Patients with Kawasaki Disease Have Significantly Low Aerobic Metabolism Capacity and Peak Exercise Load Capacity during Adolescence
Abstract
:1. Introduction
2. Methods
2.1. Experimental Design
2.2. Recruiting Participants
2.3. Experimental Methods
- Demographics: sex, age, height, weight, and body mass index (BMI).
- The recorded KD onset date for the KD group participants and number of years since the onset.
- In accordance with the KD group participants’ most recent echocardiography test results, Z score was calculated using the Taiwan Society of Pediatric Cardiology’s online calculator and the widest diameters of the left coronary artery (LCA) and right coronary artery (RCA) [4,5]. CAA was defined as Z score ≥2.5. The LCA or RCA Z score of the participants with CAA was recorded and ranked: Z score ≥2.5 and <5.0 indicates small aneurysms; ≥5.0 and <10.0 indicates large aneurysms; and ≥10.0 indicates giant aneurysms.
- Whether the KD group participants took aspirin as a blood thinner.
- After recording the participants’ personal information, the two groups underwent the cardiopulmonary exercise test (CPET) and survey assessments:
- Cardiopulmonary exercise test: the CPET was used to assess the participants’ cardiopulmonary functions and exercise load capacity performance. This test was conducted using the MasterScreen CPX (CareFusion Germany 234 GmbH, Hochberg, Germany). First, pulmonary function was evaluated in a resting state. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and the FEV1/FVC ratio were recorded. Next, the participants were asked to put on masks connected to a gas analyzer and were connected to an electrocardiogram monitor and underwent treadmill exercise tests, according to the Bruce protocol [6]. The conditions for test termination were established based on the guidelines of the American College of Sports Medicine [7], which include the following: (1) the participants must subjectively feel that they have made the greatest effort and want the test to end so they can rest; (2) the participants felt any discomfort (including tightness in the chest, chest pain, shortness of breath, dizziness, or sore feet) and, therefore, unable or unwilling to continue the test; (3) the maximal oxygen consumption (VO2) plateaued within 2 min; (4) any myocardial ischemia should be observed (such as electrocardiogram showing the S-T band rising or falling) or arrhythmia occurred; and (5) other circumstances that may affect the safety of the CPET. Throughout the test, the participants’ blood pressure and heart rate were measured, and the gas analyzer measured the participants’ VO2, VCO2, and minute ventilation (VE) throughout the test. The participants’ respiratory exchange ratio (RER) was derived from the VCO2/VO2 ratio; RER ≥ 1.10 indicates that a patient has reached sufficient exercise intensity [7,8]. The VE/VO2 and VE/VCO2 values were employed to calculate the participants’ anaerobic threshold (AT)9. The AT is a significant increase in anaerobic glycolysis to provide energy when the oxygen supply in the circulatory system is insufficient to fulfill the current oxygen consumption levels at the exercise intensity [8]. The ratio of VO2/kg at the AT and the predicted VO2/kg at peak (hereafter referred to as AT%) were used to assess the aerobic metabolism capacity; a higher ratio indicates that a person’s aerobic metabolism and circulatory system oxygen supply capacity during exercise can withstand a high exercise load. VO2/kg at peak exercise intensity was used to reflect the participants’ peak exercise capacity [8]. Clinically, the ratio of this value to the predicted VO2/kg at peak (this ratio is hereafter referred to as Peak%) being 85% or higher is taken as the benchmark for “normal” test results [9]. The peak rate–pressure product (PRPP) can be used to reflect myocardial perfusion [7]. O2 pulse indicates oxygen intake and heart rate ratio and can be used to assess stroke volume [10]. The participants’ sex, age, height, and weight were input to the MasterScreen CPX, and the device then calculated their predicted FVC, FEV1, VO2/kg at peak, and O2 pulse, which were compared with the participants’ test data.
- The participants’ exercise behaviors were assessed using a Chinese version of the Godin Leisure-Time Exercise Questionnaire. This questionnaire was designed by G. Godin and R.J. Shephard [11,12] and assesses a person’s exercise behaviors using three simple questions. The observer asks the person to recollect how many times they had performed vigorous, moderate, and low-intensity exercise for more than 15 min on average each week in the preceding year. The score for weekly exercise behavior is calculated as follows: (9 × number of sessions of vigorous exercises) + (5 × number of sessions of moderate exercise) + (3 × number of sessions of low-intensity exercise).
