Cardiorespiratory fitness, respiratory function and hemodynamic responses to maximal cycle ergometer exercise test in girls and boys aged 9-11 years: the PANIC Study

Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence

BACKGROUND

Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence.

METHODS AND RESULTS

Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (β=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (β=-0.218 [95% CI, -0.436 to 0.000]).

CONCLUSIONS

Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.

Impaired cardiorespiratory and neuromuscular fitness in children and adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study in the era of biologic drug therapies

BACKGROUND

In recent years, biologic drug therapies have altered the course of juvenile idiopathic arthritis (JIA) possibly also improving the patients' physical fitness. However, studies measuring both cardiorespiratory and muscular fitness in children with JIA are sparse and have failed to show consistent results. Our aim was to assess both cardiorespiratory and neuromuscular fitness and contributing factors in children and adolescents with JIA in the era of biologic drug therapies.

METHODS

This cross-sectional study consisted of 73 JIA patients (25 boys, 48 girls) aged 6.8- 17.5 years and 73 healthy age- and sex-matched controls, investigated in 2017-2019. Cardiorespiratory fitness was assessed by maximal ergospirometry and neuromuscular fitness by speed, agility, balance, and muscle strength tests.

RESULTS

Means (± SD) of maximal workload (W_max/kg) and peak oxygen uptake (VO2_peak/kg,) were lower in JIA patients than in controls (W_max/kg: 2.80 ± 0.54 vs. 3.14 ± 0.50 Watts, p < 0.01; VO2_peak/kg: 38.7 ± 7.53 vs. 45.8 ± 6.59 ml/min/kg, p < 0.01). Shuttle-run, sit-up and standing long jump test results were lower in JIA patients than in controls (p < 0.01). Mean (± SD) daily activity was lower (89.0 ± 44.7 vs. 112.7 ± 62.1 min/day, p < 0.05), and sedentary time was higher (427 ± 213 vs. 343 ± 211 min/day, p < 0.05) in JIA patients compared to controls. Physical activity and cardiorespiratory or neuromuscular fitness were not associated with disease activity.

CONCLUSIONS

JIA patients were physically less active and had lower cardiorespiratory and neuromuscular fitness than their same aged controls with no JIA. Therefore, JIA patients should be encouraged to engage in physical activities as a part of their multidisciplinary treatment protocols to prevent adverse health risks of low physical activity and fitness.

A Meta-Analysis of Sampled Maximal Aerobic Capacity Data for Boys Aged 11 Years Old or Less Obtained by Cycle Ergometry

The aim of this study was to develop distributions of VO_2max based on measured values that exist in the literature in prepubertal boys using cycle ergometry. PRISMA guidelines were followed in conducting this research. One database was searched for peak and maximal VO₂ values in healthy boys with mean age under 11 years old. Data were split into articles reporting absolute and relative VO_2max values and analyzed accordingly. Multilevel models grounded in Bayesian principles were used. We investigated associations between VO_2max and body mass, year of the study, and country of origin. Differences in "peak" and "maximal" VO₂ were assessed. Absolute VO_2max (Lmin^-1) increases with age (P ~100%) but mean relative VO_2max does not change (P ~100%). Absolute VO_2max is higher in more recent studies (P = 95.7 ± 0.3%) and mean relative VO_2max is lower (P = 99.6 ± 0.1%). Relative VO_2max in the USA is lower compared with boys from other countries (P = 98.8 ± 0.2%), but there are no differences in absolute values. Mean aerobic capacity estimates presented as "peak" values are higher than "maximal" values on an absolute basis (P = 97.5 ± 0.3%) but not on a relative basis (P = 99.6 ± 0.1%). Heavier boys have lower cardiorespiratory fitness (P ≈ 100%), and body mass seems to be increasing faster with age in the USA compared with other countries (P = 92.3 ± 0.3%). New reference values for cardiorespiratory fitness are presented for prepubertal boys obtained with cycle ergometry. This is new, as no reference values have been determined so far based on actual measured values in prepubertal boys. Aerobic capacity normalized to body weight does not change with age. Cardiorespiratory fitness in prepubertal boys is declining, which is associated with increasing body mass over the last few decades. Lastly, this study did not find any statistically significant difference in the sample's mean aerobic capacity estimates using the "peak" and "maximum" distinctions identified in the literature.

