Introduction: the role of exercise in the diagnosis and management of chronic disease in children and youth.

This symposium addresses the role of exercise testing and training in the diagnosis and/or management of chronic disease in children and youth. Four different diseases or disorders will be addressed including cardiovascular, pulmonary, neuromuscular disease, and obesity. The purpose of this symposium is to enable the exercise professional to recognize the importance of the use of exercise in the diagnosis and/or management of these chronic diseases. The papers give a brief description of the pathophysiology of the disease, and the resultant effects upon the child's response to acute exercise and to training. Each author has summarized as well as contributed original research specific to the understanding and improved care of children with these conditions. Also included are practical suggestions for the implementation of exercise testing and exercise training to enhance the care and well-being of these children. Where applicable, the authors have indicated research questions and similar recommendations for future research efforts. The purpose of this symposium, therefore, is to educate medical and exercise professionals concerning the importance of exercise testing and training in the overall care of children with chronic disease.

Role of exercise in the management of cardiovascular disease in children and youth.

Most cardiovascular disease in children and youth is the result of congenital anomalies. Surgical techniques for repair of these defects have improved greatly since they were first developed, and a high percentage of patients become healthy, active adults. Less frequently, other types of cardiovascular disease may be acquired sometime after birth. In patients with either congenital or acquired heart disease, there is often some degree of exercise limitation. Appropriately, there is an increasing interest in the use of exercise testing and training in the clinical management of both congenital and acquired cardiovascular disease in children and youth. This review describes the exercise responses of patients with various forms of cardiovascular disease and discusses the use of exercise training to improve the well-being of these children and adolescents.

Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents.

OBJECTIVES: This study evaluated exercise performance and myocardial perfusion during exercise in patients with Kawasaki disease who had a broad spectrum of residual coronary abnormalities. BACKGROUND: Reports of exercise performance after Kawasaki disease have generally included a small number of patients evaluated by various protocols, frequently with incomplete data. Myocardial perfusion studies have usually been limited to those using pharmacologically induced coronary vasodilation. Therefore, to our knowledge there has not been a large study directly correlating exercise performance, electrocardiographic (ECG) changes and myocardial perfusion imaging. METHODS: Forty-six patients were classified into three groups on the basis of coronary artery status: group 1 (n = 27) had no objective evidence of coronary artery lesions; group 2 (n = 11) had resolved aneurysms; group 3 (n = 8) had persistent coronary aneurysms. All patients underwent exercise testing with monitoring of ECG changes and oxygen consumption. Single-photon emission computed tomographic imaging was performed at rest and during peak exercise using technetium-99m sestamibi. RESULTS: Maximal oxygen consumption was within normal limits and was similar for all three groups. Five patients had mild ST segment changes at peak exercise. Two of these patients had stress-induced perfusion defects. Myocardial perfusion defects were present in 37% of patients in group 1, 63% in group 2 and 100% in group 3. Perfusion defects corresponded to the coronary artery lesion site in all but three patients. CONCLUSIONS: Maximal oxygen consumption is normal after Kawasaki disease regardless of coronary artery status. Stress-induced perfusion defects are frequent even in the absence of coronary abnormalities and are common in the absence of ST segment changes suggestive of ischemia.

Cardiopulmonary exercise testing in children following surgery for tetralogy of Fallot.

The purpose of this study was to compare the cardiopulmonary responses at rest and during exercise of children following surgical correction of tetralogy of Fallot. The physiologic measurements assessed at rest and during maximal treadmill exercise included diffusing capacity of the lung for carbon monoxide, heart rate, oxygen consumption, minute ventilation, and cardiac output. Twenty children with repaired tetralogy of Fallot served as the study group, and 20 normal boys and girls served as controls. Subjects with tetralogy of Fallot had significantly lower values than those of control subjects for maximal cardiac output and somewhat lower values for diffusing capacity of the lung for carbon monoxide and heart rate. We conclude that the exercise cardiac function of children with surgically corrected tetralogy of Fallot is somewhat diminished compared with that of control children. This information is necessary to establish safe, yet effective exercise guidelines for this select population.

Effects of a Rebound Exercise Training Program on Aerobic Capacity and Body Composition.

In brief: Training on rebound exercise equipment (minitrampolines) is a popular new approach to aerobic conditioning, but its physiological benefits have been a matter of debate. This study was designed to determine if rebound aerobic dancing is an effective way to improve aerobic capacity and body composition. A group of previously sedentary college women who trained on rebound equipment three times a week for eight weeks showed a 9% increase in max but no significant change in percent body fat. A control group showed no significant changes. The improvement was similar to results produced by conventional aerobic dance programs of like intensity but moderate in comparison to other established forms of aerobic exercise.