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Ferrara IR, Sadowsky CL. Muscle Mass as a Biomarker for Health Status and Function in Pediatric Individuals with Neuromuscular Disabilities: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:815. [PMID: 39062264 PMCID: PMC11276588 DOI: 10.3390/children11070815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
This systematic review aims to investigate the relationship between muscle mass and specific health outcomes in pediatric populations with neuromuscular disorders. A search was performed for any relevant studies published in English from 1996 to 2023 in five databases. To be included in this analysis, articles must have had participants with an average age ≤21, focus on children with neuromuscular disabilities, and primarily examine relationships between muscle mass and any functional or health outcomes measure. Studies including typically developing children were used to contrast and enhance findings. Thirty-two studies were included, with 10,129 unique individuals represented: seventeen studies focused on healthy/typically developing children; seven on children with cerebral palsy; three on children with Duchenne muscular dystrophy; two on children with sarcopenia; and one study each on children with osteoporosis, congenital muscular dystrophy, and other various neurologic disorders. Thirteen studies assessed functional outcomes, ten assessed bone outcomes, and nine assessed other cardiovascular/metabolic outcomes. All of the included studies demonstrated relationships between muscle mass and respective outcomes in varying measures. The results of this review demonstrate that there is a consistently recognized relationship between muscle mass and important health outcomes in children, supporting clinically targeting muscle mass as a means to optimize desired outcomes.
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Affiliation(s)
- Isabella R. Ferrara
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD 21205, USA;
| | - Cristina L. Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD 21205, USA;
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Marmol-Perez A, Ubago-Guisado E, Rodriguez-Solana A, Gil-Cosano JJ, Martinez-Vizcaino V, Cavero-Redondo I, Ruiz JR, Gracia-Marco L. Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis. Front Physiol 2023; 14:1088740. [PMID: 37035662 PMCID: PMC10081564 DOI: 10.3389/fphys.2023.1088740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions.Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment.Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1–19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.Results: A total of eight trials with 341 participants were included. The meta-analyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: −0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: −0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: −0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: −0.17, 0.25) and after the ES was 0.07 (95%CI: −0.20, 0.33).Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment.Systematic Review Registration: PROSPERO registration number: CRD42022310876
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Affiliation(s)
- Andres Marmol-Perez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- *Correspondence: Esther Ubago-Guisado,
| | - Andrea Rodriguez-Solana
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Jose J. Gil-Cosano
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Communication and Education, Universidad Loyola Andalucía, Sevilla, Spain
| | - Vicente Martinez-Vizcaino
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Ivan Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Jonatan R. Ruiz
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Gracia-Marco
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Fochesatto CF, Gaya ACA, Cristi-Montero C, Brand C, Dias AF, Ruschel Bandeira D, Marasca AR, Gaya AR. Association between physical fitness components and fluid intelligence according to body mass index in schoolchildren. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:640-646. [PMID: 34043918 DOI: 10.1080/21622965.2021.1924718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Physical fitness is considered a protective factor for children's general health and has been related to enhanced cognitive functioning. However, it appears that cognition could be affected in children with overweight or obesity. The present study aimed to determine the relationship between physical fitness components and fluid intelligence in normal-weight and overweight/obese children. In this cross-sectional study, a total of 317 schoolchildren participated (165 boys, 52.05%), aged between six and 11 years old (1st to 5th grade), belonging to a public school in the south of Brazil. Psychologists evaluated fluid intelligence through the Raven's Colored Progressive Matrix Test. The physical fitness evaluation followed the procedures of the "Brazil Sports Project". Weight and height were measured to determine body mass index and generalized linear regression analyses were used with a 95% confidence interval. Our results showed that agility was inversely associated with fluid intelligence only in the overweight/obese group (β = -1.506; p = 0.01). Cardiorespiratory and muscular fitness were not associated with fluid intelligence. In conclusion, agility was the only physical fitness component related to fluid intelligence, and this relationship was found exclusively in overweight/obese schoolchildren.
