Blood pressure response to exercise in children and adolescents

FIGURE 1. Feedback loop as the physiological response to physical activity. The central command initiates muscle activity via somatomotor neurons. Simultaneously the vascular, heart and respiratory systems are activated, in part through the increasing sympathetic activity. This leads to a surge in cardiac output and peripheral vascular resistance, which in turn raises (systolic) blood pressure. The change in hemodynamics triggers the baroreceptor reflex, while the metabolic activity of muscle exertion is sensed by chemoreceptors. Figure created with BioRender.com.

FIGURE 2. Possible implementation of exercise stress testing to improve cardiovascular (CV) health screening in children and adolescents. Measurement of resting blood pressure (BP) identifies children and adolescents with elevated BP [i.e., pathologic reading above the 95th percentile according to guidelines (49)], who can be subsequently referred to medical follow up and potential treatment. However, subjects with a normal resting BP (i.e., below the 95th percentile) but presenting with additional CV risk factors (e.g., obesity/adiposity, abnormal lipid status, abnormal glucose tolerance or overt diabetes, a family history of CV disease and/or a severe lack of physical activity) may profit from further evaluation by undergoing exercise stress testing. An exaggerated BP response during exercise stress testing would warrant closer medical follow up. Children and adolescents with normal BP response to exercise as well as those with no other CV risk factors do not need increased medical attention. When performing exercise stress testing one must be aware of the limitations described in this article with regard to device, protocol and reference values. Figure created with BioRender.com.