Exercise Concerns in Children Exercise Tests in Children

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Exercise Concerns in Children Exercise Tests in Children

Transcript Of Exercise Concerns in Children Exercise Tests in Children

Exercise Concerns in Children
Š Exercise Testing Š Exercise
Prescription Š Congenital Heart

Exercise Tests in Children
Š Fitness Tests
• commonly used in school-based physical education
• field test batteries
• Fitnessgram • President’s Challenge test
Š Clinical Tests
• known or suspected abnormalities • symptoms associated with exercise • measure functional capacity

Field Fitness Tests (table 11-1)

Š Aerobic Capacity

1-mile walk/run

Š Strength/endurance

curl-ups pull-ups/push up

Š Flexibility


Š Agility

Shuttle run

Š Body composition


Stress Testing in Children
Š Most children will not give a maximal effort, crying may be the end-point
• most children are sprinters not runners
Š Treadmill testing usually is preferred over cycle
• less leg fatigue, less need for cooperation
Š Results often are related to size, rather than age

12 Year-Olds

Special Precautions
Š children are more prone to overuse injuries or damage to bone epiphyseal plates if excessive strain is applied
• Vary sports participation?
Š children are more prone to environmental temperatures
• smaller surface area/mass ratio • smaller absolute blood volume

Aerobic Prescription for kids, ACSM
Š Optimum amount and type is not defined
• individualized based in maturity, skill, medical status
• > 6 yrs, > 30 min moderate intensity, each day
• older children, 20-30 min vigorous ex, 3-5 d

AHA Physical Activity Standards for Children
Š Walking, bicycling, backyard play; use of stairs, playgrounds, and gymnasiums; interaction with other children
Š Less than 2hr/d TV and video games Š Weekly, organized sports, lessons, etc Š Daily, 20 min organized school exercises Š Regular participation in household chores Š Weekly active family outings Š Positive role models (parents, teachers)
REX Prescription for Kids
Š avoid maximal weights (8 or more reps/set) not to maximal exertion
Š 1-2 sets of 8-10 exercises Š rest 1-2 min between exercises Š twice per week

Resistance Exercise Prescription in Kids?
Š Children can participate in properly designed and supervised REX program
• proper instruction in techniques is essential • slow controlled movements, no ballistic • avoid power lifting and body building goals • full ROM, multi-joint exercises
Congenital Heart Diseases
Š Atrial and ventricular septal defects Š Patent Ductus Arteriosus Š Coarctation of the Aorta Š Tetralogy of Fallot Š Uncommon
• atrioventricular septal defect • transposition of the great arteries • single ventricle (Fontan operation) • congenital coronary artery abnormalities

Heart Diseases: in general
Š Most are recognized in the first few yrs Š Outcome is usually better if repaired
early--before long-lasting effects Š Often there are residual effects after
surgery Š But, patients usually can participate in
sports after repair
• depends on age and residual effects

Causes of Heart Defects
Š Hereditary factor (1-2%) Š Injury to the fetus
• vitamin deficiency, defective maternal metabolism, poor diet, drug effect, drugs and alcohol
Š Diseases during pregnancy
• German measles, rubella

Congenital Heart Disease
Š Occurs in 0.8% of all live births Š Most common kind of congenital defect Š 98% of the time, diagnosed by 4 ys of age
• well-publicized exceptions
Š children are usually at low risk for sudden death during exercise
• side effects haven’t developed yet

Atrial and Ventricular Septal Defects
Š Atrial (5-10% of congenital heart disease) Š Ventricular (15-20%) Š Hole between the left and right chambers
• left to right shunt • pulmonary hypertension • atrial and ventricular hypertrophy

Atrial Septal Defect
Š Evander Holyfield, boxer of the decade, 1990-2000
Š small atrial septal defect was found while training

Septal Defects
Š Symptoms
• fatigue, increased respiratory illnesses, shortness of breathe, pulmonary hypertension
• murmur, splitting of the second heart sound
• arrhythmias, atrial & ventricular hypertrophy
• limited exercise capacity

