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Cilenti NA, Tamaroff JG, Capiola CJ, Faig W, McBride MG, Paridon SM, O'Malley S, Edelson JB, Lynch DR, McCormack SE, Lin KY. Cardiopulmonary exercise testing on adaptive equipment in children and adults with Friedreich ataxia. Muscle Nerve 2024; 69:613-619. [PMID: 38515223 PMCID: PMC11013735 DOI: 10.1002/mus.28085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION/AIMS Traditional exercise is often difficult for individuals with Friedreich ataxia (FRDA), and evidence is limited regarding how to measure exercise performance in this population. We evaluated the feasibility, reliability, and natural history of adaptive cardiopulmonary exercise test (CPET) performance in children and adults with FRDA. METHODS Participants underwent CPET on either an arm cycle ergometer (ACE) or recumbent leg cycle ergometer (RLCE) at up to four visits (baseline, 2 weeks, 4 weeks, and 1 year). Maximum work, oxygen consumption (peak VO2), oxygen (O2) pulse, and anaerobic threshold (AT) were measured in those who reached maximal volition. Test-retest reliability was assessed with intraclass coefficients, and longitudinal change was assessed using regression analysis. RESULTS In our cohort (N = 23), median age was 18 years (interquartile range [IQR], 14-23), median age of FRDA onset was 8 years (IQR 6-13), median Friedreich Ataxia Rating Scale score was 58 (IQR 54-62), and GAA repeat length on the shorter FXN allele (GAA1) was 766 (IQR, 650-900). Twenty-one (91%) completed a maximal CPET (n = 8, ACE and n = 13, RLCE). Age, sex, and GAA1 repeat length were each associated with peak VO2. Preliminary estimates demonstrated reasonable agreement between visits 2 and 3 for peak work by both ACE and RLCE, and for peak VO2, O2 pulse, and AT by RLCE. We did not detect significant performance changes over 1 year. DISCUSSION Adaptive CPET is feasible in FRDA, a relevant clinical trial outcome for interventions that impact exercise performance and will increase access to participation as well as generalizability of findings.
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Affiliation(s)
- Nicolette A. Cilenti
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jaclyn G. Tamaroff
- Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J. Capiola
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Walter Faig
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael G. McBride
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephen M. Paridon
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shannon O'Malley
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan B. Edelson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David R. Lynch
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana E. McCormack
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberly Y. Lin
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Armstrong N, Welsman J. Comment on 'Developing a New Curvilinear Allometric Model to Improve the Fit and Validity of the 20-m Shuttle Run Test as a Predictor of Cardiorespiratory Fitness in Adults and Youth'. Sports Med 2021; 51:1591-1593. [PMID: 34014502 DOI: 10.1007/s40279-021-01462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Neil Armstrong
- Children's Health and Exercise Research Centre, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Jo Welsman
- Children's Health and Exercise Research Centre, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Burstein DS, McBride MG, Min J, Paridon AA, Perelman S, Huffman EM, O'Malley S, Del Grosso J, Groepenhoff H, Paridon SM, Brothers JA. Normative Values for Cardiopulmonary Exercise Stress Testing Using Ramp Cycle Ergometry in Children and Adolescents. J Pediatr 2021; 229:61-69.e5. [PMID: 32926876 DOI: 10.1016/j.jpeds.2020.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To provide sex, age, and race specific reference values for ramp cycle ergometer cardiopulmonary exercise test (CPET) in children in the US. STUDY DESIGN Retrospective review was conducted of all cardiopulmonary CPET data from our Exercise Physiology Laboratory on healthy children and adolescents (6-18 years) with body mass index between the 5th and 95th percentiles and structurally normal hearts who performed a ramp cycle ergometry stress test between 1999 and 2015. Twenty-eight exercise variables were included: peak oxygen consumption, oxygen consumption at ventilatory anaerobic threshold, peak work rate, resting and peak heart rate and blood pressure, resting pulmonary function testing, and ventilatory responses to progressive exercise using breath-by-breath gas exchange. Owing to the nonlinear association between CPET results and age, fractional polynomials were used in the mixed-effects regression models to describe the sex- and age-specific normative values with 95% CIs, after adjusting for race and body mass index. RESULTS We analyzed data on 1829 children (average age, 13.6 ± 2.6 years; 52% male). After 12 years of age, males generally had higher peak values for aerobic capacity and work rate. There were progressive increases with age for both sexes in resting pulmonary function and ventilatory response to exercise, peak aerobic and work rate, and oxygen pulse. Notably, there was an age-related decrease in ventilatory equivalents of oxygen and carbon dioxide at the ventilatory anaerobic threshold. CONCLUSIONS Future research using prospective, inclusive, and statistically planned cohorts with standardized laboratory approaches and confirmed interoperability should be considered as a focus for validating normative pediatric CPET values in the future.
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Affiliation(s)
- Danielle S Burstein
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Michael G McBride
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jungwon Min
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexander A Paridon
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Sarah Perelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erika M Huffman
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shannon O'Malley
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Del Grosso
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Stephen M Paridon
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie A Brothers
- Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA
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A Pilot Study of Cardiorespiratory Fitness, Adiposity, and Cardiometabolic Health in Youth With Overweight and Obesity. Pediatr Exerc Sci 2020; 32:124-131. [PMID: 32335525 PMCID: PMC7606316 DOI: 10.1123/pes.2019-0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/07/2020] [Accepted: 03/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To conduct a preliminary assessment of the relationships between cardiorespiratory fitness, adiposity, and cardiometabolic health using gold standard measures in diverse youth ranging from overweight to severe obesity. METHODS Twenty of 30 participants (mean [SD]; age 13.2 [1.8] y, 55% female, 45% African American) met the criteria for VO2peak during a graded cycle ergometer test to volitional fatigue. The body composition was measured by dual-energy X-ray absorptiometry (percentage of body fat, fat mass index, and fat-free mass) and magnetic resonance imaging (abdominal visceral and subcutaneous [SAT] adipose tissue). The VO2peak was expressed relative to fat-free mass. Fasting lipid levels, glycemic biomarkers, and vital signs were examined individually and used in a composite cardiometabolic risk score. Accelerometer-measured physical activity and sedentary time were included as covariates. RESULTS VO2peak was negatively associated with abdominal SAT (r = -.49, P < .05), but not visceral adipose tissue or markers of cardiometabolic health. The association between SAT and VO2peak was partly explained by habitual sedentary time. CONCLUSIONS We demonstrated a significant negative association between cardiorespiratory fitness and SAT in a diverse group of high-risk youth. The inclusion of rigorous, laboratory-based measures and youth with severe obesity extends the previous work in pediatric populations.
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Tremblay MS, Tomkinson GR. Discussion of "Establishing modified Canadian Aerobic Fitness Test (mCAFT) cut-points to detect clustered cardiometabolic risk among Canadian children and youth aged 9 to 17 years" - The need for foundational fitness research in Canada: is there room for innovation? Appl Physiol Nutr Metab 2020; 45:344-345. [PMID: 32122184 DOI: 10.1139/apnm-2019-0556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Grant R Tomkinson
- Department of Education, Health and Behavior Studies, University of North Dakota, ND 58202, USA.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences & Sansom Institute for Health Research, University of South Australia, SA 5001, Australia
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