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A Pilot Study of Exercise Training for Children and Adolescents With Inflammatory Bowel Disease: An Evaluation of Feasibility, Safety, Satisfaction, and Efficacy

Mila Bjelica, Rachel G. Walker, Joyce Obeid, Robert M. Issenman, and Brian W. Timmons

Background: Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. Purpose: To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD. Methods: Children with IBD completed 16 weeks of training (2 supervised + 1 home sessions per week). Feasibility was assessed by tracking recruitment, adherence, and compliance rates. Safety was assessed by tracking symptoms and adverse events. Posttraining interviews gauged satisfaction. Circulating inflammatory markers, body composition, muscle strength, aerobic fitness, and habitual physical activity were measured at baseline, midtraining (8 wk), and posttraining. Results: Eleven youth were recruited and 10 completed the study. Participants adhered to 28 (1) of 32 prescribed supervised sessions and 8 (4) of 16 prescribed home sessions. There were no adverse events, and overall feedback on training was positive. Posttraining, we observed an increase in lean mass (+2.4 [1.1] kg), bone density (+0.0124 [0.015] g·cm−2), aerobic fitness (+2.8 [5.7] mL·kg LM−1· min−1), and vigorous physical activity levels (+13.09 [8.95] min·h−1) but no change in inflammation or muscle strength. Conclusion: Supervised exercise training is feasible, safe, and effective for youth with IBD and should be encouraged.

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Acute and Long-Term Changes in Blood-Borne Biomarkers in Response to Dynamic Standing in Nonambulant Children With Cerebral Palsy

Tibor V. Varga, Åsa Andersson, Katarina Lauruschkus, and Åsa B. Tornberg

Purpose: To investigate acute and long-term changes in hormonal and inflammatory biomarkers in nonambulant children with cerebral palsy in response to dynamic standing exercise. Methods: Fourteen children with severe cerebral palsy were recruited. Anthropometrics and body composition measures were obtained. Physical activity levels before the study were assessed using hip-worn accelerometry. All children underwent a 30-minute dynamic standing exercise using the Innowalk standing aid. Respiratory data during exercise were collected using indirect calorimetry. Blood samples were collected before and after exercise. Blood samples were also obtained after two 16-week exercise protocols, in a resting state. Hormonal and inflammatory metabolites were measured from blood serum/plasma, and acute and long-term changes in biomarker levels were assessed using Wilcoxon signed-rank tests. Results: Of the 14 children at baseline, all had slightly/moderately/severely elevated C-reactive protein and cortisol levels. C-reactive protein levels were decreased following a 30-minute bout of dynamic standing (before exercise: 53 mg/L [interquartile range: 40–201]; after exercise: 39 mg/L [interquartile range: 20–107]; P = .04). Conclusions: We show that several hormonal and inflammatory biomarkers are dysregulated in children with cerebral palsy. Our preliminary results from a small, but deep-phenotyped prospective cohort indicate acute and long-term alterations of several biomarkers in response to exercise.

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Editor’s Notes

Craig A. Williams

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Mediolateral Postural Control Mechanisms and Proprioception Improve With Kicking Sports Training During Adolescence

Mariève Blanchet and François Prince

Sensorimotor stimulation during the sensitive period is crucial for proper brain development. Kicking sports (KS) training stimulates these sensorimotor functions. The purpose of this study was to investigate if incorporating specific sensorimotor stimulation in mediolateral axis and proprioceptive inputs during KS training will improve the specific sensorimotor performance in adolescents. We assessed stability limits in 13 KS practitioners and 20 control participants. Starting from an upright position, subjects were asked to lean as far as possible (forward, backward, rightward, and leftward). Three sensory conditions were tested: (1) eyes open, (2) eyes closed, and (3) eyes closed while standing on a foam mat. We analyzed the maximal center of pressure excursion and the root means square of the center of pressure displacements. Results showed that KS group had smaller root means square and larger maximal center of pressure excursions than those of control participants in mediolateral axis in all sensory conditions. Furthermore, the results also revealed a significant smaller root means square excursion in KS group under foam mat condition compared to control group ML axis. This study provides evidence that KS training improved the lateral balance control and proprioceptive integration.

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Physical Activity Questionnaire for Children: Validity and Cut-Points to Identify Sufficient Levels of Moderate- to Vigorous-Intensity Physical Activity Among Children and Adolescents Diagnosed With HIV

João Antônio Chula de Castro, Luiz Rodrigo Augustemak de Lima, Richard Larouche, Mark S. Tremblay, and Diego Augusto Santos Silva

Purpose: To investigate the validity of the Physical Activity Questionnaire for Older Children (PAQ-C) to assess the moderate- to vigorous-intensity physical activity (MVPA) level of children and adolescents diagnosed with HIV and propose cut-points, with accelerometer measures as the reference method. Method: Children and adolescents, aged 8–14 years (mean age = 12.21 y, SD = 2.09), diagnosed with HIV by vertical transmission, participated in the study. MVPA was investigated through the PAQ-C and triaxial accelerometer (ActiGraph GT3X+). Receiver operating characteristic curve and sensitivity and specificity values were used to identify a cut-point for PAQ-C to distinguish participants meeting MVPA guidelines. Results: Fifty-six children and adolescents participated in the study. Among those, 16 met MVPA guidelines. The PAQ-C score was significantly related to accelerometry-derived MVPA (ρ = .506, P < .001). The PAQ-C score cut-point of 2.151 (sensitivity = 0.625, specificity = 0.875) was able to discriminate between those who met MVPA guidelines and those that did not (area under the curve = 0.751, 95% confidence interval, 0.616–0.886). Conclusion: The PAQ-C was useful to investigate MVPA among children and adolescents diagnosed with HIV and to identify those who meet MVPA guidelines.

