Publications by authors named "Craig A Williams"

147 Publications

Reliability and validity of using the global school-based student health survey to assess 24 hour movement behaviours in adolescents from Saudi Arabia.

J Sports Sci 2022 Jun 28:1-9. Epub 2022 Jun 28.

Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.

This study aimed to examine the reliability and validity of Global School-based Student Health Survey (GSHS) to measure 24-hour movement behaviours (moderate-to-vigorous physical activity - MVPA; sedentary behaviour in the form of recreational screen time - ST; and sleep) in Saudi Arabian youths. A total of 120 (50% female) participants aged 12-15 years old were recruited from eight Saudi public middle schools. Participants completed GSHS survey twice and wore GENEActiv accelerometers for seven consecutive days and completed a diary log. ICC indicated moderate reliability in all 24-hour movement behaviours (ICC = 0.41 - 0.60), whereas ST and sleep were strongly reliable for females only (ICC = 0.61 - 0.80). Kappa agreements for all 24-hr movement behaviours were moderate (k = 0.41 - 0.60), but fair in MVPA and ST for males only (k = 0.21 - 0.40). Spearman's indicated low validity (r = 0.1 - 0.3) in MVPA and sleep between GSHS and GENEActiv. However, kappa test results indicated poor-to-slight agreements (k = <0.00 - 0.2) in MVPA and sleep, but fair in MVPA for males only (k = 0.21 - 0.4). GSHS provided good reliability for single items of 24-hour movement behaviours, and the validity was acceptable and in line with other comparable questionnaires.
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http://dx.doi.org/10.1080/02640414.2022.2092982DOI Listing
June 2022

Sleep, Sedentary Time and Physical Activity Levels in Children with Cystic Fibrosis.

Int J Environ Res Public Health 2022 06 10;19(12). Epub 2022 Jun 10.

Applied Sports, Technology, Exercise and Medicine Research Centre, Bay Campus, Swansea, Wales SA1 8EN, UK.

The aim of this study was to compare the use of generic and cystic fibrosis (CF)-specific cut-points to assess movement behaviours in children and adolescents with CF. Physical activity (PA) was assessed for seven consecutive days using a non-dominant wrist-worn ActiGraph GT9X in 71 children and adolescents (36 girls; 13.5 ± 2.9 years) with mild CF. CF-specific and generic Euclidean norm minus one (ENMO) cut-points were used to determine sedentary time (SED), sleep, light physical activity (LPA), moderate physical activity and vigorous physical activity. The effect of using a CF-specific or generic cut-point on the relationship between PA intensities and lung function was determined. Movement behaviours differed significantly according to the cut-point used, with the CF-specific cut-points resulting in less time asleep (-31.4 min; < 0.01) and in LPA (-195.1 min; < 0.001), and more SED and moderate-to-vigorous PA (159.3 and 67.1 min, respectively; both < 0.0001) than the generic thresholds. Lung function was significantly associated with LPA according to the CF-specific cut-points (r = 0.52; = 0.04). Thresholds developed for healthy populations misclassified PA levels, sleep and SED in children and adolescents with CF. This discrepancy affected the relationship between lung function and PA, which was only apparent when using the CF-specific cut-points. Promoting LPA seems a promising strategy to enhance lung function in children and adolescents with CF.
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http://dx.doi.org/10.3390/ijerph19127133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222933PMC
June 2022

Non-invasive MR imaging techniques for measuring femoral arterial flow in a pediatric and adolescent cohort.

Physiol Rep 2022 05;10(10):e15182

Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.

Magnetic Resonance Imaging (MRI) is well-suited for imaging peripheral blood flow due to its non-invasive nature and excellent spatial resolution. Although MRI is routinely used in adults to assess physiological changes in chronic diseases, there are currently no MRI-based data quantifying arterial flow in pediatric or adolescent populations during exercise. Therefore the current research sought to document femoral arterial blood flow at rest and following exercise in a pediatric-adolescent population using phase contrast MRI, and to present test-retest reliability data for this method. Ten healthy children and adolescents (4 male; mean age 14.8 ± 2.4 years) completed bloodwork and resting and exercise MRI. Baseline images consisted of PC-MRI of the femoral artery at rest and following a 5 × 30 s of in-magnet exercise. To evaluate test-retest reliability, five participants returned for repeat testing. All participants successfully completed exercise testing in the MRI. Baseline flow demonstrated excellent reliability (ICC = 0.93, p = 0.006), and peak exercise and delta rest-peak flow demonstrated good reliability (peak exercise ICC = 0.89, p = 0.002, delta rest-peak ICC = 0.87, p = 0.003) between-visits. All three flow measurements demonstrated excellent reliability when assessed with coefficients of variance (CV's) (rest: CV = 6.2%; peak exercise: CV = 7.3%; delta rest-peak: CV = 7.1%). The mean bias was small for femoral arterial flow. There was no significant mean bias between femoral artery flow visits 1 and 2 at peak exercise. There were no correlations between age or height and any of the flow measurements. There were no significant differences between male and female participants for any of the flow measurements. The current study determined that peripheral arterial blood flow in children and adolescents can be evaluated using non-invasive phase contrast MRI. The MRI-based techniques that were used in the current study for measuring arterial flow in pediatric and adolescent patients demonstrated acceptable test-retest reliability both at rest and immediately post-exercise.
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http://dx.doi.org/10.14814/phy2.15182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133543PMC
May 2022

The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials.

Disabil Rehabil 2022 May 16:1-11. Epub 2022 May 16.

Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK.

Purpose: Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP.

Methods: Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data.

Results: Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies.

Conclusions: The effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.
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http://dx.doi.org/10.1080/09638288.2022.2071484DOI Listing
May 2022

A Compositional Analysis of Physical Activity, Sedentary Time, and Sleep and Associated Health Outcomes in Children and Adults with Cystic Fibrosis.

Int J Environ Res Public Health 2022 04 23;19(9). Epub 2022 Apr 23.

Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University Bay Campus, Swansea SA1 8EN, UK.

This study sought to investigate the association of light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time (SED), and sleep with lung function in children and adults with CF. In total, 86 children (41 females; 13.6 ± 2.8 years; FEV%: 86 ± 1%) and 43 adults (21 females; 24.6 ± 4.7 years; FEV%: 63 ± 21%) with CF participated in this study. Wrist-worn accelerometery was used to assess PA, SED and sleep. Compositional linear regression models were conducted following normalisation via isometric log-ratio transformations. Sequential binary partitioning was applied to investigate the impact of reallocating 10 to 30 min between each behaviour on FEV%. A decline in FEV% was predicted with the reallocation of 30 min from MVPA to SED or LPA or sleep to any other behaviour in children (-3.04--0.005%) and adults (-3.58--0.005%). Conversely, improvements in FEV% were predicted when 30 min was reallocated to MVPA from LPA or SED in children (0.12-1.59%) and adults (0.77-2.10%), or when 30 min was reallocated to sleep from any other behaviour in both children (0.23-2.56%) and adults (1.08-3.58%). This study supports the importance of MVPA and sleep for maintaining and promoting lung function in people with CF.
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http://dx.doi.org/10.3390/ijerph19095155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102111PMC
April 2022

The Effect of Dysglycaemia on Changes in Pulmonary and Aerobic Function in Cystic Fibrosis.

Front Physiol 2022 30;13:834664. Epub 2022 Mar 30.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom.

Cross-sectional studies have reported lower pulmonary and aerobic function during exercise in people with cystic fibrosis-related diabetes (CFRD) compared to non-CFRD counterparts. However, this association has yet to be longitudinally investigated. Therefore, this study examines these differences over time between people with cystic fibrosis (CF) of differing glycaemic status. Annual review data, including cardiopulmonary exercise tests and pulmonary function tests, were retrospectively analysed at baseline (T0, = 82) and at a one-year follow-up (T1, = 54). Data was analysed in three groups: normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and CFRD. Further analyses were undertaken, with a dichotomous split of NGT and a combined IGT/CFRD group. At baseline, a significant reduction in the majority of variables, including forced expiratory volume in one second (FEV) and maximal oxygen uptake (VO), was observed in the CFRD ( = 19) group compared to NGT ( = 58). At follow-up, no significant differences were observed, and no interaction effect between CFRD status and time was identified. FEV and VO presented with varying directions and magnitudes of change within patients. In summary, patients with CFRD have a reduced aerobic and pulmonary function compared to non-CFRD counterparts, although such changes disappeared at follow up. Varying responses for FEV and VO highlight the need to consider both variables as independent markers of function in CF.
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http://dx.doi.org/10.3389/fphys.2022.834664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005891PMC
March 2022

The impact of COVID-19 upon the delivery of exercise services within cystic fibrosis clinics in the United Kingdom.

Clin Respir J 2022 Apr 1;16(4):335-340. Epub 2022 Mar 1.

Children's Health and Exercise Research Centre, Sport and Health Science, University of Exeter, St Luke's Campus, Exeter, UK.

Objectives: The COVID-19 pandemic has resulted in unprecedent changes to clinical practice, and as the impact upon delivery of exercise services for people with cystic fibrosis (CF) in the United Kingdom was unknown, this was characterised via a national survey.

Methods: An electronic survey was distributed to healthcare professionals involved in the exercise management of CF via established professional networks.

Results: In total, 31 CF centres participated. Findings included significant reductions in exercise testing and widespread adaptation to deliver exercise training using telehealth methods. Promisingly, 71% stated that they would continue using virtual methods of engaging patients in future practice.

Conclusion: These findings highlight adaptation to the COVID-19 pandemic and the need to develop sustainable and standardised telehealth services to manage patients moving forwards.
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http://dx.doi.org/10.1111/crj.13484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9060009PMC
April 2022

Exercise intolerance in cystic fibrosis-the role of CFTR modulator therapies.

J Cyst Fibros 2022 03 24;21(2):282-292. Epub 2021 Dec 24.

Translational Medicine Program, SickKids Research Institute, Toronto, ON M5G 0A4, Canada. Electronic address:

Exercise intolerance is common in people with CF (pwCF), but not universal among all individuals. While associated with disease prognosis, exercise intolerance is not simply a reflection of the degree of lung disease. In people with severe CF, respiratory limitations may contribute more significantly to impaired exercise capacity than in those with mild-moderate CF. At all levels of disease severity, there are peripheral factors e.g., abnormal macro- and micro-vascular function that impair blood flow and reduce oxygen extraction, and mitochondrial defects that diminish metabolic efficiency. We discuss advances in understanding the central and peripheral mechanisms underlying exercise intolerance in pwCF. Exploring both the central and peripheral factors that contribute to exercise intolerance in CF can help inform the development of new therapeutic targets, as well as help define prognostic criteria.
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http://dx.doi.org/10.1016/j.jcf.2021.11.011DOI Listing
March 2022

Investigating the Accuracy of Quantitative Echocardiographic-Modified Task Force Criteria for Arrhythmogenic Ventricular Cardiomyopathy in Adolescent Male Elite Athletes.

Pediatr Cardiol 2022 Feb 23;43(2):457-464. Epub 2021 Oct 23.

Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK.

