Chronotropic Incompetence During Exercise Testing in Obese Adolescents
- Conditions
- Cardiac DiseaseObesity, ChildhoodCardiovascular Risk Factor
- Interventions
- Diagnostic Test: The prevalence of chronotropic incompetence during maximal cardiopulmonary exercise testing
- Registration Number
- NCT04185753
- Lead Sponsor
- Hasselt University
- Brief Summary
In adolescents with obesity cardiopulmonary exercise testing (CPET) has become an important clinical examination providing valuable information with regard to the integrative exercise responses, including the pulmonary, cardiovascular and muscular systems.
During CPET, mechanical constraints in ventilation, an elevated risk for hypoxia and chronotropic incompetence (CI) (defined as the inability of the heart to increase its rate with increased activity), or compromised cardiac function (e.g. lowered heart rate (HR) recovery, chronotropic index and stroke volume) are often observed in obese adults. Moreover, several studies regarding exercise capacity and cardiopulmonary responses to maximal endurance exercise testing have been performed in obese adolescents. Despite these previous investigations in obese adolescents it remains controversial whether cardiopulmonary disturbances can be observed consistently during CPET. However, a number of studies have reported a suboptimal response to exercise, in particular a reduced peak heart rate (HRpeak) and peak cycling power output (Wpeak). Adult obesity modifies cardiac behavior, including resting HR and CI, which has a marked effect on exercise capacity. Therefore, chronotropic variables are the most important factors that affect exercise performance. It has been shown that both peak and resting HR account for over forty percent of variability of exercise capacity. Interestingly, resting HR and HR response to exercise, including a blunted HR increase, low chronotropic index and HR recovery, are important predictors of all-cause mortality and cardiovascular death, at least in adults. These changes in HR during and recovery from CPET are mediated by the balance between sympathetic and vagal activity of the autonomic nervous system. Adverse cardiovascular outcomes associated with the metabolic syndrome may be mediated by autonomic dysfunction, whereby obesity is characterized by sympathetic predominance and a decrease in vagal activity in the basal state, where reduced sympathetic responsiveness has been observed during exercise. Therefore, these multiple exercise risk markers could provide valuable clinical information regarding cardiometabolic health. Nonetheless HR behavior during CPET has not been described in obese adolescents. The goal of this study is to examine the HR behavior of obese adolescents during CPET to clarify whether this population suffer from CI.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 60
- obese or lean (based on extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity)
- Parental permission
- Chronic cardiovascular, renal, pulmonary or orthopaedic disease
- Medication use that could possibly influence the heart rate
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Control group The prevalence of chronotropic incompetence during maximal cardiopulmonary exercise testing Obese adolescents without chronotropic incompetence Obese adolescents with CI The prevalence of chronotropic incompetence during maximal cardiopulmonary exercise testing Obese adolescents with chronotropic incompetence
- Primary Outcome Measures
Name Time Method Peak workload during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed and the incremental workload is measured
Heart rate (HR) during exercise testing day 1 Assessed using a 12-lead ECG device
Peak oxygen uptake (VO2) during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed. With the aid of continuous pulmonary gas exchange analysis VO2 is collected breath-by-breath and averaged every ten seconds.
- Secondary Outcome Measures
Name Time Method Hip circumference day1 Hip circumference will be measured to the nearest 0.1cm using a flexible metric measuring tape with participants barefoot (in underwear) in standing position. Hip circumference is measured at the widest circumference of the hip at the level of the greater trochanter.
Body weight day 1 Body weight (in underwear) is determined using a digital-balanced weighting scale to the nearest 0.1kg
Low-density lipoprotein cholesterol day 1 Blood analyses
Insulin day 1 Blood analyses
Minute ventilation(VE) during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed. With the aid of continuous pulmonary gas exchange analysis VE is collected breath-by-breath and averaged every ten seconds.
Breathing frequency (BF) during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed. With the aid of continuous pulmonary gas exchange analysis BF is collected breath-by-breath and averaged every ten seconds.
Body height day 1 Body height is measured to the nearest 0.1cm using a wall-mounted Harpenden stadiometer, with participants barefoot
Physical activity questionnaire for adolescents (PAQ-A) day 1 physical activity determined using the validated Dutch physical activity questionnaire for adolescents
Waist circumference day 1 Waist circumference will be measured to the nearest 0.1cm using a flexible metric measuring tape with participants barefoot (in underwear) in standing position. Waist circumference is measured at the midpoint between the lower rib margin and the top of the iliac crest.
Serum leptin concentration day 1 Blood analyses
Tanner stage day 1 Puberty stage (ranging from 1 to 5) will be assessed in all participants by the pediatric endocrinologist using Tanner staging criteria.
Plasma glucose day 1 Blood analyses
Tidal volume (Vt) during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed. With the aid of continuous pulmonary gas exchange analysis Vt is collected breath-by-breath and averaged every ten seconds.
High-density lipoprotein cholesterol day 1 Blood analyses
Triglyceride concentration day 1 Blood analyses
Total cholesterol day 1 Blood analyses
C-reactive protein day 1 Blood analyses
Homeostatic model assessment for insulin resistance (HOMA-IR) day 1 Homeostatic model assessment for insulin resistance calculated from insulin and glucose concentration
Carbon dioxide output (VCO2) during exercise testing day 1 Cardiopulmonary exercise test on an electronically braked cycle ergometer is performed. With the aid of continuous pulmonary gas exchange analysis VCO2 is collected breath-by-breath and averaged every ten seconds.
Trial Locations
- Locations (1)
Virga Jesse hospital - Heart centre Hasselt
🇧🇪Hasselt, Limburg, Belgium