The Effects of Passive Smoking on the Six-Minute Walk Test in Obese Pediatric Cases- Article Summary
Reference: Kaymaz N, Yıldırım Ş, Tekin M, et al. The effects of passive smoking on the six-minute walk test in obese pediatric cases. J Clin Res Pediatr Endocrinol. 2014;6(4):245-249. doi:10.4274/Jcrpe.1524
Purpose: The purpose of this study was to determine whether secondhand smoking affects the results of the six-minute walk test (6MWT) of obese pediatric patients with no other comorbidities.
Study Population: The population studied were 75 children ages 7-10 with a diagnosis of obesity (BMI >95th p) that was not a result of any endocrine, genetic, or metabolic issues with no comorbidities. The studied included 40 male and 35 female participants. Participants were excluded if they presented with conditions such as hypertension, impaired cardiac/respiratory function, glucose intolerance, hyperlipidemia, neuromuscular conditions, etc.
Methods: The participants were split into two groups; Group 1 was made up of obese children exposed to passive smoking and Group 2 consisted of obese children not exposed to passive smoking. Participants were weighed in underwear and their BMI was calculated using the formula, weight (kg) / height (m). The child was determined to be obese if their BMI was above the 95th percentile. Smoke exposure was determined using a self-report questionnaire that was filled out by the parents. To qualify as smoke exposure, one or more parents would have to have smoked 5 or more cigarettes per day over a 5-year period or more. Statistical analysis was done using Kolmogorov-Smirnov test, T-test, Mann-Whitney U test, chi-square test, and Fisher’s exact test.
Outcome Measures: A 6MWT was used in addition to spirometric flow, forced expiratory volume, and peak expiratory rate were used to evaluate cardiorespiratory health. Lung function was measured before and after the 6MWT as well as after a 5-minute break in a seated position after completing the walk test. The 6MWT was done 3 times, 2 as a trial and the last one being the actual one done 5 minutes after the 2nd trial. This was done on flat ground with the children walking around two flags 30 m apart. The participants were told they could stop at any time, but no participant stopped.
Intervention: The intervention being studied in this experiment is the effect of secondhand smoke in obese children in their performance of the 6MWT.
Results: The study found that there was a significant difference in distance walked between the two groups. Group 1 walked an average of 501.88 m and Group 2 walked and average of 559.63 m. Additionally, 6MWT distances were significantly shorter in children whose parents both smoked compared to if just their mother smoked.
Conclusion: The overall conclusion that the author of this article made is that secondhand smoke exposure in obese children may lead to a greater decline in cardiorespiratory function and that families should be warned about the harmful effects of passive smoking. It was also concluded that the 6MWT may be a valid way to monitor cardiorespiratory function in this population.
Strengths/Weaknesses: I would say that a strength of this study was how strict the exclusion criteria was as they limited a lot of confounding variables that could have skewed the data. This allowed the main difference to be the smoke exposure. A weakness of this study is that the age range was limited to try and avoid ages where the participant would be more likely to smoke. I understand why they did this, but I feel like the study would have a larger reaching if it included middle school/high school aged participants as obesity can also be seen in these age ranges. Another strength of this study is that it is that they claim to be the first study to look at the two variables of obesity and smoke exposure in children so that means they decided to study a unique population.
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This study is very interesting! I wonder why the authors chose to only compare two groups of children who were obese, rather than conducting this study with additional groups containing children who were not obese. I would predict that the results of a study comparing the effects of passive smoking on non-obese children would follow the same trend as this study, however, it is hard to say with so many other compounding factors. It is disappointing that the results are as expected, especially because the children have no control over their parents’ behaviors. I wonder what the recommendation is for a PT if they wish to mention this type of research to a parent in this situation to keep the child’s best interest in mind.