Athlete preparticipation screening focuses on preventing sudden cardiac death (SCD) by detecting diseases such as arrhythmogenic ventricular cardiomyopathy (AVC), which affects primarily the right ventricular myocardium. Diagnosis may be obscured by physiological remodeling of the athlete heart. Healthy athletes may meet the 2010 Task Force Criteria right ventricular outflow tract (RVOT) dimension cut-offs, questioning the suitability of the modified Task Force Criteria (mTFC) in adolescent athletes. In this study, 67 male adolescent footballers undergoing preparticipation screening were reviewed. All athletes underwent a screening for resting ECG and echocardiogram according to the English FA protocol, as well as cardiopulmonary exercise testing, stress ECG, and exercise echocardiography. Athletes' right ventricular outflow tract (RVOT) that met the major AVC diagnostic criteria for dilatation were identified. Of 67 evaluated athletes, 7 had RVOT dilatation that met the major criteria, all in the long axis parasternal view measurement. All had normal right ventricular systolic function, including normal free-wall longitudinal strain (ranging from - 21.5 to - 32.7%). Left ventricular ejection fraction ranged from 52 to 67%, without evidence of structural changes. Resting ECGs and cardiopulmonary exercise tests were normal in all individuals. In a series of healthy athletes meeting the major AVC diagnostic criteria for RVOT dilatation, none had any other pathological changes on a detailed screening including ECG, exercise testing, and echocardiography. This report highlights that current AVC echocardiographic diagnosis criteria have limitations in this population.
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http://dx.doi.org/10.1007/s00246-021-02744-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8850234PMC
February 2022

Monitoring Postmatch Fatigue During a Competitive Season in Elite Youth Soccer Players.

J Athl Train 2022 Feb;57(2):184-190

Children's Health and Exercise Research Centre, College of Life & Environmental Sciences, University of Exeter, Devon, United Kingdom.

Context: Countermovement jump (CMJ) and perceived wellness measures are useful for monitoring fatigue. Fatigue indicators should simultaneously show sensitivity to previous load and demonstrate influence on subsequent physical output; however, these factors have not been examined.

Objective: To explore the efficacy of CMJ and wellness measures to both detect postmatch fatigue and predict subsequent physical match output in elite youth soccer players.

Design: Cross-sectional study.

Patients Or Other Participants: Sixteen soccer players (18 ± 1 years) from 36 English Football League Youth Alliance League fixtures.

Main Outcome Measure(s): Physical match outputs (total distance, high-speed running, very high-speed running, and accelerations and decelerations [AD]) were recorded using a 10-Hz global positioning system and 200-Hz accelerometer device during competitive match play. The CMJ height and perceived wellness were assessed weekly and daily, respectively, as indirect indicators of fatigue. Four subunits of wellness (perceived soreness, energy, general stress, and sleep) were measured using customized psychometric questionnaires.

Results: Simple linear regression showed that match AD predicted energy (R2 = 0.08, P = .001), stress (R2 = 0.09, P < .001), and total wellness (R2 = 0.06, P = .002) at 2 days postmatch. The CMJ (R2 = 0.05, P = .002), stress (R2 = 0.08, P < .001), sleep (R2 = 0.03, P = .034), and total wellness (R2 = 0.05, P = .006) measures at 5 days prematch predicted AD during the subsequent match.

Conclusions: The CMJ and wellness measures may be useful for detecting postmatch fatigue. Wellness scores, but not CMJ, at 5 days prematch influenced subsequent match output and therefore may be used to plan and periodize training for the upcoming microcycle.
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http://dx.doi.org/10.4085/1062-6050-0245.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876877PMC
February 2022

Exercise training in paediatric congenital heart disease: fit for purpose?

Arch Dis Child 2022 06 17;107(6):525-534. Epub 2021 Sep 17.

Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK.

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
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http://dx.doi.org/10.1136/archdischild-2020-321390DOI Listing
June 2022

The role of cardiopulmonary exercise testing in predicting mortality and morbidity in people with congenital heart disease: a systematic review and meta-analysis.

Eur J Prev Cardiol 2022 03;29(3):513-533

Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.

Aims: The role of cardiopulmonary exercise testing (CPET) in predicting major adverse cardiovascular events (MACE) in people with congenital heart disease (ConHD) is unknown. A systematic review with meta-analysis was conducted to report the associations between CPET parameters and MACE in people with ConHD.

Methods And Results: Electronic databases were systematically searched on 30 April 2020 for eligible publications. Two authors independently screened publications for inclusion, extracted study data, and performed risk of bias assessment. Primary meta-analysis pooled univariate hazard ratios across studies. A total of 34 studies (18 335 participants; 26.2 ± 10.1 years; 54% ± 16% male) were pooled into a meta-analysis. More than 20 different CPET prognostic factors were reported across 6 ConHD types. Of the 34 studies included in the meta-analysis, 10 (29%), 23 (68%), and 1 (3%) were judged as a low, medium, and high risk of bias, respectively. Primary univariate meta-analysis showed consistent evidence that improved peak and submaximal CPET measures are associated with a reduce risk of MACE. This association was supported by a secondary meta-analysis of multivariate estimates and individual studies that could not be numerically pooled.

Conclusion: Various maximal and submaximal CPET measures are prognostic of MACE across a variety of ConHD diagnoses. Further well-conducted prospective multicentre cohort studies are needed to confirm these findings.
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http://dx.doi.org/10.1093/eurjpc/zwab125DOI Listing
March 2022

Effects of High-Intensity Interval Training on the Vascular and Autonomic Components of the Baroreflex at Rest in Adolescents.

Pediatr Exerc Sci 2022 02 26;34(1):13-19. Epub 2021 Jul 26.

University of Exeter.

Purpose: In a sample of healthy adolescents, the authors aimed to investigate the effects of high-intensity interval exercise (HIIE) training and detraining on baroreflex sensitivity (BRS) and it's vascular and autonomic components at rest.

Methods: Nineteen volunteers were randomly allocated to (1) 4 weeks HIIE training performed 3 times per week or (2) a control condition with no intervention for the same duration as HIIE training. PRE, POST, and following 2 weeks of detraining resting supine heart rate and blood pressure were measured, and a cross-spectral method (integrated gain [gain in low frequency]) was used to determine BRS gain. Arterial compliance (AC) was assessed as the BRS vascular component. LFgain divided by AC (LFgain/AC) was used as the autonomic determinant of BRS.

