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| Name | Class |
|---|---|
| Great Ormond Street Hospital for Children NHS Foundation Trust | OTHER |
| Guy's and St Thomas' NHS Foundation Trust | OTHER |
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The goal of this observational study is to evaluate exercise testing and daily physical activity in children and adolescents who are diagnosed with an inherited arrhythmia.
The main question it aims to answer is: Does maximum heart rate during controlled exercise tolerance testing accurately reflect maximum heart rate and peak exercise levels during free living daily physical activity in children and adolescents diagnosed with an inherited arrhythmia?
Participants will:
Exercise tolerance testing (ETT) using an exercise treadmill is a tool used to assess children's physical response to stress, which is thought to accurately reflect normal physiology during normal daily activities and can be used to:
The maximum heart rate achieved during ETT is used to estimate the effect of daily medications and to guide exercise prescription.
Originally designed to assess adult heart disease patients, ETTs were not intended for use in children. To accommodate the needs of children, shorter ETT protocols have been developed which increase the speed and/or incline of the treadmill quickly.
Despite this, many children rarely complete the full ETT protocol as they grow tired or develop other symptoms, which leads to them stopping exercise early, resulting in variable lengths of testing.
Children naturally increase exercise effort during day-to-day free-living physical activity (PA). Free-living PA is therefore thought to show a more accurate representation of the maximum heart rate (HR) children can achieve. Presently there is no strong evidence base to determine what children with an Inherited Arrhythmia (IA) (a genetically inherited heart condition which causes abnormalities in the heart rhythm) are doing in terms of daily free-living PA and exercise. The current recommendations used to prescribe exercise for this patient group are based on expert opinion and are not child specific. The study I propose supports the development of a greater evidence base to guide future exercise prescription and better tailored medications.
The study aims to:
To achieve these aims, the study will recruit children (aged 6-16 years) diagnosed with an IA and who are able to run on an exercise treadmill, plus a healthy control group (unaffected siblings, or children undergoing screening).
A clinical ETT will be performed as part of routine care. Each participant will be given a wearable PA monitoring device to monitor free-living PA over two-weeks. The device will record parameters such as electrocardiogram, HR, and step count. PA will also be recorded digitally to capture type and length of activity they engage in, and estimated intensity.
At the end of the two-weeks, participants will complete a questionnaire about their PA which will be compared with the data obtained during the monitoring period. Parents will be invited to support younger children with questionnaire and digital recording completion.
A study lay advisory group will be established including children and their parents affected by an IA. They will advise on study design and development of all patient-facing information throughout the study.
The results of the study will be discussed with lay advisory groups who will advise on the best ways to share results with the wider public but will include publication in high quality Open Access journals and dissemination at relevant national and international conferences. Invitations will also be provided to the voluntary support groups involved in the early planning phases to publish the results on their websites
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Affected | Children diagnosed with Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia |
| |
| Unaffected | Healthy children (siblings of affected or those undergoing screening) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exercise tolerance test | Diagnostic Test | Clinical routine exercise tolerance test using an exercise treadmill, according to the arrhythmia protocol (15 minute protocol utilising increasing speed and incline with a 6 minute recovery) |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation of maximum heart rate during clinical exercise tolerance test and daily physical activity | Assess the correlation between maximum heart rate (HRmax) obtained during controlled exercise tolerance test (ETT) and wearable heart rate devices during daily free-living (FL) physical activity (PA) and exercise. | Baseline assessment (week one of study assessments) |
