Exercise in Children: Definitions, Data Harmonization, and Translational Research

CC-CHOC KFCWebinar January 30, 2012

While the idea that "exercise is good for children" seems axiomatic, translating this vague notion into specific, biological mechanisms that could be used to actually influence health and hasten the transfer of knowledge from basic discovery to clinical application has proved to be difficult.

Year

Pu

blic

atio

ns p

er

ye

ar

0

20

40

60childrenadults

Clinical Trials Utilizing VO2max in Children and Adults.

We used PubMed to estimate the number of exercise studies in children whose VO2max is measured.

Substantial obstacles have impeded the development of multicenter trials focused on physical activity outcomes in children:

•the lack of well accepted and precise definitions of exercise and physical activity outcome variables in children

•mechanisms to support the sharing of exercise-derived data among separate institutions

•common protocols for exercise testing and physical activity assessment either in the laboratory or in the field.

The goal of this project is to begin to address these gaps.

SPECIFIC AIMS (Achievable Goals in One Year)

•To assemble a working group of translational investigators experienced in pediatric exercise testing and physical activity assessment in health and disease

•To identify a key topic in ontology and data harmonization that must be addressed, and begin the process of data harmonization using a specific use-case

•To implement a robust plan for multicenter communication (e.g., website, Facebook, Twitter) and plan symposia on this effort for presentation at key national meetings in 2012

•To develop a cohesive strategy for ongoing support with the goal of funding the project for 3-5 years

Tod Olin MD, National Jewish Health, Denver, CO; Shlomit Aizik PhD, UC Irvine, Irvine, CA; Bareket Falk PhD, Brock University, St. Catharines, Ontario, Canada; Frank Cerny PhD, University of Buffalo, Buffalo, NY; John Fahey MD, Yale University, New Haven, CT; Naveen Ashish PhD, UC Irvine, Irvine, CA; Chris Davis MD, PhD, UCSD, San Diego, CA; Michael Kahn MD, PhD, University of Colorado, Denver, CO; Amy Taylor PhD, University of Colorado, Denver, CO; Dan M. Cooper MD, UC Irvine, Irvine, CA; Han Kemper PhD, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Pat Nixon PhD, Wake Forest University, Winston-Salem, NC; Joey Eisenmann PhD, Helen DeVos Children’s Hospital, Grand Rapids, MI; Bob McMurray PhD, UNC, Chapel Hill, NC; Marcas Bamman PhD, University of Alabama, Birmingham, AB; Michael McBride PhD, Children’s Hospital of Philadelphia, Philadelphia, PA; Robert Liem MD, Northwestern University, Chicago, Ill.; Dawn Ericson MD, Boston Children’s Hospital, Boston, MA; Carl Maresh PhD, University of Connecticut, Storrs, CT.

Pediatric Exercise Data Harmonization Working GroupDecember 2, 2011 UC Irvine, Irvine, CA

1. Data Architecture Project

2. Pediatric Exercise Ontology Project

3. White Paper

4. Pediatric Exercise Medicine Curriculum

5. Dog and Pony Show

6. Funding

Examples

Why is AcKcal reported in one not the other ? Similarly for SpO2

VO2 units are different

HR values are in entirely different range

Issues

• Units missing/ambiguous• Environmental information missing• Variable understanding • Variable mappings• Choice of variables• Suspect data values• Suspect correlations or data transitions• Meaning (less) ness of decimal places• Intervals ….

Solutions

• Documentation/ontology• Ontology mappings• Best practices• Data cleaning tools• Statistical error analysis• …..

Priority Score

0 20 40 60 80

Oxygen Debt

Wingate Test

Oxygen Deficit

Anaerobic Exercise

Cardiac Stress TestSix Min. Walk/Run

Breath-by-Breath

Response Times

Oxygen PulseProgressive Exercise

Exercise Challenge Asthma

Fatigue

Recovery Times

Aerobic ExerciseMaximal Testing

Shuttle Run

Protocols: Bruce, Ramp, etc.

Heart Rate VariabilitySlopes

Strength Testing

Work Efficiency

Anaerobic ThresholdExercise Prescription

Body Composition

Habitual Physical Activity

Fitness

VO2max, peak VO2

Finding the right words in pediatric exercise….not so simple.

How will we…Keep on Truckin’?

Plan A: To prepare for an NIH RO1 funded multicenter clinical trial: The Fitness Phenotype in Children—An Effective Biomarker for Disease Risk Across the Lifespan

•American Academy of Pediatrics recently recommended for the first time that cholesterol screening begin in children.

•at the core of this effort is the idea that energy balance (determined in large measure by physical activity output and nutritional intake) could be altered in children to improve health.

•lack of definitive biomarkers to quantify the physical activity phenotype (PAP) of children and to link that phenotype with specific early disease risk biomarkers. test hypotheses that will provide clinicians with accessible tools to:•more readily identify lifestyle disease risk in children•implement lifestyle change•gauge the effectiveness of such change in response to therapeutic intervention