Results: The HIIE training was completed with 100% compliance. HIIE did not change resting gain in low frequency (LFgain) (P = .66; effect size = 0.21), AC (P = .44; effect size = 0.36), or LFgain/AC (P = .68; effect size = 0.19) compared to control.

Conclusion: Four weeks of HIIE training does not change BRS and its autonomic and vascular determinant in a sample of healthy adolescents at rest.
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http://dx.doi.org/10.1123/pes.2020-0220DOI Listing
February 2022

Injuries and Training Practices in Competitive Adolescent Distance Runners: A Retrospective Cross-Sectional Study.

Front Sports Act Living 2021 24;3:664632. Epub 2021 Jun 24.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom.

Distance running is one of the most popular sports around the world. The epidemiology of running-related injury (RRI) has been investigated in adults, but few studies have focused on adolescent distance runners. (1) To provide descriptive epidemiology of RRI (risks, rates, body regions/areas, and severity) and examine the training practices (frequency, volume, and intensity) of competitive adolescent distance runners (13-18 years) in England, and (2) to describe potential risk factors of RRI. A cross-sectional study design was used. Adolescent distance runners ( = 113) were recruited from England Athletics affiliated clubs. Participants voluntarily completed an online questionnaire between April and December 2018. At the time of completion, responses were based on the participant's previous 12-months of distance running participation. Incidence proportions (IP) and incidence rates (IR) were calculated. The IP for "all RRI" was 68% (95% CI: 60-77), while the IR was 6.3/1,000 participation hours (95% CI: 5.3-7.4). The most commonly injured body areas were the knee, foot/toes, and lower leg; primarily caused by overuse. The number of training sessions per week (i.e., frequency) significantly increased with chronological age, while a large proportion of participants (58%) self-reported a high level of specialisation. RRI is common in competitive adolescent distance runners. These descriptive data provide guidance for the development of RRI prevention measures. However, analytical epidemiology is required to provide better insight into potential RRI risk factors in this specific population.
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http://dx.doi.org/10.3389/fspor.2021.664632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264289PMC
June 2021

The Role of Speckle Tracking Echocardiography in the Evaluation of Common Inherited Cardiomyopathies in Children and Adolescents: A Systematic Review.

Diagnostics (Basel) 2021 Apr 1;11(4). Epub 2021 Apr 1.

Population Health Sciences Department, University of Bristol, Bristol BS8 2PS, UK.

Speckle tracking echocardiography (STE) has gained importance in the evaluation of adult inherited cardiomyopathies, but its utility in children is not well characterized. We conducted a systematic review to evaluate the role of STE in pediatric inherited cardiomyopathies. PubMed, EMBASE, Web of Science, Scopus, CENTRAL and CINAHL databases were searched up to May 2020, for terms related to inherited cardiomyopathies and STE. Included were dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (ACM). A total of 14 cohorts were identified, of which six were in DCM, four in HCM, three in LVNC and one in ACM. The most commonly reported STE measurements were left ventricular longitudinal strain (S), circumferential strain (S), radial strain (S) and rotation/torsion/twist. S, S and were abnormal in all DCM and LVNC cohorts, but not in all HCM. Apical rotation and twist/torsion were increased in HCM, and decreased in LVNC. Abnormal STE parameters were reported even in cohorts with normal non-STE systolic/diastolic measurements. STE in childhood cardiomyopathies can detect early changes which may not be associated with changes in cardiac function detectable by non-STE methods. Longitudinal and circumferential strain should be introduced in the cardiomyopathy echocardiography protocol, reflecting current practice in adults.
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http://dx.doi.org/10.3390/diagnostics11040635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066718PMC
April 2021

The impact of physical activity and exercise interventions for physical health in people with cystic fibrosis: protocol for a systematic review.

Syst Rev 2021 02 26;10(1):64. Epub 2021 Feb 26.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.

Background: Cystic fibrosis (CF) is a genetically inherited, life-limiting condition, affecting ~90,000 people globally. Physical activity (PA) and exercise form an integral component of CF management, and have been highlighted by the CF community as an area of interest for future research. Previous reviews have solely focused on PA or structured exercise regimens independent of one another, and thus a comprehensive assessment of the physical health benefits of all PA, including exercise, interventions, is subsequently warranted. Therefore, the purpose of this review is to evaluate the effects of both PA and exercise upon outcomes of physical health and healthcare utilisation in people with CF.

Methods: A systematic review has been registered and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P guidelines. This will include randomised control trials on the effects of PA and exercise, relative to usual treatment, upon people with CF. Primary outcomes will include variables associated with fitness, PA, lung health, inflammation, body composition, glycaemic control and patient-reported outcomes. Secondary outcomes will include adverse events and healthcare utilisation. Searches will be undertaken in Ovid MEDLINE, OVID EMBASE, PsychINFO, ERIC, SPORTDiscus, ASSIA, CCTR, CINHAL and Web of Science databases, and will be searched from date of inception onwards. Two reviewers will independently screen citations and abstracts, and full-texts, for inclusion and data extraction, respectively. Methodological quality will be assessed using the Cochrane Risk of Bias-2 tool. If feasible, random-effects meta-analyses will be conducted where appropriate. Additional analyses will explore potential sources of heterogeneity, such as age, sex, and disease severity.

Discussion: This systematic review will build on previous research, by comprehensively assessing the impact of both PA and exercise upon physical health and healthcare utilisation in people with CF. Results of this review will be utilised to inform discussions that will ultimately result in a consensus document on the impact of physical activity and exercise for people with CF.

Systematic Review Registration: PROSPERO CRD42020184411.
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http://dx.doi.org/10.1186/s13643-021-01614-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913325PMC
February 2021

Prevalence and burden of health problems in competitive adolescent distance runners: A 6-month prospective cohort study.

J Sports Sci 2021 Jun 27;39(12):1366-1375. Epub 2021 Jan 27.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK.

