The impact of maternity (Mat) on subsequent athletic performance is not well known. This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid-career maternity, performance development was reconstituted throughout the career. Maternity data and career break time span (Ttotal) were collected from publicly available informations. Performances were modelled according to the known age-performance relationship and the impact of maternity was added into the model. Linear mixed effect model was used to study the influence of maternity on the overall career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty-six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age-performance relationship model explains 92% of the performance variability during the career's progression. When age is considered, maternity does not have significant impact on performance development. World's most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development.Highlights Mid-career maternity does not have a significant impact on overall progression in high level runners, who return to official races.The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance.Age is the variable that explains most of performance progression, independently of mid-career maternity occurrence(s).

Abstract
. Background
. High-intensity interval training (HIIT) is an effective strategy for improving a variety of health outcomes within the school setting. However, there is limited research on the implementation of school-based HIIT interventions and the integration of HIIT within the Health and Physical Education (HPE) curriculum. The aims of the Making a HIIT study are to: 1) describe the methodology and evaluate the feasibility of co-designing HIIT workouts with students and teachers in HPE; 2) determine the effect of co-designed HIIT workouts on cardiorespiratory and muscular fitness, and executive function; 3) understand the effect of co-design on students’ motivation, enjoyment, and self-efficacy towards the workouts; and 4) evaluate the implementation of the intervention.
.
. Methods
. Three schools will participate. Within each school, three different groups will be formed from Year 7 and 8 classes: 1) Co-Designers; 2) HIIT Only; and 3) Control. The study will include two phases. In phase one, Group 1 will co-design HIIT workouts as part of the HPE curriculum using an iterative process with the researcher, teacher, and students as collaborators. This process will be evaluated using student discussions, student surveys, and teacher interviews. In phase two, Groups 1 and 2 will use the co-designed 10-minute HIIT workouts in HPE for 8-weeks. Group 3 (control) will continue their regular HPE lessons. All students will participate in cardiorespiratory fitness, muscular fitness, and executive function assessments before and after the HIIT program or control period. Students will complete questionnaires on their motivation, enjoyment, and self-efficacy of the workouts. Differences between groups will be assessed using linear regressions to account for covariates. Heart rate and rating of perceived exertion will be collected during each HIIT session. The implementation will be evaluated using the Framework for Effective Implementation. Ethical approval was granted by the University of Queensland Human Research Ethics Committee and other relevant bodies.
.
. Discussion
. This study will be the first to co-design HIIT workouts with teachers and students within the HPE curriculum. As this study relies on co-design, each HIIT workout will differ, which will add variability between HIIT workouts but increase the ecological validity of the study.
.
. Trial registration
. ACTRN, ACTRN12622000534785, Registered 5 April 2022 – Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000534785.aspx
.

Purpose
1) to investigate the effectiveness of school-based high-intensity interval training (HIIT) interventions in promoting health outcomes of children and adolescents compared with either a control group or other exercise modality; and 2) to explore the intervention characteristics and process outcomes of published school-based HIIT interventions.


Methods
We searched Medline, Embase, CINAHL, SPORTDiscus, and Web of Science from inception until 31 March 2021. Studies were eligible if 1) participants aged 5–17 years old; 2) a HIIT intervention within a school setting ≥ 2 weeks duration; 3) a control or comparative exercise group; 4) health-related, cognitive, physical activity, nutrition, or program evaluation outcomes; and 5) original research published in English. We conducted meta-analyses between HIIT and control groups for all outcomes with ≥ 4 studies and meta-regressions for all outcomes with ≥ 10 studies. We narratively synthesised results between HIIT and comparative exercise groups.


Results
Fifty-four papers met eligibility criteria, encompassing 42 unique studies (35 randomised controlled trials; 36 with a high risk of bias). Meta-analyses indicated significant improvements in waist circumference (mean difference (MD) = -2.5cm), body fat percentage (MD = -1.7%), body mass index (standardised mean difference (SMD) = -1.0), cardiorespiratory fitness (SMD = +1.0), resting heart rate (MD = -5bpm), homeostatic model assessment–insulin resistance (MD = -0.7), and low-density lipoprotein cholesterol (SMD = -0.9) for HIIT compared to the control group. Our narrative synthesis indicated mixed findings between HIIT and other comparative exercise groups.


