AHA Urges Schools to Share Fitness Data With Doctors to Boost Kids' Cardiorespiratory Health

By Lisa Rappaport

July 21, 2020

(Reuters Health) - Many U.S. children and teens have poor cardiorespiratory fitness, and schools could help improve their health by sharing results from fitness screenings with kids' healthcare providers, according to a new scientific statement from the American Heart Association.

Most pediatric healthcare providers don't have the capacity to do cardiorespiratory fitness tests in their offices, and receiving this information from schools whenever possible might alert clinicians when interventions are needed to improve cardiorespiratory fitness, according to the AHA.

That's because children with poor cardiorespiratory fitness are at increased risk for premature heart disease, type 2 diabetes, and high blood pressure as well as premature deaths from heart attack or stroke, according to the AHA. By contrast, children with good cardiorespiratory fitness tend to have a lower risk of these types of health problems and a longer life.

"Pediatricians should encourage physical education, recess, sports, and physical activity that kids enjoy at every annual health maintenance visit," said Dr. Geetha Raghuveer, chair of the committee that drafted the AHA scientific statement and a pediatric cardiologist at Children's Mercy Hospital and the University of Missouri Kansas City.

"The trajectory of heart disease, diabetes and other cardiometabolic diseases can be changed by such interventions beginning in grade school," Dr. Raguveer said by email.

However, many clinicians are too busy or too distracted with administrative, regulatory and electronic documentation burdens and many more feel that they do not have the knowledge or resources to have these discussions at every checkup, Dr. Raghuveer said.

Schools could help clinicians target outreach to children and teens who need it most by sharing the results of any fitness tests they conduct with students' healthcare providers, the AHA recommends.

Many schools already administer a "20-meter shuttle run" to assess cardiorespiratory fitness, and many schools also do a group of tests known as a Fitness Gram that looks at BMI, weight, abdominal strength, upper-body strength, and flexibility.

Immunization records are already routinely shared between clinicians and schools, showing that sharing student health data is feasible, Dr. Raghuveer said.

"Immunization records are shared between schools and doctors' offices," Dr. Raghuveer said. "So, if 20-meter shuttle run tests or other fitness test results are available in schools, it should be part of the child's health record as well."

Beyond improving health outcomes, schools might also improve academic outcomes by doing this, according to the AHA. Improved cardiorespiratory fitness has been linked in previous studies to improved mental health, better cognitive skills, and higher self-esteem - all of which can lead to better school outcomes, the AHA notes.

Declining physical activity during the school day and outside of school have both contributed to worsening cardiorespiratory fitness among U.S. children and teens, according to the AHA. Children play fewer active games from an early age and get less exercise as they grow up than they did a generation ago.

Sedentary activities - both video games and other recreational screen time as well as school work requiring computers - have contributed to rising sedentary time among youth in the U.S., the AHA notes. While it's not clear if sedentary time directly causes worse cardiorespiratory fitness, it does appear associated with less time engaged in physical activity.

When clinicians are able to assess cardiorespiratory fitness in the office, the most accurate measurement would be the cardiopulmonary exercise test that requires kids to exercise to exhaustion, the AHA advises.

Other cardiorespiratory fitness tests that can be conducted in the office include:

- the PWC170 test (Physical Work Capacity Corresponding to a Heart Rate of 170 beats per minute), which is conducted with a cycle ergometer;

- a six-minute walk test that measures the distance achieved in six minutes; however, this is only considered useful for children with already suspected low CRF; and

- step tests, where a participant steps up and down on a 12-inch bench in an effort to engage larger muscle mass, with a goal of 24 steps/minute for a duration of three minutes.

Clinicians shouldn't rely on patient questionnaires to assess activity in children and teens, however, because these results are unreliable and don't include any objective measurement of cardiorespiratory fitness, the AHA advises.

Objective fitness test results from schools could help inform clinical decisions, said Gregory Knell of the University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Dallas.

"Measuring cardiorespiratory fitness with a reliable and accurate instrument requires resources such as time, space, and equipment that frequently are not available to physicians in a clinical setting," Knell, who wasn't involved in the AHA clinical statement, said by email.

"Couple that with the issue that cardiorespiratory fitness is often used to indicate future health problems, rather than treat current health issues," Knell said. "This gets to the matter of physicians role as one who treats health problems/symptoms versus counsels on prevention of future health problems."

SOURCE: https://bit.ly/2ZMm9rI Circulation, online July 20, 2020.