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of theValley
Heart of theValley
Cardiopulmonary Assessment
Young Athlete
Cardiopulmonary Assessment
Young Athlete Assessment Information for
Athlete, Family and Provider
Main Clinic: Pleasanton Clinic
5933 Coronado Lane, Suite 1 F Don’t let unidentified asthma
Pleasanton, CA 94588
slow your athlete down!
Our Cardiopulmonary Assessment Services: Satellite Clinics:
Fremont, Tracy, Brentwood, San Mateo
* Assessment of pulmonary function.
* Assessment of exercise capacity (physical fitness)
as measured by maximal oxygen consumption
(VO2max) and other metabolic parameters.
* Detection of exercise-induced asthma and
assessment of response to medications
* Detection of vocal cord dysfunction syndrome
* Education and counseling for families Please visit our website for locations of satellite clinics

Metabolic Testing during bicycle ergometry. Parameters tested include Maxi- Cardiopulmonary Assessments are performed
mal Oxygen Consumption, Work, Anaerobic Threshold, Heart Rate Rise only in our Pleasanton Clinic.
Andrew J. Maxwell, MD, FACC
Dr. Maxwell is a Board Certified Pediatric Heart of the Valley Pediatric Cardiology
Cardiologist and Pediatrician. He received his APPTS. AND REFERRALS: is a full-service pediatric cardiology clinic
medical degree from Johns Hopkins Medical
School, completed a Residency in Pediatrics Contact us at 925-416-0100 serving expecting parents, infants, children and
at UCSF and Fellowships in Pediatric Cardiol- young adults.
ogy at Packard Children’s Hospital at Stanford MORE INFORMATION:
and Children’s Hospital of Philadelphia. He has
been in private practice since 2002. visit
HEART OF THE VALLEY - Young Athlete Assessment
Why assess cardiac and pulmonary fitness in young Are there limitations of this assessment?
athletes? Not all asthma is reproducible in the clinic setting and so may
Top athletic performance requires perfect cardiac and not be detected even though it exists. Not all cardiac and pulmo-
pulmonary function. Two of the most common limitations nary problems can be detected by these non-invasive tests.
to athletic performance is under-conditioning (inadequate
training) and unrecognized, untreated asthma. There are
other cardiac and pulmonary problems that are less
common that go unrecognized as well. All of these issues
can be detected by cardiopulmonary athletic assessment.

About 1 in 5 young athletes have some form and degree of
asthma and most of these athletes manifest worse asthma Pulmonary Function Testing: Produces Flow-Volume Loops. Normal
during exercise. Unrecognized asthma is the single most healthy lungs produce loops that touch the black dots. This athlete dem-
onstrated very mild asthma at baseline (red line in left panel), Following
common cause of exertional chest pain, shortness of breath treadmill running to exhaustion the athlete demonatrated a marked reduction
and dizziness in young people. Alternatively, these in lung function or exercise-induced asthma (blue line in left panel). Twenty
symptoms can also be caused by serious cardiac problems. minutes after inhaling albuterol, the athlete demonstrated supra-normal lung
function (right). Other medications may improve lung function further.
Inadequate Training
Assessing pulmonary function: an athlete breaths through the apparatus
Who might benefit from a cardiopulmonary assessment?
Under-conditioning can also explain athletic under-
first slowly and then with as much force as possible. This is done before All participants in competitive sports should consider this
performance. For athletes who have demonstrated no other
exercise to obtain a baseline assessment. It is repeated after exercise assessment and particularly those who feel their athletic
underlying cause, parameters of physical fitness may point to determine the presence of exercise-induced asthma. It may then be performance is hampered and certainly anyone who has the
to a lack of sufficient training. repeated a third time, after a pulmonary bronchodilator is inhaled, to
determine if lung function can be corrected to normal.
following symptoms in the table below:
Other Causes of Limitations
Another limitation to performance that is less common is
Athlete History Questions: Has your athlete ever...
dysfunction of the vocal cords leading to sudden breathing ..had extreme fatigue associated with exercise (different
difficulty at peak-intensity performance. Unrecognized car- from peers)?
diac defects also occasionally interfere with performance. ..had unusual or extreme shortness of breath during
What tests are used to assess cardiopulmonary fitness?
..had discomfort, pain, or pressure in his/her chest during
Physical fitness and conditioning is best measured using
bicycle or treadmill testing with metabolic analysis. These
methods measure different parameters of physical fitness ..complained of his/her heart “racing or skipping beats?
such as maximal oxygen consumption, maximal work ..passed out during or after exercise?
performed, anaerobic threshold, and heart rate rise.
Unrecognized asthma and vocal cord dysfunction may be How is an assessment paid for?
detected from a combination of pulmonary function testing If an athlete has none of the symptoms above then the ex-
and exercise stress testing with treadmill or bicycle. pense is usually paid out-of-pocket. If symptoms are present
Abnormalities found by these assessments may be followed or a medical abnormality is detected, insurance usually cov-
Assessing Exercise Functional Capacity: This can be done with either
by additional studies such as an ultrasound or an ECG. Treadmill Testing or Bicycle Ergometry. In either case, an athlete is asked ers the evaluation.
to perform to exhaustion while being monitored with ECG.