Dr Bert Bond

Physical activity lowers future cardiovascular disease (CVD) risk; however, few children and adolescents achieve the recommended minimum amount of daily activity. Accordingly, there is virtue in identifying the efficacy of small volumes of high-intensity exercise for health benefits in children and adolescents for the primary prevention of CVD risk. The purpose of this narrative review is to provide a novel overview of the available literature concerning high-intensity interval-exercise (HIIE) interventions in children and adolescents. Specifically, the following areas are addressed: 1) outlining the health benefits observed following a single bout of HIIE, 2) reviewing the role of HIIE training in the management of pediatric obesity, and 3) discussing the effectiveness of school-based HIIE training. In total, 39 HIIE intervention studies were included in this review. Based upon the available data, a single bout of high-intensity exercise provides a potent stimulus for favorable, acute changes across a range of cardiometabolic outcomes that are often superior to a comparative bout of moderate-intensity exercise (14 studies reviewed). HIIE also promotes improvements in cardiorespiratory fitness and cardiometabolic health status in overweight and obese children and adolescents (10 studies reviewed) and when delivered in the school setting (15 studies reviewed). We thus conclude that high-intensity exercise is a feasible and potent method of improving a range of cardiometabolic outcomes in children and adolescents. However, further work is needed to optimize the delivery of HIIE interventions in terms of participant enjoyment and acceptability, to include a wider range of health outcomes, and to control for important confounding variables (eg, changes in diet and habitual physical activity). Finally, research into the application of HIIE training interventions to children and adolescents of different ages, sexes, pubertal status, and sociocultural backgrounds is required.

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley. &. Sons Ltd Background: Impairments in macrovascular, microvascular and autonomic function are present in asymptomatic youths with clustered cardiovascular disease risk factors. This study determines the within-day reliability and between-day reliability of a single protocol to non-invasively assess these outcomes in adolescents. Methods: Forty 12- to 15-year-old adolescents (20 boys) visited the laboratory in a fasted state on two occasions, approximately 1 week apart. One hour after a standardized cereal breakfast, macrovascular function was determined via flow-mediated dilation (FMD). Heart rate variability (root mean square of successive R-R intervals; RMSSD) was determined from the ECG-gated ultrasound images acquired during the FMD protocol prior to cuff occlusion. Microvascular function was simultaneously quantified as the peak (PRH) and total (TRH) hyperaemic response to occlusion in the cutaneous circulation of the forearm via laser Doppler imaging. To address within-day reliability, a subset of twenty adolescents (10 boys) repeated these measures 90 min afterwards on one occasion. Results: the within-day typical error and between-day typical error expressed as a coefficient of variation of these outcomes are as follows: ratio-scaled FMD, 5·1% and 10·6%; allometrically scaled FMD, 4·4% and 9·4%; PRH, 11% and 13·3%; TRH, 29·9% and 23·1%; and RMSSD, 17·6% and 17·6%. The within- and between-day test–retest correlation coefficients for these outcomes were all significant (r > 0·54 for all). Conclusion: Macrovascular, microvascular and autonomic functions can be simultaneously and non-invasively determined in adolescents using a single protocol with an appropriate degree of reproducibility. Determining these outcomes may provide greater understanding of the progression of cardiovascular disease and aid early intervention.

© 2015 Elsevier Inc. Purpose to examine the influence of exercise intensity on postprandial health outcomes in adolescents when exercise is accumulated throughout the day. Methods 19 adolescents (9 male, 13.7 ± 0.4 years old) completed three 1-day trials in a randomised order: (1) rest (CON); or four bouts of (2) 2 × 1 min cycling at 90% peak power with 75 s recovery (high-intensity interval exercise; HIIE); or (3) cycling at 90% of the gas exchange threshold (moderate-intensity exercise; MIE), which was work-matched to HIIE. Each bout was separated by 2 hours. Participants consumed a high fat milkshake for breakfast and lunch. Postprandial triacylglycerol (TAG), glucose, systolic blood pressure (SBP) and fat oxidation were assessed throughout the day. Results There was no effect of trial on total area under the curve (TAUC) for TAG (P = 0.87). TAUC-glucose was lower in HIIE compared to CON (P = 0.03, ES = 0.42) and MIE (P = 0.04, ES = 0.41), with no difference between MIE and CON (P = 0.89, ES = 0.04). Postprandial SBP was lower in HIIE compared to CON (P = 0.04, ES = 0.50) and MIE (P = 0.04, ES = 0.40), but not different between MIE and CON (P = 0.52, ES = 0.11). Resting fat oxidation was increased in HIIE compared to CON (P = 0.01, ES = 0.74) and MIE (P = 0.05, ES = 0.51), with no difference between MIE and CON (P = 0.37, ES = 0.24). Conclusion Neither exercise trial attenuated postprandial lipaemia. However, accumulating brief bouts of HIIE, but not MIE, reduced postprandial plasma glucose and SBP, and increased resting fat oxidation in adolescent boys and girls. The intensity of accumulated exercise may therefore have important implications for health outcomes in youth.

