Health-related fitness in children and adolescents

Physical Fitness Surveillance and Monitoring Systems Inventory for Children and Adolescents: A Scoping Review with a Global Perspective

Surveillance of health-related physical fitness can improve decision-making and intervention strategies promoting health for children and adolescents. However, no study has comprehensively analyzed surveillance/monitoring systems for physical fitness globally. This review sought to address this gap by identifying: (1) national-level surveillance/monitoring systems for physical fitness among children and adolescents globally, (2) the main barriers and challenges to implementing surveillance/monitoring systems, and (3) governmental actions related to existing surveillance/monitoring systems. We used a scoping review to search, obtain, group, summarize, and analyze available evidence. Our review involved three stages: (1) identification of surveillance systems through a systematic literature review, with complementary search of the grey literature (e.g., reference lists, Google Scholar, webpages, recommendations), (2) systematic consultation with relevant experts using a Delphi method to confirm/add systems and to gather and analyze information on the barriers and challenges to implementing systems, and (3) Web searches for public documents on government sites and surveillance/monitoring system pages, and direct internet searches to identify relevant governmental actions related to surveillance systems. A total of 15 fitness surveillance/monitoring systems met our inclusion criteria. Experts identified a lack of government support and funding, and the low priority of fitness on the public health agenda as the main barriers/challenges to implementation. Several governmental actions related to surveillance systems were identified, including policies, strategies, programs, and guidelines. We propose a Global Observatory of Physical Fitness to help address these issues.

Associations between Dietary Patterns and Physical Activity with Physical Fitness among Adolescents in Shandong Province, China: A Cross-Sectional Study

Background: The trend of physical fitness (PF) and physical activity (PA) among Chinese adolescents is not optimistic, and unhealthy dietary behaviors are common. PA and dietary patterns (DPs) have been linked to PF in adolescents, but the associations between DPs and PF with PF in Chinese adolescents are rarely discussed. Methods: A total of 8796 adolescents aged 11–18 were enrolled from Shandong Province, China. The CNSPFS battery was applied to assess PF. PA levels and diet quality were determined using the Physical Activity Questionnaire for Adolescents and the modified Chinese Diet Quality Questionnaire, respectively. This study used factor analysis to identify DPs and linear regression models to investigate the association between PF and related factors. Results: The average PF score of the participants was 75.67. Adolescents who were girls, lived in rural areas and were active in PA performed better on the PF test (p < 0.05). Boys whose fathers were university educated or above had a higher probability of achieving higher PF scores (OR 4.36, 95% CI 1.32–14.36); however, if their mothers were university educated or above, they had a lower probability of achieving higher PF scores (OR 0.22, 95% CI 0.063–0.76). Unhealthy dietary pattern was negatively correlated with cardiorespiratory fitness in boys (OR 0.56, 95% CI 0.31–0.98). The association between unhealthy dietary pattern and girls’ BMI became significant after adjustment for PA (p < 0.05). Conclusions: Girls performed better in PF than boys. Highly educated fathers could contribute to improve the PF performance in boys. There were four DPs among adolescents in Shandong Province, and different DPs may have different effects on PF in boys and girls.

Forced migration and integration - comparison of physical fitness of children from Poland and Ukraine as an indicator of general health

OBJECTIVES

The aim of the study was to briefly analyze the results of selected fitness tests of Ukrainian adolescents against their Polish counterparts.

METHODS

The study was school-based, carried out between April and June 2022. It included 642 children from Poland and Ukraine (aged 10 to 16) who attended 10 randomly selected primary schools in Kraków (Poland). Analyzed parameters included physical fitness tests: flexibility test, standing broad jump, 10x5m shuttle run, abdominal muscle strength test (sit-ups, 30 s), handgrip strength (left and right hand) and overhead medicine ball throw (backwards).

RESULTS

The Ukrainian girls obtained less favorable results of the fitness tests compared to the Polish children, with the exception of handgrip strength. Also the Ukrainian boys were characterized by lower results of the fitness tests, except for the shuttle run and handgrip strength of the left hand, compared to their counterparts from Poland.

CONCLUSION

The Ukrainian children obtained mainly less favorable results of the fitness tests compared to the Polish children. It should be stressed that analyzed characteristics play an important role in childrens' current as well as future health. Considering the obtained results, to properly accommodate to the changing needs of the population, educators, teachers and parents should advocate for more physical activity opportunities for children. Additionally, interventions focused on fitness, health and wellness promotion, as well as risk-reduction on individual and community levels should be developed and implemented.

Trend in health-related physical fitness for Chinese male first-year college students: 2013-2019

Introduction

Physical fitness is a health indicator contributing to the prevention of non-communicable diseases that threaten public health. Studies across a number of global populations indicate that physical fitness is generally declining. This study investigated the trend in physical fitness of Chinese male first-year college students from 2013 to 2019 to offer critical information for fostering individual and public health.

Methods

This study used archival data and a natural experiment design capturing 4 years of data prior to implementation of the Healthy China 2030 initiative and 3 years following. Physical fitness tests were based on the Chinese national student physical fitness standards for males including body mass index, vital capacity, standing-long-jump, sit-and-reach, pull-ups, 50 m sprint, and 1,000 m run. Because the physical fitness tests set different standards for males and females, female data will be reported separately. Data from a total of 3,185 Chinese male first-year college students from a private university in Hebei Province of China were included in the study. A one-way multivariate analysis of variance was used for analyzing the research data.

Results

The results indicated an overall significant difference in health-related physical fitness of Chinese male first-year college students, with scores on health indicators generally declining from 2013 to 2019. Despite improvement on some fitness variables in some years, performance on virtually all indicators was diminished compared to baseline years.

Discussion

These findings can contribute to the existing global literature in the field of public health showing general declines in physical fitness. Chinese universities have the opportunity to support Healthy China 2030 goals and cultivate individuals' physical fitness by offering physical education course that encourage college students to participate in moderate-to-vigorous-intensity physical activities in order to support physical fitness development.

Effect of resistance circuit training on health-related physical fitness, plasma lipid, and adiponectin in obese college students

The purpose of this study is to investigate the effects of resistance circuit training on health-related physical fitness, plasma lipid and adiponectin in obese college students. Twenty male college students participated in this study and they were randomly divided into the sedentary group (SG, n=10) and the resistance circuit training group (RCG, n=10). The exercise group underwent the resistance circuit training program for 60 min 3 times a week for 12 weeks, while the sedentary group continued activities of daily living as usual. The levels of health-related fitness, blood lipid, and adiponectin were measured twice before and after the experiment. To analyze the statistically significance of collected data, Two-way repeated measure analysis of variance was used to determine the changes in the groups over the training period. A paired t-test was used to verify the difference within each group, and an independent t-test was used to verify the difference between the groups. In this study, the body composition including body fat mass, percent body fat and body mass index were significantly decreased in RCG compared to those in SG, and the health-related fitness showed a significant difference between RCG and SG. In addition, RCG positively modulated blood concentration of total cholesterol, triglycerides, high-density and low-density lipoprotein cholesterol. However, plasma adiponectin concentration did not show any significant differences between the two groups. Therefore, the present data suggested that resistance circuit training might be regulator to improve health-related physical fitness and decrease the level of plasma lipid in obese male college students.

