Purpose: Few data exist on the descriptions of LV myocardial mechanics and reserve during dynamic exercise of adolescent athletes. The aim of this study was to describe the LV myocardial and cardiopulmonary changes during exercise using 2-D strain deformation imaging. Methods: Elite adolescent male football players (n = 42) completed simultaneous cardiopulmonary exercise testing (CPET) and exercise echocardiography measurement of LV myocardial deformation by 2-D strain imaging. LV longitudinal and circumferential 2-D strain and strain rates were analyzed at each stage during incremental exercise to a work rate of 150 W. Additionally, exercise LV myocardial deformation and its relation to metabolic exercise parameters were evaluated at each exercise stage and in recovery using repeated measures ANOVA, linear regression and paired t tests. Results: LV peak systolic baseline 2-D strain (longitudinal: − 15.4 ± 2.5%, circumferential: − 22.5 ± 3.1%) increased with each exercise stage, but longitudinal strain plateaued at 50 W (mean strain reserve − 7.8 ± 3.0) and did not significantly increase compared to subsequent exercise stages (P > 0.05), whilst circumferential strain (mean strain reserve − 11.6 ± 3.3) significantly increased (P < 0.05) throughout exercise up to 150 W as the dominant mechanism of exercise LV contractility increase. Regression analyses showed LV myocardial strain increased linearly relative to HR, VO2 and O2 pulse (P < 0.05) for circumferential deformation, but showed attenuation for longitudinal deformation. Conclusion: This study describes LV myocardial deformation dynamics by 2-D strain and provides reference values for LV myocardial strain and strain rate during exercise in adolescent footballers. It found important differences between LV longitudinal and circumferential myocardial mechanics during exercise and introduces a methodology that can be used to quantify LV function and cardiac reserve during exercise in adolescent athletes.

BACKGROUND: Congenital heart disease (ConHD) affects approximately 1% of all live births. People with ConHD are living longer due to improved medical intervention and are at risk of developing non-communicable diseases. Cardiorespiratory fitness (CRF) is reduced in people with ConHD, who deteriorate faster compared to healthy people. CRF is known to be prognostic of future mortality and morbidity: it is therefore important to assess the evidence base on physical activity interventions in this population to inform decision making. OBJECTIVES: to assess the effectiveness and safety of all types of physical activity interventions versus standard care in individuals with congenital heart disease. SEARCH METHODS: We undertook a systematic search on 23 September 2019 of the following databases: CENTRAL, MEDLINE, Embase, CINAHL, AMED, BIOSIS Citation Index, Web of Science Core Collection, LILACS and DARE. We also searched ClinicalTrials.gov and we reviewed the reference lists of relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCT) that compared any type of physical activity intervention against a 'no physical activity' (usual care) control. We included all individuals with a diagnosis of congenital heart disease, regardless of age or previous medical interventions.  DATA COLLECTION AND ANALYSIS: Two review authors (CAW and CW) independently screened all the identified references for inclusion. We retrieved and read all full papers; and we contacted study authors if we needed any further information. The same two independent reviewers who extracted the data then processed the included papers, assessed their risk of bias using RoB 2 and assessed the certainty of the evidence using the GRADE approach. The primary outcomes were: maximal cardiorespiratory fitness (CRF) assessed by peak oxygen consumption; health-related quality of life (HRQoL) determined by a validated questionnaire; and device-worn 'objective' measures of physical activity. MAIN RESULTS: We included 15 RCTs with 924 participants in the review. The median intervention length/follow-up length was 12 weeks (12 to 26 interquartile range (IQR)). There were five RCTs of children and adolescents (n = 500) and 10 adult RCTs (n = 424). We identified three types of intervention: physical activity promotion; exercise training; and inspiratory muscle training. We assessed the risk of bias of results for CRF as either being of some concern (n = 12) or at a high risk of bias (n = 2), due to a failure to blind intervention staff. One study did not report this outcome. Using the GRADE method, we assessed the certainty of evidence as moderate to very low across measured outcomes. When we pooled all types of interventions (physical activity promotion, exercise training and inspiratory muscle training), compared to a 'no exercise' control CRF may slightly increase, with a mean difference (MD) of 1.89 mL/kg-1/min-1 (95% CI -0.22 to 3.99; n = 732; moderate-certainty evidence). The evidence is very uncertain about the effect of physical activity and exercise interventions on HRQoL. There was a standardised mean difference (SMD) of 0.76 (95% CI -0.13 to 1.65; n = 163; very low certainty evidence) in HRQoL. However, we could pool only three studies in a meta-analysis, due to different ways of reporting. Only one study out of eight showed a positive effect on HRQoL. There may be a small improvement in mean daily physical activity (PA) (SMD 0.38, 95% CI -0.15 to 0.92; n = 328; low-certainty evidence), which equates to approximately an additional 10 minutes of physical activity daily (95% CI -2.50 to 22.20). Physical activity and exercise interventions likely result in an increase in submaximal cardiorespiratory fitness (MD 2.05, 95% CI 0.05 to 4.05; n = 179; moderate-certainty evidence). Physical activity and exercise interventions likely increase muscular strength (MD 17.13, 95% CI 3.45 to 30.81; n = 18; moderate-certainty evidence). Eleven studies (n = 501) reported on the outcome of adverse events (73% of total studies). of the 11 studies, six studies reported zero adverse events. Five studies reported a total of 11 adverse events; 36% of adverse events were cardiac related (n = 4); there were, however, no serious adverse events related to the interventions or reported fatalities (moderate-certainty evidence). No studies reported hospital admissions. AUTHORS' CONCLUSIONS: This review summarises the latest evidence on CRF, HRQoL and PA. Although there were only small improvements in CRF and PA, and small to no improvements in HRQoL, there were no reported serious adverse events related to the interventions. Although these data are promising, there is currently insufficient evidence to definitively determine the impact of physical activity interventions in ConHD. Further high-quality randomised controlled trials are therefore needed, utilising a longer duration of follow-up.

Background Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics. Methods a three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice. Results There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity. Conclusion Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18�
years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement.

Background: Osteoporosis is a skeletal disease associated with high morbidity, mortality and increased economic costs. Early prevention during adolescence appears to be one of the most beneficial practices. Exercise is an effective approach for developing bone mass during puberty, but some sports may have a positive or negative impact on bone mass accrual. Plyometric jump training has been suggested as a type of exercise that can augment bone, but its effects on adolescent bone mass have not been rigorously assessed. The aims of the PRO-BONE study are to: 1) longitudinally assess bone health and its metabolism in adolescents engaged in osteogenic (football), non-osteogenic (cycling and swimming) sports and in a control group, and 2) examine the effect of a 9 month plyometric jump training programme on bone related outcomes in the sport groups.
Methods/Design: This study will recruit 105 males aged 12-14 years who have participated in sport specific training for at least 3 hours per week during the last 3 years in the following sports groups: football (n=30), cycling (n=30) and swimming (n=30). An age-matched control group (n=15) that does not engage in these sports more than 3 hours per week will also be recruited. Participants will be measured on 5 occasions: 1) at baseline; 2) after 12 months of sport specific training where each sport group will be randomly allocated into two sub-groups: intervention group (sport + plyometric jump training) and sport group (sport only); 3) exactly after the 9 months of intervention; 4) 6 months following the intervention; 5) 12 months following the intervention. Body composition (dual energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance), bone stiffness index (ultrasounds), physical activity (accelerometers), diet (24 h recall questionnaire), pubertal maturation (Tanner stage), physical fitness (cardiorespiratory and muscular) and biochemical markers of bone formation and resorption will be measured at each visit.
Discussion: the PRO-BONE study is designed to investigate the impact of osteogenic and non-osteogenic sports on bone development in adolescent males during puberty, and how a plyometric jump training programme is associated with body composition parameters.

This editorial summarises a recently published, international and multidisciplinary, expert consensus statement about the important role of physical activity and exercise for people with cystic fibrosis (pwCF) – a genetic condition that currently affects ~11,000 people in the UK. This work from Williams et al. (2022) synthesises previous guidelines, clinical practice, and interpretation of evidence about the benefits of activity and exercise for patient health and management of illness.

Background: Public health guidelines for children advocate physical activity (PA) and the restriction of continuous sedentary time. Schools offer an attractive setting for health promotion, however school-based interventions to increase PA typically fail, and primary school children may spend most of the school day sitting down. Classroom movement breaks have been identified as an attractive opportunity to address this concern and may positively influence behaviour, but little is known about the barriers to implementing movement within lessons from a multi stakeholder perspective. The purpose of this study was to explore 1) the perceptions of primary school pupils, staff members and governors regarding classroom movement breaks, and 2) their perceived barriers and facilitators to implementing PA into the classroom. Methods: Thirty-four pupils (Key Stages 1 and 2, ages 5-7 y) took part in a focus group discussion. Sixty-four staff members and twenty governors completed a questionnaire and an optional follow up semi-structured telephone interview. Qualitative data were analysed using thematic analysis. Results: Pupils, staff members and governors expressed an enthusiasm for movement breaks provided that they were short, simple, pupil-guided and performed at the discretion of the teacher. Time and concerns regarding transitioning back to work following a movement break were identified as key barriers by pupils and staff. Governors and some staff expressed that favourable evidence for movement breaks is needed to facilitate their adoption, particularly regarding the potential for improvements in cognitive functioning or classroom behaviour. Conclusion: There is a wide appeal for classroom-based activity breaks, when delivered in a manner that is not disruptive. Future research which examines the potential benefits of such activity breaks is warranted.

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 effect of exercise intensity and the time course in response to acute exercise are unknown. Methods: Twenty adolescents (10 male, 14.1 ± 0.3 y) on separate days, and in a counter-balanced order: 1) cycled at 90% of the gas exchange threshold (moderate-intensity exercise; MIE); 2) completed 8x1 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 micro-vascular function were assessed before, immediately post, and 1 and 2 hours after exercise by flow mediated dilation (FMD) and laser Doppler imaging (total reactive hyperaemia). Results: FMD was attenuated immediately after HIIE (P

ABSTRACTThe COVID-19 pandemic has resulted in unprecedent change to clinical practice. As the impact upon delivery of exercise services for people with cystic fibrosis (CF) in the UK was unknown, this was characterised via a national survey. In total, 31 CF centres participated. Principal findings included a significant reduction in exercise testing, and widespread adaptation to deliver exercise training using telehealth methods. Promisingly, 71% stated that they would continue to use virtual methods of engaging patients in future practice. This does, however, highlight a need to develop sustainable and more standardised telehealth services further to manage patients moving forwards.

Abstract
. Background: Distance running is one of the most popular sports around the world. The epidemiology of running-related injuries (RRI) has been examined in adults, but only a few studies have focused on adolescent distance runners. Therefore, the purpose of this study was 1) to examine the training practices (frequency, volume, and intensity) and descriptive epidemiology of RRI (risks, rates, sites, and severity) in competitive adolescent distance runners (13-18 years) in England, and 2) to explore potential correlates (risk factors) of RRI. Methods: a cross-sectional study design was used. Adolescent distance runners (n = 113) were recruited from England Athletics affiliated athletics clubs. Participants voluntarily completed an online questionnaire between April and December 2018. At the point of completion, responses were based on the participant’s previous 12-months of distance running participation. Injury incidence proportions (IP) and incidence rates (IR) were calculated. Potential correlates of RRI were estimated using an odds ratio (OR) and 95% confidence intervals (CI). Results: the injury IP was 122/100 participants/year (95% CI: 113 to 138). The injury IR was 6.3/1000 participation hours (95% CI: 5.3 to 7.4). The most common injury sites were the knee, foot/toes, and lower leg; primarily caused by overuse. Exploratory univariate analyses showed a larger number of training sessions per week (volume) is associated with a lower risk of RRI (OR = 0.71, 95% CI: 0.53 to 0.94), and that a higher level of specialisation is associated with a lower risk of time loss injury (OR = 0.26, 95% CI: 0.11 to 0.63). Conclusions: Injury is common in adolescent distance runners, aligned with adult-based research. These data provide guidance for the development of appropriate injury prevention interventions.

Physical activity in the form of moderate-to-vigorous physical activity (MVPA), sedentary behaviour in the form of recreational screen time (ST), and sleep, are individually associated with cardiovascular disease (CVD) risk factors in adolescents. Commonly, researchers investigate these three movement behaviours in relation to CVD risk factors in isolation. However, after the launch of the Canadian 24-Hour Movement Guidelines for children and youth, there have been calls to integrate all three 24-hour behaviours (PA, ST, & sleep). Furthermore, a scientific statement from the American Heart Association highlights the importance of cardiorespiratory fitness (CRF) as a measurement for health screening in children and adolescents as CRF is a strong predictor of CVD risk. Previous studies have individually explored how the 24-hour movement guidelines or CRF are associated with CVD risk factors in adolescents; however, which of the two (24-hour movement guidelines or CRF) is more strongly associated with CVD risk factors in adolescents is unknown. Currently, most studies have been conducted in North America and Europe, with the Middle East neglected, including Saudi Arabia, which has a very different lifestyle, environment, climate, school system, and culture compared to North America and Europe. Therefore, to address this gap in the literature in the context of Saudi Arabia, the studies included in this thesis aimed to investigate the prevalence of 24-hour movement guidelines and CRF and their relationship with CVD risk factors in adolescents from Saudi Arabia aged 12–15 years old. Chapter 4 narratively reviewed movement guidelines and CRF in relation to CVD risk factors in children and adolescents from the Gulf Cooperation Council Countries, which indicated gaps in the literature investigating the 24-hour movement guidelines. In addition, Chapter 4 highlighted that there is poor evidence for an association between single movement guidelines and CRF with multiple CVD risk factors; most studies have only examined associations with weight status. Chapter 5 examined the reliability and validity of using the Global School-Based Student Health Survey (GSHS) to assess the 24-hour movement guidelines in (n = 120; 50% females) adolescents aged 12–15 years old, from Saudi Arabia and found acceptable reliability and validity. In Chapter 6, the GSHS was used to examine the prevalence of the 24-hour movement guidelines and their associations with overweight/obesity in a sample of (n = 4224; 52% females) participants aged 12–15 years old. The results indicated that only 2.7% achieved the recommended 24-hour movement guidelines and highlighted weak, non-significant associations with the risk of overweight/obesity. In Chapter 7 a subsample of (n = 120; 50% females) participants aged 12–15 years old from the study in Chapter 6 underwent a 24-hour movement guidelines assessment using GENEActiv accelerometers (for MVPA and sleep) and the GSHS (for ST). In addition, CRF was assessed using the Progressive Aerobic Cardiovascular Endurance Run test, and fasting blood samples, blood pressure, and anthropometrics were collected. None of the adolescents in this subsample met all three of the 24-hour movement guidelines, and there were no favourable significant associations with individual or clustered CVD risk factors. In addition, few males (16%) and almost half of the female (46.3%) participants had a healthy CRF. However, in males only, having a CRF was significantly and negatively associated with waist circumference (WC) and clustered CVD risk. Collectively, the results presented in this PhD thesis contribute to enhancing the literature in four ways. Firstly, it demonstrates that there is a lack of studies on the 24-hour movement guidelines and CRF in relation to CVD risk factors for adolescents from the Gulf Cooperation Council countries. Secondly, it is the first study to examine a questionnaire for its reliability and validity to measure the 24-hour movement guidelines, which found an acceptable reliability and validity. Thirdly, it shows that via a questionnaire few adolescents (2.7%) from Saudi Arabia are meeting the 24-hour movement guidelines, which is not significantly associated with being at risk of overweight/obesity. Lastly, it shows that when using device-based accelerometry, none of the adolescents from Saudi Arabia are meeting the 24-hour movement guidelines, which is not significantly associated with individual or clustered CVD risk factors profiles in both sexes. Moreover, healthy CRF was not significantly associated with individual or clustered CVD risk factors in females, while in males, healthy CRF was only significantly and inversely associated with WC and clustered CVD risk factors.
Based on the above findings, it is suggested that 24-hour movement guidelines are not favourable strongly associated with individual or clustered CVD risk factors in adolescents of both sexes from Saudi Arabia. In addition, in females it appears that there are no significant associations between CRF and individual or clustered CVD risk factors. Initiatives should be developed to encourage male adolescents from Saudi Arabia aged 12–15 years old to achieve a healthy CRF to reduce the risk of WC and clustered CVD risk factors. However, future longitudinal studies with larger sample sizes would enable further insight into the associations between 24-hour movement guidelines and CRF in relation to CVD risk factors in adolescents from Saudi Arabia and should provide specific recommendations for both sexes.

INTRODUCTION: Improving healthy lifestyles of adolescents is challenging. Citizen Science is a way to engage them in the design and delivery of interventions, and may also increase their interest in science, technology, engineering and mathematics (STEM). The Science Engagement to Empower aDolescentS (SEEDS) project aims to use an equity-lens, and engage and empower boys and girls from deprived areas by designing and cocreating interventions to promote healthy lifestyles, and to seed interest in STEM. METHODS AND ANALYSIS: SEEDS is a cluster randomised controlled trial in four countries (Greece, the Netherlands, Spain and the UK). Each country will recruit six to eight high schools from lower socioeconomic neighbourhoods. Adolescents aged 13-15 years are the target population. High schools will be randomised into intervention or control group. Each country will select 15 adolescents from intervention schools called ambassadors, who will be involved throughout the project.In each country, focus groups with ambassadors and stakeholders will focus on physical activity, snacking behaviour and STEM. The input from focus groups will be used to shape Makeathon events, cocreation events where adolescents and stakeholders will develop the interventions. The resultant intervention will be implemented in the intervention schools during 6 months. In total, we aim to recruit 720 adolescents who will complete questionnaires related to healthy lifestyles and STEM outcomes at baseline (November 2021) and after the 6 months (June 2022). ETHICS AND DISSEMINATION: the four countries obtained approval from their corresponding Ethics Committees (Greece: Bioethics Committee of Harokopio University; the Netherlands: the Medical Research Ethics Committee of the Erasmus Medical Center; Spain: the Drug Research Ethics Committee of the Pere Virgili Health Research Institute; UK: Sport and Health Sciences Ethics Committee of the University of Exeter). Informed consent will be collected from adolescents and their parents in line with General Data Protection Regulation legislation. The findings will be disseminated by conference presentations, publications in scientific peer-reviewed journals and during (local) stakeholders and public events. Lessons learnt and the main results will also be used to provide policy recommendations. TRIAL REGISTRATION NUMBER: NCT05002049.

Social factors and psychological characteristics can influence participation and development in talent pathways. However, the interaction between these two factors is relatively unknown. The aim of this study was to investigate the implications of socioeconomic status and psychological characteristics in English academy soccer players (n=58; aged 11 to 16 years). To assess socioeconomic status, participants' home postcodes were coded according to each individual's social classification and credit rating, applying the UK General Registrar Classification system and CameoTM geodemographic database, respectively. Participants also completed the six factor Psychological Characteristics for Developing Excellence Questionnaire (PCDEQ). A classification of 'higher-potentials' (n=19) and 'lower-potentials' (n=19) were applied through coach potential rankings. Data were standardised using z-scores to eliminate age bias and data were analysed using independent sample t-tests. Results showed that higher-potentials derived from families with significantly lower social classifications (p=0.014) and reported higher levels for PCDEQ Factor 3 (coping with performance and developmental pressures) (p=0.007) compared to lower-potentials. This study can be used to support the impetus for researchers and practitioners to consider the role of social factors and psychological characteristics when developing sporting talent. For example, facilitating player-centred development within an academy and, where necessary, providing individuals with additional support.

Individuals with Down syndrome (DS) present similar heart rate variability (HRV) parameters at rest but different responses to selected movement maneuvers in comparison to individuals without DS, which indicates reduced vagal regulation. The present study undertakes a scoping review of research on HRV in individuals with DS, with special attention paid to the compliance of the studies with standards and methodological paper guidelines for HRV assessment and interpretation. A review was performed using PubMed, Web of Science and CINAHL databases to search for English language publications from 1996 to 2020 with the MESH terms “heart rate variability” and “down syndrome”, with the additional inclusion criteria of including only human participants and empirical investigations. From 74 studies, 15 were included in the review. None of the reviewed studies met the recommendations laid out by the standards and guidelines for providing the acquisition of RR intervals and necessary details on HRV analysis. Since authors publishing papers on this research topic do not adhere to the prescribed standards and guidelines when constructing the methodology, results of the research papers on the topic are not directly comparable. Authors need to design the study methodology more robustly by following the aforementioned standards, guidelines and recommendations.

BACKGROUND: Children and young people with CHD benefit from regular physical activity. Parents are reported as facilitators and barriers to their children's physical activity. The aim of this study was to explore parental factors, child factors, and their clinical experience on physical activity participation in young people with CHD. METHODS: an online questionnaire was co-developed with parents (n = 3) who have children with CHD. The survey was then distributed in the United Kingdom by social media and CHD networks, between October 2021 and February 2022. Data were analysed using mixed methods. RESULTS: Eighty-three parents/guardians responded (94% mothers). Young people with CHD were 7.3 ± 5.0 years old (range 0-20 years; 53% female) and 84% performed activity. Parental participation in activity (X2(1) = 6.9, P < 0.05) and perceiving activity as important for their child were positively associated with activity (Fisher's Exact, P < 0.05). Some parents (∼15%) were unsure of the safety of activity, and most (∼70%) were unsure where to access further information about activity. Fifty-two parents (72%) had never received activity advice in clinic, and of the 20 who received advice, 10 said it was inconsistent. Qualitative analysis produced the theme "Knowledge is power and comfort." Parents described not knowing what activity was appropriate or the impact of it on their child. CONCLUSION: Parental participation and attitudes towards activity potentially influence their child's activity. A large proportion of young people performed activity despite a lack and inconsistency of activity advice offered by CHD clinics. Young people with CHD would benefit from activity advice with their families in clinics.

OBJECTIVE: (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. DESIGN: Systematic review and quality appraisal of policy documents. DATA SOURCES: a systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: an article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening. RESULTS AND SUMMARY: of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12-18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%). CONCLUSION: Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.

BackgroundIncreased maximal oxygen uptake (V̇O2max) is beneficial in children with cystic fibrosis (CF) but remains lower compared to healthy peers. Intrinsic metabolic deficiencies within skeletal muscle (muscle “quality”) and skeletal muscle size (muscle “quantity”) are both proposed as potential causes for the lower V̇O2max, although exact mechanisms remain unknown. This study utilises gold-standard methodologies to control for the residual effects of muscle size from V̇O2max to address this “quality” vs. “quantity” debate.MethodsFourteen children (7 CF vs. 7 age- and sex-matched controls) were recruited. Parameters of muscle size – muscle cross-sectional area (mCSA) and thigh muscle volume (TMV) were derived from magnetic resonance imaging, and V̇O2max obtained via cardiopulmonary exercise testing. Allometric scaling removed residual effects of muscle size, and independent samples t-tests and effect sizes (ES) identified differences between groups in V̇O2max, once mCSA and TMV were controlled for.ResultsV̇O2max was shown to be lower in the CF group, relative to controls, with large ES being identified when allometrically scaled to mCSA (ES = 1.76) and TMV (ES = 0.92). Reduced peak work rate was also identified in the CF group when allometrically controlled for mCSA (ES = 1.18) and TMV (ES = 0.45).ConclusionsA lower V̇O2max was still observed in children with CF after allometrically scaling for muscle size, suggesting reduced muscle “quality” in CF (as muscle “quantity” is fully controlled for). This observation likely reflects intrinsic metabolic defects within CF skeletal muscle.