To describe all health problems (injuries and illnesses) in relation to type, location, incidence, prevalence, time loss, severity, and burden, in competitive adolescent distance runners in England. Prospective observational study: 136 competitive adolescent distance runners (73 female athletes) self-reported all health problems for 24-weeks between May and October 2019. Athletes self-reported health problems using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. The incidence of running-related injury per 1,000 hours of exposure was markedly higher, compared to previous research. At any time, 24% [95% Confidence Intervals (CI): 21-26%] of athletes reported a health problem, with 11% [95% CI: 9-12%] having experienced a health problem that had substantial negative impact on training and performance. Female athletes reported noticeably more illnesses, compared to male athletes, including higher prevalence, incidence, time loss, and severity. The most burdensome health problems, irrespective of sex, included lower leg, knee, and foot/toes injuries, alongside upper respiratory illnesses. The mean weekly prevalence of time loss was relatively low, regardless of health problem type or sex. Competitive adolescent distance runners are likely to be training and competing whilst concurrently experiencing health problems. These findings will support the development of injury and illness prevention measures.
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http://dx.doi.org/10.1080/02640414.2021.1874160DOI Listing
June 2021

Cochrane corner: Physical activity interventions for people with congenital heart disease.

Heart 2021 Jan 15. Epub 2021 Jan 15.

Children's Health and Exercise Research Centre, University of Exeter College of Life and Environmental Sciences, Exeter, Devon, UK

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http://dx.doi.org/10.1136/heartjnl-2020-318459DOI Listing
January 2021

The acute effect of high- and moderate-intensity interval exercise on vascular function before and after a glucose challenge in adolescents.

Exp Physiol 2021 04 22;106(4):913-924. Epub 2021 Jan 22.

Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.

New Findings: What is the central question of this study? What is the effect of high-intensity and moderate-intensity interval running on macro- and microvascular function in a fasted state and following a glucose challenge in adolescents? What is the main finding and its importance? Both macro- and microvascular function were improved after interval running independent of intensity. This finding shows that the intermittent exercise pattern and its associated effect on shear are important for vascular benefits. In adolescents, macrovascular function was enhanced after an acute glucose load. However, the effect of chronic glucose consumption on vascular function remains to be elucidated.

Abstract: Interventions targeting vascular function in youth are an important strategy for the primary prevention of cardiovascular diseases. This study examined, in adolescents, the effect of high-intensity interval running (HIIR) and moderate-intensity interval running (MIIR) on vascular function in a fasted state and postprandially after a glucose challenge. Fifteen adolescents (13 male, 13.9 ± 0.6 years) completed the following conditions on separate days in a counterbalanced order: (1) 8 × 1 min HIIR interspersed with 75 s recovery; (2) distance-matched amount of 1 min MIIR interspersed with 75 s recovery; and (3) rest (CON). Macro- (flow-mediated dilatation, FMD) and microvascular (peak reactive hyperaemia, PRH) function were assessed immediately before and 90 min after exercise/rest. Participants underwent an oral glucose tolerance test (OGTT) 2 h after exercise/rest before another assessment of vascular function 90 min after the OGTT. Following exercise, both HIIR and MIIR increased FMD (P = 0.02 and P = 0.03, respectively) and PRH (P = 0.04, and P = 0.01, respectively) with no change in CON (FMD: P = 0.51; PRH: P = 0.16) and no significant differences between exercise conditions. Following the OGTT, FMD increased in CON (P < 0.01) with no changes in HIIR and MIIR (both P > 0.59). There was no change in PRH after the OGTT (all P > 0.40). In conclusion, vascular function is improved after interval running independent of intensity in adolescents. Acute hyperglycaemia increased FMD, but prior exercise did not change vascular function after the OGTT in youth.
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http://dx.doi.org/10.1113/EP089159DOI Listing
April 2021

A multidisciplinary investigation into "playing-up" in academy football according to age phase.

J Sports Sci 2021 Apr 17;39(8):854-864. Epub 2020 Nov 17.

College of Life & Environmental Sciences, University of Exeter, Exeter, UK.

In an attempt to facilitate more appropriate levels of challenge, a common practice in academy football is to play-up talented youth players with chronologically older peers. However, the context of playing-up in academy football is yet to be empirically explored. Thus, the purpose of this study was to examine the multidimensional factors that differentiated players who play-up from those who do not. Ninety-eight participants from a single football academy were examined within their age phase: Foundation Development Phase (FDP; under-9 to under-11; n = 40) and Youth Development Phase (YDP; under-12 to under-16; n = 58). Drawing upon the FA Four Corner Model, 27 factors relating to Technical/Tactical, Physical, Psychological, and Social development were assessed. Following MANOVA analysis within both the FDP and YDP, significant differences were observed for Technical/Tactical and Social sub-components (P < 0.05). Further differences were observed for Physical and Psychological sub-components (P < 0.05) within the YDP. In sum, Technical/Tactical and Social characteristics appeared to differentiate those who play-up compared to those who do not within the FDP. In the YDP however, there were measures representing all sub-components from the FA Four Corner Model. Subsequently, it is suggested coaches and practitioners consider these holistic factors when playing-up youth football players within relevant age-phases.
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http://dx.doi.org/10.1080/02640414.2020.1848117DOI Listing
April 2021

Test-Retest Reliability of Handgrip Strength Measurement in Children and Preadolescents.

Int J Environ Res Public Health 2020 10 31;17(21). Epub 2020 Oct 31.

Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland.

