess intraob-
2900 metabolic cart (Yorba Linda, CA), which utilizes a server reliability (R 5 0.97). Interobserver reliability (R 5
zirconium oxide cell for fractional percentage of expired O2 0.98) was assessed on six subjects by comparing the measure-
determination, an infrared absorption analyzer for fractional ments of the primary technologist with those of a registered

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percent of expired CO2 (FECO2) determination, and a mass cardiac sonographer.
flowmeter for measuring minute ventilation. Both before and Shortening fraction (SF, %) was calculated as [(LVIDd 2
after each test, the gas analyzers were calibrated with gases LVIDs )/LVIDd] 3100. LVM was calculated using the formula
of known concentration and the flowmeter was calibrated proposed by the American Society of Echocardiography (47),
with a known volume of air. V̇O2 max and maximal RER were as described by Devereux et al. (13), which has been validated
the average of the two highest consecutive 20-s values. in adult necrospy studies (12, 13), a child autopsy study (11),
HR was monitored and recorded with a Polar HR monitor and in a study of animals with heart sizes that were similar to
at 5-s intervals throughout the treadmill and cycle maximal those of the children involved in this study (9).
tests and at 15-s intervals during the submaximal tests. Immediately after the last submaximal exercise test in
Q̇ was measured indirectly by using the CO2-rebreathing adults and children, blood was collected for [Hb] assessment.
equilibration method (7). The CO2-rebreathing apparatus A venipuncture in the antecubital vein was performed while
was modified for the children. A 2600 series Hans Rudolph subjects were in the sitting position. [Hb] was measured in
two-way valve (48-ml dead space) was connected to an 8200 quadruplicate by the cyanmethemoglobin method. An aver-
series Hans Rudolph rebreathing switching system for the age of the four measurements was used as the [Hb]. To most
children, whereas a 2700 series Hans Rudolph two-way valve accurately adjust Q̇ for the change in [Hb] during exercise,
(108-ml dead space) was attached to the rebreathing switch blood was drawn immediately after exercise.
Analysis. The differences in submaximal cardiovascular
for the adults. In addition, a 3-liter bag was used for
responses to exercise between the boys and girls have been
CO2-rebreathing in children and small adults, and a 5-liter
reported elsewhere (51). Because the primary focus of this
bag was used in larger adults. Gas concentrations used
paper is child vs. adult differences in submaximal cardiovas-
during rebreathing for children ranged from 8.0 to 10.0%
cular responses to exercise, the differences between the men
whereas values for adults ranged from 9.0 to 13.5%.
and women are presented but not discussed, and only the
Of the variables used to calculate Q̇, V̇CO2 was obtained by
differences between the boys vs. men and girls vs. women are
averaging three consecutive 20-s V̇CO2 values during steady-
presented in detail. Differences in descriptive variables be-
state exercise. The partial pressure of CO2 in arterial blood
tween groups were analyzed with an analysis of variance
(PaCO2) was estimated from a 20-s average of PETCO2. The
(ANOVA). Test-retest reliability of submaximal metabolic
partial pressure of CO2 in mixed venous blood (PvCO2) was and cardiovascular variables for each modality was deter-
estimated from the equilibration method as described by mined by intraclass correlation R calculated from a one-way
Jones (28, 29). The downstream correction was applied to the ANOVA model and is reported as the reliability of the mean of
partial pressure of equilibrium CO2 to adjust PvCO2 for the the test scores (MS) for each subject [(MSb 2 MSw )/MSb],
alveolar-to-blood PCO2 difference (27, 40). while reliability for relative fat and LVM is reported as the
PvCO2 and PaCO2 were converted to content of CO2 in the reliability of scores collected on 1 day (MSb 2MSw )/(MSb 1
venous (CvCO2) and arterial blood (CaCO2), respectively, MSw ) (3), where MSb is mean square between and MSw is
through an equation derived from the CO2 dissociation curve mean square within.
as described by Jones and Campbell (27) and as adapted from For the adult vs. child comparisons of the cardiovascular
McHardy (39). This content was then corrected for the effect variables measured during submaximal exercise, the mean of
of [Hb] on CO2-carrying capacity of the blood (27, 39). The the values collected on the first day and second day for both
[Hb] used for the children who did not consent to having their the treadmill and cycle ergometer was used. Differences
blood drawn was the average value obtained in this study for between adults and children in metabolic and cardiovascular
their gender. variables at a given rate of work were determined with a
SV (ml) was calculated as Q̇ (ml)/HR (beats/min). MBP one-way ANOVA. Child vs. adult cardiovascular response
(mmHg) was determined as [systolic BP 1 (2 · diastolic BP)]/3. differences at a given V̇O2 were determined by regression
Total peripheral resistance (TPR, units) was calculated analysis. Analysis of covariance of heterogeneous regression
as MBP/Q̇. V̇O2 was divided by Q̇ to calculate (a-v)O2 lines (SPSS) was used to determine whether significant
(ml/100 ml). differences existed between the slopes and intercepts of the
CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE 951