Associations of fitness, motor competence, and adiposity with the indicators of physical activity intensity during different physical activities in children

We investigated the associations of peak oxygen uptake (V̇O2peak), ventilatory threshold (VT), muscle strength, motor competence (MC), and adiposity with the indicators of PA intensity during different physical activities used to create absolute PA intensity cut-offs among 35 children 7-11-years-of-age. V̇O2peak was defined as the highest V̇O2 achieved in the maximal cardiopulmonary exercise test (CPET) on a cycle ergometer, self-paced running, or running on a treadmill at 8 km/h. VT was defined from the CPET data. Peak isometric knee extensor and flexor strength was assessed by a dynamometer, MC by the Körperkoordination test für Kinder tests, and body composition by the bioelectrical impedance analysis. PA intensity was assessed using V̇O2 as a % of V̇O2reserve or V̇O2 at VT, mean amplitude deviation (MAD) measured by accelerometry, metabolic equivalent of task (MET), and muscle activity measured by textile electromyography during walking or running on a treadmill at 4, 6, and 8 km/h, playing hopscotch, walking up and down the stairs, self-paced walking, and self-paced running. Children with lower V̇O2peak, V̇O2 at VT, and MC operated at higher intensity level during given physical task than their peers with higher fitness and MC when PA intensity was expressed using relative PA intensity using V̇O2 as a % of V̇O2reserve or V̇O2 at VT (p < 0.05). MAD and METs during different tasks were not able to discriminate PA intensity between children with varying levels of physical fitness or MC. Traditionally used absolute measures of PA intensity based on accelerometry or MET underestimated PA intensity in children with lower V̇O2peak, V̇O2 at VT, and MC.

25-Hydroxyvitamin D and Cardiorespiratory Fitness in Prepubertal Overweight and Obese Children

Childhood obesity has become a major global health problem. Vitamin D deficiency and poor cardiorespiratory fitness are highly prevalent in children with overweight or obesity, but little is known about their relationships. In this study, we aimed to analyze the relationship between serum 25-hydroxyvitamin D (25(OH)D) and cardiorespiratory fitness parameters in prepubertal obese and overweight children. A cross-sectional design with a sample of 57 prepubertal children, aged 9–11 years, with overweight or obesity was used. The fasting concentration of 25(OH)D was analyzed with a chemiluminescent microparticle immunoassay. Fat and lean body masses were determined by using DXA. Maximal oxygen uptake (VO_2max) was measured with the maximal treadmill test. A total of 68.4% of the sample had sufficient levels of 25(OH)D. As expected, their cardiorespiratory fitness was poor compared with that of normal-weight children, but 60% of the group exceeded the median obesity-specific reference values. No differences were found between the sexes for relative VO_2max or 25(OH)D levels. Moreover, no correlations were found between 25(OH)D and body composition or cardiorespiratory parameters for sex or vitamin D groups. Vitamin D status seems not to be directly related to body composition or cardiorespiratory fitness in prepubertal overweight or obese children.

Validity of traditional physical activity intensity calibration methods and the feasibility of self-paced walking and running on individualised calibration of physical activity intensity in children