Bioelectrical Impedance Analysis-Derived Phase Angle and Body Composition Are Predictors of Health-Related Fitness in Children and Adolescents with Obesity

There is little evidence in children and adolescents with obesity of the relationships between muscle strength/cardiorespiratory fitness (both components of health-related fitness = HRF) and body composition. Body composition and HRF were studied in 281 children and adolescents with obesity to explore their mutual relationship and to identify the predictors of HRF. By performing a bioelectrical impedance analysis (BIA), the fat-free mass (FFM) and percentage of body fat (%BF) were calculated, and the phase angle (PhA) was recorded. Handgrip strength (HGS), the standard broad jump (SBJ), and five broad jumps (FIVEBJ) were considered for the assessment of muscle strength, and the six-minute walking distance (SIXMWD) for cardiorespiratory fitness. The BMI Z-score was slightly higher in boys, and the %BF was higher in girls, with no difference in the FFM. HGS, the SBJ, and FIVEBJ were greater in the male sex. After controlling for sex, HGS was associated with the FFM, and with height, weight, and absolute BMI. On the contrary, the SBJ and FIVEBJ were negatively associated with adiposity, with a weak relationship with the FFM. The SIXMWD was only poorly related to height, the BMI Z-score, and the waist-to-height ratio. These results were confirmed with a multiple regression analysis. HGS, the SBJ, and FIVEBJ were higher in the first compared to the third tertile of the PhA in both sexes. The PhA also remained a consistent predictor of HGS, the SBJ, and FIVEBJ in a multiple regression analysis. In conclusion, the following predictors have been identified for HRF: the FFM for the isometric strength of the upper limbs and adiposity indicators for the SBJ and FIVEBJ. The PhA emerged as a proxy index of muscle strength.

Small Business Support Is Associated with the Quantity, Quality, and Usage of Youth Physical Activity Opportunities in Urban, Low-Income, African American Neighborhoods

Evidence suggests small businesses could play a significant role in bringing quality youth physical activity opportunities (YPAOs) to urban areas. Knowing more about their involvement with YPAOs in African American neighborhoods would be of significant value given the relatively low PA rates of African American youth. The current study examined associations between small businesses and YPAOs in low-income, African American urban neighborhoods. Surveys were conducted with 46.4% (n = 223) of eligible small business owners/managers and 44.2% (n = 38) of eligible YPAO providers in 20 low-income, African American urban neighborhoods to ascertain business and YPAO characteristics. Audits were conducted at the YPAOs and parks (n = 28) in the study areas to obtain counts of users and data on amenities/incivilities. Analyses included multiple linear regression. Only 33.6% of all businesses were currently supporting YPAOs. The percentage of businesses supporting only local YPAOs (YPAOs near the business) was significantly associated with the number of YPAOs in the area, number of YPAO amenities, youth participants, teams, amenity quality, and the severity of incivilities after controlling for neighborhood demographics. Businesses supporting only local YPAOs were at their location longer, and their owners were more likely to have a sports background, children, and believe small businesses should support YPAOs than business not supporting local YPAOs. This study provides evidence that YPAOs in low-income, African American urban neighborhoods are improved by support from small businesses. Efforts to enhance PA among African American youth living in low-income urban neighborhoods could benefit from involving small businesses.

Behaviours involved in the role of victim and aggressor in bullying: Relationship with physical fitness in adolescents

Physical fitness is related to well-being and health. Adolescence is a key period in the psychological and social development of the person, in which interpersonal relationships gain strength, being bullying a type of violence that can affect the personality of those involved. At present, there is not enough research to determine the relationships between bullying and physical condition. The purpose of this study is to find out if there are any relationships among physical fitness, victimisation, and aggression in bullying, and to identify these behaviours. This is a descriptive study done in 1035 adolescents aged 12 to 17 years (M = 14.67, SD = 1.49). The European Bullying Intervention Project Questionnaire (EBIPQ) scale was used, and anthropometric characteristics of weight and height were measured. In addition, physical fitness tests from the Eurofit battery, sit-and-reach, 30-second sit-ups, horizontal jump, manual dynamometry, and 20-meter Multistage Shuttle Run Test (SRT) were included. The relationships between variables were analysed using Spearman correlations, linear regressions, and ordinal regressions. The most relevant findings indicate an inverse relationship between being a victim of bullying and having a better cardiorespiratory cardiovascular endurance. These also show a direct relationship between being a bully and skeletal muscle strength measured through the horizontal jump, 30-second sit-ups, and manual dynamometry tests. Theoretically, we can conclude that physical condition can be considered a predictor to consider in bullying. Specifically, cardiorespiratory fitness, in addition to its multiple physical and mental benefits, may be a protective element against bullying victimisation. In contrast, muscular strength, especially in boys, may be an important predictor, especially in the physical component, of aggression in bullying.

Association between physical fitness, body mass index and intelligence quotient in individuals with intellectual disabilities

BACKGROUND

Physical exercise seems to improve cognitive abilities at different physiological levels. Numerous studies have examined the relationship between physical fitness (PF), physical activity and cognition among populations without intellectual disabilities (ID), but very few have addressed this question with respect to people with ID. This study aimed to determine the correlation between intelligence quotient (IQ) and factors related to PF in healthy adults with ID.

METHODS

A multicentre cross-sectional study was conducted in 91 individuals with ID. All participants were assessed with the K-BIT tests and the following test items from the SAMU DIS-FIT Battery: body mass index, handgrip strength (HGS), leg strength, dynamic balance and physical endurance.

RESULTS

Significant differences between men and women were tested by multiple regression. IQ was found to be statistically related to HGS and leg strength, with a medium effect size. Statistical relationships were also found between sex and physical endurance, with a medium effect size, and HGS, with a large effect size.

CONCLUSIONS

The study results highlight relationships between the variables of muscular strength and the participants' IQ. Further studies with experimental designs are needed to enhance the understanding of the relationships between PF and cognition in persons with ID.

Raw bioelectrical impedance analysis variables (phase angle and impedance ratio) are significant predictors of hand grip strength in adolescents and young adults

OBJECTIVES

Musculoskeletal fitness and body composition are major components of health-related physical fitness that are expected to be linked to each other. The aim of this study was to explore the association of musculoskeletal fitness (expressed as hand grip strength [HGS]) and raw bioelectrical impedance analysis (BIA) variables and other predictors in the second and third decades of life.

METHODS

Four groups of healthy normal-weight and overweight participants were studied: 130 male adolescents (age 16.0 ± 1.1 y), 143 female adolescents (16.0 ± 0.9 y), 141 young men (25.5 ± 2.0 y), and 141 young women (25.2 ± 1.9 y). Raw BIA variables (impedance [Z] and phase angle [PhA]) for the whole body were measured at four frequencies (5, 50, 100, and 250 kHz), and HGS was measured in both upper limbs.

