Lankhorst K.1,2,3, Haapala E.4,5, de Groot J.F.2,3, Zwinkels M.3,6, Verschuren O.3,6, Wittink H.2, Backx F.7, Visser-Meily A.6, Takken T.3,8
1University of Applied Sciences, Institute for Human Movement Studies, Utrecht, Netherlands, 2University of Applied Sciences, Research Group Lifestyle and Health, Utrecht, Netherlands, 3Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, Netherlands, 4Childhood Health & Active Living Research Group, University of Jyväskylä, Jyväskylä, Finland, Department of Biology of Physical Activity, Jyväskylä, Finland, 5Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland, 6Brain Center Rudolf Magnus, University Medical Center, Center of Excellence in Rehabilitation Medicine, Utrecht, Netherlands, 7Brain Center Rudolf Magnus, University Medical Center, Department of Rehabilitation, Physical Therapy Science & Sports, Utrecht, Netherlands, 8Wilhelmina Children's Hospital, University Medical Center Utrecht, Child Development and Exercise Center, Utrecht, Netherlands
Background: Arteriosclerotic cardiovascular diseases are one of the leading causes of morbidity and mortality and the costs related to arteriosclerosis demonstrate a considerable economic burden. Early identification of youth with increased arterial stiffness is of importance in order to prevent arteriosclerotic cardiovascular diseases in later years. Poor cardiovascular fitness, obesity and low levels of habitual physical activity (PA) have been associated with higher arterial stiffness. High levels of vigorous PA have been linked to lower arterial stiffness. Evidence suggest that youth with chronic diseases or physical disabilities have lower cardiorespiratory fitness, higher prevalence of overweight and obesity, lower levels of PA, and they participate less often in organized sports, than their apparently healthy or typically developing peers. Therefore, youth with chronic disease or disabilities may also have increased arterial stiffness. To date, there are no studies on the associations of cardiorespiratory fitness, body adiposity, and sports participation with arterial stiffness in a large sample of youth with chronic diseases or physical disabilities.
Purpose: To investigate the associations of
1) cardiorespiratory fitness,
2) body adiposity, and
3) sports participation, with arterial stiffness in 140 children and adolescents with chronic diseases or physical disabilities.
1) cardiorespiratory fitness,
2) body adiposity, and
3) sports participation, with arterial stiffness in 140 children and adolescents with chronic diseases or physical disabilities.
Methods: In this study, 84 boys, 56 girls with a mean age of 14.3 (SD 2.7) were recruited. Diseases identified in this sample were; cardiovascular-, pulmonary-, immunological/hematological- and metabolic diseases, neuromuscular-, and musculoskeletal/orthopedic disability, cancer, and epilepsy. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake (VO2peak) by fat free mass (FFM). Body adiposity was assessed using waist circumference. Sports participation was assessed with a questionnaire. Aortic pulse wave velocity PWV (PWVao), a measure of arteria stiffness, and augmentation index (AIX%), a measure of peripheral arterial tone, were assessed by a non-invasive oscillometric tonometry device.
Results: VO2peak / FFM (β=-0.173, 95% CI=-0.329 to -0.017, P=0.030) was inversely and waist circumference directly (β=0.245, 95% confidence interval (CI)=0.093 to 0.414, P=0.002) associated with PWVao. However, the association of the measure of cardiorespiratory fitness with PWVao was attenuated after further adjustment for waist circumference. A higher waist circumference (β=-0.215, 95% CI=-0.381 to -0.049, P=0.012) was related to lower AIX%. Seventy-six (56%) subjects participated in sports, nevertheless sport-participation was not associated with PWVao.
Conclusion(s): Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in youth with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference.
Implications: These results emphasize the importance of body weight management in youth with chronic diseases or physical disabilities from a cardiovascular health perspective. Furthermore, PA is the only behavioral intervention capable to improve cardiorespiratory fitness and it has been demonstrated to have beneficial effects on body composition among obese but otherwise healthy children and adolescents. Therefore, a combination of increasing PA levels and nutrition intake management might be an intervention to improve arterial health among youth with chronic diseases or physical disabilities.
Funding acknowledgements: The study was funded by an unconditional grant of the Dutch Organization of Health Research (ZONMW). Grant number: 525001005.
Topic: Cardiorespiratory
Ethics approval: Approved by the Medical Ethical Committee of the University Medical Center Utrecht, the Netherlands (METC number: 14-332/c and 14-118/m)
All authors, affiliations and abstracts have been published as submitted.
