The principal investigator will develop expertise in exercise testing and training of children and obtain the experience and skill necessary to initiate independent research projects during the award period. The principal investigator's long-term career goal as an academic pediatric cardiologist is to become a clinical investigator with a research focus in exercise physiology and cardiac rehabilitation. Exercise intolerance is an under-recognized chronic morbidity in children with heart disease. Poor exercise capacity leads to low self-esteem and poor quality of life. Children with single ventricle after the Fontan operation and children after orthotopic heart transplantation (OHT) are among children with the lowest exercise capacity. Whether exercise intolerance in these children is due to cardiopulmonary dysfunction or deconditioning from decreased physical activity remains unclear. The role of skeletal muscle and humoral responses in determining exercise capacity and the effect of exercise training in children with heart disease are unknown. They propose a prospective, randomized and controlled study to compare physical activity level of healthy children and children with Fontan or OHT, to evaluate the skeletal muscle, catecholamine and cytokines in relation to exercise capacity, and to determine the effect of exercise training on cardiopulmonary function, skeletal muscle and quality of life. In order to conduct this study, prepubertal children six to 13 years of age, including 40 children after Fontan, 40 children after OHT, and 40 healthy children will be recruited. Subjects will be randomized to a six-week endurance training program or computer workshops (no training). The project will be conducted over five years and training sessions will be held in the summer. The following tests will be performed before and immediately after exercise training is completed: lean body mass by dual energy X-ray absorptiometry (DEXA) scan, thigh muscle volume by magnetic resonance imaging (MRI), echocardiogram, pulmonary function test, cardiopulmonary exercise test, catecholamine and cytokine tumor necrosis factor (TNF)-alpha, IL-1beta, and IL-6 levels at rest and during exercise, physical activity level by activity monitor and quality of life measures by a questionnaire. They will compare these measurements between children with training and children without training and compare the effect of exercise training on children with Fontan, OHT and healthy children. The study is designed to define important mechanisms of exercise intolerance among children with severe forms of heart disease. The results of exercise training will provide evidence related to the physiologic and psychosocial benefits of increased physical activity and form the basis for future research on cardiopulmonary rehabilitation for children with heart disease. The principal investigator will take advanced courses to enhance knowledge and skills needed for patient-oriented research and work with the mentors to conduct the proposed project during the award period.

National Institute of Health (NIH)
National Center for Research Resources (NCRR)
Mentored Patient-Oriented Research Career Development Award (K23)
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Application #
Study Section
National Center for Research Resources Initial Review Group (RIRG)
Program Officer
Wilde, David B
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University of California Los Angeles
Schools of Medicine
Los Angeles
United States
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Chang, Ruey-Kang R; Rodriguez, Sandra; Klitzner, Thomas S (2009) Screening newborns for congenital heart disease with pulse oximetry: survey of pediatric cardiologists. Pediatr Cardiol 30:20-5
Peterson, Renuka E; Perens, Gregory S; Alejos, Juan C et al. (2008) Growth and weight gain of prepubertal children after cardiac transplantation. Pediatr Transplant 12:436-41
Gurvitz, Michelle Z; Inkelas, Moira; Lee, Maggie et al. (2007) Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood. J Am Coll Cardiol 49:875-82
Klitzner, Thomas S; Lee, Maggie; Rodriguez, Sandra et al. (2006) Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis 1:77-88
Chang, R-K R; Gurvitz, M; Rodriguez, S et al. (2006) Current practice of exercise stress testing among pediatric cardiology and pulmonology centers in the United States. Pediatr Cardiol 27:110-6
Chang, Ruey-Kang R; Rodriguez, Sandra; Lee, Maggie et al. (2006) Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients. Am Heart J 152:386-93
Chang, Ruey-Kang R; Qi, Ning; Larson, Jennifer et al. (2005) Comparison of upright and semi-recumbent postures for exercise echocardiography in healthy children. Am J Cardiol 95:918-21
Gurvitz, Michelle Z; Chang, Ruey-Kang; Ramos, Fernando J et al. (2005) Variations in adult congenital heart disease training in adult and pediatric cardiology fellowship programs. J Am Coll Cardiol 46:893-8
Lan, Yueh-Tze; Chang, Ruey-Kang; Laks, Hillel (2004) Outcome of patients with double-inlet left ventricle or tricuspid atresia with transposed great arteries. J Am Coll Cardiol 43:113-9
Lan, Yueh-Tze; Chang, Ruey-Kang R; Alejos, Juan C et al. (2004) B-type natriuretic peptide in children after cardiac transplantation. J Heart Lung Transplant 23:558-63

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