RESULTS

HGS was higher in males than females and higher in young men than male adolescents. A fairly strong correlation emerged in both genders between HGS and raw BIA variables-that is, bioimpedance index (height²/Z), PhA, and impedance ratios (Z at high frequency/Z at low frequency). In multiple regression analysis, bioimpedance index, PhA, and impedance ratio were more effective predictors of HGS than BIA-derived estimates of body composition or anthropometric variables such as height, weight, and body mass index. In both genders, HGS was significantly higher in young adults than in adolescents for the same PhA or impedance ratio.

CONCLUSIONS

This study provides some insight into the use of raw BIA variables and HGS in the first decades of life, suggesting a new approach for a reliable assessment of muscle quality in terms of both muscle structure and strength.

Association between neighborhood built environment and health-related fitness: a systematic review protocol

OBJECTIVE

The objective of this review is to summarize the current literature on the association between the neighborhood built environment and components of health-related fitness. The findings may be useful for policy-makers and health professionals to inform the development of health-supportive neighborhood built environments.

INTRODUCTION

There is accumulating evidence linking neighborhood built environments to health, including physical activity and chronic health conditions, yet little is known about the potential links between the built environment and health-related fitness. Although physical activity and health-related fitness are intimately linked, health-related fitness is thought to be a more proximate and stronger correlate of health. Understanding how the built environment influences health-related fitness will allow better health-promoting urban design and population-level interventions.

INCLUSION CRITERIA

Published and unpublished evidence will be included if it has a quantitative component and the sample includes adults aged 18 years or older, with no physical disabilities or health issues that may affect health-related fitness. The exposure of interest will be objectively measured and self-reported neighborhood built characteristics. The outcome of interest will be objectively measured and self-reported components of health-related fitness (ie, morphological, muscular, motor, and cardiorespiratory fitness).

METHODS

We will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases used in the search will include MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, and Transport Research International Documentation with no date or language restrictions. Two independent reviewers will screen titles and abstracts, and assess full-text studies against the inclusion criteria. Study quality will be assessed by two independent reviewers using the critical appraisal tools from JBI. A narrative approach will be used to synthesize the study findings; if data permit, a meta-analysis will be completed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020179807.

Health-Related Fitness Levels among Title I Elementary School Students

Over the past few decades, studies have emphasized improving children’s health by increasing health-related fitness levels. Despite the known benefits of health-related fitness in youth, studies have also highlighted a lack of physical activity opportunities for children living in low-income households. The purpose of this study was to investigate the health-related fitness levels of students attending Title I (low-income) elementary schools. A total of 77 elementary students (50.6% female; M_age = 10.0, SD = 0.827) from two Title I elementary schools in the western United States completed the FitnessGram assessments of aerobic capacity, muscular strength and endurance, and flexibility. Descriptive statistics were used to identify the number of students in the Healthy Fitness Zone (HFZ) based upon the FitnessGram HFZ Performance Standards. Less than 17% of students achieved the HFZ for aerobic capacity and only 31.2% achieved the HFZ for upper body strength and endurance. Students performed better for abdominal strength and endurance and flexibility with 55.8% and 68.8% achieving the HFZ, respectively. The results of this study offer insights into the health-related fitness levels of a unique population, students attending Title I schools. School health professionals, including physical education teachers, need to be aware of existing disparities and make efforts to systematically intervene.

Considerations for the Design of a Physical Fitness Battery to Assess Adults with Intellectual Disabilities: Preliminary Reference Values for the SAMU DIS-FIT Study

For the assessment of the health-related physical fitness (PF) of individuals with intellectual disabilities (ID), tools designed for people without disabilities have generally been used. Also, the results of these assessments have routinely been compared with the scores obtained by people without ID. The objectives of the present study are to present the rationale for the design of an assessment battery for PF, the so-called SAMU DIS-FIT battery, and to present the results obtained by the participants classified according to age, sex, and level of PF (physical fitness). The selection criteria for the tests that would make up the battery were: (i) utility, (ii) psychometric properties, (iii) easiness and diversity, (iv) simplicity of execution, (v) familiarity and motivation, and (vi) economy of resources. A cross-sectional study was designed to assess the PF of 261 individuals with ID. To interpret the results obtained by the participants, each of the quantitative variables of PF was categorized into three levels: lower-fit, mid-fit, and higher-fit. The findings of this study serve as a first step in establishing PF baseline values for individuals with ID.

Assessment of Validity of Children's Movement Skill Quotient (CMSQ) Based on the Physical Education Classroom Environment

The development of movement skills in children is a critical element in promoting physical activity and other positive health trajectories over their lifetime. A reliable and valid assessment tool is essential for evaluating children's movement skills in daily physical education environments. The purpose of this study was to examine the validity of Children's Motor Skills Quotient (CMSQ) used in the classroom setting. Six raters conducted evaluation to participants, and a total of 734 children completed all the test items and were included in the study. Descriptive statistics and Rasch analysis were used in this study. The descriptive statistics were mainly used for calculating the mean, standard deviation, percentage, and internal consistency coefficient. Rasch analysis was used to verify the fitting statistics, project difficulty, and functional differences of the items of the CMSQ. The findings showed that the CMSQ met the assumption of the Rasch model, including the unidimensionality, local independence, person measure, and item difficulty hierarchy. The CMSQ also demonstrated adequate interrater reliability and internal consistency. The differential item functioning (DIF) demonstrated a few items showing different probabilities across sex and age. To maintain the item difficulty hierarchy of the CMSQ, no items were deleted. Overall, the CMSQ seems to have appropriate test items with an appropriate rating scale structure for measuring 6-9-year-old children's movement skills in the physical education classroom environment.

Effects of an Alternative Sports Program Using Kin-Ball in Individuals with Intellectual Disabilities

The first aim of the present work was to examine the effects of a physical activity sports program, specifically Kin-Ball, within a group of individuals with intellectual disabilities, on decreasing sedentary behavior and improving basic physical skills. The second aim was to evaluate social validity and acceptability of the intervention. In this pre-experimental study, 47 individuals participated (46.8% male and 53.2% female) with an average age of 29.85 (SD = 10.41). All participants were administered an intervention program based on the alternative sport of Kin-Ball. BMI was calculated for body composition and age-related Z-scores were interpreted with the tables provided by the WHO. Endurance was measured through a modified six-minute test, speed was analyzed using a 50 m test, and strength was estimated according to a hand-grip dynamometer. Likewise, balance and coordination were examined in line with adaptations proposed by the scientific literature. Results indicated that all cases experienced statistically significant differences following the intervention program (p = 0.000). Improvement effects were detected in all post-intervention tests (endurance, strength, speed, balance, and coordination). As a main conclusion, it is indicated that an alternative sports-based program improves physical ability and motor skills in individuals with intellectual disabilities.