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Affiliation(s)
- Camila Felin Fochesatto
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Adroaldo Cezar Araujo Gaya
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos Cristi-Montero
- School of Physical Education, Pontificia Universidad Católica de Valparaíso, Valparaiso, Chile
| | - Caroline Brand
- Post-graduation Program in Health Promotion, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Arieli Fernandes Dias
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Denise Ruschel Bandeira
- Post-graduation Program in Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Riboli Marasca
- Post-graduation Program in Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anelise Reis Gaya
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gil-Cosano JJ, Ubago-Guisado E, Sánchez MJ, Ortega-Acosta MJ, Mateos ME, Benito-Bernal AI, Llorente-Cantarero FJ, Ortega FB, Ruiz JR, Labayen I, Martinez-Vizcaino V, Vlachopoulos D, Arroyo-Morales M, Muñoz-Torres M, Pascual-Gázquez JF, Vicho-González MC, Gracia-Marco L. The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial. BMC Public Health 2020; 20:1520. [PMID: 33032564 PMCID: PMC7545891 DOI: 10.1186/s12889-020-09607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. METHODS A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. DISCUSSION Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society. TRIAL REGISTRATION Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.
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Affiliation(s)
- Jose J Gil-Cosano
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Maria J Sánchez
- Andalusian School of Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria J Ortega-Acosta
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria E Mateos
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | | | - Francisco J Llorente-Cantarero
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), 28029, Madrid, Spain
- Department of Specific Didactics, Faculty of Education, University of Córdoba, 14071, Córdoba, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Jonatan R Ruiz
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Idoia Labayen
- Institute for Innovation and Sustainable Development in Food Chain (IS-FOOD), Navarra's Health Research Institute (IdiSNA), Department of Health Sciences, Public University of Navarra, Calle Tajonar 22, 31006, Pamplona, Navarra, Spain
| | - Vicente Martinez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Manuel Arroyo-Morales
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18012, Granada, Spain
- Department of Physiotherapy, University of Granada, E-18016, Granada, Spain
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), E-18016, Granada, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, Spain
- CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universidad de Granada, Granada, Spain
| | - Juan F Pascual-Gázquez
- Servicio de Pediatría y Oncohematología Pediátricas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Maria C Vicho-González
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
| | - Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain.
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Differences in areal bone mineral density between metabolically healthy and unhealthy overweight/obese children: the role of physical activity and cardiorespiratory fitness. Pediatr Res 2020; 87:1219-1225. [PMID: 31822016 DOI: 10.1038/s41390-019-0708-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/03/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine whether areal bone mineral density (aBMD) differs between metabolically healthy (MHO) and unhealthy (MUO) overweight/obese children and to examine the role of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) in this association. METHODS A cross-sectional study was developed in 188 overweight/obese children (10.4 ± 1.2 years) from the ActiveBrains and EFIGRO studies. Participants were classified as MHO or MUO based on Jolliffe and Janssen's metabolic syndrome cut-off points for triglycerides, glucose, high-density cholesterol and blood pressure. MVPA and CRF were assessed by accelerometry and the 20-m shuttle run test, respectively. Body composition was measured by dual-energy X-ray absorptiometry. RESULTS In model 1 (adjusted for sex, years from peak high velocity, stature and lean mass), MHO children had significantly higher aBMD in total body less head (Cohen's d effect size, ES = 0.34), trunk (ES = 0.43) and pelvis (ES = 0.33) than MUO children. These differences were attenuated once MVPA was added to model 1 (model 2), and most of them disappeared once CRF was added to the model 1 (model 3). CONCLUSIONS This novel research shows that MHO children have greater aBMD than their MUO peers. Furthermore, both MVPA and more importantly CRF seem to partially explain these findings.
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Rodríguez-Gómez I, Martín-García M, García-Cuartero B, González-Vergaz A, Carcavilla A, Aragonés Á, Alegre LM, Ara I. Body Composition as a Mediator between Cardiorespiratory Fitness and Bone Mass during Growth. Med Sci Sports Exerc 2020; 52:498-506. [PMID: 31939913 DOI: 10.1249/mss.0000000000002146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND PURPOSE To examine the effect of cardiorespiratory fitness (CRF) and muscle power output (MPO) on bone mass of prepubertal and pubertal children using lean mass (LM) and percentage of fat mass (%FM) as mediator variables. The hypothesis was that both LM and %FM would be independent mediators of the relationships during the sexual maturation period. METHODS We analyzed 200 children (88 boys and 112 girls [11.5 ± 2.0 yr]). Body composition was analyzed by bone densitometry, and indirect calorimetry and cycle ergometer were used to calculate V˙O2peak (mL·kg·min) and MPO (W) during an incremental exercise test. Sample was divided by pubertal status. RESULTS In the prepubertal group, LM and %FM acted independently as mediators in the relationship between bone mass and CRF or MPO (22%-25% for LM and 37%-50% for %FM, respectively). In pubertal children, LM acted as mediator at 37%. CONCLUSIONS Although the independent mediator role of LM and %FM in the associations between CRF or MPO and bone mass was present during the prepubertal stage, only LM remain its mediator role in these associations during the postpubertal period. Therefore, with growth and sexual maturation, the full effect of LM seems to increase, whereas the influence of %FM seems to disappear.