There are no practical and valid methods for the assessment of individualised physical activity (PA) intensity in observational studies. Therefore, we investigated the validity of commonly used metabolic equivalent of tasks (METs) and pre-determined PA intensity classification methods against individualised PA intensity classification in 35 children 7–11-years-of-age. Then, we studied validity of mean amplitude deviation (MAD) measured by accelerometry during self-paced walking and running in assessment of individualised PA intensity. Individualised moderate PA (MPA) was defined as V̇O₂ ≥ 40% of V̇O_2reserve and V̇O₂ < ventilatory threshold (VT) and vigorous PA (VPA) as V̇O₂ ≥ VT. We classified > 3–6 (or alternatively > 4–7) METs as MPA and > 6 (> 7) METs as VPA. Task intensities were classified according to previous calibration studies. MET-categories correctly identified 25.9–83.3% of light PA, 85.9–90.3% of MPA, and 56.7–82.2% of VPA. Task-specific categories correctly classified 53.7% of light PA, 90.6% of MPA, and 57.8% of VPA. MAD during self-paced walking discriminated MVPA from light PA (sensitivity = 67.4, specificity = 88.0) and MAD during self-paced running discriminated VPA from MPA (sensitivity = 78.8, specificity = 79.3). In conclusion, commonly used methods may misclassify PA intensity in children. MAD during self-paced running may provide a novel and practical method for determining individualised VPA intensity in children.

The Impact of the Weight Status on Cardiovascular Parameters Related to Physical Effort in Young Athletes

Excess weight leads to an impaired cardiovascular response to physical exertion even at a young age. Sports training during youth promotes cardiovascular adaptations. The aim of the study is to verify the impact of weight status on cardiovascular parameters related to physical effort in young people who engage in competitive sports. A retrospective study was conducted on 8307 young athletes (5578 males and 2729 females) aged 6–18 years (mean age 13.9 ± 2.2 years). The data concerning graded exercise tests of young athletes in normal weight and overweight were compared. Approximately, 13.4% of the sample had excess weight. Young overweight athletes show a higher resting heart rate as well as systolic and diastolic pressure than young normal weight athletes. Excess weight condition leads to a reduction in the duration of the graded exercise test, reaching higher blood pressure values at the end of the test compared to those with normal weight. After four min from the end of the test, heart rate and systolic/diastolic blood pressure remained higher in the young overweight athletes. Excess weight affects cardiovascular parameters both at rest and in response to physical exertion during youth; however, competitive sport seems to be able to keep these parameters within the normal range even in young overweight athletes.

The effects of a 2-year physical activity and dietary intervention on plasma lipid concentrations in children: the PANIC Study

PURPOSE

We studied the effects of a physical activity and dietary intervention on plasma lipids in a general population of children. We also investigated how lifestyle changes contributed to the intervention effects.

METHODS

We carried out a 2-year controlled, non-randomized lifestyle intervention study among 504 mainly prepubertal children aged 6-9 years at baseline. We assigned 306 children to the intervention group and 198 children to the control group. We assessed plasma concentrations of total, LDL, HDL, and VLDL cholesterol, triglycerides, HDL triglycerides, and VLDL triglycerides. We evaluated the consumption of foods using 4-day food records and physical activity using a movement and heart rate sensor. We analyzed data using linear mixed-effect models adjusted for age at baseline, sex, and pubertal stage at both time points. Furthermore, specific lifestyle variables were entered in these models.

RESULTS

Plasma LDL cholesterol decreased in the intervention group but did not change in the control group ( - 0.05 vs. 0.00 mmol/L, regression coefficient (β) =  - 0.0385, p = 0.040 for group*time interaction). This effect was mainly explained by the changes in the consumption of high-fat vegetable oil-based spreads (β =  - 0.0203, + 47% change in β) and butter-based spreads (β =  - 0.0294, + 30% change in β), moderate-to-vigorous physical activity (β =  - 0.0268, + 30% change in β), light physical activity (β =  - 0.0274, + 29% change in β) and sedentary time (β =  - 0.0270, + 30% change in β). The intervention had no effect on other plasma lipids.

CONCLUSION

Lifestyle intervention resulted a small decrease in plasma LDL cholesterol concentration in children. The effect was explained by changes in quality and quantity of dietary fat and physical activity.

CLINICAL TRIAL REGISTRY NUMBER

NCT01803776, ClinicalTrials.gov.

Cardiorespiratory Fitness, Physical Activity, and Insulin Resistance in Children

PURPOSE

Few studies have investigated the independent and joint associations of cardiorespiratory fitness (CRF) and body fat percentage (BF%) with insulin resistance in children. We investigated the independent and combined associations of CRF and BF% with fasting glycemia and insulin resistance and their interactions with physical activity (PA) and sedentary time among 452 children age 6 to 8 yr.