cardiovascular variables on V̇O2 (l/min) for children vs. adults. Table 2. Treadmill and cycle ergometer maximal data
All significant differences are at the P # 0.05 level unless
stated otherwise. Variable Boys Girls Men Women

RESULTS Treadmill
V̇O2 max , l/mina,f 1.60 6 0.21 1.51 6 0.23 4.23 6 0.52 2.95 6 0.44
The physical characteristics of the subjects are pre- V̇O2 max ,
21
ml · kg · min21
sented in Table 1. All values for the subjects’ physical a,d,e 54.4 6 5.5 53.1 6 4.4 53.2 6 5.3 46.9 6 4.3
characteristics were significantly lower in the children HR, beats/mind,e 200 6 11 202 6 9 198 6 10 192 6 6
(boys and girls) than in both the men and women except RERf 1.08 6 0.06 1.10 6 0.05 1.20 6 0.06 1.20 6 0.06
for relative fat and SF. Relative fat was significantly Cycle ergometer
higher in the women than in both the children (boys V̇O2 max , l/mina,f 1.49 6 0.20 1.33 6 0.26 3.93 6 0.64 2.66 6 0.52
V̇O2 max ,
and girls) and men. Furthermore, relative fat was 21
ml · kg · min21
significantly higher in the girls than men, but it was a,d,e 50.7 6 4.6 47.0 6 5.5 48.9 6 6.7 41.9 6 5.4
not significantly different between the boys and men. HR, beats/mind,e 195 6 10 199 6 8 192 6 10 185 6 8
The reliability coefficients for relative fat estimates in RER f 1.09 6 0.05 1.12 6 0.07 1.21 6 0.05 1.24 6 0.06
this study for 12 children and 12 adults were R 5 0.96 Values are means 6 SD. V̇O2 max , maximal O2 consumption; HR,
and R 5 0.98, respectively. SF was not different be- heart rate; RER, respiratory exchange ratio. Significant difference
tween any of the groups. (P # 0.05): a between men and women; b between men and boys;
c between men and girls; d between women and boys; e between women
Table 2 presents the V̇O2 max data from both the and girls; f between both men and women compared with both boys
treadmill and cycle ergometer for all groups. V̇O2 max and girls.

