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A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents

Kelsey L. McAlister, Diana Zhang, Kristen N. Moore, Tiffany M. Chapman, Jennifer Zink, and Britni R. Belcher

Purpose: To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. Methods: Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5–17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. Results: Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. Conclusion: While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.

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The Percentage of Mature Height as a Morphometric Index of Somatic Growth: A Formal Scrutiny of Conventional Simple Ratio Scaling Assumptions

Lorenzo Lolli, Amanda Johnson, Mauricio Monaco, Valter Di Salvo, Greg Atkinson, and Warren Gregson

Purpose: To assess conventional assumptions that underpin the percentage of mature height index as the simple ratio of screening height (numerator) divided by actual or predicted adult height (denominator). Methods: We examined cross-sectional data from 99 academy youth soccer players (chronological age range, 11.5 to 17.7 y) skeletally immature at the screening time and with adult height measurements available at follow-up. Results: The y-intercept value of −60 cm (95% confidence interval, −115 to −6 cm) from linear regression between screening height and adult height indicated the failure to meet the zero y-intercept assumption. The correlation coefficient between present height and adult height of .64 (95% confidence interval, .50 to .74) was not equal to the ratio of coefficient of variations between these variables (CV x /CV y  = 0.46) suggesting Tanner’s special circumstance was violated. The non-zero correlation between the ratio and the denominator of .21 (95% confidence interval, .01 to .39) indicated that the percentage of mature height was biased low for players with generally shorter adult height, and vice versa. Conclusion: For the first time, we have demonstrated that the percentage of mature height is an inconsistent statistic for determining the extent of completed growth, leading to potentially biased inferences for research and applied purposes.

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Abstracts From the 2022 North American Society for Pediatric Exercise Medicine Conference: The Child’s Right to be Fit (August 2022, Saskatoon, Saskatchewan, Canada)

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Clusters of Activity-Related Social and Physical Home Environmental Factors and Their Association With Children’s Home-Based Physical Activity and Sitting

Michael P. Sheldrick, Clover Maitland, Kelly A. Mackintosh, Michael Rosenberg, Lucy J. Griffiths, Richard Fry, and Gareth Stratton

Purpose: Understanding which physical activity (PA) and sedentary behavior correlates cluster in children is important, particularly in the home, where children spend significant time. Therefore, this study aimed to assess clustering of physical and social activity-related factors at home, and whether these clusters are related to home-based sitting and PA in children. A secondary aim was to explore whether the clusters were associated with child, parent, and family characteristics. Methods: Altogether, 235 children (55% girls, mean age = 10.2 [0.7] y) and their parents took part. Physical (eg, PA and electronic media equipment, house and garden size, layout) and social (eg, activity preferences, priorities, parental rules) home environmental factors were obtained via the HomeSPACE-II audit and self-report, respectively. Principal component analysis was used to identify clusters of physical and social environmental factors. Backward regression analysis and partial correlations were used to examine relationships between clusters, children’s device-measured home-based activity behaviors, and background characteristics. Results: The findings show that physical and social environment activity-related factors at home cluster. The clusters were associated with several background characteristics, with socioeconomic factors appearing to be particularly influential. The clusters were also associated with home-based activity behaviors in the hypothesized directions. Conclusion: Interventions which target clusters of social and physical factors at home, especially among low-socioeconomic status families, are warranted.

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Volume 34 (2022): Issue 3 (Aug 2022)

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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.