Cardiorespiratory Fitness Evaluation In Obese Youth
ebook.ecog-obesity.eu/chapter-energy-expenditure-physical-activity/cardiorespiratory-fitness-evaluation-
obese-youth
David Thivel
Clermont University, Blaise Pascal University, EA 3533, Laboratory of the Metabolic Adaptations to
Exercise under Physiological and Pathological Conditions (AME2P), BP 80026, F-63171 Aubière cedex,
France
Julien Aucouturier
Université Droit et Santé Lille 2, EA 4488 "Activité Physique, Muscle, Santé", Faculté des Sciences du
Sport et de l'Education Physique, 59790 Ronchin, France
Cardiorespiratory fitness in obese children and adolescents
Obese children and adolescents usually have lower overall physical abilities and especially lower
cardiorespiratory fitness (CRF) when compared to their normal-weight peers. This is mainly because of
the increased effort required to move their larger body mass and carry an excessive amount of body fat 1.
It is only among extremely obese children that the lower CRF can partly result from impaired lung
function, with decreased expiratory reserve volume and functional residual capacities due to their lower
chest wall and lung compliance 2-5. He and al. did not observe any difference of pulmonary functions
between lean and obese children, despite a higher prevalence of respiratory symptoms that may
occasionally impair cardiorespiratory fitness in obese youth 6. Although lower cardiorespiratory
performances are observed in obese children and adolescents compared to those of lean children and
adolescents when adjusted to body mass, absolute performances are similar or higher, and these
differences disappear when performances are adjusted to fat free mass, suggesting that muscle maximal
oxidative ability is not impaired with obesity in youth 7, 8. As an example, Lazzer et al. reported a
maximal oxygen uptake (VO2max) approximately 27% higher in 12-16 years old obese youth when
expressed in absolute terms (L.min-1) , but when VO2max was adjusted to Fat-Free Mass there was no
difference between the obese adolescents and their normal weight controls as illustrated by the Figure 1 9.
Using an incremental treadmill test conducted to exhaustion and the measurement of VO2max, Watanabe et
al. observed an inverse and significant relation between 12-15 years old obese adolescents’ CRF and their
body fat mass 7. CRF results are similar when VO2max cannot be directly assessed and indirect methods
are used to assess CRF (Queen’s college step test) 10. Excessive body fat is also thought to contribute to
the exercise intolerance and low CRF in obese youth 7. Some studies suggest different effects of obesity
in girls and boys, as Mota et al. did not observe any CRF difference between lean, overweight or obese 8
years old boys, whereas overweight and obese girls were more likely to be unfit compared to lean girls 11.
This is in accordance with previous findings from a longitudinal study showing that CRF among girls but
not boys was significantly associated with the incidence of overweight and obesity 12.
2
Figure 1. Illustration of the VO2 differences between lean and obese youth depending on its expression
during an incremental exercise test (relative to Body Mass (A) or Fat Free Mass (B).
Although exercise training represent the best method to improve CRF in obese youth, their initial low
fitness level is a barrier to their engagement in regular physical activity, contributing to the poor
compliance usually observed in physical activity interventions 13. An important clinical challenge to track
the changes in physical fitness with these interventions is to properly assess CRF in obese youth by using
validated and accurate tests.
3
How to measure CRF in pediatric obesity?
Maximal oxygen uptake (VO2max): the “Gold Standard”
Laboratory tests to assess cardiorespiratory fitness either measure or predict oxygen uptake (VO2max) and
are accepted as reference methods 14-17. Basically, VO2max is assessed during a cycling or running graded
exhaustive test with increasing workload (in Watt) when performed on a cycle ergometer or speed and/or
slope when performed on a treadmill. Whether it is on a cycle ergometer or a treadmill, the stage duration
at each workload or speed ranges between 1 to 3 minutes of duration. In children and adolescents, the
criteria for achievement of VO2max are subjective exhaustion, heart rate above 195 beats.min-1 and/or
Respiratory Exchange Ratio (RER, VCO2/VO2) above 1.02 and/or a plateau of VO2 18. Although this
method is widely used the completion of maximal test requires strong encouragement from the
investigation or medical team and remains difficult to perform in obese subjects. Obese children and
adolescents specifically have been shown to express a significantly higher rate of perceived exertion
during incremental test compared to their normal-weight peers 19, with pain and fatigue considered as the
main causes. Children who rarely engage in physical activity of high intensity, often fail to reach the
required VO2max criteria during a maximal CRF test, and if the aforementioned criteria are not met, the
maximal oxygen uptake measured is termed VO2peak rather than VO2max 20. VO2peak represents the highest
value of oxygen consumed by participants in a maximal protocol but with less stringent criteria than
VO2max. As an example, Breithaupt et al. reported that only 18 out of 62 obese children who performed a
maximal CRF test were able to achieve VO2max based on the criteria presented above 21.
