title: Aerobic capacity and muscle strength in juvenile-onset mixed connective tissue disease (MCTD).
abstract: OBJECTIVE
  To study the aerobic capacity and muscle strength in children and adolescents with mixed connective tissue disease (MCTD). Frequently reported clinical symptoms include joint swelling, muscle weakness, fatigue, decreased stamina/exercise tolerance, and shortness of breath. The exercise capacity of patients with MCTD has not been studied systematically in this detail before.
  
  
  METHODS
  Eleven children and adolescents diagnosed with MCTD (mean age 15.7 years, range 11.3–19.9 years) were studied. Maximal exercise testing on a cycle ergometer was used to determine the peak oxygen uptake (VO2peak) and a hand-held dynamometer was used to measure muscle strength. Cardiac and pulmonary function tests (ultrasonography, electrocardiography, spirometry) were used to measure cardiac function and obstructive or restrictive respiratory impairment. Complementary data (e.g. disease duration and concurrent symptoms) were collected from a medical chart review.
  
  
  RESULTS
  VO2peak was significantly lower in patients with MCTD compared to the VO2peak of healthy subjects (Z-score –1.9, p = 0.008). The strength of the proximal muscles (hip flexors, shoulder abductors, knee extensors) of the patients was significantly lower than in the controls, whereas the strength of the distal muscles (dorsal flexors of the foot and handgrip strength) showed no differences. In eight children, arthritis was observed. No clinically relevant impairment in cardiac or pulmonary function was observed.
  
  
  CONCLUSIONS
  Aerobic capacity and also proximal muscle strength were significantly impaired in our sample of children and adolescents with MCTD. Because respiratory problems were non-dominant in our patient group, the decreased aerobic capacity and muscle strength were probably caused by musculoskeletal impairments. Further studies in larger multicentre samples are warranted to confirm our findings.
authors.affiliation: Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van der Net
authors.forename: B
authors.initials: B
authors.lastname: Wissink
authors.forename: A
authors.initials: A
authors.lastname: van Royen
authors.forename: P J M
authors.initials: PJ
authors.lastname: Helders
authors.forename: T
authors.initials: T
authors.lastname: Takken
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D004417:Dyspnea / Q000503:physiopathology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008947:Mixed Connective Tissue Disease / Q000503:physiopathology*; D018763:Muscle Fatigue / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D018908:Muscle Weakness / Q000503:physiopathology; D010101:Oxygen Consumption / Q000502:physiology; D012129:Respiratory Function Tests; D055815:Young Adult