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Evaluation of Left Ventricular Outflow Gradients During Staged Exercise Stress Echocardiography Helps Differentiate Pediatric Patients With Hypertrophic Cardiomyopathy From Athletes and Normal Subjects

Mansi Gaitonde, Shannon Jones, Courtney McCracken, Matthew E. Ferguson, Erik Michelfelder, Ritu Sachdeva, and William Border

Background: Elevated left ventricular outflow tract (LVOT) gradients during exercise can occur in patients with hypertrophic cardiomyopathy (HCM) as well as in athletes and normal controls. The authors’ staged exercise protocol calls for imaging at rest and during each stage of exercise to evaluate the mechanism of LVOT obstruction at each stage. They investigated whether this staged approach helps differentiate HCM from athletes and normal controls. Methods: They reviewed pediatric exercise stress echocardiograms completed between January 2009 and October 2017 at their center and identified those with gene-positive HCM, athlete’s heart, and normal controls. Children with inducible obstruction (those with no LVOT gradient at rest who developed a LVOT peak gradient > 25 mm Hg during exercise) were included. LVOT peak gradient, velocity time integral, acceleration time, and deceleration time were measured at rest, submaximal stages, and peak exercise. Results: Compared with athletes, HCM patients had significantly higher LVOT peak gradients at rest (P = .019), stage 1 of exercise (P = .002), and peak exercise (P = .051), as well as a significantly higher change in LVOT peak gradient from rest to stage 1 (P = .016) and from rest to peak (P = .038). The acceleration time/deceleration time ratio of the LVOT Doppler was significantly lower in HCM patients compared with normal controls at peak exercise. Conclusions: The HCM patients who develop elevated LVOT gradients at peak exercise typically manifest early obstruction in the submaximal stages of exercise, which helps to differentiate them from athletes and normal controls.

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Effects of Long-Duration Home Isolation Linked to the COVID-19 Pandemic on Mental Health of Adolescent Athletes

Nevzad Denerel, Seçkin Şenışık, Ogün Köyağasıoğlu, Sema Çiğdem, and Serhat Tunç

Purpose: To assess whether adolescent athletes were affected or not in terms of mental health by the long duration at home linked to isolation enforced during the COVID-19 pandemic. Method: The study included 940 team athletes, 274 individual athletes, and 131 nonathlete controls aged 12–17 years. Demographic data were obtained with a form including questions about age, sex, sports type, and physical activity status (type, duration, and frequency) during the isolation period. Participants completed the Children’s Revised Impact of Event Scale-13, Center for Epidemiological Studies Depression Scale for Children, and State-Trait Anxiety Inventory for Children. Results: Among participants, 88% did not meet the physical activity recommendations for children and adolescents, while 42.8% felt depressed. Depressive symptoms were present in 38.1% of boys and 59.7% of girls, with girls (6.4%) having higher posttraumatic stress symptoms than boys (3.5%). Among athletes, depressive and anxiety symptoms were lower compared with nonathlete controls (P < .01). Posttraumatic stress symptoms were lower among athletes than nonathlete controls for girls (team vs control, P = .006; individual vs control, P = .002) but similar for boys (P > .05). The depression (P = .518), state (P = .866), and trait anxiety (P = .507) symptoms were similar between team athletes and individual athletes. Conclusion: Though adolescent athletes’ depression, anxiety, and posttraumatic stress symptoms were significantly lower than nonathlete controls, athletes also had high depression levels. These findings show the need to take precautions to protect the psychological health of not only nonathletes, but also athletes in the pandemic period.

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Acute Cardiometabolic and Perceptual Responses to Individual and Group-Based Body-Weight Resistance Exercise in Girls