ObjectivesRegular exercise testing is recommended for people with cystic fibrosis (pwCF), as is the provision and regular review of exercise training programmes. A previous survey on exercise testing and training for pwCF in the UK was conducted over a decade ago. With the landscape of CF changing considerably during this time, this survey aimed to evaluate UK-based exercise testing and training practices for pwCF a decade on.DesignCross-sectional, online survey.ParticipantsA survey was distributed electronically to UK CF clinics and completed by the individual primarily responsible for exercise services. Descriptive statistics and qualitative analyses were undertaken.ResultsIn total, 31 CF centres participated, representing ~50% of UK specialist clinics. of these, 94% reported using exercise testing, 48% of which primarily use cardiopulmonary exercise testing. Exercise testing mostly occurs at annual review (93%) and is most often conducted by physiotherapists (62%). A wide variation in protocols, exercise modalities, normative reference values and cut-offs for exercise-induced desaturation are currently used. All centres reportedly discuss exercise training with pwCF; 94% at every clinic appointment. However, only 52% of centres reportedly use exercise testing to inform individualised exercise training. Physiotherapists typically lead discussions around exercise training (74%).ConclusionsThese data demonstrate that the majority of respondent centres in the UK now offer some exercise testing and training advice for pwCF, representing a marked improvement over the past decade. However, continued efforts are now needed to standardise exercise practices, particularly regarding field testing practices and the translation of test results into personalised training programmes for pwCF.

New Findings
What is the central question of this study?
What is the effect of 4 weeks of high‐intensity interval training (HIIT) and 2 weeks of detraining on vascular function and traditional cardiovascular disease (CVD) risk factors in male adolescents?

What is the main finding and its importance?
Four weeks of HIIT improved macrovascular function in adolescents. However, this training period did not measurably change microvascular function, body composition or blood biomarkers. Following 2 weeks of detraining, the improvement in flow‐mediated dilatation (FMD) was lost. This highlights the importance of the continuation of regular exercise for the primary prevention of CVD.

AbstractHigh‐intensity interval training (HIIT) represents an effective method to improve cardiometabolic health in adolescents. This study aimed to investigate the effect of 4 weeks of HIIT followed by 2 weeks of detraining on vascular function and traditional cardiovascular disease (CVD) risk factors in adolescent boys. Nineteen male adolescents (13.3 ± 0.5 years) were randomly allocated to either a training (TRAIN, n = 10) or control (CON, n = 9) group. Participants in TRAIN completed 4 weeks of HIIT running with three sessions per week. Macro‐ (flow‐mediated dilatation, FMD) and microvascular (peak reactive hyperaemia, PRH) function, body composition (fat mass, fat free mass, body fat percentage) and blood biomarkers (glucose, insulin, total cholesterol, high‐ and low‐density lipoprotein, triacylglycerol) were assessed pre‐, 48 h post‐ and 2 weeks post‐training for TRAIN and at equivalent time points for CON. Following training, FMD was significantly greater in TRAIN compared to CON (9.88 ± 2.40% and 8.64 ± 2.70%, respectively; P = 0.036) but this difference was lost 2 weeks after training cessation (8.22 ± 2.47% and 8.61 ± 1.99%, respectively; P = 0.062). No differences were detected between groups for PRH (P = 0.821), body composition (all P &gt; 0.14) or blood biomarkers (all P &gt; 0.18). In conclusion, 4 weeks of HIIT improved macrovascular function; however, this training period did not measurably change microvascular function, body composition or blood biomarkers. The reversal of the FMD improvement 2 weeks post‐training highlights the importance of the continuation of regular exercise for the primary prevention of CVD.

PURPOSE: Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP. METHODS: Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data. RESULTS: Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies. CONCLUSIONS: the effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.

BACKGROUND: Current echocardiographic criteria cannot accurately differentiate exercise induced left ventricular (LV) hypertrabeculation in athletes from LV non-compaction cardiomyopathy (LVNC). This study aims to evaluate the role of speckle tracking echocardiography (STE) in characterising LV myocardial mechanics in healthy adolescent athletes with and without LVNC echocardiographic criteria. METHODS: Adolescent athletes evaluated at three sports academies between 2014 and 2019 were considered for this observational study. Those meeting the Jenni criteria for LVNC (end-systolic non-compacted/compacted myocardium ratio > 2 in any short axis segment) were considered LVNC+ and the rest LVNC-. Peak systolic LV longitudinal strain (Sl), circumferential strain (Sc), rotation (Rot), corresponding strain rates (SRl/c) and segmental values were calculated and compared using a non-inferiority approach. RESULTS: a total of 417 participants were included, mean age 14.5 ± 1.7 years, of which 6.5% were LVNC+ (n = 27). None of the athletes showed any additional LVNC clinical criteria. All average Sl, SRl Sc, SRc and Rot values were no worse in the LVNC+ group compared to LVNC- (p values range 0.0003-0.06), apart from apical SRc (p = 0.2). All 54 segmental measurements (Sl/Sc SRl/SRc and Rot) had numerically comparable means in both LVNC+ and LVNC-, of which 69% were also statistically non-inferior. CONCLUSIONS: Among healthy adolescent athletes, 6.5% met the echocardiographic criteria for LVNC, but showed normal LV STE parameters, in contrast to available data on paediatric LVNC describing abnormal myocardial function. STE could better characterise the myocardial mechanics of athletes with LV hypertrabeculation, thus allowing the transition from structural to functional LVNC diagnosis, especially in suspected physiological remodelling.

AIMS: Echocardiographic assessment of adolescent athletes for arrhythmogenic cardiomyopathy (ACM) can be challenging owing to right ventricular (RV) exercise-related remodelling, particularly RV outflow tract (RVOT) dilation. The aim of this study is to evaluate the role of RV 2-D speckle tracking echocardiography (STE) in comparing healthy adolescent athletes with and without RVOT dilation to patients with ACM. METHODS AND RESULTS: a total of 391 adolescent athletes, mean age 14.5 ± 1.7 years, evaluated at three sports academies between 2014 and 2019 were included, and compared to previously reported ACM patients (n = 38 definite and n = 39 borderline). Peak systolic RV free wall (RVFW-Sl), global and segmental strain (Sl), and corresponding strain rates (SRl) were calculated. The participants meeting the major modified Task Force Criteria (mTFC) for RVOT dilation were defined as mTFC+ (n = 58, 14.8%), and the rest as mTFC- (n = 333, 85.2%). Mean RVFW-Sl was -27.6 ± 3.4% overall, -28.2 ± 4.1% in the mTFC+ group and - 27.5 ± 3.3% in the mTFC- group. mTFC+ athletes had normal RV-FW-Sl when compared to definite (-29% vs -19%, p 

This study sought to investigate the association of light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time (SED), and sleep with lung function in children and adults with CF. In total, 86 children (41 females; 13.6 ± 2.8 years; FEV1%predicted: 86 ± 1%) and 43 adults (21 females; 24.6 ± 4.7 years; FEV1%predicted: 63 ± 21%) with CF participated in this study. Wrist-worn accelerometery was used to assess PA, SED and sleep. Compositional linear regression models were conducted following normalisation via isometric log-ratio transformations. Sequential binary partitioning was applied to investigate the impact of reallocating 10 to 30 min between each behaviour on FEV1%predicted. A decline in FEV1%predicted was predicted with the reallocation of 30 min from MVPA to SED or LPA or sleep to any other behaviour in children (−3.04–−0.005%) and adults (−3.58–−0.005%). Conversely, improvements in FEV1%predicted were predicted when 30 min was reallocated to MVPA from LPA or SED in children (0.12–1.59%) and adults (0.77–2.10%), or when 30 min was reallocated to sleep from any other behaviour in both children (0.23–2.56%) and adults (1.08–3.58%). This study supports the importance of MVPA and sleep for maintaining and promoting lung function in people with CF.

The talent development processes in youth football are both complex and multidimensional.
The purpose of this two-fold study was to apply a multidisciplinary, machine learning approach
to examine: (a) the developmental characteristics of under-9 to under-16 academy players (n = 98;
Study 1), and (b) the characteristics of selected and deselected under-18 academy players (n = 18;
Study 2). A combined total of 53 factors cumulated from eight data collection methods across two
seasons were analysed. A cross-validated Lasso regression was implemented, using the glmnet
package in R, to analyse the factors that contributed to: (a) player review ratings (Study 1), and
(b) achieving a professional contract (Study 2). Results showed non-zero coefficients for improvement
in subjective performance in 15 out of the 53 analysed features, with key findings revealing advanced
percentage of predicted adult height (0.196), greater lob pass (0.160) and average dribble completion
percentage (0.124), more total match-play hours (0.145), and an older relative age (BQ1 vs. BQ2:
􀀀0.133; BQ1 vs. BQ4: 􀀀0.060) were the most important features that contributed towards player
review ratings. Moreover, PCDEQ Factor 3 and an ability to organise and engage in quality practice
(PCDEQ Factor 4) were important contributing factors towards achieving a professional contract.
Overall, it appears the key factors associated with positive developmental outcomes are not always
technical and tactical in nature, where coaches often have their expertise. Indeed, the relative
importance of these factors is likely to change over time, and with age, although psychological
attributes appear to be key to reaching potential across the academy journey. The methodological
techniques used here also serve as an impetus for researchers to adopt a machine learning approach
when analysing multidimensional databases.

The 12-lead electrocardiogram is a key component of cardiac screening in elite adolescent footballers. Current technology hampers mobile electrocardiogram monitoring that could reduce the time-to-diagnosis in symptomatic athletes. Recently, a 22-lead mobile electrocardiogram monitor, CardioSecur (Personal MedSystems GmbH), has been approved for use in adults. In this study, the differences in parameter accuracy between CardioSecur's 22-lead electrocardiogram and the gold standard 12-lead electrocardiogram were assessed in elite adolescent footballers (n=31) using Bland-Altman and paired t-tests/Wilcoxon analysis. Agreement between the two devices was clinically acceptable for heart rate (bias=- 0.633 bpm), PR Interval (bias=- 1.73 ms), Bazzett's corrected QTc interval (bias=2.03 ms), T-wave axis (bias=6.55°), P-wave duration (bias=- 0.941 ms), Q-wave amplitude (bias=0.0195 mV), Q-wave duration (bias=1.98 ms), rhythm (bias=0.0333), ST-segment (bias=- 0.0629), J-point analysis (bias=- 0.01) and extended T wave and QRS duration analysis. Unsatisfactory agreement was observed in QRS axis (bias=- 19.4°), P-wave axis (bias=- 0.670°), QRS amplitude (bias=- 0.660 mV), P-wave amplitude (bias=0.0400 mV) and T-wave amplitude (bias=- 0.0675 mV). CardioSecur's 22-lead electrocardiogram agrees with the gold standard in rhythm, durations, T-wave determination in all leads assessed, permitting its use in adolescent footballers for immediate pitch- or track-side analysis.

Exercise intolerance is common in people with CF (pwCF), but not universal among all individuals. While associated with disease prognosis, exercise intolerance is not simply a reflection of the degree of lung disease. In people with severe CF, respiratory limitations may contribute more significantly to impaired exercise capacity than in those with mild-moderate CF. At all levels of disease severity, there are peripheral factors e.g. abnormal macro- and micro-vascular function that impair blood flow and reduce oxygen extraction, and mitochondrial defects that diminish metabolic efficiency. We discuss advances in understanding the central and peripheral mechanisms underlying exercise intolerance in pwCF. Exploring both the central and peripheral factors that contribute to exercise intolerance in CF can help inform the development of new therapeutic targets, as well as help define prognostic criteria.

Athlete preparticipation screening focuses on preventing sudden cardiac death (SCD) by detecting diseases such as arrhythmogenic ventricular cardiomyopathy (AVC), which affects primarily the right ventricular myocardium. Diagnosis may be obscured by physiological remodeling of the athlete heart. Healthy athletes may meet the 2010 Task Force Criteria right ventricular outflow tract (RVOT) dimension cut-offs, questioning the suitability of the modified Task Force Criteria (mTFC) in adolescent athletes. In this study, 67 male adolescent footballers undergoing preparticipation screening were reviewed. All athletes underwent a screening for resting ECG and echocardiogram according to the English FA protocol, as well as cardiopulmonary exercise testing, stress ECG, and exercise echocardiography. Athletes' right ventricular outflow tract (RVOT) that met the major AVC diagnostic criteria for dilatation were identified. of 67 evaluated athletes, 7 had RVOT dilatation that met the major criteria, all in the long axis parasternal view measurement. All had normal right ventricular systolic function, including normal free-wall longitudinal strain (ranging from - 21.5 to - 32.7%). Left ventricular ejection fraction ranged from 52 to 67%, without evidence of structural changes. Resting ECGs and cardiopulmonary exercise tests were normal in all individuals. In a series of healthy athletes meeting the major AVC diagnostic criteria for RVOT dilatation, none had any other pathological changes on a detailed screening including ECG, exercise testing, and echocardiography. This report highlights that current AVC echocardiographic diagnosis criteria have limitations in this population.

CONTEXT: Countermovement jump (CMJ) and perceived wellness measures are useful for monitoring fatigue. Fatigue indicators should simultaneously show sensitivity to previous load and demonstrate influence on subsequent physical output; however, these factors have not been examined. OBJECTIVE: to explore the efficacy of CMJ and wellness measures to both detect postmatch fatigue and predict subsequent physical match output in elite youth soccer players. DESIGN: Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS: Sixteen soccer players (18 ± 1 years) from 36 English Football League Youth Alliance League fixtures. MAIN OUTCOME MEASURE(S): Physical match outputs (total distance, high-speed running, very high-speed running, and accelerations and decelerations [AD]) were recorded using a 10-Hz global positioning system and 200-Hz accelerometer device during competitive match play. The CMJ height and perceived wellness were assessed weekly and daily, respectively, as indirect indicators of fatigue. Four subunits of wellness (perceived soreness, energy, general stress, and sleep) were measured using customized psychometric questionnaires. RESULTS: Simple linear regression showed that match AD predicted energy (R2 = 0.08, P =. 001), stress (R2 = 0.09, P <. 001), and total wellness (R2 = 0.06, P =. 002) at 2 days postmatch. The CMJ (R2 = 0.05, P =. 002), stress (R2 = 0.08, P <. 001), sleep (R2 = 0.03, P =. 034), and total wellness (R2 = 0.05, P =. 006) measures at 5 days prematch predicted AD during the subsequent match. CONCLUSIONS: the CMJ and wellness measures may be useful for detecting postmatch fatigue. Wellness scores, but not CMJ, at 5 days prematch influenced subsequent match output and therefore may be used to plan and periodize training for the upcoming microcycle.

Magnetic Resonance Imaging (MRI) is well-suited for imaging peripheral blood flow due to its non-invasive nature and excellent spatial resolution. Although MRI is routinely used in adults to assess physiological changes in chronic diseases, there are currently no MRI-based data quantifying arterial flow in pediatric or adolescent populations during exercise. Therefore the current research sought to document femoral arterial blood flow at rest and following exercise in a pediatric-adolescent population using phase contrast MRI, and to present test-retest reliability data for this method. Ten healthy children and adolescents (4 male; mean age 14.8 ± 2.4 years) completed bloodwork and resting and exercise MRI. Baseline images consisted of PC-MRI of the femoral artery at rest and following a 5 × 30 s of in-magnet exercise. To evaluate test-retest reliability, five participants returned for repeat testing. All participants successfully completed exercise testing in the MRI. Baseline flow demonstrated excellent reliability (ICC = 0.93, p = 0.006), and peak exercise and delta rest-peak flow demonstrated good reliability (peak exercise ICC = 0.89, p = 0.002, delta rest-peak ICC = 0.87, p = 0.003) between-visits. All three flow measurements demonstrated excellent reliability when assessed with coefficients of variance (CV's) (rest: CV = 6.2%; peak exercise: CV = 7.3%; delta rest-peak: CV = 7.1%). The mean bias was small for femoral arterial flow. There was no significant mean bias between femoral artery flow visits 1 and 2 at peak exercise. There were no correlations between age or height and any of the flow measurements. There were no significant differences between male and female participants for any of the flow measurements. The current study determined that peripheral arterial blood flow in children and adolescents can be evaluated using non-invasive phase contrast MRI. The MRI-based techniques that were used in the current study for measuring arterial flow in pediatric and adolescent patients demonstrated acceptable test-retest reliability both at rest and immediately post-exercise.

ObjectiveThe importance of aerobic fitness (VO2peak) in cystic fibrosis (CF) is well established, and regular exercise testing is recommended. To standardise VO2peak, a ‘percentage of predicted’ (%pred) derived from normative reference values (NRV), as promoted by the 2015 European Cystic Fibrosis Society Exercise Working Group (ECFS EWG), can be reported. However, the NRVs used in CF and their relative frequency is unknown.MethodA scoping review was performed via systematic database searches (PubMed, Embase, Web of Science, SciELO, EBSCO) and forward citation searches for studies that include people with CF and report VO2peakas %pred. Studies were screened using Covidence, and data related to patient demographics, testing modality and reference equations were extracted. Additional analyses were performed on studies published in 2016–2021, following the ECFS EWG statement in 2015.ResultsA total of 170 studies were identified, dating from 1984 to 2022, representing 6831 patients with CF, citing 34 NRV. Most studies (154/170) used cycle ergometry, 15/170 used treadmills, and the remainder used alternative, combination or undeclared modalities. In total, 61/170 failed to declare the NRV used. There were 61 studies published since the ECFS EWG statement, whereby 18/61 used the suggested NRV.ConclusionThere is a wide discrepancy in NRV used in the CF literature base to describe VO2peakas %pred, with few studies using NRV from the ECFS EWG statement. This high variance compromises the interpretation and comparison of studies while leaving them susceptible to misinterpretation and limiting replication. Standardisation and alignment of reporting of VO2peakvalues are urgently needed.

This study aimed to examine the reliability and validity of Global School-based Student Health Survey (GSHS) to measure 24-hour movement behaviours (moderate-to-vigorous physical activity - MVPA; sedentary behaviour in the form of recreational screen time - ST; and sleep) in Saudi Arabian youths. A total of 120 (50% female) participants aged 12-15 years old were recruited from eight Saudi public middle schools. Participants completed GSHS survey twice and wore GENEActiv accelerometers for seven consecutive days and completed a diary log. ICC indicated moderate reliability in all 24-hour movement behaviours (ICC = 0.41 - 0.60), whereas ST and sleep were strongly reliable for females only (ICC = 0.61 - 0.80). Kappa agreements for all 24-hr movement behaviours were moderate (k = 0.41 - 0.60), but fair in MVPA and ST for males only (k = 0.21 - 0.40). Spearman's indicated low validity (r = 0.1 - 0.3) in MVPA and sleep between GSHS and GENEActiv. However, kappa test results indicated poor-to-slight agreements (k =

. Background
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. ) is traditionally divided (“ratio‐scaled”) by body mass (BM) for clinical interpretation. Yet, it is unknown whether ratio‐scaling to BM can produce a valid size‐independent expression of peak
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. in people with a Fontan circulation. Furthermore, people with a Fontan circulation have deficits in lean mass, and it is unexplored whether using different measures of body composition may improve scaling validity. The objective was to assess the validity of different scaling denominators (BM, stature, body surface area, fat‐free mass, lean mass, and appendicular lean mass using ratio and allometric scaling).
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. Methods and Results
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. Eighty‐nine participants (age: 23.3±6.7 years; 53% female) with a Fontan circulation had their cardiorespiratory fitness and body composition measured by cardiopulmonary exercise testing and dual‐energy x‐ray absorptiometry. Ratio and allometric (log‐linear regression) scaling was performed and Pearson correlations assessed scaling validity. Scaling denominators BM (
. r
. =−0.25,
. P
. =0.02), stature (
. r
. =0.46,
. P
. &lt;0.001), and body surface area (0.23,
. P
. =0.03) were significantly correlated with their respective ratio‐scaled expressions of peak
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. but fat‐free mass, lean mass, or appendicular lean mass were not (
. r
. ≤0.11;
. R
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. =1%). Allometrically expressed peak
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. resulted in no significant correlation with any scaling denominator (
. r
. =≤0.23;
. R
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. =≤4%).
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. Conclusions
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. The traditional and accepted method of ratio‐scaling to BM is invalid because it fails to create a size‐independent expression of peak
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. in people with a Fontan circulation. However, ratio‐scaling to measures of body composition (fat‐free mass, lean mass, and appendicular lean mass) and allometric techniques can produce size‐independent expressions of peak
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. in people with a Fontan circulation.
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The aim of this study was to compare the use of generic and cystic fibrosis (CF)-specific cut-points to assess movement behaviours in children and adolescents with CF. Physical activity (PA) was assessed for seven consecutive days using a non-dominant wrist-worn ActiGraph GT9X in 71 children and adolescents (36 girls; 13.5 ± 2.9 years) with mild CF. CF-specific and generic Euclidean norm minus one (ENMO) cut-points were used to determine sedentary time (SED), sleep, light physical activity (LPA), moderate physical activity and vigorous physical activity. The effect of using a CF-specific or generic cut-point on the relationship between PA intensities and lung function was determined. Movement behaviours differed significantly according to the cut-point used, with the CF-specific cut-points resulting in less time asleep (−31.4 min; p &lt; 0.01) and in LPA (−195.1 min; p &lt; 0.001), and more SED and moderate-to-vigorous PA (159.3 and 67.1 min, respectively; both p &lt; 0.0001) than the generic thresholds. Lung function was significantly associated with LPA according to the CF-specific cut-points (r = 0.52; p = 0.04). Thresholds developed for healthy populations misclassified PA levels, sleep and SED in children and adolescents with CF. This discrepancy affected the relationship between lung function and PA, which was only apparent when using the CF-specific cut-points. Promoting LPA seems a promising strategy to enhance lung function in children and adolescents with CF.

Cross-sectional studies have reported lower pulmonary and aerobic function during exercise in people with cystic fibrosis-related diabetes (CFRD) compared to non-CFRD counterparts. However, this association has yet to be longitudinally investigated. Therefore, this study examines these differences over time between people with cystic fibrosis (CF) of differing glycaemic status. Annual review data, including cardiopulmonary exercise tests and pulmonary function tests, were retrospectively analysed at baseline (T0, n = 82) and at a one-year follow-up (T1, n = 54). Data was analysed in three groups: normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and CFRD. Further analyses were undertaken, with a dichotomous split of NGT and a combined IGT/CFRD group. At baseline, a significant reduction in the majority of variables, including forced expiratory volume in one second (FEV1) and maximal oxygen uptake (VO2max), was observed in the CFRD (n = 19) group compared to NGT (n = 58). At follow-up, no significant differences were observed, and no interaction effect between CFRD status and time was identified. FEV1 and VO2max presented with varying directions and magnitudes of change within patients. In summary, patients with CFRD have a reduced aerobic and pulmonary function compared to non-CFRD counterparts, although such changes disappeared at follow up. Varying responses for FEV1 and VO2max highlight the need to consider both variables as independent markers of function in CF.

