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Feasibility and Provisional Efficacy of Embedding High-Intensity Interval Training Into Physical Education Lessons: A Pilot Cluster-Randomized Controlled Trial

Nigel Harris, Isaac Warbrick, Denise Atkins, Alain Vandal, Lindsay Plank, and David R. Lubans

Purpose: The aim of this study was to determine the feasibility of generalist school teachers delivering curriculum connected high-intensity interval training in a school’s physical education class time. Method: Two schools volunteered to participate. A total of 84 students (11.9 [0.5] y, M = 64 and F = 19) volunteered to participate. Four classes from 2 schools were randomized to either intervention (n = 53) or control (n = 31) for one school term (8 wk). Intervention class teachers participated in a 1-day workshop instructing them how to deliver twice weekly, high-intensity interval training sessions. The control classes continued with their usual physical education curriculum. Recruitment, intervention fidelity, and program satisfaction were assessed. Preliminary efficacy (primary outcome cardiorespiratory fitness) was quantified using generalized linear mixed models, expressed as effect size. A range of secondary outcomes was also assessed. Results: The recruitment rate was 88%. About 84% of the sessions were delivered. The heart rate peak over all sessions was 89.6% (13%) of the predicted maximum. The intervention teachers reported high levels of satisfaction. Almost all student participants were positive about participating. No adverse events occurred. The adjusted between-group difference for cardiorespiratory fitness was trivial (effect size 0.02). Conclusions: This teacher-delivered high-intensity interval training program was feasible and acceptable to both teachers and student participants. It is therefore potentially scalable.

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Volume 33 (2021): Issue 3 (Aug 2021)

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Effects of High-Intensity Interval Training on the Vascular and Autonomic Components of the Baroreflex at Rest in Adolescents

Ricardo S. Oliveira, Alan R. Barker, Sascha H. Kranen, Florian Debras, and Craig A. Williams

Purpose: In a sample of healthy adolescents, the authors aimed to investigate the effects of high-intensity interval exercise (HIIE) training and detraining on baroreflex sensitivity (BRS) and it’s vascular and autonomic components at rest. Methods: Nineteen volunteers were randomly allocated to (1) 4 weeks HIIE training performed 3 times per week or (2) a control condition with no intervention for the same duration as HIIE training. PRE, POST, and following 2 weeks of detraining resting supine heart rate and blood pressure were measured, and a cross-spectral method (integrated gain [gain in low frequency]) 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 determinant of BRS. Results: The HIIE training was completed with 100% compliance. HIIE did not change resting gain in low frequency (LFgain) (P = .66; effect size = 0.21), AC (P = .44; effect size = 0.36), or LFgain/AC (P = .68; effect size = 0.19) compared to control. Conclusion: Four weeks of HIIE training does not change BRS and its autonomic and vascular determinant in a sample of healthy adolescents at rest.

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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.