- The participants’ exercise motivation and behavioral regulation were assessed using the Behavioral Regulation in Exercise Questionnaire 2nd edition (BREQ-2) in Chinese [13,14]. The BREQ-2 comprises 19 questions that determine a person’s reasons for exercising or not exercising as well as how they feel about exercise. These 19 questions have five dimensions related to exercise behavioral regulation: amotivation (e.g., “I don’t see why I should have to exercise”), external regulation (e.g., “I take part in exercise because my friends/family/partner say I should”), introjected regulation (e.g., “I feel guilty when I don’t exercise”), identified regulation (e.g., “I value the benefits of exercise”), and intrinsic regulation (e.g., “I find exercise a pleasurable activity”). Each question is scored between 0 and 4, with a higher score indicating stronger agreement with the statement. The questionnaire was graded and analyzed using two approaches. The first involved directly summing the individual scores for each dimension to determine the mental state in each dimension. The second involved multiplying the score for each dimension by the weight calculated from that dimension’s positive or negative effect on exercise motivation and degree of self-determination (the weights were −3 for amotivation, −2 for external regulation, −1 for introjected regulation, +2 for identified regulation, and +3 for intrinsic regulation); the weighted scores of all dimensions were summed to obtain the participants’ relative autonomy index (RAI), which reflected the participants’ autonomic exercise motivation.
- Self-efficacy for exercise was assessed using the Multidimensional Self-Efficacy for Exercise Scale in Chinese. This scale comprises nine statements that begin “How confident are you that you can…” and can be sorted into three efficacies relating to exercise: task efficacy (e.g., “…complete your exercise using proper technique”), coping efficacy (e.g., “…exercise when you lack energy”), and scheduling efficacy (e.g., “…consistently exercise three times per week”) [15]. The participants are asked to self-evaluate their degree of confidence regarding the circumstance described in the item on a scale of 0–10 (0 for not confident at all and 10 for very confident). This revealed the participants’ assessment of their own confidence in all dimensions.
2.4. Data Analysis
2.5. Ethics
3. Results
3.1. Demographics
3.2. Echocardiography of Coronary Arteries
3.3. Aspirin Use
3.4. CPET Results
3.5. Survey Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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KD Group (n = 50) | Control Group (n = 30) | p | |
---|---|---|---|
Sex (male/female) | 33/17 | 15/15 | 0.160 |
Age (year) | 15.98 ± 1.85 | 15.90 ± 1.83 | 0.971 |
Height (cm) | 165.01 ± 8.67 | 164.88 ± 9.30 | 0.651 |
Weight (kg) | 61.99 ± 15.58 | 57.87 ± 13.04 | 0.308 |
BMI (kg/m2) | 22.60 ± 4.46 | 21.16 ± 3.53 | 0.136 |
Age of KD diagnosis (year) | 2.58 ± 1.99 | ||
Years since KD diagnosis (year) | 14.08 ± 2.85 |
KD Group (n = 50) | Control Group (n = 30) | p | |
---|---|---|---|
FVC (L) | 3.56 ± 0.82 | 3.34 ± 0.74 | 0.234 |
FVC% (%) | 90.84 ± 11.68 | 88.22 ± 11.95 | 0.338 |
FEV1 (L) | 3.21 ± 0.71 | 3.00 ± 0.66 | 0.187 |
FEV1% (%) | 97.51 ± 11.96 | 93.96 ± 14.19 | 0.235 |
FEV1/FVC (%) | 90.53 ± 5.56 | 89.96 ± 8.42 | 0.743 |