BACKGROUND: the roles of physical activity (PA) and exercise within the management of cystic fibrosis (CF) are recognised by their inclusion in numerous standards of care and treatment guidelines. However, information is brief, and both PA and exercise as multi-faceted behaviours require extensive stakeholder input when developing and promoting such guidelines. METHOD: on 30th June and 1st July 2021, 39 stakeholders from 11 countries, including researchers, healthcare professionals and patients participated in a virtual conference to agree an evidence-based and informed expert consensus about PA and exercise for people with CF. This consensus presents the agreement across six themes: (i) patient and system centred outcomes, (ii) health benefits, iii) measurement, (iv) prescription, (v) clinical considerations, and (vi) future directions. The consensus was achieved by a stepwise process, involving: (i) written evidence-based synopses; (ii) peer critique of synopses; (iii) oral presentation to consensus group and peer challenge of revised synopses; and (iv) anonymous voting on final proposed synopses for adoption to the consensus statement. RESULTS: the final consensus document includes 24 statements which surpassed the consensus threshold (>80% agreement) out of 30 proposed statements. CONCLUSION: This consensus can be used to support health promotion by relevant stakeholders for people with CF.

New Findings
What is the central question of this study?
What is the effect of three repeated breath‐hold techniques routinely used by freedivers, thought to manipulate arterial partial pressures of O2 and CO2, on the cardiorespiratory and haematological response to breath‐holding during facial immersion?

What is the main finding and its importance?
All three techniques increased breath‐hold by a similar duration, probably owing to the similar marked increase in end‐tidal O2 and decrease in end‐tidal CO2 observed in all three trials before facial immersion. These were the only cardiorespiratory changes that were consistently manipulated before the maximal breath‐hold. This would suggest that pronounced bradycardia and vasoconstriction of selective vascular beds are probably not obligatory for prolonging breath‐hold duration.

AbstractRepeated maximal breath‐holds have been demonstrated to induce bradycardia, increase haematocrit and haemoglobin and prolong subsequent breath‐hold duration by 20%. Freedivers use non‐maximal breath‐hold techniques (BHTs) to improve breath‐hold duration. The aim of this study was to investigate the cardiorespiratory and haematological responses to various BHTs. Ten healthy men (34.5 ± 1.9 years) attended five randomized experimental trials and performed a 40 min period of quiet rest or one of three BHTs followed by a maximal breath‐hold challenge during facial immersion in water at 30 or 10°C. Cardiovascular and respiratory parameters were measured continuously using finger plethysmography and breath‐by‐breath gas analysis, respectively, and venous blood samples were collected throughout. Facial immersion in cold water caused marked bradycardia (74.1 vs. 50.2 beats/min after 40 s) but did not increase breath‐hold duration compared with warm water control conditions. Facial immersion breath‐hold duration was 30.8–43.3% greater than the control duration when preceded by BHTs that involved repeated breath‐holds of constant duration (P = 0.021), increasing duration (P &lt; 0.001) or increasing frequency (P &lt; 0.001), with no difference observed between BHTs. The increased duration of apnoea across all three BHT protocols was associated with a 6.8% increase in end‐tidal O2 and a 13.1% decrease in end‐tidal CO2 immediately before facial immersion. There were no differences in blood pressure, cardiac output, heart rate, haematocrit or haemoglobin between each BHT and control conditions (P &gt; 0.05). In conclusion, the duration of apnoea can be extended by manipulating blood gases through repeated prior breath‐holds, but changes in cardiac output and red blood cell mass do not appear essential.

Abstract
. Background
. Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap.
.
. Methods
. Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error.
.
. Results
. Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO2, the primary criteria for establishing a maximal effort. The majority of participants otherwise presented with secondary criteria of respiratory exchange ratios in excess of 1.05, and maximal heart rates in excess of their predicted values. Repeatability analyses identified that the typical error (expressed as percent of coefficient of variation) was 20% over 3-months in those reaching volitional exhaustion.
.
. Conclusion
. This work has, for the first time, fully characterised how patients with ILD respond to CPET in terms of primary and secondary verification criteria, and generated novel repeatability data that will prove useful in the assessment of disease progression, and future evaluation of therapeutic regimens where VO2peak is used as an outcome measure.
.

Cardiovascular diseases (CVD) are the leading cause of non-communicable deaths worldwide. It is well established that atherosclerosis, as a precursor to overt CVD, originates in youth. Vascular endothelial function has been identified as a ‘novel’ risk factor for CVD and can be non-invasively assessed using flow-mediated dilation (FMD). It has been shown that exercise improves vascular function, however, children and adolescents fail to meet the recommended daily physical activity levels. Therefore, it is important to identify the optimal exercise strategy to improve vascular function.
In adults, new vascular measurements such as low-flow-mediated constriction (L-FMC) have been established to supplement the information gained from the measurement of FMD. Furthermore, the near-infrared spectroscopy (NIRS)-derived reperfusion rate of tissue oxygen saturation (slope 2 StO2) has been shown to be reliable and significantly correlated with FMD in adults, suggesting it may have utility to assess vascular function.
Therefore, Chapters 4 and 5 are concerned with acute and chronic exercise, respectively, while Chapters 6 and 7 investigate novel assessments of vascular function and their reliability in a paediatric population.
Chapter 4 demonstrates that both macro- and microvascular function were enhanced following an acute bout of interval running independent of exercise intensity in a group of adolescents, suggesting that the exercise pattern (i.e. interval) and the accompanying shear are important for vascular improvements. In addition, an acute glucose load improved macrovascular function whereas no changes in FMD were observed with a prior bout of exercise. The effect of a chronic exercise intervention on traditional and novel CVD risk factors in adolescent boys was examined in Chapter 5. Four weeks of high-intensity interval training improved FMD significantly with no concomitant changes in microvascular function or traditional risk factors (glucose, insulin, blood lipids, body composition), suggesting the training duration was too short to elicit further enhancements. However, the improvements in FMD were lost two weeks after training cessation.
Chapter 6 showed that the brachial artery of adolescents constricts during a period of low flow, however, on an individual level low-flow vasoreactivity is inconsistent between days. The measurement of L-FMC has poor reliability compared to FMD and no significant correlation was observed between FMD and L-FMC.
Finally, Chapter 7 revealed that the reliability of the NIRS-derived slope 2 StO2 is comparable to the reproducibility of FMD in male adolescents. However, slope 2 StO2 was not significantly correlated with FMD and therefore its use as a surrogate measure for FMD is precluded. In contrast to FMD, slope 2 StO2 was not sensitive to an acute bout of high-intensity interval exercise.
In conclusion, this thesis demonstrates that the intermittent stimulus may be more important than the exercise intensity with regards to improvements in vascular function. In addition, enhancements of traditional CVD risk factors are not achievable within four weeks of training in healthy adolescents despite improvements in FMD. Improvements in vascular function were lost after two weeks of detraining, highlighting the importance of regular exercise for promoting vascular health. While the reproducibility of L-FMC in adolescents is poor, slope 2 StO2 can be measured reliably in adolescents. However, due to the lack of correlation with FMD, slope 2 StO2 may not be used as a measure of macrovascular function.

Purpose: Few data exist on the descriptions of LV myocardial mechanics and reserve during dynamic exercise of adolescent athletes. The aim of this study was to describe the LV myocardial and cardiopulmonary changes during exercise using 2-D strain deformation imaging. Methods: Elite adolescent male football players (n = 42) completed simultaneous cardiopulmonary exercise testing (CPET) and exercise echocardiography measurement of LV myocardial deformation by 2-D strain imaging. LV longitudinal and circumferential 2-D strain and strain rates were analyzed at each stage during incremental exercise to a work rate of 150 W. Additionally, exercise LV myocardial deformation and its relation to metabolic exercise parameters were evaluated at each exercise stage and in recovery using repeated measures ANOVA, linear regression and paired t tests. Results: LV peak systolic baseline 2-D strain (longitudinal: − 15.4 ± 2.5%, circumferential: − 22.5 ± 3.1%) increased with each exercise stage, but longitudinal strain plateaued at 50 W (mean strain reserve − 7.8 ± 3.0) and did not significantly increase compared to subsequent exercise stages (P > 0.05), whilst circumferential strain (mean strain reserve − 11.6 ± 3.3) significantly increased (P < 0.05) throughout exercise up to 150 W as the dominant mechanism of exercise LV contractility increase. Regression analyses showed LV myocardial strain increased linearly relative to HR, VO2 and O2 pulse (P < 0.05) for circumferential deformation, but showed attenuation for longitudinal deformation. Conclusion: This study describes LV myocardial deformation dynamics by 2-D strain and provides reference values for LV myocardial strain and strain rate during exercise in adolescent footballers. It found important differences between LV longitudinal and circumferential myocardial mechanics during exercise and introduces a methodology that can be used to quantify LV function and cardiac reserve during exercise in adolescent athletes.

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults’ cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.

Abstract
Purpose: the purpose of this study was: 1) to explore the perceptions of primary school staff members, pupils and governors in regard to classroom based physical activity (CBPA); 2) to understand the multiple levels of factors impacting these stakeholder’s acceptability of interventions and 3) to collaboratively design a successful classroom movement intervention that is accepted by the school governors, feasible for teachers and enjoyable for the pupils, with the main aim of breaking up continuous uninterrupted
classroom sedentary time.
Methods: Sixty-four staff members and twenty governors completed a questionnaire and 7 participants (n=5 staff and n=2 governors) took part in a further follow up semi structured telephone interview. Thirty-four Key Stage (KS) 1 and KS2 pupils from one federated village school in Somerset took part in a focus group discussion.
Results: all staff members, governors and pupils were aware of the value of PA and had similar barriers for implementation within the classroom environment. Two main barriers that were reported by the majority of staff members are time and transitioning back to work following movement. In addition, suggestions for increasing adoption and implementation were identified, for example, short and simple breaks, pupil guided choice and performed at the teacher’s discretion. Furthermore, the need for more sufficient evidence regarding pupil cognition following a movement break were requested by both governors and staff.
Key words: qualitative research, classroom, movement breaks, stakeholders, prolonged sedentary time
Abbreviations: Physical activity (PA), Key Stage 1 (KS1), Key Stage 2 (KS2)

Although distance running is associated with multiple health benefits, adult-based research indicates that participation is also associated with unfavourable health outcomes, such as running-related injury (RRI). As there is limited literature related to the health problems (i.e. injury and illness) that competitive adolescent distance runners (13-18 years) experience, this research aimed to describe and evaluate the extent of the injury and illness problem in competitive adolescent distance runners in England.

The first study (Chapter 4) demonstrates that session rating of perceived exertion (sRPE), whether reported 0, 15, or 30 minutes following session completion, provides a valid measure of internal training load in adolescent distance runners. This allows sRPE to be used during training and future epidemiological studies. The second study (Chapters 5 and 6) employed a mixed-methods study design. Chapter 5 presents a retrospective epidemiological study (n = 113), whereby the incidence of RRI was 6.3 per 1,000 hours of exposure and the most commonly injured body areas were the knee, foot/toes, and lower leg. Exploratory univariate analyses indicated that a larger number of training sessions per week (volume) and higher specialisation (i.e. intense, year-round training in a single sport with the exclusion of other sports) were both associated with a lower risk of RRI. Chapter 6 investigated psychosocial responses to RRI in those athletes (n = 19) who self-reported a serious RRI (>28 days-6 months of time loss). Based upon a reflexive thematic analysis of interview data, fifteen codes and three themes were developed. These data indicate that serious RRI acts to ‘destabilise athletic identity’ in competitive adolescent distance runners. The third study (Chapter 7) presents a prospective cohort study (n = 136), whereby the incidence of RRI was 25 per 1,000 hours of exposure. At any time, the mean weekly prevalence of all health problems was 24%, regardless of type or sex, reducing to 11% and 4% for substantial and time loss health problems, respectively. These data show that competitive adolescent distance runners are likely to be training and/or competing whilst concurrently experiencing one or more health problems. Also, female athletes self-reported more illnesses, when compared to male athletes. Collectively, these studies provide valuable and novel insight into the health and wellbeing of competitive adolescent distance runners in England. In turn, this thesis will support the development of injury and illness prevention measures.

Background: Distance running is one of the most popular sports around the world. The epidemiology of running-related injury (RRI) has been investigated in adults, but few studies have focused on adolescent distance runners.Objectives: (1) to provide descriptive epidemiology of RRI (risks, rates, body regions/areas, and severity) and examine the training practices (frequency, volume, and intensity) of competitive adolescent distance runners (13–18 years) in England, and (2) to describe potential risk factors of RRI.Methods: a cross-sectional study design was used. Adolescent distance runners (n = 113) were recruited from England Athletics affiliated clubs. Participants voluntarily completed an online questionnaire between April and December 2018. At the time of completion, responses were based on the participant's previous 12-months of distance running participation. Incidence proportions (IP) and incidence rates (IR) were calculated.Results: the IP for “all RRI” was 68% (95% CI: 60–77), while the IR was 6.3/1,000 participation hours (95% CI: 5.3–7.4). The most commonly injured body areas were the knee, foot/toes, and lower leg; primarily caused by overuse. The number of training sessions per week (i.e. frequency) significantly increased with chronological age, while a large proportion of participants (58%) self-reported a high level of specialisation.Conclusions: RRI is common in competitive adolescent distance runners. These descriptive data provide guidance for the development of RRI prevention measures. However, analytical epidemiology is required to provide better insight into potential RRI risk factors in this specific population.

Speckle tracking echocardiography (STE) has gained importance in the evaluation of adult inherited cardiomyopathies, but its utility in children is not well characterized. We conducted a systematic review to evaluate the role of STE in pediatric inherited cardiomyopathies. PubMed, EMBASE, Web of Science, Scopus, CENTRAL and CINAHL databases were searched up to May 2020, for terms related to inherited cardiomyopathies and STE. Included were dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (ACM). A total of 14 cohorts were identified, of which six were in DCM, four in HCM, three in LVNC and one in ACM. The most commonly reported STE measurements were left ventricular longitudinal strain (Sl), circumferential strain (Sc), radial strain (Sr) and rotation/torsion/twist. Sl, Sc and were abnormal in all DCM and LVNC cohorts, but not in all HCM. Apical rotation and twist/torsion were increased in HCM, and decreased in LVNC. Abnormal STE parameters were reported even in cohorts with normal non-STE systolic/diastolic measurements. STE in childhood cardiomyopathies can detect early changes which may not be associated with changes in cardiac function detectable by non-STE methods. Longitudinal and circumferential strain should be introduced in the cardiomyopathy echocardiography protocol, reflecting current practice in adults.

New Findings

What is the central question of this study?
What is the effect of high‐intensity and moderate‐intensity interval running on macro‐ and microvascular function in a fasted state and following a glucose challenge in adolescents?


What is the main finding and its importance?
Both macro‐ and microvascular function were improved after interval running independent of intensity. This finding shows that the intermittent exercise pattern and its associated effect on shear are important for vascular benefits. In adolescents, macrovascular function was enhanced after an acute glucose load. However, the effect of chronic glucose consumption on vascular function remains to be elucidated.

AbstractInterventions targeting vascular function in youth are an important strategy for the primary prevention of cardiovascular diseases. This study examined, in adolescents, the effect of high‐intensity interval running (HIIR) and moderate‐intensity interval running (MIIR) on vascular function in a fasted state and postprandially after a glucose challenge. Fifteen adolescents (13 male, 13.9 ± 0.6 years) completed the following conditions on separate days in a counterbalanced order: (1) 8 × 1 min HIIR interspersed with 75 s recovery; (2) distance‐matched amount of 1 min MIIR interspersed with 75 s recovery; and (3) rest (CON). Macro‐ (flow‐mediated dilatation, FMD) and microvascular (peak reactive hyperaemia, PRH) function were assessed immediately before and 90 min after exercise/rest. Participants underwent an oral glucose tolerance test (OGTT) 2 h after exercise/rest before another assessment of vascular function 90 min after the OGTT. Following exercise, both HIIR and MIIR increased FMD (P = 0.02 and P = 0.03, respectively) and PRH (P = 0.04, and P = 0.01, respectively) with no change in CON (FMD: P = 0.51; PRH: P = 0.16) and no significant differences between exercise conditions. Following the OGTT, FMD increased in CON (P &lt; 0.01) with no changes in HIIR and MIIR (both P &gt; 0.59). There was no change in PRH after the OGTT (all P &gt; 0.40). In conclusion, vascular function is improved after interval running independent of intensity in adolescents. Acute hyperglycaemia increased FMD, but prior exercise did not change vascular function after the OGTT in youth.

Abstract
. Background
. Cystic fibrosis (CF) is a genetically inherited, life-limiting condition, affecting ~90,000 people globally. Physical activity (PA) and exercise form an integral component of CF management, and have been highlighted by the CF community as an area of interest for future research. Previous reviews have solely focused on PA or structured exercise regimens independent of one another, and thus a comprehensive assessment of the physical health benefits of all PA, including exercise, interventions, is subsequently warranted. Therefore, the purpose of this review is to evaluate the effects of both PA and exercise upon outcomes of physical health and healthcare utilisation in people with CF.
.
. Methods
. A systematic review has been registered and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P guidelines. This will include randomised control trials on the effects of PA and exercise, relative to usual treatment, upon people with CF. Primary outcomes will include variables associated with fitness, PA, lung health, inflammation, body composition, glycaemic control and patient-reported outcomes. Secondary outcomes will include adverse events and healthcare utilisation. Searches will be undertaken in Ovid MEDLINE, OVID EMBASE, PsychINFO, ERIC, SPORTDiscus, ASSIA, CCTR, CINHAL and Web of Science databases, and will be searched from date of inception onwards. Two reviewers will independently screen citations and abstracts, and full-texts, for inclusion and data extraction, respectively. Methodological quality will be assessed using the Cochrane Risk of Bias-2 tool. If feasible, random-effects meta-analyses will be conducted where appropriate. Additional analyses will explore potential sources of heterogeneity, such as age, sex, and disease severity.
.
. Discussion
. This systematic review will build on previous research, by comprehensively assessing the impact of both PA and exercise upon physical health and healthcare utilisation in people with CF. Results of this review will be utilised to inform discussions that will ultimately result in a consensus document on the impact of physical activity and exercise for people with CF.
.
. Systematic review registration
. PROSPERO CRD42020184411
.

Background: Bone marrow oedema (BMO), seen on magnetic resonance imaging, can be associated with various injuries to the knee but may also occur in asymptomatic athletes. The prevalence and causal factors for these observations are not well understood. The aim of this study was to determine the prevalence of BMO in asymptomatic knees of athletes, competing at a high level, and to investigate the associated factors. Materials and Methods: Twenty-five asymptomatic university athletes, competing at regional to international level, were recruited. Bilateral knee magnetic resonance imaging was performed in each athlete (total 50 knee scans) at the end of their competitive season. Imaging studies were reported independently by two experienced consultant musculoskeletal radiologists. Results: There was almost perfect agreement between reporters for diagnosis of BMO (κ = 0.896). Seven participants (28%) were found to have BMO (six in one knee and one bilaterally). The amount of time spent training, during the season, was significantly associated with the appearance of BMO (p < 0.05). Conclusion: the occurrence of BMO in asymptomatic knees of athletes is common (occurring in over one-quarter of knees) and may be associated with training intensity. This should be considered when treating athletes and deciding upon appropriate treatment plans.

This is a data set for the Risk of Bias (2) for a Cochrane Review (Intervention).

Dinghy sailing, although frequently researched at elite and developmental levels, lacked research focused on the foundation levels in children. This thesis employed qualitative and quantitative methods to investigate the impact of dinghy sailing on children during a taster session, a beginner sailing course and those who were participating regularly on a weekly basis. While individualising each study to focus upon specific aspects, mental and physical wellbeing were common themes across all three studies.
In Study 1, participants (n=66; boys n= 35 and girls n= 31) aged between 8-13 years (10.5 ±0.6 y) completed the Daily Reconstruction Method for Children (DRM-C) and Before and After Feeling and Thoughts (BAFT) questionnaire. Key findings consisted of a general increase in both happiness and enjoyment from pre-to post- taster session. Sex comparisons found boys utilised sport more to assist in mental wellbeing even though girls expressed greater changes in emotion during taster session.
In Study 2 children (n=52) aged 10.3 (±2.7) y attended a RYA Stage 1 (n= 43), and/or Stage 2 (n= 27) course and participated in the DRM-C and BAFT questionnaire, as well as wearing wrist worn accelerometers and heart rate monitors. Overall, results in the morning sessions showed a decrease in emotions compared to afternoon sessions. In particular, the first afternoon (session 2) of both stage 1 and 2 recorded significant increases in happiness for both boys and girls. Physically, participants accrued 44% of their moderate to vigorous physical activity (MVPA) recommended guideline during their stage 1 and/ or 2 course. Overall, increased levels of physical activity was found for boys compared to girls.
In Study 3, youth sailors (n=12) with a mean age 11 ± 1.54 y, who sailed regularly (at least once a week) were interviewed to investigate a range of topics related to their journey in participation of dinghy sailing. Findings reported multiple positive areas present from starting to sail to regular participation including environment exposure, improved mental wellbeing, improved physical wellbeing, developed social skills, developed life skills, learnt sailing specific skills and assisted in school/ career ideas. The current study also found some negative areas including restraints in time and social factors, expenses, risk of injury/ hazards, and limitations in sailing performance to other areas of life. In relation to the recent document of Sport England for sports to establish evidence of benefits of sports participation, this study provides evidence to support the promotion of dinghy sailing for young people in physical wellbeing, mental wellbeing, individual and social development.

Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms "heart rate variability" and "cerebral palsy" in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0-18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.

ABSTRACT
. Talent identification and development in male youth soccer are complex and multidimensional processes. The English Football Association “4 Corner Model” is often adopted by academies to support coaches and practitioners to implement a multidisciplinary approach to their talent identification and development framework. This holistic approach is characterized by technical/tactical, psychological, social, and physical attributes, which are central to academy recruitment and individual long-term athlete development. The aim of this narrative review is to provide a critical synthesis of the physical characteristics within this model, which facilitate talent identification and development, namely physical performance, growth and maturation, and the relative age effect.

