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Exercise Capacity and Biomarkers Among Children and Adolescents With Sickle Cell Disease

Lea Barbetta Pereira da Silva, Gilmar Mercês de Jesus, José de Bessa Junior, Valter Abrantes Pereira da Silva, Ivanilde Guedes de Mattos, Coretta Melissa Jenerette, and Evanilda Souza de Santana Carvalho

Background: Sickle cell disease is the most common genetic hemoglobinopathy globally and systemically affects body functioning, decreasing exercise capacity. Objective: To assess exercise capacity through the 6-minute walk test (6MWT) and biomarkers in children and adolescents with sickle cell disease. Materials and Methods: Cross-sectional study involving 20 children and adolescents from Brazil. Demographic and socioeconomic data were obtained. Baseline measurements included biomarkers (red blood cells, hemoglobin, hematocrit, white blood cells, platelets, reticulocytes, lactate dehydrogenase, creatine phosphokinase, C-reactive protein, interleukin 6, and fetal hemoglobin). The following data were obtained before, during, and after the 6MWT: heart rate, blood pressure, and peripheral oxygen saturation. Results: Eighteen children and adolescents ages 5–14 years old were analyzed, 61.1% boys, 100% black or brown, and 61.1% in primary education, with low household income. The average distance walked in 6MWT was 463.8 (137.7) m, significantly less than the predicted value (P < .001). The distance of 6MWT was associated positively with age (P = .042) and inversely with reticulocyte count (P = .42) and interleukin 6 (P = .00). Age modified the effect of interleukin 6 in younger children (P = .038). Conclusion: Our findings suggest increased baseline levels of biomarkers of hemolysis and inflammation impact on 6MWT performance.

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Associations of Device-Measured Physical Activity, Sedentary Behavior, and Executive Function in Preadolescents: A Latent Profile Approach

Yuxin Zhu, Fenghua Sun, Gary C.C. Chow, Sisi Tao, Simon B. Cooper, Borui Zhang, and Thomson W.L. Wong

Purpose: This study investigated the associations between physical activity (PA), sedentary behavior, and executive function in preadolescents. Methods: One hundred and twenty preadolescents were recruited from 2 Hong Kong primary schools. PA and sedentary behavior were recorded for 7 consecutive days by accelerometer. Executive function performance, including inhibition (Stroop task and Flanker task) and working memory (Sternberg paradigm task), were measured. Body mass index and cardiorespiratory fitness (multistage fitness test) were tested. Latent profile analysis explored the profiles of PA and sedentary behavior in preadolescents. Results: Three distinct profiles were identified: low activity, average activity, and high activity. Participants in low activity performed worse in the accuracy of Stroop task (vs average activity, P = .03; vs high activity, P < .01), Flanker task (vs average activity, P = .02; vs high activity, P < .001), and Sternberg paradigm task (vs average activity, P < .01; vs high activity, P < .01). No significant difference was observed between participants with average and high activities. No significant association was observed for profiles on body mass index and cardiorespiratory fitness. Conclusion: Supplementing the consensus of the literature that moderate to vigorous PA benefits cognition, the authors conclude that light PA may also enhance preadolescents’ executive functioning.

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Correlates of Sedentary Time Among Children and Adolescents in Ethiopia: A Cross-Sectional Study

Sibhatu Biadgilign, Tennyson Mgutshini, Bereket Gebremichael, Demewoz Haile, Lioul Berhanu, Stanley Chitekwe, and Peter Memiah

Purpose: To assess the correlates of sedentary time among children and adolescents in Ethiopia. Methods: The study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models were used to determine associations of sedentary time and predictor variables. Results: The mean sedentary time was 4.61 (95% confidence interval [CI], 4.35–4.86) hours per day. Overall, the prevalence of high sedentary time (>3 h/d) was 68.2% (95% CI, 64.2–72.2). Results of multivariable logistic regression analyses showed a statistically significant association between high sedentary time and female household head (adjusted odds ratio [AOR] = 0.50; 95% CI, 0.32–0.80), literate mothers (AOR = 1.98; 95% CI, 1.26–3.11), child attending public school (AOR = 1.79; 95% CI, 1.12–2.85), children who belonged to the poor and rich household wealth tertiles compared with medium wealth tertile (AOR = 2.30; 95% CI, 1.42–3.72 and AOR = 2.04; 95% CI, 1.14–3.65, respectively), and those families that did not have adequate indoor play space for children (AOR = 0.45; 95% CI, 0.29–0.72). Conclusion: The study found that time spent sedentary was high in the study area as compared with other studies of similar settings. Several modifiable factors were identified that can be targeted in interventions to reduce sedentary time in the study setting.

