The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies—A Narrative Review

Abstract

Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases.

Physical exercise and cardiovascular response: design and implementation of a pediatric CMR cohort study

“…However, combined with CMR, cycling cannot be combined with long breath holds and a treadmill exercise is not feasible within the MRI. Isometric handgrip exercise is the most feasible physical stressor in combination with CMR as it allows scanning without losing image quality due to movement artefacts [ 19 ]. This is the first large pediatric population-based cohort study exploring the cardiovascular effects of an isometric handgrip exercise combined with detailed cardiovascular measurements [ 19 ].…”

“…To provoke a cardiovascular stress reaction, we used a sustained isometric handgrip exercise. Earlier studies have shown that a sustained handgrip of 30% to 40% of the maximal voluntary contraction (MVC) for 7 min is a feasible exercise that leads to a substantial increase in heart rate and blood pressure [ 19 ]. To measure the MVC, all participants were tested in the seated position with their elbow flexed at 90°.…”

“…Several small studies have used CMR to obtain more detailed insight into cardiac adaptations to exercise and showed differences in cardiac response to exercise in diseased and non-diseased populations [ 16 – 18 ]. Combined with CMR, Isometric handgrip exercise is the most feasible physical stressor as it allows scanning without losing image quality due to movement artefacts [ 19 ].…”

Cardiac Evaluation of Exercise Testing in a Contemporary Population of Preschool Children: A New Approach Providing Reference Values

“…Children 2022, 9, 654 2 of 13 originate in childhood [6]. Throughout the maturation process (i.e., from babyhood to adulthood), some variations in the modulation of the autonomic nervous system over the heart occur, inducing changes in heartbeat patterns.…”

“…Heart rate (HR) can be used to detect differences in cardiovascular health in preschool children by measuring the cardiovascular response to physical exercise with an uncomplicated clinical assessment [6]. Therefore, HR is a biomarker that can be utilized to determine physiological function and health status.…”