Exercise as Medicine ElBosque October 2010
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Pediatric ExerciseMedicine
Greg Wells, Ph.D.Physiology and Experimental Medicine
The Hospital for Sick Children
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Principles
Non-invasive
To use advanced exercise and MRI / MRSmeasurement techniques to elucidate thepathophysiologyof chronic diseases in children
Athlete - Healthy - Chronic Disease
Use results to develop evidence-basedinterventions
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Progress
www.exerciseismedicine.org
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http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/ -
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Factors that limit VO2max
Greg Wells Ph.D., 2010
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Aerobic Power Testing
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Greg Wells, 2010
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Chronic Disease &
Muscle Function
Abnormal skeletal muscle metabolism and/orhemodynamics?
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Greg Wells, 2010
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Mean elta BOLD Signal Mean Slope BOLD Signal Recovery
Group Average SD Group Average SD
CF 0.57 0.2 CF 0.010 0.003
PCD 1.04 0.5 PCD 0.017 0.009
HC 1.31 0.4 HC 0.022 0.007
CF & PCD Results
Under analysis:
Turners SyndromeObesity
Preconditioning
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Greg Wells, 2010
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Greg Wells, 2010
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Systemic Inflammation
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Implications...
Delayed PCr recovery reduced anti-oxidant capacityarising from systemic
inflammation and oxidative damagethat lowers the efficiency of mitochondria inpatients with CF (35,36,37) and PCD (38).
***No differences in VO2max!
35 Hebestreit H, Hebestreit A, Trusen A, et al. Oxygen uptake kinetics are slowed in cystic fibrosis. Med Sci Sports Exerc 2005; 37:10-1736 Moorcroft AJ, Dodd ME, Morris J, et al. Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis. Eur Respir J 2005; 25:1050-105637 Fischer R, Simmerlein R, Huber RM, et al. Lung disease severity, chronic inflammation, iron deficiency, and erythropoietin response in adults with cystic fibrosis. Pediatr Pulmonol 2007; 42:1193-1197
38 Zihlif N, Paraskakis E, Tripoli C, et al. Markers of airway inflammation in primary ciliary dyskinesia studied using exhaled breath condensate. Pediatr Pulmonol 2006; 41:509-514
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Effect of Training
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dFEV1 high -1.3 %/year, low -2.8
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Wells GD, Tein I,Selvadurai H.
Bioenergetic provisionof energy for muscular
activity. PediatricRespiratory Reviews.2009 Sep;10(3):83-90.
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Decreased Resting HR
Decreased Submax HR
Increased V @ MaxHR
Stress, Immunity,
Detraining
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How to ImplementAerobic Training
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Aerobic Training Factor : Volume
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Aerobic Training Factor : Intensity
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Exercise Medicine
The use of exercise physiology presents an
opportunity to help elucidate thepathophysiology of diseases non-invasively.
Exercise as therapy holds greatpotential as a treatment modality
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exerciseismedicine.org
drgregwells.com
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http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/ -
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Summary
The use of exercise physiology presents anopportunity to help elucidate the
pathophysiology of diseases non-invasively.
Exercise as therapy holds great potential asa treatment modality