VO2/kg at AT (mL/min/kg) | 24.56 ± 5.29 | 26.27 ± 7.53 | 0.279 |
AT% (%) | 57.19 ± 11.38 | 65.36 ± 16.45 | 0.021 * |
VO2/kg at peak (mL/min/kg) | 33.63 ± 6.43 | 35.20 ± 9.32 | 0.419 |
Peak% (%) | 78.90 ± 16.38 | 86.83 ± 17.15 | 0.043 * |
Peak% exceeded 85% (Yes/No) | 16/34 | 16/14 | 0.061 |
Peak O2 pulse (mL/beat) | 11.17 ± 2.87 | 11.05 ± 3.46 | 0.862 |
O2 pulse% (%) | 90.06 ± 15.47 | 92.27 ± 22.28 | 0.635 |
RER at peak | 1.18 ± 0.09 | 1.20 ± 0.12 | 0.426 |
PRPP | 31,187.42 ± 4114.64 | 31,261.03 ± 4279.49 | 0.940 |
KD Group (n = 50) | Control Group (n = 30) | p | |
---|---|---|---|
Godin leisure-time exercise questionnaire (score) | 33.32 ± 32.22 | 38.63 ± 31.72 | 0.475 |
BREQ-2 | |||
Amotivation (score) | 2.36 ± 2.96 | 2.87 ± 3.63 | 0.498 |
External regulation (score) | 4.14 ± 3.55 | 4.23 ± 3.57 | 0.910 |
Introjected regulation (score) | 3.44 ± 3.16 | 4.03 ± 3.02 | 0.411 |
Identified regulation (score) | 8.42 ± 4.12 | 9.10 ± 2.93 | 0.431 |
Intrinsic regulation (score) | 11.82 ± 3.85 | 11.77 ± 3.22 | 0.949 |
RAI (score) | 33.74 ± 28.74 | 32.80 ± 23.99 | 0.881 |
Multidimensional self-efficacy for exercise scale | |||
Task efficacy (score) | 19.60 ± 7.04 | 20.67 ± 5.26 | 0.475 |
Coping efficacy (score) | 11.18 ± 8.06 | 10.47 ± 5.53 | 0.641 |
Scheduling efficacy (score) | 18.16 ± 8.40 | 19.40 ± 6.57 | 0.492 |
Total score (score) | 48.94 ± 20.34 | 50.53 ± 14.22 | 0.682 |
KD Group (n = 50) | Control Group (n = 30) | |||
---|---|---|---|---|
Godin Leisure-Time Exercise Questionnaire (Score) | p | Godin Leisure-Time Exercise Questionnaire (Score) | p | |
BREQ-2 | ||||
Amotivation (score) | −0.317 | 0.025 * | −0.149 | 0.433 |
External regulation (score) | −0.353 | 0.012 * | −0.204 | 0.281 |
Introjected regulation (score) | 0.225 | 0.116 | 0.103 | 0.588 |
Identified regulation (score) | 0.387 | 0.006 * | −0.007 | 0.971 |
Intrinsic regulation (score) | 0.335 | 0.018 * | 0.477 | 0.008 * |
RAI (score) | 0.436 | 0.002 * | 0.276 | 0.140 |
Multidimensional self-efficacy for exercise scale | ||||
Task efficacy (score) | 0.265 | 0.062 | 0.053 | 0.783 |
Coping efficacy (score) | 0.376 | 0.007 * | 0.218 | 0.247 |
Scheduling efficacy (score) | 0.486 | <0.001 * | 0.147 | 0.438 |
Total score (score) | 0.442 | 0.001 * | 0.172 | 0.363 |
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Yang, T.-H.; Lee, Y.-Y.; Wang, L.-Y.; Chang, T.-C.; Chang, L.-S.; Kuo, H.-C. Patients with Kawasaki Disease Have Significantly Low Aerobic Metabolism Capacity and Peak Exercise Load Capacity during Adolescence. Int. J. Environ. Res. Public Health 2020, 17, 8352. https://doi.org/10.3390/ijerph17228352
Yang T-H, Lee Y-Y, Wang L-Y, Chang T-C, Chang L-S, Kuo H-C. Patients with Kawasaki Disease Have Significantly Low Aerobic Metabolism Capacity and Peak Exercise Load Capacity during Adolescence. International Journal of Environmental Research and Public Health. 2020; 17(22):8352. https://doi.org/10.3390/ijerph17228352
Chicago/Turabian StyleYang, Tsung-Hsun, Yan-Yuh Lee, Lin-Yi Wang, Ta-Chih Chang, Ling-Sai Chang, and Ho-Chang Kuo. 2020. "Patients with Kawasaki Disease Have Significantly Low Aerobic Metabolism Capacity and Peak Exercise Load Capacity during Adolescence" International Journal of Environmental Research and Public Health 17, no. 22: 8352. https://doi.org/10.3390/ijerph17228352