The reliability of handgrip strength (HGS) measurement has been confirmed in adults but has been sparsely addressed in pediatric populations. The aims of this study are twofold: to determine whether sex, age and/or hand-dominance influence the test-retest differences and to establish the reliability level of the HGS measurement in typical developing pediatric participants. A total of 338 participants aged 7-13 years were tested using a digital handgrip strength (HGS) dynamometer (Jamar Plus+ Dynamometer) by the same rater on two testing trials separated by a one-day interval between sessions. The HGS testing was conducted according to the American Society of Hand Therapists recommendations. Relative and absolute reliability statistics were calculated. Age influenced the test-retest difference of the HGS measurement as children compared to preadolescents had lower intraclass correlation coefficients (0.95 vs. 0.98), standard error of measurement (SEM) (0.74 vs. 0.78 kg), smallest detectable difference (SDD) (2.05 vs. 2.16 kg) and higher values of the percentage value of SEM (5.48 vs. 3.44%), normalized SDD (15.52 vs. 9.61%) and a mean difference between the test and retest values (0.50 vs. 0.02 kg) for the dominant hand. The results indicate that the protocol using the Jamar digital handgrip dynamometer is a reliable instrument to measure HGS in participants aged 7-13 years with typical development. Clinicians and researchers therefore can have confidence in determining the minimally clinical effect for HGS.
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http://dx.doi.org/10.3390/ijerph17218026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663254PMC
October 2020

Physical activity interventions for people with congenital heart disease.

Cochrane Database Syst Rev 2020 10 28;10:CD013400. Epub 2020 Oct 28.

Institute of Health Research, University of Exeter Medical School, Exeter, UK.

Background: Congenital heart disease (ConHD) affects approximately 1% of all live births. People with ConHD are living longer due to improved medical intervention and are at risk of developing non-communicable diseases. Cardiorespiratory fitness (CRF) is reduced in people with ConHD, who deteriorate faster compared to healthy people. CRF is known to be prognostic of future mortality and morbidity: it is therefore important to assess the evidence base on physical activity interventions in this population to inform decision making.

Objectives: To assess the effectiveness and safety of all types of physical activity interventions versus standard care in individuals with congenital heart disease.

Search Methods: We undertook a systematic search on 23 September 2019 of the following databases: CENTRAL, MEDLINE, Embase, CINAHL, AMED, BIOSIS Citation Index, Web of Science Core Collection, LILACS and DARE. We also searched ClinicalTrials.gov and we reviewed the reference lists of relevant systematic reviews.

Selection Criteria: We included randomised controlled trials (RCT) that compared any type of physical activity intervention against a 'no physical activity' (usual care) control. We included all individuals with a diagnosis of congenital heart disease, regardless of age or previous medical interventions.  DATA COLLECTION AND ANALYSIS: Two review authors (CAW and CW) independently screened all the identified references for inclusion. We retrieved and read all full papers; and we contacted study authors if we needed any further information. The same two independent reviewers who extracted the data then processed the included papers, assessed their risk of bias using RoB 2 and assessed the certainty of the evidence using the GRADE approach. The primary outcomes were: maximal cardiorespiratory fitness (CRF) assessed by peak oxygen consumption; health-related quality of life (HRQoL) determined by a validated questionnaire; and device-worn 'objective' measures of physical activity.

Main Results: We included 15 RCTs with 924 participants in the review. The median intervention length/follow-up length was 12 weeks (12 to 26 interquartile range (IQR)). There were five RCTs of children and adolescents (n = 500) and 10 adult RCTs (n = 424). We identified three types of intervention: physical activity promotion; exercise training; and inspiratory muscle training. We assessed the risk of bias of results for CRF as either being of some concern (n = 12) or at a high risk of bias (n = 2), due to a failure to blind intervention staff. One study did not report this outcome. Using the GRADE method, we assessed the certainty of evidence as moderate to very low across measured outcomes. When we pooled all types of interventions (physical activity promotion, exercise training and inspiratory muscle training), compared to a 'no exercise' control CRF may slightly increase, with a mean difference (MD) of 1.89 mL/kg/min (95% CI -0.22 to 3.99; n = 732; moderate-certainty evidence). The evidence is very uncertain about the effect of physical activity and exercise interventions on HRQoL. There was a standardised mean difference (SMD) of 0.76 (95% CI -0.13 to 1.65; n = 163; very low certainty evidence) in HRQoL. However, we could pool only three studies in a meta-analysis, due to different ways of reporting. Only one study out of eight showed a positive effect on HRQoL. There may be a small improvement in mean daily physical activity (PA) (SMD 0.38, 95% CI -0.15 to 0.92; n = 328; low-certainty evidence), which equates to approximately an additional 10 minutes of physical activity daily (95% CI -2.50 to 22.20). Physical activity and exercise interventions likely result in an increase in submaximal cardiorespiratory fitness (MD 2.05, 95% CI 0.05 to 4.05; n = 179; moderate-certainty evidence). Physical activity and exercise interventions likely increase muscular strength (MD 17.13, 95% CI 3.45 to 30.81; n = 18; moderate-certainty evidence). Eleven studies (n = 501) reported on the outcome of adverse events (73% of total studies). Of the 11 studies, six studies reported zero adverse events. Five studies reported a total of 11 adverse events; 36% of adverse events were cardiac related (n = 4); there were, however, no serious adverse events related to the interventions or reported fatalities (moderate-certainty evidence). No studies reported hospital admissions.

Authors' Conclusions: This review summarises the latest evidence on CRF, HRQoL and PA. Although there were only small improvements in CRF and PA, and small to no improvements in HRQoL, there were no reported serious adverse events related to the interventions. Although these data are promising, there is currently insufficient evidence to definitively determine the impact of physical activity interventions in ConHD. Further high-quality randomised controlled trials are therefore needed, utilising a longer duration of follow-up.
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http://dx.doi.org/10.1002/14651858.CD013400.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490972PMC
October 2020

Characterisation of LV myocardial exercise function by 2-D strain deformation imaging in elite adolescent footballers.

Eur J Appl Physiol 2021 Jan 8;121(1):239-250. Epub 2020 Oct 8.

Institute of Sport Exercise and Health (ISEH), University College London, London, W1T 7HA, UK.

Purpose: Few data exist on the descriptions of LV myocardial mechanics and reserve during dynamic exercise of adolescent athletes. The aim of this study was to describe the LV myocardial and cardiopulmonary changes during exercise using 2-D strain deformation imaging.