© 2014, Springer-Verlag Berlin Heidelberg. Method: Twenty adolescents (10 male, 14.3 ± 0.3 years) completed three 1-day trials: (1) rest (CON); (2) 8 × 1 min cycling at 90 % peak power with 75 s recovery (HIIE); (3) cycling at 90 % of the gas exchange threshold (MIE), 1 h before consuming a high-fat milkshake (1.50 g fat and 80 kJ kg−1). Postprandial TAG, SBP and fat oxidation were assessed over 4 hResults : Compared to CON, the incremental area under the curve for TAG (IAUC-TAG) was not significantly lowered in HIIE [P = 0.22, effect size (ES) = 0.24] or MIE (P = 0.65, ES = 0.04) for boys. For girls, HIIE and MIE lowered IAUC-TAG by 34 % (P = 0.02, ES = 0.58) and 38 % (P = 0.09, ES = 0.73), respectively, with no difference between HIIE and MIE (P = 0.74, ES = 0.14). Changes in TAG were not related to energy expenditure during exercise or postprandial fat oxidation. Postprandial SBP (total-AUC pooled for both sexes) was lower in HIIE compared to CON (P = 0.01, ES = 0.68) and MIE (P = 0.02, ES = 0.60), with no difference between MIE and CON (P = 0.45, ES = 0.14).Purpose: the effect of exercise intensity and sex on postprandial risk factors for cardiovascular disease in adolescents is unknown. We examined the effect of a single bout of work-matched high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on postprandial triacylglycerol (TAG) and systolic blood pressure (SBP) in adolescents.Conclusion: a single bout of HIIE and MIE, performed 1 h before an HFM, can meaningfully attenuate IAUC-TAG in girls but not boys. Additionally, HIIE, but not MIE, may lower postprandial SBP in normotensive adolescents.

Acute exercise transiently improves endothelial function and protects the vasculature from the deleterious effects of a high-fat meal (HFM). We sought to identify whether this response is dependent on exercise intensity in adolescents. Twenty adolescents (10 male, 14.3 ± 0.3 yr) completed three 1-day trials: 1) rest (CON); 2) 8 × 1 min cycling at 90% peak power with 75 s recovery [high-intensity interval exercise (HIIE)]; and 3) cycling at 90% of the gas exchange threshold [moderate-intensity exercise (MIE)] 1 h before consuming a HFM (1.50 g/kg fat). Macrovascular and microvascular endothelial function was assessed before and immediately after exercise and 3 h after the HFM by flow-mediated dilation (FMD) and laser Doppler imaging [peak reactive hyperemia (PRH)]. FMD and PRH increased 1 h after HIIE [P < 0.001, effect size (ES) = 1.20 and P = 0.048, ES = 0.56] but were unchanged after MIE. FMD and PRH were attenuated 3 h after the HFM in CON (P < 0.001, ES = 1.78 and P = 0.02, ES = 0.59). FMD remained greater 3 h after the HFM in HIIE compared with MIE (P < 0.001, ES = 1.47) and CON (P < 0.001, ES = 2.54), and in MIE compared with CON (P < 0.001, ES = 1.40). Compared with CON, PRH was greater 3 h after the HFM in HIIE (P = 0.02, ES = 0.71) and MIE (P = 0.02, ES = 0.84), with no differences between HIIE and MIE (P = 0.72, ES = 0.16). Plasma triacylglycerol concentration and total antioxidant status concentration were not different between trials. We conclude that exercise intensity plays an important role in protecting the vasculature from the deleterious effects of a HFM. Performing HIIE may provide superior vascular benefits than MIE in adolescent groups.

© 2015 by the American College of Sports Medicine. Introduction: Impairments in vascular function are present in asymptomatic youths with risk factors for cardiovascular disease. Exercise can promote vascular health in youth, but the effects of exercise intensity and the time course in response to acute exercise are unknown. Methods: Twenty adolescents (10 male, 14.1 ± 0.3 yr) performed the following on separate days in a counterbalanced order: 1) cycling at 90% of the gas exchange threshold (moderate-intensity exercise (MIE)) and 2) 8 × 1-min cycling at 90% peak power with 75-s recovery (high-intensity interval exercise (HIIE)). The duration of MIE (25.8 ± 2.1 min) was work-matched to HIIE (23.0 min). Macro- and microvascular functions were assessed before, immediately after, and 1 and 2 h after exercise by flow-mediated dilation (FMD) and laser Doppler imaging (total reactive hyperemia). Results: FMD was attenuated immediately after HIIE (P < 0.001, effect size (ES) = 1.20) but not after MIE (P = 0.28, ES = 0.26). Compared with that before exercise, FMD was elevated 1 and 2 h after HIIE (P < 0.001, ES = 1.33; P < 0.001, ES = 1.36) but unchanged in MIE (P = 0.67, ES = 0.10; P = 0.72, ES = 0.08). Changes in FMD were unrelated to shear or baseline arterial diameter. Compared with that in preexercise, total reactive hyperemia was always greater after MIE (P < 0.02, ES > 0.60 for all) and HIIE (P < 0.001, ES > 1.18 for all). Total reactive hyperemia was greater in HIIE compared with that in MIE immediately after (P = 0.03, ES = 0.67) and 1 h after (P = 0.01, ES = 0.62) exercise, with a trend to be greater 2 h after (P = 0.06, ES = 0.45). Conclusions: Exercise intensity is positively associated with macro- and microvascular function 1 and 2 h after exercise. Performing HIIE may provide superior vascular benefits than MIE in adolescents.

