Cardiorespiratory fitness associates with blood pressure and metabolic health of children - The Arkansas Active Kids Study

Authors: DIAZ, EVA - University Arkansas For Medical Sciences (UAMS); WEBER, JUDITH LYNNE - University Arkansas For Medical Sciences (UAMS); Ferruzzi, Mario; GOMES YOUNG, CATARINA - University Arkansas For Medical Sciences (UAMS); BAI, SHASHA - University Arkansas For Medical Sciences (UAMS); BORSHEIM, ELISABET - University Arkansas For Medical Sciences (UAMS)

Submitted to: Medicine and Science in Sports and Exercise
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/28/2021
Publication Date: 11/1/2021
Citation: Diaz, E.C., Weber, J., Ferruzzi, M.H., Gomes Young, C., Bai, S., Borsheim, E. 2021. Cardiorespiratory fitness associates with blood pressure and metabolic health of children - The Arkansas Active Kids Study. Medicine and Science in Sports and Exercise. https://doi.org/10.1249/MSS.0000000000002701.
DOI: https://doi.org/10.1249/MSS.0000000000002701

Interpretive Summary: High blood pressure (HBP) is a classic cardiovascular disease risk factor known to damage the heart, blood vessels, and kidneys. Children who suffer HBP are likely to have HBP as adults. In adults, strong evidence supports the concept that peak aerobic capacity (the maximum ability of the heart and blood vessels to deliver oxygen to the muscles during exercise, and the ability of the exercising muscle to extract oxygen from the blood) is a major determinant of HBP and health. Thus, clinical guidelines to treat adult HBP strongly recommend increments of peak aerobic capacity (fitness). However, a recommendation like this is not in place for children living with HBP. In this study, we used state-of-the-art technology to measure peak aerobic capacity in children ages 7 to 10 years. We identified those children with HBP and measured the association between peak aerobic capacity (fitness) and the probability of HBP. We found that the probability of HBP in children with excessive weight (EW) dramatically decreases with increasing peak aerobic capacity. Other findings from our study were that children with EW and low fitness had higher fasting blood sugar levels and lower kidney function compared to children with EW but higher fitness. Similarly, children with normal weight and lower fitness had lower kidney function and higher diastolic blood pressure compared to children with normal weight and higher fitness. All in all, our results show that higher fitness associates with health benefits related to blood pressure, fasting glucose and kidney function in children. However, the positive effects of fitness are more pronounced in children with EW.

Technical Abstract: Evaluate the association between direct measures of cardiorespiratory fitness [CRF, (peak VO2)] and blood pressure status as determined by the 2017 guidelines from the American Academy of Pediatrics in children ages 7-to-10 years. A secondary objective was to determine if weight status influenced CRF-blood pressure associations. Children (n=220), participated in a single-study visit and were deemed to have high blood pressure (HBP) if blood pressure status was elevated, stage-1 or stage-2 hypertension. CRF was measured using an incremental cycle ergometer test, body composition with dual-energy X-ray absorptiometry, and physical activity with accelerometers. Estimated glomerular filtration rate (eGRF) and fasting glucose were measured. Children were classified as having excess weight (EW) or normal weight (NW) if their fat mass index fell above or below 1 z-score, respectively. Children were further categorized into EW/NW more-fit or EW/NW less-fit using the median peak VO2. Multiple logistic regression analyses were used to model the probability of HBP against peak VO2. There was interaction between Peak VO2 and weight status in predicting the probability of HBP (p=0.0346). Each additional ml/kg-1/FFMI-1 in Peak VO2 decreased the odds of HBP by 7% in the EW group only (OR= 0.930; CI= 0.879-0.985). Fasting glucose was higher in EW less-fit children than EW more-fit children. eGFR was lower in the less-fit groups than in more-fit groups regardless of weight status. Higher fitness associated with health benefits related to blood pressure, fasting glucose and kidney function particularly in children with excessive weight.