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Metabolism and Exercise During Youth

Keith Tolfrey

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Pediatric Fitness: Secular Trends and Geographic Variability

Keith Tolfrey

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Exercise Protocols to Estimate Fatmax and Maximal Fat Oxidation in Children

Julia Zakrzewski and Keith Tolfrey

Consensus on the exercise protocol used to measure Fatmax (exercise intensity corresponding to maximum fat oxidation (MFO)) in children has not been reached. The present study compared Fatmax estimated using the 3 min incremental cycling protocol (3-INC) and a protocol consisting of several 10 min constant work rate exercise bouts (10-CWR) in 26 prepubertal children. Group Fatmax values were the same for 3-INC and 10-CWR (55% VO2peak) and 95% limits of agreement (LoA) were ± 7% VO2peak. Group MFO values were similar between protocols, although 95% LoA were -94 to 113 mg·min−1. While 3-INC provides a valid estimation of Fatmax compared with 10-CWR, caution should be exercised when estimating MFO in prepubertal children.

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Effects of a 12-Week Exercise Intervention on Subsequent Compensatory Behaviors in Adolescent Girls: An Exploratory Study

Rachel Massie, James Smallcombe, and Keith Tolfrey

Purpose: Chronic exercise programs can induce adaptive compensatory behavioral responses through increased energy intake (EI) and/or decreased free-living physical activity in adults. These responses can negate the benefits of an exercise-induced energy deficit; however, it is unclear whether young people experience similar responses. This study examined whether exercise-induced compensation occurs in adolescent girls. Methods: Twenty-three adolescent girls, heterogeneous for weight status, completed the study. Eleven adolescent girls aged 13 years completed a 12-week supervised exercise intervention (EX). Twelve body size–matched girls comprised the nonexercise control group (CON). Body composition, EI, free-living energy expenditure (EE), and peak oxygen uptake ( V ˙ O 2 ) were measured repeatedly over the intervention. Results: Laboratory EI (EX: 9027, 9610, and 9243 kJ·d−1 and CON: 9953, 9770, and 10,052 kJ·d−1 at 0, 12, and 18 wk, respectively; effect size [ES] = 0.26, P = .46) and free-living EI (EX: 7288, 6412, and 5273, 4916 kJ·d−1 and CON: 7227, 7128, and 6470, 6337 kJ·d−1 at 0, 6, 12, and 18 wk, respectively; ES ≤ 0.26, P = .90) did not change significantly over time and were similar between groups across the duration of the study. Free-living EE was higher in EX than CON (13,295 vs 12,115 kJ·d−1, ES ≥ 0.88, P ≥ .16), but no significant condition by time interactions were observed (P ≥ .17). Conclusion: The current findings indicate that compensatory changes in EI and EE behaviors did not occur at a group level within a small cohort of adolescent girls. However, analysis at the individual level highlights large interindividual variability in behaviors, which suggests a larger study may be prudent to extend this initial exploratory research.

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Genetics and Pediatric Exercise Science: A Brief Commentary and Review

Joey C. Eisenmann and Keith Tolfrey

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Fluid Intake During Wheelchair Exercise in the Heat: Effects of Localized Cooling Garments

Victoria L. Goosey-Tolfrey, Nicholas J. Diaper, Jeanette Crosland, and Keith Tolfrey


Wheelchair tennis players, competing in hot and humid environments, are faced with an increased risk of heat-related illness and impaired performance. This study examined the effects of head and neck cooling garments on perceptions of exertion (RPE), thermal sensation (TS), and water consumption during wheelchair exercise at 30.4 ± 0.6°C.


Eight highly trained wheelchair tennis players (1 amputee and 7 spinal cord injured) completed two 60-min, intermittent sprint trials; once with cooling (COOL) and once without cooling (CON) in a balanced cross-over design. Players could drink water ad libitum at five predetermined intervals during each trial. Heart rate, blood lactate concentration, peak speed, TS, and RPE were recorded during the trials. Body mass and water consumption were measured before and after each trial.


Water consumption was lower in COOL compared with CON (700 ± 393 mL vs. 1198 ± 675 mL respectively; P = 0.042). Trends in data suggested lower RPE and TS under COOL conditions (N.S.). Total sweat losses ranged from 200 to 1300 mL; this equated to ~1% dehydration after water consumption had been accounted for when averaged across all trials. The ad libitum drinking volumes matched and, in some cases, were greater than the total sweat losses.


These results suggest that there is a counterproductive effect of head and neck cooling garments on water consumption. However, despite consuming volumes of water at least equivalent to total sweat loss, changes in body mass suggest an incidence of mild dehydration during wheelchair tennis in the heat.