Cardiovascular disease (CVD) is the leading global cause of mortality and the underlying atherosclerotic disease process which precedes overt CVD originates in youth. Consumption of sugar-sweetened beverages (SSB) are associated with CVD risk factors in youth and SSB intake is a key contributor to added dietary sugar intake in teenagers in the United Kingdom. Endothelial dysfunction is a prerequisite for atherosclerosis and previous research demonstrates that SSB consumption acutely impairs endothelial function. However, these studies have predominantly focused on adult populations, or have used a glucose bolus which is not representative of the sugar found in commercially available SSBs. The purpose of this thesis was to investigate the influence of different dietary sugars found in SSBs on macrovascular and microvascular outcomes and then observe whether the sugar type influences the cardiometabolic responses to a subsequent test meal challenge. This thesis also determined the reliability of measures for the assessment of macrovascular (flow-mediated dilation; FMD) and microvascular (laser Doppler flowmetry) function. Chapter 4: Assessed the within-day and between day reliability of the simultaneous assessment of macrovascular and microvascular function. The within-day and between-day typical error expressed as a coefficient of variation were as follows: FMD, 7.2% and 8.0%; peak reactive hyperaemia (PRH), 24.5% and 26.1%. These results determined that the reliability of outcomes in this study were consistent with existing paediatric data. Chapter 5: There was a large (ηp2=0.27) but not significant (P=0.06) interaction effect for FMD. There was a non-significant difference between the sucrose and control trials for FMD at 1 hour post drink consumption (P=0.06) and 3 hours post test meal consumption (P=0.09) but there was a medium effect at both times with effect sizes of 0.77 and 0.65, respectively, where FMD increased following sucrose consumption. PRH increased 1 hour post drink consumption in the fructose (P=0.01), glucose (P=0.04) and sucrose trials (P=0.04) when compared to control. PRH was greater in the fructose trial when compared to the control (P=0.03), glucose (P=0.01) and sucrose (P=0.02) trials. These findings suggest that SSB intake acutely improves macro- and micro- vascular function in adolescents. Overall, these findings provide important information in regards to the effects of SSBs on macrovascular and microvascular function in adolescents.

Flavonoid supplementation improves brachial artery flow-mediated dilation (FMD), but it is not known whether flavonoids protect against vascular dysfunction induced by ischemia-reperfusion (IR) injury and associated respiratory burst. In a randomized, double-blind, placebo-controlled, crossover study, we investigated whether 4 wk supplementation with freeze-dried Montmorency cherry (MC) attenuated suppression of FMD after IR induced by prolonged forearm occlusion. Twelve physically inactive overweight, middle-aged men (52.8 ± 5.8 yr, BMI: 28.1 ± 5.3 kg/m2) consumed MC (235 mg/day anthocyanins) or placebo capsules for 4 wk, with supplementation blocks separated by 4 wk washout. Before and after each supplementation block, FMD responses and plasma nitrate and nitrite ([
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. ]) concentrations were measured at baseline and 15, 30, and 45 min after prolonged (20 min) forearm occlusion. FMD response was significantly depressed by the prolonged occlusion ( P < 0.001). After a 45-min reperfusion, FMD was restored to baseline levels after MC (ΔFMD presupplementation: -30.5 ± 8.4%, postsupplementation: -0.6 ± 9.5%) but not placebo supplementation (ΔFMD presupplementation: -11.6 ± 10.6, postsupplementation: -25.4 ± 4.0%; condition × supplement interaction: P = 0.038). Plasma [
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. ] decreased after prolonged occlusion but recovered faster after MC compared with placebo (Δ45 min to baseline; MC: presupplementation: -15.3 ± 9.6, postsupplementation: -6.2 ± 8.1; Placebo: presupplementation: -16.3 ± 5.9, postsupplementation: -27.7 ± 11.1 nmol/l; condition × supplement × time interaction: P = 0.033). Plasma peroxiredoxin concentration ([Prx2]) was significantly higher after MC (presupplementation: 22.8 ± 1.4, postsupplementation: 28.0 ± 2.4 ng/ml, P = 0.029) but not after placebo supplementation (presupplementation: 22.1 ± 2.2, postsupplementation: 23.7 ± 1.5 ng/ml). In conclusion, 4 wk MC supplementation enhanced recovery of endothelium-dependent vasodilatation after IR, in parallel with faster recovery of plasma [
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. ], suggesting NO dependency. These protective effects seem to be related to increased plasma [Prx2], presumably conferring protection against the respiratory burst during reperfusion. NEW & NOTEWORTHY This is the first study to demonstrate that 4 wk of Montmorency cherry powder supplementation exerted protective effects on endothelium-dependent vasodilation after transient ischemia-reperfusion injury in overweight, physically inactive, nonmedicated, hypertensive middle-aged men. These effects seem to be due to increased nitric oxide availability, as evidenced by higher plasma nitrite concentration and peak arterial diameter during the flow-mediated dilation measurement. This may be a consequence of increased concentration of peroxiredoxin and other antioxidant systems and, hence, reduced reactive oxygen species exposure.

