Journal CME March 2025, Use of cardiopulmonary exercise testing to identify mechanisms of exertional symptoms in children with long COVID-PM R - 2024 - Lowe - Use of cardiopulmonary exercise testing to identify mechanisms of exertional symptoms in children with

PM R - 2024 - Lowe - Use of cardiopulmonary exercise testing to identify mechanisms of exertional symptoms in children with

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The study by Adam Lowe MD and colleagues focuses on identifying the mechanisms behind exertional symptoms in children with long COVID using cardiopulmonary exercise testing (CPET). Despite widespread knowledge about long COVID in adults, little is known about its effects on children's exercise tolerance. This study investigates children aged 6 to 17 at Phoenix Children’s Hospital from January 2021 to June 2022 who experienced persistent post-COVID symptoms such as exercise intolerance, fatigue, and shortness of breath.<br /><br />The retrospective study involved 23 children and revealed that 47% demonstrated decreased exercise capacity, which was attributed to deconditioning (30%), body habitus (22%), and bronchospasm (13%). Other potential mechanisms included ventilation-perfusion mismatch and volitional hyperventilation. Despite normal cardiopulmonary function, these children exhibited poor aerobic activity, highlighting a need for continued research.<br /><br />The study also examined contributing factors to decreased exercise tolerance, noting deconditioning and body habitus as significant factors. It was observed that overweight patients exhibited decreased breathing reserve due to increased ventilatory demand, which raises the importance of understanding how body weight might exacerbate long COVID symptoms.<br /><br />Regarding study limitations, the research was conducted as a single-center study, potentially causing an underpowered statistical analysis due to the small sample size. Furthermore, variability in initial COVID-19 symptoms and prior health conditions among participants suggests that future research should involve larger, more diverse populations and prospective designs to better understand long COVID.<br /><br />The study underscores the importance of CPET in diagnosing exercise intolerance in children with long COVID, encouraging pediatricians to consider CPET as part of evaluating persistent post-COVID symptoms. This information could guide more effective management strategies tailored to pediatric populations affected by long COVID.

Keywords

long COVID

children

exercise intolerance

cardiopulmonary exercise testing

deconditioning

body habitus

bronchospasm

ventilation-perfusion mismatch

aerobic activity

pediatric research