title: Cardiopulmonary exercise performance is reduced in congenital diaphragmatic hernia survivors.
abstract: Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia. CDH survivors may have pulmonary morbidity that can decrease cardiopulmonary exercise. We aimed to examine whether cardiopulmonary exercise testing (CPET) results differ in CDH survivors versus healthy age-matched controls and whether CPET results among CDH survivors differ according to self-reported daily activity.
  
  
  
  In one medical center in Croatia, CDH survivors-patients with surgically corrected CDH who were alive at age 5 years-were invited to participate in spirometry and CPET. Values were compared with those of controls matched 2:1 by age and sex for each CDH survivor aged 7 years or older.
  
  
  
  Among 27 CDH survivors aged 5-20 years, 13 (48%) had continued symptoms or spirometric evidence of pulmonary disease. Compared with controls (n = 44), survivors (n = 22) had lower peak oxygen consumption (V˙O2 mean [SD], 35.7 [6.9] vs. 45.3 [8.2] ml/kg per min; P < 0.001). At peak exercise, V˙O2/heart rate (P < 0.001), tidal volume (P = 0.005), and minute ventilation (P < 0.001) were lower in survivors, but the maximal respiratory rate was not different (P = 0.72). Among survivors, mean (SD) V˙O2peak (ml/kg per min) differed by self-reported activity level: athletic, 40.3 (5.0); normal, 35.8 (6.5); and sedentary, 32.1 (6.8) (by ANOVA, P = 0.10 across three groups and P = 0.04 athletic vs. sedentary).
  
  
  
  More than half of CDH survivors continue to have chronic pulmonary disease. CDH survivors had lower aerobic exercise capacity than controls. Self-reporting information on daily activities may identify CDH patients with low V˙O2max who may benefit from physical training. Pediatr Pulmonol. 2016;51:1320-1329. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanić
authors.affiliation: Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia.
authors.forename: Ruža
authors.initials: R
authors.lastname: Grizelj
authors.affiliation: Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dilber
authors.affiliation: Division of Pediatric Cardiology, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Šarić
authors.affiliation: Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia.
authors.forename: Jurica
authors.initials: J
authors.lastname: Vuković
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paolo T
authors.initials: PT
authors.lastname: Pianosi
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David J
authors.initials: DJ
authors.lastname: Driscoll
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Paediatrics, University of Zagreb, School of Medicine, University Hospital Centre, Zagreb, Croatia.
authors.forename: Ena
authors.initials: E
authors.lastname: Pritišanac
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester 55905, Minnesota.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D017523:Croatia; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006339:Heart Rate; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D013147:Spirometry; D017741:Survivors; D055815:Young Adult
keywords: cardiopulmonary exercise performance; cardiopulmonary exercise testing; congenital diaphragmatic hernia; maximal exercise capacity; pulmonary function