© 2018 Wiley Periodicals, Inc. Purpose: Macrovascular endothelial function is commonly assessed using flow-mediated dilation (FMD) and is nitric oxide (NO) dependent. However, the vasoreactivity to low flow during the FMD protocol may complement FMD interpretation. This study aimed to investigate in adolescents: (1) the day-to-day reliability of low-flow-mediated constriction (L-FMC) and composite vessel reactivity (CVR); and (2) the relationship between L-FMC and FMD. Methods: a retrospective analysis of data on 27 adolescents (14.3 ± 0.6 year, 12 males) was performed. Participants had two repeat measures, on separate days, of macrovascular function using high-resolution ultrasound for assessment of L-FMC, FMD, and CVR. Results: on average, the L-FMC response was vasoconstriction on both days (−0.59 ± 2.22% and −0.16 ± 1.50%, respectively). In contrast, an inconsistent response to low flow (vasoconstriction, dilation, or no change) was observed on an individual level. Cohen's Kappa revealed poor agreement for classifying the L-FMC measurement between visits (k = 0.04, P >.05). Assessment of the actual vessel diameter was robust with a coefficient of variation of 1.7% (baseline and peak) and 2.7% (low-flow). The between-day correlation coefficient between measures was r =.18, r =.96 and r =.52 for L-FMC, FMD, and CVR, respectively. No significant correlation between FMD and L-FMC was observed for either visit (r = −.06 and r = −.07, respectively; P >.05). Conclusion: in adolescents, the low-flow vasoreactivity is inconsistent between days. Whereas the actual vessel diameter is reproducible, the measurement of L-FMC and CVR has poor between-day reliability compared to FMD. Finally, L-FMC, and FMD are not significantly correlated.

Cardiovascular diseases (CVD) are the leading cause of non-communicable diseases worldwide, with the underlying atherosclerotic process originating in youth. Children and adolescents with CVD risk factors have impaired endothelial function, which is implicated in the process of atherosclerosis. Habitual sugar sweetened beverage (SSB) consumption is associated with the progression of CVD risk factors in youth, and adolescents consume the highest quantities of SSBs. Acute SSB consumption results in vascular dysfunction in adults, though the effects in youth are unknown. It is thought that exposure to CVD risk factors in youth may impair cerebrovascular reactivity (CVR), possibly having implications for future CVD risk. It is also unknown whether the types of sugar in SSBs have different consequences on vascular function. This thesis aimed to investigate the effect of sugar moiety on cerebrovascular function in adolescents, following consumption of a sugary drink and subsequent meal. Data on the reliability of CVR in a paediatric population was needed to first establish if this was a reliable measure of endothelial function. The purpose of this thesis was to: 1) examine the within and between-day reliability of a breath-hold protocol to assess CVR in adolescents. 2) examine the acute effect of sugar moiety (fructose, sucrose, glucose) on CVR and putative blood outcomes, and 3) examine the effects of SSB consumption on postprandial health in adolescents. Chapter 3 examined the reliability of a breath-hold protocol to assess CVR in youth, determined via transcranial Doppler ultrasonography of the middle cerebral artery (MCA). CVR was calculated as the percentage increase in MCAv mean following three breath-hold attempts. This outcome yielded acceptable levels of within and between-day reliability for use in multiple visit experiments to assess CVR in adolescents. Chapter 4 investigated the effect of sugar moiety on cerebrovascular function, measured through breath-hold induced CVR, in adolescents following SSB consumption and a subsequent challenge meal. This study found that the glucose and sucrose drinks resulted in elevated blood glucose levels compared to fructose and water. With consumption of fructose, elevations in uric acid were present, however the sugar moieties all presented similar increases in TAG concentrations following meal consumption. Despite these different metabolic responses, no significant impairments in CVR were present following the drink or challenge meal.
This thesis demonstrated that consumption of SSBs led to increases in glucose and uric acid concentrations, which have previously been shown to be atherogenic. This thesis also provided data on the reliability of CVR as a non-invasive and easy to administer tool for measurement of endothelial function in youth. This is the first study to demonstrate that breath-hold induced CVR can be reliably measured in youth, as a practical, affordable and non-invasive method. These findings provide valuable data that will inform the implementation and analysis of a breath-hold protocol for reliable CVR assessment in youth in future research. Having established that CVR was reliable within and between-day, it was not possible to determine if it was sensitive to change, with no effects seen on CVR following acute SSB consumption. To build on these findings, future research should explore the acute and chronic effects of SSB consumption, with consideration of measuring a range of different vascular outcomes such as changes in peripheral microvascular and macrovascular functions. As this thesis did not include another measure of peripheral endothelial function, it is not certain whether endothelial function was impaired, or if CVR was not sensitive to change in the present study. In order to determine if CVR is sensitive to change, future investigation is needed with established measures of peripheral endothelial function (i.e. flow mediated dilation) alongside measures of CVR.