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(l/min) was significantly higher in the men vs. women,
boys, and girls and in the women vs. the boys and girls. on the treadmill, and between the boys and men on the
V̇O2 max relative to body mass (ml · kg21 · min21) was not cycle ergometer. Thus, to determine whether there
different between the children (boys and girls) and were significant differences in cardiovascular re-
men, but it was significantly lower in the women than sponses between the groups at equivalent V̇O2 (l/min)
in the boys, girls, and men on both the treadmill and levels, the regression lines of each of the cardiovascu-
cycle ergometer. Maximal HR in the women was signifi- lar variables on V̇O2 (l/min) were statistically compared.
cantly lower than in the boys and girls on both modali- Figures 1–5 present the mean cardiovascular data on
ties. Maximal RER was significantly higher on both V̇O2 (l/min) for each work rate for all groups on both the
modalities in both the men and women vs. both the boys cycle ergometer (A) and treadmill (B). The insets in
and girls. each of these figures present the regression equation
Day-to-day reliability for each of the steady-state for the specific cardiovascular variable and V̇O2 (l/min),
submaximal cardiovascular variables was moderately and the legends give the statistical significance of
high for both modalities in all groups (Table 3). V̇O2 differences, if any, in slopes and intercepts of the
(l/min) day-to-day reliability was also high on both the regression lines between the groups.
cycle ergometer and treadmill in all groups (Table 3). Figure 1, A and B, demonstrates that Q̇ at a given
The cycle ergometer and treadmill submaximal meta- V̇O2 was lower in boys vs. men and girls vs. women for
bolic and cardiovascular data for the boys vs. men and both the cycle ergometer and treadmill, respectively.
girls vs. women are summarized in Tables 4 and 5, When the regression lines of Q̇ on V̇O2 were compared,
respectively. There were significant differences in V̇O2 the intercept for the boys vs. men and girls vs. women
(l/min) at equivalent rates of work between both groups was significantly lower on both modalities. The slopes
of these relationships were not different between
Table 1. Physical characteristics of subjects the groups.
The mean HR responses for all groups for both the
Variable Boys Girls Men Women cycle ergometer and treadmill can be seen in Fig. 2, A
and B, respectively. There were no significant differ-
Age, yrf 9.1 6 0.7 8.8 6 0.7 22.8 6 2.0 23.6 6 2.1
Height, cma,f 134.4 6 6.3 132.6 6 6.3 180.6 6 4.2 166.0 6 3.1 ences in the intercepts of the regression lines of HR on
Weight, kga,f 29.5 6 4.3 28.5 6 4.8 80.0 6 5.0 63.3 6 8.2 V̇O2 between the boys vs. men or girls vs. women. The
BMI, kg/m2 f 16.2 6 1.5 16.2 6 2.0 24.6 6 1.4 22.9 6 2.5 slope of the HR-V̇O2 relationship in the boys vs. men
BSAa,f 1.04 6 0.10 1.02 6 0.11 2.01 6 0.08 1.71 6 0.13 and girls vs. women was significantly greater on both
Fat, %a,c,d,e 15.8 6 4.3 16.8 6 4.4 13.6 6 2.9 23.1 6 5.2
Fat massa,f 4.8 6 1.8 4.9 6 2.0 10.8 6 2.7 14.8 6 4.6
modalities. The significantly steeper slopes of this
FFM, kg a,f 24.7 6 3.1 23.6 6 3.1 69.3 6 4.6 48.5 6 5.3 relationship in children explain why the intercepts of
[Hb], g/dla,b,c 13.2 6 0.8* 13.5 6 0.7† 15.9 6 1.2 14.3 6 1.0 the HR-V̇O2 relationship in the children vs. adults are
LVM, ga,f 78.8 6 12.2 66.0 6 11.6 202.5 6 26.9 140.6 6 31.0 not significantly higher. However, Fig. 2, A and B,
SF, % 34.1 6 3.8 32.3 6 4.4 32.9 6 5.1 32.1 6 3.2 shows that HR in the children was higher than HR in
Values are means 6 SD. BMI, body mass index; BSA, body surface the adults at a given V̇O2 on both the cycle ergometer
area; FFM, fat free mass; [Hb], hemoglobin concentration; LVM, left and treadmill.
ventricular mass; SF, shortening fraction. * n 5 9; † n 5 8. Significant The comparison of SV-V̇O2 between the groups is
difference (P # 0.05): a between men and women; b between men and
boys; c between men and girls; d between women and boys; e between
presented in Fig. 3, A and B, for both the cycle
women and girls; f between both men and women compared with both ergometer and treadmill, respectively. The intercept of
boys and girls. SV on V̇O2 for the boys vs. men and girls vs. women was
952 CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE

Table 3. Cycle ergometer and treadmill reliability ranges


Boys Girls Men Women

Variable Cycle Treadmill Cycle Treadmill Cycle Treadmill Cycle Treadmill

Q̇, l/min 0.96–0.97 0.96–0.97 0.90–0.92 0.95–0.99 0.88–0.98 0.70–0.98 0.75–0.83 0.88–0.97
SV, ml 0.94–0.98 0.88–0.90 0.78–0.94 0.79–0.88 0.86–0.95 0.91–0.98 0.56–0.69 0.78–0.97
HR, beats/min 0.96–0.99 0.97–0.99 0.93–0.98 0.99 0.83–0.91 0.90–0.95 0.84–0.90 0.91–0.96
(a-v)O2, ml/100 ml 0.93–0.97 0.92–0.94 0.88–0.96 0.94–0.95 0.81–0.91 0.61–0.93 0.57–0.79 0.65–0.92
TPR, units 0.83–0.89 0.80–0.85 0.71–0.87 0.83–0.87 0.72–0.93 0.68–0.96 0.64–0.81 0.75–0.94
V̇O2 , l/min 0.97–0.99 0.99 0.97–0.99 0.99 0.85–0.95 0.93–0.98 0.80–0.99 0.97–0.99
Values are range of reliability for all rates of work. Cycle, cycle ergometer reliability; Treadmill, treadmill reliability. Q̇, cardiac output; SV,
stroke volume; (a-v)O2 , arterial-mixed venous O2 difference; TPR, total peripheral resistance; V̇O2 , O2 consumption.

