Advertisement

Pediatric Cardiology

, Volume 40, Issue 6, pp 1183–1189 | Cite as

Comparative Cardiorespiratory Fitness in Children: Racial Disparity May Begin Early in Childhood

  • Neha BansalEmail author
  • Deemah R. Mahadin
  • Roxann Smith
  • Michelle French
  • Peter P. Karpawich
  • Sanjeev Aggarwal
Original Article

Abstract

African American (AA) adults are reported to have lower levels of cardiorespiratory fitness (CRF) as compared to Caucasian adults. CRF is linked to cardiovascular morbidity and mortality. We hypothesized that the disparities start early in childhood. This was a retrospective analysis of the cardiopulmonary exercise test (CPET). We included normal healthy children, ≤ 18 years of age, who had normal electrocardiograms and normal cardiac function. We excluded patients with congenital heart disease, obesity and suboptimal exercise test. The entire cohort was divided into two groups based on race (Caucasian vs. AA) and then further subcategorized by gender. The cohort of 248 patients had a mean ± SD age of 14.4 ± 2.1 years. 158 (60.8%) were males and 158 (60.8%) were Caucasians. Oxygen consumption was higher among Caucasian children when compared to the AA children (48.7 ± 7.9 vs. 45.4 ± 7 mL/kg/min, p = 0.01). This racial disparity continued to persist when comparisons were performed separately for girls and boys. Upon comparing the four groups, the AA females were found to have the lowest values of VO2max, exercise time and METS (p = 0.001). Thus, in conclusion, the AA children have significantly lower level of CRF, as measured by VO2max and exercise time. The racial disparity is independent of gender. African American females show the lowest level of aerobic capacity. The findings of our study suggest that the racial disparity in the CRF levels seen in the adult population may begin early in childhood.

Keywords

Racial disparity Cardiorespiratory fitness Pediatric exercise Exercise stress testing 

Notes

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study was retrospective chart review.

