Cardiorespiratory Fitness in Obese Adolescents

Cardiorespiratory Fitness in Obese Adolescents Pau Redon, PhD Cardiovascular Risk Unit Hospital General Universitario University of Valencia CIBERObn Instituto de Salud Carlos III, Madrid, Spain

Prologue What 3 things in common with this top 5 world soccer players?

Agenda Introduction Methodology Case I: Prediction of CRF and relationship with cardiometabolic parameters. Case II: CRF and its relationship with cardiac autonomous nervous system activity (cans). Conclusions

Childhood obesity in figures Childhood obesity is one of the severest health problems for the 21 st century.- World Health Organization (2016). Childhood obesity impact in Spain Cardio-metabolic conditions in Europe 1.3 million families have an obese or overweight son under 16. 2.1 million children, under 16, are obese or overweight. 20 000 type 2 diabetes > 400 000 IGT > 1 million CV-metabolic risk factor > 1.4 million early stages of NAFLD

Tools to fight against obesity pandemia Intervention Lifestyle modification at schools Lifestyle modifications at community levels Education & empowerment Regulatory Physicians counselling Target School-age children Families School age children and families Society 9-15 children Obesity degree Personalization Disturbance Side Effects Health Impact Costs General school population General population QALY General population General population Overweight and obese Drugs Children Overweight and obese Surgery Children Severe obese

Intervention Target Tools to fight against pandemia Current alternatives to fight childhood obesity Obesity degree Personalization Disturbance Side Effects Health Impact Costs QALY Lifestyle modification at schools School-age children General school population Lifestyle modifications at community levels Families General population Education & empowerment School age children and families General population Regulatory Physicians counselling Society 9-15 children General population Overweight and obese Drugs Children Overweight and obese Surgery Children Severe obese

Relevance of the cardiopulmonary exercise test (CPET) PUBMED Database GOOGLE Trends Interest score per year AHA recommendation for routine analysis of CRF. 838 884 EAPC & AHA a joint document streamline test interpretation and increase clinical application. 726 723 512 408 292 284 231 280 337 99 145 162 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Specific field Others (PA)

Relevance of the cardiopulmonary exercise test (CPET) Pool of variables: Effort time Breathing rate RER VE/VCO2 EPOC slope Oxygen Deficit maximal VE/VO2 Speed Second component Tidal volumen First component submaximal VO2peak METS TE Heart rate Excess Oxygen Power

Relevance of the cardiopulmonary exercise test (CPET) Reference values for healthy children and adolescents: F. B. Ortega. Br J Sports Med 2011;45:20 29 Joey C. Eisenmann. Am J Prev Med 2011;41(4S2):S106 S110 HELENA STUDY [Austria, Belgium, France, Germany, Greece, Hungary, Italy, Spain and Sweden], 2009. N: 2997 (1519 girls) Age: 15.6 ± 0.1 (boys), 15.5 ± 0.1 (girls) BMI: 22.7 ± 0.2 (boys), 23.0 ± 0.2 (girls) VO2max: 46.6 ± 0.5 (boys), 39.0 ± 0.3 (girls) N: 3528 (1845 girls) Age: 15.0 ± 1.2 (boys), 14.9 ± 1.2 (girls) BMI: 21.6 ± 4.0 (boys), 21.4 ± 3.5 (girls) VO2max: 44.3 ± 7.5 (boys), 37.1 ± 5.6 (girls)

Measuring cardiorespiratory fitness in youth Cardio pulmonar exercise test (CPET) Treadmill protocol

Case I.- VO2 peak prediction and CM parameters Control Moderate Obese Severe Obese n 43 38 45 p-value Age [years] 11.3 ± 1.3 12.3 ± 1.6 12.0 ± 2.0 0.146 BMI [kg/m2] 15.8 ± 2.7 26.2 ± 2.6 29.0 ± 4.0 0.000 VO2 peak [mlo2*min -1 *kg -1 ] General characteristics of the studied population 37.4 ± 5.6 25.9 ± 4.4 24.9 ± 5.7 0.000 depicts significant differences between moderate and severe obese with normal weight subjects.

