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Predicted Aerobic Capacity of Asthmatic Children: A Research Study from Clinical Origin  [PDF]
Lene Lochte
Pulmonary Medicine , 2012, DOI: 10.1155/2012/854652
Abstract: Objective. To compare longitudinally PAC of asthmatic children against that of healthy controls during ten months. Methods. Twenty-eight asthmatic children aged 7–15 years and 27 matched controls each performed six submaximal exercise tests on treadmill, which included a test of EIA (exercise-induced asthma). Predicted aerobic capacity (mLO2/min/kg) was calculated. Spirometry and development were measured. Physical activity, medication, and “ever asthma/current asthma” were reported by questionnaire. Results. Predicted aerobic capacity of asthmatics was lower than that of controls ( ) across observation times and for both groups an important increase in predicted aerobic capacity according to time was observed ( ). FEV1 of the asthmatic children was within normal range. The majority (86%) of the asthmatics reported pulmonary symptoms to accompany their physical activity. Physical activity (hours per week) showed important effects for the variation in predicted aerobic capacity at baseline ( , ) and at the T4 observation ( , ) and the analyses showed important asthma/control group effects at baseline, month four, and month ten. Physical activity of the asthmatics correlated positively with predicted aerobic capacity. Conclusion. The asthmatic children had consistently low PAC when observed across time. Physical activity was positively associated with PAC in the asthmatics. 1. Introduction Children with asthma often experienced breathlessness during physical activity and therefore tended to avoid vigorous physical activity with disadvantageous consequences to their physical conditioning [1, 2]. There are few paediatric pulmonary conditions in which physical activity has had such potentially harmful effect on patients, not only by limiting exercise capability, but also by acting as a direct stimulus to the underlying pathophysiology [3]. Exercise-induced asthma (EIA) has been recognized as one major manifestation of untreated asthma [4] with physical activity acknowledged as a powerful trigger of asthmatic disease [3, 5]. Physical activity in paediatric asthma has been influenced by physical as well as psychosocial variables. The comprehensive psychosocial variables included attitudes towards exercise. Asthmatic children have demonstrated negative attitudes towards physical activity [6] to be influenced by the limitations that they experienced in safely and unrestrictedly to join physical activities [5]. The cardiopulmonary fitness of asthmatic children was often suboptimal. Some studies revealed lower predicted aerobic capacity (PAC) among asthmatic
The clinical importance of cardiopulmonary exercise testing and aerobic training in patients with heart failure
Arena, R;Myers, J;Guazzi, M;
Brazilian Journal of Physical Therapy , 2008, DOI: 10.1590/S1413-35552008000200002
Abstract: introduction: the appropriate physiological response to an acute bout of progressive aerobic exercise requires proper functioning of the pulmonary, cardiovascular and skeletal muscle systems. unfortunately, these systems are all negatively impacted in patients with heart failure (hf), resulting in significantly diminished aerobic capacity compared with apparently healthy individuals. cardiopulmonary exercise testing (cpx) is a noninvasive assessment technique that provides valuable insight into the health and functioning of the physiological systems that dictate an individual?s aerobic capacity. the values of several key variables obtained from cpx, such as peak oxygen consumption and ventilatory efficiency, are often found to be abnormal in patients with hf. in addition to the ability of cpx variables to acutely reflect varying degrees of pathophysiology, they also possess strong prognostic significance, further bolstering their clinical value. once thought to be contraindicated in patients with hf, participation in a chronic aerobic exercise program is now an accepted lifestyle intervention. following several weeks/months of aerobic exercise training, an abundance of evidence now demonstrates an improvement in several pathophysiological phenomena contributing to the abnormalities frequently observed during cpx in the hf population. these exercise-induced adaptations to physiological function result in a significant improvement in aerobic capacity and quality of life. conclusions: furthermore, there is initial evidence to suggest that aerobic exercise training improves morbidity and mortality in patients with hf. this paper provides a review of the literature highlighting the clinical significance of aerobic exercise testing and training in this unique cardiac population.