In addition to the measurement of VO2max, two ventilatory thresholds (VT1 and VT2) can be determined
during incremental test and are each characterized by a disproportionate increase in minute ventilation
(VE) relative to the increase in VO2. Also VT1 and VT2 are considered as good physiological indicators
of cardiorespiratory endurance, they are difficult to determine accurately in obese children and
adolescents due to frequently erratic breathing. Some authors indicate that the thresholds are almost
undetectable in up to 20% of children and adolescents 22, 23. Despite these limitations, VT determination
can be used for exercise prescription. For example, training below VT1 will represent a moderate
intensity of exercise that will favor fat oxidation 24, training alternating moderate and high intensities
(between VT1 and VT2) has been shown to reduce cardiovascular risk factors 25 and exercising at the
VT2 can reduce post-exercise energy consumption 26.
Maximal laboratory tests with gas exchange measurement may represent the most accurate method to
asses CRF, but these tests are often expensive and not accessible to all obese youth. Submaximal tests
have been therefore been developed 27 for and validated in the general pediatric population, and are now
applied to obese youth.
Submaximal tests: from the laboratory to the field setting
When using validated tests, submaximal exercise testing offers a valuable and reliable alternative to
estimate VO2max. Submaximal measures do not require the participants to exercise until exhaustion and
may thus overcome some of the limitations of maximal testing and are better tolerated by patients
4
experiencing physical limitation, important fatigue and pain while exercising 17. Basically, extrapolations
of VO2max or maximal power output are performed from the theoretical maximal heart rate (HR), and the
linear relationship between power output (or VO2) and heart rate measured during at least two bouts of
exercise performed at two different submaximal intensities of exercise 28. Estimation of CRF can also be
done using other predictive variables such as HR recovery during step tests 29, 30 or validated predictive
equations with parameters such as age, gender, body weight or rest heart rate among others 31-33.
Recently, Breithaupt et al. proposed a new submaximal protocol adapted to obese youth (The HALO
protocol: Healthy Active Living and Obesity research group Protocol) that they compared with a direct
progressive maximal test to exhaustion in 21 obese adolescents 34. The test consists in a walking test at
constant speed (brisk but confortable) during 4-min stages to ensure that steady state of VO2 and HR is
reached. After a 4-min warm-up, the incline of the treadmill is increased by 3% over each subsequent
stage. The test ends when: i) the participant reaches 85% of his maximal estimated HR; ii) he completes
20 minutes of exercise; iii) he indicates that he can no longer continue. Then VO2peak is predicted by
extrapolating the HR-VO2 linear relationship to age-predicted HRmax. While only 29% of their sample
reaches a VO2 plateau during the maximal test, all the participants ended the HALO protocol and
expressed lower RPE. According to their results, the HALO submaximal protocol provides an accurate
and valid method to estimate VO2peak compared with a classical maximal test. Furthermore, this test
results in better estimates of VO2peak compared with previously validated submaximal estimations in
obese youth 34.
A shorter submaximal protocol has also been validated in obese adolescents against a laboratory-bases
maximal VO2max measure. Nemeth et al. asked 113 obese 12 years old boys and girls to complete a 4-
minute treadmill exercise 33. After a 4-minute warm-up at a self-selected confortable walking speed
(treadmill grade = 0%); the participants were asked to maintain this speed for 4 minutes while the
treadmill grade increased to 5%. Heart rate was recorded at rest and at the end of the 4 minutes as well as
the self-selected speed. Based on these two variables, the authors proposed an equation that also included
sex, weight (kg) and height (cm) to estimate VO2max. These simple methods requiring only HR
measurement accurately predict VO2max in overweight and obese children and adolescents 33 and offers
then practitioners feasible and simple methods to assess cardiorespiratory fitness.