Case I: VO2 peak prediction and metabolic parameters Relationship between VO2 peak and metabolic parameters: peak **Guixeres J. et al. Nutrición Hospitalaria 2014; 29(6): 1290-97.

Measured VO2peak [mlo2*kg -1 *min -1 ] Measured VO2peak [mlo2*kg -1 *min -1 ] Case I. VO2 peak prediction and CM abnormalities Non-exercise based model Exercise based model 50 45 40 35 30 25 20 15 Mean accuracy = 74% Mean accuracy = 82% 50 45 40 35 30 25 20 15 10 10 15 20 25 30 35 40 45 50 Predicted VO2 peak [mlo2*kg -1 *min -1 ] 10 10 15 20 25 30 35 40 45 50 Predicted VO2peak [mlo2*kg -1 *min -1 ] Guixeres et al. Cardiorespiratory fitness in youth: association with obesity and metabolic abnormalities. 2014

Measured VO2peak [mlo2*kg -1 *min -1 ] 50 45 40 35 30 25 20 Case I.- VO2 peak prediction and metabolic parameters Exercise based model 2.0 Bland-Altaman plot 15 10 10 15 20 25 30 35 40 45 50 Predicted VO2peak [mlo2*kg -1 *min -1 ] Diff_between_ methods Mean accuracy = 90% T- student Table T-student Value test = 0 95% interval of confidence Sig. Mean t gl for difference (bilateral) difference lower higher 1.679 52.099 1.48811 -.2905 3.2668 Model (Constant) Mean *Pau Redon et al. European Alliance Congress for Personalized Medicine. Belfast 2017. Linear regression results Coefficients Linear Regression No standarized coefficients Tipified coefficients t Sig. 95% interval of confidence for B B Error típ. Beta lower higher -.360 6.236 -.058.954-12.879 12.160.071.239.042.299.766 -.408.551

Case I: VO2 peak prediction and metabolic parameters Transfer of research results to clinical practice: Old procedure CPET New procedure CPET

Case II.- CRF and its relationship with cans activity General characteristics of the studied population Overweight Moderate Obese Severe Obese n 14 33 17 p-value Age [years] 12.8 ± 1.1 12.0 ± 2.0 11.7 ± 2.4 0.260 BMI [kg/m2] 24.6 ± 1.2 28.2 ± 3.0 33.5 ± 3.5 0.000 VO2peak [mlo2*min -1 *kg -1 ] 31.30 ± 7.1 26.9 ± 3.8 24.5 ± 5.3 * 0.001 depicts significant differences between moderate and overweight subjects. * Depicts significant differences between severe obese and overweight subjects.

Case II.- CRF and its relationship with cans activity 23-25ºC *Compher C. et al. J Am Diet Assoc 2006; 106: 881-903. R R 250Hz 15min Time domain, Frequency domain and non-linear componentes **Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart 1996; 17:354-61.

Case II: CRF and its relationship with cans activity peak *Redon P. et al. Journal of Hypertension 2017; 35 (3): 571-77.

Case II: CRF and its relationship with cans activity Relationship with metabolic parameters and cans: Redon P. et al. Journal of Hypertension 2017; 35 (3): 571-77.

Conclusions VO2 peak has shown good correlation with anthropometric data and cardiometabolic risk factors. VO2 peak has shown a good correlation with heart rate variability parameters. Cardiorespiratory fitness, assessed by oxygen consumption, is indeed a good contributor for cardiometabolic risk assessment. Continue to reduce the traslational gap in the children health exercise field.

Acknowledgements This work, as part of the Project Prometeo 2016/084, is financed by the Generalitat Valenciana in the framework Ayudas Prometeo para grupos de investigación de excelencia of 2016. I will also like to thank the following team members: Dra. E. Lurbe, Dr. J. Redon, Dra. M.I. Torró, Dr. J. Alvarez-Pitti, Dr. Francisco Aguilar and Francisco Ponce.

Prologue What 3 things in common with this top 5 world soccer players? At least once a year their cardiorespiratory fitness is measured. Their personalised physical activity plan is designed according to their performance and specific goals. The employment of new technologies allows real-time monitoring during exercise.

Thank-you February 9th-11th, ICHCA 2018, Valencia