Methods: Elite adolescent male football players (n = 42) completed simultaneous cardiopulmonary exercise testing (CPET) and exercise echocardiography measurement of LV myocardial deformation by 2-D strain imaging. LV longitudinal and circumferential 2-D strain and strain rates were analyzed at each stage during incremental exercise to a work rate of 150 W. Additionally, exercise LV myocardial deformation and its relation to metabolic exercise parameters were evaluated at each exercise stage and in recovery using repeated measures ANOVA, linear regression and paired t tests.

Results: LV peak systolic baseline 2-D strain (longitudinal: - 15.4 ± 2.5%, circumferential: - 22.5 ± 3.1%) increased with each exercise stage, but longitudinal strain plateaued at 50 W (mean strain reserve - 7.8 ± 3.0) and did not significantly increase compared to subsequent exercise stages (P > 0.05), whilst circumferential strain (mean strain reserve - 11.6 ± 3.3) significantly increased (P < 0.05) throughout exercise up to 150 W as the dominant mechanism of exercise LV contractility increase. Regression analyses showed LV myocardial strain increased linearly relative to HR, VO and O pulse (P < 0.05) for circumferential deformation, but showed attenuation for longitudinal deformation.

Conclusion: This study describes LV myocardial deformation dynamics by 2-D strain and provides reference values for LV myocardial strain and strain rate during exercise in adolescent footballers. It found important differences between LV longitudinal and circumferential myocardial mechanics during exercise and introduces a methodology that can be used to quantify LV function and cardiac reserve during exercise in adolescent athletes.
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http://dx.doi.org/10.1007/s00421-020-04510-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815563PMC
January 2021

Physical activity for cystic fibrosis: perceptions of people with cystic fibrosis, parents and healthcare professionals.

ERJ Open Res 2020 Jul 21;6(3). Epub 2020 Sep 21.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK.

Background: The benefits of physical activity (PA) for people with cystic fibrosis (pwCF) are widely accepted, yet how PA is promoted and utilised by pwCF is unclear.

Method: An online questionnaire to explore attitudes, practices and promotion of PA in cystic fibrosis was completed by healthcare providers (HCP), pwCF and parents/caregivers.

Results: 351 respondents (105 HCP, 120 pwCF, and 126 parents/caregivers) from 12 countries completed the survey. Importance of PA was rated highly by the majority of respondents. Physical ( health), psychological ( enjoyment) and social ( social interaction) factors were motives for PA for 82%, 49% and 37% of pwCF, respectively, irrespective of country. Common barriers to PA included time (49% and 36%) and tiredness (61% and 7%) for pwCF and parents/carers, respectively. pwCF also reported psychosocial barriers ( stigma, demoralisation), while parents/caregivers reported structural barriers ( cost). Clinical teams varied substantially in terms of the emphasis placed on PA, facilities available, staff and training, and advice given to pwCF.

Conclusion: Despite the majority of participants rating the importance of PA highly, substantial variability was evident regarding the facilities and clinical support available to them, as well as why and how people were active. There remains a need to identify what constitutes "best practice" for PA promotion within clinics.
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http://dx.doi.org/10.1183/23120541.00294-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502697PMC
July 2020

Test-retest reliability of pulmonary oxygen uptake and muscle deoxygenation during moderate- and heavy-intensity cycling in youth elite-cyclists.

J Sports Sci 2020 Nov 11;38(21):2462-2470. Epub 2020 Jul 11.

Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter , Exeter, UK.

To establish the test-retest reliability of pulmonary oxygen uptake (O), muscle deoxygenation (deoxy[haem]) and tissue oxygen saturation (StO) kinetics in youth elite-cyclists. From baseline pedalling, 15 youth cyclists completed 6-min step transitions to a moderate- and heavy-intensity work rate separated by 8 min of baseline cycling. The protocol was repeated after 1 h of passive rest. O was measured breath-by-breath alongside deoxy[haem] and StO of the vastus lateralis by near-infrared spectroscopy. Reliability was assessed using 95% limits of agreement (LoA), the typical error (TE) and the intraclass correlation coefficient (ICC). During moderate- and heavy-intensity step cycling, TEs for the amplitude, time delay and time constant ranged between 3.5-21.9% and 3.9-12.1% for O and between 6.6-13.7% and 3.5-10.4% for deoxy[haem], respectively. The 95% confidence interval for estimating the kinetic parameters significantly improved for ensemble-averaged transitions of O (p < 0.01) but not for deoxy[haem]. For StO, the TEs for the baseline, end-exercise and the rate of deoxygenation were 1.0-42.5% and 1.1-5.5% during moderate- and heavy-intensity exercise, respectively. The ICC ranged from 0.81 to 0.99 for all measures. Test-retest reliability data provide limits within which changes in O, deoxy[haem] and StO kinetics may be interpreted with confidence in youth athletes.
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http://dx.doi.org/10.1080/02640414.2020.1792115DOI Listing
November 2020

Calibration and validation of accelerometry using cut-points to assess physical activity in paediatric clinical groups: A systematic review.

Prev Med Rep 2020 Sep 8;19:101142. Epub 2020 Jun 8.

School of Sport and Exercise Sciences, Swansea University, Bay Campus, Swansea, Wales, UK.

