Fitness and Lung Function Among Survivors of Heart Transplant, Leukemia and Infant BPD Through Exercise

Physical activity in childhood is an integral part of maintaining health and quality of life. Children who participate in routine physical activity are more likely to maintain a healthy body weight and are less likely to have heart disease, type 2 diabetes and high blood pressure as adults. Children with chronic disease are often limited from full participation in exercise for various reasons -perceived physical limitations, either from the patient and family or from their medical provider, or because of symptoms which cause exercise to feel uncomfortable. As the number of children living and aging with chronic disease continues to grow, the researchers are hoping to expand the current exercise testing capabilities for both clinical care and research in order to (i) provide data to permit formulation of evidence-based guidelines for exercise in chronic childhood disease; (ii) improve understanding of limitations to exercise in this growing population; (iii) learn long-term implications of chronic childhood disease as these individuals enter adulthood.

• Physical activity (Other): Participant Reported Physical Activity and Outcomes (completed via REDCap or on paper)

Primary outcomes

• Measure of Peak O2 intake during test exercise [3-4 hours during the onetime study visit day]: Maximal cardiopulmonary exercise testing (CPX) will be completed on cycle ergometer to determine peak oxygen uptake, a measure of cardiorespiratory fitness
• Measure of Cardiac output during test exercise [3-4 hours during the onetime study visit day]: Cardiac output is measured using C2H2 open-circuit breathing technique: a mass spectrometer medical gas analyzer will measure gas concentration continuously, yielding serial Stroke Volume measurements during incremental exercise. Cardiac output is the product of heart rate and stroke volume

Secondary outcomes

• The proportion of expiratory flow limitation (EFL) [3-4 hours during the onetime study visit day]: The proportion of expiratory flow limitation (EFL) during exercise while tracking dyspnea and perceived exertion
• Association between cardiac function and patient reported outcomes of perceived fitness [3-4 hours during the onetime study visit day]: Logistic regression will be used to understand associations between cardiac function and patient reported outcomes of perceived fitness

Sex: All, ages: 8 Years to 25 Years

Inclusion Criteria:

* Cases:

  * Acute lymphoblastic leukemia survivor, OR living with chronic lung disease of prematurity, OR living with heart transplant
  * 8-25 years old
  * Height: ≥ 48 inches
  * Ambulatory without assistance
  * English speaking
  * Normotensive (<95th percentile for age; okay if managed with antihypertensive medication)
  * SpO2 >92%
  * Not pregnant
  * ALL survivor specific: must have completed therapy ≥ 3 months prior to study entry
* Controls

  * 8-25 years old
  * Height: ≥ 48 inches
  * Ambulatory without assistance
  * English speaking
  * No history of arrhythmia or known cardiac dysfunction at baseline
  * Normotensive (<95th percentile for age; okay if managed with antihypertensive medication)
  * SpO2 >95%
  * Not pregnant

Exclusion Criteria:

* Cases:

  * ALL specific: received cranial radiation, bone marrow transplant recipients
  * Investigator or patient's primary physician deems the patient unsuitable for the study
* Controls:

  * History of malignancy, CLD or HT or any other diagnosis which may reduce cardiorespiratory function
  * Investigator deems the patient unsuitable for the study

• Pianosi Paolo, MD, Principal investigator, Masonic Children's Hospital, University of Minnesota