Conclusion
School-based HIIT is effective for improving several health outcomes. Future research should address the paucity of information on physical activity and nutrition outcomes and focus on the integration and long-term effectiveness of HIIT interventions within school settings.


Trial registration number
PROSPERO CRD42018117567.

Breakfast cereal improves overall diet quality yet is under constant scrutiny with assertions that the category has not improved over time. This study aimed to comprehensively analyse the category of breakfast cereals, the nutritional values, and health claims across eight distinct sub-categories at four time points (2013, 2015, 2018, and 2020). An audit of products from four major supermarkets in metropolitan Sydney (Aldi, Coles, IGA, and Woolworths) collected ingredient lists, nutrition information, claims and Health Star Rating (HSR) for biscuits and bites; brans; bubbles, puffs, and flakes; granola and clusters; hot cereal flavoured; hot cereal plain; muesli; breakfast biscuits. The median (IQR) were calculated for energy, protein, fat, saturated fat, carbohydrate, sugars, dietary fibre, and sodium for comparisons over time points by nutrient. Data from 2013 was compared with 2020 (by sub-category and then for a sub-section of common products available at each time point). Product numbers between 2013 (n = 283) and 2020 (n = 543) almost doubled, led by granola and clusters. Whole grain cereals ≥ 8 g/serve made up 67% of products (↑114%). While there were positive changes in nutrient composition over time within the full data set, the most notable changes were in the nutrition composition of cereals marketed as the same product in both years (n = 134); with decreases in mean carbohydrate (2%), sugar (10%) and sodium (16%) (p < 0.000), while protein and total fat increased significantly (p = 0.036; p = 0.021). Claims regarding Dietary Fibre and Whole Grain doubled since 2013. Analysis of sub-categories of breakfast cereal assisted in identifying some changes over time, but products common to both timeframes provided a clearer analysis of change within the breakfast category, following introduction of HSR. Whole grain products were lower in the two target nutrients, sodium and sugars, and well-chosen products represent a better choice within this category.

Objectives: the purpose of this study was to determine and weigh the anthropometric indicators that were associated with pacing performances for each Olympic rowing category.Methods: Between 2010 and 2015, 1,148 rowers (650 men and 498 women) participated in the finals of World Championships in each heavyweight Olympic event. They were categorized into four morphological clusters according to their height and body mass index (BMI): tall and thin (TT), tall and robust (TR), small and thin (ST), and small and robust (SR). Time and speed, were collected every 50 m for all boats in each competition. Non-parametric inferential methods were used to understand the differences in performance between morphological clusters over the entire race. After, we calculated a new indicator to determine the differences between these morphotypes within the race.Results: in this article, we determined which morphologies had a significant effect on speed for both men and women. For example, the biggest rowers were the fastest in skiff. Analysis of each 50 m demonstrated that between the four morphological categories that the TR male athletes were significantly faster than their ST counterparts between the 800 and 2,000 m of the race by 1.76% of mean speed. Furthermore, the SR were the fastest in female coxless pairs over the majority of the race. These differences in speed by morphological cluster are summarized, by race segment, for all categories and sex.Conclusion: Anthropometric factors impact pacing among rowers' categories. Coupling anthropometry and race pacing is not only helpful to understand which factors work where, but is also helpful in improving training and performance. This can help both in the recruiting of rowers for specific boats and adapting the race strategy. In future, the method used can be adapted for factors other than anthropometry. It can also be individualized to enable athletes to prepare for their race according to future competitors.

