Pediatric Exercise

Medicine
Greg Wells, Ph.D.
Physiology and Experimental Medicine
The Hospital for Sick Children

Tuesday, October 12, 2010 1

 Principles
• Non-invasive
• To use advanced exercise and MRI / MRS
measurement techniques to elucidate the
pathophysiology of chronic diseases in children
• Athlete - Healthy - Chronic Disease
• Use results to develop evidence-based
interventions

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 Progress

www.exerciseismedicine.org

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 Exercise Respiratory
Physiology Medicine

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 Factors that limit VO2max

© Greg Wells Ph.D., 2010

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 Aerobic Power Testing

© Greg Wells, 2010

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 Chronic Disease &
Muscle Function

• Abnormal skeletal muscle metabolism and/or

hemodynamics?

© Greg Wells, 2010

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© Greg Wells, 2010
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 -#%./#$0(
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© Greg Wells, 2010

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 CF & PCD Results

Mean Delta 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

Under analysis:

Turner’s Syndrome
Obesity
Preconditioning
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 Systemic Inflammation

© Greg Wells, 2010

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 Targeted Interventions Based on Metabolism

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 Implications...
• Delayed PCr recovery reduced anti-
oxidant capacity arising from systemic
inflammation and oxidative damage
that lowers the efficiency of mitochondria in
patients with CF and PCD . (35,36,37) (38)

• ***No differences in VO 2max!

35 Hebestreit H, Hebestreit A, Trusen A, et al. Oxygen uptake kinetics are slowed in cystic fibrosis. Med Sci Sports Exerc 2005; 37:10-17
36 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; 25:1050-1056
37 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

© Greg Wells, 2010

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 Effect of Training

© Greg Wells, 2010

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 dFEV1 high -1.3 %/year, low -2.8
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 Wells GD, Tein I,
Selvadurai H.
Bioenergetic provision
of energy for muscular
activity. Pediatric
Respiratory Reviews.
2009 Sep;10(3):83-90.
© Greg Wells, 2010
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 Increased V @ MaxHR
Stress, Immunity,
Detraining

Decreased Submax HR

Decreased Resting HR

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 How to Implement
Aerobic Training

© Greg Wells, 2010

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 Aerobic Training Factor: Volume

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 Aerobic Training Factor: Intensity

© Greg Wells, 2010

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 Aerobic Training Factor: Set Design

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 Activity Guidelines
• Children and Youth (aged 5-17) How much and how often?

• Children and youth should accumulate at least 60 minutes, and up to several hours, of
moderate physical activity (such as brisk walking, skating or bike riding) each day.

• For very inactive or sedentary children and youth, some health benefits can be
achieved through 30 minutes of moderate physical activity per day.

• Some physical activity is better than none, and more is better.

• What kind?
• The physical activity should be mostly aerobic, and should include vigorous activity
(such as running and playing soccer) at least 3 days a week, and muscle and bone
strengthening activities (such as skipping, jumping or playing in the park) at least 3 days
a week.

• Daily physical activity should be achieved through play, games, sport, work,
transportation, recreation, physical education or planned exercise, with family, at
school and in the community.

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 Exercise Medicine

• The use of exercise physiology presents an

opportunity to help elucidate the
pathophysiology of diseases non-invasively.
• Exercise as therapy holds great
potential as a treatment modality

© Greg Wells, 2010

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 exerciseismedicine.org

drgregwells.com

© Greg Wells, 2010

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 Summary
• The use of exercise physiology presents an
opportunity to help elucidate the
pathophysiology of diseases non-invasively.
• Exercise as therapy holds great potential as
a treatment modality

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