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Influence of Exercise and Training on Critical Stages of Bone Growth and Development

Panagiota Klentrou

Although osteoporosis is considered a geriatric disease, factors affecting bone strength are most influential during child growth and development. This article reviews what is known and still unclear in terms of bone growth, development and adaptation relative to physical activity before and during puberty. Bone is responsive to certain exercise protocols early in puberty and less so in postpubertal years, where bone strength, rather than bone mass, being the outcome of interest. Mechanical loading and high impact exercise promote bone strength. Intense training before and during puberty, however, may negatively affect bone development. Future research should focus on increasing our mechanistic understanding of the manner by which diverse physical stressors alter the integrity of bone. Longitudinal studies that examine the extent to which muscle and bone are comodulated by growth in children are also recommended.

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Effects of Exercise Training with Weighted Vests on Bone Turnover and Isokinetic Strength in Postmenopausal Women

Panagiota Klentrou, Jill Slack, Brian Roy, and Michel Ladouceur

The effects of 12 wk of exercise training using weighted vests on bone turnover and isokinetic strength were evaluated in postmenopausal women randomly assigned as exercisers (EX; n = 9) or controls (CON; n = 7). Training included 3 multimodal exercise sessions per wk wearing weighted vests. The vest load was progressively increased each wk to a maximum of 15% of body weight. Bone turnover was determined from resting levels of serum osteocalcin and NTx. Knee and ankle strength were measured at 60°/s and 180°/s using an isokinetic dynamometer. After 12 wk, NTx decreased by 14.5% (P ≤ .05) in EX, with no significant changes in osteocalcin. EX also showed a 40% (P ≤ .05) improvement in ankle plantar-flexion strength at 60°/s. Relative body fat significantly decreased and fat-free mass increased in EX. Exercise compliance was 80%. These findings support the use of progressive exercise training using weighted vests in postmenopausal women.

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Bone Speed of Sound, Bone Turnover and IGF-I in Adolescent Synchronized Swimmers

Izabella A. Ludwa, Bareket Falk, Matthew Yao, Lauren Corbett, and Panagiota Klentrou

This pilot study compared bone speed of sound (SOS), bone turnover and insulin-like growth factor 1 (IGF-1) between 20 Caucasian, postmenarcheal, adolescent synchronized swimmers (SS) and 20 aged- and maturity-matched nonswimmers (NS). Daily dietary intake and physical activity levels were also assessed. Bone SOS was measured by quantitative ultrasound. Blood samples were analyzed for osteocalcin, cross-linked N-teleopeptide of type I collagen (NTx), IGF-I and 25-OH vitamin D. Although no differences in bone SOS or turnover markers were observed between groups, the lower IGF-1 and vitamin D intake found in synchronized swimmers, in combination with their higher strenuous activity levels, should be further explored.

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Ventilatory Breakpoints in Boys and Men

Panagiota Klentrou, Mary Lou Nishio, Michael Plyley, and Brock University

The purpose of this study was to compare the ventilatory breakpoints during exercise between young boys and adult men. Twenty-four active volunteers, 12 boys (10.8 ± 0.3 years of age) and 12 men (24.6 ± 1.1 years of age) with similar aerobic power (53.6 ± 4.2 to 55.7 ± 3.5 mlkg−1min−1), participated in the study. Each participant completed a standardized Physical Activity Questionnaire and anthropometric variables were measured. The exercise testing consisted of two graded tests to exhaustion on a treadmill. Heart rates were recorded every minute and gas exchange parameters were obtained every 30 s throughout the tests. Each ventilatory breakpoint was determined using a three-part model. Although the relative VO2peak values were not significantly different between the boys and the young adults, the boys reported significantly (p < .05) higher total activity than the adults. The boys had a significantly higher (p > .05) first ventilatory breakpoint expressed as a percentage of VO2peak than the adults (64.9% vs. 57.7%). Only 50% of the boys demonstrated a discernable VB2, and the VB2 of this group was not significantly different from that of the adults.

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CAN-flip: A Pilot Gymnastics Program for Children With Cerebral Palsy

Olivia Cook, Gail Frost, Donna Twose, Linda Wallman, Bareket Falk, Victoria Galea, Allan Adkin, and Panagiota Klentrou

This pilot study examined whether an adapted gymnastics program, CAN-flip, could be a feasible activity for children with cerebral palsy (CP) leading to improvements in muscle fitness, motor performance, and physical self-perception. Four girls and 1 boy (9.8 ± 1.3 yr) with CP participated in this multiple-baseline acrosssubjects design and were randomly assigned to start either the 6-wk gymnastics or the 6-wk control period. Muscle strength, neuromuscular activation, range of motion, gross motor performance, balance, and physical self-perception were assessed at baseline, after the first 6-wk period, and at the conclusion of the study. The gymnastics program comprised two 1-hr individualized classes per week. All participants were able to complete the gymnastics classes without injury and showed improvement in specific gymnastics skills. In addition, 3 of the 5 participants registered for regular gymnastics classes after the study, demonstrating the program’s usability as a link to inclusive gymnastic classes.