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The Effect of Physical Exertional Testing on Postconcussion Symptom Scale Scores in Male and Female High School Students

Lauren N. Miutz, Carolyn A. Emery, Amanda M. Black, Matthew J. Jordan, Jonathan D. Smirl, and Kathryn J. Schneider

Purpose: Symptom scores commonly measured following concussion were compared between male and female adolescents with (Hx+) and without (Hx−) a history of concussion, pre and post physical exertion testing. Methods: Eighty (males [n = 60; Hx+ = 19], female [n = 20; Hx+ = 5]) high school students (ages 15–17 y) completed the Buffalo Concussion Treadmill Test once and the modified shuttle run test twice. Symptom scores were collected using the 22-point Symptom Evaluation Scale on the Sport Concussion Assessment Tool (version 5) immediately pre and post physical exertion testing. Results: The symptoms most reported during preexertional testing were fatigue/low energy, feeling slowed down, and nervous/anxious, whereas feeling slowed down, fatigue/low energy, “pressure in head” (males only), and headache (females only) were most frequently reported during postexertion testing. Conclusion: An understanding of the common exertion-related symptoms at baseline in a laboratory or field-based setting in adolescents may be advantageous for clinicians as they manage individual recovery postconcussion. This is particularly important during an adolescent’s recovery and return to play when exertional testing may be implemented, especially since symptoms were reported pre and post exertional testing in both males and females regardless of concussion history.

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Questionnaires Measuring Physical Activity in Clinical Pediatric Populations: A Systematic Review

Si Min Lew, Christal K.L. Hewlett, Daniel Anderson, Matthew Finberg, Leo Ng, Angela L. Spence, Andrew Maiorana, Vinutha B. Shetty, and Raymond J. Davey

Purpose: Regular physical activity (PA) is a cornerstone therapy for many childhood chronic health conditions, and questionnaires offer a simple method for monitoring PA and identifying children who do not meet clinical practice guidelines. The purpose of this systematic review is to determine which questionnaires are most efficacious for assessing PA in children with chronic health conditions. Methods: Systematic literature searches were conducted through ProQuest, MEDLINE, Scopus, and SPORTDiscus from January 2010 to August 2020 to identify studies that measured PA with a validated questionnaire in children and adolescents aged 3–18 years old with chronic health conditions. In eligible studies, the validity and reliability of questionnaires were identified, and the modified COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality and strength of evidence and risk of bias. Results: Four thousand four hundred and seventy-eight references were extracted, and 10 articles were included for review. From 10 eligible studies, 6 questionnaires were identified, none of which adequately measure PA in clinical pediatric populations. Conclusion: Questionnaires to adequately measure PA in children with chronic conditions are lacking. This compromises the identification of those who do not meet PA guidelines, limiting the opportunity to identify and address factors contributing to low PA levels.

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Bone Turnover Markers and Osteokines in Adolescent Female Athletes of High- and Low-Impact Sports Compared With Nonathletic Controls

Steven Kottaras, Joshua Stoikos, Brandon J. McKinlay, Izabella A. Ludwa, Andrea R. Josse, Bareket Falk, and Panagiota Klentrou

This study examined differences in resting concentrations of markers of bone formation and resorption, and osteokines between female adolescent (12–16 y) swimmers, soccer players, and nonathletic controls. Resting, morning blood samples were obtained after an overnight fast from 20 swimmers, 20 soccer players, and 20 nonathletic controls, matched for age. carboxyl-terminal cross-linking telopeptide of type I collagen (CTX), amino-terminal propeptide of type I collagen (P1NP), total osteocalcin (OC), sclerostin, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa B ligand (RANKL) were analyzed in serum. After controlling for percent body fat, there were no significant differences between swimmers and nonathletic controls in any of the measured markers. In contrast, soccer players had significantly higher P1NP (89.5 [25.6] ng·mL−1), OC (57.6 [22.9] ng·mL−1), and OPG (1052.5 [612.6] pg·mL−1) compared with both swimmers (P1NP: 66.5 [20.9] ng·mL−1; OC: 24.9 [12.5] ng·mL−1; OPG: 275.2 [83.8] pg·mL−1) and controls (P1NP: 58.5 [16.2] ng·mL−1; OC: 23.2 [11.9] ng·mL−1; OPG: 265.4 [97.6] pg·mL−1), with no differences in CTX, sclerostin, and RANKL. These results suggest that bone formation is higher in adolescent females engaged in high-impact sports like soccer compared with swimmers and controls.

