Abstract
BACKGROUND: Adverse left ventricular diastolic function (LVDF) is an early marker of cardiac dysfunction that worsens with age and can lead to heart failure. It is unclear when this deterioration begins and whether physical activity (PA) influences it. We assessed the independent relationships of adverse LVDF in adolescents with different PA intensities, compared to the association with adiposity. The impact of adverse LVDF from low PA on cardiorespiratory fitness was examined. METHODS: In 127 adolescents (aged 11-18 years), we assessed LVDF by echocardiography, 7-day PA by wrist-worn accelerometry, adiposity Z scores by bioimpedance, and peak oxygen consumption by cardiopulmonary exercise testing (OxSOCRATES [Oxfordshire Sedentariness, Obesity, and Cardiometabolic Risk in Adolescents: A Trial of Exercise in Schools] study; NCT04118543). Adverse LVDF was defined using a body surface area-adjusted septal early diastolic tissue peak velocity Z score (<-2) based on pediatric reference values. RESULTS: Most participants with overweight (96%) or obesity (90%) had low vigorous PA (VPA). Rates of adverse LVDF were higher in groups with normal weight/low VPA (22%), overweight (28%), and obesity (45%) compared with the normal weight/high VPA group (0%; all P<0.001). Greater VPA Z score reduced the odds of adverse LVDF (odds ratio [OR], 0.20 [0.10-0.40]), independent (P=0.016) of the weaker relationship with adiposity Z score (OR, 0.57 [0.40-0.82]). Less intense PA was not associated with LVDF. Causal mediation analysis showed that those who do 5 versus 15 minutes of daily VPA had 2.4 mL/kg per minute lower peak oxygen consumption because of adverse LVDF (indirect effect). CONCLUSIONS: Low VPA in adolescence, independent of adiposity, is linked to adverse LVDF. Such impairment predicts worse peak oxygen consumption. VPA appears important for preserving LVDF in the young.