The Effect of Aerobic Exercise on O2 Saturation in Children with Sickle Cell Trait  [cached]
Masoumeh Rahim,Marzieh Asadizaker,Bizhan Keykhaei Dehdezi
Jundishapur Scientific Medical Journal , 2012,
Abstract: Background and Objective: Intensive anaerobic exercise is a risk factor for children with sickle cell anemia. However, it remains unclear whether anaerobic or aerobic exercises have any effect on subjects with sickle cell trait. This study conducted to determine of the effect of aerobic exercise on O2 saturation in children with sickle cell trait. Subjects and Methods: Eighty-two healthy and trait children (age 6-18) were allocated randomly in two groups: case (41) and control (41) in this study. Anthropometrics profile and hemoglobin concentration were measured. HbS hemoglobin recognized with HPLC. All children performed a cycle ergometer 2-min exercise and 3-min rest. Before and after exercise, O2 saturation was assessed with pulseoximetry.Results: There was no significant difference between two groups for O2 saturation before and after exercise (P>0.05). This parameter remained normal in children with sickle cell trait. Conclusion: It seems aerobic exercise is safe for children with sickle cell trait.
Effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis
Bulent Elbasan, Nur Tunali, Irem Duzgun, Ugur Ozcelik
Italian Journal of Pediatrics , 2012, DOI: 10.1186/1824-7288-38-2
Abstract: The aim of this study was to evaluate the effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis.Sixteen patients with cystic fibrosis, between the ages 5-13 years, were included in this study. All children were assessed at the beginning and at the end of 6 week of the training. Modified Bruce protocol was used for assessing the cardiovascular endurance. The sit-up test was used to evaluate the dynamic endurance of abdominal muscles, standing long jump was used to test power, sit and reach, trunk lateral flexion, trunk hyperextension, trunk rotation and forward bending tests were used to assess flexibility, 20 m shuttle run test and 10-step stair climbing tests were used to assess power and agility. All patients received chest physiotherapy and aerobic training, three days a week for six weeks. Active cycle of breathing technique and aerobic exercise training program on a treadmill were applied.By evaluating the results of the training, positive progressions in all parameters except 20 m shuttle run and 10 stairs climbing tests were observed (p < 0.05). Active cycle of breathing techniques were used together with exercise training in clinically stable cystic fibrosis patients increases thoracic mobility (p < 0.05) and the physical fitness parameters such as muscle endurance, strength and speed (p < 0.05). Comparison of the results in sit and reach and forward bending tests were not significant (p > 0.05).It is thought that in addition to medical approaches to the systems affected, the active cycle of breathing techniques along with aerobic training helps to enhance the aerobic performance, thoracic mobility and improves physical fitness in children with cystic fibrosis.Cystic fibrosis is a multisystem disease where the main problems are existing in the respiratory system [1]. Most common problems requiring help in these patients are excessive bronchial secretion, decreased exercise tolerance and feelin
Exercise Interventions in Children with Cancer: A Review  [PDF]
Tseng-Tien Huang,Kirsten K. Ness
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/461512
Abstract: The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer. Relevant studies were identified by entering the following search terms into Pubmed: aerobic training; resistance training; stretching; pediatric; children; AND cancer. Reference lists in retrieved manuscripts were also reviewed to identify additional trials. We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses. Nine included children with an acute lymphoblastic leukemia (ALL) diagnosis, and six children with mixed cancer diagnoses. Generally, interventions tested were either in-hospital supervised exercise training or home based programs designed to promote physical activity. Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness, improved muscle strength and flexibility, reduced fatigue and improved physical function. Generalizations to the entire childhood cancer and childhood cancer survivor populations are difficult as most of the work has been done in children during treatment for and among survivors of ALL. Additional randomized studies are needed to confirm these benefits in larger populations of children with ALL, and in populations with cancer diagnoses other than ALL.