significantly lower on both modalities, although the cantly greater, in the boys vs. men and girls vs. women
slopes of these relationships were not different between on both modalities. Although the slope differences may
the groups. be primarily responsible for the significant differences
Figure 4, A and B, present the (a-v)O2-V̇O2 re- in intercepts between the children vs. adults, Fig. 5
lationship for all groups on both the cycle ergometer demonstrates that TPR was higher in the boys and girls
and treadmill, respectively. The slope of this relation- at a given V̇O2.
ship was significantly greater in the boys vs. men and The relationship between resting LVM and SV on the

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girls vs. women on both the cycle ergometer and tread- cycle ergometer at 40 W is presented in Fig. 6 for both
mill. The reason that the (a-v)O2-V̇O2 intercept was not the males and females. LVM was closely related to SV
significantly higher in the children is likely due to on both the cycle ergometer at 40 W (r 5 0.89 and 0.90)
the phenomenon discussed above for the HR-V̇O2 rela- and 60 W (r 5 0.91 and 0.88) and on the treadmill at 3
tionship. Figure 4, A and B, demonstrates that, at mph (r 5 0.92 and 0.93) and 5 mph (r 5 0.92 and 0.90)
a given V̇O2, the (a-v)O2 is higher in the boys vs. men in males and females, respectively.
and girls vs. women on both the cycle ergometer
and treadmill, respectively. DISCUSSION
The TPR-V̇O2 relationship for each group is pre-
sented in Fig. 5, A and B, for the cycle ergometer and The results of this study indicate that Q̇ in 7- to
treadmill, respectively. The intercept of this relation- 9-yr-old boys and girls is significantly lower at a given
ship was significantly higher, and the slope was signifi- V̇O2 compared with adult men and women on both the

Table 4. Cycle ergometer and treadmill submaximal metabolic and cardiovascular data
by work rate for boys and men
V̇O2 , V̇O2 , V̇O2 , Q̇, HR, (a-v)O2, SBP, DBP,
Ergometer/Work Rate l/min ml · kg21 · min21 %V̇O2 max RER l/min SV, ml beats/min ml/100 ml TPR, units mmHg mmHg