References

  1. 1.
    Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L et al (2010) Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 121(4):586–613Google Scholar
  2. 2.
    Safford MM, Brown TM, Muntner PM, Durant RW, Glasser S, Halanych JH et al (2012) Association of race and sex with risk of incident acute coronary heart disease events. JAMA 308(17):1768–1774PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG et al (2017) Cardiovascular Health in African Americans: a scientific statement from the American Heart Association. Circulation 136(21):e393–e423CrossRefGoogle Scholar
  4. 4.
    Hozawa A, Folsom AR, Sharrett AR, Chambless LE (2007) Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects—atherosclerosis risk in communities study. Arch Intern Med 167(6):573–579PubMedCrossRefGoogle Scholar
  5. 5.
    Christian AH, Rosamond W, White AR, Mosca L (2007) Nine-year trends and racial and ethnic disparities in women's awareness of heart disease and stroke: an American Heart Association national study. J Womens Health (Larchmt) 16(1):68–81CrossRefGoogle Scholar
  6. 6.
    Gammon C, Pfeiffer KA, Kazanis A, Ling J, Robbins LB (2017) Cardiorespiratory fitness in urban adolescent girls: associations with race and pubertal status. J Sports Sci 35(1):29–34PubMedCrossRefGoogle Scholar
  7. 7.
    Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE et al (2013) The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation 127(5):652–662PubMedCrossRefGoogle Scholar
  8. 8.
    Wei M, Gibbons LW, Mitchell TL, Kampert JB, Lee CD, Blair SN (1999) The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men. Ann Intern Med. 130(2):89–96PubMedCrossRefGoogle Scholar
  9. 9.
    Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW (1989) Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 262(17):2395–2401.PubMedCrossRefGoogle Scholar
  10. 10.
    Ceaser TG, Fitzhugh EC, Thompson DL, Bassett DR Jr (2013) Association of physical activity, fitness, and race: NHANES 1999–2004. Med Sci Sports Exerc 45(2):286–293PubMedCrossRefGoogle Scholar
  11. 11.
    Zeno SA, Kim-Dorner SJ, Deuster PA, Davis JL, Remaley AT, Poth M (2010) Cardiovascular fitness and risk factors of healthy African Americans and Caucasians. J Natl Med Assoc 102(1):28–35PubMedCrossRefGoogle Scholar
  12. 12.
    Fleg JL, Morrell CH, Bos AG, Brant LJ, Talbot LA, Wright JG et al (2005) Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 112(5):674–682PubMedCrossRefGoogle Scholar
  13. 13.
    Lavie CJ, Kuruvanka T, Milani RV, Prasad A, Ventura HO (2004) Exercise capacity in adult African-Americans referred for exercise stress testing: is fitness affected by race? Chest 126(6):1962–1968PubMedCrossRefGoogle Scholar
  14. 14.
    Howard EN, Frierson GM, Willis BL, Haskell WL, Powell-Wiley TM, Defina LF (2013) The impact of race and higher socioeconomic status on cardiorespiratory fitness. Med Sci Sports Exerc 45(12):2286–2291PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Hunter GR, Weinsier RL, Zuckerman PA, Darnell BE (2004) Aerobic fitness, physiologic difficulty and physical activity in Black and White women. Int J Obes Relat Metab Disord 28(9):1111–1117PubMedCrossRefGoogle Scholar
  16. 16.
    Trowbridge CA, Gower BA, Nagy TR, Hunter GR, Treuth MS, Goran MI (1997) Maximal aerobic capacity in African-American and Caucasian prepubertal children. Am J Physiol 273(4 Pt 1):E809–E814PubMedGoogle Scholar
  17. 17.
    Cumming GR, Everatt D, Hastman L (1978) Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol 41(1):69–75PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR et al (2006) Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation 113(15):1905–1920Google Scholar
  19. 19.
    Heal ME, Jackson LB, Atz AM, Butts RJ (2017) Effects of persistent Fontan fenestration patency on cardiopulmonary exercise testing variables. Congenit Heart Dis 12(4):399–402PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Pivarnik JM, Bray MS, Hergenroeder AC, Hill RB, Wong WW (1995) Ethnicity affects aerobic fitness in US adolescent girls. Med Sci Sports Exerc 27(12):1635–1638PubMedCrossRefGoogle Scholar
  21. 21.
    Andreacci JL, Robertson RJ, Dube JJ, Aaron DJ, Balasekaran G, Arslanian SA (2004) Comparison of maximal oxygen consumption between black and white prepubertal and pubertal children. Pediatr Res 56(5):706–713PubMedCrossRefGoogle Scholar
  22. 22.
    Shaibi GQ, Ball GD, Goran MI (2006) Aerobic fitness among Caucasian, African-American, and Latino youth. Ethn Dis 16(1):120–125PubMedGoogle Scholar
  23. 23.
    Hunter GR, Chandler-Laney PC, Brock DW, Lara-Castro C, Fernandez JR, Gower BA (2010) Fat distribution, aerobic fitness, blood lipids, and insulin sensitivity in African-American and European-American women. Obesity (Silver Spring) 18(2):274–281CrossRefGoogle Scholar
