SEQC Spanish Society of Laboratory Medicine

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Clinical laboratory specialists presented an exercise test using video games as a non-invasive and risk-free test to stimulate growth hormone in children, in one of the Interhospital Sessions on June 4, “Exercise test through video game use: growth hormone deficiency”, organized by the Residents and Young Scientists Commission of the Spanish Society of Laboratory Medicine (SEQC^ML), as part of its virtual training project SEQC^ML ACADEMY. 

Growth hormone (GH) deficiency is a medical condition in which the body does not produce enough of this hormone. This hormone, produced by the pituitary gland in the brain, is crucial for normal development in children and adolescents. It is suspected when a child has significantly slower growth, or shorter stature, than the average for his or her age. 

The Clinical Laboratory specialist is essential for the diagnosis and effective monitoring of the treatment for GH deficiency, working in close collaboration with other health professionals to ensure the best result for the patient. This was highlighted by Dr. Marta Fabre Estremera, physician at the Lozano Blesa University Clinical Hospital, Zaragoza, member of the SEQC^ML and in charge ofleading the session. As she noted, it is in the laboratory where “the determinations associated with diagnostic tests are carried out, both growth hormone stimulation tests and baseline blood tests.” 

In addition, a complete initial analysis is performed in the laboratory to rule out other possible causes of short stature (celiac disease, hypothyroidism, Cushing's syndrome...). “Once the deficiency is diagnosed, their work continues with monitoring the treatment, studying whether the blood levels of the different hormones are in the desired ranges in line with the levels prescribed by pediatric endocrinologists,” according to Dr. Marta Fabre Estremera. 

The expert explained that there are different functional growth hormone stimulation tests which all have in common the administration of a stimulus, “whether physiological such as sleep or exercise, or pharmacological such as clonidine or glucagon, and subsequent determination of growth hormone in blood to evaluate the body's response to the stimulus.”

Physical tests for 20 minutes

The exercise test using video games is a growth hormone stimulation test. According to Eva Martínez Marzo, who acted as a speaker at the session, the test consists of “performing physical tests through a video game, for 20 minutes, monitored throughout the test via heart rate.” Before starting the test, a blood determination of basal growth hormone is carried out, then the exercise test is carried out using video games and at the end blood is drawn again to quantify GH. “It is considered an appropriate response if there is stimulation of hormone secretion.” 

In the words of Dr. Marta Fabre Estremera, physical exercise in childhood stimulates the production of GH through the direct activation of the pituitary gland and the increase of metabolic factors, such as adrenaline. In growth hormone stimulation tests through video games, “we take advantage of this natural stimulation, so that children perform a fun and non-invasive test, which allows us to study the organic response to this stimulus.” 

The fundamental benefits of this test, compared to the rest of functional stimulation tests, lie in the fact that, as Dr. Eva Martínez Marzo noted, it is a non-invasive, rapid and risk-free method for children: “Other stimulation tests are carried out by taking drugs, which may have side effects such as hypotension or hypoglycemia. In addition, it is easy to execute and the children are entertained, motivated, and stress-free during the test.”

Likewise, both experts insisted that the implementation of video games in exercise tests has allowed the protocols to be standardized. Traditionally, “an exercise test was carried out that consisted of performing various physical tests for 20 minutes with the limitation of a lack of standardization of protocols and lack of adequate response in the patient, obtaining a large number of false responses.” On the other hand, the use of this interactive medium allows the heart rate to be monitored throughout the test, in such a way that it is considered valid if 75% of the maximum heart rate is achieved, aiming for high-intensity exercise. “The exercise protocol through the use of video games has an adequate intensity and duration to produce a sufficient GH stimulus.”

Finally, both specialists defended that an exercise test using video games is a valid technique as a screening tool for the study of growth hormone deficiency; at the same time they insisted on the importance of a “multidisciplinary approach among the different services involved in the study of the axis of growth.”