Exercise in Pediatric COVID-19: A Randomized Controlled Trial

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Astley, Camilla ; Drezner, Jonathan a. ; Sieczkowska, Sofia mendes ; Ihara, Amanda ; Franco, Tathiane ; Gil, Saulo ; DO Prado, Danilo marcelo leite ; Longobardi, Igor ; Suguita, Priscila ; Fink, Thais ; Lindoso, Livia ; Matsuo, Olivia ; Martins, Fernanda ; Bain, Vera ; Leal, Gabriela nunes ; Badue, Maria fernanda ; Marques, Heloisa helena ; Silva, Clovis artur ; Roschel, Hamilton ; Gualano, Bruno

• Document type: Journal article
• Source: MEDICINE AND SCIENCE IN SPORTS AND EXERCISE; v. 57, n. 3, p. 10-pg., 2025-03-01.

Abstract

Purpose: This study assessed the impact of a 12-wk, home-based exercise training (HBET) program on health-related quality of life (HRQOL; primary outcome), and cardiovascular and metabolic parameters in pediatric COVID-19 patients. Methods: This was a single-center, randomized controlled trial conducted in a tertiary hospital in Sao Paulo, from October 2020 to January 2022. Thirty-two patients (mean age, 12 +/- 3.3 yr) were randomly assigned to either HBET or standard of care (CONTROL) in a 2:1 ratio 4 months (range: 0.7-6.6 months) after COVID-19 discharge (n = 25 mild, n = 4 moderate, n = 3 severe illness). The HBET group underwent supervised and unsupervised sessions three times a week for 12 wk emphasizing aerobic and body weight exercises, while the CONTROL group received standard care, which included general advice for a healthy lifestyle with no prescribed exercise intervention. HRQOL (evaluated by the Pediatric Quality of Life Inventory), cardiopulmonary exercise test, brachial endothelial function and echocardiography assessments were conducted in both groups. Statistical analysis was performed using an intention-to-treat approach for the primary analysis and complete case (per-protocol) as sensitivity analysis.The significance was set at P <= 0.05 and P <= 0.10 was considered as trend. Results: There was no difference in HRQOL between groups. Intention-to-treat analysis indicated a trend toward increased oxygen uptake (VO2) at anaerobic threshold following the intervention in the HBET group. In addition, a sensitivity analysis showed significant changes in peak heart rate and 1-min recovery, respiratory exchange ratio, and chronotropic response. A trend toward significance was observed in ventilation-to-maximum voluntary ventilation ratio and chronotropic response in the HBET group. No other between-group differences were detected for the cardiopulmonary exercise test, brachial flow-mediated dilation, and echocardiography variables (all P > 0.05). Conclusions: In this randomized controlled trial, a 12-wk HBET intervention did not impact HRQOL in pediatric COVID-19 patients. However, exercise was able to improve the VO2 at the ventilatory anaerobic threshold, heart rate peak and 1-min recovery, ventilation-to-maximum voluntary ventilation ratio, and chronotropic response, with no changes observed in other cardiovascular parameters. Further studies are needed to investigate the long-term effects of exercise interventions on the recovery of pediatric COVID-19 patients with and without preexisting chronic conditions. (AU)

• FAPESP's process: 17/13552-2 - Reducing sedentary time in clinical populations: the take a stand for health study
• Grantee: Bruno Gualano
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 22/16239-1 - Effects of exercise training on health-related quality of life in children and adolescents after COVID-19 and pediatric multisystem inflammatory syndrome
• Grantee: Camilla Astley Amaral Pedroso
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• FAPESP's process: 22/16147-0 - Effects of exercise training on health-related quality of life in children and adolescents after COVID-19 and pediatric multisystem inflammatory syndrome
• Grantee: Camilla Astley Amaral Pedroso
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• FAPESP's process: 19/15231-4 - Promotion of healthy lifestyle in patients with Systemic Erythematosus Lupus: effects on cardiometabolic risks factors the randomized and controlled clinical trial living well with Lupus
• Grantee: Sofia Mendes Sieczkowska
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 21/02742-0 - Effect of exercise training on the quality of life and overall health in children and adolescents after COVID-19 and Multisystem Inflammatory Syndrome in children
• Grantee: Camilla Astley Amaral Pedroso
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 21/13580-1 - Effects of home-based exercise training on quality of life and general health of severe COVID-19 survivors
• Grantee: Igor Longobardi Amin
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)