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Running Habits and Injury Frequency Following COVID-19 Restrictions in Adolescent Long-Distance Runners

Rachel N. Meyers, Micah C. Garcia, Jeffery A. Taylor-Haas, Jason T. Long, Mitchell J. Rauh, Mark V. Paterno, Kevin R. Ford, and David M. Bazett-Jones

Purpose: A decline in youth running was observed at the start of the COVID-19 pandemic. We investigated whether the resumption of organized running after social distancing restrictions changed running habits or injury frequency in adolescent runners. Methods: Adolescents (age = 16.1 [2.1] y) who participated in long-distance running activities completed an online survey in the Spring and Fall of 2020. Participants self-reported average weekly running habits and whether they sustained an injury during the Fall 2020 season. Poisson regression models and 1-way analysis of variance compared running habits while Fisher exact test compared differences in frequencies of injuries during Fall 2020 among season statuses (full, delayed, and canceled). Results: All runners, regardless of season status, increased weekly distance during Fall 2020. Only runners with a full Fall 2020 season ran more times per week and more high-intensity runs per week compared with their Spring 2020 running habits. There were no differences in running volume or running-related injury frequency among Fall 2020 season statuses. Conclusions: There were no significant differences in running-related injury (RRI) frequency among runners, regardless of season status, following the resumption of cross-country. Health care providers may need to prepare for runners to increase running volume and intensity following the resumption of organized team activities.

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Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities

Emily Bremer, Kelly P. Arbour-Nicitopoulos, Brianna Tsui, Kathleen A. Martin Ginis, Sarah A. Moore, Krista L. Best, and Christine Voss

Purpose: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. Method: Participants (4–17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. Results: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = −21.2; 95% CI, −33.6 to −8.7) than children. More daily steps were taken by boys than girls (mean difference = −1040; 95% CI, −1465 to −615) and individuals with a nonphysical disability than a physical disability (mean difference = −1120; 95% CI, −1474 to −765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. Conclusion: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

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Comparison Between Cardiorespiratory Fitness and Functions of Cognitive Control in Adolescents: A Tracking Study of 3 Years

Vinícius Muller Reis Weber, Jose Castro‐Piñero, Julio Cesar da Costa, Daniel Zanardini Fernandes, Marcelo Romanzini, and Enio Ricardo Vaz Ronque

Purpose: Compare tracking groups with cognitive control functions and plasma brain-derived neurotrophic factors concentrations from childhood to adolescence. Methods: This is a prospective study with 3 years of follow-up. At baseline, data from 394 individuals were collected (11.7 y), and data were obtained from 134 adolescents (14.9 y) at the 3-year follow-up. At both time points, anthropometric and maximal oxygen uptake data were collected. Cardiorespiratory fitness (CRF) groups were classified into high or low CRF. At follow-up, cognitive outcomes were collected via the Stroop and Corsi block test; plasma brain-derived neurotrophic factors concentrations were also analyzed. Results: Comparisons demonstrated that maintaining high CRF over 3 years results in shorter reaction time, better inhibitory control, and higher working memory values. Likewise, the group that moved from low to high CRF over 3 years presented better reaction time. Plasma brain-derived neurotrophic factors concentrations were higher for the group that increased its CRF over the 3 years in relation to the low–low group (90.58 pg·mL−1; P = .004). However, after scaling by an allometric approach, differences were only found for reaction time and working memory between high–high and high–low groups. Conclusion: Maintaining high CRF over 3 years was positively related to reaction time and working memory in relation to adolescents that decreased their levels of CRF.

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Volume 35 (2023): Issue 2 (May 2023)

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Reporting of Adverse Events in Muscle Strengthening Interventions in Youth: A Systematic Review

Diane E. Mack, Daniel Anzovino, Malcolm Sanderson, Raffy Dotan, and Bareket Falk

Clear definition, identification, and reporting of adverse event (AE) monitoring during training interventions are essential for decision making regarding the safety of training and testing in youths. Purpose: To document the extent to which AEs, resulting from intervention studies targeting muscle strengthening training (MST) in youth, are reported by researchers. Methods: Electronic databases (CINAHL, PubMed, SPORTDiscus, and Web of Science) were searched for English peer-reviewed articles published before April 2018. Inclusion criteria were: (1) average age <16 years, (2) use of MST, (3) statement(s) linked to the presence/absence of AEs, and (4) randomized controlled trials or quasi-experimental designs. Risk of reporting bias for AEs followed recommendations by the Cochrane Collaboration group. Results: One hundred and ninety-one full-text articles were screened. One hundred and thirty met all MST criteria, out of which only 44 (33.8%; n = 1278, age = 12.1 [1.1] y) included a statement as to the presence/absence of adverse events. The 86 other studies (66.2%) included no such statement. Of the reporting 44 studies, 18 (40.1%) indicated one or more adverse events. Of the 93 reported adverse events, 55 (59.1%) were linked to training or testing. Conclusions: Most MST studies in youth do not report presence/absence of adverse events, and when reported, adverse events are not well defined.