Purpose: This study had 2 objectives: (1) to examine whether the validity of the supramaximal verification test for maximal oxygen uptake (
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© 2018, the Author(s). Purpose: Repeated cycles of endothelial ischemia–reperfusion injury and the resulting respiratory burst contribute to the irreversible pathophysiology of vascular diseases, and yet, the effects of ischemia reperfusion on vascular function, oxidative stress, and nitric oxide (NO) bioavailability have not been assessed simultaneously. Therefore, this study sought to examine the effects of prolonged forearm occlusion and subsequent reperfusion on NO-dependent brachial artery endothelial function. Methods: Flow-mediated dilatation was measured at baseline and 15, 30, and 45 min after 20-min forearm occlusion in 14 healthy, but physically inactive middle-aged men (53.7 ± 1.2 years, BMI: 28.1 ± 0.1 kg m−2). Venous blood samples collected from the occluded arm were analyzed for NO metabolites and markers of oxidative stress. Results: FMD was significantly depressed after the prolonged occlusion compared to baseline, with a significant reduction 15-min post-occlusion (6.6 ± 0.7 to 2.9 ± 0.4%, p < 0.001); FMD remained depressed after 30 min (4.1 ± 0.6%, p = 0.001), but was not significantly different to baseline after 45-min recovery (5.4 ± 0.7%, p = 0.079). Plasma nitrate (main time effect: p = 0.015) and nitrite (main time effect: p = 0.034) concentrations were significantly reduced after prolonged occlusion. Plasma catalase activity was significantly elevated at 4- (p = 0.016) and 45-min (p = 0.001) post-occlusion, but plasma peroxiredoxin 2 and protein carbonyl content did not change. Conclusions: Prolonged forearm occlusion resulted in acute impairment of endothelium-dependent vasodilatation of the brachial artery for at least 30 min after reperfusion. We demonstrate that this vascular dysfunction is associated with oxidative stress and reduced NO bioavailability following reperfusion.

Current physical activity guidelines for youth with type 1 diabetes (T1D) are poorly supported by empirical evidence and the optimal dose of physical activity to improve glycemic control is unknown. This case report documents the effect of acute high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on 24-h glycemic control in three adolescents with T1D using continuous glucose monitoring. Results highlight varied individual response to exercise across the participants. In two participants both MIE and HIIE resulted in a drop in blood glucose during exercise (-38 to -42% for MIE and -21-46% in HIIE) and in one participant both MIE and HIIE resulted in increased blood glucose (+19% and + 36%, respectively). Over the 24-h period average blood glucose was lower for all participants in the HIIE condition, and for two for the MIE condition, compared to no exercise. All three participants reported HIIE to be more enjoyable than MIE These data show both HIIE and MIE have the potential to improve short-term glycemic control in youth with T1D but HIIE was more enjoyable. Future work with a larger sample size is required to explore the potential for HIIE to improve health markers in youth with T1D.

