Exercise Tests in Children Exercise Concerns in Children Fitness Tests Exercise Testing • commonly used in school-based physical education Exercise Prescription • field test batteries • Fitnessgram Congenital Heart • President’s Challenge test Diseases Clinical Tests • known or suspected abnormalities • symptoms associated with exercise • measure functional capacity Field Fitness Tests (table 11-1) Aerobic Capacity 1-mile walk/run Strength/endurance curl-ups pull-ups/push up Flexibility Sit-reach Agility Shuttle run Body composition BMI/SKF 12 Year-Olds Stress Testing in Children Most children will not give a maximal effort, crying may be the end-point • most children are sprinters not runners Treadmill testing usually is preferred over cycle • less leg fatigue, less need for cooperation Results often are related to size, rather than age 1 Aerobic Prescription for kids, Special Precautions ACSM children are more prone to overuse Optimum amount and type is not defined injuries or damage to bone epiphyseal • individualized based in maturity, skill, medical plates if excessive strain is applied status • Vary sports participation? • > 6 yrs, > 30 min moderate intensity, each day children are more prone to environmental temperatures • older children, 20-30 min vigorous ex, 3-5 d • smaller surface area/mass ratio • smaller absolute blood volume AHA Physical Activity Resistance Exercise Prescription Standards for Children in Kids? Walking, bicycling, backyard play; use of Children can participate in properly stairs, playgrounds, and gymnasiums; designed and supervised REX program interaction with other children Less than 2hr/d TV and video games • proper instruction in techniques is essential Weekly, organized sports, lessons, etc • slow controlled movements, no ballistic Daily, 20 min organized school exercises • avoid power lifting and body building goals Regular participation in household chores Weekly active family outings • full ROM, multi-joint exercises Positive role models (parents, teachers) REX Prescription for Kids Congenital Heart Diseases Atrial and ventricular septal defects avoid maximal weights (8 or more reps/set) not to maximal exertion Patent Ductus Arteriosus Coarctation of the Aorta 1-2 sets of 8-10 exercises Tetralogy of Fallot rest 1-2 min between exercises Uncommon twice per week • atrioventricular septal defect • transposition of the great arteries • single ventricle (Fontan operation) • congenital coronary artery abnormalities 2 Heart Diseases: in general Causes of Heart Defects Most are recognized in the first few yrs Hereditary factor (1-2%) Outcome is usually better if repaired Injury to the fetus early--before long-lasting effects • vitamin deficiency, defective maternal Often there are residual effects after metabolism, poor diet, drug effect, drugs and surgery alcohol Diseases during pregnancy But, patients usually can participate in sports after repair • German measles, rubella • depends on age and residual effects Atrial and Ventricular Septal Congenital Heart Disease Defects Occurs in 0.8% of all live births Atrial (5-10% of congenital heart disease) Most common kind of congenital defect Ventricular (15-20%) 98% of the time, diagnosed by 4 ys of age Hole between the left and right chambers • well-publicized exceptions • left to right shunt children are usually at low risk for • pulmonary hypertension sudden death during exercise • atrial and ventricular hypertrophy • side effects haven’t developed yet Atrial Septal Defect Septal Defects Atrial defect Symptoms Evander Holyfield, • fatigue, increased boxer of the decade, respiratory illnesses, 1990-2000 shortness of breathe, small atrial septal pulmonary hypertension defect was found • murmur, splitting of the while training second heart sound • arrhythmias, atrial & ventricular hypertrophy • limited exercise capacity Foramen ovale 3 A-V Septal Defects A-V Septal Defects Treatments Exercise Guidelines • closure during childhood • small defect w/o pulmonary hypertension • open heart surgery or transcatheter repair • participate in all sports Residual effects • mild pulmonary hypertension • low intensity sports only • arrhythmias, RBBB • markedly elevated right heart pressures • sinus node dysfunction • should not participate in competitive sports 80% normal exercise tolerance after repair Patent Ductus Arteriosus Patent DA, symptoms DA is a normal In adult, patent DA allows blood to flow connection between the from aorta to pulmonary artery pulmonary artery and • increases lung bf the aorta in the fetus • left ventricle must work extra hard • closes within hrs of birth Increased bf in lungs due to increased oxygen left atrial and left ventricular dilation 5-10% of congenital pulmonary vascular disease (high heart disease—hole pressures) remains open murmur Patent DA, exercise effects Coarctation of the Aorta Small DA 8-10% of congenital heart disease • participate in all sports narrowing of the aorta Moderate or large DA with ventricular elevated blood pressures in the upper enlargement and severe pulmonary body hypertension lower blood pressures in the lower body • Must close DA reduced development of the lower limbs • restricted from all sports until 3 months after repair 4 Coarctation of the Aorta Coarctation, symptoms Chris Waller 1992 Men’s National Murmur Gymnastic champion cold feet, leg cramps, nosebleeds, successful headaches coarctation repair much higher blood pressures/pulse in shortened lower body upper body than lower body segment is an advantage in some hypertension sports dilated ascending aorta reduced exercise capacity, increased SBP Tetralogy of Fallot Blue Baby Syndrome Coarctation, exercise effects 6% of congential heart disease Pressure gradient between upper and 4 characteristics lower body < 20 mmHg, normal resting • pulmonary artery bp, peak exercise SBP < 230 mmHg stenosis • all but static sports, no power-lifting • right ventricular Pressure grad > 20 mmHg, hypertension, hypertrophy peak exercise SBP > 230 mmHg • ventricular septal • low intensity exercise only defect • Enlarged aorta Tetrology, symptoms Tetrology, repair Cyanotic cardiac disease Surgical closure of the shunt and opening hypoxic spells, relieved by squatting- of the pulmonary outflow tract • increase pressure in the left ventricle, closing 80-85% will have a normal exercise the septal shunt so venous blood won’t bypass capacity the lungs 73% will have ventricular arrhythmias • murmur and right ventricular hypertrophy 34% supraventricular tachycardia impaired exercise responses 5 Tetrology, exercise effects Congenital Valve Diseases Normal or near-normal right-sided heart Pulmonary valve stenosis, 8-12 % of pressures, no residual shunt, no congenital heart disease arrhythmias Aortic valve stenosis, 3-6 % • all competitive sports Increased pressures in right or left Marked pulmonary regurgitation, ventricles, respectively elevated right ventricular pressure, Decreased exercise capacity arrhythmias Risk of sudden death • low physical activity only • restrict static exercises Valve Repair Prosthetic Valve Balloon valvuplasty Homograft • pulmonary valve moved to aortic valve • “homograft” valve put in pulmonary position Prosthetic valves Advantages of homograft • valve grows with child • avoidance of anticoagulants Valve replacement, exercise Conclusions: effects Children after the age of 6 have similar exercise guidelines as adults, except Usually some remaining regurgitation • limit maximal aerobic or resistive exercise New valve is weaker and prone to • special precaution in hot or cold weather stenosis and blood clotting Children with heart diseases Subject may be on anti-coagulant • usually are diagnosed before they begin sports therapy • may be diagnosed from an unusual exercise • care with high static sports response • care with contact sports • have minimal long-lasting effects when diagnosed early 6.