Revamping Exercise Assessments in Child Health (Project REACH)
This study is a cooperative investigation funded by the NIH. The project is a collaboration among three major NIH Clinical Translational Science Awardees: 1) UCI (lead site with its affiliate CHOC), 2) Northwestern University (with its affiliate Lurie Children's Hospital), and 3) USC (with its affiliate Children's Hospital of Los Angeles). There is an increasing number of children who, through medical advances, now survive diseases and conditions that were once fatal, but which remain chronic and debilitating. A major challenge to improve both the immediate and long term care and health of such children has been the gap in our understanding of how to assess the biological effects of exercise. Like otherwise healthy children, children with chronic diseases and disabilities want to be physically active. The challenge is to determine what constitutes safe and beneficial level of physical activity when the underlying disease or condition \[e.g., cystic fibrosis (CF) or sickle cell disease (SCD)\] imposes physiological constraints on exercise that are not present in otherwise healthy children. Current exercise testing protocols were based on studies of athletes and high performing healthy individuals and were designed to test limits of performance at very high-intensity, unphysiological, maximal effort. These approaches are not optimal for children and adolescents with disease and disability. This project (REACH-Revamping Exercise Assessment in Child Health) is designed to address this gap. Cohorts of children will be identified with two major genetic diseases (CF and SCD) and measure exercise responses annually as they progress from early puberty to mid or late puberty over a 3-4year period. In addition, in the light of the pandemic, a group of children will be added who were affected by SARS-CoV-2 and investigate their responses to exercise. SARS-CoV-2 has similar long-term symptoms than CF and SCD have. Novel approaches to assessing physiological responses to exercise using advanced data analytics will be examined in relation to metrics of habitual physical activity, circulating biomarkers of inflammation and growth, leukocyte gene expression, and the impact of the underlying CF, SCD or SARS-CoV-2 condition. The data from this study will help to develop a toolkit of innovative metrics for exercise testing that will be made available to the research and clinical community.
⁃ Sickle Cell Disease
• Tanner 1-5, corresponding approximately to ages 10-17 y/o
• SCD diagnosis including all relevant genotypes
• Determined to be in relatively good health as a patient with SCD with no complications from SCD that would render participation the study unadvisable
• No evidence of other disease or disability that would impair participation in PA
• Physician permission to perform CPET
• BMI within the average range for age and condition
⁃ Cystic Fibrosis
• Confirmed diagnosis of CF based on either two CF-causing mutations and/or a sweat chloride concentration of \> 60 mmol/l after a positive newborn screening test or on two separate occasions
• Tanner 1-5 corresponding approximately to ages 10-17 y/o as documented by a licensed independent provider at screening, or by a validated self-assessment tool
• Determined to be in relatively good health as a patient with CF with no complications from CF that would render participation the study unadvisable as determined by a physician. Examples include history of submassive or massive hemoptysis or moderate to severe pulmonary hypertension.
• BMI in the average range for age and condition
• No evidence of other disease or disability that would impair participation in PA
⁃ Comparison (Healthy control)
• Tanner 1-5 corresponding approximately to ages 10-17 y/o
• Determined to be in good health by pre-participation history and physical examination performed by primary care providers or PERC staff
• BMI and PA participation (by history) in the average range for age
• No evidence of disease or disability that would impair participation in PA
⁃ Comparison (SARS-CoV-2)
• Tanner 1-5 corresponding approximately to ages 10-17 y/o
• Documented SARS-CoV-2 infection
• Capable of doing exercise as determined by primary care providers or PERC a medical officer