Exercise Capacity In Adolescents Research Articles

Age-specific determinants of reduced exercise capacity in youth after heart transplant: A longitudinal cohort study

BackgroundAlthough prior studies show that children have impaired exercise capacity after heart transplant, the age-specific determinants of this phenomenon are not well understood. We examine exercise capacity and its associations in school-age and adolescent youth post-heart transplant. MethodsThis retrospective cohort study of heart transplant patients who completed a cardiopulmonary exercise test between 1999-2018 includes 332 tests on 104 patients younger than 18 years. Tests were stratified into those by school-aged children (5 to 11 years old) and adolescents (12-17). The primary outcome was peak oxygen consumption; secondary outcomes were anaerobic threshold and peak power production. Potential determinants included age at transplant, diagnosis, and laboratory and invasive hemodynamic measurements. ResultsAll exercise capacity outcomes for patients post-transplant regardless of age were significantly reduced compared to the predicted performance of age and sex-matched controls. Percent predicted median peak oxygen consumption (62.63, 95% confidence interval 59.18, 66.07), anaerobic threshold (66.52, 95%CI 62.24, 70.81), and peak power production (54.00, 95%CI 50.56, 57.44) were reduced. Younger age at transplant and a higher peak heart rate were independently associated with increased peak oxygen consumption across age groups. Elevated wedge pressure and BNP predict decreased exercise capacity in adolescents. ConclusionsYouth after heart transplant have significantly reduced exercise capacity. Younger age at transplant and higher peak heart rate predict increased exercise capacity throughout childhood. Indicators of congestion predict decreased exercise capacity in adolescents. These findings should encourage deeper attention to the relationship between exercise physiology and the social context of children after transplant.

Impact of CFTR modulators on exercise capacity in adolescents with cystic fibrosis.

Exercise capacity is an independent predictor of clinical worsening in cystic fibrosis (CF). There is limited evidence of the impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on exercise capacity in children with CF. The aim of the present study was to assess the impact of CFTR modulators on exercise capacity in a cohort of adolescents with CF. A prospective single-centre cohort study was carried out. Cardiopulmonary exercise testing (CPET) was performed at baseline, prior to starting Symkevi or Kaftrio and between 4 and 8 months after starting treatment. 19 adolescents with CF had CPET performed prior to and after CFTR modulator treatment, between December 2019 and March 2022. Breathing reserve improved in the whole cohort, with greater improvement in the modulator-naïve patients after starting treatment with Kaftrio. There was no improvement in peak oxygen uptake and anaerobic threshold after 4 to 8 months of treatment with CFTR modulators. Exercise testing with CPET can be used as an additional tool to monitor response to CFTR modulators. Breathing reserve on CPET may provide a surrogate marker to monitor the improvement in CF lung disease with CFTR modulator treatment.

Elexacaftor-Tezacaftor-Ivacaftor improves exercise capacity in adolescents with cystic fibrosis.

Elexacaftor/Tezacaftor/Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator with the potential to improve exercise capacity. This case series of three adolescents with CF aimed to investigate whether 6 weeks treatment with Elexacaftor/Tezacaftor/Ivacaftor could improve exercise capacity in CFTR modulator naive adolescents with CF. Three adolescents (14.0 ± 1.4 years) with CF (FEV1 % predicted: 62.5 ± 17.1; F508del/F508del genotype) completed an exhaustive maximal cardiopulmonary exercise test on a cycle ergometer to determine peak oxygen uptake ( O2peak ) and measure changes in gas exchange and ventilation during exercise at 6 weeks. We also analyzed wrist-worn device-based physical activity (PA) data in two of the three cases. Validated acceleration thresholds were used to quantify time spent in each PA intensity category. Clinically meaningful improvements in O2peak were observed in all three cases (+17.6%, +52.4%, and +32.9%, respectively), with improvements greatest in those with more severe lung disease and lower fitness at baseline. Although lung function increased in all cases, inconsistent changes in markers of ventilatory and peripheral muscle efficiency likely suggest different mechanisms of improvement in this case group of adolescents with CF. Device-based analysis of PA was variable, with one case increasing and one case decreasing. In this case series, we have observed, for the first time, improvements in exercise capacity following 6 weeks of treatment with Elexacaftor/Tezacaftor/Ivacaftor. Improvements were greatest in the presence of more severe CF lung disease and lower aerobic fitness at baseline. The mechanism(s) responsible for these changes warrant further investigation in larger trials.