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Affiliation(s)
| | | | | | | | | | - Ángel Aragonés
- Endocrinology and Pediatric Service, Virgen de la Salud Hospital, SPAIN
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Ren Y, Xi X, Hu D, Shang W, Peng S, Fan L, Tu S, Zhang H, Shen M, Du Y. Determinants for low bone mineral density in pre-school children: a matched case-control study in Wuhan, China. J Pediatr Endocrinol Metab 2019; 32:739-748. [PMID: 31150360 DOI: 10.1515/jpem-2018-0554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/24/2019] [Indexed: 01/31/2023]
Abstract
Introduction Reduced bone mass will increase bone fragility and risk of fractures. Thus, it is better to note its determinants as early as possible. Objective This study aimed to find and determine the determinants for low bone mineral density (BMD) in pre-school children. Methods Between November 2014 and April 2015, a matched case-control study was performed to detect information on growth and development condition and consumption frequency of products of cases with low BMD and controls with normal BMD. Anthropometric data measurement and blood tests were conducted. Besides, the questionnaires concerning the mentioned information were completed to get relevant determinants. A paired t-test, the McNemar test and univariate and multiple conditional logistic regression models were used to explore the association between these factors and low BMD. Results In total, 88 (28 boys, 60 girls) incident cases (4.15 ± 0.78 years) of low BMD and 88 sex- and age-matched (±2 months) controls (4.16 ± 0.80 years) of normal BMD were enrolled. The results of multiple conditional logistic regression analysis indicated that if children had larger chest circumference (odds ratio [OR] = 0.763), longer duration of breastfeeding (OR = 0.899) and lower frequency of eating snacks (OR = 0.439), the risk of low BMD would decrease. Conclusions Our findings suggest that pre-school children with an association of larger chest circumference, longer duration of breastfeeding and lower frequency of eating snacks could have lower risk for low BMD. Intended measures to strengthen those protective factors could be effective in reducing the cases of low BMD.
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Affiliation(s)
- Yali Ren
- Department of Medical Affairs, Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
| | - Xiaoyan Xi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
| | - Dan Hu
- Department of Child Medical and Health Care Center, Dalian Maternal and Child Health Care Hospital, Dalian, Liaoning Province, P.R. China
| | - Weifeng Shang
- Department of Nephrology, Wuhan Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
| | - Songxu Peng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
| | - Linlin Fan
- Shanghai Pudong New Area People's Hospital, Shanghai, P.R. China
| | - Si Tu
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, P.R. China
| | - Hongping Zhang
- College of Health Science & Nursing, Wuhan Polytechnic University, Dongxihu District, Wuhan, Hubei Province, P.R. China
| | - Min Shen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
| | - Yukai Du
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P.R. China
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an updated summary on the unique aspects of caring for female youth and adolescent athletes. RECENT FINDINGS Recent research on female athletes has led to a better understanding of injuries and conditions that are more likely to occur in female youth and adolescent athletes, including the frequency and severity of concussions, musculoskeletal injury such as involving the anterior cruciate ligament, and the female athlete triad. Social factors, such as the growing pressure to specialize in a sport particularly at an early age, also put young female athletes at risk for issues such as overuse injuries. Researchers continue to explore the benefits of athletic participation that extend beyond physical fitness. SUMMARY Female participation in youth sports has increased dramatically during the past 50 years. This has led to greater research on how to manage risks and maximize benefits for young female athletes, although there is still much to be learned. Providers should educate patients, parents, and coaches on both the increased risks for female athletes and ways to provide better support and accessibility of youth sports to all children.
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