METHODS

We assessed CRF with a maximal cycle ergometer exercise test and used allometrically scaled maximal power output (Wmax) for lean body mass (LM) and body mass (BM) as measures of CRF. The BF% and LM were measured by dual-energy X-ray absorptiometry, fasting glycemia by fasting plasma glucose, and insulin resistance by fasting serum insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The PA energy expenditure, moderate-to-vigorous PA (MVPA), and sedentary time were assessed by combined movement and heart rate sensor.

RESULTS

Wmax/LM was not associated with glucose (β = 0.065, 95% confidence interval [CI] = -0.031 to 0.161), insulin (β = -0.079, 95% CI = -0.172 to 0.015), or HOMA-IR (β = -0.065, 95% CI = -0.161 to 0.030). Wmax/BM was inversely associated with insulin (β = -0.289, 95% CI = -0.377 to -0.200) and HOMA-IR (β = -0.269, 95% CI = -0.359 to -0.180). The BF% was directly associated with insulin (β = 0.409, 95% CI = 0.325 to 0.494) and HOMA-IR (β = 0.390, 95% CI = 0.304 to 0.475). Higher Wmax/BM, but not Wmax/LM, was associated with lower insulin and HOMA-IR in children with higher BF%. Children with higher BF% and who had lower levels of MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR.

CONCLUSIONS

Children with higher BF% together with less MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR. Cardiorespiratory fitness appropriately controlled for body size and composition using LM was not related to insulin resistance among children.

Heart Rate Response During Treadmill Exercise Test in Children and Adolescents With Congenital Heart Disease

Background: Impaired exercise capacity is a common feature of congenital heart disease (CHD). In adults with CHD, it has been shown that impaired heart rate response during exercise may contribute to exercise limitation. Systematic data in children and adolescents on this topic is limited. We therefore purposed to assess heart rate response during treadmill exercise testing in children and adolescents with CHD compared to healthy controls. Methods: One hundred and sixty three children and adolescents (103 with CHD, median age 15 years and 60 age-matched controls) performed cardiopulmonary exercise testing and were included in this study. Beyond peak oxygen consumption, increase in heart rate from resting level to peak exercise (heart rate reserve) and decrease of heart rate after peak exercise (heart rate recovery) were measured. Chronotropic index was defined as percentage of age predicted maximal heart rate reserve. According to data from adults on bicycle exercise, chronotropic incompetence was assumed for chronotropic index below 0.8. Results: While resting heart rate was similar between both groups, peak heart rate, heart rate reserve as well as chronotropic index were lower in the CHD group than in controls. Chronotropic index was lowest in patients with single ventricle hemodynamics and correlated with peak oxygen consumption. Heart rate recovery was impaired in the CHD group 1 and 2 min after peak exercise compared to controls and correlated with peak oxygen consumption. Chronotropic index below 0.8 was a relatively frequent finding even in the control group suggesting that the threshold of 0.8 appears inadequate for the identification of chronotropic incompetence using treadmill exercise testing in children. After normalizing to the 2.5th chronotropic index percentile of the control group we obtained a chronotropic incompetence threshold of 0.69. Conclusion: As an adjunct to measurement of peak oxygen consumption, heart rate response to exercise appears to be a physiologically important diagnostic parameter in children and adolescents with CHD. However, interpretation of heart rate response needs to consider specific age characteristics and the mode of exercise test. Our data may help future studies on chronotropic incompetence using treadmill ergometer protocols in children and adolescents.

Longitudinal associations of physical activity and sedentary time with cardiometabolic risk factors in children

BACKGROUND

There are few prospective studies on the associations of changes in objectively measured vigorous physical activity (VPA_∆ ), moderate-to-vigorous physical activity (MVPA_∆ ), light physical activity (LPA_∆ ), and sedentary time (ST_∆ ) with changes in cardiometabolic risk factors (_∆ ) in children. We therefore investigated these relationships among children.

