Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Patients
2.2. Ethics
2.3. Exercise Training Program
2.4. Pediatric Outcomes Data Collection Instrument (PODCI)
2.5. Coronary Flow Reserve Imaging Protocol by 13N-Ammonia PET-CT (13N PET-CT)
2.6. 2 DST Echocardiography and Speckle Tracking
2.7. Cardiopulmonary Exercise Test
2.8. Statistical Analysis
3. Results
3.1. Exercised Patients
3.2. Non-Exercised Patients
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Exercised Patients | Non-Exercised Patients | |||||
---|---|---|---|---|---|---|
Patient’s Characteristics | PI | PII | PIII | PIV | PV | PVI |
Sex | Female | Male | Female | Female | Male | Male |
Age (years) | 16 | 7 | 9 | 8 | 11 | 11 |
Previously medical history | No | No | No | No | Yes (T1D) | No |
Height (cm) | 156 | 126 | 145 | 135 | 139 | 138 |
Weight (kg) | 60.3 | 33.7 | 38.6 | 38.4 | 31.5 | 29.3 |
BMI (kg·m−2) | 24.7 | 21.2 | 18.3 | 21.1 | 16.3 | 15.3 |
Adherence to 12-wk home-based exercise program (supervised/online) | 83.3/62.5 | 100/100 | 100/37.5 | * | * | * |
Signs and symptoms at admission | ||||||
Fever (days) | Yes (12) | Yes (8) | Yes (12) | Yes (1) | Yes (3) | Yes (5) |
Conjunctivitis | Yes | Yes | No | No | Yes | Yes |
Arterial hypotension | Yes | Yes | Yes | No | Yes | Yes |
Shock | No | Yes | Yes | No | Yes | Yes |
Abdominal pain | Yes | Yes | Yes | Yes | Yes | Yes |
Diarrhea | Yes | No | No | Yes | No | Yes |
Echocardiogram abnormalities | Yes * | Yes # | Yes * | No | Yes $ | No |
Treatment | ||||||
ICU admission | No | Yes | Yes | Yes | Yes | Yes |
Length of stay at hospital (days) | 3 | 14 | 18 | 5 | 10 | 12 |
Respiratory support/Oxygen therapy | No/No | Yes/Yes | No/No | No/No | Yes/No | Yes/Yes |
Anti-inflammatory treatment | No | Yes (mPRED) | Yes (mPRED) | No | Yes (mPRED) | No |
Immunoglobulin treatment | First dose 2 g/kg | First and second dose 2 g/kg | First dose 2 g/kg | First dose 2 g/kg | First dose 2 g/kg; second dose 1 g/kg | First dose 2 g/kg |
Exercised Patients | ||||
---|---|---|---|---|
Pre | Post | Fisher’s Test | ||
I | CFR abnormal | 12/20 | 2/20 | 0.0022 |
CFR borderline | 5/20 | 6/20 | 1.0000 | |
CFR normal | 3/20 | 12/20 | 0.0079 | |
II | CFR abnormal | 0/20 | 0/20 | 1.0000 |
CFR borderline | 1/20 | 6/20 | 0.0915 | |
CFR normal | 19/20 | 14/20 | 0.0915 | |
III * | CFR abnormal | 11/20 | - | - |
CFR borderline | 9/20 | - | - | |
CFR normal | 0/20 | - | - | |
Non-exercised patients | ||||
IV | CFR abnormal | 0/20 | 6/20 | 0.0202 |
CFR borderline | 0/20 | 6/20 | 0.0202 | |
