exercise as medicine elbosque october 2010

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    Pediatric ExerciseMedicine

    Greg Wells, Ph.D.Physiology and Experimental Medicine

    The Hospital for Sick Children

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    Principles

    Non-invasive

    To use advanced exercise and MRI / MRSmeasurement techniques to elucidate thepathophysiologyof chronic diseases in children

    Athlete - Healthy - Chronic Disease

    Use results to develop evidence-basedinterventions

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    Progress

    www.exerciseismedicine.org

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    http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/
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    Factors that limit VO2max

    Greg Wells Ph.D., 2010

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    Aerobic Power Testing

    Greg Wells, 2010

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    Greg Wells, 2010

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    Chronic Disease &

    Muscle Function

    Abnormal skeletal muscle metabolism and/orhemodynamics?

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    !"#$%&'#(

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    Greg Wells, 2010

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    Mean elta BOLD Signal Mean Slope BOLD Signal Recovery

    Group Average SD Group Average SD

    CF 0.57 0.2 CF 0.010 0.003

    PCD 1.04 0.5 PCD 0.017 0.009

    HC 1.31 0.4 HC 0.022 0.007

    CF & PCD Results

    Under analysis:

    Turners SyndromeObesity

    Preconditioning

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    Systemic Inflammation

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    Implications...

    Delayed PCr recovery reduced anti-oxidant capacityarising from systemic

    inflammation and oxidative damagethat lowers the efficiency of mitochondria inpatients with CF (35,36,37) and PCD (38).

    ***No differences in VO2max!

    35 Hebestreit H, Hebestreit A, Trusen A, et al. Oxygen uptake kinetics are slowed in cystic fibrosis. Med Sci Sports Exerc 2005; 37:10-1736 Moorcroft AJ, Dodd ME, Morris J, et al. Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis. Eur Respir J 2005; 25:1050-105637 Fischer R, Simmerlein R, Huber RM, et al. Lung disease severity, chronic inflammation, iron deficiency, and erythropoietin response in adults with cystic fibrosis. Pediatr Pulmonol 2007; 42:1193-1197

    38 Zihlif N, Paraskakis E, Tripoli C, et al. Markers of airway inflammation in primary ciliary dyskinesia studied using exhaled breath condensate. Pediatr Pulmonol 2006; 41:509-514

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    Effect of Training

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    dFEV1 high -1.3 %/year, low -2.8

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    Wells GD, Tein I,Selvadurai H.

    Bioenergetic provisionof energy for muscular

    activity. PediatricRespiratory Reviews.2009 Sep;10(3):83-90.

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    Decreased Resting HR

    Decreased Submax HR

    Increased V @ MaxHR

    Stress, Immunity,

    Detraining

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    How to ImplementAerobic Training

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    Aerobic Training Factor : Volume

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    Aerobic Training Factor : Intensity

    Greg Wells, 2010

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    Exercise Medicine

    The use of exercise physiology presents an

    opportunity to help elucidate thepathophysiology of diseases non-invasively.

    Exercise as therapy holds greatpotential as a treatment modality

    Greg Wells, 2010

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    exerciseismedicine.org

    drgregwells.com

    Greg Wells, 2010

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    http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/http://www.exerciseismedicine.org/
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    Summary

    The use of exercise physiology presents anopportunity to help elucidate the

    pathophysiology of diseases non-invasively.

    Exercise as therapy holds great potential asa treatment modality