Decreased ventricular size and mass mediate the reduced exercise capacity in adolescents and adults born premature

BackgroundPremature birth is associated with lower levels of cardiorespiratory fitness (CRF) but the underlying mechanisms responsible remain unclear. This study assessed whether differences in cardiac morphology or function mediate differences in CRF among adolescents and young adults born preterm. MethodsAdolescents and young adults born moderately to extremely premature (gestational age ≤ 32 weeks or birth weight < 1500 g) and age-matched term born participants underwent resting cardiac MRI and maximal exercise testing. Mediation analysis assessed whether individual cardiovascular variables accounted for a significant proportion of the difference in maximal aerobic capacity between groups. ResultsIndividuals born preterm had lower VO2max than those born term (41.7 ± 8.6 v 47.5 ± 8.7, p < 0.01). Several variables differed between term and preterm born subjects, including systolic and diastolic blood pressure, mean pulmonary artery pressure, indexed left ventricular end-diastolic volume (LVEDVi), right ventricular end-diastolic volume (RVEDVi), LV mass (LVMi), LV stroke volume index (LVSVi), and LV strain (p < 0.05 for all). Of these variables, LVEDVi, RVEDVi, LVSVi, LVMi, and LV longitudinal strain were significantly related to VO2max (p < 0.05 for all). Significant portions of the difference in VO2max between term and preterm born subjects were mediated by LVEDVi (74.3%, p = 0.010), RVEDVi (50.6%, p = 0.016), and LVMi (43.0%, p = 0.036). ConclusionsLower levels of CRF in adolescents and young adults born preterm are mediated by differences in LVEDVi, RVEDVi, and LVMi. This may represent greater risk for long-term cardiac morbidity and mortality in preterm born individuals.

Blunted cardiac output response to exercise in adolescents born preterm.

Premature birth is associated with lasting effects, including lower exercise capacity and pulmonary function, and is acknowledged as a risk factor for cardiovascular disease. The aim was to evaluate factors affecting exercise capacity in adolescents born preterm, including the cardiovascular and pulmonary responses to exercise, activity level and strength. 21 preterm-born and 20 term-born adolescents (age 12-14years) underwent strength and maximal exercise testing with thoracic bioimpedance monitoring. Baseline variables were compared between groups and ANCOVA was used to compare heart rate, cardiac output (Q) and stroke volume (SV) during exercise between groups while adjusting for body surface area. Preterm-borns had lower maximal aerobic capacity than term-borns (2.0 ± 0.5 vs. 2.5 ± 0.5 L/min, p = 0.01) and lower maximal power (124 ± 26 vs. 153 ± 33 watts, p < 0.01), despite similar physical activity scores. Pulmonary function and muscular strength did not differ significantly. Although baseline Q and SV did not differ between groups, preterm adolescents had significantly lower cardiac index (Qi) at 50, 75 and 100% of maximal time to exhaustion, driven by SV volume index (SVi, 50% max time: 53.0 ± 9.0 vs. 61.6 ± 11.4; 75%: 51.7 ± 8.4 vs. 64.3 ± 11.1; 100%: 51.2 ± 9.3 vs. 64.3 ± 11.5ml/m2, all p < 0.01), with similar heart rates. Otherwise healthy and physically active adolescents born very preterm exhibit lower exercise capacity than term-born adolescents. Despite similar baseline cardiovascular values, preterm-born adolescents demonstrate significantly reduced Qi and SVi during incremental and maximal exercise.

