Viabilidade do unsupported upper limb exercise test e six-minute peg ring board test em crianças e adolescentes saudáveis

Abstract

Introduction: Activities involving the upper limbs (UL) are part of daily life; however, this topic has not been studied in the pediatric population with chronic respiratory conditions. Objective: To evaluate the reproducibility and feasibility of two field clinical tests for upper limbs (Unsupported Upper Limb Exercise Test - UULEX and Six-Minute Pegboard Ring Test - 6PBRT) in healthy children and adolescents. Methods: Methodological study. Fifteen healthy volunteers aged 6 to 17 years were included. Spirometry was performed, followed by randomization: (i) first, to determine the choice between the Cardiopulmonary Exercise Test (CPET) or the field clinical tests, and (ii) second, the choice of field clinical tests (UULEX or 6PBRT). The CPET was performed on an upper limb ergometer with a load increment protocol every minute. For the UULEX, the volunteer sits in front of a panel and raises their arms while holding bars of different weights (0.25 kg to 2.0 kg) at different heights. Outcome: execution time. For the 6PBRT, the volunteer sits in front of a panel with four pins (two upper and two lower) and moves rings from the upper pins to the lower ones (and vice versa) for six consecutive minutes. Outcome: number of rings moved. For all tests, maximum oxygen consumption (VO₂peak) and peak ventilation per minute (VEpeak) were also evaluated outcomes. The UULEX and 6PBRT were performed twice each (test and retest), with 30 minute intervals between them. For feasibility, less than 15% of volunteers could reach the ceiling effect (UULEX reaching the last level - 2.0 kg; 6PBRT moving more than 450 rings) and/or floor effect (UULEX not exceeding the first level - 0.25 kg; 6PBRT moving less than 200 rings). Results: The median age was 11 years (9-15 years). All participants had normal pulmonary function (FVC, FEV1, FEV1/FVC > 80% predicted). The UULEX time in the test and retest was 9.5 min [8.0 - 12.0 min] vs. 9.4 min [8.2 - 12.0 min], respectively; and the number of rings in the 6PBRT was 299 [258 - 373] vs. 340 [244 - 387], respectively, p > 0.05. The ICC between the test and retest for the UULEX was 0.90 (0.67 - 0.97) p < 0.001, and for the 6PBRT, it was 0.97 (0.90 - 0.99) p < 0.001. The CPET showed higher VO₂peak at 20.4 (17.4 - 24.5) mL/kg compared to the UULEX at 11.7 (9.4 - 13.6) mL/kg, p = 0.003, and the 6PBRT at 10.3 (8.3 - 11.9) mL/kg, p = 0.003; similar results were seen for VEpeak, which was higher in the CPET at 32.5 (22.9 - 33.9) L/min compared to the UULEX at 19.7 (13.5 - 23.4) L/min, p = 0.004, and the 6PBRT at 15.7 (11.9 - 19.3) L/min, p = 0.004. Volunteers reached 9.5 minutes (8.3-12.0) in the UULEX, with two (13%) achieving the maximum test time; the 6PBRT had a median of 340 (258–387) rings moved. Conclusion: The UULEX and 6PBRT are reproducible and feasible field clinical tests for upper limbs in children and adolescents, providing an alternative to assess upper limbs in chronic respiratory conditions.