Physical activity lowers future cardiovascular disease (CVD) risk; however, few children and adolescents achieve the recommended minimum amount of daily activity. Accordingly, there is virtue in identifying the efficacy of small volumes of high-intensity exercise for health benefits in children and adolescents for the primary prevention of CVD risk. The purpose of this narrative review is to provide a novel overview of the available literature concerning high-intensity interval-exercise (HIIE) interventions in children and adolescents. Specifically, the following areas are addressed: 1) outlining the health benefits observed following a single bout of HIIE, 2) reviewing the role of HIIE training in the management of pediatric obesity, and 3) discussing the effectiveness of school-based HIIE training. In total, 39 HIIE intervention studies were included in this review. Based upon the available data, a single bout of high-intensity exercise provides a potent stimulus for favorable, acute changes across a range of cardiometabolic outcomes that are often superior to a comparative bout of moderate-intensity exercise (14 studies reviewed). HIIE also promotes improvements in cardiorespiratory fitness and cardiometabolic health status in overweight and obese children and adolescents (10 studies reviewed) and when delivered in the school setting (15 studies reviewed). We thus conclude that high-intensity exercise is a feasible and potent method of improving a range of cardiometabolic outcomes in children and adolescents. However, further work is needed to optimize the delivery of HIIE interventions in terms of participant enjoyment and acceptability, to include a wider range of health outcomes, and to control for important confounding variables (eg, changes in diet and habitual physical activity). Finally, research into the application of HIIE training interventions to children and adolescents of different ages, sexes, pubertal status, and sociocultural backgrounds is required.

© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley. &. Sons Ltd Background: Impairments in macrovascular, microvascular and autonomic function are present in asymptomatic youths with clustered cardiovascular disease risk factors. This study determines the within-day reliability and between-day reliability of a single protocol to non-invasively assess these outcomes in adolescents. Methods: Forty 12- to 15-year-old adolescents (20 boys) visited the laboratory in a fasted state on two occasions, approximately 1 week apart. One hour after a standardized cereal breakfast, macrovascular function was determined via flow-mediated dilation (FMD). Heart rate variability (root mean square of successive R-R intervals; RMSSD) was determined from the ECG-gated ultrasound images acquired during the FMD protocol prior to cuff occlusion. Microvascular function was simultaneously quantified as the peak (PRH) and total (TRH) hyperaemic response to occlusion in the cutaneous circulation of the forearm via laser Doppler imaging. To address within-day reliability, a subset of twenty adolescents (10 boys) repeated these measures 90 min afterwards on one occasion. Results: the within-day typical error and between-day typical error expressed as a coefficient of variation of these outcomes are as follows: ratio-scaled FMD, 5·1% and 10·6%; allometrically scaled FMD, 4·4% and 9·4%; PRH, 11% and 13·3%; TRH, 29·9% and 23·1%; and RMSSD, 17·6% and 17·6%. The within- and between-day test–retest correlation coefficients for these outcomes were all significant (r > 0·54 for all). Conclusion: Macrovascular, microvascular and autonomic functions can be simultaneously and non-invasively determined in adolescents using a single protocol with an appropriate degree of reproducibility. Determining these outcomes may provide greater understanding of the progression of cardiovascular disease and aid early intervention.

© 2015 Elsevier Inc. Purpose to examine the influence of exercise intensity on postprandial health outcomes in adolescents when exercise is accumulated throughout the day. Methods 19 adolescents (9 male, 13.7 ± 0.4 years old) completed three 1-day trials in a randomised order: (1) rest (CON); or four bouts of (2) 2 × 1 min cycling at 90% peak power with 75 s recovery (high-intensity interval exercise; HIIE); or (3) cycling at 90% of the gas exchange threshold (moderate-intensity exercise; MIE), which was work-matched to HIIE. Each bout was separated by 2 hours. Participants consumed a high fat milkshake for breakfast and lunch. Postprandial triacylglycerol (TAG), glucose, systolic blood pressure (SBP) and fat oxidation were assessed throughout the day. Results There was no effect of trial on total area under the curve (TAUC) for TAG (P = 0.87). TAUC-glucose was lower in HIIE compared to CON (P = 0.03, ES = 0.42) and MIE (P = 0.04, ES = 0.41), with no difference between MIE and CON (P = 0.89, ES = 0.04). Postprandial SBP was lower in HIIE compared to CON (P = 0.04, ES = 0.50) and MIE (P = 0.04, ES = 0.40), but not different between MIE and CON (P = 0.52, ES = 0.11). Resting fat oxidation was increased in HIIE compared to CON (P = 0.01, ES = 0.74) and MIE (P = 0.05, ES = 0.51), with no difference between MIE and CON (P = 0.37, ES = 0.24). Conclusion Neither exercise trial attenuated postprandial lipaemia. However, accumulating brief bouts of HIIE, but not MIE, reduced postprandial plasma glucose and SBP, and increased resting fat oxidation in adolescent boys and girls. The intensity of accumulated exercise may therefore have important implications for health outcomes in youth.