EFFECTS OF AN EXERCISE-ORIENTED REHABILITATION PROGRAM ON MECHANICAL EFFICIENCIY AND AEROBIC CAPACITY IN CHILDREN WITH SPASTIC CEREBRAL PALSY  [cached]
M. Izadi,MM. Taghdiri,GH. Bagheri,D. Khorshidi
Iranian Journal of Child Neurology , 2008,
Abstract: ObjectiveChildren suffering from Cerebral Palsy (CP), exhibit movement limitations and physiological abnormalities as compared to normal individuals.The objective of this study was to assess mechanical efficiency and certain cardiovascular indices before and after an exercise-rehabilitation program in children with dipelegia spastic cerebral palsy (experimental group) in comparison with able-bodied children(controls).Material and MethodsIn this study, 15 spastic cerebral palsy (dipelegic) children participated in an exercise-rehabilitation program, three days a week for three months with an average 144bpm of heart rate. The mechanical efficiency (net, gross), rest and submaximal heart rate and maximal oxygen consumption(VO2max) were measured before (pretest) and after (posttest) exercise program on the cycle ergometer according to the Macmaster ergometer protocol. Then control group, of 18 normal children underwent the exercise program and were assessed, following which results of the 2 groups were compared using SPSS for statistical analysis (P<0.05).ResultsMechanical efficiency (net, gross) increased significantly in CP patients after the exercise-rehabilitation program; reults did not alter significantly for the controls. Rest and submaximal heart rate in CP patients decreased significantly after exercise program. Maximal oxygen consumption, which remained unchanged in patients following the exercise program, was similar in patients and controls after the program.ConclusionCerebral palsy patients, because of their high muscle tone, severe degree of spasticity, and involuntary movements are physically more incapacitated and need more energy than normal able-bodied individuals.Rehabilitation and aerobic exercise can be effective in improving their cardiovascular fitness and muscle function and increasing their mechanical efficiency.
Cardiovascular and autonomic modulation by the central nervous system after aerobic exercise training
Martins-Pinge, M.C.;
Brazilian Journal of Medical and Biological Research , 2011, DOI: 10.1590/S0100-879X2011007500102
Abstract: the autonomic nervous system plays a key role in maintaining homeostasis under normal and pathological conditions. the sympathetic tone, particularly for the cardiovascular system, is generated by sympathetic discharges originating in specific areas of the brainstem. aerobic exercise training promotes several cardiovascular adjustments that are influenced by the central areas involved in the output of the autonomic nervous system. in this review, we emphasize the studies that investigate aerobic exercise training protocols to identify the cardiovascular adaptations that may be the result of central nervous system plasticity due to chronic exercise. the focus of our study is on some groups of neurons involved in sympathetic regulation. they include the nucleus tractus solitarii, caudal ventrolateral medulla and the rostral ventrolateral medulla that maintain and regulate the cardiac and vascular autonomic tonus. we also discuss studies that demonstrate the involvement of supramedullary areas in exercise training modulation, with emphasis on the paraventricular nucleus of the hypothalamus, an important area of integration for autonomic and neuroendocrine responses. the results of these studies suggest that the beneficial effects of physical activity may be due, at least in part, to reductions in sympathetic nervous system activity. conversely, with the recent association of physical inactivity with chronic disease, these data may also suggest that increases in sympathetic nervous system activity contribute to the increased incidence of cardiovascular diseases associated with a sedentary lifestyle.
Exercise Training in Children and Adolescents with Cystic Fibrosis: Theory into Practice  [PDF]
Craig A. Williams,Christian Benden,Daniel Stevens,Thomas Radtke
International Journal of Pediatrics , 2010, DOI: 10.1155/2010/670640
Abstract: Physical activity and exercise training play an important role in the clinical management of patients with cystic fibrosis (CF). Exercise training is more common and recognized as an essential part of rehabilitation programmes and overall CF care. Regular exercise training is associated with improved aerobic and anaerobic capacity, higher pulmonary function, and enhanced airway mucus clearance. Furthermore, patients with higher aerobic fitness have an improved survival. Aerobic and anaerobic training may have different effects, while the combination of both have been reported to be beneficial in CF. However, exercise training remains underutilised and not always incorporated into routine CF management. We provide an update on aerobic and anaerobic responses to exercise and general training recommendations in children and adolescents with CF. We propose that an active lifestyle and exercise training are an efficacious part of regular CF patient management. 