Intrauterine growth restriction is not associated with decreased exercise capacity in adolescents with congenital heart disease

Intrauterine growth restriction is not associated with decreased exercise capacity in adolescents with congenital heart disease

Intrauterine growth restriction is not associated with decreased exercise capacity in adolescents with congenital heart disease

Purpose Infants exposed to inadequate delivery of nutrients or oxygen are at risk for impaired fetal growth, commonly termed intrauterine growth restriction (IUGR). Multiple studies demonstrate association of low birth weight and IUGR with early and late-onset cardiovascular disease, as well as various measures of impaired aerobic fitness in adolescents and adults. To our knowledge, there are no studies including individuals with history of both IUGR and congenital heart disease (CHD) when evaluating aerobic fitness, nor are there studies evaluating exercise capacity in …

Design and rationale of the Fontan Udenafil Exercise Longitudinal (FUEL) trial

The Fontan operation creates a circulation characterized by elevated central venous pressure and low cardiac output. Over time, these characteristics result in a predictable and persistent decline in exercise performance that is associated with an increase in morbidity and mortality. A medical therapy that targets the abnormalities of the Fontan circulation might, therefore, be associated with improved outcomes. Udenafil, a phosphodiesterase type 5 inhibitor, has undergone phase I/II testing in adolescents who have had the Fontan operation and has been shown to be safe and well tolerated in the short term. However, there are no data regarding the long-term efficacy of udenafil in this population. The Fontan Udenafil Exercise Longitudinal (FUEL) Trial is a randomized, double-blind, placebo-controlled phase III clinical trial being conducted by the Pediatric Heart Network in collaboration with Mezzion Pharma Co, Ltd. This trial is designed to test the hypothesis that treatment with udenafil will lead to an improvement in exercise capacity in adolescents who have undergone the Fontan operation. A safety extension trial, the FUEL Open-Label Extension Trial (FUEL OLE), offers the opportunity for all FUEL subjects to obtain open-label udenafil for an additional 12 months following completion of FUEL, and evaluates the long-term safety and tolerability of this medication. This manuscript describes the rationale and study design for FUEL and FUEL OLE. Together, these trials provide an opportunity to better understand the role of medical management in the care of those who have undergone the Fontan operation.

Exercise intolerance in adolescents born preterm associated with left ventricular diastolic dysfunction

IntroductionPreterm birth disrupts the development of vital organ systems, and places significant challenges on these systems to function in an underdeveloped state. Physiological challenges have been well documented in the preterm infant, and recent evidence suggests that young adults born preterm have higher incidence of hypertension, cardiac dysfunction, and exercise intolerance. However, it is unclear whether adolescent children who received modern neonatal care, including surfactant therapy and lower mechanical ventilation pressures, express these same impairments. Our study sought to determine exercise capacity in adolescents born preterm, as well as resting blood pressure (BP), stroke volume (SV) during exercise, and left ventricular (LV) function using a cardiac MRI.MethodsAdolescent children born preterm in 2003 and 2004 weighing &lt;1500g with an average gestational age of 28 weeks, and healthy age‐matched controls with an average gestational age of 40 weeks were studied. Participants filled out a self‐reported physical activity questionnaire (PAQ) and underwent progressive maximal exercise testing on the upright cycle ergometer, where maximal aerobic capacity (VO2max), maximal power (Pmax), and time to exhaustion (Tmax) were determined. SV throughout exercise was determined using thoracic bioimpedance (PhysioFlow). Average resting BP was recorded during a 10‐minute supine rest, and resting cardiac structure and function measurements were acquired by cardiovascular magnetic resonance by a 3‐T GE scanner. Statistics were performed using Mann‐Whitney tests, and significance was determined as p&lt;0.05. Results are reported as mean±SD.ResultsPreterm adolescents had lower absolute VO2max than controls (2.1±0.5 vs 2.5±0.5 L/min, respectively, p=0.01), lower Pmax, (124±27 watts vs 151±29, p&lt;0.01), lower Tmax, (8.3±2.6 minutes vs 10.4±2.1, p&lt;0.01), with no difference in PAQ scores. Mean BP was higher in preterms than controls (82.2±3.7 vs 76.6±4.0 mmHg, p&lt;0.01), and sex‐, age‐ and height‐adjusted median z‐scores for systolic BP (SBP) and diastolic BP (DBP) were significantly higher in preterms than controls (SBP 0.60±0.57 vs −0.09±0.38, p&lt;0.01), (DBP 0.22±0.46 vs −0.42±0.51, p&lt;0.01). At rest, preterms had lower end diastolic volume (EDVi) (72.9±9.5 vs 84.2±7.2 ml/m2, p=0.02), with a higher LV ejection fraction (EF; 64.1±3.5 vs 58.1±5.5%, p=0.02). The change in SV from rest to maximal exercise was significantly lower in preterms (ΔSV; 4.8±12.7 vs 26.2±18.7 ml, p&lt;0.01).DiscussionWhile the underlying mechanisms of exercise impairment in our population are unclear, we found that preterm adolescents have higher resting BP, lower EDVi, elevated EF, and a blunted SV response to maximal exercise. A lower EDVi suggests diastolic dysfunction, and combined with an elevated EF at rest suggests a hyperdynamic heart. Taken together, our data suggest that there may be a cardiac function limitation in conjunction with cardiovascular autonomic dysfunction causing exercise intolerance in this young population. Our findings, together with blunted stroke volume reserve during exercise, resemble those seen in early stage heart failure with preserved EF, and suggest further study in this population.Support or Funding InformationNIH‐NHLBI R01–HL115061This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Intrauterine growth restriction is not associated with decreased exercise capacity in adolescents with congenital heart disease.