BACKGROUND: Congenital heart disease (ConHD) affects approximately 1% of all live births. People with ConHD are living longer due to improved medical intervention and are at risk of developing non-communicable diseases. Cardiorespiratory fitness (CRF) is reduced in people with ConHD, who deteriorate faster compared to healthy people. CRF is known to be prognostic of future mortality and morbidity: it is therefore important to assess the evidence base on physical activity interventions in this population to inform decision making. OBJECTIVES: to assess the effectiveness and safety of all types of physical activity interventions versus standard care in individuals with congenital heart disease. SEARCH METHODS: We undertook a systematic search on 23 September 2019 of the following databases: CENTRAL, MEDLINE, Embase, CINAHL, AMED, BIOSIS Citation Index, Web of Science Core Collection, LILACS and DARE. We also searched ClinicalTrials.gov and we reviewed the reference lists of relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCT) that compared any type of physical activity intervention against a 'no physical activity' (usual care) control. We included all individuals with a diagnosis of congenital heart disease, regardless of age or previous medical interventions.  DATA COLLECTION AND ANALYSIS: Two review authors (CAW and CW) independently screened all the identified references for inclusion. We retrieved and read all full papers; and we contacted study authors if we needed any further information. The same two independent reviewers who extracted the data then processed the included papers, assessed their risk of bias using RoB 2 and assessed the certainty of the evidence using the GRADE approach. The primary outcomes were: maximal cardiorespiratory fitness (CRF) assessed by peak oxygen consumption; health-related quality of life (HRQoL) determined by a validated questionnaire; and device-worn 'objective' measures of physical activity. MAIN RESULTS: We included 15 RCTs with 924 participants in the review. The median intervention length/follow-up length was 12 weeks (12 to 26 interquartile range (IQR)). There were five RCTs of children and adolescents (n = 500) and 10 adult RCTs (n = 424). We identified three types of intervention: physical activity promotion; exercise training; and inspiratory muscle training. We assessed the risk of bias of results for CRF as either being of some concern (n = 12) or at a high risk of bias (n = 2), due to a failure to blind intervention staff. One study did not report this outcome. Using the GRADE method, we assessed the certainty of evidence as moderate to very low across measured outcomes. When we pooled all types of interventions (physical activity promotion, exercise training and inspiratory muscle training), compared to a 'no exercise' control CRF may slightly increase, with a mean difference (MD) of 1.89 mL/kg-1/min-1 (95% CI -0.22 to 3.99; n = 732; moderate-certainty evidence). The evidence is very uncertain about the effect of physical activity and exercise interventions on HRQoL. There was a standardised mean difference (SMD) of 0.76 (95% CI -0.13 to 1.65; n = 163; very low certainty evidence) in HRQoL. However, we could pool only three studies in a meta-analysis, due to different ways of reporting. Only one study out of eight showed a positive effect on HRQoL. There may be a small improvement in mean daily physical activity (PA) (SMD 0.38, 95% CI -0.15 to 0.92; n = 328; low-certainty evidence), which equates to approximately an additional 10 minutes of physical activity daily (95% CI -2.50 to 22.20). Physical activity and exercise interventions likely result in an increase in submaximal cardiorespiratory fitness (MD 2.05, 95% CI 0.05 to 4.05; n = 179; moderate-certainty evidence). Physical activity and exercise interventions likely increase muscular strength (MD 17.13, 95% CI 3.45 to 30.81; n = 18; moderate-certainty evidence). Eleven studies (n = 501) reported on the outcome of adverse events (73% of total studies). of the 11 studies, six studies reported zero adverse events. Five studies reported a total of 11 adverse events; 36% of adverse events were cardiac related (n = 4); there were, however, no serious adverse events related to the interventions or reported fatalities (moderate-certainty evidence). No studies reported hospital admissions. AUTHORS' CONCLUSIONS: This review summarises the latest evidence on CRF, HRQoL and PA. Although there were only small improvements in CRF and PA, and small to no improvements in HRQoL, there were no reported serious adverse events related to the interventions. Although these data are promising, there is currently insufficient evidence to definitively determine the impact of physical activity interventions in ConHD. Further high-quality randomised controlled trials are therefore needed, utilising a longer duration of follow-up.

AbstractThe world’s greatest professional football players are able to execute effective tactical decisions as well as fulfil various physical demands. However, the degree to which both are associated with greater potential in a football academy is unknown. Therefore, the aim of this study was to investigate decision-making skill and physical performance as contributing factors to coach potential rankings in an English football academy. Ninety-eight outfield academy players (Foundation Development Phase [FDP] under-9 to under-11 n = 40; Youth Development Phase [YDP] under-12 to under-16 n = 58) participated in the study. They engaged in 45 film-based simulations at two occlusion phases (e.g. the visual display is cut-off at a precise time during an action), firstly “during” and secondly “post” execution, to examine decision-making skill. Participants also completed four fitness tests to examine physical performance. A classification of “higher-potentials” (top third) and “lower-potentials” (bottom third) were applied through coach rankings. Independent t-tests compared the decision-making and physical performance tests. Higher-potentials made significantly more accurate decisions within the “post” phase within the FDP (P &lt; 0.05) and the “during” phase within the YDP (P &lt; 0.05). Additionally, higher-potentials were significantly faster for the 0–30 m sprint in both the FDP and YDP (P &lt; 0.05), with higher-potentials within the YDP also significantly faster in the 0–10 m sprint (P &lt; 0.05) and jumped significantly higher in the countermovement jump (P &lt; 0.05). These findings indicated that greater football potential may be associated with superior perceptual-cognitive expertise and quicker sprint ability in both academy age phases, with a greater discriminatory function within the older cohort.

The reliability of handgrip strength (HGS) measurement has been confirmed in adults but has been sparsely addressed in pediatric populations. The aims of this study are twofold: to determine whether sex, age and/or hand-dominance influence the test–retest differences and to establish the reliability level of the HGS measurement in typical developing pediatric participants. A total of 338 participants aged 7–13 years were tested using a digital handgrip strength (HGS) dynamometer (Jamar Plus+ Dynamometer) by the same rater on two testing trials separated by a one-day interval between sessions. The HGS testing was conducted according to the American Society of Hand Therapists recommendations. Relative and absolute reliability statistics were calculated. Age influenced the test–retest difference of the HGS measurement as children compared to preadolescents had lower intraclass correlation coefficients (0.95 vs. 0.98), standard error of measurement (SEM) (0.74 vs. 0.78 kg), smallest detectable difference (SDD) (2.05 vs. 2.16 kg) and higher values of the percentage value of SEM (5.48 vs. 3.44%), normalized SDD (15.52 vs. 9.61%) and a mean difference between the test and retest values (0.50 vs. 0.02 kg) for the dominant hand. The results indicate that the protocol using the Jamar digital handgrip dynamometer is a reliable instrument to measure HGS in participants aged 7–13 years with typical development. Clinicians and researchers therefore can have confidence in determining the minimally clinical effect for HGS.

Abstract
Background
Numerous studies have measured the prognostic associations between cardiorespiratory fitness and patient outcomes in congenital heart disease, but no systematic review has assessed these associations for all types of congenital heart disease. It is therefore a timely opportunity to syntheses all available data using a systematic review methodology. The aim of this study is to detail the protocol for a systematic review and meta-analysis.

Objectives
Within this paper we have developed a protocol for a prognostic factors systematic review and meta-analysis, to assess the role of cardiopulmonary exercise testing/cardiorespiratory fitness, in the prognosis of mortality and morbidity in congenital heart disease.

Methods
We have outlined, in detail, the process for this systematic review using the latest accepted methodological guidelines for prognostic factors research, such as the PICOTS system, CHARMS-PF data extraction, QUIPS risk of bias assessments and the prognostic GRADE guidelines (see list of abbreviations).

Conclusion
The implications of this review will aid future treatments, interventions and individual patient risk prediction. The publication of this protocol aims to improve scientific rigour by ensuring transparency in the systematic review and meta-analysis process.

BACKGROUND: Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF. METHODS: Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality. DISCUSSION: This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all individuals with CF, to support physical activity and exercise participation at a time and location of the user's choosing, regardless of microbiological status. TRIAL REGISTRATION: Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at (ACTRN12617001009303).

High-intensity interval exercise (HIIE) has been shown to promote multiple health benefits and well-being in youth. However, HIIE is proposed to elicit negative affect responses (unpleasant feelings) as predicted by the dual mode theory (DMT), and may negatively impact on future exercise adherence. Previous studies have explored how perceptual, physiological and cognitive factors are associated to negative affect responses during continuous high-intensity exercise, but affect experience (pleasure/displeasure) during HIIE is poorly understood in adolescents. The purpose of this thesis is to evaluate acute affect responses to HIIE in adolescents, and to examine the influence of physiological (i.e. heart rate (HR) and prefrontal cortex (PFC)), perceptual (i.e. enjoyment and rating of perceived exertion (RPE)), and cognitive (i.e. self-efficacy and personality traits) factors. Chapter 4 demonstrates that HIIE (work intervals performed at 90% of peak power (PPO)) is perceived to be more enjoyable due to elevated feelings of reward, excitement and success than continuous moderate-intensity exercise, which was perceived to be more boring in adolescents. Chapter 5 examined the acute affect, enjoyment and RPE responses to HIIE (work intervals performed at 90% of maximal aerobic speed) compared with moderate-intensity interval exercise (MIIE). Chapter 5 reports that HIIE elicits less pleasurable feelings at the later stages of work intervals but greater post-enjoyment than MIIE, extending and reinforcing the findings in Chapter 4. The findings from Chapter 5 are furthered in Chapters 6 and 7, which identified that the affect responses during HIIE are dependent on the intensity and delivery (decreasing vs increasing) of the HIIE protocol. Chapter 6 revealed that HIIE performed at 100% PPO elicited a greater decline and lower affect responses across all work intervals than HIIE performed at 85% and 70% PPO. However, all HIIE conditions generated similar enjoyment responses during and after exercise. Chapter 7 showed that affect and enjoyment responses improve (more pleasurable and enjoyable) near the end of HIIE with decreasing work intensity compared to HIIE with increasing work intensity. Moreover, the increases in positive affect experienced during HIIE were positively related to an increase in PFC oxygenation. Chapters 5-7 also demonstrate that RPE and HR responses were inversely related to changes in the affect responses in all HIIE conditions. Finally, Chapter 8 identified that both individual self-efficacy and personality traits may decrease or increase the likelihood that a person will experience positive affective and enjoyment responses to HIIE at the later stages of work intervals in adolescents. Collectively, the studies presented in this thesis demonstrate that affect responses during HIIE are dependent on the work intensity, work delivery, and changes in enjoyment, RPE, PFC oxygenation and cognitive factors. Given that some permutations of HIIE protocols do not elicit prominent and entirely negative affective responses, HIIE protocols could serve as a strategy to encourage exercise adoption and promote health benefits in adolescents.

Cystic fibrosis (CF) is a debilitating chronic condition, which requires complex and expensive disease management. Exercise has now been recognised as a critical factor in improving health and quality of life in patients with CF. Hence, cardiopulmonary exercise testing (CPET) is used to determine aerobic fitness of young patients as part of the clinical management of CF. However, at present there is a lack of conclusive evidence for one limiting system of aerobic fitness for CF patients at individual patient level. Here, we perform detailed data analysis that allows us to identify important systems-level factors that affect aerobic fitness. We use patients’ data and principal component analysis to confirm the dependence of CPET performance on variables associated with ventilation and metabolic rates of oxygen consumption. We find that the time at which participants cross the gas exchange threshold (GET) is well correlated with their overall performance. Furthermore, we propose a predictive modelling framework that captures the relationship between ventilatory dynamics, lung capacity and function and performance in CPET within a group of children and adolescents with CF. Specifically, we show that using Gaussian processes (GP) we can predict GET at the individual patient level with reasonable accuracy given the small sample size of the available group of patients. We conclude by presenting an example and future perspectives for improving and extending the proposed framework.
The modelling and analysis have the potential to pave the way to designing personalised exercise programmes that are tailored to specific individual needs relative to patient’s treatment therapies.

Cystic fibrosis (CF) is the most common, genetically inherited, life-shortening condition in the Caucasian population, with ~11,000 people in the United Kingdom having the disease. The genetic defect responsible for CF results in accumulation of thick, sticky mucus that blocks the airways and digestive systems. As there is currently no cure for CF, it is a disease that is managed using antibiotics, nutrition, physiotherapy and exercise. Exercise capacity, as measured by peak oxygen uptake (V̇O2peak), and where possible, maximal oxygen uptake (V̇O2max), is reduced in patients with CF and a low V̇O2peak is associated with increased risk of hospitalisation, mortality and low quality of life. As a result, regular exercise testing is recommended, with cardiopulmonary exercise testing (CPET) considered the ‘gold standard’ procedure by leading international clinical organisations. The purpose of this thesis was to further our understanding surrounding the use of CPET in the assessment and treatment of children and adolescents with CF.
The first component of this thesis sought to identify and evaluate submaximal parameters of aerobic function derived from CPET, namely the oxygen uptake efficiency slope (OUES) and plateau (OUEP). Findings revealed that allometric scaling for body surface area (BSA) was necessary when evaluating OUES, and a power function of 1.40 (i.e. OUES/BSA1.40) removed residual effects of body size (Chapter 4). Subsequently, results identified that the OUES was not a valid surrogate of aerobic fitness in CF, despite a significant correlation (r = 0.47, p = 0.004) with V̇O2max when expressed relative to body mass, as it was unable to discriminate aerobic fitness within a CF group, nor against a control group (Chapter 5). As OUES was not a valid surrogate of aerobic fitness, the utility of OUEP as an independent marker of aerobic fitness was explored. Whilst the OUEP was correlated with V̇O2peak in CF, when expressed as an absolute value (r = 0.43, p = 0.010) and when allometrically scaled for body mass (r = 0.52, p = 0.001), it was unable to discriminate aerobic fitness to the same extent as V̇O2peak. However, the OUEP was associated with disease status and severity, being significantly (p < 0.001) lower in the CF group, but also significantly and positively correlated with lung function (forced expiratory volume in one-second [FEV1]) in the CF group (r = 0.43, p = 0.010), a finding that warrants further, longitudinal investigation (Chapter 6).
The second component of this thesis utilised CPET to investigate musculoskeletal limitations to the reduced V̇O2max that has previously been reported in CF. Parameters of muscle size (thigh cross-sectional area, muscle cross-sectional area and thigh muscle volume) were first quantified using magnetic resonance imaging, alongside the error associated with estimating muscle volume using alternative calculation techniques (Chapter 7). These parameters were then allometrically scaled for, which successfully removes residual effects of muscle size (i.e. muscle ‘quantity’) from V̇O2max. When this scaling is undertaken, V̇O2max is lower in children with CF relative to age- and sex-matched controls, indicating that exercise capacity is not size-dependent in CF and that intrinsic muscular factors (i.e. muscle ‘quality’) are likely responsible for the reduced V̇O2max observed in CF (Chapter 8).
Finally, the third component identified applications of CPET for both patients with CF and staff responsible for care. CPET, using a case-study approach, was utilised to describe exercise-related changes in an 11 year old female with CF following surgical insertion of a percutaneous endoscopic gastrostomy and overnight nutritional supplementation. This evaluation identified a maintenance of V̇O2max over one year, in contrast to a fluctuation in FEV1, and increase in body mass index (BMI), therefore highlighting the independent prognostic information afforded by use of CPET (Chapter 9). Following this patient-centred application of CPET, two meetings were held with NHS staff, to provide a platform for exchange of ideas and best practice, but to also survey roles, responsibilities, prevalence of CPET and resources needed for effective implementation of exercise testing and training (Chapter 10).
In conclusion, this thesis has further highlighted the utility of CPET in the management of CF. Moreover, it has explored the prognostic and diagnostic properties of CPET, as well as its implementation for patients and staff alike.

Cystic fibrosis (CF) is a debilitating chronic condition, which requires complex and expensive disease management. Exercise has now been recognised as a critical factor in improving health and quality of life in patients with CF. Hence, cardiopulmonary exercise testing (CPET) is used to determine aerobic fitness of young patients as part of the clinical management of CF. However, at present there is a lack of conclusive evidence for one limiting system of aerobic fitness for CF patients at individual patient level. Here, we perform detailed data analysis that allows us to identify important systems-level factors that affect aerobic fitness. We use patients’ data and principal component analysis to confirm the dependence of CPET performance on variables associated with ventilation and metabolic rates of oxygen consumption. We find that the time at which participants cross the gas exchange threshold (GET) is well correlated with their overall performance. Furthermore, we propose a predictive modelling framework that captures the relationship between ventilatory dynamics, lung capacity and function and performance in CPET within a group of children and adolescents with CF. Specifically, we show that using Gaussian processes (GP) we can predict GET at the individual patient level with reasonable accuracy given the small sample size of the available group of patients. We conclude by presenting an example and future perspectives for improving and extending the proposed framework. The modelling and analysis have the potential to pave the way to designing personalised exercise programmes that are tailored to specific individual needs relative to patient’s treatment therapies.

PURPOSE: to investigate the effects of an oral glucose tolerance test (OGTT) on baroreflex sensitivity (BRS) in a sample of healthy adolescents, and how acute exercise bouts of different intensities alter the effects of the OGTT on BRS. METHODS: Thirteen male adolescents (14.0 ± 0.5 years) completed three conditions on separate days in a counterbalanced order: (1) high-intensity interval exercise (HIIE); (2) moderate-intensity interval exercise (MIIE); and (3) resting control (CON). At ~ 90 min following the conditions, participants performed an OGTT. Supine heart rate and blood pressure were monitored continuously at baseline, 60 min following the conditions, and 60 min following the OGTT. A cross-spectral method (LFgain) was used to determine BRS gain. Arterial compliance (AC) was assessed as the BRS vascular component. LFgain divided by AC (LFgain/AC) was used as the autonomic component. RESULTS: Although non-significant, LFgain moderately decreased post-OGTT when no exercise was performed (pre-OGTT = 24.4 ± 8.2 ms mmHg- 1; post-OGTT = 19.9 ± 5.6 ms mmHg- 1; ES = 0.64, P > 0.05). This was attributed to the decrease in LFgain/AC (pre-OGTT = 1.19 ± 0.5 ms µm- 1; post-OGTT = 0.92 ± 0.24 ms µm- 1; ES = 0.69, P > 0.05). Compared to CON (Δ = - 4.4 ± 8.7 ms mmHg- 1), there were no differences for the pre-post-OGTT delta changes in LF/gain for HIIE (Δ = - 3.5 ± 8.2 ms mmHg- 1) and MIIE (Δ = 1.3 ± 9.9 ms mmHg- 1) had no effects on BRS following the OGTT (all ES 

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: to assess the effectiveness and safety of physical activity promotion and exercise training interventions in individuals with congenital heart disease.

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.

Background: Females with cystic fibrosis have higher mortality rates than their male counterparts. Pulmonary function defined as forced expiratory volume in 1 s (FEV1) is a predictor of mortality. However, when pulmonary function is accounted for, females still have a higher mortality rate than males. Independent of lung function, peak oxygen uptake (VO2peak) is a significant predictor of mortality, with higher values of VO2peak relating to a lower risk of mortality. In healthy children, VO2peak is significantly different between sexes, however it has yet to be determined whether sex differences in VO2peak occur in CF. Aim: to identify sex differences in exercise capacity in young people with CF, when appropriately scaled for different body size variables and adjusted for key clinical parameters such as lung function and nutritional and maturity status. Methods: 52 young people (29 males and 23 females) aged 8 – 25 y with CF underwent a ramp cycle test to exhaustion. 47 completed an additional supramaximal cycle test to exhaustion at 110 % of ramp test peak power to verify that a true VO2max was obtained. VO2peak was scaled allometrically and using the ratio standard method. ANCOVAs were utilised to remove the influence of clinical parameters. Results: VO2peak was significantly lower in females than males for absolute VO2peak (p < 0.001, 1.41 ± 0.38 L∙min-1 and 2.17 ± 0.82 L∙min-1, respectively), VO2peak/BM*β (p < 0.001, 53.28 ± 10.93 mL·kg*0.82·min-1 and 73.04 ± 19.57 mL·kg*0.82·min-1, respectively), VO2peak/BSA*β (p < 0.001, 814.58 ± 159.05 mL·m2(*1.29)·min-1 and 1108.06 ± 296.24 mL·m2(*1.29)·min-1, respectively), and VO2peak/Stature*β (p

PURPOSE: to investigate the effect of measurement timing and concurrent validity of session and differential ratings of perceived exertion (sRPE and dRPE, respectively) as measures of internal training load in adolescent distance runners. METHODS: a total of 15 adolescent distance runners (15.2 [1.6] y) performed a 2-part incremental treadmill test for the assessment of maximal oxygen uptake, heart rate (HR), and blood lactate responses. Participants were familiarized with RPE and dRPE during the treadmill test using the Foster modified CR-10 Borg scale. Subsequently, each participant completed a regular 2-wk mesocycle of training. Participants wore an HR monitor for each exercise session and recorded their training in a logbook, including sRPE, dRPE leg exertion (dRPE-L), and breathlessness (dRPE-B) following session completion (0 min), 15 min postsession, and 30 min postsession. RESULTS: sRPE, dRPE-L, and dRPE-B scores were all most likely lower when reported 30 min postsession compared with scores 0 min postsession (%change, ±90% confidence limits; sRPE -26.5%, ±5.5%; dRPE-L -20.5%, ±5.6%; dRPE-B -38.9%, ±7.4%). sRPE, dRPE-L, and dRPE-B all maintained their largest correlations (r = .74-.89) when reported at session completion (0 min) in comparison with each of the HR-based criteria measures. CONCLUSION: sRPE, whether reported 0, 15, or 30 min postsession, provides a valid measure of internal training load in adolescent distance runners. In addition, dRPE-L and dRPE-B can be used in conjunction with sRPE across all time points (0, 15, and 30 min) to discriminate between central and peripheral exertion.

Abstract
. Background
. Current evidence of metabolic health benefits of high-intensity interval training (HIIT) are limited to longer training periods or conducted in overweight youth. This study assessed 1) fasting and postprandial insulin and glucose before and after 2 weeks of HIIT in healthy adolescent boys, and 2) the relationship between pre intervention health outcomes and the effects of the HIIT intervention.
.
. Methods
. Seven healthy boys (age:14.3 ± 0.3 y, BMI: 21.6 ± 2.6, 3 participants classified as overweight) completed 6 sessions of HIIT over 2 weeks. Insulin resistance (IR) and blood glucose and insulin responses to a Mixed Meal Tolerance Test (MMTT) were assessed before (PRE), 20 h and 70 h after (POST) the final HIIT session.
.
. Results
. Two weeks of HIIT had no effect on fasting plasma glucose, insulin or IR at 20 h and 70 h POST HIIT, nor insulin and glucose response to MMTT (all P &gt; 0.05). There was a strong negative correlation between PRE training IR and change in IR after HIIT (r = − 0.96, P &lt; 0.05).
.
. Conclusion
. Two weeks of HIIT did not elicit improvements to fasting or postprandial glucose or insulin health outcomes in a group of adolescent boys. However the negative correlation between PRE IR and improvements after HIIT suggest that interventions of this type may be effective in adolescents with raised baseline IR.
.

Purpose: This study had 2 objectives: (1) to examine whether the validity of the supramaximal verification test for maximal oxygen uptake ( V˙O2max ) differs in children and adolescents when stratified for sex, body mass, and cardiorespiratory fitness and (2) to assess sensitivity and specificity of primary and secondary objective criteria from the incremental test to verify V˙O2max. Methods: in total, 128 children and adolescents (76 male and 52 females; age: 9.3-17.4 y) performed a ramp-incremental test to exhaustion on a cycle ergometer followed by a supramaximal test to verify V˙O2max. Results: Supramaximal tests verified V˙O2max in 88% of participants. Group incremental test peak V˙O2 was greater than the supramaximal test (2.27 [0.65] L·min-1 and 2.17 [0.63] L·min-1; P 

PURPOSE: When exposed to the same external load, players receive different internal loads, resulting in varied adaptations in fitness. In adult soccer, internal training load is measured using heart rate (HR) and session rating of perceived exertion (sRPE) scales, but these have been underutilized in youth soccer. This study investigated the in-season variation in correlation between HR and sRPE estimations of training load for adolescent soccer players. METHOD: Fifteen male professional adolescent players were monitored for 7 months. Within-participant correlations and Bland-Altman agreement plots for HR and sRPE were calculated for each month to analyze variation over the season and for individual players to analyze the validity of the scale. RESULTS: the monthly correlations ranged from r = .60 to r = .73 (P 

PURPOSE: Sports have different effects on bone development and effective interventions to improve bone health of adolescent athletes are needed. The purpose of the study was to investigate the effect of a 9-month jumping intervention on bone geometry and metabolism in adolescent male athletes. METHODS: Ninety-three adolescent (14.1 yr old) male swimmers (SWI), footballers (FOO), and cyclists (CYC) were randomized to intervention and sport (INT-SWI = 19, INT-FOO = 15, and INT-CYC = 14) or sport only (CON-SWI = 18, CON-FOO = 15, and CON-CYC = 12) groups. Cross-sectional area, cross-sectional moment of inertia (CSMI), and section modulus (Z) at the femoral neck were assessed using hip structural analysis and trabecular texture of the lumbar spine using trabecular bone score. Bone mineral content (BMC) at femoral neck and lumbar spine was assessed using dual-energy x-ray absorptiometry. Serum N-terminal propeptide of procollagen type I, isomer of the carboxy-terminal telopeptide of type 1 collagen, total serum calcium, and 25-hydroxyvitamin D were analyzed. RESULTS: INT-CYC acquired significantly higher lumbar spine BMC (4.6%) and femoral neck BMC (9.8%) than CON-CYC. INT-CYC acquired significantly higher cross-sectional area (11.0%), CSMI (10.1%), and trabecular bone score (4.4%) than CON-CYC. INT-SWI acquired significantly higher femoral neck BMC (6.0%) and CSMI (10.9%) than CON-SWI. There were no significant differences between INT-FOO and CON-FOO in any bone outcomes. N-terminal propeptide of procollagen type I significantly decreased in CON-SWI, INT-FOO, CON-FOO, and CON-CYC. Carboxy-terminal telopeptide of type 1 collagen significantly decreased in CON-SWI and CON-CYC. The 25-hydroxyvitamin D significantly increased in INT-CYC, CON-CYC, INT-FOO, and CON-FOO. CONCLUSIONS: a 9-month jumping intervention improved bone outcomes in adolescent swimmers and cyclists, but not in footballers. This intervention might be used by sports clubs to improve bone health of adolescent athletes.