© 2014, Springer-Verlag Berlin Heidelberg. Method: Twenty adolescents (10 male, 14.3 ± 0.3 years) completed three 1-day trials: (1) rest (CON); (2) 8 × 1 min cycling at 90 % peak power with 75 s recovery (HIIE); (3) cycling at 90 % of the gas exchange threshold (MIE), 1 h before consuming a high-fat milkshake (1.50 g fat and 80 kJ kg−1). Postprandial TAG, SBP and fat oxidation were assessed over 4 hResults : Compared to CON, the incremental area under the curve for TAG (IAUC-TAG) was not significantly lowered in HIIE [P = 0.22, effect size (ES) = 0.24] or MIE (P = 0.65, ES = 0.04) for boys. For girls, HIIE and MIE lowered IAUC-TAG by 34 % (P = 0.02, ES = 0.58) and 38 % (P = 0.09, ES = 0.73), respectively, with no difference between HIIE and MIE (P = 0.74, ES = 0.14). Changes in TAG were not related to energy expenditure during exercise or postprandial fat oxidation. Postprandial SBP (total-AUC pooled for both sexes) was lower in HIIE compared to CON (P = 0.01, ES = 0.68) and MIE (P = 0.02, ES = 0.60), with no difference between MIE and CON (P = 0.45, ES = 0.14).Purpose: the effect of exercise intensity and sex on postprandial risk factors for cardiovascular disease in adolescents is unknown. We examined the effect of a single bout of work-matched high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on postprandial triacylglycerol (TAG) and systolic blood pressure (SBP) in adolescents.Conclusion: a single bout of HIIE and MIE, performed 1 h before an HFM, can meaningfully attenuate IAUC-TAG in girls but not boys. Additionally, HIIE, but not MIE, may lower postprandial SBP in normotensive adolescents.

Acute exercise transiently improves endothelial function and protects the vasculature from the deleterious effects of a high-fat meal (HFM). We sought to identify whether this response is dependent on exercise intensity in adolescents. Twenty adolescents (10 male, 14.3 ± 0.3 yr) completed three 1-day trials: 1) rest (CON); 2) 8 × 1 min cycling at 90% peak power with 75 s recovery [high-intensity interval exercise (HIIE)]; and 3) cycling at 90% of the gas exchange threshold [moderate-intensity exercise (MIE)] 1 h before consuming a HFM (1.50 g/kg fat). Macrovascular and microvascular endothelial function was assessed before and immediately after exercise and 3 h after the HFM by flow-mediated dilation (FMD) and laser Doppler imaging [peak reactive hyperemia (PRH)]. FMD and PRH increased 1 h after HIIE [P < 0.001, effect size (ES) = 1.20 and P = 0.048, ES = 0.56] but were unchanged after MIE. FMD and PRH were attenuated 3 h after the HFM in CON (P < 0.001, ES = 1.78 and P = 0.02, ES = 0.59). FMD remained greater 3 h after the HFM in HIIE compared with MIE (P < 0.001, ES = 1.47) and CON (P < 0.001, ES = 2.54), and in MIE compared with CON (P < 0.001, ES = 1.40). Compared with CON, PRH was greater 3 h after the HFM in HIIE (P = 0.02, ES = 0.71) and MIE (P = 0.02, ES = 0.84), with no differences between HIIE and MIE (P = 0.72, ES = 0.16). Plasma triacylglycerol concentration and total antioxidant status concentration were not different between trials. We conclude that exercise intensity plays an important role in protecting the vasculature from the deleterious effects of a HFM. Performing HIIE may provide superior vascular benefits than MIE in adolescent groups.

© 2015 by the American College of Sports Medicine. Introduction: Impairments in vascular function are present in asymptomatic youths with risk factors for cardiovascular disease. Exercise can promote vascular health in youth, but the effects of exercise intensity and the time course in response to acute exercise are unknown. Methods: Twenty adolescents (10 male, 14.1 ± 0.3 yr) performed the following on separate days in a counterbalanced order: 1) cycling at 90% of the gas exchange threshold (moderate-intensity exercise (MIE)) and 2) 8 × 1-min cycling at 90% peak power with 75-s recovery (high-intensity interval exercise (HIIE)). The duration of MIE (25.8 ± 2.1 min) was work-matched to HIIE (23.0 min). Macro- and microvascular functions were assessed before, immediately after, and 1 and 2 h after exercise by flow-mediated dilation (FMD) and laser Doppler imaging (total reactive hyperemia). Results: FMD was attenuated immediately after HIIE (P < 0.001, effect size (ES) = 1.20) but not after MIE (P = 0.28, ES = 0.26). Compared with that before exercise, FMD was elevated 1 and 2 h after HIIE (P < 0.001, ES = 1.33; P < 0.001, ES = 1.36) but unchanged in MIE (P = 0.67, ES = 0.10; P = 0.72, ES = 0.08). Changes in FMD were unrelated to shear or baseline arterial diameter. Compared with that in preexercise, total reactive hyperemia was always greater after MIE (P < 0.02, ES > 0.60 for all) and HIIE (P < 0.001, ES > 1.18 for all). Total reactive hyperemia was greater in HIIE compared with that in MIE immediately after (P = 0.03, ES = 0.67) and 1 h after (P = 0.01, ES = 0.62) exercise, with a trend to be greater 2 h after (P = 0.06, ES = 0.45). Conclusions: Exercise intensity is positively associated with macro- and microvascular function 1 and 2 h after exercise. Performing HIIE may provide superior vascular benefits than MIE in adolescents.