Several inexpensive, easy to implement and reproducible field-methods initially validated in non-obese
youth are commonly used obese youth 17, 35-37. The two main field tests used among pediatric obese
populations are the Six-Minute Walk Test (6MWT) and the 20-Meter Shuttle Run Test (20MST).
The 6-minute walk test is an accurate and convenient method to assess CRF at submaximal intensity in
children 38 and has been shown to better reflect daily living activities than any other functional walk test
39
. The recently established reference values have facilitated the use of the 6MWT and allow determining
whether a child has a good or a poor CRF 40-44. Not surprisingly, several studies have shown lower
distances completed during the 6MWT in obese compared to lean children and adolescents 45, 46. Elloumi
et al. confirmed the validity of the 6MWT in obese adolescents by comparison with a validated
incremental submaximal protocol with gas exchange measurements 47. The 6MWT has also been shown
to be sensitive to changes in physical fitness of obese adolescents following a 2-month physical activity 47,
48
. The 6MWT has also been used to estimate the maximal fat oxidation point (Fatmax or lipoxmax),
when gas exchange measurement - with the VO2 and VCO2 data used to calculate the rate of fat oxidation
- is not available (using the distance performed during the test as a central values in a predictive equation)
49
.
5
The 20-meter shuttle run test (20MST) developed by Leger et al. is among the most used field tests to
assess cardiorespiratory fitness in youth 50. During this test, children are instructed to run for as long as
possible between two lines drawn 20 meters apart at an increasing speed imposed by a recording emitting
tones at appropriate intervals. The test starts at 8 km/h and increases by 0.5 km/h every minute. The test
ends when the participant is not able anymore to complete a whole stage. Castro-Pineiro et al. showed
that overweight and obese children performed less well than lean ones at this test 51, and this is partly
explained by the excessive start speed during the original test (8 km/h). This led to the development of an
adapted version of the test, with the use of an incremental shuttle walk test with 15 levels from 1.8 to 10.3
km/h over a 10-meter distance 36. More recently, an adapted version of the 20MST has been developed in
obese children and adolescents 52. 10 stages have been added at the beginning of the original 20MSRT in
order to reduce the starting speed and speed over the duration of the test 52. Then, the participants are
asked to start at 4 km/h (walk speed) with an increment of 0.5 km/h every minute. The original start speed
of 8 km/h is reach after the first 10 minutes. The authors reported a strong correlation between the
maximum speed obtained and laboratory-assessed peak VO2 (r=0.81), which indicates the validity of this
adapted version of the test in obese youth 52.
Conclusion and Recommendations
Cardiorespiratory fitness is impaired in obese children and adolescents, and is among the main reasons for
their low engagement into physical activities. There is a double interest in properly assessing CRF in this
population. First, CRF is an important clinical parameter for the diagnosis and follow-up of the current
and future functional and metabolic health of obese youth. A laboratory-based direct and maximal
assessment should thus be encouraged.
Second, from a more practical point of view, CRF is necessary information to obtain when implementing
interventions for the treatment of obesity, especially when it is based on physical activity-based programs.
Disposing of CRF indicators will help the practitioners and/or educators to properly prescribe physical
activities by determining the appropriate exercise intensities and controlling their progression through the
intervention. When direct VO2max measurement is not available, submaximal and field testing are reliable
alternatives. Thanks to their easy feasibility, these tests can be repeated many times during the program to
and bring adaptation to the exercise prescription if necessary.
6
BOX 1
Cardiorespiratory fitness, or aerobic capacity, describes the ability of the body to perform
high-intensity activity for a prolonged period without undue physical stress or fatigue. HIgh level
of cardiorespiratory fitness enables people to carry out their daily occupational tasks and leisure
pursuits more easily and with greater efficiency 53.
Cardiorespiratory endurance, or aerobic fitness, is the ability of the cardiorespiratory system
to supply oxygen to active skeletal muscles during prolonged submaximal exercise and the ability
of the skeletal muscles to perform aerobic metabolism 54.
