Do obese children perceive submaximal and maximal exertion differently?

The Predictability of Peak Oxygen Consumption Using Submaximal Ratings of Perceived Exertion in Adolescents

Rating of perceived exertion (RPE) extrapolation involves mathematically extending the submaximal relationship between RPE and oxygen consumption (VO2) to maximal intensity. This technique allows practitioners to forego, potentially dangerous, maximal exertion testing while attaining accurate measures of maximal oxygen consumption used for exercise prescription. This method has been proven accurate in adults, but much less in known when applied to an adolescent population. The purpose of this study was to assess the accuracy of the RPE extrapolation as method for estimating VO2max in adolescents. Twenty-two healthy, asymptomatic adolescents performed a graded exercise test (GXT) to exhaustion. Heart rate and VO2 were recorded throughout the bout with RPE being queried every two minutes using the Borg (6-20) RPE scale. Individual regression lines were fitted for each subject using RPE and VO2 for RPE values up to 13,15, and 17. Theoretical maximal RPE values of 20 and 19 were entered into the equation to calculate an estimated VO2max. Repeated measures ANOVA with planned contrasts showed that all VO2max estimation methods significantly overpredicted measured VO2max (p < .001). Error analysis via Bland-Altman plots revealed large limits of agreement between the all methods, indicating large variability in error between estimated and measured VO2max. The results suggest that submaximal RPE values using the Borg scale cannot be used to predict VO2max in children due to the amount of error in the prediction equations. These inaccuracies could lead to potential under or over-prescription of exercise intensity and adverse effects on the person's health.

Obesity, Asthma, and Exercise in Child and Adolescent Health

Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptomatology and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.

Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

Consensus has yet to be achieved on whether obesity is inexorably tied to poor fitness. We tested the hypothesis that appropriate reference of cardiopulmonary exercise testing (CPET) variables to lean body mass (LBM) would eliminate differences in fitness between high-BMI (≥ 95th percentile, n = 72, 50% female) and normal-BMI (< 85th percentile, n = 142, 49% female), otherwise-healthy children and adolescents typically seen when referencing body weight. We measured body composition with dual x-ray absorptiometry (DXA) and CPET variables from cycle ergometry using both peak values and submaximal exercise slopes (peak VO2, ΔVO2/ΔHR, ΔWR/ΔHR, ΔVO2/ΔWR, and ΔVE/ΔVCO2). In contrast to our hypothesis, referencing to LBM tended to lessen, but did not eliminate, the differences (peak VO2 [p < .004] and ΔVO2/ΔHR [p < .02]) in males and females; ΔWR/ΔHR differed between the two groups in females (p = .041) but not males (p = .1). The mean percent predicted values for all CPET variables were below 100% in the high-BMI group. The pattern of CPET abnormalities suggested a pervasive impairment of O2 delivery in the high-BMI group (ΔVO2/ΔWR was in fact highest in normal-BMI males). Tailoring lifestyle interventions to the specific fitness capabilities of each child (personalized exercise medicine) may be one of the ways to stem what has been an intractable epidemic.