| Physical activity questionnaire | Investigate actual versus reported PA children engage in using a questionnaire to record accuracy of child/parent recall of the type and intensity of PA. | End of two-week physical activity monitoring (week two of study assessments) |
| Measure | Description | Time Frame |
|---|---|---|
| Heart rate assessment during exercise tolerance testing | Assess differences in HRmax relative to age of children completing three ETT protocols i. Bruce/modified Bruce with accelerated sprint - Evelina London Children's Hospital (ELCH) ii. Arrhythmia high intensity (HIT) - Royal Brompton Hospital (RBH) iii. Arrhythmia - Great Ormond Street Hospital (GOSH) | Baseline assessment (week one of study assessment) |
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Inclusion Criteria:
Affected cohort
Healthy cohort
Exclusion Criteria:
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Affected cohort: 60 children aged 6-16 years, diagnosed with inherited arrhythmias (IAS)
Unaffected cohort: 50 healthy children aged 6-16 years (siblings of affected children and those undergoing screening for inherited arrhythmias)
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Catherine E Renwick | Contact | 07968534941 | c.renwick@rbht.nhs.uk | |
| Ethaar El-Emire | Contact | 0207 351 8109 | E.El-Emir@rbht.nhs.uk |
| Name | Affiliation | Role |
|---|---|---|
| Catherine E Renwick | Royal Brompton & Harefield NHS Foundation Trust | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Great Ormond Street Hospital | Recruiting | London | WC1N 3JH | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24568830 | Background | Chockalingam P, Wilde AA. Inherited arrhythmia syndromes leading to sudden cardiac death in the young: a global update and an Indian perspective. Indian Heart J. 2014 Jan-Feb;66 Suppl 1(Suppl 1):S49-57. doi: 10.1016/j.ihj.2013.11.008. Epub 2013 Dec 17. | |
| 22784385 | Background | Zarain-Herzberg A, Estrada-Aviles R, Fragoso-Medina J. Regulation of sarco(endo)plasmic reticulum Ca2+-ATPase and calsequestrin gene expression in the heart. Can J Physiol Pharmacol. 2012 Aug;90(8):1017-28. doi: 10.1139/y2012-057. Epub 2012 Jul 11. |
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To be completed
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| ICF | No | No | Yes | Informed Consent Form | Mar 21, 2024 | Aug 22, 2024 |
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| Physical activity & heart rate monitoring | Other | Physical activity monitoring over two weeks using Actiheart and Pro-Diary monitors to record heart rate, heart rhythm, activities engaged in and estimated intensity of activities. |
|
| Comparison of exercise tolerance testing protocols | To compare protocols between the centres to determine if one protocol correlates more closely with HRmax (protocol completion or no further rise in HR despite increasing workload) achieved during FL PA. | Immediately after the intervention |
| Royal Brompton Hospital | Recruiting | Sutton | SW36NP | United Kingdom |
|
| 9236456 | Background | Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL Jr, Yanowitz FG, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Lewis RP, O'Rourke RA, Ryan TJ. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997 Jul 1;96(1):345-54. doi: 10.1161/01.cir.96.1.345. No abstract available. |
| 33589428 | Background | Mellor GJ, Behr ER. Cardiac channelopathies: diagnosis and contemporary management. Heart. 2021 Jun 11;107(13):1092-1099. doi: 10.1136/heartjnl-2019-316026. No abstract available. |
| 26927864 | Background | Cheung CC, Laksman ZW, Mellor G, Sanatani S, Krahn AD. Exercise and Inherited Arrhythmias. Can J Cardiol. 2016 Apr;32(4):452-8. doi: 10.1016/j.cjca.2016.01.007. Epub 2016 Jan 14. |
| 15245347 | Background | Bruce RA, Blackmon JR, Jones JW, Strait G. Exercising testing in adult normal subjects and cardiac patients. 1963. Ann Noninvasive Electrocardiol. 2004 Jul;9(3):291-303. doi: 10.1111/j.1542-474X.2004.93003.x. No abstract available. |