Boys
Cycle 20 W 0.55 18.6 37.4 0.90 6.8 60.5 114.0 8.2 11.7 113.0 61.6
6 0.06 6 2.1 6 5.0 6 0.03 6 1.0 6 10.2 6 12.0 6 1.4 6 1.5 6 9.9 6 3.9
Cycle 40 W 0.78 26.5 53.1 0.91 8.3 61.7 135.8 9.6 10.2 122.8 62.9
6 0.06* 6 3.1* 6 6.9* 6 0.03* 6 1.2* 6 11.7* 6 14.7* 6 1.2* 6 1.4* 6 10.9* 6 6.3*
Cycle 60 W 1.02 34.7 69.5 0.93 9.4 61.9 153.1 11.1 9.8 131.7 68.7
6 0.06* 6 4.7* 6 9.0* 6 0.04 6 1.6* 6 13.1* 6 14.9* 6 1.4* 6 1.4* 6 8.9* 6 7.3
Tm 3 mph 0.57 19.3 35.7 0.90 6.7 57.7 116.0 8.7 12.6 122.0 62.5
6 0.07* 6 1.4* 6 3.6* 6 0.03 6 1.0* 6 9.3* 6 10.8* 6 0.8 6 1.6* 6 8.1* 6 4.4*
Tm 4 mph 0.86 30.1 54.7 0.91 8.6 60.7 142.9 10.1 10.4 134.8 66.2
6 0.10 6 5.1 6 8.5 6 0.05 6 0.9 6 7.5 6 15.6 6 1.1 6 1.0 6 14.1 6 10.8
Tm 5 mph 1.17 39.3 72.8 0.94 10.1 60.5 168.3 11.6 9.5 145.9 69.2
6 0.14* 6 2.6* 6 7.0* 6 0.03 6 1.2* 6 7.6* 6 13.7* 6 0.8* 6 1.2* 6 10.6* 6 9.4
Men
Cycle 40 W 0.93 11.6 24.0 0.89 11.4 129.4 91.8 8.2 8.5 140.5 72.4
6 0.07 6 0.9 6 3.6 6 0.02 6 1.4 6 22.2 6 9.6 6 1.0 6 1.0 6 13.1 6 5.2
Cycle 60 W 1.09 13.7 28.3 0.91 12.4 126.8 97.8 8.9 7.9 147.1 72.0
6 0.07 6 1.0 6 4.4 6 0.02 6 1.6 6 20.5 6 10.5 6 1.0 6 0.7 6 13.5 6 6.1
Cycle 60% 244 30.5 62.1 0.97 19.7 136.1 146.2 12.4 5.9 191.4 77.4
6 0.37 6 3.8 6 2.7 6 0.03 6 3.0 6 25.5 6 11.5 6 1.2 6 0.7 6 22.7 6 7.3
Tm 3 mph 1.02 12.8 24.1 0.89 12.3 135.7 92.0 8.4 7.9 144.4 70.1
6 0.10 6 0.8 6 2.4 6 0.03 6 1.6 6 24.6 6 10.4 6 0.9 6 1.0 6 11.6 6 6.1
Tm 5 mph 2.43 30.3 57.6 0.93 19.3 133.7 146.2 12.7 5.5 172.9 68.9
6 0.23 6 1.7 6 6.8 6 0.02 6 2.1 6 23.8 6 15.5 6 1.3 6 0.8 6 20.9 6 9.3
Tm 60% 2.61 32.7 61.7 0.93 19.8 128.0 153.5 13.3 5.4 171.8 69.8
6 0.23 6 2.2 6 3.4 6 0.02 6 2.6 6 26.7 6 12.2 6 1.0 6 1.0 6 13.7 6 12.3
Values are means 6 SD. Cycle, cycle ergometer; W, watts; Tm, treadmill; mph, miles/h; 60%, 60% maximal V̇O2 consumption (V̇O2 max ). SBP,
systolic blood pressure; DBP, diastolic blood pressure. *Significantly different (P # 0.05) from men at same work rate on same exercise modality.
CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE 953

Table 5. Cycle ergometer and treadmill submaximal metabolic and cardiovascular data by work rate
for girls and women
V̇O2 , V̇O2 , HR, (a-v)O2,
Ergometer/Work Rate V̇O2 , l/min ml · kg21 · min21 %V̇O2 max RER Q̇, l/min SV, ml beats/min ml/100 ml TPR, units SBP, mmHg DBP, mmHg

Girls
Cycle 20 W 0.51 18.3 39.8 0.90 6.6 56.3 118.9 7.8 11.2 105.2 57.1
6 0.05 6 3.0 6 8.8 6 0.03 6 0.5 6 7.6 6 12.2 6 0.6 6 1.0 6 57.1 6 7.3
Cycle 40 W 0.75 26.7 57.9 0.91 8.1 57.8 140.8 9.3 9.6 115.1 57.6
6 0.06 6 5.0* 6 13.9* 6 0.03 6 0.4* 6 7.0* 6 15.9* 6 0.7* 6 0.9 6 6.4* 6 7.2*
Cycle 60 W 0.98 33.9 72.0 0.93 9.1 57.6 159.7 10.8 9.2 127.0 61.2
6 0.06 6 5.3* 6 8.0* 6 0.05 6 0.8* 6 9.2* 6 18.1* 6 0.7* 6 0.9 6 4.6 6 6.2*
Tm 3 mph 0.55 19.4 36.7 0.89 6.5 55.6 118.2 8.5 12.3 115.3 60.4
6 0.07* 6 2.0* 6 3.7* 6 0.03 6 0.8* 6 8.5* 6 11.9* 6 0.6 6 1.4* 6 8.7* 6 6.5*
Tm 4 mph 0.87 30.8 58.4 0.93 8.5 54.9 155.5 10.2 9.9 128.1 59.9
6 0.15 6 4.3 6 9.3 6 0.04 6 1.1 6 7.0 6 11.7 6 0.7 6 1.8 6 10.7 6 8.7
Tm 5 mph 1.13 39.5 74.7 0.93 9.7 57.1 171.5 11.6 8.9 136.5 59.3
6 0.14* 6 3.0* 6 5.2* 6 0.03 6 1.12* 6 7.9* 6 12.1* 6 0.7* 6 1.0* 6 12.8* 6 10.2
Women
Cycle 40 W 0.79 12.6 30.6 0.90 9.6 97.9 94.8 8.3 9.3 127.1 68.8
6 0.05 6 0.9 6 5.2 6 0.05 6 1.0 6 9.1 6 11.8 6 0.8 6 0.9 6 13.7 6 10.5
Cycle 60 W 0.97 15.4 37.6 0.92 10.6 102.1 106.0 9.2 8.8 135.0 70.8
6 0.05 6 1.4 6 7.0 6 0.04 6 1.1 6 10.7 6 11.5 6 0.8 6 1.1 6 12.3 6 9.6

