The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

Ashish, Naveen; Bamman, Marcas M.; Cerny, Frank J.; Cooper, Dan M.; d’Hemecourt, Pierre A.; Eisenmann, Joey C.; Ericson, Dawn; Fahey, John T.; Falk, Bareket; Gabriel, Rainer; Kahn, Michael G.; Kemper, Han C. G.; Leu, Szu-Yun; Liem, Robert I.; McMurray, Robert G.; Nixon, Patricia A.; Olin, J. Tod; Pianosi, Paul; Purucker, Mary; Radom‐Aizik, Shlomit; Taylor, Amy C.

doi:10.1111/cts.12194

Cited by 17 publications

(13 citation statements)

References 49 publications

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“…CPET biomarkers are used to assess disease severity, progress, and response to therapy (including exercise prescriptions) across an expanding range of childhood diseases and conditions and across the lifespan (Ploeger et al, 2009;Pahkala et al, 2013;Liem et al, 2015;Sule and Fontaine, 2016;Cordingley et al, 2016;Gualano et al, 2017;Li et al, 2017). Despite these factors, CPET has failed to fulfil its promise in child health research and clinical practice (Ashish et al, 2015). A major barrier to more accurate and effective clinical use of CPET in children and adults has been a lack of harmonization of protocol types and exercise modalities (Ashish et al, 2015), factors that influence CPET results (Fredriksen et al, 1998;Beltrami et al, 2012;Bires et al, 2013;May et al, 2014;Cunha et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Despite these factors, CPET has failed to fulfil its promise in child health research and clinical practice (Ashish et al, 2015). A major barrier to more accurate and effective clinical use of CPET in children and adults has been a lack of harmonization of protocol types and exercise modalities (Ashish et al, 2015), factors that influence CPET results (Fredriksen et al, 1998;Beltrami et al, 2012;Bires et al, 2013;May et al, 2014;Cunha et al, 2015). For example, in clinical trials involving CPET in children over the past five years, a PubMed search revealed 40 published studies that used CE and 113 that used TM.…”

Section: Introductionmentioning

confidence: 99%

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The effect of test modality on dynamic exercise biomarkers in children, adolescents, and young adults

et al. 2019

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Cardiopulmonary exercise testing (CPET) modalities, treadmill (TM), and cycle ergometer (CE), influence maximal gas exchange and heart rate (HR) responses. Little is known regarding CPET modality effect on submaximal biomarkers during childhood and adolescence. Ninety‐four healthy participants (7–34 y.o., 53% female) performed TM and CE CPET to address two major gaps: (1) the effect of modality on submaximal CPET biomarkers, and (2) estimation of work rate in TM CPET. Breath‐by‐breath gas exchange enabled calculation of linear regression slopes such as trueV˙O2/ΔHR and ΔtrueV˙E/ΔtrueV˙CO2. Lean body mass (LBM) was measured with dual X‐ray absorptiometry. We tested a novel TM CPET estimate of work rate based on TM velocity2, incline, and body mass (VIM). Like the linear relationship between trueV˙O2 and work rate in CE CPET, trueV˙O2 increased linearly with TM VIM. TM ΔtrueV˙O2/ΔHR was highly correlated with CE (r = 0.92), and each increased substantially with LBM (P < 0.0001 for TM and CE). ΔtrueV˙O2/ΔHR was to a small (~8.7%) but significant extent larger in TM (1.6 mL/min/beat, P = 0.04). In contrast, TM and CE ΔtrueV˙E/ΔtrueV˙CO2 decreased significantly with LBM, supporting earlier observations from CE CPET. For both CE and TM, males had significantly higher ΔtrueV˙O2/ΔHR but lower ΔtrueV˙E/ΔtrueV˙CO2 than females. Novel TM CPET biomarkers such as ΔVIM/ΔHR and ∆trueV˙O2/ΔVIM paralleled effects of LBM observed in CE CPET. TM and CE CPET submaximal biomarkers are not interchangeable, but similarly reflect maturation during critical periods. CPET analysis that utilizes data actually measured (rather than estimated) may improve the clinical value of TM and CE CPET.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of test modality on dynamic exercise biomarkers in children, adolescents, and young adults

et al. 2019

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“…Assessing aerobic fitness in pediatric populations, typically using CPET, has been shown to have substantial discrepancies with lack of common terminology, standard protocols, and calibration (4). Measuring aerobic fitness in children is complicated because muscle and fat mass and hormonal regulation of metabolism and growth change rapidly in children and adolescents (32;53;108).…”

Section: Obstacles In Identifying the Gaps Of Knowledge; Linking Obesmentioning

confidence: 99%

Obesity, Asthma, and Exercise in Child and Adolescent Health

Manoukian

Radom‐Aizik

et al. 2016

Pediatric Exercise Science

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Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptomatology and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.

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“…It will not only facilitate the large-scale studies required to advance pediatric care, but will also ultimately lead to the establishment of true, nationally representative, normative data for children’s physiological response to exercise. The Data Harmonization in Exercise Data study group has identified a strategy and direction for achieving data harmonization which can be accomplished by carefully examining exercise data as well as data collection and reporting protocols for peak

data from multiple institutions [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Exercise Testing: Value and Implications of Peak Oxygen Uptake

et al. 2017

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Peak oxygen uptake (peakV˙O2) measured by clinical exercise testing is the benchmark for aerobic fitness. Aerobic fitness, estimated from maximal treadmill exercise, is a predictor of mortality in adults. PeakV˙O2 was shown to predict longevity in patients aged 7–35 years with cystic fibrosis over 25 years ago. A surge of exercise studies in young adults with congenital heart disease over the past decade has revealed significant prognostic information. Three years ago, the first clinical trial in children with pulmonary arterial hypertension used peakV˙O2 as an endpoint that likewise delivered clinically relevant data. Cardiopulmonary exercise testing provides clinicians with biomarkers and clinical outcomes, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response hidden at rest. Momentum from these pioneering observations in multiple disease states should impel clinicians to employ similar methods in other patient populations; e.g., sickle cell disease. Advances in pediatric exercise science will elucidate new pathways that may identify novel biomarkers. Our initial aim of this essay is to highlight the clinical relevance of exercise testing to determine peakV˙O2, and thereby convince clinicians of its merit, stimulating future clinical investigators to broaden the application of exercise testing in pediatrics.

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The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

Cited by 17 publications

References 49 publications

The effect of test modality on dynamic exercise biomarkers in children, adolescents, and young adults

The effect of test modality on dynamic exercise biomarkers in children, adolescents, and young adults

Obesity, Asthma, and Exercise in Child and Adolescent Health

Pediatric Exercise Testing: Value and Implications of Peak Oxygen Uptake

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