Upper and Lower Limb Strength and Body Posture in Children with Congenital Hypothyroidism: An Observational Case-Control Study

BACKGROUND

Congenital hypothyroidism (CH) is an endocrine disease with a precocious significant impairment of growth and neuromotor development. Thyroid hormones are essential for central nervous system development, maturation, and myelination. Furthermore, thyroid hormone deficiency affects the function of several systems, including the musculoskeletal system. The disease has a significant incidence in the general population (1:3000-1:2000 newborns in Italy). The aim of the present study was to evaluate any differences in upper and lower limb strength, body sway, and plantar loading distribution in children with CH compared to healthy children.

METHODS

In this study, the case group was composed of children with CH (CHG), while the control group included healthy children (CG). Both groups comprised 19 children (CHG: female = 12; CG: female = 9). The maximum isometric handgrip strength and explosive-elastic lower limb strength were assessed with the handgrip test and the Sargent test, respectively. The stabilometric and baropodometric analyses were used to measure the Center of Pressure displacements and the plantar loading distribution between feet, respectively. The differences between groups were analyzed by a univariate analysis of covariance using as covariates weight and height with the significant level set at < 0.05.

RESULTS

We found that CHG children were shorter and thinner than CG ones (p < 0.05). No significant difference in the upper and lower limb strength was found between groups. CHG exhibited a significant greater Sway Path Length (p < 0.01) and Ellipse Surface (p < 0.05) than CG. Moreover, CHG displayed an asymmetric plantar loading distribution with a significant lower percentage in the right than in the left foot (p < 0.05). Moreover, a significant lower plantar loading percentage in the right foot of CHG than in the right foot of CG was observed (p < 0.05).

CONCLUSIONS

These findings seem to suggest that CH does not affect muscle strength in early treated children. However, these patients show poor postural control ability and asymmetric plantar loading distribution. Increasing the physical activity in these children could improve their body posture.

Feasibility and reliability of a physical fitness tests battery for adults with intellectual disabilities: The SAMU DIS-FIT battery

BACKGROUND

People with intellectual disability (ID) have lower performances in physical fitness (PF) tests than people without ID, a situation that exists during all the life stages. However, the assessment of the FP of persons with ID often uses instruments that were designed for non-disabled people.

AIM

To check the reliability and feasibility of 8 PF tests in adults with mild to moderate ID.

METHODS

A cross-sectional study was carried out with a test-retest design in a maximum interval of 2 weeks with 240 adults (160 men and 80 women) with mild to moderate ID in order to assess the feasibility and reliability of the following 8 tests: body mass index (BMI), waist circumference (WC), the timed up & go test (TUG), the deep trunk flexion test (DTF), the hand grip test (HG), the timed stand test (TST), the 30-s sit-up (SUP) test, and the 6-min walk test (6MWT). The complete battery was called the SAMU-Disability Fitness Battery (SAMU-DISFIT). The psychometric properties of the battery, feasibility, reliability, the standard error of the measurement (SEM) and the minimal detectable change (MDC) were calculated.

RESULTS

The TUG, DTF, HG, TST, and 6MWT showed an intraclass correlation coefficient (ICC) from fair to high reliability. Only the SUP test in men had an ICC lower than 0.7 and high SEM values.

CONCLUSION

The psychometric properties provide robust data on the use of the SAMU-DISFIT battery in people with ID and can be considered a useful tool for assessing PF in adults with mild to moderate ID in future research.

The effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder: A systematic review

Difficulty performing age-appropriate motor skills affects up to 83% of children with autism spectrum disorder. This systematic review examined the effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder and the effect of motor learning strategies on motor skill acquisition, retention, and transfer. Six databases were searched from 2000 to 2019. Forty-one studies were included: 34 intervention studies and 7 motor learning studies. The overall quality of the evidence was low. Participants included 1173 children with autism spectrum disorder ranging from 3 to 19 years. Results from level II and III intervention studies supported that participation outcomes improved with a physical education intervention; activity outcomes improved with aquatic, motor activity, motor skill, and simulated horse riding interventions; and body structure and function outcomes improved with aquatic, exergaming, motor activity, motor skill, and simulated horse riding interventions. Results from level II and III motor learning studies supported that motor skill acquisition improved with visual, versus verbal, instructions but was not influenced by differences in instructional personnel. More rigorous research on motor intervention is needed with well-controlled study designs, adequate sample sizes, and manualized protocols. In addition, research on motor learning strategies is warranted as it generalizes across motor interventions.

Insulin Sensitivity, Depression/Anxiety, and Physical Fitness in At-Risk Adolescents

Poor physical fitness contributes to the early progression of cardiometabolic disease, yet the physiological and psychological factors underpinning poor fitness in at-risk adolescents are not well understood. In this study, we sought to determine the relationship of physical fitness with two developmental phenomena of adolescence, insulin resistance and depression/anxiety symptoms among at-risk youth. We conducted secondary data analyses of 241 overweight or obese adolescents (12–17 years), drawn from two study cohorts. Insulin sensitivity index was derived from oral glucose tolerance tests. Adolescents self-reported depressive symptoms and anxiety symptoms on validated surveys. A walk/run test was administered to determine perceived exertion and physical fitness (distance traveled). Insulin sensitivity was positively associated with walk/run distance ( b =0.16, P< 0.01), even after accounting for all covariates. Anxiety symptoms were inversely related to perceived exertion ( b =–0.11, P< 0.05), adjusting for covariates. These findings suggest that insulin resistance and anxiety symptoms are associated with different dimensions of physical fitness in overweight or obese adolescents and could both potentially contribute to declining fitness and worsening metabolic outcomes in at-risk youth.

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness.Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2-18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied.Results: High rates of overweight (23-25%) and obesity (10-15%) were found. A majority of the participants (71-91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27-0.44; p < 0.05).Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components.Implications for rehabilitationStrikingly low levels of physical fitness were seen in children and adolescents with moderate to severe intellectual disabilities.This vulnerable group is in need of appropriate interventions to increase their physical fitness levels.Increasing the physical activity is a potential component in these interventions.Improving motor development will most likely lead to improved physical fitness as well.

Physical exercise training for type 3 spinal muscular atrophy

BACKGROUND

Physical exercise training might improve muscle and cardiorespiratory function in spinal muscular atrophy (SMA). Optimization of aerobic capacity or other resources in residual muscle tissue through exercise may counteract the muscle deterioration that occurs secondary to motor neuron loss and inactivity in SMA. There is currently no evidence synthesis available on physical exercise training in people with SMA type 3.

OBJECTIVES

To assess the effects of physical exercise training on functional performance in people with SMA type 3, and to identify any adverse effects.

SEARCH METHODS

On 8 May 2018, we searched the Cochrane Neuromuscular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, and LILACS. On 25 April 2018 we searched NHSEED, DARE, and ClinicalTrials.gov and WHO ICTRP for ongoing trials.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) or quasi-RCTs lasting at least 12 weeks that compared physical exercise training (strength training, aerobic exercise training, or both) to placebo, standard or usual care, or another type of non-physical intervention for SMA type 3. Participants were adults and children from the age of five years with a diagnosis of SMA type 3 (Kugelberg-Welander syndrome), confirmed by genetic analysis.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures.

