Exercise Capacity, Physical Fitness, and Physical Activity Levels in Children With CAH

Recruiting

• Conditions: Exercise Capacity; Congenital Adrenal Hyperplasia; Physical Activity; Quality of Life

• Registration Number: NCT06449456
• Lead Sponsor: Hacettepe University

Brief Summary

Congenital Adrenal Hyperplesia (CAH) is a group of automosal recessive disorders that develop due to a deficiency of one of the five enyzmes necessary for cortisol synthesis in the adrenal cortex. Research indicates a predisposition in children and adolescents with CAH towards adverse metabolic changes such as obesity, hypertension, insulin resistance and increased intima-media thickness. This study aims to compare the extent to which children and adolescents with CAH are effected in terms of respiratory and peripheral muscle strength, exercise capasity, physical fitness and physical activity levels compared o their matched healthy individuals.

Detailed Description

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases caused by the deficiency of one of the five enzymes necessary for cortisol synthesis in the adrenal cortex. Dysfunction in cortisol synthesis, as seen in other enzyme deficiencies, leads to an increase in adrenocorticotropic hormone (ACTH) secretion, resulting in hypertension and hypokalemia. Additionally, patients with CAH exhibit excess androgens alongside cortisol deficiency. İn CAH treatment, glucocorticoids are used to suppress androgen production in the adrenal cortex. Deficiency in glucocorticoids and mineralocorticoids, as well as excess androgens, can contribute to the development of adverse metabolic and cardiovascular anomalies.

Ongoing research has revealed a predisposition for adverse metabolic changes in children and adolescents with CAH, including obesity, hypertension, insulin resistance, and increased intima-media thickness, which can increase the risk of developing cardiovascular disease in adulthood. Furthermore, subclinical left ventricular diastolic dysfunction has been observed in adolescents with CAH. İn these patients, due to the deficiency of epinephrine there is an increased tendency for hypoglycemia under stress conditions.

These metabolic changes can lead to impaired exercise performance in patients with CAH, consequently affecting their quality of life.

A study involving twenty classic CAH adolescents and twenty healthy counterparts demonstrated that classic CAH patients exhibited reduced exercise capacity with lower peak workload and higher peak systolic blood pressure during exercise. However, there is a lack of research in the literature comparing respiratory and peripheral muscle strength, daily life activities, physical fitness, and levels of physical activity in children and adolescents with CAH to their healthy peers.

Study Timeline

• Study Start: 2024-02-22
• Study First Submitted: 2024-05-27
• Study First Submitted QC: 2024-06-03
• Study First Posted: 2024-06-10
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-01
• Last Update Posted: 2025-03-04
• Primary Completion: 2025-04-01
• Study Completion: 2025-04-15

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Peripheral Muscle Strength	1 day	Peripheral muscles'strength will be assessed using the K-Force hand dynamometer.
Handgrip strength	1 day	Jamar hand dynamometer (Jamar®, California, USA) will be used to measure grip strength.
Physical Activity Level	1 day	The Physical Activity Level will be assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Physical Activity Questionnaire for Children (PAQ-C). The scores for PAQ-A and PAQ-C range from 9 to 45, with higher scores indicating better physical activity levels. The results of both questionnaires will be presented separately. The PAQ-A score will be reported as a distinct outcome measure for adolescents, and the PAQ-C score will be reported as a distinct Outcome Measure for children. This approach ensures a clear evaluation of physical activity levels in both age groups.
Respiratory Muscle Strength	1 day	Respiratory muscle strength will be measured using a portable, electronic mouth pressure measurement device (Micro Medical MicroMPM, UK). The best of three measurements for Maximal inspiratory pressure (MIP) and Maximal expiratory pressure (MEP) will be selected. Real MIP and MEP values and the percentages of expected values based on age and gender will be used in the analyses.
Physical Fitness Level	1 day	It will be evaluated with the Fitnessgram test battery.
Functional Exercise Capacity	1 day	It will be measured using the 6-Minute Walk Test.

Secondary Outcome Measures

Name	Time	Method
Body composition	1 day	Body composition will be evaluated using bioelectric impedance analysis (Body Composition Analyzer MC-780MA). Measurements will include fat mass, fat-free mass, and water percentage. Each of these measurements will be reported as separate outcome measures. Fat mass will be reported in kilograms, fat-free mass in kilograms, and water percentage as a percentage of total body weight.
Participation	1 day	Quality of life will be assessed using the Pediatric Outcome Data Collection Instrument (PODCI) child and adolescent form. Scores for all dimensions range from 0 to 100, with 100 indicating the highest level of function or participation.
Anthropometric Measurements	1 day	Anthropometric measurements will include separate measurements of waist and hip circumference, and calculations of the waist/hip ratio and waist/height ratio.
Heart Rate Variability	1 day	HRV will be assessed by measuring it with the Polar H10 device before, after, and during the recovery phase of the 6-minute walk test, specifically in the first and second minutes.

Trial Locations

Locations (1)

Hacettepe University; 🇹🇷 Ankara, State, Turkey