Multiple studies demonstrate the association of intrauterine growth restriction (IUGR) with impaired aerobic fitness in adolescents and adults. To our knowledge, there are no studies including individuals with the history of both IUGR and congenital heart disease (CHD). Thus, we sought to evaluate the impact of IUGR on exercise capacity in adolescents with CHD. We conducted a retrospective chart review of patients <18 years of age who underwent cardiopulmonary exercise testing (CPET) between August 1, 2003 and July 1, 2016. Individuals with birth weight <10th percentile for gestational age were defined as IUGR. Patients with IUGR were matched with non-IUGR patients by cardiac diagnosis and age at CPET. We excluded patients >18 years of age at time of CPET, those without a documented birth weight, gestational age, or Race. A total of 282 patients were included with CHD present in 86 IUGR cases and 86 controls. There was no difference in percent predicted exercise duration (IUGR: 65.2% ± 31.2, non-IUGR: 67.4% ± 27.2; P = .67). Resting heart rate, chronotropic index, percent-predicted peak oxygen consumption, and pulmonary function were similar between groups. Regression analyses confirmed that IUGR was not independently associated with difference in percent-predicted exercise duration. Intrauterine growth restriction is not associated with the differences in the measurements of exercise capacity in adolescents with CHD. These findings contrast earlier studies, showing decreased fitness in individuals with low birth weight but without CHD. To our knowledge, this is the first study to examine the impact of IUGR on exercise capacity in patients with CHD.