The purpose of this study was to assess the acute effect of high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on glucose tolerance, insulin sensitivity and fat oxidation in young boys. Eleven boys (8.8 ± 0.8 y) completed three conditions: 1) HIIE; 2) work-matched MIE; and 3) rest (CON) followed by an oral glucose tolerance test (OGTT) to determine glucose tolerance and insulin sensitivity (Cederholm index). Fat oxidation was measured following the OGTT using indirect calorimetry. There was no effect for condition on plasma [glucose] and [insulin] area under the curve (AUC) responses following the OGTT (P > 0.09). However, there was a “trend” for a condition effect for insulin sensitivity with a small increase after HIIE (P = 0.04, ES = 0.28, 9.7%) and MIE (P = 0.07, ES = 0.21, 6.5%) compared to CON. There was an increase in fat oxidation AUC following HIIE (P = 0.008, ES = 0.79, 38.9%) compared to CON, but with no differences between MIE and CON and HIIE and MIE (P > 0.13). In conclusion, 7- to 10-year-old boys may have limited scope to improve insulin sensitivity and glucose tolerance after a single bout of HIIE and MIE. However, fat oxidation is augmented after HIIE but not MIE.

The study aimed to explore how both sex and dietary restraint impacts brain activation in response to visual food stimuli in young adolescents (12-13 years) under fed and fasted conditions. Food and non-food images were viewed by 15 boys and 14 girls, while functional magnetic resonance images were acquired. The adolescents were either fasted or in a satiated (fed) state following a randomized crossover study design. When satiation state was not considered, girls showed significantly greater brain activity than boys in regions associated with executive function and decision making, working memory, and self-awareness. In contrast, when either fasted or fed states were considered separately, boys showed significantly increased brain activity in regions linked to executive function, self-awareness, and decision making than the girls. When fasted, compared to unrestrained eaters, restrained individuals showed heightened activation in regions connected to executive function and decision making, with areas associated with self-assessment showing increased activity for unrestrained eaters relative to restrained under fed conditions. These findings highlight important differences in adolescent brain activity and support further investigations to gain greater insight into how these differences might evolve with age.

BACKGROUND: Hand grip strength (HGS) test is commonly used as an indicator of overall muscle strength in medical and sport practices. Recently, several studies have proposed that the measurement of the maximal HGS depends on dynamometer's handle position. The aim of the present study was to identify the optimal handle position to obtain maximal HGS using the hand grip dynamometer (HGD) for school-aged children. METHODS: HGS was assessed with the Jamar digital HGD. Each participant performed three maximum contractions of each hand on three handle positions progressing from first to third position. RESULTS: a total of 135 healthy children aged 5-9 years participated in the study. Participants obtained significantly higher results using position 2 than using positions 1 or 3. The maximal mean (± SD) HGS achieved was 9.9 (± 3.1) kg with position 1, 10.4 (± 3.1) kg with position 2, and 9.0 (± 3.2) kg with position 3. Handle position 2 was the most comfortable position for 73% of participants. CONCLUSIONS: Our results provide useful methodological information indicating that the second handle position of the Jamar digital HGD is optimal to measure maximal HGS in non-athletic healthy pediatric participants aged 5-9 years.

The aims of this study were to investigate in adolescents: 1) the relationships of physical activity (PA) and cardiorespiratory fitness (CRF) to traditional CVD risk factors, rest and recovery autonomic function; and 2) whether autonomic function strengthens the associations between PA, CRF and CVD risk. Fifty-four (22 girls) adolescents had traditional CVD risk factors, rest and recovery autonomic function evaluated. CRF was measured using a steep ramp cycle test and PA was assessed with accelerometers. Resting HRV (and RMSSD30) and heart rate recovery (T30, HHRτ) were used. Clustered traditional (CVDRtrad) and autonomic (CVDRauto) risk scores were created and added to form a composite clustered CVD risk score (CVDRcom). PA and CRF were significantly and negatively associated with traditional CVD risk factors. Moderate (MPA) and vigorous (VPA) were positively related to resting RMSSD, and negatively related to T30 and HHRτ (all P

In 2017, considerable attention has been paid by researchers on early sports specialization for youth athletes. Issues related to injury, burnout, and talent development to name a few have been debated, particularly when contrasted against other opposing youth development approaches, such as a multisport approach. The increasing professionalization of young athletes, a particular concern of this author, is coupled with the ensuing physical and mental pressures on these youngsters, as highlighted by the 2 highlighted publications in this commentary. Moreover, the financial costs to parents to support talented youngsters lead me to conclude that we must not treat them as "mini-adult athletes." Trying to predict too far into the sporting future of a 9- or 10-year athlete can lead us to forgetting that they are just a 9 year, who typically wants to play, have fun, and be with their friends. Embarking on concentrated training programs, endless travel for tournaments, and an overemphasis on winning can be detrimental to participation rates as shown by recent data in the United States. Therefore, the challenge for researchers in elite youth sports is to ensure that practices we pursue with our young charges promote their health and well-being and that sports is for the benefit of the athlete and not the other way around.

Purpose: in recent decades, the interest for exercise-induced fatigue in youth has substantially increased, and the effects of growth on the peripheral (muscular) and central (neural) mechanisms underpinning differences in neuromuscular fatigue between healthy children and adults have been described more extensively. The purpose of this review is to retrieve, report, and analyse the findings of studies comparing neuromuscular fatigue between children and adults. Objective measures of the evaluation of the physiological mechanisms are discussed. Method: Major databases (PubMed, Ovid, Scopus and Web of Science) were systematically searched and limited to English language from inception to September 2017. Result: Collectively, the analyzed studies indicate that children experience less muscular and potentially more neural fatigue than adults. However, there are still many unknown aspects of fatigue regarding neural (supraspinal and spinal) and peripheral mechanisms that should be more thoroughly examined in children. Conclusion: Suitable methods, such as transcranial magnetic stimulation, transcranial electrical stimulation, functional magnetic resonance imaging, near-infrared spectroscopy, tendon vibration, H-reflex, and ultrasound are recommended in the research field of fatigue in youth. By designing studies that test the fatigue effects in movements that replicate daily activities, new knowledge will be acquired. The linkage and interaction between physiological, cognitive, and psychological aspects of human performance remain to be resolved in young people. This can only be successful if research is based on a foundation of basic research focused on the mechanisms of fatigue while measuring all three above aspects.

NEW FINDINGS: What is the central question of this study? What are the autonomic and vascular components of the baroreflex during hypotension following different exercise intensities in adolescents? What is the main finding and its importance? Hypotension after high-intensity exercise lasted 60 min, whereas following moderate-intensity exercise, blood pressure was restored after 20 min. Stroke volume and peripheral resistance responses were different between intensities. Post both exercise intensities, baroreflex sensitivity was lowered mainly due to the autonomic component, which returned to baseline 60 min post-exercise. The different haemodynamic stimuli indicate potential differences in cardiovascular health benefits of exercise intensity in healthy adolescents. ABSTRACT: This work aimed to investigate the time course of changes in baroreflex sensitivity (BRS) and its vascular and autonomic components after different exercise intensities in adolescents. Thirteen male adolescents (age 13.9 ± 0.5 years) completed on separate days in a counterbalanced order (1) high-intensity interval exercise (HIIE): 8 × 1 min running at 90% of maximal aerobic speed with 75 s of active recovery; (2) moderate-intensity interval exercise (MIIE): 10-12 bouts of 1 min running at 90% of gas exchange threshold with 75 s of active recovery; and (3) resting as a control. Supine heart rate and blood pressure were monitored continuously at baseline, and 5 and 60 min following the conditions. A cross-spectral method (low frequency gain; LFgain ) was used to determine BRS gain. Arterial compliance (AC) was assessed as the BRS vascular component. LFgain /AC was used as the autonomic component. LFgain decreased 5 min post-exercise bouts (HIIE P 

PURPOSE: Continuous high-intensity exercise is proposed to evoke unpleasant sensations as predicted by the dual-mode theory and may negatively impact on future exercise adherence. Previous studies support unpleasant sensations in affective responses during continuous high-intensity exercise, but the affect experience during high-intensity interval exercise (HIIE) involving brief bursts of high-intensity exercise separated by low-intensity activity is poorly understood in adolescents. We examined the acute affective, enjoyment, and perceived exertion responses to HIIE compared with moderate-intensity interval exercise (MIIE) in adolescents. METHODS: Thirteen adolescent boys (mean ± SD: age, 14.0 ± 0.5 yr) performed two counterbalanced exercise conditions: 1) HIIE: 8 × 1-min work intervals at 90% maximal aerobic speed; and 2) MIIE: between 9 and 12 × 1-min work intervals at 90% ventilatory threshold where the number of intervals performed were distance-matched to HIIE. HIIE and MIIE work intervals were interspersed with 75 s active recovery at 4 km·h. Affect, enjoyment, and RPE were recorded before, during, and after exercise. RESULTS: Affect responses declined in both conditions but the fall was greater in HIIE than MIIE (P < 0.025, effect size [ES], 0.64 to 0.81). Affect remained positive at the end-work interval for both conditions (MIIE, 2.62 ± 1.50; HIIE, 1.15 ± 2.08 on feeling scale). No enjoyment differences were evident during HIIE and MIIE (P = 0.32), but HIIE elicited greater postexercise enjoyment compared with MIIE (P = 0.01, ES = 0.47). RPE was significantly higher during HIIE than MIIE across all work intervals (all P < 0.03, ES > 0.64). CONCLUSIONS: Despite elevated RPE, HIIE did not elicit prominent unpleasant feelings as predicted by the dual-mode theory and was associated with greater postexercise enjoyment responses than MIIE. This study demonstrates the feasibility of the application of HIIE as an alternative form of physical activity in adolescents.

OBJECTIVES: Affect experienced during high-intensity interval exercise (HIIE) is dependent on work-intensity, but the influence of increasing (low-to-high (L-H)) or decreasing (high-to-low (H-L)) work-intensity during HIIE remains unclear in adolescents. The role of prefrontal cortex haemodynamics in mediating changes in affect during HIIE also remains unexplored in adolescents. We examined affect, enjoyment and cerebral haemodynamic responses to HIIE with increasing or decreasing work intensities in adolescents. METHODS: Participants (N = 16; 8 boys; age 12.5 ± 0.8 years) performed, on separate days, HIIE cycling consisting of 8 × 1-min work-intervals at 100%-to-70% (HIIEH-L), 70%-to-100% (HIIEL-H) or 85% (HIIECON) peak power separated by 75 s recovery. Affect, enjoyment and cerebral haemodynamics (oxygenation (∆O2Hb), deoxygenation (∆HHb) and tissue oxygenation index (TOI)) were recorded before, during, and after all conditions. RESULTS: Affect and enjoyment were lower during HIIEH-L compared to HIIEL-H and HIIECON at work-intervals 1 to 3 (all P  0.83) but were greater during HIIEH-L than HIIEL-H and HIIECON at work-interval 8 (all P  0.83). ∆O2Hb was similar across conditions (P = 0.87) but TOI and ∆HHb were significantly greater and lower, respectively during HIIEH-L compared to HIIEL-H and HIIECON at work-interval 8 (all P  0.40). Affect was correlated with TOI (all r > 0.92) and ∆HHb (all r > -0.73) across conditions. CONCLUSIONS: HIIEH-L offers advancement to the HIIECON and HIIEL-H which bring significant greater affect and enjoyment towards the end HIIE work-interval, implicating the feasibility and adoption of this protocol for health promotion in youth. Also, changes in prefrontal cortex haemodynamics are associated with the affect during HIIE.

Rationale, aims and objectives: Physical activity (PA) and exercise are important in maintaining and improving health and wellbeing in people with cystic fibrosis (CF) and measures of exercise capacity are useful outcomes in monitoring disease progression. The roles and responsibilities of CF multi-disciplinary team (MDT) members in supporting PA and exercise have yet to be fully defined. This communication reports on national meetings of CF MDT staff whose interest is to improve and standardise person-centered exercise provision and testing as part of routine CF care. We also introduce the role of the physiotherapy technician in supporting PA interventions.Meetings: the two meetings covered a range of presentations, discussions and workshops, focusing on the role of exercise and PA in CF management. Forty people from 15 NHS Hospital Trusts and 3 universities were asked to provide feedback via a questionnaire.Results: the common roles and responsibilities of clinical staff involved in exercise testing and prescription are described, with a wide range of duties identified. In addition, physiotherapists were reported as the main MDT member responsible for exercise provision. The majority of teams reported discussing exercise at every clinical visit (57%) and felt confident in discussing exercise with patients (67%).Conclusions: While this report highlights the current provision of exercise in CF MDTs, it also provides insight into the resources MDTs may require in order to enhance the profile of exercise within CF services, including enhanced training, guidelines and standardised clinical roles.

Improvements in the autonomic and vascular systems are implicated in cardiovascular disease risk reduction. Baroreflex sensitivity (BRS) is composed of vascular and autonomic components. This study aimed to investigate between- and within-day reliability of BRS and its autonomic and vascular determinants in adolescents. Thirteen male adolescents (14·1 ± 0·5 y) participated in this study. For between-day reliability, participants completed four experimental visits separated by a minimum of 48-h. For within-day reliability, participants repeated BRS assessments three times in the morning with one hour between the measures. BRS was evaluated using the cross-spectral gain (LFgain) between blood pressure and heart rate interval. BRS was further divided into: 1) vascular component using arterial compliance (AC); and 2) autonomic component measured as LFgain divided by AC (LFgain/AC). LFgain, AC and LFgain/AC presented between-day coefficient of variation (CV) of 20%, 17%, and 20%, respectively. Similarly, variables associated with blood pressure control, such as cardiac output, mean arterial pressure, heart rate and total peripheral resistance, presented CVs ranging from 6% to 15%. Within-day reliability was poorer compared to between-day for LFgain (25%), AC (25%), and LFgain/AC (31%), as well as all hemodynamic variables (CVs from 11% to 22%, except heart rate with presented CV of 6%). This study indicates suitable between- and within-reliability of BRS and its autonomic and vascular determinants, as well as hemodynamic variables associated with BRS, in adolescents.

OBJECTIVES: Research investigating the longitudinal effects of the most popular sports on bone development in adolescent males is scarce. The aim is to investigate the effect of 12-month participation in osteogenic and non-osteogenic sports on bone development. DESIGN: a 12-month study was conducted in adolescent males involved in football, swimming and cycling and compared with an active control group. METHODS: 116 adolescent males (13.1±0.1years at baseline): 37 footballers, 37 swimmers, 28 cyclists and 14 active controls were followed for 12 months. Bone mineral content (BMC) was measured by dual-energy X-ray absorptiometry, and bone stiffness was measured by quantitative ultrasound. Bone outcomes at 12 months were adjusted for baseline bone status, age, height, lean mass and moderate to vigorous physical activity. RESULTS: Footballers had higher improvement in adjusted BMC at the total body, total hip, shaft, Ward's triangle, legs and bone stiffness compared to cyclists (6.3-8.0%). Footballers had significantly higher adjusted BMC at total body, shaft and legs compared to swimmers (5.4-5.6%). There was no significant difference between swimmers and cyclists for any bone outcomes. Swimming and cycling participation resulted in non-significant lower bone development at most sites of the skeleton compared to controls (-4.3 to -0.6%). CONCLUSIONS: Football participation induces significantly greater improvements in BMC and bone stiffness over 12 months compared to cycling and swimming. CLINICAL TRIAL REGISTRATION: ISRCTN17982776.

UNLABELLED: This study demonstrates that a 9-month jumping intervention can improve bone mass gains and physical fitness performance in adolescent males participating in non-osteogenic sports, such as swimming and cycling. PURPOSE: to examine the effect of a jumping intervention on bone mass, bone stiffness and fitness parameters in adolescents involved in different sports. METHODS: Ninety-three adolescent male swimmers (SWI), footballers (FOO) and cyclists (CYC) were randomised to intervention (INT) and sport (INT-SWI = 19, INT-FOO = 15, INT-CYC = 14) or sport only (CON-SWI = 18, CON-FOO = 15, CON-CYC = 12) groups. The 9-month jumping intervention consisted of 3 levels (12 weeks each) of 20 repetitions per set of counter movement jumps (CMJ) using adjustable weight vests (level 1 = 20 CMJ jumps/set, 0 kg, 3 sets/day, 3 times/week; level 2 = 20 CMJ jumps/set, 2 kg, 4 sets/day, 3 times/week; level 3 = 20 CMJ jumps/set, 5 kg, 4 sets/day, 4 times/week). Total body bone mineral content (BMC) at total body less head (TBLH) was measured using dual-energy X-ray absorptiometry and bone stiffness using quantitative ultrasound. Fitness was assessed using the 20-m shuttle run (20mSRT), CMJ and standing long jump (SLJ) tests. RESULTS: INT-SWI had significantly higher increase in BMC legs and bone stiffness compared to CON-SWI (4.2-12.7%). INT-CYC had significantly higher increase in BMC at TBLH and legs and bone stiffness compared to CON-CYC (5.0-12.3%). There were no significant differences between INT-FOO and CON-FOO in any bone outcomes (0.9-3.9%). The increase in CMJ performance was significantly higher in INT-SWI (3.1 cm) and INT-CYC (3.2 cm) compared to CON-SWI and CON-CYC groups, respectively. CONCLUSIONS: a 9-month jumping intervention can improve bone mass, bone stiffness and muscular fitness in adolescent males participating in non-osteogenic sports, such as swimming and cycling. CLINICAL TRIAL REGISTRATION: ISRCTN17982776.

BACKGROUND: Maximal cardiopulmonary exercise testing is recommended on an annual basis for children with cystic fibrosis (CF), due to clinically useful prognostic information provided by maximal oxygen uptake (V̇O2max ). However, not all patients are able, or willing, to reach V̇O2max , and therefore submaximal alternatives are required. This study explored the validity of the oxygen uptake efficiency slope (OUES) as a submaximal measure of V̇O2max in children and adolescents with CF. METHODS: Data were collated from 72 cardiopulmonary exercise tests (36 CF, 36 controls), with OUES determined relative to maximal and submaximal parameters of exercise intensity, time, and individual metabolic thresholds. Pearson's correlation coefficients, independent t-tests, and factorial ANOVAs were used to determine validity. RESULTS: Significant (P  0.05). When split by V̇O2max tertiles, minimal significant differences were found between, and within, groups for OUES, indicating poor discrimination of V̇O2max. CONCLUSIONS: the OUES is not a valid (sub) maximal measure of V̇O2max in children and adolescents with mild-to-moderate CF. Clinicians should continue to use maximal markers (ie, V̇O2max ) of exercise capacity.

Background Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics. Methods a three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice. Results There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity. Conclusion Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

This study examined the time course of adaptions in insulin sensitivity (IS) in adolescent boys after acute high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE). Eight boys (15.1±0.4 y) completed three 3-day experimental trials in a randomised order: 1) 8×1 min cycling at 90% peak power with 75 s recovery (HIIE); 2) cycling at 90% of gas exchange threshold for a duration to match work during HIIE (MIE); and 3) rest (CON). Plasma [glucose] and [insulin] were measured before (PRE-Ex), 24 and 48 h post (24 h-POST, 48 h-POST) in a fasted state, and 40 min (POST-Ex) and 24 h (24 h-POST) post in response to an oral glucose tolerance test (OGTT). IS was estimated using the Cederholm (OGTT) and HOMA (fasted) indices. There was no change to HOMA at 24 h or 48 h-POST (all P>0.05). IS from the OGTT was higher POST-EX for HIIE compared to CON (17.4%, P=0.010, ES=1.06), and a non-significant increase in IS after MIE compared to CON (9.0%, P=0.14, ES=0.59). At 24 h-POST, IS was higher following both HIIE and MIE compared to CON (HIIE: P=0.019, 13.2%, ES=0.88; MIE: 9.7%, P=0.024, ES=0.65). In conclusion, improvements to IS after a single bout of HIIE and MIE persist up to 24 h after exercise when assessed by OGTT.

PURPOSE: to evaluate the efficacy of existing performance models to assess the progression of male and female adolescent swimmers through a quantitative and qualitative mixed-methods approach. METHODS: Fourteen published models were tested using retrospective data from an independent sample of Dutch junior national-level swimmers from when they were 12-18 y of age (n = 13). The degree of association by Pearson correlations was compared between the calculated differences from the models and quadratic functions derived from the Dutch junior national qualifying times. Swimmers were grouped based on their differences from the models and compared with their swimming histories that were extracted from questionnaires and follow-up interviews. RESULTS: Correlations of the deviations from both the models and quadratic functions derived from the Dutch qualifying times were all significant except for the 100-m breaststroke and butterfly and the 200-m freestyle for females (P <. 05). In addition, the 100-m freestyle and backstroke for males and 200-m freestyle for males and females were almost directly proportional. In general, deviations from the models were accounted for by the swimmers' training histories. Higher levels of retrospective motivation appeared to be synonymous with higher-level career performance. CONCLUSION: This mixed-methods approach helped confirm the validity of the models that were found to be applicable to adolescent swimmers at all levels, allowing coaches to track performance and set goals. The value of the models in being able to account for the expected performance gains during adolescence enables quantification of peripheral factors that could affect performance.

In my 2015 editorial, I selected two research publications with a focus on an applied sports sciences perspective. This year I have chosen to focus on two publications from a methodological viewpoint, highlighting the importance of laboratory procedures and extraction of data through a systematic review respectively. The first publication by Leites and colleagues (J Appl Physiol) addresses questions in relation to thermoregulation and carbohydrate metabolism in young people. This topic is difficult to conduct due to additional ethical and safety concerns due to exercising in the heat. Nonetheless, there are important basic science questions to be answered. Using a range of measurement techniques including rectal thermometry, 13C-enriched carbohydrate isotopes and procedures to standardize the heat stress equally between a group of men and boys, this project demonstrates an exemplary range of experimental skills. In my second selected paper by Lesinski et al. (Brit J Sports Med), both a systematic review and a meta-analyses were conducted to investigate the dose-response relationships of resistance training on physical performance in youth athletes. As the requirement for more evidence based practice is demanded, the move away from a narrative review to a more methodological and rigorous approach is to be encouraged. It is, in my opinion, a skill that we should be encouraging all our early career pediatric researchers to learn from the outset, the outcome of which can only make our discipline stronger.