MAIN RESULTS

We included one RCT that studied the effects of a six-month, home-based, combined muscle strength and recumbent cycle ergometry training program versus usual care in 14 ambulatory people with SMA. The age range of the participants was between 10 years and 48 years. The study was evaluator-blinded, but personnel and participants could not be blinded to the intervention, which placed the results at a high risk of bias. Participants performed strength training as prescribed, but 50% of the participants did not achieve the intended aerobic exercise training regimen. The trial used change in walking distance on the six-minute walk test as a measure of function; a minimal detectable change is 24.0 m. The change from baseline to six months' follow-up in the training group (9.4 m) was not detectably different from the change in the usual care group (-0.14 m) (mean difference (MD) 9.54 m, 95% confidence interval (CI) -83.04 to 102.12; N = 12). Cardiopulmonary exercise capacity, assessed by the change from baseline to six months' follow-up in peak oxygen uptake (VO2max) was similar in the training group (-0.12 mL/kg/min) and the usual care group (-1.34 mL/kg/min) (MD 1.22 mL/kg/min, 95% CI -2.16 to 4.6; N = 12). A clinically meaningful increase in VO2max is 3.5 mL/kg/min.The trial assessed function on the Hammersmith Functional Motor Scale - Expanded (HFMSE), which has a range of possible scores from 0 to 66, with an increase of 3 or more points indicating clinically meaningful improvement. The HFMSE score in the training group increased by 2 points from baseline to six months' follow-up, with no change in the usual care group (MD 2.00, 95% CI -2.06 to 6.06; N = 12). The training group showed a slight improvement in muscle strength, expressed as the manual muscle testing (MMT) total score, which ranges from 28 (weakest) to 280 (strongest). The change from baseline in MMT total score was 6.8 in the training group compared to -5.14 in the usual care group (MD 11.94, 95% CI -3.44 to 27.32; N = 12).The trial stated that training had no statistically significant effects on fatigue and quality of life. The certainty of evidence for all outcomes was very low because of study limitations and imprecision. The study did not assess the effects of physical exercise training on physical activity levels. No study-related serious adverse events or adverse events leading to withdrawal occurred, but we cannot draw wider conclusions from this very low-certainty evidence.

AUTHORS' CONCLUSIONS

It is uncertain whether combined strength and aerobic exercise training is beneficial or harmful in people with SMA type 3, as the quality of evidence is very low. We need well-designed and adequately powered studies using protocols that meet international standards for the development of training interventions, in order to improve our understanding of the exercise response in people with SMA type 3 and eventually develop exercise guidelines for this condition.

Elementary school physical activity opportunities and physical fitness of students: A statewide cross-sectional study of schools

BACKGROUND

Using a cross-sectional design, we assessed the relationship between the time schools provide for physical activity and the proportion of students achieving a healthy aerobic capacity or body mass index.

METHODS

In 2013-2014, physical education and grade-level teachers from 905 of 1,244 Georgia elementary schools provided survey data about the frequency and duration of physical activity opportunities offered before, during, and after school. Log-binomial models related the weekly physical activity minutes provided by schools to the proportion of children in the FitnessGram healthy fitness zone for aerobic capacity or body mass index while adjusting for school characteristics and demographics.

RESULTS

During-school physical activity time was not associated with student fitness, but schools with before-school physical activity programs had a moderately higher prevalence of healthy aerobic capacity (prevalence ratio among girls: 1.06; 99% confidence interval: 1.00-1.13; prevalence ratio among boys: 1.03; 99% confidence interval: 0.99-1.08). Each additional 30 minutes of recess per week was associated with no more than a 3%-higher proportion of students with healthy body mass indexes (prevalence ratio among girls: 1.01; 99% confidence interval: 1.00-1.03; prevalence ratio among boys: 1.01; 99% confidence interval: 0.99-1.03).

CONCLUSIONS

The amount of physical activity time provided by schools is not strongly associated with school-aggregated student fitness. Future studies should be designed to assess the importance of school-based physical activity time on student fitness, relative to physical activity type and quality.

Is the Limit-Cycle-Attractor an (almost) invariable characteristic in human walking?

BACKGROUND

Common methods of gait analyses measure step length/width, gait velocity and gait variability to name just a few. Those parameters tend to be changing with fitness and skill of the subjects. But, do stable subject characteristic parameters in walking exist? Does the Limit-Cycle-Attractor qualify as such a parameter?.

RESEARCH QUESTION

The attractor method is a new approach focusing on the dynamics of human motion. It classifies the fundamental walking pattern by calculating the Limit-Cycle-Attractor and its variability from acceleration data of the feet. Our hypothesis is that the fundamental walking pattern in healthy controls and in people with Multiple Sclerosis (pwMS) is stable, but can be altered through acute interventions or rehabilitation.

METHODS

For this purpose, two investigations were conducted involving 113 subjects. The short-term stability was tested pre and post a 15 min passive/active MOTOmed (ergometer) session as well as up to 20 min afterwards. The long-term stability was tested over five weeks of rehabilitation once a week in pwMS. The main parameter of interest describes the velocity normalized average difference between two attractors (δM), which is an indicator for the change in movement pattern.

RESULTS

The Friedman's two-way ANOVA by ranks did not reveal any significant difference in δM. However, the conventional walking tests (6 min.10 m) improved significantly (p < 0.05) during rehabilitation. Contrary to our original hypothesis, the fundamental walking pattern was highly stable against controlled motor-assisted movement initiation via MOTOmed and rehabilitation treatment. Movement characteristics appeared to be independent of the improved fitness as indicated by the enhanced walking speed and distance.

SIGNIFICANCE

The individual Limit-Cycle-Attractor is extremely robust and might indeed qualify as an (almost) invariable characteristic in human walking. This opens up the possibility to encode the individual walking characteristics. Conditions as Parkinson, Multiple Sclerosis etc., might display disease specific distinctions via the Limit-Cycle-Attractor.

Feasibility and Reliability of Tests Measuring Health-Related Physical Fitness in Children With Moderate to Severe Levels of Intellectual Disability

Physical fitness is an important marker for health. In this study we investigated the feasibility and reliability of health-related physical fitness tests in children with moderate to severe levels of intellectual disability. Thirty-nine children (2-18 yrs) performed tests for muscular strength and endurance, the modified 6-minute walk test (6mwt) for cardiorespiratory fitness, and body composition tests, and 30-97% of the tests were successfully completed. Short-term test-retest reliability of all tests was good (Intraclass Correlation Coefficient [ICC] > .8), long-term test-retest reliability was good for most tests (ICC > .7), but low ICCs were found for most strength tests. Measuring body composition and cardiorespiratory fitness is feasible and reliable. Measuring muscle endurance is fairly feasible and reliable.