Atrial defect
Foramen ovale

A-V Septal Defects
Š Treatments
• closure during childhood • open heart surgery or transcatheter repair
Š Residual effects
• arrhythmias, RBBB • sinus node dysfunction
Š 80% normal exercise tolerance after repair

A-V Septal Defects
Š Exercise Guidelines
• small defect w/o pulmonary hypertension
• participate in all sports
• mild pulmonary hypertension
• low intensity sports only
• markedly elevated right heart pressures
• should not participate in competitive sports

Patent Ductus Arteriosus
Š DA is a normal connection between the pulmonary artery and the aorta in the fetus
• closes within hrs of birth due to increased oxygen
Š 5-10% of congenital heart disease—hole remains open
Patent DA, exercise effects
Š Small DA
• participate in all sports
Š Moderate or large DA with ventricular enlargement and severe pulmonary hypertension
• Must close DA • restricted from all sports until 3 months after

Patent DA, symptoms
Š In adult, patent DA allows blood to flow from aorta to pulmonary artery
• increases lung bf • left ventricle must work extra hard
Š Increased bf in lungs Š left atrial and left ventricular dilation Š pulmonary vascular disease (high
pressures) Š murmur
Coarctation of the Aorta
Š 8-10% of congenital heart disease Š narrowing of the aorta Š elevated blood pressures in the upper
body Š lower blood pressures in the lower body Š reduced development of the lower limbs

Coarctation of the Aorta
Š Chris Waller Š 1992 Men’s National
Gymnastic champion Š successful
coarctation repair Š shortened lower body
segment is an advantage in some sports

Coarctation, symptoms
Š Murmur Š cold feet, leg cramps, nosebleeds,
headaches Š much higher blood pressures/pulse in
upper body than lower body Š hypertension Š dilated ascending aorta Š reduced exercise capacity, increased SBP

Coarctation, exercise effects
Š Pressure gradient between upper and lower body < 20 mmHg, normal resting bp, peak exercise SBP < 230 mmHg
• all but static sports, no power-lifting
Š Pressure grad > 20 mmHg, hypertension, peak exercise SBP > 230 mmHg
• low intensity exercise only

Tetralogy of Fallot
Š 6% of congential Blue Baby Syndrome
heart disease
Š 4 characteristics
• pulmonary artery stenosis
• right ventricular hypertrophy
• ventricular septal defect
• Enlarged aorta

Tetrology, symptoms
Š Cyanotic cardiac disease Š hypoxic spells, relieved by squatting-
• increase pressure in the left ventricle, closing the septal shunt so venous blood won’t bypass the lungs
• murmur and right ventricular hypertrophy
Š impaired exercise responses

Tetrology, repair
Š Surgical closure of the shunt and opening of the pulmonary outflow tract
Š 80-85% will have a normal exercise capacity
Š 73% will have ventricular arrhythmias Š 34% supraventricular tachycardia

Tetrology, exercise effects
Š Normal or near-normal right-sided heart pressures, no residual shunt, no arrhythmias
• all competitive sports
Š Marked pulmonary regurgitation, elevated right ventricular pressure, arrhythmias
• low physical activity only • restrict static exercises
Valve Repair
Š Balloon valvuplasty Š Homograft
• pulmonary valve moved to aortic valve • “homograft” valve put in pulmonary
Š Prosthetic valves Š Advantages of homograft
• valve grows with child • avoidance of anticoagulants

Congenital Valve Diseases
Š Pulmonary valve stenosis, 8-12 % of congenital heart disease
Š Aortic valve stenosis, 3-6 % Š Increased pressures in right or left
ventricles, respectively Š Decreased exercise capacity Š Risk of sudden death
Prosthetic Valve

Valve replacement, exercise effects
Š Usually some remaining regurgitation Š New valve is weaker and prone to
stenosis and blood clotting Š Subject may be on anti-coagulant
• care with high static sports • care with contact sports

Š Children after the age of 6 have similar exercise guidelines as adults, except
• limit maximal aerobic or resistive exercise • special precaution in hot or cold weather
Š Children with heart diseases
• usually are diagnosed before they begin sports • may be diagnosed from an unusual exercise
response • have minimal long-lasting effects when
diagnosed early