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Metabolism and Exercise During Youth

Keith Tolfrey, Julia K. Zakrzewski-Fruer, and James Smallcombe

Three publications were selected based on the strength of the research questions, but also because they represent different research designs that are used with varying degrees of frequency in the pediatric literature. The first, a prospective, longitudinal cohort observation study from 7 to 16 years with girls and boys reports an intrinsic reduction in absolute resting energy expenditure after adjustment for lean mass, fat mass, and biological maturity. The authors suggest this could be related to evolutionary energy conservation, but may be problematic now that food energy availability is so abundant. The second focuses on the effect of acute exercise on neutrophil reactive oxygen species production and inflammatory markers in independent groups of healthy boys and men. The authors suggested the boys experienced a “sensitized” neutrophil response stimulated by the exercise bout compared with the men; moreover, the findings provided information necessary to design future trials in this important field. In the final study, a dose-response design was used to examine titrated doses of high intensity interval training on cardiometabolic outcomes in adolescent boys. While the authors were unable to identify a recognizable dose-response relationship, there are several design strengths in this study, which was probably underpowered.

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Interrater Reliability of the New Sport-Specific Evidence-Based Classification System for Para Va'a

Johanna S. Rosén, Victoria L. Goosey-Tolfrey, Keith Tolfrey, Anton Arndt, and Anna Bjerkefors

The purpose of this study was to examine the interrater reliability of a new evidence-based classification system for Para Va'a. Twelve Para Va'a athletes were classified by three classifier teams each consisting of a medical and a technical classifier. Interrater reliability was assessed by calculating intraclass correlation for the overall class allocation and total scores of trunk, leg, and on-water test batteries and by calculating Fleiss’s kappa and percentage of total agreement in the individual tests of each test battery. All classifier teams agreed with the overall class allocation of all athletes, and all three test batteries exhibited excellent interrater reliability. At a test level, agreement between classifiers was almost perfect in 14 tests, substantial in four tests, moderate in four tests, and fair in one test. The results suggest that a Para Va'a athlete can expect to be allocated to the same class regardless of which classifier team conducts the classification.

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Brief Report: Training Load, Salivary Immunoglobulin A, and Illness Incidence in Elite Paratriathletes

Ben T. Stephenson, Eleanor Hynes, Christof A. Leicht, Keith Tolfrey, and Victoria L. Goosey-Tolfrey

Purpose: To gain an exploratory insight into the relation between training load (TL), salivary secretory immunoglobulin A (sIgA), and upper respiratory tract illness (URI) in elite paratriathletes. Methods: Seven paratriathletes were recruited. Athletes provided weekly saliva samples for the measurement of sIgA over 23 consecutive weeks (February to July) and a further 11 consecutive weeks (November to January). sIgA was compared to individuals’ weekly training duration, external TL, and internal TL, using time spent in predetermined heart-rate zones. Correlations were assessed via regression analyses. URI was quantified via weekly self-report symptom questionnaire. Results: There was a significant negative relation between athletes’ individual weekly training duration and sIgA secretion rate (P = .028), with changes in training duration accounting for 12.7% of the variance (quartiles: 0.2%, 19.2%). There was, however, no significant relation between external or internal TL and sIgA parameters (P ≥ .104). There was no significant difference in sIgA when URI was present or not (101% vs 118% healthy median concentration; P ≥ .225); likewise, there was no difference in sIgA when URI occurred within 2 wk of sampling or not (83% vs 125% healthy median concentration; P ≥ .120). Conclusions: Paratriathletes’ weekly training duration significantly affects sIgA secretion rate, yet the authors did not find a relation between external or internal TL and sIgA parameters. Furthermore, it was not possible to detect any link between sIgA and URI occurrence, which throws into question the potential of using sIgA as a monitoring tool for early detection of illness.

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A Multifactorial Assessment of Elite Paratriathletes’ Response to 2 Weeks of Intensified Training

Ben T. Stephenson, Christof A. Leicht, Keith Tolfrey, and Victoria L. Goosey-Tolfrey

Purpose: In able-bodied athletes, several hormonal, immunological, and psychological parameters are commonly assessed in response to intensified training due to their potential relationship to acute fatigue and training/nontraining stress. This has yet to be studied in Paralympic athletes. Methods: A total of 10 elite paratriathletes were studied for 5 wk around a 14-d overseas training camp whereby training load was 137% of precamp levels. Athletes provided 6 saliva samples (1 precamp, 4 during camp, and 1 postcamp) for cortisol, testosterone, and secretory immunoglobulin A; weekly psychological questionnaires (Profile of Mood State [POMS] and Recovery-Stress Questionnaire for Athletes [RESTQ-Sport]); and daily resting heart rate and subjective wellness measures including sleep quality and quantity. Results: There was no significant change in salivary cortisol, testosterone, cortisol:testosterone ratio, or secretory immunoglobulin A during intensified training (P ≥ .090). Likewise, there was no meaningful change in resting heart rate or subjective wellness measures (P ≥ .079). Subjective sleep quality and quantity increased during intensified training (P ≤ .003). There was no significant effect on any POMS subscale other than lower anger (P = .049), whereas there was greater general recovery and lower sport and general stress from RESTQ-Sport (P ≤ .015). Conclusions: There was little to no change in parameters commonly associated with the fatigued state, which may relate to the training-camp setting minimizing external life stresses and the careful management of training loads from coaches. This is the first evidence of such responses in Paralympic athletes.