Association between Masticatory Performance and Exercise Capacity of Adolescents

Association between Masticatory Performance and Exercise Capacity of Adolescents

Longitudinal changes in adolescents with TOF: implications for care

We sought to identify predictors of change in right ventricular function and exercise capacity in adolescents following repair for tetralogy of Fallot. We performed a longitudinal study with serial cardiac magnetic resonance imaging and/or exercise stress tests. Patients with interim intervention on the pulmonary valve were excluded. Paired t-test was used to detect longitudinal changes and multivariable regression models were built to identify predictors of change. Initial and follow up magnetic resonance and exercise stress test studies were available for 65 and 63 subjects, respectively. Age at initial testing was 11.7 ± 2.7 years. Average follow up time was 4.5 ± 1.8 (magnetic resonance) and 4.0 ± 1.6 (exercise test) years. There was a significant increase in right ventricular end diastolic and systolic volume (119 ± 34 to 128 ± 35 ml/m2, P = 0.006; 49 ± 20 to 56 ± 23 ml/m2, P = 0.001, respectively), and a decrease in right ventricular ejection fraction (60 ± 7 to 56 ± 8%, P = 0.001), with no significant change in pulmonary regurgitant fraction or right ventricular cardiac index. Predictors of right ventricular dilation over time included: time elapsed from surgical repair, severity of pulmonary insufficiency and right ventricular dilation at the initial magnetic resonance imaging. Of those, time elapsed from surgical repair had the most significant effect. There was no change in exercise capacity. In the adolescent with tetralogy of Fallot, longer time from surgery, more pulmonary insufficiency and greater right ventricular dilation at initial magnetic resonance imaging are associated with progressive right ventricular dilation. These results suggest early monitoring with magnetic resonance imaging might identify those at highest risk for progressive disease.

Adolescents who were born extremely preterm demonstrate modest decreases in exercise capacity.

We aimed to investigate exercise capacity in adolescents who were born extremely preterm and to study changes through puberty and associations with neonatal data, exercise habits and lung function. This Norwegian population-based controlled cohort study focused on all infants (n = 35) born at a gestational age of ≤ 28 weeks or with a birthweight of ≤ 1000 grams in 1991-1992, together with matched term-born controls. Participants underwent spirometry and a maximal cardiopulmonary treadmill exercise test at 10 and 18 years. At 18 years of age, mean (95% confidence interval) peak oxygen consumption (peak VO2 ) was 42.3 (39.2-45.4) vs 45.3 (41.3-49.3) mL/kg/min in the preterm- and term-born groups, while the completed treadmill distance was 915 (837-992) vs 1017 (912-1122) metres. Peak VO2 was unrelated to neonatal factors and current lung function. Changes between 10 and 18 were similar in the two groups, and positive associations between exercise habits and peak VO2 developed during the period. Exercise capacity was modestly reduced in adolescents born extremely preterm, but the values were considered normal in most participants. Changes during puberty were similar to those observed for term controls, and the findings suggest similar trainability.

Bosentan improves exercise capacity in adolescents and adults after Fontan operation: the TEMPO (Treatment With Endothelin Receptor Antagonist in Fontan Patients, a Randomized, Placebo-Controlled, Double-Blind Study Measuring Peak Oxygen Consumption) study.

The Fontan procedure has improved survival in children with functionally univentricular hearts. With time, however, complications such as reduced exercise capacity are seen more frequently. Exercise intolerance is multifactorial, but pulmonary vascular resistance probably plays a crucial role. Elevated pulmonary vascular resistance has been associated with raised levels of endothelin-1, which are common both before and after Fontan operations. Treatment with endothelin-1 receptor antagonists could theoretically improve cardiopulmonary hemodynamics and exercise capacity. The aim of this study was therefore to examine the efficacy and safety of bosentan in Fontan patients. Seventy-five adolescents and adults were randomized 1:1 to 14 weeks of treatment with bosentan or placebo. Cardiopulmonary exercise test, functional class, blood samples, and quality-of-life questionnaires were evaluated at baseline and at the end of treatment. Sixty-nine patients (92%) completed the study. Peak oxygen consumption increased 2.0 mL·kg(-1)·min(-1) (from 28.7 to 30.7 mL·kg(-1)·min(-1)) in the bosentan group compared with 0.6 mL·kg(-1)·min(-1) (from 28.4 to 29.0 mL·kg(-1)·min(-1)) in the placebo group (P=0.02). Cardiopulmonary exercise test time increased by 0.48 minute (from 6.79 to 7.27 minutes) versus 0.08 minute (from 6.94 to 7.02 minutes; P=0.04). Nine bosentan-treated patients improved 1 functional class, whereas none improved in the placebo group (P=0.0085). Side effects were mild and occurred equally in both groups. No serious adverse effects were seen, and no patients had liver enzyme levels above the 3-fold upper limit. Bosentan improves exercise capacity, exercise time, and functional class in Fontan patients without serious adverse events or hepatotoxicity. http://www.clinicaltrials.gov. Unique identifier: NCT01292551.