Systematic review of field-based physical fitness tests for children and adolescents with intellectual disabilities

BACKGROUND

Testing physical fitness in children and adolescents with intellectual disabilities (ID) can be challenging. This review provides an overview on psychometric properties of field-based physical fitness tests studied in children and adolescents with ID.

METHODS

A literature search was performed in March 2014. Studies were included if they evaluated feasibility, reliability and/or validity of a field-based physical fitness test in children and adolescents with ID.

RESULTS

Twenty-six papers met the inclusion criteria and described 18 tests on body composition (4), muscular strength (4), muscular endurance (6), and cardiorespiratory fitness (4). Best results on feasibility, reliability and/or validity were found for bioelectric impedance analysis, body mass index, grip strength, arm hang and distance run/walk tests. These results were mainly found in adolescents with mild to moderate ID.

CONCLUSION

Some tests were found feasible, reliable and/or valid in subgroups of children and adolescents with ID, but not in children and adolescents with all ages and levels of ID. Further assessment is needed before wider application in all children and adolescents with ID.

Physical exercise training interventions for children and young adults during and after treatment for childhood cancer

BACKGROUND

A decreased physical fitness has been reported in patients and survivors of childhood cancer. This is influenced by the negative effects of the disease and the treatment of childhood cancer. Exercise training for adult cancer patients has frequently been reported to improve physical fitness. In recent years, literature on this subject has also become available for children and young adults with cancer, both during and after treatment. This is an update of the original review that was performed in 2011.

OBJECTIVES

To evaluate the effect of a physical exercise training intervention on the physical fitness (i.e. aerobic capacity, muscle strength, or functional performance) of children with cancer within the first five years from their diagnosis (performed either during or after cancer treatment), compared to a control group of children with cancer who did not receive an exercise intervention.To determine whether physical exercise within the first five years of diagnosis has an effect on fatigue, anxiety, depression, self efficacy, and HRQoL and to determine whether there are any adverse effects of the intervention.

SEARCH METHODS

We searched the electronic databases of Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PEDro; ongoing trial registries and conference proceedings on 6 September 2011 and 11 November 2014. In addition, we performed a handsearch of reference lists.

SELECTION CRITERIA

The review included randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that compared the effects of physical exercise training with no training, in people who were within the first five years of their diagnosis of childhood cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified studies meeting the inclusion criteria, performed the data extraction, and assessed the risk of bias using standardized forms. Study quality was rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria.

MAIN RESULTS

Apart from the five studies in the original review, this update included one additional RCT. In total, the analysis included 171 participants, all during treatment for childhood acute lymphoblastic leukaemia (ALL).The duration of the training sessions ranged from 15 to 60 minutes per session. Both the type of intervention and intervention period varied in all the included studies. However, the control group always received usual care.All studies had methodological limitations, such as small numbers of participants, unclear randomization methods, and single-blind study designs in case of one RCT and all results were of moderate to very low quality (GRADE).Cardiorespiratory fitness was evaluated by the 9-minute run-walk test, timed up-and-down stairs test, the timed up-and-go time test, and the 20-m shuttle run test. Data of the 9-minute run-walk test and the timed up-and-down stairs test could be pooled. The combined 9-minute run-walk test results showed significant differences between the intervention and the control groups, in favour of the intervention group (standardized mean difference (SMD) 0.69; 95% confidence interval (CI) 0.02 to 1.35). Pooled data from the timed up-and-down stairs test showed no significant differences in cardiorespiratory fitness (SMD -0.54; 95% CI -1.77 to 0.70). However, there was considerable heterogeneity (I(2) = 84%) between the two studies on this outcome. The other two single-study outcomes, 20-m shuttle run test and the timed up-and-go test, also showed positive results for cardiorespiratory fitness in favour of the intervention group.Only one study assessed the effect of exercise on bone mineral density (total body), showing a statistically significant positive intervention effect (SMD 1.07; 95% CI 0.48 to 1.66). The pooled data on body mass index showed no statistically significant end-score difference between the intervention and control group (SMD 0.59; 95% CI -0.23 to 1.41).Three studies assessed flexibility. Two studies assessed ankle dorsiflexion. One study assessed active ankle dorsiflexion, while the other assessed passive ankle dorsiflexion. There were no statistically significant differences between the intervention and control group with the active ankle dorsiflexion test; however, in favour of the intervention group, they were found for passive ankle dorsiflexion (SMD 0.69; 95% CI 0.12 to 1.25). The third study assessed body flexibility using the sit-and-reach distance test, but identified no statistically significant difference between the intervention and control group.Three studies assessed muscle strength (knee, ankle, back and leg, and inspiratory muscle strength). Only the back and leg strength combination score showed statistically significant differences on the muscle strength end-score between the intervention and control group (SMD 1.41; 95% CI 0.71 to 2.11).Apart from one sub-scale of the cancer scale (Worries; P value = 0.03), none of the health-related quality of life scales showed a significant difference between both study groups on the end-score. For the other outcomes of fatigue, level of daily activity, and adverse events (all assessed in one study), there were no statistically significant differences between the intervention and control group.None of the included studies evaluated activity energy expenditure, time spent on exercise, anxiety and depression, or self efficacy as an outcome.

AUTHORS' CONCLUSIONS

The effects of physical exercise training interventions for childhood cancer participants are not yet convincing. Possible reasons are the small numbers of participants and insufficient study designs, but it can also be that this type of intervention is not as effective as in adult cancer patients. However, the first results show some positive effects on physical fitness in the intervention group compared to the control group. There were positive intervention effects for body composition, flexibility, cardiorespiratory fitness, muscle strength, and health-related quality of life (cancer-related items). These were measured by some assessment methods, but not all. However, the quality of the evidence was low and these positive effects were not found for the other assessed outcomes, such as fatigue, level of daily activity, and adverse events. There is a need for more studies with comparable aims and interventions, using a higher number of participants that also include diagnoses other than ALL.

Multiple components of fitness improved among overweight and obese adolescents following a community-based lifestyle intervention

Fitness is an important component of health, and obese adolescents regularly have poor fitness. Unfortunately, few have assessed the impact of community-based lifestyle interventions on multiple components of fitness. The purpose of this study was to assess the impact of participation in a community-based intervention involving adolescents and parents on multiple components of fitness of obese adolescents. In a within-subject, waitlist controlled clinical trial with 12 months follow-up in Western Australia, participants (n = 56) completed multiple fitness measures at baseline, immediately prior to beginning an 8-week intervention and at 3, 6 and 12 months during a maintenance period. Performance on the shuttle walk was improved immediately post-intervention (increase of 42.8 m, 95% CI: 7.5, 78.2) and at 12 months post-intervention (increase of 44.6 m, 95% CI: 1.3, 87.8) compared with pre-intervention. Muscle performance of quadriceps and deltoids were improved post-intervention (increase of 1.1 (95% CI: 0.1, 2.1) kg · F and 1.0 (0.02, 2.1) kg · F, respectively) and all muscle performance measures were improved at 12 months following the intervention. There were no changes in waist circumference. A community-based lifestyle programme such as Curtin University's Activity, Food and Attitudes Program (CAFAP) may be a viable strategy for improving fitness in overweight adolescents.