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Cycle 60% 1.69 26.6 63.6 0.98 14.3 100.0 143.7 11.8 7.3 163.4 73.8
6 0.32 6 3.3 6 1.5 6 0.04 6 1.6 6 1.6 6 9.4 6 1.2 6 0.8 6 19.2 6 9.3
Tm 3 mph 0.81 12.8 27.6 0.88 9.6 100.4 96.3 8.5 9.5 132.1 68.5
6 0.13 6 0.9 6 3.8 6 0.04 6 1.4 6 14.8 6 13.9 6 0.7 6 1.4 6 15.3 6 10.1
Tm 5 mph 1.85 29.4 63.3 0.94 14.9 101.9 147.3 12.5 6.6 154.7 68.1
6 0.25 6 2.3 6 9.9 6 0.04 6 1.6 6 12.5 6 16.2 6 1.1 6 0.9 6 14.4 6 11.8
Tm 60% 1.81 28.6 61.0 0.92 14.7 98.6 149.3 12.3 7.0 158.5 71.5
6 0.26 6 3.1 6 2.1 6 0.02 6 1.8 6 13.6 6 10.5 6 1.0 6 1.3 6 17.2 6 13.4
Values are means 6 SD. Definitions as in Tables 1–4. * Significantly different (P # 0.05) from women at same work rate on same exercise
modality.

cycle ergometer and treadmill. The lower Q̇ is the result the children. The lower Q̇ in children at a given V̇O2 is
of a lower SV in the children that is only partially compensated for by a higher (a-v)O2.
compensated for by a higher HR at a given absolute Several methodological factors must be considered
V̇O2. The lower SV is related to the smaller heart size in when these data are interpreted. Both shorter (10) and
longer (52) recirculation times have been reported in

Fig. 1. Cardiac output (Q̇) on O2 consumption (vo2) for cycle ergom-


eter (A) and treadmill (B). Insets: regression equations used in Fig. 2. Heart rate (HR) on V̇O2 for cycle ergometer (A) and treadmill
statistical analysis. *Intercept significantly different from correspond- (B). Insets: regression equations used in statistical analysis. † Slope
ing adult value; P # 0.05. q Intercept significantly different from significantly different from corresponding adult value; P #0.05.
women; P # 0.05. D Slope significantly different from women; P #0.05.
954 CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE

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Fig. 3. Stroke volume (SV) on V̇O2 for cycle ergometer (A) and Fig. 5. Total peripheral resistance (TPR) on V̇O2 for cycle ergometer
treadmill (B). Insets: regression equations used in statistical analy- (A) and treadmill (B). Insets: regression equations used in statistical
sis. * Intercept significantly different from corresponding adult value; analysis. * Intercept significantly different from corresponding adult
P # 0.05. q Intercept significantly different from women; P # 0.05. value; P # 0.05. † Slope significantly different from corresponding
adult value; P #0.05. q Intercept significantly different from women;
P # 0.05. D Slope significantly different from women; P #0.05.
children compared with adults. Differing recircula-
tion times could affect Q̇ estimations when the CO2-
rebreathing method is used. However, we did not see an recirculation. Furthermore, the accuracy of using a
effect, as the rebreathing curves for both the children single postexertional hemoglobin (Hb) measurement
and adults showed good equilibration and no signs of for Q̇ calculation is not ideal. However, to best account
for the changes that occur in Hb levels during exer-
cise, while still limiting the invasiveness of the proce-
dures (which is necessary when working with young
children), a single postexertional measurement is most
appropriate.
In our study, Q̇ at a V̇O2 of 1.0 l/min was 2.5 and 1.5
l/min lower on the cycle ergometer and was 2.9 and 1.3
l/min lower on the treadmill in boys vs. men and in girls
vs. women, respectively. A lower Q̇ of a similar magni-
tude on the cycle ergometer in children vs. adults at a
given rate of work is supported by research literature
(2, 16, 30, 32, 42, 52) but is in conflict with others who
have reported Q̇ on the cycle ergometer to be the same
(17–19). The studies that have reported lower Q̇ in