Renal function is associated with peak exercise capacity in adolescents with type 1 diabetes.

OBJECTIVEDiabetic nephropathy and cardiovascular disease are strongly related in adults with type 1 diabetes, yet little is known about this relationship in adolescents prior to the onset of detectable clinical disease. We hypothesized that cardiopulmonary fitness would be directly associated with albumin-to-creatinine ratio (ACR) and inversely related to estimated glomerular filtration rate (eGFR) in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSSixty-nine adolescents with type 1 diabetes and 13 nondiabetic control subjects of similar pubertal stage and BMI had insulin sensitivity (glucose infusion rate [GIR]), measured by hyperinsulinemic-euglycemic clamp, and lean body mass, measured by DEXA. Cardiopulmonary fitness was measured by cycle ergometry to obtain peak volume of oxygen (VO2peak), and renal function was measured by eGFR using the Bouvet equation (measuring creatinine and cystatin C levels) and ACR.RESULTSAdolescents (15.5 ± 2.2 years of age) with type 1 diabetes (6.3 ± 3.8 years diabetes duration) had reduced VO2peak (31.5 ± 6.3 vs. 36.2 ± 7.9 mL/kg ⋅ min, P = 0.046) and VO2peak/lean kg (43.7 ± 7.0 vs. 51.0 ± 8.6 mL/lean kg ⋅ min, P = 0.007) compared with nondiabetic control subjects. eGFR was inversely associated with VO2peak and VO2peak/lean kg after adjusting for sex, Tanner stage, GIR, HbA1c level, systolic blood pressure, and LDL cholesterol level (β ± SE, VO2peak: −0.19 ± 0.07, P = 0.02; VO2peak/lean kg: −0.19 ± 0.09, P = 0.048). Moreover, participants in the highest tertile for eGFR had significantly lower sex- and Tanner-adjusted VO2peak and VO2peak/lean kg compared with participants in the lowest tertile.CONCLUSIONSAdolescents with type 1 diabetes had reduced exercise capacity, which was strongly associated with renal health, independent of insulin sensitivity. Future studies should examine the underlying interrelated pathophysiology in order to identify probable targets for treatment to reduce cardiovascular and renal complications.

Predictors of sildenafil effects on exercise capacity in adolescents and adults with Fontan circulation

A single dose of sildenafil improves exercise capacity in Fontan patients. However, a recent study failed to show a long-term effect of sildenafil. This study evaluated whether there are factors that might predict sildenafil effects. We studied 36 patients (16-42 years, 14 female) with univentricular heart after various modifications of the Fontan surgery (13 APC, 16 AVC, 7 TCPC). They performed two cardiopulmonary exercise tests, with at least 120 min rest and a single dose of 50 mg sildenafil in between. After sildenafil administration, patients improved their peak oxygen uptake from 64.5 to 67.3 % predicted (p = 0.0003) without change in ventilatory efficiency ([Formula: see text] slope), oxygen saturation (SpO2) at rest or at peak exercise, respiratory exchange ratio. In addition, resting systolic blood pressure was slightly reduced after sildenafil administration. There was a moderate negative correlation of this improvement to baseline peak oxygen uptake (r = -0.395; p = 0.017). The change in peak oxygen uptake could not be correlated to time of surgery, type of surgery, NT-pro-BNP, or to other clinical data. Nevertheless, all four patients with NT-pro-BNP levels higher than 1,000 pg/ml had the most prominent improvements in exercise capacity. Fontan patients have an improved exercise capacity after a single dose of sildenafil. Patients with worse baseline peak oxygen uptake profit more.

