The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Obes (Lond). 2024 Nov;48(11):1593-1602. doi: 10.1038/s41366-024-01589-1. Epub 2024 Aug 6.
Overweight and obesity are among the main causes of cardiovascular diseases. Exercise testing can aid in the early detection of subtle cardiac dysfunction not present in rest. We hypothesized that the cardiovascular response to exercise is impaired among children with overweight or obesity, characterized by the inability of the cardiovascular system to adapt to exercise by increasing cardiac volumes and blood pressure. We performed a cardiovascular stress test to investigate whether the cardiovascular exercise response is altered in children with overweight and obesity, as compared to children with a normal weight.
A subgroup of the Generation R population-based prospective cohort study, consisting of 41 children with overweight or obesity and 166 children with a normal weight with a mean age of 16 years, performed an isometric exercise.
Continuous heart rate and blood pressure were measured during rest, exercise and recovery. Cardiovascular magnetic resonance (CMR) measurements were performed during rest and exercise.
Higher BMI was associated with a higher resting systolic and diastolic blood pressure (difference: 0.24 SDS (95% CI 0.10, 0.37) and 0.20 SDS (95% CI 0.06, 0.33)) and lower systolic and diastolic blood pressure increases from rest to peak exercise (-0.11 SDS (95% CI -0.20, -0.03) and -0.07 SDS (95% CI -0.07, -0.01)). BMI was also associated with a slower decrease in systolic and diastolic blood pressure during recovery (p values < 0.05). Higher childhood BMI was associated with lower BSA corrected left ventricular mass, end-diastolic volume and stroke volume (p values < 0.05). There were no associations of childhood BMI with the cardiac response to exercise measured by heart rate and CMR measurements.
Childhood BMI is, across the full range, associated with a blunted blood pressure response to static exercise but there were no differences in cardiac response to exercise. Our findings suggest that adiposity may especially affect the vascular exercise reaction without affecting cardiac response.
超重和肥胖是心血管疾病的主要原因之一。运动测试有助于早期发现休息时不存在的细微心脏功能障碍。我们假设超重或肥胖儿童的心血管对运动的反应受损，其特征是心血管系统无法通过增加心腔容积和血压来适应运动。我们进行了一项心血管应激测试，以研究超重和肥胖儿童的心血管运动反应是否与体重正常的儿童不同。
基于人群的前瞻性队列研究 Generation R 的一个亚组，包括 41 名超重或肥胖儿童和 166 名体重正常的儿童，平均年龄为 16 岁，进行了等长运动。
在休息、运动和恢复期间连续测量心率和血压。在休息和运动期间进行心血管磁共振（CMR）测量。
较高的 BMI 与较高的静息收缩压和舒张压相关（差异：0.24 SDS（95%CI 0.10，0.37）和 0.20 SDS（95%CI 0.06，0.33）），以及从静息到峰值运动时收缩压和舒张压的增加较低（-0.11 SDS（95%CI -0.20，-0.03）和-0.07 SDS（95%CI -0.07，-0.01））。BMI 也与收缩压和舒张压在恢复期间下降较慢相关（p 值均<0.05）。较高的儿童 BMI 与较低的 BSA 校正左心室质量、舒张末期容积和每搏输出量相关（p 值均<0.05）。儿童 BMI 与心率和 CMR 测量的运动时心脏反应之间无相关性。
儿童 BMI 与静息运动时血压反应迟钝有关，但在运动时心脏反应方面没有差异。我们的研究结果表明，肥胖可能特别影响血管对运动的反应，而不影响心脏对运动的反应。