Theme park operators and medical professionals advise children with heart conditions against using rollercoaster rides, but these recommendations are not evidence-based. The underlying assumption is that the combination of adrenergic stimulation through stress and acceleration might trigger arrhythmias in susceptible individuals. We conducted a cross-sectional observational study to assess heart rate and rhythm in healthy children during commercial rollercoaster rides. Twenty healthy children (9 male) aged 11-15 (mean 13.3 ± 1.4) years underwent continuous heart rate and rhythm monitoring (2-lead ECG) from 5 min before until 10 min after each of 4 high speed (>50 km h-1), high g-force (>4) commercial rollercoaster rides. Total recording time was 13 h 20 min. No arrhythmic events were detected. Resting heart rate was 81 ± 10 b min-1 and increased to 158 ± 20 b·min-1 during rides. The highest mean HR (165 ± 23 b min-1) was observed on the ride with the lowest g-force (4.5 g), but one of the highest speeds (100 km h-1). Anticipatory tachycardia (126 ± 15 b min-1) within 5 min was frequently observed. A 10 min recovery HR (124 ± 17 b min-1) was 56 % greater than resting HR. The speed and g-force experienced on roller coasters induce sinus tachycardia but do not elicit pathological arrhythmias in healthy children.

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.

BACKGROUND: Heart rate variability (HRV) is considered to explain improvements in cardiovascular health accrued by physical activity (PA) and cardiorespiratory fitness (CRF) over and above traditional cardiovascular risk factors. OBJECTIVE: to systematically address associations between HRV, PA and CRF in children and adolescents. DATA SOURCES: Medline, EMBASE, SportDISCUS and CINAHL Plus were searched on 5th September 2015 and updated on 4th August 2016. ELIGIBILITY CRITERIA: Observational studies comparing HRV in different groups of PA and CRF, and/or studies investigating associations between PA, CRF and HRV. Sports practices and PA intensities were also included. The square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD), the spectral density in the high (HF) and low (LF) frequency, and the LF/HF ratio were included. Risk of bias was assessed using the adapted Newcastle-Ottawa Scale (NOS). RESULTS: Heterogeneity exists in the assessment of the exposures and outcomes, and sample characteristics. Risk of bias (NOS) was observed in most of the studies. Studies with low risk of bias showed positive associations between moderate-to-vigorous PA and RMSSD. The evidence for the associations between PA and frequency indices is weak. Similarly, the evidence for the association between CRF and HRV is weak. CONCLUSIONS: Despite the heterogeneity in the studies, moderate-to-vigorous PA is positively associated with RMSSD, but less clear are the associations between CRF and HRV, as well as other PA intensities. Further research is needed to clarify the role of PA and CRF on HRV in children and adolescents.

Adolescence is a crucial period for bone development, and exercise can enhance bone acquisition during this period of life. However, it is not known how the different loading sports practiced can affect bone acquisition in adolescent male athletes. Therefore, the purpose of the present study was to determine the 1-year longitudinal bone acquisition among adolescent males involved in osteogenic (football) and non-osteogenic (swimming and cycling) sports and to compare with active controls. A total of 116 adolescent males aged 12 to 14 years at baseline were followed for 1 year: 37 swimmers, 37 footballers, 28 cyclists, and 14 active controls. Bone mineral content (BMC) was assessed using dual-energy X-ray absorptiometry (DXA); cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and section modulus (Z) at the femoral neck was assessed using hip structural analysis (HSA); and bone texture of the lumbar spine was assessed using trabecular bone score (TBS). Serum N-terminal propeptide of procollagen type I (PINP), isomer of the Carboxi-terminal telopeptide of type 1 collagen (CTX-I), total serum calcium, and 25 hydroxyvitamin D [25(OH)D] were analyzed. Footballers had significantly higher adjusted BMC at the lumbar spine (7.0%) and femoral neck (5.0%) compared with cyclists, and significantly greater BMC at the lumbar spine (6.9%) compared with swimmers. Footballers presented significantly greater TBS (4.3%) compared with swimmers, and greater CSMI (10.2%), CSA (7.1%), Z (8.9%) and TBS (4.2%) compared with cyclists. No differences were noted between cyclists and swimmers, both groups had similar bone acquisition compared with controls. PINP was significantly higher in footballers and controls compared with cyclists and swimmers (3.3% to 6.0%), and 25(OH)D was significantly higher in footballers and cyclists compared with swimmers and controls (9.9% to 13.1%). These findings suggest that bone acquisition is higher in adolescent male footballers compared with swimmers and cyclists at the femoral neck and lumbar spine sites of the skeleton. © 2017 American Society for Bone and Mineral Research.

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.

OBJECTIVE: to identify a method to predict the maximal heart rate (MHR) in children and adolescents, as available prediction equations developed for adults have a low accuracy in children. We hypothesized that MHR may be influenced by resting heart rate, anthropometric factors, or fitness level. DESIGN: Cross-sectional study. SETTING: Sports medicine center in primary care. PARTICIPANTS: Data from 627 treadmill maximal exercise tests performed by 433 pediatric athletes (age 13.7 ± 2.1 years, 70% males) were analyzed. INDEPENDENT VARIABLES: Age, sex, sport type, stature, body mass, BMI, body fat, fitness level, resting, and MHR were recorded. MAIN OUTCOME MEASURES: to develop a prediction equation for MHR in youth, using stepwise multivariate linear regression and linear mixed model. To determine correlations between existing prediction equations and pediatric MHR. RESULTS: Observed MHR was 197 ± 8.6 b·min. Regression analysis revealed that resting heart rate, fitness, body mass, and fat percent were predictors of MHR (R = 0.25, P < 0.001), whereas age was not. Resting heart rate explained 15.6% of MHR variance, body mass added 5.7%, fat percent added 2.4%, and fitness added 1.2%. Existing adult equations had low correlations with observed MHR in children and adolescents (r = -0.03-0.34). CONCLUSIONS: a new equation to predict MHR in children and adolescents was developed, but was found to have low predictive ability, a finding similar to adult equations applied to children. CLINICAL RELEVANCE: Considering the narrow range of MHR in youth, we propose using 197 b·min as the mean MHR in children and adolescents, with 180 b·min the minimal threshold value (-2 standard deviations).

© Copyright 2017 by the American College of Sports Medicine. Purpose the aim of this study was to describe the relationship between body size and oxygen uptake efficiency slope (OUES) in pediatric patients with cystic fibrosis (CF) and healthy controls (CON), to identify appropriate scaling procedures to adjust the influence of body size upon OUES. Methods the OUES was derived using maximal and submaximal points from cardiopulmonary exercise testing in 72 children (36 CF and 36 CON). OUES was subsequently scaled for stature, body mass (BM), and body surface area (BSA) using ratio-standard (Y/X) and allometric (Y/Xb) methods. Pearson's correlation coefficients were used to determine the relationship between body size and OUES. Results When scaled using the ratio-standard method, OUES had a significant positive relationship with stature (r = 0.54, P < 0.001) and BSA (r = 0.25, P = 0.031) and significant negative relationship with BM (r = -0.38, P = 0.016) in the CF group. Combined allometric exponents (b) for CF and CON were stature 3.00, BM 0.86, and BSA 1.40. A significant negative correlation was found between OUES and stature in the CF group when scaled allometrically (r = -0.37, P = 0.027). Nonsignificant (P > 0.05) correlations for the whole group were found between OUES and allometrically scaled BM (CF r = -0.25, CON, r = 0.15) and BSA (CF r = -0.27, CON r = 0.13). Conclusions Only allometric scaling of either BM or BSA, and not ratio-standard scaling, successfully eliminates the influence of body size upon OUES. Therefore, this enables a more direct comparison of the OUES between patients with CF and healthy controls.

Energy intake (EI) and energy expenditure (EE) should not be considered independent entities, but more an inter-connected system. With increased physical activity and reduced snacking initiatives as prevalent Public Health measures, any changes to subsequent EI from these recommendations should be monitored. The aim of this study was to investigate changes in acute EI and appetite over four conditions: (1) a control condition with no snack and no exercise (CON); (2) a snack condition (+1 MJ; SK); (3) a moderate-intensity cycling exercise condition (-1 MJ; EX); and finally (4) both snack and exercise condition (+1 MJ, -1 MJ; EXSK). Acute changes in appetite (visual analogue scale) and lunchtime EI (ad libitum pizza meal) were recorded in twenty boys and eighteen girls (12-13 years). Lunch EI was not significantly different between conditions or sexes (P>0·05). Relative EI was calculated, where the energy manipulation (+1 MJ from the snack or -1 MJ from the exercise) was added to lunchtime EI. Relative EI indicated no significant differences between the sexes (P>0·05); however, in the EX condition, relative EI was significantly lower (P

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.

Cystic fibrosis (CF) is a genetic condition affecting the respiratory and gastrointestinal systems, with patients experiencing problems maintaining weight, especially during rapid growth periods such as puberty. The aim of this case report was to monitor the effect of gastrostomy insertion and implementation of overnight supplemental feeding upon clinical outcomes, including body mass index (BMI), lung function (FEV1), and exercise-related variables (maximal oxygen uptake [VO2max] and ventilatory efficiency [VE/VO2]) in an 11-year-old female with CF. Combined incremental and supramaximal exercise testing to exhaustion was performed at four time points: 3 months prior to the procedure (T1), 2 days prior to (T2), 4 months (T3), and 1 year following the procedure (T4). Improvements following gastrostomy insertion were observed at the 1 year follow-up with regards to BMI (+20%); whereas absolute VO2max remained stable and lung function fluctuated throughout the period of observation. Declines in function with regards to body weight relative VO2max (−16.3%) and oxygen uptake efficiency (+7.5%) were observed during this period. This case report is the first to consider exercise-related clinical outcomes in assessing the effect of implementing gastrostomy feeding in CF. The varied direction and magnitude of the associations between variables shows that further investigations are required.

The purpose of this research was to determine the expected progression of adolescent female swimming performances using a longitudinal approach. The performances of 514 female swimmers (12⁻19 year olds) who participated in one or more FINA-regulated annual international schools' swimming championships over an eight-year period were analysed. Quadratic functions for each of the seven individual events (50, 100, 200 m freestyle, 100 m backstroke, breaststroke, butterfly, 200 m individual medley) were determined using mixed linear models. The predicted threshold of peak performance ranged from 16.8 ± 0.2 (200 m individual medley) to 20.6 ± 0.1 (100 m butterfly) years of age, preceded by gradual rates of improvement (mean rate of 1.6% per year). However, following cross validation, only three events (100 m backstroke, 200 m individual medley and 200 m freestyle) produced reliable models. Identifying the factors that contribute to the progression of female performance in this transitory period of life remains challenging, not least since the onset of puberty is likely to have occurred prior to reaching 12 years of age, the minimum competition age for this championship.

PURPOSE: This study aimed to investigate the effects of mild-to-moderate cystic fibrosis (CF) on the pulmonary oxygen uptake (V˙O2) kinetics of seven pediatric patients (13.5 ± 2.8 yr) versus seven healthy matched controls (CON; 13.6 ± 2.4 yr). We hypothesized that CF would slow the V˙O2 kinetic response at the onset of moderate (MOD) and very heavy (VH) intensity cycling. METHODS: Changes in breath-by-breath V˙O2, near-infrared spectroscopy-derived muscle deoxygenation ([HHb]) at the vastus lateralis muscle and thoracic bioelectrical impedance-derived heart rate (HR), stroke volume index, and cardiac index were measured during repeat transitions to MOD (90% of the gas exchange threshold) and VH (Δ60%) intensity cycling exercise. RESULTS: During MOD, the phase II V˙O2 τ (P = 0.84, effect size [ES] = 0.11) and the overall mean response time (MRT) (P = 0.52, ES = 0.11) were not significantly slower in CF versus CON. However, during VH exercise, the phase II V˙O2 τ (P = 0.02, ES = 1.28) and MRT (P = 0.01, ES = 1.40) were significantly slower in CF. Cardiac function, central O2 delivery (stroke volume index and cardiac index), and muscle [HHb] kinetics were unaltered in CF. However, the arteriovenous O2 content difference ((Equation is included in full-text article.)) was reduced during VH at 30 s (P = 0.03, ES = 0.37), with a trend for reduced levels at 0 s (P = 0.07, ES = 0.25), 60 s (P = 0.05, ES = 0.28), and 120 s (P = 0.07, ES = 0.25) in CF. Furthermore, (Equation is included in full-text article.)significantly correlated with the VH phase II V˙O2 τ (r = -0.85, P = 0.02) and MRT (r = -0.79, P = 0.03) in CF only. CONCLUSION: Impairments in muscle oxidative metabolism during constant work rate exercise are intensity dependent in young people with mild-to-moderate CF. Specifically, V˙O2 kinetics are slowed during VH but not MOD cycling and appear to be mechanistically linked to impaired muscle O2 extraction and utilization.

Insufficient data on adolescent athletes is contributing to the challenges facing youth athletic development and accurate talent identification. The purpose of this study was to model the progression of male sub-elite swimmers' performances during adolescence. The performances of 446 males (12⁻19 year olds) competing in seven individual events (50, 100, 200 m freestyle, 100 m backstroke, breaststroke, butterfly, 200 m individual medley) over an eight-year period at an annual international schools swimming championship, run under FINA regulations were collected. Quadratic functions for each event were determined using mixed linear models. Thresholds of peak performance were achieved between the ages of 18.5 ± 0.1 (50 m freestyle and 200 m individual medley) and 19.8 ± 0.1 (100 m butterfly) years. The slowest rate of improvement was observed in the 200 m individual medley (20.7%) and the highest in the 100 m butterfly (26.2%). Butterfly does however appear to be one of the last strokes in which males specialise. The models may be useful as talent identification tools, as they predict the age at which an average sub-elite swimmer could potentially peak. The expected rate of improvement could serve as a tool in which to monitor and evaluate benchmarks.

From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18�
years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement.

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 y) completed three 1-day trials in a randomised order: 1) rest (CON); or four bouts of 2) 2 x 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.

PURPOSE: This study aimed to characterize changes in deoxyhemoglobin ([HHb]) response dynamics in boys and girls during ramp incremental exercise to investigate whether the reduced peak oxygen uptake (peak V˙O2) in girls is associated with poorer matching of muscle O2 delivery to muscle O2 utilization, as evidenced by a more rapid increase in [HHb]. METHODS: Fifty-two children (31 boys, 9.9 ± 0.6 yr, 1.38 ± 0.07 m, 31.70 ± 5.78 kg) completed ramp incremental exercise on a cycle ergometer during which pulmonary gas exchange and muscle oxygenation parameters were measured. RESULTS: When muscle [HHb] was expressed against absolute work rate and V˙O2, girls had an earlier change in [HHb], as evidenced by the lower c/d parameter (girls, 54 ± 20 W, vs boys, 67 ± 19 W, P = 0.023; girls, 0.82 ± 0.28 L·min(-1), vs boys, 0.95 ± 0.19 L·min(-1), P = 0.055) and plateau (girls, 85 ± 12 W, vs boys, 99 ± 18 W, P = 0.031; girls, 1.02 ± 0.25 L·min(-1), vs boys, 1.22 ± 0.28 L·min(-1), P = 0.014). However, when expressed against relative work rate or V˙O2, there were no sex differences in ([HHb]) response dynamics (all P > 0.20). Significant correlations were observed between absolute and fat-free mass normalized peak V˙O2 and the HHb c/d and plateau parameters when expressed against absolute work rate or V˙O2. Furthermore, when entered into a multiple regression model, the [HHb] plateau against absolute V˙O2 contributed 12% of the variance in peak V˙O2 after adjusting for fat-free mass, gas exchange threshold, and body fatness (model R2 = 0.81, P < 0.001). CONCLUSIONS: the sex difference in peak V˙O2 in 9- to 10-yr-old children is, in part, related to sex-specific changes in muscle O2 extraction dynamics during incremental exercise.

The clinical importance of exercise testing and training in the healthcare management of young patients with cystic fibrosis (CF) is growing. The aim of the present study was to determine the incidence of airflow limitation following cardiopulmonary exercise testing (CPET) and heavy-intensity intermittent exercise (HIIE) in young patients with CF. Nineteen young patients with CF and respective paired–matched controls performed CPET and HIIE on separate days. Forced expiratory volume in one second (FEV1) was measured pre- and post each exercise modality. A fall in FEV1 of 10 % or greater was used to define airflow limitation. The incidence of airflow limitation was significantly greater in the CF group than in the controls following CPET (32 vs. 5 %; p = 0.03); however, no significant difference in the incidence of airflow limitation was shown following HIIE between the CF group and controls (11 vs. 16 %; p = 0.64). Conclusion: Our data show that the incidence of airflow limitation following CPET in young patients with CF is high. Therefore, clinicians may wish to identify whether young CF patients experience airflow limitation following strenuous exercise, such as CPET, before it is performed. However, HIIE carries a low risk for airflow limitation and may be prescribed as a safe, yet effective exercise modality for young patients with CF.

The aim of this study is to establish the level of agreement between test performance of young elite cyclists in a laboratory and a track field-based trial. Fourteen adolescent cyclists (age: 14.8 ± 1.1 years; (Equation is included in full-text article.): 63.5 ± 5.6 ml·min(-1)·kg(-1)) performed 3 tests of 10 seconds, 1 minute, and 3 minutes on an air-braked ergometer (Wattbike) and on a 250-m track using their own bikes mounted with mobile power meters (SRM). The agreement between the maximum and mean power output (Pmax and Pmean) measured on the Wattbike and SRM was assessed with the 95% limits of agreement (LoA). Power output was strongly correlated between Wattbike and SRM for all tests (r = 0.94-0.96; p < 0.001). However, power output was significantly higher on the Wattbike compared with track cycling during all tests. The bias and 95% LoA were 76 ± 78 W (8.8 ± 9.5%; p = 0.003, d = 0.38) for Pmax10s and 82 ± 55 W (10.9 ± 7.9%; p < 0.001, d = 0.46) for Pmean10s. During the 1- and 3-minute test, the bias and 95% LoA were 72 ± 30 W (17.9 ± 7.1%; p < 0.001, d = 0.84) and 28 ± 20 W (9.6 ± 6.1%; p < 0.001, d = 0.51), respectively. Laboratory tests, as assessed using a stationary ergometer, resulted in maximal and mean power output scores that were consistently higher than a track field-based test using a mobile ergometer. These results might be attributed to the technical ability of the riders and their experience to optimize gearing and cadence to maximize performance. Prediction of field-based testing on the track from laboratory tests should be used with caution.

Phosphorus excretion was studied in horses fed excess phosphorus. The hypothesis of this study was that the concentration of phosphorus and water extractable phosphorus (WEP) in the feces of sedentary horses would reflect the level of dietary phosphorus. Eight Standardbred mares were divided into two groups and received diets of grass hay and grain. The high phosphorus (HP) group received 142 g/d of monosodium phosphate (NaH2PO4), formulated to provide 4.5-times dietary phosphorus requirement, or 65-g phosphorus per day. The low phosphorus (LP) group received 28 g of phosphorus per day in the basal diet. These amounts were based on horses consuming 2% of body weight per day as hay plus supplemental grain. After a 7-day diet adaptation, a 5-day collection was conducted. Animals were housed from 4 PM until 8 AM the following morning without bedding during the collection period. After the first period, horses underwent a 10-day washout and then groups were crossed over for a second 7-day adaptation and 5-day collection. Feces was collected daily, weighed, and a 10% of aliquot taken. At the end of each collection period, feces was composited for each horse and analyzed for nitrogen, potassium, phosphorus, and WEP. Fecal phosphorus and WEP content were greater in theHP group (8.1 ± 0.3 vs. 6.8 ± 0.3 g/kg, respectively) than the LP group (3.6 ± 0.3 vs. 2.1± 0.3 g/kg, respectively; P <. 05). Overfeeding a phosphorus supplement increased phosphorus and WEP in the manure; WEP may be useful for determining phosphorus runoff risk.

Few previous studies have addressed exercise capacity in patients with corrected congenital heart disease (CHD) and significant anatomical residua. The aim of this study was to determine the aerobic fitness and peak cardiac function of patients with corrected CHD with complete or incomplete repairs, as determined by resting echocardiography. Children, adolescents and young adults (

Few previous studies have addressed exercise capacity in patients with corrected congenital heart disease (CHD) and significant anatomical residua. The aim of this study was to determine the aerobic fitness and peak cardiac function of patients with corrected CHD with complete or incomplete repairs, as determined by resting echocardiography. Children, adolescents and young adults (

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. 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 h RESULTS: 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). 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.

Schools are common sites for obesity prevention interventions. Although many theories suggest that the school context influences weight status, there has been little empirical research. The objective of this study was to explore whether features of the school context were consistently and meaningfully associated with pupil weight status (overweight or obese). Exploratory factor analysis of routinely collected data on 319 primary schools in Devon, England, was used to identify possible school-based contextual factors. Repeated cross-sectional multilevel analysis of five years (2006/07-2010/11) of data from the National Child Measurement Programme was then used to test for consistent and meaningful associations. Four school-based contextual factors were derived which ranked schools according to deprivation, location, resource and prioritisation of physical activity. None of which were meaningfully and consistently associated with pupil weight status, across the five years. The lack of consistent associations between the factors and pupil weight status suggests that the school context is not inherently obesogenic. In contrast, incorporating findings from education research indicates that schools may be equalising weight status, and obesity prevention research, policy and practice might need to address what is happening outside schools and particularly during the school holidays.

OBJECTIVES: High-intensity interval exercise (HIIE) may offer a time efficient means to improve health outcomes compared to moderate-intensity exercise (MIE). This study examined the acute effect of HIIE compared to a work-matched bout of MIE on glucose tolerance, insulin sensitivity (IS), resting fat oxidation and exercise enjoyment in adolescent boys. DESIGN: Within-measures design with counterbalanced experimental conditions. METHODS: Nine boys (14.2 ± 0.4 years) completed three conditions on separate days in a counterbalanced order: (1) HIIE; (2) work matched MIE, both on a cycle ergometer; and (3) rest (CON). An oral glucose tolerance test (OGTT) was performed after exercise or rest and the area under curve (AUC) responses for plasma [glucose] and [insulin] were calculated, and IS estimated (Cederholm index). Energy expenditure and fat oxidation were measured following the OGTT using indirect calorimetry. Exercise enjoyment was assessed using the Physical Activity Enjoyment Scale. RESULTS: the incremental AUC (iAUC) for plasma [glucose] was reduced following both MIE (-23.9%, P = 0.013, effect size [ES] = -0.64) and HIIE (-28.9%, P=0.008, ES = -0.84) compared to CON. The iAUC for plasma [insulin] was lower for HIIE (-24.2%, P = 0.021, ES = -0.71) and MIE (-29.1%, P = 0.012, ES = -0.79) compared to CON. IS increased by 11.2% after HIIE (P = 0.03, ES = 0.76) and 8.4% after MIE (P = 0.10, ES = 0.58). There was a trend for an increase in fat oxidation following HIIE (P = 0.097, ES = 0.70). Both HIIE and MIE were rated as equally enjoyable (P > 0.05, ES < 0.01). CONCLUSION: a single bout of time efficient HIIE is an effective alternative to MIE for improving glucose tolerance and IS in adolescent boys immediately after exercise.

