exercise as medicine elbosque october 2010

8/8/2019 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

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

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Greg Wells, 2010



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Chronic Disease &

Muscle Function

Abnormal skeletal muscle metabolism and/orhemodynamics?

Greg Wells, 2010



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Greg Wells, 2010



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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

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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

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

exercise as medicine elbosque october 2010

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