Distribution of health-related physical fitness in Slovak population

Purpose of the study was to examine relationship between distribution of healthy fitness zone standards of high school students and their type of housing or area of residence. Study sample consisted of 684 students (284 boys, 400 girls) from urban and rural areas of the region Presov in the eastern part of Slovakia. Physical fitness was assessed by four tests: back-saver sit and reach, shoulder stretch, curl-ups and 90° push-ups. Differences by place of residence and types of housing were examined by correspondence analysis of two-dimensional tables with computing Chi square value at significance level p < 0.05. Urban students performed higher level of flexibility, abdominal and upper strength and endurance than rural ones. Boys and girls living in a flat reached higher level of flexibility and abdominal strength/endurance however, they performed worse in upper strength and endurance than those living in a house. Slovak adolescents seem to have a healthier profile in abdominal muscular fitness and upper body flexibility than in lower body flexibility. The relationship between distribution of healthy fitness zone standards and residence area or housing type was revealed only in lower body flexibility, upper strength and endurance of urban and rural girls.

Physical activity and sedentary behavior among children and adolescents living in an area affected by the 2011 Great East Japan earthquake and tsunami for 3 years

The purpose of this study is to examine the change in physical activity levels among children and adolescents living in the area affected by the 2011 earthquake and tsunami for 3 years immediately following the disaster. Children and adolescents graded four to nine and attending school in the Pacific coastal area of northern Japan were included in a total of four serial prevalence investigations: the first at 6 months after the earthquake/tsunami (I, n = 434) and additional surveys at 1 year (II, n = 437), 2 years (III, n = 401), and 3 years (IV, n = 365) after the earthquake. Students were also required to undergo assessment of their accelerometer-determined daily steps and sedentary time using a self-administrated questionnaire. Accelerometer-determined median daily steps of children and adolescents were significantly different (p < 0.05) on both weekdays and weekends over 3 years. The median daily steps of children of both genders on weekdays and those of girls on weekends at period IV were significantly lower than those at period I. In addition, the median daily steps of adolescents on weekdays among girls and weekends among boys at period IV were significantly lower than those at period I. It appears that children and adolescents who survive the earthquake and tsunami experience a decrease in physical activity levels. Future research should elucidate longitudinal demographic and sociocultural factors that contribute to changes in physical activity levels among children and adolescents living in the areas affected by these disasters.

•

We examine changes in PA levels among children and adolescents in a disaster area.

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Four-time surveys of this serial prevalence study were conducted.

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Accelerometer-determined daily steps significantly decreased over 3 years.

•

Self-reported sedentary time on weekdays alone was significantly decreased.

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PA levels among participants in a disaster area seemed to be decreased.

The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities

PURPOSE

The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities.

SUMMARY OF KEY POINTS

Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed.

CONCLUSIONS

Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.

Adolescent fatigue, POTS, and recovery: a guide for clinicians

Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40 beats/min). A family-based approach to care with support from a multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment. The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive-behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary.

Relationship of weight-based teasing and adolescents' psychological well-being and physical health

BACKGROUND

To date, research has focused primarily on psychological correlates of weight-based teasing. In this study, we extended previous work by also examining physical health-related variables (eg, physical self-concept and physical fitness [PF]).

METHODS

Participants included 1419 middle school students (637 boys and 782 girls). Of these, 245 (17.3%) reported being teased about being overweight. Participants completed measures of self-esteem, depression, physical self-concept, physical activity (PA) self-efficacy, and self-report physical and sedentary activities. Participants also completed PF testing.

RESULTS

After controlling for demographic characteristics, participants who were teased about being overweight had higher scores on depression and lower scores on self-esteem, physical self-concept, PA self-efficacy, and health-related measures of PF in comparison to participants who were not teased.

CONCLUSIONS

The results of this study support previous research indicating relationships between teasing and low levels of psychological well-being, physical self-concept, and PA self-efficacy, and establishes one between weight-based teasing and different types of PF. Research is needed to determine the potential causal nature of the relationships between teasing and fitness and evidence-based interventions are needed to reduce weight-based teasing and its potential effects on health and well-being.

Autonomic dysfunction of overweight combined with low muscle mass

OBJECTIVE

To examine the relationship between overweight combined with low muscle mass and the cardiac autonomic nervous system using heart rate variability (HRV) in healthy workers.

METHODS

A total of 1,150 workers were included, with a mean age of 43.55 ± 11.45 years. The subjects were classified as low muscle mass if their appendicular skeletal muscle mass was below the 50th percentile of the study sample. Similarly, subjects were classified as overweight if their body mass index was above 25 kg/m(2). Electrocardiography recordings were obtained for 5 min, and the time-domain and frequency-domain indices of HRV were analyzed.

RESULTS

Compared with the high muscle mass and non-overweight (HMM) group, the low-frequency power and the standard deviation of normal-to-normal intervals were significantly decreased in both the overweight and high muscle mass (OHMM) group and the overweight and low muscle mass (OLMM) group. The significantly decreased high-frequency (HF) power and square root of the mean squared differences of successive differences, which reflects efferent parasympathetic activity, was indicative of reduced parasympathetic modulation in the OHMM and OLMM groups. In addition, the OLMM group had a lower HF power than did the OHMM group.

CONCLUSIONS

This study suggests that HRV is reduced in overweight combined with low muscle mass group than overweight and HMM group.

Exercise deficit disorder in youth: a paradigm shift toward disease prevention and comprehensive care

Despite the widely recognized benefits of daily play, recreation, sports, and physical education on the physical and psychosocial well-being of children and adolescents, many contemporary children and adolescents worldwide do not meet the recommendations for daily physical activity (PA). The decline in PA seems to start early in life, which leads to conditions characterized by reduced levels of PA in the pediatric population that are inconsistent with current public health recommendations. Unlike many other diseases and disorders in pediatrics, physical inactivity in youth is unique in that it currently lacks a clinical gold standard for diagnosis. This makes the diagnosis and treatment medically challenging, though no less important, as the resultant ramifications of a missed diagnosis are of significant detriment. Exercise-deficient children need to be identified early in life and treated with developmentally appropriate exercise programs designed to target movement deficiencies and physical weaknesses in a supportive environment. Without such interventions early in life, children are more likely to become resistant to our interventions later in life and consequently experience adverse health consequences. Integrative approaches that link health care professionals, pediatric exercise specialists, school administrators, community leaders, and policy makers may provide the best opportunity to promote daily PA, reinforce desirable behaviors, and educate parents about the exercise-health link.