METHODS

The participants were a population sample of 258 children aged 6-8 years followed for 2 years. We assessed PA and ST by a combined heart rate and movement sensor; computed continuous age- and sex-adjusted z-scores for waist circumference, blood pressure, and fasting insulin, glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol; and constructed a cardiometabolic risk score (CRS) of these risk factors. Data were analyzed using linear regression models adjusted for age, sex, the explanatory and outcome variables at baseline, and puberty.

RESULTS

VPA_∆ associated inversely with CRS_∆ (β = -0.209, P = 0.001), body fat percentage (BF%)_∆ (β = -0.244, P = 0.001), insulin_∆ (β = -0.220, P = 0.001), and triglycerides_∆ (β = -0.164, P = 0.012) and directly with HDL cholesterol_∆ (β = 0.159, P = 0.023). MVPA_∆ associated inversely with CRS_∆ (β = -0.178, P = 0.012), BF%_∆ (β = -0.298, P = <0.001), and insulin_∆ (β = -0.213, P = 0.006) and directly with HDL cholesterol_∆ (β = 0.184, P = 0.022). LPA_∆ only associated negatively with CRS_∆ (β = -0.163, P = 0.032). ST_∆ associated directly with CRS_∆ (β = 0.218, P = 0.003), BF%_∆ (β = 0.212, P = 0.016), and insulin_∆ (β = 0.159, P = 0.049).

CONCLUSIONS

Increased VPA and MVPA and decreased ST were associated with reduced overall cardiometabolic risk and major individual risk factors. Change in LPA had weaker associations with changes in these cardiometabolic risk factors. Our findings suggest that increasing at least moderate-intensity PA and decreasing ST decrease cardiometabolic risk in children.

Peak oxygen uptake cut-points to identify children at increased cardiometabolic risk - The PANIC Study

We aimed to develop cut-points for directly measured peak oxygen uptake ( V ˙ O 2 peak ) to identify boys and girls at increased cardiometabolic risk using different scaling methods to control for body size and composition. Altogether 352 children (186 boys, 166 girls) aged 9-11 years were included in the analyses. We measured V̇O_2peak directly during a maximal cycle ergometer exercise test and lean body mass (LM) by bioelectrical impedance. We computed a sex- and age-specific cardiometabolic risk score (CRS) by summing important cardiometabolic risk factors and defined increased cardiometabolic risk as >1 standard deviation above the mean of CRS. Receiver operating characteristics curves were used to detect V̇O_2peak cut-points for increased cardiometabolic risk. Boys with V̇O_2peak <45.8 mL kg body mass (BM)^-1  min^-1 (95% confidence interval [CI] = 45.1 to 54.6, area under the curve [AUC] = 0.86, P < 0.001) and <63.2 mL kg LM^-1  min^-1 (95% CI =52.4 to 67.5, AUC = 0.65, P = 0.006) had an increased CRS. Girls with V̇O_2peak <44.1 mL kg BM^-1  min^-1 (95% CI = 44.0 to 58.6, AUC = 0.67, P = 0.013) had an increased CRS. V̇O_2peak scaled by BM^-0.49 and LM^-0.77 derived from log-linear allometric modeling poorly predicted increased cardiometabolic risk in boys and girls. In conclusion, directly measured V ˙ O 2 peak <45.8 mL kg BM^-1  min^-1 among boys and <44.1 mL kg BM^-1  min^-1 among girls were cut-points to identify those at increased cardiometabolic risk. Appropriately controlling for body size and composition reduced the ability of cardiorespiratory fitness to identify children at increased cardiometabolic risk.