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Wnt Signaling–Related Osteokines at Rest and Following Plyometric Exercise in Prepubertal and Early Pubertal Boys and Girls

Panagiota Klentrou, Kirina Angrish, Nafisa Awadia, Nigel Kurgan, Rozalia Kouvelioti, and Bareket Falk

Purpose: This study examined osteokines related to Wnt signaling at rest and in response to plyometric exercise in 12 boys [10.2 (0.4) y] and 12 girls [10.5 (0.4) y]. Methods: One resting (preexercise) and 3 postexercise (5 min, 1 h, and 24 h) blood samples were analyzed for sclerostin, dickkopf-related protein 1 (DKK-1), osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-β ligand (RANKL). Results: Girls had higher resting sclerostin than boys [187.1 (40.1) vs 150.4 (36.4) pg·mL−1, respectively; P = .02]. However, boys had higher DKK-1 [427.7 (142.3) vs 292.8 (48.0) pg·mL−1, respectively; P = .02] and RANKL [3.9 (3.8) vs 1.0 (0.4) pg·mL−1, respectively; P < .01] than girls. In girls, sclerostin significantly decreased 5-minute and 1-hour postexercise (χ2 = 12.7, P = .01), and RANKL significantly decreased 5-minute postexercise (χ2 = 19.1, P < .01) and continued to decrease up to 24-hour postexercise, with large effect sizes. In boys, DKK-1 significantly decreased 1-hour postexercise and remained lower than preexercise 24-hour postexercise (χ2 = 13.0, P = .01). OPG increased in both boys (χ2 = 13.7, P < .01) and girls (χ2 = 11.4, P = .01), with boys having significantly higher OPG at 5-minute and 1-hour postexercise, whereas in girls, this increase was only seen 24-hour postexercise. Conclusion: Plyometric exercise induces an overall anabolic osteokine response favoring osteoblastogenesis over osteoclastogenesis in both boys and girls although the timeline and mechanism(s) may be different.

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Muscle Strength and Contractile Kinetics of Isometric Elbow Flexion in Girls and Women

Bareket Falk, Laura Brunton, Raffy Dotan, Charlotte Usselman, Panagiota Klentrou, and Davie Gabriel

Ten prepubertal girls and 15 young women were tested for maximal torque, peak rate of torque development, electro-mechanical delay (EMD), and time to peak rate of torque development during isometric elbow flexion. Absolute peak torque (17.0 ± 7.7 vs. 40.5 ± 8.3 Nm) and peak rate of torque development (105.9 ± 58.6 vs. 297.2 ± 113.0 Nm·s−1) were lower in the girls (p < .05). Normalized to muscle cross sectional area, torque was similar (8.27 ± 2.74 vs. 8.44 ± 1.65 Nm·cm−2), as was peak rate of torque development, normalized to peak torque (6.21 ± 1.94 vs. 7.30 ± 2.26 Nm·s−1/Nm). Both, time to peak rate of torque development (123.8 ± 36.0 vs. 110.5 ± 52.6 ms) and EMD (73.2 ± 28.6 vs. 51.9 ± 25.6 ms), were longer in the girls, although EMD’s difference only approached statistical significance (p = .06). Age-related isometric strength differences in females appear to be mainly muscle-size dependent. However, the time to peak torque and EMD findings suggest differential motor-unit activation which may functionally manifest itself in fast dynamic contractions.

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Bone Speed of Sound and Physical Activity Levels of Overweight and Normal-Weight Girls and Adolescents

Mathew Yao, Izabella Ludwa, Lauren Corbett, Panagiota Klentrou, Peter Bonsu, Kimberley Gammage, and Bareket Falk

Bone properties, reflected by speed of sound (SOS), and physical activity levels were examined in overweight (OW) girls (n = 19) and adolescents (n = 22), in comparison with normal-weight (NW) girls (n = 21) and adolescents (n = 13). Moderate-to-vigorous physical activity (MVPA) was higher in NW than in OW in both age groups. Tibial SOS was lower in OW compared with NW in both age groups. MVPA correlated with tibial SOS, once age was partialed out. The results suggest that overweight girls and adolescents are characterized by low tibial SOS, which may be partially attributed to lower physical activity levels.

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Child—Adult Differences in Muscle Activation — A Review

Raffy Dotan, Cameron Mitchell, Rotem Cohen, Panagiota Klentrou, David Gabriel, and Bareket Falk

Children differ from adults in many muscular performance attributes such as size-normalized strength and power, endurance, fatigability and the recovery from exhaustive exercise, to name just a few. Metabolic attributes, such as glycolytic capacity, substrate utilization, and VO2 kinetics also differ markedly between children and adults. Various factors, such as dimensionality, intramuscular synchronization, agonist-antagonist coactivation, level of volitional activation, or muscle composition, can explain some, but not all of the observed differences. It is hypothesized that, compared with adults, children are substantially less capable of recruiting or fully employing their higher-threshold, type-II motor units. The review presents and evaluates the wealth of information and possible alternative factors in explaining the observations. Although conclusive evidence is still lacking, only this hypothesis of differential motor-unit activation in children and adults, appears capable of accounting for all observed child—adult differences, whether on its own or in conjunction with other factors.

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Bone Properties in Overweight Pre- and Early-Pubertal Boys

Bareket Falk, Sarah Braid, Michael Moore, Deborah O’Leary, Phil Sullivan, and Panagiota Klentrou

The objective of this study was to assess bone strength using quantitative ultrasound (QUS, Sunlight Omnisense) in pre- and early-pubertal normal weight (NW, % body fat ≤20, n = 28), and overweight (OW, % body fat ≥25, n = 15) boys. Groups were similar in chronological and skeletal age, sexual maturity, sports participation, and calcium intake. Leisure-time physical activity was lower in OW boys. Radial speed of sound (SOS) was similar in the two groups. Tibial SOS, however, was significantly lower in OW compared with NW (3,554 ± 109 vs. 3,646 ± 71 m·s−1, respectively). Among pre- and early-pubertal boys, higher adiposity appears to be associated with lower bone SOS in the lower extremities.