Associations between health-related physical fitness and obesity in Taiwanese youth

This study examined associations between four health-related physical fitness measures and obesity in Taiwanese youth aged 10-18 years. Data from 13,500 school-aged youth were randomly selected from the "School Physical Fitness Database" of Taiwan by sex and age. Variables examined were height, body mass and performance on modified sit-and-reach (flexibility), bent-leg sit-up (abdominal muscular strength/endurance), standing long jump (lower body explosive strength) and distance run/walk (cardiorespiratory endurance). Adjusted logistic regression analyses were performed. Increased odds of being obese with decreased fitness levels were observed for lower body explosive strength and cardiorespiratory endurance in both sexes. The highest odds of being obese was found in the least fit quintile of cardiorespiratory endurance compared with the most fit quintile both in boys (Odds ratio, OR = 10.44; 95% confidence interval (CI), 7.94-13.73) and girls (OR = 5.40; 95% CI, 3.90-7.47). These findings suggest that in addition to cardiorespiratory fitness, lower body explosive strength is also associated with childhood and adolescent obesity.

Physical exercise training interventions for children and young adults during and after treatment for childhood cancer

BACKGROUND

A decreased physical fitness and impaired social functioning has been reported in patients and survivors of childhood cancer. This is influenced by the negative effects of disease and treatment of childhood cancer and by behavioural and social elements. Exercise training for adults during or after cancer therapy has frequently been reported to improve physical fitness and social functioning. More recently, literature on this subject became available for children and young adults with cancer, both during and after treatment.

OBJECTIVES

This review aimed to evaluate the effect of a physical exercise training intervention (at home, at a physical therapy centre, or hospital based) on the physical fitness of children with cancer, in comparison with the physical fitness in a care as usual control group. The intervention needed to be offered within the first five years from diagnosis.The second aim was to assess the effects of a physical exercise training intervention in this population on fatigue, anxiety, depression, self efficacy, and health-related quality of life and to assess the adverse effects of the intervention.

SEARCH METHODS

For this review the electronic databases of CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and ongoing trial registries were searched on 6 September 2011. In addition, a handsearch of reference lists and conference proceedings was performed in that same month.

SELECTION CRITERIA

The review included randomised controlled trials (RCTs) and clinical controlled trials (CCTs) that compared the effects of physical exercise training with no training, in people who were within the first five years of their diagnosis of childhood cancer.

DATA COLLECTION AND ANALYSIS

By the use of standardised forms two review authors independently identified studies meeting the inclusion criteria, performed the data extraction, and assessed the risk of bias. Quality of the studies was rated by using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria.

MAIN RESULTS

Five articles were included in this review: four RCTs (14, 14, 28, and 51 participants) and one CCT (24 participants). In total 131 participants (74 boys, 54 girls, three unknown) were included in the analysis, all being treated for childhood acute lymphoblastic leukaemia (ALL). The study interventions were all implemented during chemotherapy treatment.The duration of the training sessions ranged from 15 to 60 minutes per session. Both the type of intervention, as well as the intervention period, which ranged from 10 weeks to two years, varied in all the included studies. In all included studies the control group received care as usual.All studies had methodological limitations, such as small numbers of participants, unclear randomisation methods, and single-blind study designs in case of an RCT.Cardiorespiratory fitness was studied by the use of the nine-minute run-walk test, the timed up-and-down stairs test, and the 20-m shuttle run test. Only the up-and-down stairs test showed significant differences between the intervention and the control group, in favour of the intervention group (P value = 0.05, no further information available).Bone mineral density was assessed in one study, in which a statistically significant difference in favour of the exercise group was identified (standardised mean difference (SMD) 1.07; 95% confidence interval (CI) 0.48 to 1.66; P value < 0.001). Body mass index was assessed in two studies. The pooled data on this item did not show a statistically significant difference between the intervention and control study group.Flexibility was assessed in three studies. In one study the active ankle dorsiflexion method was used to assess flexibility and the second study they used the passive ankle dorsiflexion test. No statistically significant difference between the intervention and control group was identified with the active ankle dorsiflexion test, whereas with the passive test method a statistically significant difference in favour of the exercise group was found (SMD 0.69; 95% CI 0.12 to 1.25; P value = 0.02). The third study assessed body flexibility by the use of the sit-and-reach distance test; no statistically significant difference between the intervention and control group was identified.One study assessed the effects of an inspiratory muscle training programme aimed to train the lung muscles and increase physical fitness. This study reported no significant effect on either inspiratory or expiratory muscle strength. Two other studies using either knee and ankle strength changes by hand-held dynamometry or the number of completed push-ups (with knees on the ground) and a peripheral quantitative computed tomography of the tibia to determine the muscle mass did not identify statistically significant differences in muscle strength/endurance.The level of daily activity, health-related quality of life, fatigue, and adverse events were assessed in one study only; for all these items no statistically significant differences between the intervention and control group were found.None of the included studies evaluated the outcomes activity energy expenditure, time spent exercising, anxiety and depression, or self efficacy.

AUTHORS' CONCLUSIONS

The effects of physical exercise training interventions for childhood cancer participants are not yet convincing due to small numbers of participants and insufficient study methodology. Despite that, first results show a trend towards an improved physical fitness in the intervention group compared to the control group. Changes in physical fitness were seen by improved body composition, flexibility, and cardiorespiratory fitness. However, the evidence is limited and these positive effects were not found for the other assessed outcomes, such as muscle strength/endurance, the level of daily activity, health-related quality of life, and fatigue. There is a need for more studies with comparable aims and interventions, using higher numbers of participants and for studies with another childhood cancer population than ALL only.

Responding to exercise-deficit disorder in youth: integrating wellness care into pediatric physical therapy

THE PROBLEM

The decline and disinterest in regular physical activity among contemporary youth have created an immediate need to identify and treat these youngsters before they become resistant to our interventions.

KEY POINTS

Exercise-deficit disorder is a term used to describe a condition characterized by reduced levels of physical activity that are inconsistent with current public health recommendations. Pediatric physical therapists are in an enviable position to identify and treat exercise-deficit disorder in youth, regardless of body size or physical ability.

RECOMMENDATION

If pediatric physical therapists want to become advocates for children's health and wellness, there is a need to address limitations in the physical therapist professional curriculum, educate families on the benefits of wellness programming, and initiate preventive strategies that identify youth who are inactive, promote daily physical activity, and encourage healthy lifestyle choices.

Reference values for the muscle power sprint test in 6- to 12-year-old children

PURPOSE

The aims of this study were (1) to develop centile reference values for anaerobic performance of Dutch children tested using the Muscle Power Sprint Test (MPST) and (2) to examine the test-retest reliability of the MPST.

METHODS

Children who were developing typically (178 boys and 201 girls) and aged 6 to 12 years (mean = 8.9 years) were recruited. The MPST was administered to 379 children, and test-retest reliability was examined in 47 children. MPST scores were transformed into centile curves, which were created using generalized additive models for location, scale, and shape.

RESULTS

Height-related reference curves were created for both genders. Excellent (intraclass correlation coefficient = 0.98) test-retest reliability was demonstrated.

CONCLUSIONS

The reference values for the MPST of children who are developing typically and aged 6 to 12 years can serve as a clinical standard in pediatric physical therapy practice. The MPST is a reliable and practical method for determining anaerobic performance in children.