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Short-Term Muscle Power Is Related to Lower Limb Muscle Volume in Young Children

Steven J. Obst, Kaysie Florance, Luke Heales, Sasha Job, and Lee Barber

Purpose: Muscle power is a component of muscular fitness and is proportional to its volume. Reduced muscular fitness in children is linked to negative health outcomes. Associations between muscle volume (MV) and power have not been examined in young children and could reveal important insights into early neuromuscular development. Method: Forty-four children (2–8 y) completed 3 tests of short-term muscular power: repeated anaerobic sprint test, vertical jump, and horizontal jump. MV was assessed using 3D ultrasound for 3 lower limb muscles (rectus femoris, medial gastrocnemius, and tibialis anterior) and summed for across legs. Associations between muscular power and summed MV were assessed using Pearson correlation (r). Sex-based differences in muscular power and MV were assessed using 1-way analysis of covariance. Results: Moderate–strong associations (r = .57 − .87) were found between muscular power and summed MV. No differences were found between boys and girls for height, weight, MV, or muscular power. Conclusions: Young children who have larger lower limb muscles perform better at tasks dependent on short-term muscular power, such as running and jumping, compared with children with smaller muscles. Sex-based differences in short-term muscular power do not exist in young children and reflect similar anthropometry, including lower limb MV.

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A National Implementation Approach for Exercise as Usual Care in Pediatric and Adolescent Oncology: Network ActiveOncoKids

Miriam Götte, Regine Söntgerath, Gabriele Gauß, Joachim Wiskemann, Mirko Buždon, and Sabine Kesting

The diagnosis of cancer as well as accompanying acute and late effects of treatment are influencing physical activity behavior of patients with childhood cancer and survivors. Research has shown that a pediatric cancer diagnosis is associated with impairments of physical performance, and function, as well as reduced physical, and psychosocial, health conditions. From an ethical perspective, lack of knowledge of health care providers, lack of physical activity promotion, and environmental, and structural barriers to physical activity restrict children’s right to move and actively engage in physical activities. Network ActiveOncoKids is a German-wide initiative with the main goal of enabling children, adolescents, and young adults with exercise opportunities during and after cancer treatment. Since the network’s foundation in 2012, Network ActiveOncoKids focuses on: (1) physical activity support for patients and families, (2) policy change to establish structures and guidelines, and (3) generating evidence through scientific projects. The purpose of this paper is to present an overview of Network ActiveOncoKids structure, aims, and projects. This topical review will highlight the network’s structural development, research work, and implementation progress of exercise programs for patients with pediatric cancer and survivors, link international collaborations, and discuss future directions.

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Bidirectional Daily Associations Between Accelerometer-Measured Sleep and Physical Activity in Brazilian High School Students

Luís Eduardo Argenta Malheiros, Bruno Gonçalves Galdino da Costa, Marcus Vinícius Veber Lopes, Érico Pereira Gomes Felden, and Kelly Samara da Silva

Purpose: This study analyzed day-to-day estimates of bidirectional associations between sleep parameters and intensity-specific physical activity and assessed whether the timing of physical activity influences these relationships. Methods: The sample was comprised of 651 high school students (51.2% female, 16.33 [1.0] y old) from southern Brazil. Physical activity and sleep were measured using accelerometers. Multilevel models were applied to test associations of nocturnal total sleep time, onset, and efficiency with moderate to vigorous and light (LPA) physical activity. Results: Higher engagement in moderate to vigorous physical activity and LPA was associated with increased total sleep time, and this effect was greater when physical activity was performed in the morning. Morning and evening LPA were associated with increased sleep efficiency and reduced total sleep time, respectively. Practice of LPA in the morning leads to early sleep onset, whereas evening LPA was associated with later onset. Higher total sleep time and later sleep onset were associated with lower moderate to vigorous physical activity and LPA on the following day. However, higher sleep efficiency was associated with increased LPA. Conclusion: The relationship between sleep parameters and physical activity is bidirectional and dependent on physical activity intensity and timing.

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Change of Direction Speed in Youth Male Soccer Players: The Predictive Value of Anthropometrics and Biological Maturity

Yassine Negra, Senda Sammoud, Alan M. Nevill, and Helmi Chaabene

This study aimed to develop the optimal allometric body size/shape and a biological maturity model that predicted the change of direction (CoD) mean speed performance in youth male soccer players. One-hundred and fifteen youth soccer players (age: 12.4 [1.3] y) participated in this study. The 505 test was used to assess CoD mean speed performance. Anthropometric measurements comprised body height (cm), sitting height (cm), body mass (kg), fat mass (kg), lower limb length (cm), thigh length (cm), leg length (cm), foot length (cm), thigh girth (cm), and calf girth (cm). The maturity status was determined based on the maturity offset method. To identify size/shape and maturity characteristics associated with CoD speed performance, we computed a multiplicative allometric log-linear regression model, which was refined using backward elimination. The multiplicative allometric model exploring the association between 505 CoD mean speed performance and the different anthropometric characteristics in youth soccer players estimated that fat mass (P < .001), sitting height (P = .02), and maturity offset (P = .004) are the key predictors. More specifically, youths who are more mature and have a lower fat mass and a shorter trunk length, are likely to achieve a better CoD mean speed performance. These findings highlight the relevance of considering anthropometric and maturity characteristics in youth soccer players to support talent identification.