The value of exercise studies in children often resides in defining differences, which might make growing youngsters unique from their mature adult counterparts. Many such physiological and behavioral developmental differences have been identified, emphasizing that children are not, physiologically speaking, simply small adults. The following 2 studies published in the past year were chosen for their importance in contributing to the insights into previously unexplored areas. The first study addresses the influence of exercise on physiological variability, an emerging field that offers to provide important insights into the nature of such responses. The second study concerns the effects of altitude on physiological responses to exercise, an area of considerable importance for the health and physical performance of pediatric athletes, climbers, and residents at high altitude. These studies exemplify the genre of investigations that are essential for advancing our understanding of the link between exercise with physical performance and the well-being of growing children and adolescents.
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Thomas Rowland
Interest in the physiological responses to exercise unique to the pediatric age group has grown exponentially over the past 50 years. A number of issues surrounding children’s exercise have been particularly responsible for this trend, particularly a) recognition of the health benefits of exercise in youth, b) the growing involvement of young persons in highly intense levels of sports play, and c) the role that exercise may play in the diagnosis and management of children with chronic disease. As a consequence, current research to date has provided a comprehensive picture of the features specific to children’s response to exercise. Future challenges facing the field of pediatric exercise science involve translating this information into practical guidelines which can be applied to the realms of clinical medical practice, preventive health initiatives, and athletic training regimens which are appropriate for this age group.
Thomas Rowland
Recognizing the cardiac features of athletically trained children bears importance for health care providers and exercise physiologists alike. This literature review reveals that ventricular enlargement and/or hypertrophy are commonly observed in studies of pre- and early-adolescent endurance athletes, yet the magnitude of these features is less than that described in adult athletes. Moreover, the upper range of values in child athletes is sufficiently small that clinical confusion with findings mimicking those in individuals with heart disease should not be expected to occur. In contrast to sex differences in the “athlete’s heart” in adults, cardiac structural findings in child athletes are similar in males and females. The extent that cardiac features observed in trained child athletes reflect a response to training or are influenced by genetic preselection remains uncertain.
Thomas Rowland
The two articles in the area of cardiovascular physiology and disease in youth were chosen for commentary because of their exploration of new approaches to the diagnosis and management of cardiovascular derangements in young persons. The first, by Hinds et al., describes the potential clinical importance of detection of cardiovascular changes during exercise testing in adolescent athletes following concussions. This approach might prove useful in establishing safe return-to-play guidelines. The second, a review article by Van De Schoor et al, evaluates the frequency of myocardial scarring in athletes, some of adolescent age, which is a recognized risk factor for sudden cardiac death. These findings support other evidence indicating that sports participation per se might rarely increase the risk of such tragedies. Clearly more research is indicated by the information raised in both of these articles, but their importance to clinical medicine is obvious.
Thomas Rowland
Introduction:
Patients with repaired tetralogy of Fallot have good long-term survival but less is known about the subjectively assessed quality of life or objectively measured functional status of those who have not required subsequent pulmonary valve replacement. We assessed these parameters in a group of children and adults free from pulmonary valve replacement after tetralogy of Fallot repair.
Methods and Results:
A random sample of 50 subjects—16 children and 34 adults, aged 4.1-56.7 years—who had undergone tetralogy of Fallot repair and were free from subsequent pulmonary valve replacement underwent cardiopulmonary exercise testing and completed standardized questionnaires assessing health related quality of life and resilience. Patients were generally asymptomatic (median New York Heart Association class = 1). Exercise capacity was within two standard deviations of normal for most children and adults (mean z VO2max: 0.20 + 1.5; mean z VO2max: 0.20 + 1.5; mean z VE/VCO2 −0.9 + 1.3). Children reported a total health-related quality of life score similar to healthy norms (78 + 10 versus 84 + 1, p = .73). Adult survivors also reported quality of life scores comparable to healthy norms. Resilience was highly correlated with all domains of health-related quality of life (r = .713, p < .0001).
Conclusions:
Patients who have undergone tetralogy of Fallot repair in childhood and have not required pulmonary valve replacement have a good long-term health-related quality of life. The finding that patients with greater resilience had better health-related quality of life suggests that it may be beneficial to implement interventions to foster resilience.
Thomas Rowland
Science is based on the idea that there is a truth, whether or not we have access to it. What we know depends on systems of knowledge, and we may never be able to get to specific truths, but the idea is that there is a reality; there is a way humans evolved or cancers grow, for instance. And science is a way to get to that.
Ariel Ruiz I Altaba (2010)