BOX 2
Limiting factors in the evaluation of CRF in obese youth
Pain. The excess body weight characterizing overweight and obesity is responsible for increase
overall and lower limb musculoskeletal pain limiting their engagement in exercise 55. In a recent
review, Smith et al. pointed out the musculoskeletal and osteoarticular dysfunction and pain
induced by obesity in youth 56. Overweight and obese children and adolescents experience
decreased joint health and increased dysfunction resulting in more ankle, foot and knee problems
than their lean peers 57. Such physical impairments are limiting factors leading to premature
interruption during maximal and submaximal testing.
Respiratory limitations. Obesity is accompanied by numbers of respiratory complications that
limits the adherence of overweight and obese youth to exercise testing and programs. Decreased
thoracic compliance, increased airway resistance and breathing at low pulmonary volumes have
been identified among others 58-60 and contribute to ventilator constraint 61, increased fatigue of
respiratory muscles 62 leading then to dyspnea. Since ventilator response to exercise in youth is
excessive relative to the metabolic demand, it increases ventilator constraint in obese children and
adolescents 63, 64. In addition, due to their reduced airways relative to lung size 65 youth with
obesity experience increased expiratory flow limitation that limits their compliance to maximal
and submaximal exercises 66.
Rate of Perceived Exertion (RPE). Although few data are available regarding the real perceived
exertion of obese youth during incremental tests, it has been shown that obese children rate their
perceived exertion during a CRF test significantly higher than their lean peers 19. Belanger et al.
found that obese adolescents express higher absolute RPE during a maximal incremental test
compared with a submaximal one 67. According to Ward & Bar-Or, the excess body weight and
lower physical abilities and capacities induced by obesity increase their perception of exercise
difficulties and compose the main limitations to physical activity 68. This excessive RPE during
exercise may lead to premature interruption of the tests and then underestimation of their aerobic
capacities.
7
References
1 Dupuis JM, Vivant JF, Daudet G, Bouvet A, Clement M, Dazord A, et al. [Personal sports
training in the management of obese boys aged 12 to 16 years]. Arch Pediatr. 2000; 7: 1185-93.
2 Fung KP, Lau SP, Chow OK, Lee J, Wong TW. Effects of overweight on lung function. Arch Dis
Child. 1990; 65: 512-15.
3 Ferretti A, Giampiccolo P, Cavalli A, Milic-Emili J, Tantucci C. Expiratory flow limitation and
orthopnea in massively obese subjects. Chest. 2001; 119: 1401-8.
4 Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G. Effects of obesity on respiratory
resistance. Chest. 1993; 103: 1470-6.
5 Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function.
Am Rev Respir Dis. 1983; 128: 501-6.
6 He QQ, Wong TW, Du L, Jiang ZQ, Qiu H, Gao Y, et al. Respiratory health in overweight and
obese Chinese children. Pediatr Pulmonol. 2009; 44: 997-1002.
7 Watanabe K, Nakadomo F, Maeda K. Relationship between body composition and
cardiorespiratory fitness in Japanese junior high school boys and girls. Ann Physiol Anthropol. 1994; 13:
167-74.
8 Goran MI. Energy metabolism and obesity. Med Clin North Am. 2000; 84: 347-62.
9 Lazzer S, Boirie Y, Bitar A, Petit I, Meyer M, Vermorel M. Relationship between percentage of
VO2max and type of physical activity in obese and non-obese adolescents. J Sports Med Phys Fitness.
2005; 45: 13-9.
10 Chatterjee S, Chatterjee P, Bandyopadhyay A. Validity of Queen's College Step Test for
estimation of maximum oxygen uptake in female students. Indian J Med Res. 2005; 121: 32-5.
11 Mota J, Flores L, Ribeiro JC, Santos MP. Relationship of single measures of cardiorespiratory
fitness and obesity in young schoolchildren. Am J Hum Biol. 2006; 18: 335-41.
12 Kim J, Must A, Fitzmaurice GM, Gillman MW, Chomitz V, Kramer E, et al. Relationship of
physical fitness to prevalence and incidence of overweight among schoolchildren. Obes Res. 2005; 13:
1246-54.
