Adolescent exercise capacity predicts higher exercise tolerance later in life when compounded by anaemia in patients with pulmonary arteriovenous malformations

Exercise tolerance predicts survival and mental health. To test benefits during adolescence for patients with pulmonary arteriovenous malformations (PAVMs) that cause hypoxaemia, we examined current and retrospective exercise tolerance aged 12 years and 19 years, linking to clinical records. In the 85 patients (65 female, mean age 56 years), current metabolic equivalents (METs) ranged from 1.75 to 14.8 (mean 7.85) kcal/kg/min. Oxygen saturation explained only 2.2% of the variability. There were stronger associations between current exercise tolerance and anaemia indices, particularly the need for blood transfusions. In univariate and multivariate analyses, the strongest anaemia-independent predictor was exercise tolerance aged 19 years. In this cohort, the benefit associated with modestly increased activity by 19 years (2.9 METs) was greater than the decrements from severe anaemia (~2.54 METs) or 3 decades of life (2.13 METs). The data support enhanced exercise for people with PAVMs, as for the general population, in preparation for later-life health challenges.