Cardiopulmonary Exercise Performance in the Pediatric and Young Adult Population Before and During the COVID-19 Pandemic


D. S. BursteinJ. EdelsonS. O’MalleyM. G. McBrideP. StephensS. Paridon,and J. A. Brothers

Pediatr Cardiol. 2022; 43(8): 1832–1837.


Take Home Points:

  • Cardiopulmonary exercise performance decreased during the COVID-19 pandemic in children, adolescents and young adults compared to pre-pandemic values.
  • The greatest decrease in exercise performance was among those who were the most aerobically fit pre-pandemic.
  • School structure was not associated with changes in exercise performance.

Manoj Gupta

Commentary from Dr. Manoj Gupta (New York City, NY, USA), chief section editor of Pediatric & Fetal Cardiology Journal Watch:



During the COVID 19 pandemic, schools closed for the last 3 months of the 2019-2020 school year and many schools continued the following school year with online or hybrid instruction.In addition, sports teams cancelled practices and competitions, and public parks were closed to the public. Self-reported survey data and device measured activity showed a decrease in physical activity (PA) and increase in sedentary behaviors (BH) during the pandemic. This study hypothesized that there would be a decrease in exercise performance in children and adolescents after the pandemic, compared to prepandemic values.



This was a retrospective cohort study of all patients aged 6-22 who underwent at least one maximal CPET before the pandemic and one during (June 1, 2020 to May 7, 2021) at CHOP. Patients were excluded if they did not achieve maximal CPET criteria or if their cardiac condition changed during this time period (either started new medication, had dose escalation, interventions or cardiac surgery/ transplantation).

A maximal test was defined as achieving a RER > 1.1. Measured variables included VO2max, ventilator anaerobic threshold (VAT), work rate, HR. Pre and pandemic data were compared using two-sampled t test or Wilcoxon matched pair signed rank test for no parametric data distribution.



Total n was 122 patients with a median age of 14 years. The majority were white. 60% were male.

The diagnosis was long QT in 30%, hypertrophic cardiomyopathy in 9% anomalous origin of a coronary artery in 11%, Fontan in 4% and other congenital heart disease in 9%.

34% self-reported unchanged level of physical activity, while 43% reported decreased level of PA.

There was a clinically insignificant increase in BMI during the pandemic.

Aerobic capacity significantly decreased among both females (92% vs. 82% predicted peak VO2, p = 0.047) and males (96% vs. 92% predicted peak VO2, p = 0.008) during the pandemic.

Patients who were more physically fit based on a pre-pandemic peak predicted VO2 had a greater decrease in aerobic capacity during the pandemic compared to those who were less fit before the pandemic as shown in the figure below.



School structure (remote versus in person) was not associated with changes in exercise performance

There was no significant change in physical working capacity (predicted peak work) during the pandemic.