13 Quinart S, Mougin-Guillaume F, Simon-Rigaud ML, Bertrand AM, Negre V. [Sports counseling
for overweight children]. Arch Pediatr. 2010; 17: 894-5.
14 Balke B, Ware R. An experimental study of Air Force personnel. US Armed Forces Med Journal.
1959; 10: 675-88.
15 Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake and nomographic assessment of
functional aerobic impairment in cardiovascular disease. Am Heart J. 1973; 85: 546-62.
16 Patterson JA, Naughton J, Pietras RJ, Gunnar RM. Treadmill exercise in assessment of the
functional capacity of patients with cardiac disease. Am J Cardiol. 1972; 30: 757-62.
17 Noonan V, Dean E. Submaximal exercise testing: clinical application and interpretation. Phys
Ther. 2000; 80: 782-807.
18 Rowland TW. Developmental Exercise physiology. . Human Kinetics ed edn. Champaign, IL
1996.
19 Marinov B, Kostianev S, Turnovska T. Ventilatory efficiency and rate of perceived exertion in
obese and non-obese children performing standardized exercise. Clin Physiol Funct Imaging. 2002; 22:
254-60.
20 Wagner PD. New ideas on limitations to VO2max. Exerc Sport Sci Rev. 2000; 28: 10-4.
8
21 Breithaupt PG, Colley RC, Adamo KB. Using the oxygen uptake efficiency slope as an indicator
of cardiorespiratory fitness in the obese pediatric population. Pediatr Exerc Sci. 2012; 24: 357-68.
22 Washington RL, van Gundy JC, Cohen C, Sondheimer HM, Wolfe RR. Normal aerobic and
anaerobic exercise data for North American school-age children. J Pediatr. 1988; 112: 223-33.
23 Owens S, Gutin B. Exercise testing of the child with obesity. Pediatr Cardiol. 1999; 20: 79-83;
discussion 84.
24 Lazzer S, Lafortuna C, Busti C, Galli R, Tinozzi T, Agosti F, et al. Fat oxidation rate during and
after a low- or high-intensity exercise in severely obese Caucasian adolescents. Eur J Appl Physiol. 2010;
108: 383-91.
25 Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, Odegard R, et al. Aerobic interval
training reduces cardiovascular risk factors more than a multitreatment approach in overweight
adolescents. Clin Sci (Lond). 2009; 116: 317-26.
26 Thivel D, Isacco L, Montaurier C, Boirie Y, Duche P, Morio B. The 24-h energy intake of obese
adolescents is spontaneously reduced after intensive exercise: a randomized controlled trial in
calorimetric chambers. PLoS One. 2012; 7: e29840.
27 Cottin F, Lepretre PM, Lopes P, Papelier Y, Medigue C, Billat V. Assessment of ventilatory
thresholds from heart rate variability in well-trained subjects during cycling. Int J Sports Med. 2006; 27:
959-67.
28 Astrand I. Aerobic work capacity in men and women with special reference to age. Acta Physiol
Scand Suppl. 1960; 49: 1-92.
29 Weller IM, Thomas SG, Corey PN, Cox MH. Selection of a maximal test protocol to validate the
Canadian Aerobic Fitness Test. Can J Sport Sci. 1992; 17: 114-9.
30 Weller IM, Thomas SG, Cox MH, Corey PN. A study to validate the Canadian Aerobic Fitness
Test. Can J Public Health. 1992; 83: 120-4.
31 Dolgener FA, Hensley LD, Marsh JJ, Fjelstul JK. Validation of the Rockport Fitness Walking
Test in college males and females. Res Q Exerc Sport. 1994; 65: 152-8.
32 Ebbeling CB, Ward A, Puleo EM, Widrick J, Rippe JM. Development of a single-stage
submaximal treadmill walking test. Med Sci Sports Exerc. 1991; 23: 966-73.
33 Nemeth BA, Carrel AL, Eickhoff J, Clark RR, Peterson SE, Allen DB. Submaximal treadmill test
predicts VO2max in overweight children. J Pediatr. 2009; 154: 677-81.
34 Breithaupt P, Adamo KB, Colley RC. The HALO submaximal treadmill protocol to measure
cardiorespiratory fitness in obese children and youth: a proof of principle study. Appl Physiol Nutr Metab.