The first installment of this two-part commentary reviewed existing models of long-term athletic development. However, irrespective of the model that is adopted by practitioners, existing structures within competitive youth sports in addition to the prevalence of physical inactivity in a growing number of modern-day youth may serve as potential barriers to the success of any developmental pathway. The second part of this commentary will initially highlight common issues that are likely to impede the success of long-term athletic development programs and then propose solutions that will address the negative impact of such issues.

The concept of developing talent and athleticism in youth is the goal of many coaches and sports systems. Consequently, an increasing number of sporting organizations have adopted long-term athletic development models in an attempt to provide a structured approach to the training of youth. It is clear that maximizing sporting talent is an important goal of long-term athletic development models. However, ensuring that youth of all ages and abilities are provided with a strategic plan for the development of their health and physical fitness is also important to maximize physical activity participation rates, reduce the risk of sport- and activity-related injury, and to ensure long-term health and well-being. Critical reviews of independent models of long-term athletic development are already present within the literature; however, to the best of our knowledge, a comprehensive examination and review of the most prominent models does not exist. Additionally, considerations of modern day issues that may impact on the success of any long-term athletic development model are lacking, as are proposed solutions to address such issues. Therefore, within this 2-part commentary, Part 1 provides a critical review of existing models of practice for long-term athletic development and introduces a composite youth development model that includes the integration of talent, psychosocial and physical development across maturation. Part 2 identifies limiting factors that may restrict the success of such models and offers potential solutions.

AIM: to provide an evidence-based review of muscle metabolism changes with sex-, age- and maturation with reference to the development of youth sport performance. METHODS: a narrative review of data from both invasive and non-invasive studies, from 1970 to 2015, founded on personal databases supported with computer searches of PubMed and Google Scholar. RESULTS: Youth sport performance is underpinned by sex-, age- and maturation-related changes in muscle metabolism. Investigations of muscle size, structure and metabolism; substrate utilisation; pulmonary oxygen uptake kinetics; muscle phosphocreatine kinetics; peak anaerobic and aerobic performance; and fatigue resistance; determined using a range of conventional and emerging techniques present a consistent picture. Age-related changes have been consistently documented but specific and independent maturation-related effects on muscle metabolism during exercise have proved elusive to establish. Children are better equipped for exercise supported primarily by oxidative metabolism than by anaerobic metabolism. Sexual dimorphism is apparent in several physiological variables underpinning youth sport performance. As young people mature there is a progressive but asynchronous transition into an adult metabolic profile. CONCLUSIONS: the application of recent developments in technology to the laboratory study of the exercising child and adolescent has both supplemented existing knowledge and provided novel insights into developmental exercise physiology. A sound foundation of laboratory-based knowledge has been established but the lack of rigorously designed child-specific and sport-specific testing environments has clouded the interpretation of the data in real life situations. The primary challenge remains the translation of laboratory research into the optimisation of youth sports participation and performance.

Following periods of physical activity, it is not uncommon for exercisers to increase their energy intake as a reward deemed 'earned'. Consumers' awareness of the energy within food and expended from exercise has previously been found to be limited. Therefore, the aim was to investigate whether habitual exercisers (50 adults and 49 children from 5 sports clubs) were able to conceptualise the energy expenditure (EE), following 1 h of their regular sports training, into a quantifiable amount of perceived energy compensation (PEC) in the form of food (chocolate) or drink (sports drink). Mean percentage accuracy for the PEC against EE matched

Background left ventricular (LV) and right ventricular (RV) myocardial reserve during exercise in adolescents has not been directly characterized. The aim of this study was to quantify myocardial performance response to exercise by using two-dimensional (2-D) speckle tracking echocardiography and describe the relationship between myocardial reserve, respiratory, and metabolic exercise parameters. A total of 23 healthy boys and girls (mean age 13.2 ± 2.7 yr; stature 159.1 ± 16.4 cm; body mass 49.5 ± 16.6 kg; BSA 1.47 ± 0.33 m(2)) completed an incremental cardiopulmonary exercise test (25 W · 3 min increments) with simultaneous acquisition of 2-D transthoracic echocardiography at rest, each exercise stage up to 100 W, and in recovery at 2 min and 10 min. Two-dimensional LV (LV Sl) and RV (RV Sl) longitudinal strain and LV circumferential strain (LV Sc) were analyzed to define the relationship between myocardial performance reserve and metabolic exercise parameters. Participants achieved a peak oxygen uptake (V̇o 2peak) of 40.6 ± 8.9 ml · kg(-1) · min(-1) and a work rate of 154 ± 42 W. LV Sl and LV Sc and RV Sl increased significantly across work rates (P < 0.05). LV Sl during exercise was significantly correlated to resting strain, V̇o 2peak, oxygen pulse, and work rate (0.530 ≤ r ≤ 0.784, P < 0.05). This study identifies a positive and moderate relationship between LV and RV myocardial performance and metabolic parameters during exercise by using a novel methodology. Relationships detected present novel data directly describing myocardial adaptation at different stages of exercise and recovery that in the future can help directly assess cardiac reserve in patients with cardiac pathology.

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.

OBJECTIVE: the aim of this study is to examine whether there is a differential impact of primary schools upon children's weight status. METHODS: a repeated cross-sectional study was undertaken using five years (2006/07-2010/11) of National Child Measurement Programme data, comprising 57,976 children (aged 4-5 (Reception) and 10-11 (Year 6) years) from 300 primary schools across Devon, England. Examining each year separately, the schools were ranked according to their observed and residual (having accounted for school and neighbourhood clustering and pupil ethnicity and socioeconomic status) school mean body mass index standard deviation score (BMI-SDS). Subtracting the Reception from the Year 6 mean residuals gave 'value-added' scores for each school which were also ranked. The rankings were compared within and across the years to assess consistency. RESULTS: Although pupil BMI-SDS was high, >97% of the variation in BMI-SDS was attributable to environments other than the school. The 'value-added' by each school was only poorly correlated with the observed and residual pupil BMI-SDS; but none of the rankings were consistent across the five years. CONCLUSION: the inconsistency of the rankings and the small variation in BMI-SDS at the level of the school suggests that there is no systematic differential impact of primary schools upon pupil weight status.

The clinical importance of exercise testing and training in the healthcare management of young patients with cystic fibrosis (CF) is growing. The aim of the present study was to determine the incidence of airflow limitation following cardiopulmonary exercise testing (CPET) and heavy-intensity intermittent exercise (HIIE) in young patients with CF. Nineteen young patients with CF and respective paired-matched controls performed CPET and HIIE on separate days. Forced expiratory volume in one second (FEV1) was measured pre- and post each exercise modality. A fall in FEV1 of 10 % or greater was used to define airflow limitation. The incidence of airflow limitation was significantly greater in the CF group than in the controls following CPET (32 vs. 5 %; p = 0.03); however, no significant difference in the incidence of airflow limitation was shown following HIIE between the CF group and controls (11 vs. 16 %; p = 0.64).Conclusion: Our data show that the incidence of airflow limitation following CPET in young patients with CF is high. Therefore, clinicians may wish to identify whether young CF patients experience airflow limitation following strenuous exercise, such as CPET, before it is performed. However, HIIE carries a low risk for airflow limitation and may be prescribed as a safe, yet effective exercise modality for young patients with CF. © 2014 Springer-Verlag Berlin Heidelberg.

Purpose: to examine changes to neuromuscular control of leg stiffness following 42 min of soccer-specific exercise.

Cardiopulmonary exercise testing is underutilized within the clinical management of patients with cystic fibrosis. But within the last 5 years, there has been considerable interest in its implementation, which has included deliberations by the European Cystic Fibrosis Society about incorporating this method within the clinical assessment of patients. This review examines the current use of cardiopulmonary exercise testing in assessing the extent and cause(s) of exercise limitation from a pediatric perspective. Examples of the measured parameters and their interpretation are provided. Critical synthesis of recent work in the oxygen uptake (VO2) kinetics response to and following exercise is also discussed, and although identified more as a research tool, its utilization advances researchers understanding of the cardiovascular, respiratory and muscular limitations to exercise tolerance. Finally, exercise and its application in therapeutic interventions are highlighted and a number of recommendations made about the utility of exercise prescription.

The rising prevalence of overweight and obese children has seen a focus upon school-based interventions. However, little research has considered the impact of the school context on pupil weight status. The aim of this project was to identify whether primary schools have an impact upon pupil weight status, and subsequently explore which, if any, school-based contextual factors were associated with pupil weight status. Reviewing the relevant literature identified two gaps in the evidence related to primary school built environment and policy, and weight status, which were examined through systematic reviews. These reviews highlighted the paucity of literature on the school influence on pupil weight status, demonstrating the need for more research. Subsequently, the main component of the research was a repeated cross-sectional study using secondary data from the National Child Measurement Programme and additional sources. The reviews highlighted the need for studies to examine multiple contexts simultaneously, and although restricted to the school, sufficient data were available to examine the socio-demographic, built environment, physical activity, diet and ethos contexts of schools. The final data set comprised 62,554 participants, over 300 schools and 40 potential explanatory variables across five academic years (2006/07 - 2010/11). Both continuous and binary measures of weight status were assessed using national and international definitions and each academic year was analysed separately. Multilevel modelling allowed the estimation of how much of the variation in pupil weight status related to differences between schools and between-year groups within-schools, both of which were found to be small (intraclass correlation coefficient

BACKGROUND: Foods with low glycaemic index (LGI) are reported to suppress appetite mainly in overweight population but have not been investigated in athletic adults. OBJECTIVE: the aim of this study was to compare the short-term effects of LGI and high GI (HGI) meals over a day on subsequent subjective appetite sensation, energy intake, energy expenditure, energy balance and resting metabolic rate in physically active males. METHODS: This cross-sectional randomized crossover study included 14 active males (mean ± SD; age 34.5 ± 8.9 years, body mass index 22.8 ± 2.1 kg m(-2)) to consume LGI and HGI meals on two separate days. On each trial day, participants consumed a breakfast in the laboratory and then left with a packed lunch, dinner and snacks. Appetite scores, energy intake and expenditure were assessed. RESULTS: the area under the curve for appetite scores of the HGI trial was significantly smaller than that of the LGI trial during the laboratory period (p = 0.027) and throughout the day (p = 0.009). No significant differences in energy intake, energy expenditure, energy balance and resting metabolic rate were found between groups, between the trial days and between the corresponding post-trial days. CONCLUSIONS: These results show that frequent ingestion of the HGI meals, contrary to the previous reports, suppresses appetite more than that of LGI meals, but did not affect energy balance in physically active normal-weight males.

Abstract: the present study investigated the heart rate (HR) response to various types of physical education (PE) activities for 8- to 9-year-olds (five school classes, n = 93) and the fitness effects of a short-term PE training programme (three of the five classes, n = 59) with high compared to low-to-moderate aerobic intensity. HR was recorded during small-sided indoor soccer (SO), basketball (BB), unihockey (UH), circuit training (CT), walking (W) and Nintendo Wii Boxing (NWB) and Nintendo Wii Tennis (NWT). Maximal HR (HRmax) and physical fitness was determined by the Yo-Yo Intermittent Recovery Level 1 Children's test (YYIR1C) test. Following cluster randomisation, three classes were tested before and after 6 wks with 2 × 30 min/wk SO and UH lessons [high-intensity (HI), 2 classes, n = 39] or low-to-moderate intensity PE lessons (CON, 1 class, n = 20). Average HR in SO (76 ± 1% HRmax), BA (77 ± 1% HRmax) and UH (74 ± 1% HRmax) was higher (P < 0.05) than in CT (62 ± 1% HRmax), W (57 ± 1% HRmax), NWB (65 ± 2% HRmax) and NWT (57 ± 1% HRmax). Time with HR > 80% and 90% HRmax, respectively, was higher (P < 0.05) in SO (42 ± 4 and 12 ± 2%), BB (41 ± 5 and 13 ± 3%) and UH (34 ± 3 and 9 ± 2%) than in CT, W and NW (0–5%), with time >80% HRmax being higher (P < 0.05) in SO than UH. After 6 wk, YYIR1C performance was increased (P < 0.05) by 22% in HI (673 ± 57 to 821 ± 71 m), but unaltered in CON (674 ± 88 to 568 ± 81 m). HR 2 min into YYIR1C was lowered (P < 0.05) in HI after 6 wks (92.4 ± 0.8 to 89.1 ± 0.9% HRmax), but not in CON. In conclusion, ball games elicited high aerobic loading for young schoolchildren and a short-term, low-volume ball game PE-intervention improved physical fitness. Traditional PE sessions had no effects on intermittent exercise performance.

PURPOSE: This study aimed to document the matching of muscle O2 delivery to O2 use in young patients with cystic fibrosis (CF) from muscle deoxygenation (HHb) dynamics during ramp exercise. METHODS: Ten patients with stable, mild-to-moderate CF (12.7 ± 2.8 yr) and 10 healthy controls (CON, 12.8 ± 2.8 yr) completed a combined ramp and supramaximal cycling test to determine maximal O2 uptake (V˙O2max). Changes in gas exchange and ventilation, HR, and m. vastus lateralis HHb (near-infrared spectroscopy) were assessed. Δ[HHb]-work rate and Δ[HHb]-V˙O2 profiles were normalized and fit using a sigmoid function. RESULTS: Aerobic function was impaired in CF, indicated by very likely reduced fat-free mass-normalized V˙O2max (mean difference, ±90% confidence interval: -7.9 mL·kg·min, ±6.1), very likely lower V˙O2 gain (-1.44 mL·min·W, ±1.12), and a likely slower V˙O2 mean response time (11 s, ±13). An unclear effect was found upon the absolute and relative work rate (-14 W, ±44, and -0.7% peak power output, ±12.0, respectively) and the absolute and percentage (-0.10 L·min, ±0.43, and 3.3% V˙O2max, ±6.0) V˙O2 corresponding to 50% Δ[HHb] amplitude, respectively, between groups. However, arterial oxygen saturation (SpO2) was very likely lower in CF (-1%, ±1) and demonstrated moderate-to-very large relations with parameters of aerobic function. CONCLUSIONS: Young patients with mild-to-moderate CF present with impaired aerobic function during ramp incremental cycling exercise. Because the rate of fractional O2 extraction during ramp cycling exercise was not altered by CF, yet SpO2 was lower, the present findings support the notion of centrally mediated oxygen delivery to principally limit the aerobic function of pediatric patients with CF during ramp incremental cycling exercise.

PURPOSE: During constant work rate exercise above the lactate threshold (LT), the initial rapid phase of pulmonary oxygen uptake (VO₂) kinetics is supplemented by an additional VO₂ slow component (VO₂Sc) which reduces the efficiency of muscular work. The VO₂Sc amplitude has been shown to increase with maturation but the mechanisms are poorly understood. We utilized the transverse relaxation time (T₂) of muscle protons from magnetic resonance imaging (MRI) to test the hypothesis that a lower VO₂ slow component (VO₂Sc) amplitude in children would be associated with a reduced muscle recruitment compared to adults. METHODS: Eight boys (mean age 11.4 ± 0.4) and eight men (mean age 25.3 ± 3.3 years) completed repeated step transitions of unloaded-to-very heavy-intensity (U → VH) exercise on a cycle ergometer. MRI scans of the thigh region were acquired at rest and after VH exercise up to the VO₂Sc time delay (ScTD) and after 6 min. T₂ for each of eight muscles was adjusted in relation to cross-sectional area and then summed to provide the area-weighted ΣT₂ as an index of thigh recruitment. RESULTS: There were no child/adult differences in the relative VO₂Sc amplitude [Boys 14 ± 7 vs. Men 18 ± 3 %, P = 0.15, effect size (ES) = 0.8] during which the change (∆) in area-weighted ΣT₂ between the ScTD and 6 min was not different between groups (Boys 1.6 ± 1.2 vs. Men 2.3 ± 1.1 ms, P = 0.27, ES = 0.6). A positive and strong correlation was found between the relative VO₂Sc amplitude and the magnitude of the area-weighted ∆ΣT₂ in men (r = 0.92, P = 0.001) but not in boys (r = 0.09, P = 0.84). CONCLUSIONS: This study provides evidence to show that progressive muscle recruitment (as inferred from T₂ changes) contributes to the development of the VO₂Sc during intense submaximal exercise independent of age.

Purpose: During constant work rate exercise above the lactate threshold (LT), the initial rapid phase of pulmonary oxygen uptake ([Formula Presented]O2) kinetics is supplemented by an additional [Formula Presented]O2 slow component ([Formula Presented]O2Sc) which reduces the efficiency of muscular work. The [Formula Presented]O2Sc amplitude has been shown to increase with maturation but the mechanisms are poorly understood. We utilized the transverse relaxation time (T2) of muscle protons from magnetic resonance imaging (MRI) to test the hypothesis that a lower [Formula Presented]O2 slow component ([Formula Presented]O2Sc) amplitude in children would be associated with a reduced muscle recruitment compared to adults.

During constant work rate exercise above the
lactate threshold (LT ), the initial rapid phase of pulmonary
oxygen uptake (˙V O2) kinetics is supplemented by an
additional ˙V O2 slow component (˙V O2Sc) which reduces
the efficiency of muscular work. The ˙V O2Sc amplitude has
been shown to increase with maturation but the mechanisms
are poorly understood. We utilized the transverse
relaxation time (T2) of muscle protons from magnetic resonance
imaging (MRI) to test the hypothesis that a lower
˙V
O2 slow component (˙V O2Sc) amplitude in children would
be associated with a reduced muscle recruitment compared
to adults.
Methods Eight boys (mean age 11.4 ± 0.4) and eight
men (mean age 25.3 ± 3.3 years) completed repeated step
transitions of unloaded-to-very heavy-intensity (U → VH)
exercise on a cycle ergometer. MRI scans of the thigh
region were acquired at rest and after VH exercise up to
the ˙V O2Sc time delay (ScTD) and after 6 min. T2 for each of eight muscles was adjusted in relation to cross-sectional
area and then summed to provide the area-weighted ΣT2 as
an index of thigh recruitment.
Results T here were no child/adult differences in the relative
˙VO2Sc amplitude [Boys 14 ± 7 vs. Men 18 ± 3 %,
P = 0.15, effect size (ES) = 0.8] during which the change
(Δ) in area-weighted ΣT2 between the ScTD and 6 min
was not different between groups (Boys 1.6 ± 1.2 vs. Men
2.3 ± 1.1 ms, P = 0.27, ES = 0.6). A positive and strong
correlation was found between the relative ˙V O2Sc amplitude
and the magnitude of the area-weighted ΔΣT2 in men
(r = 0.92, P = 0.001) but not in boys (r = 0.09, P = 0.84).
Conclusions T his study provides evidence to show
that progressive muscle recruitment (as inferred from T2
changes) contributes to the development of the ˙V O2Sc during
intense submaximal exercise independent of age.

Children and adolescents are less susceptible to muscle fatigue during repeated bouts of high-intensity exercise than adults, but the physiological basis for these differences is not clear. The purpose of the current investigation was to investigate the muscle metabolic responses, using 31-phosphorus magnetic resonance spectroscopy, during fatiguing isometric quadriceps exercise in 13 adolescents (7 females) and 14 adults (8 females). Participants completed 30 maximal voluntary contractions (6-s duration) separated by 6 s of rest. Fatigue was quantified as the relative decrease in force over the test. Fatigue was not significantly different with age (p = 0.20) or sex (p = 0.63). Metabolic perturbation (change in phosphocreatine, inorganic phosphate, and ADP concentrations) was significantly greater in adults compared with adolescents; no sex effects were present. Muscle pH did not differ with age or sex. Phosphocreatine recovery following exercise was not significantly different with age (p = 0.27) or sex (p = 0.97) but a significant interaction effect was present (p = 0.04). Recovery tended to be faster in boys than men but slower in girls than women, though no significant group differences were identified. The results of this study show that at a comparable level of muscle fatigue, the metabolic profile is profoundly different between adolescents and adults.

Exercise training is an underused intervention in paediatric healthcare. This is surprising, since initial evidence demonstrates its effectiveness and safety; furthermore it confers socioeconomic benefits for healthcare systems. Pilot studies have assessed and confirmed the feasibility of exercise training in many paediatric disease settings. However, more research is needed to understand the pathophysiology, quantify treatment effects and monitor outcomes. A concerted effort from researchers, health professionals and police makers will be necessary to make exercise training an evidence-based and cost-effective intervention in paediatric care.

PURPOSE: the purpose of this report was to evaluate the influence of 12 weeks of ivacaftor treatment on the aerobic function of 2 teenage patients with cystic fibrosis (CF; ΔF508/G551D) using a maximal cardiopulmonary exercise test. SUMMARY OF KEY POINTS: One patient, with relatively mild disease, demonstrated no clinically meaningful changes in maximal oxygen uptake ((Equation is included in full-text article.)O2max). However, in the second case, with more established lung disease on imaging, (Equation is included in full-text article.)O2max improved by approximately 30%, an improvement out of proportion with early lung function changes. This improvement resulted from increased muscle oxygen delivery and extraction. STATEMENT OF CONCLUSIONS: Cardiopulmonary exercise testing can monitor the extent and cause(s) of change following interventions such as ivacaftor, with the potential to identify functional changes independent from spirometry indices. RECOMMENDATIONS FOR CLINICAL PRACTICE: Cardiopulmonary exercise testing represents an important and comprehensive clinical assessment tool, and its use as an outcome measure in the functional assessment of patients with CF is encouraged.

This study used priming exercise in young boys to investigate (i) how muscle oxygen delivery and oxygen utilization, and muscle activity modulate oxygen uptake kinetics during exercise; and (ii) whether the accelerated oxygen uptake kinetics following priming exercise can improve exercise tolerance. Seven boys that were aged 11.3 ± 1.6 years completed either a single bout (bout 1) or repeated bouts with 6 min of recovery (bout 2) of very heavy-intensity cycling exercise. During the tests oxygen uptake, muscle oxygenation, muscle electrical activity and exercise tolerance were measured. Priming exercise most likely shortened the oxygen uptake mean response time (change, ±90% confidence limits; -8.0 s, ±3.0), possibly increased the phase II oxygen uptake amplitude (0.11 L·min(-1), ±0.09) and very likely reduced the oxygen uptake slow component amplitude (-0.08 L·min(-1), ±0.07). Priming resulted in a likely reduction in integrated electromyography (-24% baseline, ±21% and -25% baseline, ±19) and a very likely reduction in Δ deoxyhaemoglobin/Δoxygen uptake (-0.16, ±0.11 and -0.09, ±0.05) over the phase II and slow component portions of the oxygen uptake response, respectively. A correlation was present between the change in tissue oxygenation index during bout 2 and the change in the phase II (r = -0.72, likely negative) and slow component (r = 0.72, likely positive) oxygen uptake amplitudes following priming exercise, but not for muscle activity. Exercise tolerance was likely reduced (change -177 s, ±180) following priming exercise. The altered phase II and slow component oxygen uptake amplitudes in boys following priming exercise are linked to an improved localised matching of muscle oxygen delivery to oxygen uptake and not muscle electrical activity. Despite more rapid oxygen uptake kinetics following priming exercise, exercise tolerance was not enhanced.

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.

The phosphocreatine (PCr) recovery time constant (τ) following exercise provides a measure of mitochondrial oxidative capacity. The purpose of this investigation was to use 2 different protocols to determine τ in adolescent females. 31P-MR spectra were collected during 2 exercise tests in 6 adolescent girls (13.8 ± 0.3 y) and 7 women (23.2 ± 3.4 y). The first test consisted of 23 repeated 4 seconds maximal isometric calf contractions separated by 12-second recovery; PCr recovery between the final 18 contractions was used to calculate τ. The second test was a sustained 20-second maximal contraction; recovery was fitted with an exponential function to measure τ. PCr τ did not significantly differ between groups: (gated exercise: 4 girls: 16 ± 5 s, 7 women: 17 ± 5 s, p; sustained exercise: 6 girls: 19 ± 6 s, 7 women: 19 ± 4 s). Bland-Altman analysis demonstrated a close agreement between sustained and gated exercise. Both gated and sustained exercise appear feasible in a pediatric population, and offer a noninvasive evaluation of mitochondrial oxidative capacity.

