Cardiopulmonary Exercise Performance in the Pediatric and Young Adult Population Before and During the COVID-19 Pandemic

Abstract

Physical activity (PA) decreased and sedentary behavior (SB) increased in the pediatric population during the Coronavirus Disease 2019 (COVID-19) pandemic. We examined the effects of PA and SB on cardiopulmonary exercise performance in children, adolescents and young adults both with and without underling cardiac disease, and hypothesized that there will be a change in aerobic and physical working capacity during the pandemic. This was a single-center retrospective longitudinal cohort study in patients age 6–22 years who underwent serial maximal cardiopulmonary exercise stress testing before and during the COVID-19 pandemic. Metabolic variables were obtained; PA and SB data were extracted from clinic notes. A total of 122 patients (60% male) underwent serial exercise testing with a median age of 14 years at the first CPET. Predicted peak aerobic capacity significantly decreased among both females and males during the pandemic, even after adjusting for changes in somatic growth. There was no significant change in physical working capacity during the pandemic. Patients who were more aerobically fit experienced a greater decrease in aerobic capacity during the pandemic compared to those less fit. In conclusion, cardiopulmonary exercise performance, notably aerobic activity, decreased during the COVID-19 pandemic in children, adolescents and young adults compared to pre-pandemic values. This decline was most notable in those with the highest pre-pandemic aerobic capacity values and was independent of somatic growth or changes in BMI. This study has public health implications and demonstrates the importance of PA on overall cardiovascular health.

Stable fitness during COVID-19: Results of serial testing in a cohort of youth with heart disease

“…There have been reports of decreased physical activity related to COVID-19 mitigation strategies both in healthy children and in those with heart disease ( 1 , 11 ). Whether or not our cohort engaged in less physical activity is unknown, but their objective measures of fitness did not change, which is the opposite of what was reported by Burstein DS et al ( 4 ). This may mean many of the patients were already deconditioned at the time of the initial CPET, as evidenced by an average peak VO 2 of ∼78% of predicted, compared to ∼96% in the Burstein DS et al cohort ( 4 ).…”

“…Little is known about the effect this has had on fitness and body composition in pediatric and congenital heart disease (CHD), individuals who are often already deconditioned. The only known pediatric CHD study included a combination of individuals with and without heart disease, reporting a decline in peak oxygen consumption (VO 2 ) on serial exercise testing performed during the pandemic ( 4 ).The aims of this study were to: (1) understand how COVID-19 mitigation strategies affected fitness and also body composition in youth with heart disease, and (2) determine if children with heart disease and pre-existing exercise restrictions were more likely to have alterations in their fitness or body composition compared to without such restriction.…”

The experiences of children with a cardiac transplant, their families and health care providers in the COVID‐19 pandemic

“…Current findings align with existing literature suggesting that confusion, anxiety, loneliness and ongoing doubt have occurred among families due to a lack of appropriate and insufficient information, lockdowns and/or fears of contracting COVID‐19 8,9,11,12 . While the literature has documented the need for information and resources to navigate and manage COVID‐19 risks and mental health stresses, parents in this study further recommended that conveyed information be age‐appropriate and intentional in supporting mental well‐being in daily life.…”

“…Families reported high stress, particularly among caregivers and pediatric heart transplant recipients 3 . Increased anxiety, mood disturbances, fears of contracting COVID‐19, hindered sleep quality and/or less physical exercise were reported among children and youth with congenital heart disease 8,9 or heart failure, 10 and who received a heart transplant 10,11 …”

“…Families reported high stress, particularly among caregivers and pediatric heart transplant recipients. 3 Increased anxiety, mood disturbances, fears of contracting COVID-19, hindered sleep quality and/or less physical exercise were reported among children and youth with congenital heart disease 8,9 or heart failure, 10 and who received a heart transplant. 10,11 Information and support needs intensified during the pandemic, including knowledge and resource gaps in managing COVID-19 risk 8 and mental health stresses 3,8 during the pandemic.…”