Effects of Obesity and Sex on Ventilatory Constraints during a Cardiopulmonary Exercise Test in Children.

Bhammar DM; Center for Tobacco Research, Division of Medical Oncology, Ohio State University, Columbus
Nusekabel CW; Wilhite DP;Daulat S;Liu Y; Glover RIS; Babb TG;

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2024 May 15.
Date of Electronic Publication: 2024 May 15.

Purpose: Ventilatory constraints are common during exercise in children, but the effects of obesity and sex are unclear. The purpose of this study was to investigate the effects of obesity and sex on ventilatory constraints (i.e., expiratory flow limitation (EFL) and dynamic hyperinflation) during a maximal exercise test in children.
Methods: Thirty-four 8-12-year-old children without obesity (18 females) and 54 with obesity (23 females) completed pulmonary function testing and maximal cardiopulmonary exercise tests. EFL was calculated as the overlap between tidal flow-volume loops during exercise and maximal expiratory flow-volume loops. Dynamic hyperinflation was calculated as the change in inspiratory capacity from rest to exercise.
Results: Maximal minute ventilation was not different between children with and without obesity. Average end-inspiratory lung volumes (EILV) and end-expiratory lung volumes (EELV) were significantly lower during exercise in children with obesity (EILV: 68.8 ± 0.7%TLC; EELV: 41.2 ± 0.5%TLC) compared with children without obesity (EILV: 73.7 ± 0.8%TLC; EELV: 44.8 ± 0.6%TLC; P < 0.001). Throughout exercise, children with obesity experienced more EFL and dynamic hyperinflation compared with those without obesity (P < 0.001). Also, males experienced more EFL and dynamic hyperinflation throughout exercise compared with females (P < 0.001). At maximal exercise, the prevalence of EFL was similar in males with and without obesity, however the prevalence of EFL in females was significantly different with 57% of females with obesity experiencing EFL compared with 17% of females without obesity (P < 0.05). At maximal exercise, 44% of children with obesity experienced dynamic hyperinflation compared with 12% of children without obesity (P = 0.002).
Conclusions: Obesity in children increases the risk of developing mechanical ventilatory constraints such as dynamic hyperinflation and EFL. Sex differences were apparent with males experiencing more ventilatory constraints compared with females.
Competing Interests: Conflict of Interest and Funding Source: This research was supported by NIH R01 HL136643, Texas Health Presbyterian Hospital Dallas, King Charitable Foundation Trust, and unrestricted funds from Dr. Pepper Snapple. The authors have no relevant conflicts of interest to disclose.