© 2015 the American Physiological Society. High-intensity interval training (HIIT) improves traditional cardiovascular disease (CVD) risk factors in adolescents, but no study has identified the influence of HIIT on endothelial and autonomic function in this group. Thirteen 13- to 14-yr-old adolescents (6 girls) completed six HIIT sessions over 2 wk. Each training session consisted of eight to ten 1-min repetitions of cycling at 90% peak power interspersed with 75 s of unloaded cycling. Traditional (triglycerides, cholesterol, glucose, insulin, and blood pressure) and novel [flow-mediated dilation (FMD), heart rate variability (HRV)] CVD risk factors were assessed in a fasted and postprandial state before (PRE), 1 day after (POST-1D), and 3 days after (POST-3D) training. Aerobic fitness was determined PRE and POST-3D. Two weeks of HIIT had no effect on aerobic fitness or traditional CVD risk factors determined in the fasted or postprandial state (P > 0.15). Compared with PRE, fasted FMD was improved POST-1D [P = 0.003, effect size (ES) = 0.70] but not POST-3D (P = 0.32, ES = 0.22). Fasted FMD was greater POST-1D compared with POST-3D (P < 0.04, ES = 0.48). Compared with PRE, postprandial FMD was greater POST-1D (P = 0.001, ES = 1.01) and POST-3D (P < 0.01, ES = 0.60). Fasted HRV was greater POST-1D (P = 0.001, ES = 0.71) and POST-3D (P = 0.02, ES = 0.44). The test meal lowered HRV in all laboratory visits (P < 0.001, ES = 0.59), but there were no differences in postprandial HRV between visits (P > 0.32 for all). Two weeks of HIIT enhanced endothelial function and HRV without improvements in traditional CVD risk factors. However, most of this favorable adaptation was lost POST- 3D, suggesting that regularly performing high-intensity exercise is needed to maintain these benefits.

The present study aimed to establish whether 2 weeks of high-intensity interval training would have a beneficial effect on aerobic fitness, fat oxidation, blood pressure and body mass index (BMI) in healthy adolescent boys. Ten adolescent boys (15.1 ± 0.3 years, 1.3 ± 0.2 years post-estimated peak height velocity) completed six sessions of Wingate-style high-intensity interval training over a 2-week period. The first session consisted of four sprints with training progressed to seven sprints in the final session. High-intensity interval training had a beneficial effect on maximal O2 uptake (mean change, ±90% confidence intervals: 0.19 L · min-1, ±0.19, respectively), on the O2 uptake at the gas exchange threshold (0.09 L · min-1, ±0.13) and on the O2 cost of sub-maximal exercise (-0.04 L · min-1, ±0.04). A beneficial effect on the contribution of lipid (0.06 g · min-1, ±0.06) and carbohydrate (-0.23 g · min-1, ±0.14) oxidation was observed during sub-maximal exercise, but not for the maximal rate of fat oxidation (0.04 g · min-1, ±0.08). Systolic blood pressure (1 mmHg, ±4) and BMI (0.1 kg · m2, ±0.1) were not altered following training. These data demonstrate that meaningful changes in health outcomes are possible in healthy adolescent boys after just six sessions of high-intensity interval training over a 2-week period. © 2013 © 2013 Taylor & Francis.

This study examined whether critical power (CP) in adolescents: (1) provides a landmark for maximal steady-state exercise; and (2) can be determined using 'all-out' exercise. Nine active 14-15 year olds (6 females, 3 males) performed five cycling tests: (1) a ramp test to determine VO 2peak; (2) up to four constant power output tests to determine CP; (3-4) constant power output exercise 10% above and 10% below CP; and (5) a 3 min all-out cycle test to establish the end power (EP) at 90 and 180 s of exercise. All participants completed 30 min of exercise below CP and were characterized by steady-state blood lactate and VO 2 profiles. In contrast, time to exhaustion during exercise above CP was 15.0 ± 7.0 min and characterized by an inexorable rise in blood lactate and a rise, stabilization (∼91% VO 2peak) and fall in VO 2 (∼82% VO 2peak) prior to exhaustion. Eight out of nine participants completed the 3 min test and their EPs at 90 s (148 ± 29 W) and 180 s (146 ± 30 W) were not different from CP (146 ± 27 W) (P = 0.98). The typical error of estimates for establishing CP using EP at 90 s or 180 s of the 3 min test were 25 W (19.7% CV) and 25 W (19.6% CV), respectively. CP in active adolescence provides a valid landmark for maximal steady-state exercise, although its estimation on an individual level using the 3 min all-out test may be of limited value. © Springer-Verlag 2011.