Fig. 4. Arterial-mixed venous O2 difference [(a-v)O2] on V̇O2 for cycle


ergometer (A) and treadmill (B). Insets: regression equations used in
statistical analysis. † Slope significantly different from corresponding
adult value; P #0.05. D Slope significantly different from women; Fig. 6. Relationship between left ventricular mass and SV in men
P #0.05. and women on cycle ergometer at 40 W.
CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE 955

children vs. adults have reported similar absolute ing that the heart mass available to generate SV during
values and age-related differences. exericse is not different.
Of the studies that have reported no difference Other factors may contribute to the lower SV in
between children and adults, Gadhoke and Jones (17) children. It has been suggested that SV contributions to
determined Q̇ in two groups of 20 boys (mean ages of Q̇ are higher with larger muscle mass activity (14). In
11.1 and 13.5 yr) during cycling exercise at 200 and 400 the following section, we suggest that children use a
kilopond m/min. They did not find a difference in Q̇ smaller muscle mass to do a given amount of work. The
compared with values for adults reported by Higgs et smaller muscle mass in children could result in an
al. (22). Godfrey et al. (18) tested 117 boys and girls, attenuated venous return (preload) and thus contribute
ages 6–16 yr, on the cycle ergometer at one-third and to their lower SV. Additionally, the higher whole body
two-thirds of their V̇O2 max. When they compared their TPR (Fig. 5) may represent a higher afterload, one of
results to those of Bevegard et al. (5), they concluded three primary factors that affect SV (14), and thus
that there was no difference in Q̇ at a given V̇O2. Also, contribute to a lower SV in children.
Godfrey et al. (19) measured Q̇ during cycle ergometer As previously mentioned, we suggest that for chil-
exercise at 40 and 80 W in three children (mean age, 9.7 dren to do the same rate of work (V̇O2) as adults, the
yr) and three adults (mean age, 23.3 yr). Although they children most likely use a smaller absolute amount of
did not compare their child vs. adult Q̇ differences muscle mass. A smaller absolute muscle mass is thus
statistically, by comparing the Q̇-V̇O2 relationship in stressed to a relatively greater extent, resulting in a
their six subjects, combined with the data on children greater buildup of metabolites, thus providing more
from Godfrey et al. (18) and the adult data from Rowell feedback to the medulla to increase HR (8). The assump-