1. Introduction Physical activity and exercise training have become increasingly important and widely accepted as part of therapy and rehabilitation programmes in cystic fibrosis (CF) management. Physical activity refers to any body movement produced by the skeletal muscles and occurs in a variety of forms (i.e., free play, exercise, organised sports), resulting in a substantial increase in energy expenditure [1]. Exercise training, however, can be defined as regular participation in vigorous physical activity to improve physical performance or cardiovascular function or muscle strength or any combination of these three [2]. Prior to initiation of any exercise training, detailed exercise testing is recommended, not only to monitor disease progression, but also to detect exercise-induced limitations and therefore to provide the patients with safe training recommendations [3, 4]. Ideally, exercise training should complement current therapies in CF patient healthcare. In previous reports, however, it has emerged that clinicians lack specific recommendations to instruct their patients appropriately [5, 6]. Several studies report beneficial effects of exercise training on cardiopulmonary fitness (CPF) in patients with CF [7–11]. CPF pertains to the functions of both the heart and the pulmonary system, usually expressed as peak oxygen consumption (peak ), the most reliable and reproducible measure of CPF following maximal exercise testing [12]. Recently, Bradley and Moran examined the effectiveness of exercise training in CF using a systematic Cochrane review [13]. Seven randomised controlled trials with a
Implantation of HIA-Medos system in children with and without cardiopulmonary bypass
N Reiss, A El-Banayosy, T Breymann, G Kleikamp, N Mirow, K Minami, R K?rfer
Critical Care , 2001, DOI: 10.1186/cc1005
Abstract: A HIA-Medos system was implanted by cannulation in the right atrium and the pulmonary artery for right heart support. In bridge-to-transplant patients, the left ventricle and the ascending aorta were cannulated for left heart support. In those patients who were expected to recover, the left atrium was cannulated. Cardiopulmonary bypass was instituted using standard techniques.Five patients (ages 5 days, 5 months, and 1, 5 and 8 years) were supported. Body weights ranged from 3.5 to 20 kg, and body surface area from 0.19 to 0.83 m2. The underlying disease was myocarditis in two patients, dilatative cardiomyopathy in one patient, d-transposition of the great arteries in one patient, and undetected Bland-White-Garland syndrome in one patient. Four patients underwent biventricular support, and one had left heart support. One patient had postoperative low-output syndrome, who could be weaned after a support time of 5 days. The HIA-Medos system was implanted in three out of the four bridge-to-transplant patients, with cardiopulmonary bypass. In these three patients re-exploration was necessary because of bleeding complications due to disturbed coagulation cascade. They received a mean of 2.9 erythrocyte concentrates per support day. The patients died because of multiple organ failure, among other complications. In the fourth child the HIA-Medos system was implanted without cardiopulmonary bypass. No bleeding complication occurred. Pre-existant organ dysfunction recovered. Disturbances of coagulation system were not apparent.Postoperative bleeding is the most frequent complication in children supported by the HIA-Medos system with cardiopulmonary bypass. Multiple transfusions were necessary, and the patients treated died because of multiple organ failure. Implantation without cardiopulmonary bypass appears to prevent bleeding complications, with nearly normal coagulation conditions. Recovery of all pre-existent major organ dysfunctions occurred.
Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing  [PDF]
Michael K. Stickland,Scott J. Butcher,Darcy D. Marciniuk,Mohit Bhutani
Pulmonary Medicine , 2012, DOI: 10.1155/2012/824091
Abstract: The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption ( ) is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation ( = cardiac output × arterial-venous O2 content difference). In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance. 1. Introduction The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their diagnostic evaluation of exercise intolerance and dyspnea [1, 2]. Although cardiac and pulmonary etiologies are the most common causes for dyspnea and exercise intolerance [3, 4], neurological, metabolic, hematologic, endocrine, and psychiatric disorders can all contribute. The data gathered from a CPET can provide valuable information to differentiate between these causes [5], as progressive incremental exercise testing provides the most comprehensive and objective assessment of functional impairment and yields information about the metabolic, cardiovascular, and ventilatory responses to exercise. In addition to assisting in the diagnosis of dyspnea and exercise intolerance, CPETs can be used for a broad range of other applications such as determining disease severity, exercise prescription for rehabilitation, assessing the effectiveness of pharmacological agents, or in the assessment for lung transplant (see Table 1). Table 1: Indications for cardiopulmonary exercise testing. Algorithms exist to help identify CPET patterns of known clinical diagnosis [6], and typical clinical
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