OBJECTIVES: Measuring aerobic fitness (V˙O2max) via a maximal cardiopulmonary exercise test is an important clinical tool in cystic fibrosis. This study sought to establish: (1) the validity of traditional criteria to verify maximal efforts during a ramp cardiopulmonary exercise test; and (2) whether V˙O2 measured during an exhaustive cardiopulmonary exercise test represents a valid V˙O2max in paediatric patients, using a subsequent exhaustive supramaximal (Smax) exercise test. DESIGN: Cross-sectional. METHODS: Fourteen patients (7-18 years; 10 males) completed an exhaustive ramp test to determine V˙O2max. Following 15-min recovery, Smax (110% ramp peak power output) was performed. RESULTS: Ramp test V˙O2peak was significantly higher than V˙O2 documented at traditional endpoint criteria, including a RER of 1.00 (0.99±0.47 L min(-1) vs. 1.83±0.78 L min(-1), p

Objectives: Measuring aerobic fitness (V̇O2max) via a maximal cardiopulmonary exercise test is an important clinical tool in cystic fibrosis. This study sought to establish: (1) the validity of traditional criteria to verify maximal efforts during a ramp cardiopulmonary exercise test; and (2) whether V̇O2 measured during an exhaustive cardiopulmonary exercise test represents a valid V̇O2max in paediatric patients, using a subsequent exhaustive supramaximal (Smax) exercise test. Design: Cross-sectional. Methods: Fourteen patients (7-18 years; 10 males) completed an exhaustive ramp test to determine V̇O2max. Following 15-min recovery, Smax (110% ramp peak power output) was performed. Results: Ramp test V̇O2peak was significantly higher than V̇O2 documented at traditional endpoint criteria, including a RER of 1.00 (0.99±0.47Lmin-1 vs. 1.83±0.78Lmin-1, p

In Volume 1 of Pediatric Exercise Science (PES), a paper by Fenster et al. (25) investigated the relationship between peak oxygen uptake (peak VO2) and physical activity (PA) in 6- to 8-year-old children. They used both questionnaires and large-scale integrated activity monitors (LSIs) to estimate daily PA and determined peak VO2 using an incremental treadmill test to volitional exhaustion. They concluded that peak VO2 correlated well with PA as measured by LSIs but commented that questionnaire data were only weakly and nonsignificantly associated with LSI and peak VO2 data. Peak VO2 and PA are the most researched and reported variables in the 25-year history of PES. Yet, the assessment and interpretation of young people's aerobic fitness and PA remain problematic and any meaningful relationship between them during childhood and adolescence is shrouded with controversy. The present paper uses Fenster et al.'s (25) report as an indicator of where we were 25 years ago, outlines how far we have advanced since then, and suggests future directions of research in the study of aerobic fitness and PA. In the first volume of PES, Fenster, Freedson, Washburn, and Ellison (25) investigated the relationship between 6- to 8-year-old children's peak oxygen uptake (peak VO2) and physical activity (PA). Five boys and 13 girls participated in the study and their data were pooled for analysis. Peak VO2 was determined during an incremental treadmill test to voluntary exhaustion and PA was estimated using both questionnaires and large-scale integrated activity monitors (LSIs). On the basis of a significant interclass correlation coefficient of r =. 59 between peak VO2 and the log of LSI average counts per hour Fenster et al. (25) concluded that "aerobic capacity, as measured by peak VO2 correlated well with physical activity as measured by LSI" (p.134). They also commented that questionnaire data were only weakly and nonsignificantly associated with LSI and peak VO2 data. Young people's peak VO2 and PA are the most researched and reported variables in the 25-year history of PES and yet the assessment and interpretation of peak VO2 and PA and any meaningful relationship between them during growth and maturation are still shrouded with controversy. The present paper uses Fenster et al.'s (25) work as an indicator of our understanding of young people's peak VO2 and PA in 1989, briefly reviews what we know in 2013, and suggests future directions of research.

Equine farms are increasing in number in Northeast and Mid-Atlantic states. These farms may influence environmental quality owing to manure collection, storage, spreading, and disposal practices. A manure management survey was mailed to 700 New Jersey equine farms during the winter of 2009-2010 (these farms were located in two watersheds). Two hundred forty-two surveys were returned; 10% were training or performance farms, whereas the remainder (90%) were breeding, boarding, or pleasure farms. There were differences between the two watersheds in turnout time, pasture acreage, use of drag harrows, and income. Respondents answered questions about diet and environmental management on farms. Seventy-eight percent had bunk management plans. Forty-seven percent disposed of waste feed in a manure pile, 35% left it on fields or paddocks, and 18% put it in a dumpster. Twenty-six percent engage a professional for feeding advice (21% veterinarians, 2% extension, 3% nutrition consultants). Most respondents did not have a regular feed management plan. Sixty-two percent of all farms spread manure on-farm. of those who spread, 29% have >8.09 hectares (20 acres) for spreading. Ninety-six percent of respondents stored manure >100 ft from water or wetlands. Comparison of cross-tabulations indicates a strong relationship (P

The purpose of this study was to examine the effects of submaximal sustained contractions on fatigue and recovery properties in untrained prepubescent boys (n = 14) and men (n = 14). All participants performed, in random order, an isometric plantar flexion at 20% and 60% of their maximal voluntary contraction (MVC) until exhaustion (20%fatigue and 60%fatigue, respectively). During both fatigue protocols, surface electromyogram (sEMG) of the soleus and tibialis anterior muscles was recorded. Before and after the fatigue protocol, MVCs and blood lactate concentration were obtained. During 20%fatigue and 60%fatigue, agonist and antagonist sEMG increased gradually to a similar extent in both groups. Immediately after fatigue, MVC torque decreased in both groups, compared with prefatigue values, and boys recovered faster than men in both fatigue protocols. The reduction in agonist sEMG during MVC after fatigue was not significantly different between men and boys (p < 0.05), independent of the fatigue protocol. sEMG of boys recovered to baseline values 3 min after the 20%fatigue and 60%fatigue protocols, whereas men did not recover. Lactate concentration increased immediately after the end of the fatigue protocols, compared with the prefatigue values (p < 0.05). This increase was higher for the 60%fatigue than for 20%fatigue protocol, and did not differ between boys and men. It is concluded that low- and middle-intensity submaximal sustained isometric fatigue protocols induce similar fatigue effects in boys and men. Furthermore, it was shown that boys can recover faster than men, independent of the contraction intensity that induces fatigue.

Objectives: Fatigue and unaccountable underperformance are common for athletes, but there is a lack of empirical data regarding the prevalence of non-functional overreaching (NFOR) and the overtraining syndrome (OTS). Using the overtraining definition of the European College of Sport Science (ECSS), the present study aimed to explore the prevalence, symptoms and associated factors of NFOR/OTS across Swiss elite athletes in various sports. Method: 139 Swiss elite athletes (63 males and 76 females, Mage = 23.6, SD age = 5.6 y) from 26 different sports completed al 7-item online survey about underperformance and symptoms of NFOR/OTS. 95% of the sample represented Switzerland in their sport. Athletes were classified as NFOR/OTS by according to the overtraining definition of the ECSS. Data were analysed using Mann-Whitney U nonparametric tests and ANOVAs. Results: 9% of the athletes were classified as OTS and 21% as NFOR at least once in their career. The prevalence was significantly higher in medium-physical demand sports than in low-physical demand sports (p -.02). There were no significant differences in the NFOR/OTS prevalence between individual and team sports and female and male athletes. Competition level and training load had also no significant influence on the NFOR/OTS prevalence, although low-physical demand sports trained significantly less than medium- and high-physical demand sports. Injury/illness, loss of weight and sleep disturbance rates were significantly higher in the NFOR/OTS group. More than 70% of the NFOR/OTS athletes reported loss of motivation and emotional disturbances. Conclusions: the NFOR/OTS career prevalence rate of Swiss elite athletes can be estimated at approximately 30%. NFOR/OTS is accompanied by biopsychosocial signs of maladjustment, e.g. emotional disturbances, loss of motivation, sleep disturbances, injury/illness and weight loss, but training load is not a predictor of NFOR/OTS.

Horses' physical and digestive well-being is often enhanced when allowed to graze on pastures. Furthermore, a well-managed pasture can contribute to economic viability. Grazing can however have deleterious effects on the environment if not properly managed. Although equine grazing, defecating, and ground trampling behavior is unique from that of other livestock species, pasture management practices are often based on those derived from cattle grazing. This review summarizes the current knowledge of impacts of equine grazing on pasture quality and environment and identifies gaps where further information is needed to formulate and recommend sustainable grazing methods specific to equine. © 2013.

Background: the reproducibility of cardiopulmonary exercise testing (CPET) has not been established in young cystic fibrosis (CF) patients using a valid protocol. Methods: Thirteen 7-18. year olds completed three CPETs, separated by 48. h and 4-6. weeks. CPET involved a ramp-incremental cycling test with supramaximal verification. Results: Maximal oxygen uptake was repeatedly determined with no learning effect and typical errors expressed as a coefficient of variation (TECV%) of 9.3% (48h) and 13.3% (4-6weeks). The reproducibility of additional parameters of aerobic function [gas exchange threshold (TECV%: 11.2%, 16.8%); VO2 mean response time (TECV%: 37.8%, 89.4%); VO2 gain (TECV%: 17.4%, 24.5%)] and clinical utility [e.g. SaO2% (TECV%: 2.2%, 3.1%); ventilatory drive (VE/VCO2-slope) (TECV%: 7.8%, 17.7%)] was also established over the short- and the medium-term, respectively. Conclusion: These results establish limits of variability to determine meaningful changes over the short- and the medium-term for CPET outcomes in young CF patients. © 2013 European Cystic Fibrosis Society.

BACKGROUND: the reproducibility of cardiopulmonary exercise testing (CPET) has not been established in young cystic fibrosis (CF) patients using a valid protocol. METHODS: Thirteen 7-18 year olds completed three CPETs, separated by 48 h and 4-6 weeks. CPET involved a ramp-incremental cycling test with supramaximal verification. RESULTS: Maximal oxygen uptake was repeatedly determined with no learning effect and typical errors expressed as a coefficient of variation (TE(CV%)) of 9.3% (48 h) and 13.3% (4-6 weeks). The reproducibility of additional parameters of aerobic function [gas exchange threshold (TE(CV%): 11.2%, 16.8%); VO2 mean response time (TE(CV%): 37.8%, 89.4%); VO2 gain (TE(CV%): 17.4%, 24.5%)] and clinical utility [e.g. SaO2% (TE(CV%): 2.2%, 3.1%); ventilatory drive (V(E)/VCO2-slope) (TE(CV%): 7.8%, 17.7%)] was also established over the short- and the medium-term, respectively. CONCLUSION: These results establish limits of variability to determine meaningful changes over the short- and the medium-term for CPET outcomes in young CF patients.

Short stature and later maturation of youth artistic gymnasts are often attributed to the effects of intensive training from a young age. Given limitations of available data, inadequate specification of training, failure to consider other factors affecting growth and maturation, and failure to address epidemiological criteria for causality, it has not been possible thus far to establish cause-effect relationships between training and the growth and maturation of young artistic gymnasts. In response to this ongoing debate, the Scientific Commission of the International Gymnastics Federation (FIG) convened a committee to review the current literature and address four questions: (1) is there a negative effect of training on attained adult stature? (2) is there a negative effect of training on growth of body segments? (3) Does training attenuate pubertal growth and maturation, specifically, the rate of growth and/or the timing and tempo of maturation? (4) Does training negatively influence the endocrine system, specifically hormones related to growth and pubertal maturation? the basic information for the review was derived from the active involvement of committee members in research on normal variation and clinical aspects of growth and maturation, and on the growth and maturation of artistic gymnasts and other youth athletes. The committee was thus thoroughly familiar with the literature on growth and maturation in general and of gymnasts and young athletes. Relevant data were more available for females than males. Youth who persisted in the sport were a highly select sample, who tended to be shorter for chronological age but who had appropriate weight-for-height. Data for secondary sex characteristics, skeletal age and age at peak height velocity indicated later maturation, but the maturity status of gymnasts overlapped the normal range of variability observed in the general population. Gymnasts as a group demonstrated a pattern of growth and maturation similar to that observed among short-, normal-, late-maturing individuals who were not athletes. Evidence for endocrine changes in gymnasts was inadequate for inferences relative to potential training effects. Allowing for noted limitations, the following conclusions were deemed acceptable: (1) Adult height or near adult height of female and male artistic gymnasts is not compromised by intensive gymnastics training. (2) Gymnastics training does not appear to attenuate growth of upper (sitting height) or lower (legs) body segment lengths. (3) Gymnastics training does not appear to attenuate pubertal growth and maturation, neither rate of growth nor the timing and tempo of the growth spurt. (4) Available data are inadequate to address the issue of intensive gymnastics training and alterations within the endocrine system. © 2013 the Author(s).

This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females; 12.5-17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe. © 2013 Taylor & Francis.

This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females; 12.5-17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe.

The aim of the current study was to investigate potential age-related differences in neural regulation strategies during maximal and sub-maximal hopping. Thirty-two boys from three different age groups (9-, 12- and 15-years), completed trials of both maximal and sub maximal hopping, and based on contact and flight times, measures of reactive strength index (RSI = jump height/contact time) and leg stiffness (peak ground reaction force/peak displacement of centre of mass) were collected respectively. During all trials, surface electromyograms (EMG) were recorded from four different muscle sites of the dominant lower limb, during 100. ms pre-ground contact, and then four subsequent stretch reflex phases: background muscle activity (0-30. ms), short-latency stretch reflex (31-60. ms), intermediate15 latency stretch reflex 61-90. ms and long-latency stretch reflex (91-120. ms). Reactive strength index and leg stiffness were measured during the hopping trials. During maximal hopping, both 12- and 15-year olds produced significantly greater RSI (P< 0.02) than 9-year olds, with 15-year olds utilising significantly greater soleus muscle activity during the 100. ms prior to ground contact than the younger age groups (P< 0.01). During sub-maximal hopping, 15-year olds produced significantly greater absolute leg stiffness than both 12- and 9-year olds (P< 0.01), with 9-year olds producing significantly less soleus muscle activity during the 31-60. ms time phase. For all age groups, sub-maximal hopping was associated with significantly greater background muscle activity and short-latency stretch reflex activity in the soleus and vastus lateralis, when compared to maximal hopping (P< 0.001). Results suggest that as children mature, they become more reliant on supra-spinal feed forward input and short latency stretch reflexes to regulate greater levels of leg stiffness and RSI when hopping. © 2011 Elsevier Ltd.

The objective of this study was to determine if competition intensity would have an effect on antioxidant status in horses before and during a three-day event. Body weight, body condition score, and blood was sampled from CCI2(*) (n=19) and CCI3(*) (n=23) horses before the start of dressage, 20 to 30min following cross-country, and 18-24h after cross-county. Data were analyzed using a PROC MIXED in SAS. There were no differences between CCI2(*) and CCI3(*) horses during competition for plasma cortisol, lactate, -tocopherol, retinol, or erythrocyte glutathione peroxidase. After cross-country, CCI3(*) horses had higher serum creatine kinase (P=0.003) and aspartate aminotransferase (P

Objectives were to evaluate effects of (1) repetitive arthrocentesis on biomarkers of inflammation (prostaglandin E2, PGE2) and aggrecan synthesis (chondroitin sulfate-846; CS) in synovial fluid (SF); (2) exercise and superoxide dismutase (SOD) supplementation on biomarkers of inflammation, antioxidant status, and aggrecan synthesis, in horses. Preliminary trial. Standardbreds underwent four arthrocentesis procedures within 48 h and exhibited elevated CS and no changes in PGE2. Exercise trial. this randomized crossover design used twelve Standardbred mares which received either treatment (3000 IU d-1 oral SOD powder) or placebo (cellulose powder) for 6 wks which culminated with them running a repeated sprint exercise test (RSET). Samples were collected before (PRE), during (PEAK), and following exercise (POST). Exercise resulted in increased (P 0.05) antioxidant defenses including erythrocyte SOD, total glutathione, glutathione peroxidase, gene transcripts for interferon-gamma, interleukin-10, and interleukin-1β in blood, and decreased plasma nitric oxide. Exercise increased (P 0.05) SF CS and adjusted-PGE2, and higher (P 0.05) CS and PGE2 were found in hock versus carpus joints. No treatment effects were detected. Results suggest normal adaptive responses likely due to exercise-induced tissue microdamage and oxidative stress. Additional research is needed to identify benefit(s) of SOD supplementation in horses. © 2012 Emily D. Lamprecht and Carey A. Williams.

PURPOSE: This study aimed to examine the independent associations of cardiorespiratory fitness (CRF) and body fatness with resting blood pressure (BP) in children (9-11 yr) and adolescents (12-15 yr) in Benue State of Nigeria. METHODS: a total of 3243 children (n = 1017) and adolescents (n = 2226) were evaluated for aerobic fitness, body fatness, resting preexercise BP and recovery BP at minutes 1, 5, and 10 after a progressive aerobic cardiovascular endurance run test. Regression models, controlling for age and recovery BP at 1, 5, and 10 min after the progressive aerobic cardiovascular endurance run, determined the associations of independent variables with the dependent variables. RESULTS: Fatness and fitness were independent predictors of resting BP among participants, and the relationship of fatness with BP was more robust in adolescents than in children. In all cases, the relationships were stronger in boys than in girls. Combined fitness and fatness in predicting BP was modest (R(2) = 1%-3%) after controlling for age and postexercise BP. Postexercise BP was a major determinant of resting BP in both groups (R(2) = 23%-93%). In adolescents, fatter boys had 1.9 times likelihood of systolic HTN compared with leaner peers. Systolic and diastolic BP scores varied by fit-fat groups, the fit-low-fat group demonstrated the most favorable BP profiles, whereas the unfit-high-fat group showed the most adverse profiles. CONCLUSIONS: Irrespective of fatness, participants with higher CRF had more favorable BP profiles compared with their fat-unfit peers.

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. VO(2peak)

Our objective in this study is to compare 4 of the most common bedding materials used by equine operations on the chemical and physical characteristics of composted equine stall waste. Twelve Standardbred horses were adapted to the barn and surrounding environment for 2 wk before the start of the study. Groups of 3 horses were bedded on 1 of 4 different bedding types (wood shavings, pelletized wood materials, long straw, and pelletized straw) for 16 h per day for 18 d. Stalls were cleaned by trained staff daily, and all contents removed were weighed and stored separately by bedding material on a level covered concrete pad for the duration of the study. Compost piles were constructed using 3 replicate piles of each bedding type in a randomized complete block design. Each pile was equipped with a temperature sensor and data logger. Water was added and piles were turned weekly throughout the 100-d compost process. Initial and final samples were taken, dried, and analyzed for DM mass, OM, inorganic nitrogen (nitrate-N and ammonium-N), electrical conductivity, and soluble (plant-available) nutrients. Data were analyzed using the GLM procedure, and means were separated using Fischer's protected LSD test (P < 0.05). No significant temperature differences were observed among the bedding materials. The composting process resulted in significant reductions (P < 0.05) in DM mass for each of the 4 bedding materials. The composting process resulted in significant reductions (P < 0.05) in OM and C:N ratio for all 4 bedding materials. The composted long straw material had greater concentrations of total Kjeldahl nitrogen (P < 0.05), nitrate-N (P < 0.05), and ammonium-N (P < 0.05) than the composted wood shavings. This study demonstrated that incorporating a simple aerobic composting system may greatly reduce the overall volume of manure and yield a material that is beneficial for land application in pasture-based systems. The strawbased materials may be better suited for composting and subsequent land application; however, factors such as suitability of the bedding material for equine use, material cost, labor, and availability must be considered when selecting a bedding material. © 2012 American Society of Animal Science. All rights reserved.

This study tested the effects of low-cadence (60 rev min(-1)) uphill (Int(60)) or high-cadence (100 rev min(-1)) level-ground (Int(100)) interval training on power output (PO) during 20-min uphill (TT(up)) and flat (TT(flat)) time-trials. Eighteen male cyclists ([Formula: see text]: 58.6 ± 5.4 mL min(-1) kg(-1)) were randomly assigned to Int(60), Int(100) or a control group (Con). The interval training comprised two training sessions per week over 4 weeks, which consisted of six bouts of 5 min at the PO corresponding to the respiratory compensation point (RCP). For the control group, no interval training was conducted. A two-factor ANOVA revealed significant increases on performance measures obtained from a laboratory-graded exercise test (GXT) (P (max): 2.8 ± 3.0%; p < 0.01; PO and [Formula: see text] at RCP: 3.6 ± 6.3% and 4.7 ± 8.2%, respectively; p < 0.05; and [Formula: see text] at ventilatory threshold: 4.9 ± 5.6%; p < 0.01), with no significant group effects. Significant interactions between group and uphill and flat time-trial, pre- versus post-training on PO were observed (p < 0.05). Int(60) increased PO during both TT(up) (4.4 ± 5.3%) and TT(flat) (1.5 ± 4.5%). The changes were -1.3 ± 3.6, 2.6 ± 6.0% for Int(100) and 4.0 ± 4.6%, -3.5 ± 5.4% for Con during TT(up) and TT(flat), respectively. PO was significantly higher during TT(up) than TT(flat) (4.4 ± 6.0; 6.3 ± 5.6%; pre and post-training, respectively; p < 0.001). These findings suggest that higher forces during the low-cadence intervals are potentially beneficial to improve performance. In contrast to the GXT, the time-trials are ecologically valid to detect specific performance adaptations.

The U.S. Department of Agriculture supports agricultural research by encouraging the formation of multidisciplinary and multi-institutional teams. Project teams focus on agricultural issues related to profitability and economic and environmental sustainability. Recently, a U.S. Department of Agriculture project to study the impact of equine management and feeding practices on the environment was approved. The project, " NE-1041: Environmental Impacts of Equine Operations," is a Northeast regional project but includes research and extension faculty from across the country. The project team includes representatives from Alabama, Connecticut, Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, South Dakota, and Vermont. The goal of this project is to incorporate the best available data on horse management and feeding practices, manure storage and disposal, pasture and cropping management, soil and environmental quality, erosion control, and farm management practices to minimize negative impacts of equine operations on the environment. The specific objectives of the project are to assess existing data on environmental impacts of equine operations, identify gaps in current knowledge, conduct research when data are lacking or nonexistent, and incorporate existing and newly generated data into a systematic description of nutrient flow in soil, water, and air occurring on horse farms. Estimates will be made of pathogen transports and nitrogen (N)-, phosphorus (P)-, potassium (K)-, and energy (carbon)-loss potentials. In addition to identifying system-wide losses on equine farms, another goal of the project is to assist farmers and agricultural professionals in determining the value of equine management practices and other accepted best management practices. © 2012.

OBJECTIVE: to determine the importance of the provision of external exercise information to the setting of the pacing strategy, in subjects unfamiliar with a cycling task. DESIGN: Twenty-two healthy, untrained cyclists (VO(2max), 50 ± 9 mL-(1)·kg-(1)·min-(1)) were randomly assigned