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(43), they concluded that the child and adult Q̇ values tion of a smaller absolute muscle mass in children vs.
were not different. The reason for the discrepancies adults, during exercise using the same muscle group, is
between our findings and the findings of these earlier based on the fact that adults have a significantly larger
studies (17–19) is uncertain. body mass relative to muscle mass. Not only are
Combining our results with the data from the remain- children smaller, but the percentage of their body
ing research literature, it can be concluded that, during weight that is muscle is less. The total muscle mass of a
exercise, Q̇ at a given V̇O2 (l/min) is ,1.0 to 2.9 l/min 7- to 9-yr-old boy represents ,44% of his body weight,
lower in young children than adults on both the cycle whereas that of a 20- to 29-yr-old man is ,52% (38).
ergometer and treadmill. Additionally, our results indi- This trend is not found in girls and women, likely due to
cate (Figs. 2 and 3), and other studies agree (2, 19, 32, their greater increase in FM with growth. The higher
42), that HR is higher and SV is lower at a given V̇O2 in HR and lower SV response associated with a smaller
muscle mass has been demonstrated in studies in
children vs. adults. The lower SV in children is gener-
adults comparing large and small muscle masses dur-
ally attributed to their smaller body size. We found that
ing exercise (4, 36, 50).
the significantly lower SV in children vs. adults was
The possibility that children use a smaller absolute
eliminated or greatly reduced when SV was scaled to
amount of muscle mass than adults use to exercise at
BSA. We also found that resting estimated LVM was
the same rate of work has been proposed by others (30,
closely correlated with both SV (see RESULTS ) and HR in 32) as a possible mechanism for the higher (a-v)O2 in
the males (r 5 20.85, 20.90, 20.73, 20.64) and females children, as found in the present study and others (2,
(r 5 20.80, 20.82, 20.60, 20.60) at 40 W, 60 W, 3 mph, 15, 32, 42). As stated above, the smaller muscle mass
and 5 mph, respectively. Because the adults did not do would be stressed to a relatively greater extent and
the 20-W work rate and the children did not do the thus would likely generate a larger amount of meta-
60% work rate, these rates of work were not included in bolic by-products (36) and heat per unit of muscle,
this analysis. which would then 1) increase O2 liberated from Hb by
It has been suggested that the lower Q̇-V̇O2 relation- decreasing its affinity for O2 at the muscle; 2) increase
ship in children is an indicator of depressed myocardial vasodilatation of the arteries entering the muscle (36),
functional reserve or inability to generate SV (1). This thus increasing muscle blood flow (33, 34); and 3)
may not necessarily be the case. The increase in Q̇ with increase feedback to the medulla via group III and IV
increasing V̇O2 is met by changes in both SV and HR. afferents to increase HR (8), as discussed earlier.
SV is related to body size (thus, it is higher in adults) Furthermore, the higher (a-v)O2 in children may be
and increases very little beyond light work rates. Thus, due to more of their blood flow going to active muscle.
to complete the Fick equation, HR and (a-v)O2 increase This is supported by the work of Koch (33, 34), who
more in children, so that they have a V̇O2 similar to reported higher muscle blood flow in 12- to 14-yr-old
adults. Thus the cardiovascular response of children boys compared with 25-yr-old adults after ischemic
seems to be normal for their size. Our similar work and during maximal cycle ergometer exercise.
Q̇-V̇O2 slopes in children and adults (Fig. 1) further The possibility of higher muscle blood flow in children
support this normal cardiovascular response of chil- is indirectly supported by work of Saltin et al. (48) in
dren to exercise that is relative to their body size. Also, adults. They reported that leg blood flow was inversely
there were no significant differences in LVM/FFM related to [Hb]. However, Kurdak et al. (35) report that,
between boys vs. men (3.21 6 0.49 vs. 2.92 6 0.29) or in maximally working canine muscle in situ, lower [Hb]
girls vs. women (2.81 6 0.36 vs. 2.89 6 0.50), suggest- did not significantly change blood flow distribution.
956 CHILD AND ADULT CARDIOVASCULAR RESPONSES TO EXERCISE

The [Hb] of the children in the present study was the children for the giving of their own time so their children could
significantly lower (P # 0.05) than that of the adults participate.
Address for reprint requests: K. R. Turley, Dept. of Kinesiology,
(see Table 1). When we scaled our Q̇ (l/min) and TPR Harding University, Box 2281, Searcy, AR 72149. (E-mail:
(units) to FFM (kg) we found that Q̇ · FFM21 · min21 was KRTurley@Harding.edu).
higher and TPR/FFM was lower in the children vs. Received 23 January 1996; accepted in final form 5 May 1997.
adults at a given V̇O2 on both the cycle ergometer and
treadmill. Because muscle receives up to 80–85% of the
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submaximal V̇O2 (l/min). Thus the (a-v)O2 of children at 6. Brozek, J., F. Grande, J. T. Anderson, and A. Keys. Densito-
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their maximal value. Also, HR is higher and SV is lower 17. Gadhoke, S., and N. L. Jones. The responses to exercise in
at a given V̇O2 in children compared with adults. The boys aged 9–15 years. Clin. Sci. (Lond.) 37: 789–801, 1969.
18. Godfrey, S., C. T. M. Davies, E. Wozniak, and C. A. Barnes.
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contributions to the study design and echocardiographic expertise; 62–66, 1978.
Ken Peake for help with the echocardiographic data; the adult and 22. Higgs, B. E., M. Clode, G. J. R. McHardy, N. L. Jones, and
child subjects for their participation in this study; and the parents of E. J. M. Campbell. Changes in ventilation, gas exchange and
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circulation during exercise in normal subjects. Clin. Sci. (Lond.) 38. Malina, R. M., and C. Bouchard. Growth, Maturation, and
32: 329–337, 1967. Physical Activity. Champaign, IL: Human Kinetics, 1991, p.
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