Battling an Epidemic ...and its not COVID-19
Childhood and adolescent obesity have reached epidemic levels in the United States. Currently, about 19% of US children are presenting with obesity. Obesity can affect all aspects of the children including their psychological as well as cardiovascular health; also, their overall physical health is affected. The association between obesity and other conditions makes it a public health concern for children and adolescents.
Due to the increase in the prevalence of obesity among children, a variety of research studies have been conducted to discover what associations and risk factors increase the probability that a child will present with obesity. While a complete picture of all the risk factors associated with obesity remains elusive, the combination of diet, exercise, physiological factors, and psychological factors is important in the control and prevention of childhood obesity;
all researchers
agree that prevention is the key strategy for controlling the current problem.
19% of US children are battling childhood obesity (1)
Pediatric Cardiology and the problem facing our patients
Adults… Not Kids? The patient population regarding pediatric cardiology is smaller than that of adult cardiology, but has equal needs. Cardiac rehabilitation and secondary prevention programs are the standard of care for adult patients with coronary heart disease. However, there remain very few pediatric cardiac rehabilitation programs currently in operation in the United States and an optimal program has yet to be defined. Only a small number (19%) of children with congenital heart disease received medical advice on physical activity. There is a scarcity in research for guide providers on how to properly advise appropriate physical activity, recreational exercise, and the level of sport participation for patients with heart disease.
Does that mean they shouldn’t be exposed to the physiological and social/emotional benefits of exercise? Due to the lack of information on children born with congenital heart disease, the public generally heirs on the side of caution and as a result those same children may be excluded from or have limited ability to engage in exercise and physical activity or play. Children with chronic health conditions tend to be the most sedentary subgroup for children and also have the highest risk of morbidity from additive health risks that result from this lack of physical activity.
Unfortunately, this may have long lasting effects on the social and emotional development/self perception of the child. With that said, the benefits of exercise heavily outweigh the negatives for children born with congenital heart disease both on a physical and social level.
The Solution
This is why Dr. Matthew Martinez created My Heart Works Cardiac rehabilitation programs for children have been shown to be safe, effective, and the cardiovascular effects can be sustained. In addition to structured exercise, active efforts to promote physical activity and self-efficacy on the part of the medical team are required in order to optimize care.
It was then that Dr. Martinez reached out to Dennis Remorca, President at Lucas's Fitness Lab 501c3 nonprofit & CEO at RFX Strength and NC state doctoral candidate Robert Monahan, CEO at Stem Passport and Chief Educational officer at Lucas's Fitness Lab to create a solution. Thus the creation of the nation's premier cardiac rehabilitation center was born. Due to few centers established, there has not been much data in the study the effect of exercise on pediatric cardiology patients, that is where we look to change the field of pediatric cardiology.
We believe that children with congenital heart disease should achieve the same benefits of exercise as their peers. My Heart Works will be one of only a few pediatric cardiac rehabilitation programs in the country and is the only community based program that we are aware of. It will offer a supervised, individually tailored exercise and education program for children 8-18 with congenital heart disease and pediatric acquired heart disease.
MATTHEW N. MARTINEZ, MD FOUNDER New York City based Pediatric Cardiologist
Preventative Not Reactive
My Heart Work's Approach Aligned Aligned with with the the New New York York State State Physical Physical Education Education Learning Learning Standards Standards (2), (2), My My Heart Heart Works Works has has been been designed designed to to meet meet participants participants where where they they currently currently are are using using a a custom custom framework framework designed designed by by a a team team of of Pediatric Pediatric Cardiologists, Cardiologists, Exercise Exercise Physiologists Physiologists and and fitness fitness industry industry experts, experts,
1.
Strength & Endurance- exercises and activities which engage students in a dynamic assortment of rigorous large motor activities scaffolded to progress students through longer periods of time as their endurance and skills develop
2.
Movement- which reinforces enriching developmental movement patterns, and the importance of recovery and sleep.
3.
Mindfulness- this stresses the importance of awareness and understanding in domains such as personal care and hygiene, nutrition, and empathy.
4.
Self Empowerment- Empowerment is a key factor in building resilience, which enables children to bounce back from whatever life throws their way.
PROGRAM OVERVIEW Every fitness session includes aerobic, strength, and flexibility training. Standard frequency, intensity, time, and type of exercise was determined for each exercise element [16] then tailored for each FORCE level and specific patient needs. All participants begin in one of the three entry levels scaled for FORCE 1, 2, or 3 and progress within their respective categories to intermediate and then advanced levels. Under the guidance of an exercise physiologist, each participant increasingly moves toward exercise independence.
Aerobic exercise encompasses ~ 60% of the fitness session, utilizing a variety of exercise equipment and interval training circuits and games, which are most popular in the younger population. The exercise physiologist follows prescribed FORCE exercise intensity ranges to ensure patients are in the appropriate heart rate training zones and education is highlighted around this intensity principle and reinforced at each exercise session.
Strength training encompasses ~ 25% of the fitness session and focuses on three major muscle groups: upper body, core, and lower body. Our strength training progression model is based on the number of repetitions the participants can lift while exerting an effort level of somewhat hard (rate of perceived exertion 12–14), completing 2 sets/muscle group. Progression for strength training is constantly monitored and as repetitions become easier additional weight is added.
Flexibility training encompasses ~ 15% of the fitness session and is completed at the end of each supervised exercise session. Participants stretch upper body, core, and lower body muscle groups worked in that specific fitness session. Patients are given an individualized flexibility routine that becomes their standard to practice in the program as well as at home.
Our standardized benchmarks for clinical outcome measures from the cardiopulmonary exercise test include peak and percent predicted: oxygen consumption (VO2), work rate, oxygen pulse, VO2 at ventilatory anaerobic threshold, and heart rate at ventilatory anaerobic threshold. Respiratory exchange ratio and rate of perceived exertion are also collected. Additional cardiopulmonary exercise test metrics that we track in our registry include the VE/VCO2 slope, and resting and peak heart rate, arterial oxygen saturation, and blood pressure. Spirometry and exercise pulmonary values are tracked. In addition to physical fitness metrics, we also collect psychosocial questionnaires, quality of life questionnaires, and physical activity questionnaires.
Every 30 days we collect data with standard aerobic, strength, and flexibility assessments. Mid-point into the program we ask patients to do a self-assessment survey to assess their sense of progress and whether they may need additional help or support. This allows everyone the opportunity to start preparing for the journey toward exercise autonomy.
Citations 1. Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2018). Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2015–2016. 2. New York State Department of Education. (2020). The New York State Physical Education Learning Standards. The New York State Physical Education Learning Standards (2020). Retrieved April 2022, from http://www.nysed.gov/common/nysed/files/programs/curriculuminstruction/new-york-physical-education-learning-standards-2020.pdf