Jeanette M. Ricci, Katharine D. Currie, Todd A. Astorino, and Karin A. Pfeiffer

Girls’ acute responses to group-based high-intensity interval exercise (HIIE) are not well characterized. Purpose: To compare acute responses to treadmill-based HIIE (TM) and body-weight resistance exercise circuit (CIRC) and to CIRC performed in a small-group setting (group CIRC). Method: Nineteen girls (9.1 [1.1] y) completed exercise testing on a TM to determine peak oxygen uptake, peak heart rate (HRpeak), and maximal aerobic speed. The TM involved eight 30-second sprints at 100% maximal aerobic speed. The CIRC consisted of 8 exercises of maximal repetitions performed for 30 seconds. Each exercise bout was followed by 30 seconds of active recovery. The blood lactate concentration was assessed preexercise and postexercise. The ratings of perceived exertion, affective valence, and enjoyment were recorded at preexercise, Intervals 3 and 6, and postexercise. Results: The mean heart rate was higher during group CIRC (92% [7%] HRpeak) than CIRC (86% [7%] HRpeak) and TM (85% [4%] HRpeak) ( η p 2  = .49). The mean oxygen uptake equaled 76% (11%) of the peak oxygen uptake for CIRC and did not differ from TM (d = 0.02). The CIRC elicited a greater postexercise blood lactate concentration versus TM (5.8 [1.7] vs 1.4 [0.4] mM, d = 3.61). The perceptual responses were similar among conditions (P > .05), and only the rating of perceived exertion increased during exercise ( η p 2  = .78). Conclusion: Whether performed individually or in a small group, CIRC represents HIIE and may be a feasible alternative to running-based HIIE.

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The Experimental Effect of Parent Versus Peer Influence on Children’s Physical Activity and Sedentary Behavior

Mallory Kobak, Andrew Lepp, Michael Rebold, Ellen Glickman, and Jacob E. Barkley

Purpose: To assess children’s physical activity, sedentary behavior, liking, and motivation during 3 separate simulated recess conditions: playing alone, with their parent participating, and with their peer participating. Methods: Children participated in the 3 separate conditions. During each condition, the children had access to an outdoor playground and sedentary activity options for 30 minutes. Accelerometry recorded the physical activity. Time allocated to sedentary options was monitored via a stopwatch. A visual analog scale was used to assess liking, and motivation was assessed as the children’s willingness to participate in an additional 10 minutes of each condition. Results: The children sat 88% less and were 33% more physically active with their peer versus playing alone. The children also sat 65% less during the parent condition than alone. Lastly, the children reported ≥34% liking and were ≥2-fold more likely to participate in the additional 10-minute activity bout during the parent and peer conditions than alone. The differences were significant (P ≤ .05) except for the children’s decision to participate in the additional 10 minutes in the parent versus the alone condition (P = .058). Conclusions: Relative to the alone condition, the presence of a peer or parent reduced sedentary behavior and increased liking and the motivation to participate in that condition. However, only the presence of a peer increased physical activity versus alone.

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Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

Kim D. Lu, Dan Cooper, Raluca Dubrowski, Melanie Barwick, and Shlomit Radom-Aizik

Purpose: Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians’ thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. Methods: The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. Results: Despite the pediatricians’ beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. Conclusion: The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

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Cardiovascular Effects of Aerobic Exercise With Self-Selected or Predetermined Intensity in Adolescents With Obesity

Tércio A.R. Barros, Wagner L. do Prado, Thiago R.S. Tenório, Raphael M. Ritti-Dias, Antônio H. Germano-Soares, Babu P. Balagopal, James O. Hill, and Ricardo Freitas-Dias

This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid–femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = −9 mm Hg; PEI, Δ = −4 mm Hg; P < .01), central systolic BP (SEI, Δ = −4 mm Hg; PEI, Δ = −4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = −4 mm Hg; PEI, Δ = −3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid–femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.

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Associations Between Meeting the 24-Hour Movement Guidelines and Cardiometabolic Risk in Young Children

Leigh M. Vanderloo, Jonathan L. Maguire, Charles D.G. Keown-Stoneman, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration*

Introduction: The authors aimed to examine the association between meeting the integrative movement behavior guidelines (physical activity, screen viewing, and sleep) and cardiometabolic risk (CMR) factors in young children. Methods: In this cross-sectional study, physical activity, screen viewing, and sleep were assessed using parent-reported data. The 24-Hour Movement Guidelines for the Early Years (0–4 y) were defined as 180 minutes of physical activity/day (of which ≥60 min should be moderate-to-vigorous intensity), ≤1 hour of screen viewing/day, and 10 to 13 hours of sleep/night. Waist circumference, glucose, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were measured in a clinical setting by trained staff. A total CMR score and individual CMR factors served as primary and secondary outcomes, respectively. Results: Of the 767 participants (3–4 y), 26.4% met none of the guideline’s recommendations, whereas 41.3%, 33.1%, and 10.6% of the sample met 1, 2, or all 3 recommendations, respectively. The number of recommendations met was not associated with the total CMR score or individual CMR factors (P > .05), with the exceptions of high-density lipoprotein (odds ratio = 1.61; 95% confidence interval, 1.11 to 2.33; P = .01). Conclusion: Meeting the 24-Hour Movement Guidelines in early childhood was not associated with overall CMR, but was associated with favorable cholesterol outcomes.