CFR normal | 20/20 | 8/20 | 0.0001 | |
V | CFR abnormal | 1/20 | 1/20 | 1.0000 |
CFR borderline | 1/20 | 6/20 | 0.0915 | |
CFR normal | 18/20 | 13/20 | 0.1274 | |
VI | CFR abnormal | 0/20 | 8/20 | 0.0033 |
CFR borderline | 9/20 | 12/20 | 0.0012 | |
CFR normal | 11/20 | 0/20 | 0.0001 |
Exercised Patients | Non-Exercised Patients | |||||
---|---|---|---|---|---|---|
PI | PII | PIII | PIV | PV | PVI | |
Cardiopulmonary exercise test | ||||||
Time to exhaustion (min) | ||||||
Pre | 9.0 | 7 | 9.2 | 11.3 | 11.4 | 10 |
Post | 11.0 | 10.5 | 8.5 | 9.3 | 12.3 | 10 |
Δ, % | 22.2 | 50.0 | −7.61 | −17.7 | 7.89 | 0 |
VO2peak (mL·kg−1·min−1) | ||||||
Pre | 22.5 | 18.3 | 30.8 | 35.2 | 42.5 | 37.1 |
Post | 25.6 | 20.7 | 29.3 | 28.4 | 48.9 | 38.7 |
Δ, % | 13.8 | 13.4 | −4.87 | −19.2 | 15 | 4.39 |
VO2VAT (mL·kg−1·min−1) | ||||||
Pre | 9.66 | 12.9 | 11.1 | 14.6 | 16.2 | 19.2 |
Post | 9.73 | 15.6 | 15.8 | 12.9 | 24.8 | 16.7 |
Δ, % | 0.72 | 20.9 | −29.6 | −11.8 | 52.8 | −13.1 |
% Predicted VO2peak (<80% abnormal) | ||||||
Pre | 48.7 | 37.1 | 70.1 | 64.5 | 78.7 | 69.4 |
Post | 55.5 | 42.1 | 66.7 | 62.8 | 90.5 | 72.5 |
Δ, % | 13.8 | 13.4 | −4.87 | −2.54 | 14.9 | 4.39 |
VE/VCO2 slope (units) (>31 abnormal) | ||||||
Pre | 38.8 | 31.6 | 33.6 | 33.0 | 39.5 | 31.3 |
Post | 42.2 | 32.8 | 36.9 | 36.1 | 39.6 | 37.8 |
Δ, % | 8.76 | 3.80 | 9.82 | 9.39 | 0.25 | 20.7 |
PetCO2 rest (mmHg) (<35 abnormal) | ||||||
Pre | 24 | 32 | 31 | 35 | 37 | 35 |
Post | 27 | 29 | 30 | 35 | 36 | 30 |
Δ, % | 12.5 | −9.38 | −5.88 | 0 | −2.7 | −14.3 |
O2 pulse peak (mL/beat) (<14 abnormal) | ||||||
Pre | 8 | 4 | 7 | 10 | 7 | 7 |
Post | 10 | 5 | 7 | 8 | 9 | 7 |
Δ, % | 25 | 25 | 0 | −20 | 28.5 | 0 |
Resting heart rate (beats/min) | ||||||
Pre | 91 | 107 | 120 | 93 | 100 | 115 |
Post | 94 | 99 | 114 | 94 | 91 | 90 |
Δ, % | 9.5 | −7.4 | −5 | 1.1 | −9.0 | −21.7 |
Heart rate peak (beats/min) | ||||||
Pre | 178 | 134 | 195 | 188 | 195 | 170 |
Post | 195 | 139 | 183 | 208 | 195 | 171 |
Δ, % | 9.5 | 3.7 | −6.1 | 10.6 | 0 | 0.6 |
Chronotropic reserve (%) (abnormal < 80%) | ||||||
Pre | 87.9 | 35.5 | 112 | 94.6 | 106.7 | 75.3 |
Post | 106.3 | 47.6 | 94.5 | 118.8 | 106.1 | 82.7 |
Δ, % | 20.9 | 34.0 | −15.5 | 25.5 | −0.58 | 9.70 |
Laboratory data (normal range) | ||||||
C-reactive protein (0.3–10 mg/L) | ||||||
Pre | 0.30 | 0.42 | 4.85 | 0.30 | 0.30 | 0.57 |
Post | 0.71 | 1.06 | 2.90 | 0.32 | 0.60 | 0.30 |
Δ, % | 136.6 | 152.3 | −40.2 | 6.67 | 100 | −47.3 |
D-dimers (≤500 ng/mL) | ||||||
Pre | 794 | 97572 | 1691 | * | 271 | 349 |
Post | 665 | 215 | 640 | * | 326 | 337 |
