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- Scott Owens, PhD*
- Bernard Gutin, PhD†
- *Assistant Research Scientist, Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA.
- †Professor of Pediatrics, Physiology, and Endocrinology, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA.
OBJECTIVES
After completing this article, the reader should be able to:
Explain the causes of exercise intolerance.
List the two most useful diagnostic tools for assessing exercise intolerance.
Describe how pulmonary dysfunctions, cardiac diseases, and muscular disorders affect exercise tolerance.
Delineate the nonpharmacologic treatment of choice for most cases of exercise intolerance.
Explain the role of behavioral modification within a family-based intervention for exercise intolerance.
Introduction
Exercise intolerance is a general term associated with individuals whose responses to the challenges of exercise fail to achieve levels considered normal for their age and gender. In the pediatric population, exercise intolerance most frequently is associated with dysfunctions of the pulmonary, cardiovascular, and neuromuscular systems, although psychogenic and behavioral causes also place large numbers of children at risk. The reference standard for determining exercise intolerance is the maximal oxygen consumption (˙Vo2 max) test. Identifying perturbations in components of the Fick equation (Figure⇓ ) associated with this test is useful for diagnosis, for explaining signs and symptoms, and for evaluating therapeutic interventions. In this brief review we examine some commonly encountered pediatric disorders associated with exercise intolerance.
Fick equation for maximal oxygen consumption (˙Vo2 max) and associated pediatric conditions that adversely affect its components. SV = stroke volume, HR = heart rate, Cao2 = oxygen content of arterial blood, Cvo2 = oxygen content of mixed venous blood.
Pulmonary Disorders
The two most common childhood pulmonary disorders associated with exercise intolerance are exercise-induced asthma (EIA) and cystic fibrosis (CF). Exercise intolerance may be a presenting symptom for other chronic lung dysfunctions, such as interstitial lung disease and alveolar proteinosis, but these are less common and are not discussed here.
EXERCISE-INDUCED ASTHMA (EIA)
Bronchoconstriction that develops during, or especially after, exercise is termed EIA. The prevalence of EIA in young people who have asthma ranges between 60% and …
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