2012; 37: 308-14.
35 Drinkard B, McDuffie J, McCann S, Uwaifo GI, Nicholson J, Yanovski JA. Relationships
between walk/run performance and cardiorespiratory fitness in adolescents who are overweight. Phys
Ther. 2001; 81: 1889-96.
36 Klijn PH, van der Baan-Slootweg OH, van Stel HF. Aerobic exercise in adolescents with obesity:
preliminary evaluation of a modular training program and the modified shuttle test. BMC Pediatr. 2007;
7: 19.
37 Wallman KE, Campbell L. Test-retest reliability of the Aerobic Power Index submaximal
exercise test in an obese population. J Sci Med Sport. 2007; 10: 141-6.
38 Nixon PA, Joswiak ML, Fricker FJ. A six-minute walk test for assessing exercise tolerance in
severely ill children. J Pediatr. 1996; 129: 362-6.
39 Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the
9
measurement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001; 119:
256-70.
40 Li AM, Yin J, Au JT, So HK, Tsang T, Wong E, et al. Standard reference for the six-minute-walk
test in healthy children aged 7 to 16 years. Am J Respir Crit Care Med. 2007; 176: 174-80.
41 Geiger R, Strasak A, Treml B, Gasser K, Kleinsasser A, Fischer V, et al. Six-minute walk test in
children and adolescents. J Pediatr. 2007; 150: 395-9, 99 e1-2.
42 Gulmans VA, van Veldhoven NH, de Meer K, Helders PJ. The six-minute walking test in
children with cystic fibrosis: reliability and validity. Pediatr Pulmonol. 1996; 22: 85-9.
43 Larsson UE, Reynisdottir S. The six-minute walk test in outpatients with obesity: reproducibility
and known group validity. Physiother Res Int. 2008; 13: 84-93.
44 Li AM, Yin J, Yu CC, Tsang T, So HK, Wong E, et al. The six-minute walk test in healthy
children: reliability and validity. Eur Respir J. 2005; 25: 1057-60.
45 Calders P, Deforche B, Verschelde S, Bouckaert J, Chevalier F, Bassle E, et al. Predictors of 6-
minute walk test and 12-minute walk/run test in obese children and adolescents. Eur J Pediatr. 2008; 167:
563-8.
46 Morinder G, Mattsson E, Sollander C, Marcus C, Larsson UE. Six-minute walk test in obese
children and adolescents: reproducibility and validity. Physiother Res Int. 2009; 14: 91-104.
47 Elloumi M, Makni E, Ounis OB, Moalla W, Zbidi A, Zaoueli M, et al. Six-minute walking test
and the assessment of cardiorespiratory responses during weight-loss programmes in obese children.
Physiother Res Int. 2011; 16: 32-42.
48 Geiger R, Willeit J, Rummel M, Hogler W, Stubing K, Strasak A, et al. Six-minute walk distance
in overweight children and adolescents: effects of a weight-reducing program. J Pediatr. 2011; 158: 447-
51.
49 Makni E, Moalla W, Trabelsi Y, Lac G, Brun JF, Tabka Z, et al. Six-minute walking test predicts
maximal fat oxidation in obese children. Int J Obes (Lond). 2012; 36: 908-13.
50 Leger L, Mercier D, Gadoury C, Lambert J. The mutistage 20 metre shuttle run test for aerobic
fitness. Journal of Sports Science. 1988; 6: 93-101.
51 Castro-Pinero J, Padilla-Moledo C, Ortega FB, Moliner-Urdiales D, Keating X, Ruiz JR.
Cardiorespiratory fitness and fatness are associated with health complaints and health risk behaviors in
youth. J Phys Act Health. 2011; 9: 642-9.
52 Quinart S, Mougin F, Simon-Rigaud ML, Nicolet-Guenat M, Negre V, Regnard J. Evaluation of
cardiorespiratory fitness using three field tests in obese adolescents: Validity, sensitivity and prediction of
peak V O2. J Sci Med Sport. 2013; 17: 521-5.
