Skeletal muscle deficits are associated with worse exercise performance in pediatric pulmonary hypertension

Avitabile, Catherine M.; McBride, Michael G.; Harris, Matthew A.; Whitehead, Kevin K.; Fogel, Mark A.; Paridon, Stephen M.; Zemel, Babette S.

doi:10.3389/fped.2022.1025420

Cited by 4 publications

(3 citation statements)

References 61 publications

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“…While prior studies associated handgrip strength with body size (height, weight, BMI) ( Laurson et al 2017 ; Kocher et al 2019 ; McGrath et al 2020 ), weight and BMI may conceal differences in fat and lean mass distribution in certain self-identified race/ethnicity groups ( Harsha et al 1978 ; Schutte et al 1984 ; Goran et al 1997 ; Nelson and Barondess 1997 ; Lu et al 2011 ; Sousa et al 2013 ; Weber et al 2013 ; Marwaha et al 2014 ) and in chronic disease populations. Associations between handgrip strength and lean mass may be important in assessment of paediatric populations in which lean mass deficits (surrogates for skeletal muscle deficits) are associated with functional limitations ( Avitabile et al 2014 , 2018 , 2021 , 2022 ). Future studies may explore handgrip Z-score as a marker of functional health status and potential clinical trial target in children with chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Paediatric dominant and non-dominant handgrip reference curves and the association with body composition

Avitabile,

Weber,

Zemel

2024

Annals of Human Biology

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Background: Lack of paediatric reference data limits the utility of handgrip strength as a measure of fitness and well-being. Aim: To develop paediatric handgrip reference curves and evaluate associations with body size and composition and race/ethnicity group. Subjects and methods: Handgrip, body size and composition data were obtained from National Health and Nutrition Examination Survey 2011–2014 participants aged 6–20 years. Densitometry-derived fat and appendicular lean soft tissue mass index Z-scores (FMIZ, ALSTMIZ) were generated in participants >8 years. Dominant and non-dominant handgrip reference curves were created using the LMS method. Analyses included sample weights to produce nationally representative estimates. Results: Differences in handgrip strength according to hand dominance increased with age. Handgrip strength was associated with height and arm length Z-scores ( R = 0.42 to 0.47) and ALSTMIZ ( R = 0.54). Handgrip strength was higher in the non-Hispanic Black group and lower in the Mexican American compared to non-Hispanic White group. Group differences were attenuated when adjusted for height, arm length or ALSTMIZ. Conclusion: Paediatric handgrip reference curves were generated from which individual Z-scores can be calculated separately for dominant versus non-dominant hand and adjusted for body size. Association with ALSTMIZ suggests handgrip Z-score may be used as a measure of functional body composition.

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Section: Discussionmentioning

confidence: 99%

Paediatric dominant and non-dominant handgrip reference curves and the association with body composition

Avitabile,

Weber,

Zemel

2024

Annals of Human Biology

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“…The mechanisms by which exercise interventions have a clinical effect are unclear; they may target cardiopulmonary reserve, skeletal muscle performance, endothelial function, or psychosocial factors. As skeletal muscle abnormalities are associated with worse exercise performance in both adults and children with PH 18 , 19 , 20 improving the peripheral muscle pump and augmenting RV stroke volume could improve exercise tolerance in pediatric PH.…”

Section: Exercise Limitations and Physical Inactivity In Pediatric Phmentioning

confidence: 99%

Creating a digital approach for promoting physical activity in pediatric pulmonary hypertension: A framework for future interventions

Avitabile,

Mota,

Yeaman

et al. 2024

Pulm. circ.

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Children with pulmonary hypertension (PH) often demonstrate limited exercise capacity. Data support exercise as an effective nonpharmacologic intervention among adults with PH. However, data on exercise training in children and adolescents are limited, and characteristics of the optimal exercise program in pediatric PH have not been identified. Exercise programs may have multiple targets, including muscle deficits which are associated with exercise limitations in both adult and pediatric PH. Wearable accelerometer sensors measure physical activity volume and intensity in the naturalistic setting and can facilitate near continuous data transfer and bidirectional communication between patients and the study team when paired with informatics tools during exercise interventions. To address the knowledge gaps in exercise training in pediatric PH, we designed a prospective, single arm, nonrandomized pilot study to determine feasibility and preliminary estimates of efficacy of a 16‐week home exercise intervention, targeting lower extremity muscle mass and enriched by wearable mobile health technology. The exercIse Training in pulmONary hypertEnsion (iTONE) trial includes (1) semistructured exercise prescriptions tailored to the participant's baseline level of activity and access to resources; (2) interval goal setting fostering self‐efficacy; (3) real time monitoring of activity via wearable devices; (4) a digital platform enabling communication and feedback between participant and study team; (5) multiple avenues to assess participant safety. This pilot intervention will provide information on the digital infrastructure needed to conduct home‐based exercise interventions in PH and will generate important preliminary data on the effect of exercise interventions in youth with chronic cardiorespiratory conditions to power larger studies in the future.

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“…Lean muscle mass has been correlated with strength and functional performance in healthy children [55,[85][86][87] and in those with chronic, long-standing conditions [88,89].…”

Section: Muscle Mass-function Connectionmentioning

confidence: 99%

Targeting Sarcopenia as an Objective Clinical Outcome in the Care of Children with Spinal Cord-Related Paralysis: A Clinician’s View

Sadowsky

2023

Children

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Muscle loss is consistently associated with immobility and paralysis and triggers significant metabolic and functional changes. The negative effects of sarcopenia are amplified in children who are in the process of building their muscle mass as part of development. Because muscle mass loss is consistently associated with increased morbidity and mortality throughout life, optimizing the size and health of muscles following a neurologic injury is an objective target for therapeutic interventions. This review hypothesizes that muscle mass correlates with functional outcomes in children with paralysis related to spinal cord-related neurologic deficits. We propose that the measurement of muscle mass in this population can be used as an objective outcome for clinical long-term care. Finally, some practical clinical approaches to improving muscle mass are presented.

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Skeletal muscle deficits are associated with worse exercise performance in pediatric pulmonary hypertension

Cited by 4 publications

References 61 publications

Paediatric dominant and non-dominant handgrip reference curves and the association with body composition

Paediatric dominant and non-dominant handgrip reference curves and the association with body composition

Creating a digital approach for promoting physical activity in pediatric pulmonary hypertension: A framework for future interventions

Targeting Sarcopenia as an Objective Clinical Outcome in the Care of Children with Spinal Cord-Related Paralysis: A Clinician’s View

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