Exercise Physiology, Testing and Fitness

At Inova Children’s Cardiology, we have a state-of-the-art exercise and fitness lab designed just for kids, teens, and young adults. We use the most sophisticated, up-to-date technology to assess exercise capacity and the heart and lungs’ response to exercise (while the patient runs on a treadmill). During the test, we will monitor patient heart rate, blood pressure, and electrocardiogram (ECG) both during and after exercise. If the patient has breathing problems related to exercise, we can also check lung volume before and after the workout.

Exercise testing, also known as a "stress test," allows us to observe how a patient's heart rate and blood pressure change during exercise, how well their lungs work, and how their muscles perform during exercise. It also enables us to look for any extra heartbeats, unusual rhythms, or breathing problems during and after exercise. Each patient's results are compared to age- and sex-based normal ranges, and test results provide the basis for both exercise counseling and monitoring of symptoms and/or congenital heart disease over time.

If a patient has symptoms while exercising, the exercise test can help us understand why and guide doctors in deciding if or what treatment is needed. For those born with congenital heart defects, repeated testing over time enables doctors to detect early issues that may not be apparent on routine testing performed at rest (such as the ECG and echocardiogram performed at a regular visit).

Exercise testing for chest wall abnormalities, such as pectus excavatum

Exercise testing is also helpful for young patients with chest wall abnormalities. For example, patients with pectus excavatum, where the center of the chest wall curves inward, might not be able to exercise as well because their lung volumes are smaller. These young patients develop exercise-limiting breathing symptoms before their muscles get tired. Exercise testing can identify which of these patients are likely to benefit from surgical intervention to expand the chest wall.

Exercise testing for known or suspected cardiac arrhythmia

Exercise testing can also be done by the electrophysiology team if the patient has a known or suspected cardiac arrhythmia. This testing helps us see how exercise might affect the arrhythmia and check if the patient's antiarrhythmic medications are working properly.

Exercise testing also helps physicians objectively assess a patient's fitness level. After the test, doctors can create a personalized exercise program, based on individual abilities and goals.

Important health benefits of regular exercise

The National Football League has done a great job encouraging exercise! Kids, teens, and young adults should exercise at least 60 minutes every day. This is important for everyone, especially for those born with congenital heart disease. Regular exercise has been shown to improve quality of life, self-esteem, and health for those with congenital heart defects. Talk to your child's doctor about setting up exercise testing or a fitness consultation today.

Who should be considered for exercise testing?

Exercise testing is commonly recommended for:

Exercise-related cardiac symptoms
Known or suspected arrhythmias during exercise
Cardiomyopathies
Congenital heart disease
Heart failure
Pulmonary hypertension
Pectus excavatum/other chest wall changes that reduce lung volume
Information collection to help develop a customized fitness program

Patient "to do" list: Preparing for the exercise test

Wear athletic clothes and sneakers, because there will be running involved.
Don't forget to bring a water bottle to stay hydrated after you exercise.
Make sure to eat breakfast and take any scheduled medications on the morning of your test.
The exercise test will last about 10 to 20 minutes, depending on your fitness level.
You should plan to be at our office for a total of 60 to 90 minutes. This includes getting ready for the test, doing the exercise, and talking with our exercise cardiologist after the test.

What should I expect during the exercise test?

During an exercise test, patients may experience:

ECG monitoring: You will be connected to ECG leads to monitor your heart rate and rhythm during testing.
Blood Pressure Monitoring: Your blood pressure will be measured at rest, throughout the test, and during recovery.
Oxygen Monitoring: A pulse oximeter will be placed on your index finger to check your oxygen levels while you rest and exercise.
Metabolic Evaluation: You’ll wear a face mask connected to a metabolic machine. You can breathe normally, and the machine will continuously analyze the air you breathe out during the test.
Pulmonary Evaluation: Before the test, you’ll do a breathing test (spirometry) to assess your lung volumes. If you have breathing symptoms with exercise, this test will be repeated after exercise to look for any changes compared to your resting lung volumes.
Echocardiogram: Some patients may have images of their heart taken at rest and during peak exercise, if their cardiologist requests it. This is usually reserved for patients with specific types of congenital heart disease.
Six-Minute Walk Test: Patients with have pulmonary hypertension, we’ll monitor your oxygen levels as you walk for six minutes under the supervision of our clinicians. This test helps assess your exercise capacity and oxygen levels in those who have limited exercise ability due to heart disease.