Regular physical activity is associated with physiological and psychosocial benefits in both healthy and clinical populations. However, little is known about tailoring the analysis of physical activity using accelerometers to the specific characteristics of chronic conditions. Whilst accelerometry is broadly used to assess physical activity, recommendations on calibration in paediatric clinical groups are warranted. The aim of this systematic review was to provide a critical overview of protocols used to calibrate accelerometry in children and adolescents with clinical conditions, as well as to develop recommendations for calibration and validation of accelerometry in such populations. The search was performed between March to July 2017 using text words and subject headings in six databases. Studies had to develop moderate-to-vigorous intensity physical activity (MVPA) cut-points for paediatric clinical populations to be included. Risk of bias was assessed using a specific checklist. A total of 540,630 titles were identified, with 323 full-text articles assessed. Five studies involving 347 participants aged 9 to 15 years were included. Twenty-four MVPA cut-points were reported across seven clinical conditions, 16 of which were developed for different models of ActiGraph, seven for Actical and one for Tritrac-R3D. Statistical approaches included mixed regression, machine learning and receiver operating characteristic analyses. Disease-specific MVPA cut-points ranged from 152 to 735 counts·15 s, with lower cut-points found for inherited muscle disease and higher cut-points associated with intellectual disabilities. The lower MVPA cut-points for diseases characterised by both ambulatory and metabolic impairments likely reflect the higher energetic demands associated with those conditions.
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http://dx.doi.org/10.1016/j.pmedr.2020.101142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327836PMC
September 2020

Heart Rate Variability in Children and Adolescents with Cerebral Palsy-A Systematic Literature Review.

J Clin Med 2020 Apr 16;9(4). Epub 2020 Apr 16.

Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland.

Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms "heart rate variability" and "cerebral palsy" in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0-18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.
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http://dx.doi.org/10.3390/jcm9041141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230809PMC
April 2020

A web-based intervention to promote physical activity in adolescents and young adults with cystic fibrosis: protocol for a randomized controlled trial.

BMC Pulm Med 2019 Dec 19;19(1):253. Epub 2019 Dec 19.

Monash University La Trobe University, Alfred Health and Institute for Breathing and Sleep, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Vic, 3004, Australia.

Background: Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF.

Methods: Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality.

Discussion: This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all individuals with CF, to support physical activity and exercise participation at a time and location of the user's choosing, regardless of microbiological status.

Trial Registration: Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at (ACTRN12617001009303).
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http://dx.doi.org/10.1186/s12890-019-0942-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921562PMC
December 2019

The effects of two weeks high-intensity interval training on fasting glucose, glucose tolerance and insulin resistance in adolescent boys: a pilot study.

BMC Sports Sci Med Rehabil 2019 9;11:29. Epub 2019 Dec 9.

1Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, EX1 2LU UK.

Background: Current evidence of metabolic health benefits of high-intensity interval training (HIIT) are limited to longer training periods or conducted in overweight youth. This study assessed 1) fasting and postprandial insulin and glucose before and after 2 weeks of HIIT in healthy adolescent boys, and 2) the relationship between pre intervention health outcomes and the effects of the HIIT intervention.

Methods: Seven healthy boys (age:14.3 ± 0.3 y, BMI: 21.6 ± 2.6, 3 participants classified as overweight) completed 6 sessions of HIIT over 2 weeks. Insulin resistance (IR) and blood glucose and insulin responses to a Mixed Meal Tolerance Test (MMTT) were assessed before (PRE), 20 h and 70 h after (POST) the final HIIT session.

Results: Two weeks of HIIT had no effect on fasting plasma glucose, insulin or IR at 20 h and 70 h POST HIIT, nor insulin and glucose response to MMTT (all  > 0.05). There was a strong negative correlation between PRE training IR and change in IR after HIIT ( = - 0.96,  < 0.05).

Conclusion: Two weeks of HIIT did not elicit improvements to fasting or postprandial glucose or insulin health outcomes in a group of adolescent boys. However the negative correlation between PRE IR and improvements after HIIT suggest that interventions of this type may be effective in adolescents with raised baseline IR.
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http://dx.doi.org/10.1186/s13102-019-0141-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900855PMC
December 2019

Relationship between (non)linear phase II pulmonary oxygen uptake kinetics with skeletal muscle oxygenation and age in 11-15 year olds.

Exp Physiol 2019 12 17;104(12):1929-1941. Epub 2019 Oct 17.

Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.

New Findings: What is the central question of this study? Do the phase II parameters of pulmonary oxygen uptake ( ) kinetics display linear, first-order behaviour in association with alterations in skeletal muscle oxygenation during step cycling of different intensities or when exercise is initiated from an elevated work rate in youths. What is the main finding and its importance? Both linear and non-linear features of phase II kinetics may be determined by alterations in the dynamic balance between microvascular O delivery and utilization in 11-15 year olds. The recruitment of higher-order (i.e. type II) muscle fibres during 'work-to-work' cycling might be responsible for modulating kinetics with chronological age.

Abstract: This study investigated in 19 male youths (mean age: 13.6 ± 1.1 years, range: 11.7-15.7 years) the relationship between pulmonary oxygen uptake ( ) and muscle deoxygenation kinetics during moderate- and very heavy-intensity 'step' cycling initiated from unloaded pedalling (i.e. U → M and U → VH) and moderate to very heavy-intensity step cycling (i.e. M → VH). Pulmonary was measured breath-by-breath along with the tissue oxygenation index (TOI) of the vastus lateralis using near-infrared spectroscopy. There were no significant differences in the phase II time constant ( ) between U → M and U → VH (23 ± 6 vs. 25 ± 7 s; P = 0.36); however, the was slower during M → VH (42 ± 16 s) compared to other conditions (P < 0.001). Quadriceps TOI decreased with a faster (P < 0.01) mean response time (MRT; i.e. time delay + τ) during U → VH (14 ± 2 s) compared to U → M (22 ± 4 s) and M → VH (20 ± 6 s). The difference (Δ) between the and MRT-TOI was greater during U → VH compared to U → M (12 ± 7 vs. 2 ± 7 s, P < 0.001) and during M → VH (23 ± 15 s) compared to other conditions (P < 0.02), suggesting an increased proportional speeding of fractional O extraction. The slowing of the during M → VH relative to U → M and U → VH correlated positively with chronological age (r = 0.68 and 0.57, respectively, P < 0.01). In youths, 'work-to-work' transitions slowed microvascular O delivery-to-O utilization with alterations in phase II dynamics accentuated between the ages of 11 and 15 years.
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http://dx.doi.org/10.1113/EP087979DOI Listing
December 2019
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