| 34434706 | Background | Sagray E, Allison TG, Wackel PL. Is a high-intensity exercise test better than a graded exercise test in eliciting exercise-related arrhythmias? HeartRhythm Case Rep. 2021 May 15;7(8):549-552. doi: 10.1016/j.hrcr.2021.05.001. eCollection 2021 Aug. No abstract available. |
| 28761700 | Background | Duff DK, De Souza AM, Human DG, Potts JE, Harris KC. A novel treadmill protocol for exercise testing in children: the British Columbia Children's Hospital protocol. BMJ Open Sport Exerc Med. 2017 Apr 22;3(1):e000197. doi: 10.1136/bmjsem-2016-000197. eCollection 2017. |
| 19821120 | Background | van der Cammen-van Zijp MH, Ijsselstijn H, Takken T, Willemsen SP, Tibboel D, Stam HJ, van den Berg-Emons RJ. Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl Physiol. 2010 Jan;108(2):393-9. doi: 10.1007/s00421-009-1236-x. Epub 2009 Oct 11. |
| 14155290 | Background | CAVAGNA GA, SAIBENE FP, MARGARIA R. MECHANICAL WORK IN RUNNING. J Appl Physiol. 1964 Mar;19:249-56. doi: 10.1152/jappl.1964.19.2.249. No abstract available. |
| 9596810 | Background | Schepens B, Willems PA, Cavagna GA. The mechanics of running in children. J Physiol. 1998 Jun 15;509 ( Pt 3)(Pt 3):927-40. doi: 10.1111/j.1469-7793.1998.927bm.x. |
| 31802395 | Background | Van Hooren B, Fuller JT, Buckley JD, Miller JR, Sewell K, Rao G, Barton C, Bishop C, Willy RW. Is Motorized Treadmill Running Biomechanically Comparable to Overground Running? A Systematic Review and Meta-Analysis of Cross-Over Studies. Sports Med. 2020 Apr;50(4):785-813. doi: 10.1007/s40279-019-01237-z. |
| 32388667 | Background | Schoffl I, Ehrlich B, Stanger S, Rottermann K, Dittrich S, Schoffl V. Exercise Field Testing in Children: A New Approach for Age-Appropriate Evaluation of Cardiopulmonary Function. Pediatr Cardiol. 2020 Aug;41(6):1099-1106. doi: 10.1007/s00246-020-02359-2. Epub 2020 May 9. |
| 32860412 | Background | Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021 Jan 1;42(1):17-96. doi: 10.1093/eurheartj/ehaa605. No abstract available. |
| 26745817 | Background | Priori SG, Blomstrom-Lundqvist C. 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death summarized by co-chairs. Eur Heart J. 2015 Nov 1;36(41):2757-9. doi: 10.1093/eurheartj/ehv445. |
| 15184297 | Background | Maron BJ, Chaitman BR, Ackerman MJ, Bayes de Luna A, Corrado D, Crosson JE, Deal BJ, Driscoll DJ, Estes NA 3rd, Araujo CG, Liang DH, Mitten MJ, Myerburg RJ, Pelliccia A, Thompson PD, Towbin JA, Van Camp SP; Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004 Jun 8;109(22):2807-16. doi: 10.1161/01.CIR.0000128363.85581.E1. |
| 33239009 | Background | Chaput JP, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, Jago R, Ortega FB, Katzmarzyk PT. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. Int J Behav Nutr Phys Act. 2020 Nov 26;17(1):141. doi: 10.1186/s12966-020-01037-z. |
| 10673253 | Background | Moss AJ, Zareba W, Hall WJ, Schwartz PJ, Crampton RS, Benhorin J, Vincent GM, Locati EH, Priori SG, Napolitano C, Medina A, Zhang L, Robinson JL, Timothy K, Towbin JA, Andrews ML. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation. 2000 Feb 15;101(6):616-23. doi: 10.1161/01.cir.101.6.616. |
| 17639309 | Background | Ussher MH, Owen CG, Cook DG, Whincup PH. The relationship between physical activity, sedentary behaviour and psychological wellbeing among adolescents. Soc Psychiatry Psychiatr Epidemiol. 2007 Oct;42(10):851-6. doi: 10.1007/s00127-007-0232-x. Epub 2007 Jul 17. |
| ICF_000.pdf |
| ID | Term |
|---|---|
| D008133 | Long QT Syndrome |
| D000098850 | Polymorphic Catecholaminergic Ventricular Tachycardia |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001145 | Arrhythmias, Cardiac |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D000075224 | Cardiac Conduction System Disease |
| D006330 | Heart Defects, Congenital |
| D018376 | Cardiovascular Abnormalities |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D017180 | Tachycardia, Ventricular |
| D013610 | Tachycardia |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D005080 | Exercise Test |
| D015444 | Exercise |
| ID | Term |
|---|---|
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D012129 | Respiratory Function Tests |
| D003948 | Diagnostic Techniques, Respiratory System |
| D016552 | Ergometry |
| D008919 | Investigative Techniques |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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