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Correlation Between Heart Rate at Maximal Fat Oxidation and Aerobic Threshold in Healthy Adolescent Boys and Girls

Marco Meucci, Vibhav Nandagiri, Venkata S. Kavirayuni, Alexander Whang, and Scott R. Collier

Purpose: To investigate the association between the heart rate (HR) at maximal fat oxidation (MFO) and the HR at the aerobic threshold (AerT) in adolescent boys and girls, and to identify sex differences in the intensity that elicits MFO (Fatmax) as a percentage of HR peak (HRpeak). Methods: Fifty-eight healthy adolescents participated in this study (29 boys and 29 girls). Participants performed a cardiopulmonary exercise test on a cycle ergometer. MFO was calculated using a stoichiometric equation, and the AerT was identified using gas exchange parameters. Results: A strong correlation between HR at Fatmax and HR at AerT was found in both boys and girls (r = .96 and .94, respectively). Fatmax as a percentage of HRpeak occurred at 61.0% (4.9%) of HRpeak and 66.8% (6.9%) of HRpeak in adolescent boys and girls (P = .001, F = 13.6), respectively. MFO was higher in boys compared with girls (324 [150] and 240 [95] mg/min, respectively), and no sex differences were observed in the relative contribution of fat to energy expenditure at Fatmax. Conclusions: HR at Fatmax and HR at AerT were highly correlated in adolescent boys and girls. Girls obtained Fatmax at a higher percentage of HRpeak than boys.

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The Effect of Information Placebo on Physical Activity in Overweight and Obese Children

Shira Fanti-Oren, Daphna Birenbaum-Carmeli, Alon Eliakim, Michal Pantanowitz, Dana Schujovitzky, and Dan Nemet

Purpose: To assess the effect of 1 week of consuming a placebo “energy drink” compared with a week of drinking regular water on daily physical activity in obese children participating in a weight reduction multidisciplinary program. Methods: Seventeen prepubertal (age = 128.7 [26.6] m) overweight and obese children (7 females and 10 males) participated in the study. Participants received 7 bottles of mineral water per week for 2 weeks. Different types of information were randomly provided regarding the drink consumed in each week: standard (water) versus deliberate positive information (presumed energy drink and placebo). Daily step count was measured using pedometers and compared using paired t test. Results: After consuming the placebo drink, children demonstrated a significantly higher average daily step number (10,452 [4107]) compared with the days they drank water (8168 [2928], P < .005). This difference was attributed mainly to male participants. Conclusion: The use of placebo in the form of deliberate positive information was associated with a significant increase in real-life physical activity in overweight and obese children, especially in boys. Positive information may be used to encourage children with obesity to enhance daily physical activity and energy expenditure.

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Examining the Relationship Between Parental Stress and Girls’ and Boys’ Physical Activity Among Racially/Ethnically Diverse and Immigrant/Refugee Populations

Jerica M. Berge, Octavia Cheatom, Angela R. Fertig, Allan Tate, Amanda Trofholz, Junia N. Brito, and Nathan Shippee

Given the high prevalence of overweight/obesity and the low prevalence of engaging in physical activity in children, it is important to identify barriers that impede child physical activity. One potential barrier is parental stress. The current study examined the association between parental stress levels and girls’ and boys’ moderate to vigorous physical activity. Children aged 5–7 years and their families (n = 150) from 6 racial/ethnic groups (n = 25 each Black, Hispanic, Hmong, Native American, Somali, and White families) were recruited for the Family Matters mixed-methods study in 2015 through primary care clinics in Minneapolis and St Paul, MN. Two in-home visits were carried out with families 10 days apart for data collection, with an 8-day observational period in between when children wore accelerometers. Higher parental stress levels were associated with fewer minutes of moderate to vigorous physical activity in girls (P < .05) compared with boys. On average, girls with a parent reporting a stress rating of 10 engaged in 24 minutes less of physical activity per day than girls with a parent with a stress rating of 1. The results suggest that parental stress may reduce girls’ engagement in physical activity. The implications of these results include targeting parental stress and coping skills in future physical activity interventions. In addition, when addressing child physical activity in health care visits with parents and daughters, providers may want to focus their anticipatory guidance on parental stress and coping skills in addition to providing resources to help parents manage stress.