SHORT-TERM OUTCOME EVALUATION OF A NOVEL PEDIATRIC EXERCISE MEDICINE PROGRAM

Abstract

BACKGROUND Real-world evidence to evaluate outcomes of exercise-based programs for children and adolescents with chronic health conditions are lacking. The objective of the study was to evaluate safety and short-term outcomes of a novel Pediatric Exercise Medicine (EM) Program in a sample of participants with cardiac disease. METHODS AND RESULTS A single-centred, retrospective cohort study of pediatric patients (ages 8-17 years) enrolled in the EM Program at the Hospital for Sick Children between January 2018-February 2020. Medical history and routine clinic measures were collected (anthropometry, lifestyle-related behaviours, cardiopulmonary exercise test, muscle strength using the Bruininks-Oseretsky Test, and patient and parent-proxy Pediatric Quality of Life Inventory Cardiac Module). Changes in outcome measures from baseline to 4-month visit were assessed using paired sample t-test. Interventions: The program offered a 12-month personalized, home-based physical exercise training plans, health education, and lifestyle counseling. Exercise prescription was based on quarterly clinical and functional evaluation of medical history and physical fitness coupled with monthly virtual check-ins to monitor adherence and progress. Outcomes Measures: Prevalence of adverse events, and changes in body mass index z-score (zBMI), peak exercise capacity (%predicted peakV ̇O_2), self-reported physical activity and screen time, muscle strength, and cardiac-specific quality of life (QOL) scores at follow-up. Of the 107 enrolled participants, 31 (29%) were cardiac patients and completed baseline and 4-month visits. Mean age at enrollment was 12.8±2.9 years and 58% were male. No adverse events related to the program tests and interventions were observed. At baseline, 35% (n=11/31) were overweight/obese, 94% (n=29/31) did not meet daily physical activity recommendations, and 76% (n=22/29) exceeded appropriate screen time. At 4-month visit, there was no significant change in zBMI between baseline (1.23±1.61) and follow-up (1.18±1.61), P=0.46 (n=29). Average weekend screen time at baseline reduced from 7.4±2.3 hours/day to 5.5±2.0 hours/day at follow up (P=0.01, n=11). Exercise capacity data (n=13) showed no significant change in %predicted peakV ̇O_2 between baseline (72±14%) and follow up (73±15%), P=0.79. Muscle strength data (n=18) showed a significant mean increase of 1.2 in the scale score (95% CI, 0.01–2.33, P=0.04). Parent-completed cardiac-specific QOL data (n=17) showed a significant mean improvement of 9.6% (95% CI, 0.7–18.5, P=0.03) for the heart-symptom domain. CONCLUSION The program was shown to be safe among cardiac participants. Body weight and exercise capacity stabilized at four-month visit, while weekend screen time, muscular strength and QOL improved. Continued evaluation with longer follow-up assessment is needed to determine program effectiveness. Real-world evidence to evaluate outcomes of exercise-based programs for children and adolescents with chronic health conditions are lacking. The objective of the study was to evaluate safety and short-term outcomes of a novel Pediatric Exercise Medicine (EM) Program in a sample of participants with cardiac disease. A single-centred, retrospective cohort study of pediatric patients (ages 8-17 years) enrolled in the EM Program at the Hospital for Sick Children between January 2018-February 2020. Medical history and routine clinic measures were collected (anthropometry, lifestyle-related behaviours, cardiopulmonary exercise test, muscle strength using the Bruininks-Oseretsky Test, and patient and parent-proxy Pediatric Quality of Life Inventory Cardiac Module). Changes in outcome measures from baseline to 4-month visit were assessed using paired sample t-test. Interventions: The program offered a 12-month personalized, home-based physical exercise training plans, health education, and lifestyle counseling. Exercise prescription was based on quarterly clinical and functional evaluation of medical history and physical fitness coupled with monthly virtual check-ins to monitor adherence and progress. Outcomes Measures: Prevalence of adverse events, and changes in body mass index z-score (zBMI), peak exercise capacity (%predicted peakV ̇O_2), self-reported physical activity and screen time, muscle strength, and cardiac-specific quality of life (QOL) scores at follow-up. Of the 107 enrolled participants, 31 (29%) were cardiac patients and completed baseline and 4-month visits. Mean age at enrollment was 12.8±2.9 years and 58% were male. No adverse events related to the program tests and interventions were observed. At baseline, 35% (n=11/31) were overweight/obese, 94% (n=29/31) did not meet daily physical activity recommendations, and 76% (n=22/29) exceeded appropriate screen time. At 4-month visit, there was no significant change in zBMI between baseline (1.23±1.61) and follow-up (1.18±1.61), P=0.46 (n=29). Average weekend screen time at baseline reduced from 7.4±2.3 hours/day to 5.5±2.0 hours/day at follow up (P=0.01, n=11). Exercise capacity data (n=13) showed no significant change in %predicted peakV ̇O_2 between baseline (72±14%) and follow up (73±15%), P=0.79. Muscle strength data (n=18) showed a significant mean increase of 1.2 in the scale score (95% CI, 0.01–2.33, P=0.04). Parent-completed cardiac-specific QOL data (n=17) showed a significant mean improvement of 9.6% (95% CI, 0.7–18.5, P=0.03) for the heart-symptom domain. The program was shown to be safe among cardiac participants. Body weight and exercise capacity stabilized at four-month visit, while weekend screen time, muscular strength and QOL improved. Continued evaluation with longer follow-up assessment is needed to determine program effectiveness.