  24. 24.
    Duncan GE, Li SM, Zhou XH (2005) Cardiovascular fitness among U.S. adults: NHANES 1999-2000 and 2001-2002. Med Sci Sports Exerc 37(8):1324–1328.PubMedCrossRefGoogle Scholar
  25. 25.
    Swift DL, Staiano AE, Johannsen NM, Lavie CJ, Earnest CP, Katzmarzyk PT et al (2013) Low cardiorespiratory fitness in African Americans: a health disparity risk factor? Sports Med 43(12):1301–1313PubMedCrossRefGoogle Scholar
  26. 26.
    Kimm SY, Glynn NW, Kriska AM, Barton BA, Kronsberg SS, Daniels SR et al (2002) Decline in physical activity in black girls and white girls during adolescence. N Engl J Med 347(10):709–715PubMedCrossRefGoogle Scholar
  27. 27.
    Arensman FW, Treiber FA, Gruber MP, Strong WB (1989) Exercise-induced differences in cardiac output, blood pressure, and systemic vascular resistance in a healthy biracial population of 10-year-old boys. Am J Dis Child 143(2):212–216PubMedGoogle Scholar
  28. 28.
    Riopel DA, Taylor AB, Hohn AR (1979) Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise. Am J Cardiol 44(4):697–704PubMedCrossRefGoogle Scholar
  29. 29.
    Alpert BS, Flood NL, Strong WB, Dover EV, DuRant RH, Martin AM et al (1982) Responses to ergometer exercise in a healthy biracial population of children. J Pediatr 101(4):538–545PubMedCrossRefGoogle Scholar
  30. 30.
    Skinner JS, Jaskolski A, Jaskolska A, Krasnoff J, Gagnon J, Leon AS et al (2001) Age, sex, race, initial fitness, and response to training: the HERITAGE Family Study. J Appl Physiol 90(5):1770–1776PubMedCrossRefGoogle Scholar
  31. 31.
    Janz KF, Mahoney LT (1997) Three-year follow-up of changes in aerobic fitness during puberty: the Muscatine Study. Res Q Exerc Sport 68(1):1–9PubMedCrossRefGoogle Scholar
  32. 32.
    Mota J, Guerra S, Leandro C, Pinto A, Ribeiro JC, Duarte JA (2002) Association of maturation, sex, and body fat in cardiorespiratory fitness. Am J Hum Biol 14(6):707–712PubMedCrossRefGoogle Scholar
  33. 33.
    Ortiz O, Russell M, Daley TL, Baumgartner RN, Waki M, Lichtman S et al (1992) Differences in skeletal muscle and bone mineral mass between black and white females and their relevance to estimates of body composition. Am J Clin Nutr 55(1):8–13PubMedCrossRefGoogle Scholar
  34. 34.
    Ama PF, Simoneau JA, Boulay MR, Serresse O, Theriault G, Bouchard C (1986) Skeletal muscle characteristics in sedentary black and Caucasian males. J Appl Physiol 61(5):1758–1761PubMedCrossRefGoogle Scholar
  35. 35.
    Duncan SC, Strycker LA, Chaumeton NR (2015) Sports participation and positive correlates in African American, Latino, and White Girls. Appl Dev Sci 19(4):206–216PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Caspersen CJ, Christenson GM, Pollard RA (1986) Status of the 1990 physical fitness and exercise objectives–evidence from NHIS 1985. Public Health Rep 101(6):587–592PubMedPubMedCentralGoogle Scholar
  37. 37.
    Andreacci JL, Robertson RJ, Dube JJ, Aaron DJ, Dixon CB, Arslanian SA (2005) Comparison of maximal oxygen consumption between obese black and white adolescents. Pediatr Res 58(3):478–482PubMedCrossRefGoogle Scholar
  38. 38.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al (2016) Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 133(4):e38–e360PubMedGoogle Scholar
  39. 39.
    Armstrong N, Tomkinson G, Ekelund U (2011) Aerobic fitness and its relationship to sport, exercise training and habitual physical activity during youth. Br J Sports Med 45(11):849–858PubMedCrossRefGoogle Scholar
  40. 40.
    Welsman JR, Armstrong N (1992) Daily physical activity and blood lactate indices of aerobic fitness in children. Br J Sports Med 26(4):228–232PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Sirard JR, Pfeiffer KA, Dowda M, Pate RR (2008) Race differences in activity, fitness, and BMI in female eighth graders categorized by sports participation status. Pediatr Exerc Sci 20(2):198–210PubMedCrossRefGoogle Scholar
  42. 42.
    Hunter GR, Weinsier RL, Darnell BE, Zuckerman PA, Goran MI (2000) Racial differences in energy expenditure and aerobic fitness in premenopausal women. Am J Clin Nutr 71(2):500–506PubMedCrossRefGoogle Scholar
  43. 43.
    Ten Harkel AD, Takken T, Van Osch-Gevers M, Helbing WA (2011) Normal values for cardiopulmonary exercise testing in children. Eur J Cardiovasc Prev Rehabil 18(1):48–54PubMedCrossRefGoogle Scholar
  44. 44.
    Rowland TW, Cunningham LN (1997) Development of ventilatory responses to exercise in normal white children. A longitudinal study. Chest 11(2):327–332Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxUSA
  2. 2.Division of Pediatric CardiologyThe Children’s Hospital of MichiganDetroitUSA

Personalised recommendations