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Children are the most naturally physically active human beings; reduced physical activity is a cardinal sign of childhood disease, and exercise testing provides mechanistic insights into health and disease that are often hidden when the child is at rest. The physical inactivity epidemic is leading to increased disease risk in children and, eventually, in adults in unprecedented ways. Cardiopulmonary exercise testing (CPET) biomarkers are used to assess disease severity, progress, and response to therapy across an expanding range of childhood diseases and conditions. There is mounting data that fitness in children tracks across the life span and may prove to be an early, modifiable indicator of cardiovascular disease risk later in life. Despite these factors, CPET has failed to fulfill its promise in child health research and clinical practice. A major barrier to more accurate and effective clinical use of CPET in children is that data analytics and testing protocols have failed to keep pace with enabling technologies and computing capacity. As a consequence, biomarkers of fitness and physical activity have yet to be widely incorporated into translational research and clinical practice in child health. In this review, the author re-examines some of the long-held assumptions that mold CPET in children. In particular, the author suggests that current testing strategies that rely predominantly on maximal exercise may, inadvertently, obfuscate novel and clinically useful insights that can be gleaned from more comprehensive data analytics. New pathways to discovery may emanate from the simple recognition that the physiological journey that human beings undertake in response to the challenge of exercise may be far more important than the elusive destination of maximal or peak effort.

The present study compares previous reports on the effect of “real-life” typical field individual (ie, cross-country running and wrestling—representing combat versus noncombat sports) and team sports (ie, volleyball and water polo—representing water and land team sports) training on GH and IGF-1, the main growth factors of the GH→IGF axis, in male and female late pubertal athletes. Cross-country running practice and volleyball practice in both males and females were associated with significant increases of circulating GH levels, while none of the practices led to a significant increase in IGF-I levels. The magnitude (percent change) of the GH response to the different practices was determined mainly by preexercise GH levels. There was no difference in the training-associated GH response between individual and team sports practices. The GH response to the different typical practices was not influenced by the practice-associated lactate change. Further studies are needed to better understand the effect of real-life typical training in prepubertal and adolescent athletes and their role in exercise adaptations.

The relationship between peak aerobic fitness (peakVO₂) and plasma leptin was assessed in 25 normal (BMI < 85th %tile) and 25 overweight (BMI > 85th %tile) youth, ages 7–17 years. In the overall analysis peakVO₂ was related to leptin when expressed in mL/kg/min (R ² = .516, p < .0001), or as ml/kg_FFM/min (R ² = .127, p = .01). The relationships between peakVO₂ and leptin were no longer significant when percent bodyfat was added to the models. In subanalyses by weight groups, peakVO₂: leptin relationships were not evident for normal weight, but remained for overweight youth. In conclusion the relationship between aerobic fitness and leptin in youth is dependent upon weight status.

Cross-sectional research examined whether physical activity or physical fitness was more closely linked to physical self-concept in adolescent females ages 14 to 17 (N = 103, 63% Caucasian). Moderate physical activity and vigorous physical activity were measured through a 3-day physical activity recall. Physical fitness was assessed using highly accurate measures of peak oxygen consumption (via cycle ergometer) and percent body fat (via dual X-ray absorptiometer). The Physical Self-Description Questionnaire (PSDQ) assessed self-concept in 11 domains (e.g., health, endurance, appearance). Pearson’s correlations showed that vigorous physical activity was positively associated with scores on most of the PSDQ scales (p < .005). Peak oxygen consumption was positively related to all of the selfconcept domains (p < .001), and percent body fat was negatively related on most of the PSDQ scales (p < .005). Multiple-regression analyses found that physical fitness (i.e., peak oxygen consumption and percent body fat) was more closely related to physical self-concept than was physical activity. In addition to the possibility that genetically determined fitness levels may influence physical selfconcept, these findings suggest that programs designed to elevate self-perceptions may require physical activity levels sufficient to improve cardiovascular fitness and decrease body fat.

Brief high intensity exercise induces peripheral leukocytosis possibly leading to a higher incidence of allergic symptoms in athletes undergoing excessive training. We studied the exercise-induced alternation of circulating Tregs and FoxP3+ Tregs due to acute intense swim exercise in elite swimmers (n = 22, 12 males, age = 15.4 yrs). Twelve had prior or current rhinitis or asthma and 10 had no current or prior allergy or asthma. Circulating Tregs increased significantly (p < .001) following exercise (pre = 133 ± 11.2, post = 196 ± 17.6) as did FoxP3+ cells (pre = 44, post = 64 cells/μl). Increases in Tregs and FoxP3+ Tregs occurred to the same extent in both groups of adolescent swimmers.

Consensus has yet to be achieved on whether obesity is inexorably tied to poor fitness. We tested the hypothesis that appropriate reference of cardiopulmonary exercise testing (CPET) variables to lean body mass (LBM) would eliminate differences in fitness between high-BMI (≥ 95th percentile, n = 72, 50% female) and normal-BMI (< 85th percentile, n = 142, 49% female), otherwise-healthy children and adolescents typically seen when referencing body weight. We measured body composition with dual x-ray absorptiometry (DXA) and CPET variables from cycle ergometry using both peak values and submaximal exercise slopes (peak VO₂, ΔVO₂/ΔHR, ΔWR/ΔHR, ΔVO₂/ΔWR, and ΔVE/ΔVCO2). In contrast to our hypothesis, referencing to LBM tended to lessen, but did not eliminate, the differences (peak VO₂ [p < .004] and ΔVO₂/ΔHR [p < .02]) in males and females; ΔWR/ΔHR differed between the two groups in females (p = .041) but not males (p = .1). The mean percent predicted values for all CPET variables were below 100% in the high-BMI group. The pattern of CPET abnormalities suggested a pervasive impairment of O2 delivery in the high-BMI group (ΔVO₂/ΔWR was in fact highest in normal-BMI males). Tailoring lifestyle interventions to the specific fitness capabilities of each child (personalized exercise medicine) may be one of the ways to stem what has been an intractable epidemic.

Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptoms and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.