OBJECTIVE: to examine the relationships between the occurrence and severity of injuries using three workload ratios (ACWR, EWMA, REDI) in elite female soccer players and international male and female pentathletes. MATERIALS AND METHODS: Female soccer players in the U16 to U18 national French teams (n = 24) and international athletes (n = 12, 4 women and 8 men) in the French modern pentathlon team were monitored throughout an entire season. The Acute Chronic Workload Ratio (ACWR), the Exponentially Weighted Moving Averages (EWMA), and the Robust Exponential Decreasing Index (REDI) were calculated for internal load by the ROE method in soccer and external load in pentathlon. The occurrence and severity of injuries (determined according to time-loss) were quantified in the sweet spot zone [0.8; 1.3] and compared to the other zones of load variation: [0; 0.8], [1.3; 1.5], [1.5; +8], using the three ratios. RESULTS: over the study period, a total of sixty-six injuries (2.75 per athlete) were reported in the soccer players and twelve in pentathletes (1 per athlete). The cumulative severity of all injuries was 788 days lost in soccer and 36 in pentathlon: respectively, 11.9 days lost per injury in soccer player and 3.0 per pentathlete. The mean values across the three methods in soccer showed a higher number of injuries detected in the [0; 0.8] workload ratio zone: 22.3 ± 6.4. They were 17.3 ± 3.5 in the sweet spot ([0.8-1.3] zone) and 17.6 ± 5.5 in the [1.5; +8] zone. In comparison to the [1.5; +8] zone, soccer players reported a higher number of days lost to injuries in the presumed sweet spot and in the [0-0.8] zone: 204.7 ± 28.7 and 275.0 ± 120.7 days, respectively. In pentathletes, ten of the twelve injuries (83.3%) occurred in the presumed sweet spot. REDI was the only method capable of tracking workloads over all-time series. CONCLUSION: in the present cohort of elite soccer players and pentathletes, acute chronic workload calculations showed an association with injury occurrence and severity but did not provide evidence supporting existence of a sweet spot diminishing injury risk.

ObjectiveTo determine the risk of death due to prominent mental disorders, substance abuse, and self-harm among US Olympians compared with the general population.MethodsAll female (n=2301) and male (n=5823) US Olympians who participated in the summer or winter Games between 1912 and 2012 were followed until 2016. The National Death Index certified their vital statuses and causes of death. We performed a Standard Mortality Ratio (SMR) analysis for all causes studied and applied the years-saved (YS) method to quantify differences in the risk of death for (1) anxiety, depression and self-harm and (2) substance abuse and eating disorders. Additionally, we examined the YS across sports with greater than 100 total deaths and between medalists and non-medalists.ResultsUS Olympians had a 32% (SMR=0.68, 95% CI 0.49 to 0.91) lower risk of death compared with the general population, resulting in a longevity advantage of 0.21 YS (95% CI 0.14 to 0.29) for deaths by depression, anxiety and self-harm and 0.12 years (95% CI 0.08 to 0.15) for substance abuse and eating disorders. There were no significant differences between medalists and non-medalists, but findings varied by sports. Most sports (eg, athletics, swimming, rowing) had significantly lower risks of deaths than the general population with the exceptions of fencing and shooting. Shooting showed a trend towards a higher risk through suicide by firearm.ConclusionOlympians have a lower risk of death, favouring an increased longevity compared with the general population for mental disorders, substance abuse and suicides.

INTRODUCTION: Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation. MATERIALS AND METHODS: Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry. RESULTS: There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10-0.14) and for controls was 0.11 mm (IQR, 0.10-0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12-0.16) and for controls was 0.13 (IQR, 0.11-0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients. DISCUSSION: OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.

Heart transplant recipients are at increased risk for atherosclerosis and cardiac allograft vasculopathy, both initially presenting as intimal thickening. We aimed to determine the presence, extent, and anatomical characteristics of intimal thickness at coronary bifurcations in children using OCT. We measured the intimal thickness of coronary arteries in pediatric transplant recipients using OCT during routine cardiac catheterization. Intimal thickening was defined as (i) a percent change in contralateral intimal thickness greater than 50% when comparing the thickness at the bifurcation to the baseline thickness, and (ii) greater than 0.1 mm. We evaluated 153 unique coronary bifurcations in 31 children (58% boys, median 12.7 years). Intimal thickening was almost exclusively observed in the left coronary system (22 of 67 bifurcations) and rare in the right coronary system (2 of 86 bifurcations; P 

BACKGROUND: the phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the accuracy of oscillometric and aneroid BP devices compared with the mercury sphygmomanometer for the measurement of BP in children. METHODS: We systematically searched four electronic databases (MEDLINE, Embase, CINAHL, and Web of Science) and relevant journals for eligible articles published before 30 July 2015. We screened 1415 articles, and two authors independently reviewed 92 full-text articles. RESULTS: We included 29 articles (38 studies) with 26 879 children. Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of SBP than auscultation with a mercury sphygmomanometer (pooled effect estimate 2.53 mmHg; 95% CI 0.57-4.50; P 