Cardiopulmonary fitness is strongly associated with body cell mass and fat-free mass: The Study of Health in Pomerania (SHIP)

Peak oxygen uptake (VO2peak) is commonly indexed by total body weight (TBW) to determine cardiopulmonary fitness (CPF). This approach may lead to misinterpretation, particularly in obese subjects. We investigated the normalization of VO2peak by different body composition markers. We analyzed combined data of 3848 subjects (1914 women; 49.7%), aged 20-90, from two independent cohorts of the population-based Study of Health in Pomerania (SHIP-2 and SHIP-TREND). VO2peak was assessed by cardiopulmonary exercise testing. Body cell mass (BCM), fat-free mass (FFM), and fat mass (FM) were determined by bioelectrical impedance analysis. The suitability of the different markers as a normalization variable was evaluated by taking into account correlation coefficients (r) and intercept (α-coefficient) values from linear regression models. A combination of high r and low α values was considered as preferable for normalization purposes. BCM was the best normalization variable for VO2peak (r = .72; P ≤ .001; α-coefficient = 63.3 mL/min; 95% confidence interval [CI]: 3.48-123) followed by FFM (r = .63; P ≤ .001; α-coefficient = 19.6 mL/min; 95% CI: -57.9-97.0). On the other hand, a much weaker correlation and a markedly higher intercept were found for TBW (r = .42; P ≤ .001; α-coefficient = 579 mL/min; 95% CI: 483 to 675). Likewise, FM was also identified as a poor normalization variable (r = .10; P ≤ .001; α-coefficient = 2133; 95% CI: 2074-2191). Sex-stratified analyses confirmed the above order for the different normalization variables. Our results suggest that BCM, followed by FFM, might be the most appropriate marker for the normalization of VO2peak when comparing CPF between subjects with different body shape.

Associations of Objectively Measured Physical Activity and Sedentary Time With Arterial Stiffness in Pre-Pubertal Children

PURPOSE

To investigate the relationships of objectively measured physical activity (PA) and sedentary time (ST) to arterial stiffness in prepubertal children.

METHOD

Altogether 136 children (57 boys, 79 girls) aged 6-8-years participated in the study. Stiffness index (SI) was assessed by pulse contour analysis based on photoplethysmography. ST, light PA, moderate PA, and vigorous PA were assessed using combined acceleration and heart rate monitoring. We investigated the associations of ST (<1.5METs) and time spent in intensity level of PA above 2-7METs in min/d with SI using linear regression analysis. We studied the optimal duration and intensity of PA to identify children being in the highest quarter of SI using Receiver Operating Characteristics curves.

RESULTS

Moderate PA, vigorous PA, and cumulative time spent in PA above 3 (β=-0.279, p = .002), 4 (β =-0.341, P<0.001), 5 (β =-0.349, P<0.001), 6 (β =-0.312, P<0.001), and 7 (β =-0.254, p = .005) METs were inversely associated with SI after adjustment for age, sex, and monitor wear time. The cutoffs for identifying children being in the highest quarter of SI <68 min/d for PA exceeding 5 METs and <26 min/d for PA exceeding 6 METs.

CONCLUSION

Lower levels of PA exceeding 3-6 METs were related to higher arterial stiffness in children.

Ventilatory Efficiency in Children and Adolescents: A Systematic Review

Introduction. The index of ventilatory efficiency (VE/VCO₂) obtained by the progressive exercise test has been considered the gold standard in the prognosis of adults with heart failure, but few studies have evaluated this approach in children. Objective. To verify the scientific evidence about the VE/VCO₂ in pediatric and adolescents patients. Methods. A systematic literature review was carried out using the key words VE/VCO₂, children, and adolescents using the PEDro and PubMed/MedLine databases. Clinical trials published from 1987 to 2014, including children, adolescents, and young adults up to 25 years, addressing the VE/VCO₂ index as a method of evaluation, monitoring, and prognosis were considered. Results. Initially, 95 articles were found; 12 were excluded as the title/abstract did not contain the VE/VCO₂ index or because they included patients greater than 25 years of age. From the remaining 83, 58 were repeated between the databases. The final sample consisted of 32 studies including healthy children and children with respiratory and other diseases. Conclusion. There are few studies involving cardiorespiratory assessment by ventilatory efficiency. The studies highlight the fact that high VE/VCO₂ values are associated with a worse prognosis of patients due to the relationship with the decrease in pulmonary perfusion and cardiac output.