Table 1.

Causes and factors contributing to the clinical translational gap in child health exercise research

Key factor	Impact on the translational gap
Semantic, syntactic, and data interoperability and harmonization	Words matter—As the electronic medical record becomes universally adopted the need for formal concept mapping of commonly used variables such as “VO2max” or “peak VO2” will be essential for clinical applications and research. Data or reports from current CPET devices and laboratories remain inconsistent in how variables are reported and scaled. Lack of standardization in data element details can lead to costly errors and misinterpretations in multicenter trials or the inability to use the data altogether.
The need for norms	There is substantial challenge in establishing normative CPET data in children for a number of reasons, including: (1) accounting for dynamic changes occurring during growth and development; (2) gender dimorphism; (3) ethnic, racial, socioeconomic, and geographic effects; and (4) finding useful normative data for children with chronic diseases and disabilities.
Training in exercise medicine and science for the next generation of child health researchers and clinicians	Despite widespread interest in the topic of exercise and physical activity among child health clinical trainees, few formal didactic programs exist that can provide clinicians with evidence‐based formative knowledge in exercise medicine.
Exercise testing protocols, calibration, equipment.	There are not as yet existing approaches to ensure that the results of an exercise test performed, for example, on a child at Boston Children's Hospital are truly comparable to results obtained at UC Irvine. Such approaches are necessary if clinical trials using exercise are to increase.
Recognition of exercise as a biomarker of health and disease, as therapy, and as a tool for drug and device discovery and development.	Beyond the vague notion that exercise benefits child health, basic science concepts of exercise physiology, assessment of physical activity, and exercise as therapy have yet to be fully incorporated into practice guidelines. This lack of clinical application exists despite the wealth of published data demonstrating the utility of CPET in assessing treatment effects across the child health spectrum. Moreover, the idea that exercise and/or exercise testing can be used to promote drug and device discovery and development in child health is only beginning to be incorporated into research design.