Is Maximal Exercise Testing Appropriate for All Students?

by Francois Gazzano, BSc.

Maximal cardiovascular tests (1-mile run, Pacer, bleep test, etc.) are widely used in U.S. schools to assess students’ aerobic fitness. These tests requires participants to run to run as fast as possible to cover a specific distance (1-Mile), to cover the maximum distance during a specific period of time, or to run at a continuously increasing speed, until he/she cannot maintain the imposed running pace anymore (Pacer). All these tests require a maximal effort from the participant, which could be contraindicated4 for the many students with cardiovascular risk factors or a low tolerance to vigorous exercise due to their sedentary lifestyles and/or excess of body mass11.

The Bogalusa Heart Study, one of the longest and most detailed studies of children health in the world1, has reported that approximately 60% of overweight children 5-10 years of age have at least one cardiovascular disease factor (hypertension, high cholesterol, diabetes, etc.). Twenty-five percent of them have two or more risk factors.  In 2008, the CDC found that 14% of all U.S. adolescents7 had prehypertension or hypertension; 22% had borderline-high/high cholesterol; and 15% had pre-diabetes/diabetes.

The prevalence of cardiovascular risk factors is also higher for the 9 million children and adolescents who are obese (18 %9 of ALL U.S. 6-17 year olds according to the Center for Disease Control).

To complicate things further, while some risk factors are relatively easy to identify (obesity can usually be identified through simple BMI calculation), others, such as hypertension, are frequently undiagnosed2 in children and adolescents, making the identification of ‘at-risk’ students very difficult.

Maximal testing is not for everyone. Alternative exists.

Asking all students to perform a fitness test that requires a maximal effort in a non-medical setting raises safety questions for the growing number of students who demonstrate multiple cardiovascular risks factors and/or an impaired tolerance to high intensity exercise.

According to the American Heart Association Council on Cardiovascular Disease in the Young and the Committee on Atherosclerosis, Hypertension, and Obesity in Youth4, a sub-maximal and self-paced 6-minute walk test (6MWT) could be a reliable alternate protocol to assess cardiovascular fitness and exercise capacity in the millions of children who are obese, who demonstrate cardiovascular risk factors, or for those who have an impaired tolerance to vigorous exercise, and for whom maximal exercise testing may be too stressful.


1 Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007;150(1):12–17.

2 Matthew L. Hansen et al. : Underdiagnosis of Hypertension in Children and Adolescents, JAMA. 298(8):874-879, 2007


5 Klepper, SE and Muir, N: Reference Values on the 6-Minute Walk Test for Children Living in the United States, Pediatric Physical Therapy, 23-1, 2011

6 Neeti Pathare and al.: 6-Minute Walk Test Performance in Young Children who are Normal Weight and Overweight, Cardiopulm Phys Ther J. 23(4): 12–18, 2012






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