Chronic inflammation and infection associate with a lower exercise training response in cystic fibrosis adolescents

Considerable heterogeneity among training-induced effects is observed in patients with cystic fibrosis (CF). We previously showed that longitudinal changes in exercise capacity in adolescents with CF were negatively associated with Pseudomonas aeruginosa (P. aeruginosa) colonization and total immunoglobulin G (IgG) levels, independent of age, pulmonary function and bodyweight. This is the first study investigating whether chronic inflammation and infection also associate with the exercise training response in adolescents with CF. Participants performed a home-based exercise training program for 12 weeks. Pulmonary function, anthropometrics, exercise capacity, markers of inflammation and P. aeruginosa colonization status were measured at baseline. Exercise training-induced changes in pulmonary function and exercise capacity were compared between patients with a low and high inflammation-infection status. Participants with CF with high total IgG levels and P. aeruginosa colonization improved significantly less from the exercise training program, with regard to maximal oxygen consumption. These observations support the hypothesis that chronic systemic inflammation and infection leads to devastating effects on skeletal muscles, hampering skeletal muscle tissue to improve from regular physical exercise. Data further suggest that patients with CF should preferentially be encouraged to engage in regular physical exercise when inflammation and infection status is low (e.g. at a young age).

FRI0477-HPR The efficacy of land-based home exercise program in patients with juvenile idiopathic arthritis: A randomized-controlled, single-blind study

BackgroundJuvenile idiopathic arthritis (JIA) is a common chronic illness that affects 1 in 1,000 children (1). Patients with JIA may experience significant disability due to muscular weakness, joint pain, contracture,...

Relationship between exercise capacity and quality of life in adolescents with asthma

OBJECTIVE: To determine whether the quality of life of adolescents with asthma correlates with parameters obtained prior to and after the six-minute step test (6MST); spirometric results after the 6MST; and level of physical activity. METHODS: Nineteen adolescents with asthma, ranging from 11-15 years of age, were assessed with spirometry, 6MST, the International Physical Activity Questionnaire (IPAQ), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 10-point Borg category-ratio scale. RESULTS: Sensation of dyspnea correlated negatively with the total PAQLQ score (r = −0.54) and with the scores of its activity limitation (AL) and symptoms domains (r = −0.64 and r = −0.63, respectively), leg fatigue also correlating negatively with those same domains (r = −0.49 and r = −0.56, respectively). The total IPAQ score correlated with the total PAQLQ score (r = 0.47) and with the PAQLQ AL domain (r = 0.51); IPAQ time spent walking correlated with the PAQLQ symptoms domain (r = 0.45); and IPAQ time spent in vigorous activity correlated with the AL domain (r = 0.50). In the regression analysis, only sensation of dyspnea remained significantly correlated with the total PAQLQ score and the PAQLQ AL domain; leg fatigue remained significantly correlated with the symptoms domain. CONCLUSIONS: Higher levels of physical activity indicate better quality of life, as do lower perception of dyspnea and less leg fatigue. The 6MST proved to be a viable option for evaluating exercise capacity in adolescents with asthma, because it reflects the discomfort that asthma causes during activities of daily living.

Cardiopulmonary Function and Exercise Capacity in Adolescents with Ventricular Septal Defect

Ventricular septal defect (VSD) is the most common defect (50%) among children diagnosed with pediatric congenital heart disease. This study aimed to evaluate the differences of cardiopulmonary function and exercise capacity between normal adolescents and adolescents with VSDs. A cardiopulmonary exercise stress test was performed for the experimental subjects (n = 45) and control subjects (n = 44). The results of the pulmonary function test showed no variation on forced vital capacity (FVC) or forced expiratory volume in one second (FEV1). Neither statistical differences in maximum voluntary ventilation (MVV) nor FEV1/FVC were noticed. In contrast, healthy participants showed significantly higher maximum heart rate compared to adolescents with VSDs, but no significant differences were found in maximal METs and maximal systolic blood pressure. In conclusion, adolescents with VSDs have a normal cardiopulmonary function and exercise capacity, despite a mild chronotropic limitation. We recommend adolescents with VSDs should be encouraged as receive appropriate exercise training, and can participate in sports competitions in order to enhance the quality of life in the future.