53 Health GW. Behavioral approaches tp physical activity promotion. In: Ehrman JK, Gordon PM,
Visich PS, Keteyian SJ (eds.). Clinical Exercise Physiology. Human Kinetics: Champaign IL 2008; 18-
19.
54 Visich PS, Ehrman JK. Graded exercise testing and exercise prescription. In: Ehrman JK, Gordon
PM, Visich PS, Keteyian SJ (eds.). Clinical Exercise Physiology. Human Kinetics: Champaign IL 2008;
95.
55 Tsiros MD, Buckley JD, Howe PR, Walkley J, Hills AP, Coates AM. Musculoskeletal pain in
obese compared with healthy-weight children. Clin J Pain. 2014; 30: 583-8.
56 Smith SM, Sumar B, Dixon KA. Musculoskeletal pain in overweight and obese children. Int J
Obes (Lond). 2014; 38: 11-5.
57 Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW.
10
Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009; 7: 352-6.
58 Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Can Respir J.
2006; 13: 203-10.
59 Schiel R, Beltschikow W, Kramer G, Stein G. Overweight, obesity and elevated blood pressure in
children and adolescents. Eur J Med Res. 2006; 11: 97-101.
60 Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired
glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002; 346: 802-
10.
61 Wang LY, Cerny FJ. Ventilatory response to exercise in simulated obesity by chest loading. Med
Sci Sports Exerc. 2004; 36: 780-6.
62 Chlif M, Keochkerian D, Feki Y, Vaidie A, Choquet D, Ahmaidi S. Inspiratory muscle activity
during incremental exercise in obese men. Int J Obes (Lond). 2007; 31: 1456-63.
63 Cooper DM, Kaplan MR, Baumgarten L, Weiler-Ravell D, Whipp BJ, Wasserman K. Coupling
of ventilation and CO2 production during exercise in children. Pediatr Res. 1987; 21: 568-72.
64 Rowland TW, Cunningham LN. Development of ventilatory responses to exercise in normal
white children. A longitudinal study. Chest. 1997; 111: 327-32.
65 Mead J. Dysanapsis in normal lungs assessed by the relationship between maximal flow, static
recoil, and vital capacity. Am Rev Respir Dis. 1980; 121: 339-42.
66 Gibson N, Johnston K, Bear N, Stick S, Logie K, Hall GL. Expiratory flow limitation and
breathing strategies in overweight adolescents during submaximal exercise. Int J Obes (Lond). 2014; 38:
22-6.
67 Belanger K, Breithaupt P, Ferraro ZM, Barrowman N, Rutherford J, Hadjiyannakis S, et al. Do
obese children perceive submaximal and maximal exertion differently? Clin Med Insights Pediatr. 2013;
7: 35-40.
68 Ward DS, Bar-Or O. Usefulness of Borg scale in exercise prescription for overweight youth. .
Canadian Journal of Sport Science. 1990; 15: 120-25.
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~ About the Authors ~
David Thivel
David Thivel is Assistant Professor at the Faculty of Sports Sciences at Blaise
Pascal University (Clermont-Ferrand, France). He completed a PhD in Exercise
Physiology and Human Nutrition in 2011 at French the National Institute for
Agronomic Research and Blaise Pascal University of Clermont-Ferrand. He
mainly explores the impact of physical activity on the behavioral and
physiological control of energy intake and appetite in lean and obese children
and adolescents. His other research interests are in the field of physical fitness,
body composition and metabolic health in pediatric populations.
David Thivel is a member of the AME2P Laboratory of Clermont-Ferrand (Metabolic Adaptations to
Exercise under Physiological and Pathological conditions) and is particularly involved in its “Energy
Metabolism” research group.
Julien Aucouturier
Julien Aucouturier is assistant professor at the Faculty of Sports Sciences and
Physical Education, at Lille 2 University (France). Since his PhD, he has been
working on the link between physical activity and metabolic health in children,
with a particular interest for the metabolic responses to exercise and food intake
in obese people. His other research interests are in the field of training and
nutrition for sports performance.
Julien Aucouturier is a member of the “Physical Activity, Muscle, Health” Laboratory where
investigations are conducted on topics such as the health benefits of physical activity, the physiological
factors limiting performances, dysfunction of the neuromuscular system and its adaptation to exercise
12
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