Fitkids Treadmill Test: Clinical Utility and Factors Associated With Its Use Among Physical Therapists.

BACKGROUND: Although the Fitkids Treadmill Test (FTT) has been validated and normative values are available for healthy 6- to 18-year-old children and adolescents, these facts do not automatically imply uptake of the test in routine practice of physical therapists. OBJECTIVE: The objectives of this study were to evaluate the utility of the FTT in different diagnostic groups and to explore potential factors affecting the use of the FTT in clinical practice. DESIGN: Mixed methods with both quantitative and qualitative data were used in this study. METHODS: Outcome parameters from the FTT were retrieved from the Fitkids database. For evaluation of the utility of the FTT, 2 indicators, exercise duration and maximal effort, were used. An online survey was sent to physical therapists in Fitkids practices to identify factors affecting the use of the FTT in clinical practice. RESULTS: The proportion of children and adolescents in each of the diagnostic groups who reached the minimal duration of a maximal exercise test ranged from 94% to 100%. The proportion of participants who reached a peak heart rate ≥180 beats/min ranged from 46% for participants with cognitive, psychological, or sensory disorders to 92% for participants with metabolic diseases. The most important facilitator for use of the FTT was the fact that most physical therapists were convinced of the additional value of the FTT. The main barriers were therapists' attitudes (resistance to change/lack of experience) and, on the environmental level, the absence of a treadmill ergometer in physical therapist practice. LIMITATIONS: Structured interviews would have provided more information on potential factors affecting the use of the FTT in clinical practice. CONCLUSIONS: This study has shown the clinical utility of the FTT in different diagnostic groups in pediatric physical therapist practice. Responding to the factors identified in this study should enable improved uptake of the FTT in clinical practice.

Fitkids Treadmill Test: Age- and Sex-Related Normative Values in Dutch Children and Adolescents.

BACKGROUND: Recent research has shown that the Fitkids Treadmill Test (FTT) is a valid and reproducible exercise test for the assessment of aerobic exercise capacity in children and adolescents who are healthy. OBJECTIVE: The study objective was to provide sex- and age-related normative values for FTT performance in children and adolescents who were healthy, developing typically, and 6 to 18 years of age. DESIGN: This was a cross-sectional, observational study. METHODS: Three hundred fifty-six children and adolescents who were healthy (174 boys and 182 girls; mean age=12.9 years, SD=3.7) performed the FTT to their maximal effort to assess time to exhaustion (TTE). The least-mean-square method was used to generate sex- and age-related centile charts (P3, P10, P25, P50, P75, P90, and P97) for TTE on the FTT. RESULTS: In boys, the reference curve (P50) showed an almost linear increase in TTE with age, from 8.8 minutes at 6 years of age to 16.1 minutes at 18 years of age. In girls, the P50 values for TTE increased from 8.8 minutes at 6 years of age to 12.5 minutes at 18 years of age, with a plateau in TTE starting at approximately 10 years of age. LIMITATIONS: Youth who were not white were underrepresented in this study. CONCLUSIONS: This study describes sex- and age-related normative values for FTT performance in children and adolescents who were healthy, developing typically, and 6 to 18 years of age. These age- and sex-related normative values will increase the usefulness of the FTT in clinical practice.

Validity and Reproducibility of a New Treadmill Protocol: The Fitkids Treadmill Test.

PURPOSE: This study aimed to investigate the validity and reproducibility of a new treadmill protocol in healthy children and adolescents: the Fitkids Treadmill Test (FTT). METHODS: Sixty-eight healthy children and adolescents (6-18 yr) were randomly divided into a validity group (14 boys and 20 girls; mean ± SD age, 12.9 ± 3.6 yr) that performed the FTT and Bruce protocol, both with respiratory gas analysis within 2 wk, and a reproducibility group (19 boys and 15 girls; mean ± SD age, 13.5 ± 3.5 yr) that performed the FTT twice within 2 wk. A subgroup of 21 participants within the reproducibility group performed both FTT with respiratory gas analysis. Time to exhaustion (TTE) was the main outcome of the FTT. RESULTS: V˙O2peak measured during the FTT showed excellent correlation with V˙O2peak measured during the Bruce protocol (r = 0.90; P < 0.01). Backward multiple regression analysis provided the following prediction equations for V˙O2peak (L·min) for boys and girls, respectively: V˙O2peak FTT = -0.748 + (0.117 × TTEFTT) + (0.032 × body mass) + 0.263, and V˙O2peak FTT = -0.748 + (0.117 × TTEFTT) + (0.032 × body mass) [R = 0.935; SEE = 0.256 L·min]. Cross-validation of the regression model showed an R value of 0.76. Reliability statistics for the FTT showed an intraclass correlation coefficient of 0.985 (95% confidence interval, 0.971-0.993; P < 0.001) for TTE. Bland-Altman analysis showed a mean bias of -0.07 min, with limits of agreement between +1.30 and -1.43 min. CONCLUSIONS: Results suggest that the FTT is a useful treadmill protocol with good validity and reproducibility in healthy children and adolescents. Exercise performance on the FTT and body mass can be used to adequately predict V˙O2peak when respiratory gas analysis is not available.

Effects of the Fitkids exercise therapy program on health-related fitness, walking capacity, and health-related quality of life.

BACKGROUND: Children with disabilities have an increased risk for reduced fitness and reduced health-related quality of life (HRQoL). Fitkids, a nationwide exercise therapy program in the Netherlands, was developed to improve fitness and HRQoL in children with disabilities. OBJECTIVE: The study objective was to determine the effects of the Fitkids program on health-related fitness, walking capacity, and HRQoL in children with disabilities or chronic conditions. DESIGN: This was a quasi-experimental single-group longitudinal study. METHODS: Fifty-two children and adolescents who were referred to the Fitkids program participated in this study. Participants received a graded exercise training program for 6 months, with frequencies of 1 hour 2 times per week in the first 3 months and 1 hour per week during months 4 to 6. Health-related fitness (aerobic fitness, anaerobic fitness, and muscle strength), walking capacity, and HRQoL were evaluated at baseline and after 3 and 6 months of training. Multilevel modeling was used to quantify the contributions of repeated measures, participants, and Fitkids centers to variations in health-related fitness, walking capacity, and HRQoL during the intervention period. The models were adjusted for sex, height, and weight. RESULTS: After 6 months of training, significant intervention effects were found for aerobic fitness, anaerobic fitness, and muscle strength. A significant effect also was found for walking capacity. On the HRQoL measure, significant improvements were found for the self-reported and parent-reported physical and emotion domains and for the parent-reported total score for HRQoL. LIMITATIONS: No control group was included in this study. CONCLUSIONS: The Fitkids exercise therapy program has significantly improved health-related fitness, walking capacity, and HRQoL in children and adolescents with chronic conditions or disabilities.

Fitkids exercise therapy program in the Netherlands.

PURPOSE: To describe the demographics, medical diagnoses, and initial aerobic fitness levels of children participating in Fitkids: an exercise therapy program for children with chronic conditions or disabilities in the Netherlands. METHODS: We reviewed data of children who were in the program on September 2010. RESULTS: In total, 2482 children from 105 Fitkids centers were included. Results showed the large heterogeneity of the population regarding demographic characteristics and medical diagnoses. Significantly reduced scores on the 6-minute walk test and half Bruce treadmill test were observed. CONCLUSION: The Fitkids population has great heterogeneity. In addition, a plethora of fitness tests were used, and registration of data in the Fitkids database was suboptimal. Moreover, this study showed the impaired aerobic fitness of children participating in Fitkids. Future research should investigate the effectiveness of the Fitkids program.