Percutaneous radiofrequency perforation (RFP) of the pulmonary valve is used as a primary therapy in neonates with pulmonary atresia and intact ventricular septum (PAIVS). We sought to determine the safety and efficacy of RFP for PAIVS in a single center and assess the pre-intervention anatomical parameters associated with a biventricular outcome. We retrospectively reviewed all cases of PAIVS treated with RFP at a single center from 1999 through 2012. We collected baseline imaging data, technical aspects of the procedure, adverse events and outcomes. RFP was attempted in 18 patients with 17 successful procedures. There was no mortality; one patient had an acute complication requiring surgical intervention. All were alive at the most recent follow-up (median 4.9 years; IQR = 2.0-6.8 years), 12/17 (71%) had a biventricular circulation, 2/17 (12%) had a 1½ ventricle repair, 2/17 (12%) had a univentricular repair and 1/17 was lost to follow-up. A biventricular outcome in patients with PAIVS was associated with the pre-intervention tricuspid valve/mitral valve (TV/MV) ratio and tricuspid valve (TV) z-score. The median TV/MV ratio for patients who underwent a biventricular repair and a non-biventricular repair was 0.82 (IQR = 0.71-0.90) and 0.59 (IQR = 0.39-0.76), P = 0.036, respectively. The median TV z-scores were -3.2 [(-4.9 to -2.6), and -6.8 (-9.7 to -4.8] P = 0.036 for the biventricular and non-biventricular groups, respectively. RFP is a safe primary therapy for PAIVS. With appropriate patient selection, RFP will often result in a biventricular circulation. Both the TV/MV and TV z-score were found to be a predictor of a biventricular outcome in our cohort.

BACKGROUND: Children with congenital heart disease (CHD) are thought to have low levels of physical activity (PA), but few studies have used objective measures of PA in this population. METHODS AND RESULTS: We recruited patients with mild, moderate, and severe CHD and cardiac transplant recipients, aged 8 to 19 years, from pediatric cardiology clinics throughout British Columbia and Yukon, Canada. Participants were fitted with an ActiGraph accelerometer to be worn over the right hip for 7 days. Daily means were estimated for a variety of accelerometry-derived metrics, including moderate-to-vigorous PA and percentage of sedentary time if they had at least 3 valid days of accelerometry data. Participants also completed a PA questionnaire. We included 90 participants (aged 13.6±2.7 years; 54% male), of which 26 had mild CHD, 26 had moderate CHD, 29 had severe CHD, and 9 were cardiac transplant recipients. Median daily moderate-to-vigorous PA was 43 min/day (interquartile range: 28.9-56.9 min/day), and 8% met PA guidelines of 60 minutes of moderate-to-vigorous PA at least 6 days a week. There were no significant differences in any accelerometry-derived metric according to CHD severity. Boys were significantly more active and less sedentary than girls. Activity declined and sedentary behaviors increased with age in both sexes. Sports participation was common, including competitive out-of-school clubs (57%). PA restrictions from cardiologists were rare (15%). CONCLUSIONS: We found normal age-sex patterns of PA in children with CHD. There were no differences in PA by CHD severity, suggesting that sociocultural factors are likely important determinants of PA in these children.

OBJECTIVE: to assess the criterion validity, internal consistency, reliability and cut-point for the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in children and adolescents with congenital heart disease-a special population at high cardiovascular risk in whom physical activity has not been extensively evaluated. METHODS: We included 84 participants (13.6±2.9 yrs, 50% female) with simple (37%), moderate (31%), or severe congenital heart disease (27%), as well as cardiac transplant recipients (6%), from BC Children's Hospital, Canada. They completed the PAQ-C (≤11yrs, n = 28) or-A (≥12yrs, n = 56), and also wore a triaxial accelerometer (GT3X+ or GT9X) over the right hip for 7 days (n = 59 met valid wear time criteria). RESULTS: Median daily moderate-to-vigorous physical activity was 46.9 minutes per day (IQR 31.6-61.8) and 25% met physical activity guidelines defined as ≥60 minutes of moderate-to-vigorous physical activity per day. Median PAQ-score was 2.6 (IQR 1.9-3.0). PAQ-Scores were significantly related to accelerometry-derived metrics of physical activity (rho = 0.44-0.55, all p