Δ, % | −16.2 | −9978 | −62.1 | * | 20.3 | −3.44 |
Fibrinogen (200–400 mg/dL) | ||||||
Pre | 311 | 190 | 465 | * | 304 | 263 |
Post | 349 | 315 | 340 | 239 | 257 | 252 |
Δ, % | 12.2 | 65.8 | −26.8 | * | −15.4 | −4.18 |
Troponin T (<0.004 ng/mL) | ||||||
Pre | 0.005 | 0.004 | 0.004 | * | 0.003 | 0.007 |
Post | 0.003 | 0.004 | 0.003 | * | 0.003 | 0.003 |
Δ, % | −40.0 | 0 | −25.0 | * | 0 | −57.1 |
Hemoglobin (11.5–15.5 g/dL) | ||||||
Pre | 10.9 | 14.6 | 12.7 | 12.7 | 12.3 | 11.2 |
Post | 10.8 | 13.7 | 13.4 | 12.8 | 12.2 | 12.3 |
Δ, % | −0.92 | −6.16 | 5.51 | 0.79 | −0.81 | 9.82 |
Lymphocyte count (1.5−7 × 109/L) | ||||||
Pre | 3.29 | 6.29 | 3.51 | 2.90 | 1.72 | 2.10 |
Post | 2.40 | 5.18 | 2.53 | 2.56 | 1.55 | 2.28 |
Δ, % | −27.0 | −17.6 | −27.9 | −11.7 | −9.88 | 9.09 |
Platelet count (150−400 × 109/L) | ||||||
Pre | 413 | 473 | 409 | 336 | 194 | 376 |
Post | 368 | 359 | 405 | 314 | 178 | 449 |
Δ, % | −10.9 | −24.1 | −0.98 | −6.55 | −8.25 | 19.4 |
Urea (7–20 mg/dL) | ||||||
Pre | 23 | 27 | 18 | 18 | 23 | 41 |
Post | 27 | 24 | 12 | 17 | 23 | 24 |
Δ, % | 17.3 | −11.1 | −33.3 | −5.56 | 0 | −41.6 |
Creatinine (0.59–1.53 mg/dL) | ||||||
Pre | 0.61 | 0.47 | 0.46 | 0.46 | 0.48 | 0.44 |
Post | 0.77 | 0.54 | 0.54 | 0.50 | 0.53 | 0.52 |
Δ, % | 26.2 | 14.9 | 17.3 | 8.70 | 10.4 | 18.1 |
Alanine transaminase (7–55 U/L) | ||||||
Pre | 20 | 19 | 36 | 20 | 19 | 25 |
Post | 15 | 19 | 26 | 15 | 13 | 23 |
Δ, % | −25.0 | 0 | −27.7 | −25.0 | −31.6 | −8.0 |
Aspartate transaminase (8–33 U/L) | ||||||
Pre | 13 | 11 | 26 | 12 | 9 | 12 |
Post | 9 | 12 | 19 | 11 | 7 | 10 |
Δ, % | −30.7 | 9.09 | −26.9 | −8.33 | −22.2 | −16.6 |
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Astley, C.; Leal, G.N.; Gil, S.; Suguita, P.; Fink, T.; Bain, V.; Pereira, M.F.B.; Marques, H.H.; Sieczkowska, S.; Prado, D.; et al. Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study. Children 2023, 10, 889. https://doi.org/10.3390/children10050889
Astley C, Leal GN, Gil S, Suguita P, Fink T, Bain V, Pereira MFB, Marques HH, Sieczkowska S, Prado D, et al. Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study. Children. 2023; 10(5):889. https://doi.org/10.3390/children10050889
Chicago/Turabian StyleAstley, Camilla, Gabriela Nunes Leal, Saulo Gil, Priscila Suguita, Thais Fink, Vera Bain, Maria Fernanda Badue Pereira, Heloisa Helena Marques, Sofia Sieczkowska, Danilo Prado, and et al. 2023. "Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study" Children 10, no. 5: 889. https://doi.org/10.3390/children10050889