• Canadian Society for Exercise Physiology Position Paper: Resistance Training in Children and Adolescents

      Behm, David G.; Faigenbaum, Avery D.; Falk, Bareket; Klentrou, Panagiota (2008)
      Many position stands and review papers have refuted the myths associated with resistance training (RT) in children and adolescents. With proper training methods, RT for children and adolescents can be relatively safe and improve overall health. The objective of this position paper and review is to highlight research and provide recommendations in aspects of RT that have not been extensively reported in the pediatric literature. In addition to the well-documented increases in muscular strength and endurance, RT has been used to improve function in pediatric patients with cystic fibrosis, cerebral palsy and burn victims. Increases in children’s muscular strength have been attributed primarily to neurological adaptations due to the disproportionately higher increase in muscle strength than in muscle size. Although most studies using anthropometric measures have not shown significant muscle hypertrophy in children, more sensitive measures such as magnetic resonance imaging and ultrasound have suggested hypertrophy may occur. There is no minimum age for RT for children. However the training and instruction must be appropriate for children and adolescents involving a proper warm-up, cool-down and an appropriate choice of exercises. It is recommended that low-to-moderate intensity resistance should be utilized 2-3 times per week on non-consecutive days, with 1-2 sets initially, progressing to 4 sets of 8-15 repetitions for 8-12 exercises. These exercises can include more advanced movements such as Olympic style lifting, plyometrics and balance training, which can enhance strength, power, co-ordination and balance. However specific guidelines for these more advanced techniques need to be established for youth. In conclusion, a RT program that is within a child’s or adolescent’s capacity, involves gradual progression under qualified instruction and supervision with appropriately sized equipment can involve more advanced or intense RT exercises which can lead to functional (i.e. muscular strength, endurance, power, balance and co-ordination) and health benefits.
    • Do Neuro-Muscular Adaptations Occur in Endurance-Trained Boys and Men?

      Cohen, Rotem; Mitchell, Cam; Dotan, Raffy; Gabriel, David; Klentrou, Panagiota; Falk, Bareket (2010)
      Most research on the effects of endurance training has focused on endurance training's health-related benefits and metabolic effects in both children and adults. The purpose of this study was to examine the neuromuscular effects of endurance training and to investigate whether they differ in children (9.0-12.9 years) and adults (18.4-35.6 years). Maximal isometric torque, rate of torque development (RTD), rate of muscle activation (Q30), electromechanical delay (EMD), and time to peak torque and peak RTD were determined by isokinetic dynamometry and surface electromyography (EMG) in elbow and knee flexion and extension. The subjects were 12 endurance-trained and 16 untrained boys, and 15 endurance-trained and 20 untrained men. The adults displayed consistently higher peak torque, RTD, and Q30, in both absolute and normalized values, whereas the boys had longer EMD (64.7+/-17.1 vs. 56.6+/-15.4 ms) and time to peak RTD (98.5+/-32.1 vs. 80.4+/-15.0 ms for boys and men, respectively). Q30, normalized for peak EMG amplitude, was the only observed training effect (1.95+/-1.16 vs. 1.10+/-0.67 ms for trained and untrained men, respectively). This effect could not be shown in the boys. The findings show normalized muscle strength and rate of activation to be lower in children compared with adults, regardless of training status. Because the observed higher Q30 values were not matched by corresponding higher performance measures in the trained men, the functional and discriminatory significance of Q30 remains unclear. Endurance training does not appear to affect muscle strength or rate of force development in either men or boys.
    • Isoflavone exposure throughout suckling results in improved adult bone health in mice

      Dinsdale, E.C.; Kaludjerovic, J; Ward, W.E. (Cambridge University Press, 2012-02-15)
      Exposure to isoflavones (ISO), abundant in soy protein infant formula, for the first 5 days of life results in higher bone mineral density (BMD),greater trabecular connectivity and higher fracture load of lumbar vertebrae (LV) at adulthood. The effect of lengthening the duration of exposure to ISO on bone development has not been studied. This study determined if providing ISO for the first 21 days of life, which more closely mimics the duration that infants are fed soy protein formula, results in higher BMD, improved bone structure and greater strength in femurs and LV than a 5-day protocol. Female CD-1 mice were randomized to subcutaneous injections of ISO (7 Q1 mg kg/body weight/day) or corn oil from postnatal day 1 to 21. BMD, structure and strength were measured at the femur and LV at 4 months of age, representing young Q2 adulthood. At the LV, exposure to ISO resulted in higher (P,0.05) BMD, trabecular connectivity and fracture load compared with control (CON). Exposure to ISO also resulted in higher (P,0.05) whole femur BMD, higher (P,0.05) bone volume/total volume and Q3 lower (P,0.05) trabecular separation at the femur neck, as well as greater (P,0.05) fracture load at femur midpoint and femur neck compared with the CON group. Exposure to ISO throughout suckling has favorable effects on LV outcomes, and, unlike previous studies using 5-day exposure to ISO, femur outcomes are also improved. Duration of exposure should be considered when using the CD-1 mouse to model the effect of early life exposure of infants to ISO.
    • EARLY LIFE EXPOSURE TO GENISTEIN AND DAIDZEIN DISRUPTS STRUCTURAL DEVELOPMENT OF REPRODUCTIVE ORGANS IN FEMALE MICE

      Kaludjerovic, Jovana; Chen, Jianmin; Ward, Wendy E. (Taylor & Francis, 2012-04-04)
      In mice, exposure to isoflavones (ISO), abundant in soy infant formula, during the first 5 d of life alters structural and functional development of reproductive organs. Effects of longer exposures are unknown. The study objective was to evaluate whether exposure to a combination of daidzein and genistein in the first 10 compared to 5 d of life results in greater adverse effects on ovarian and uterine structure in adult mice. Thirteen litters of 8–12 pups were cross-fostered and randomized to corn oil or ISO (2 mg daidzein + 5 mg genistein/kg body weight/d) for the first 5 or 10 d of life. The 10-d protocol mimicked the period when infants are fed soy protein formula (SPF) but avoids the time when suckling pups can consume the mother’s diet. Body and organ weights and histology of ovaries and uteri were analyzed. There were no differences in the ovary or uterus weight, number of ovarian follicles, number of multiple oocyte follicles, or percent of ovarian cysts with 5 or 10 d of ISO intervention compared to respective controls. The 10-d ISO group had higher body weights from 6 d to 4 mo. of age and a higher percent of hyperplasia in the oviduct than the respective control. Lower numbers of ovarian corpus lutea and a higher incidence of abnormal changes were reported in the uteri of both ISO groups compared to their respective controls. Five- and 10-d exposure to ISO had similar long-lasting adverse effects on the structures of ovaries and uterus in adult mice. Only the 10-d ISO exposure resulted in greater body weight gain at adulthood.
    • Higher PLIN5 but not PLIN3 content in isolated skeletal muscle mitochondria following acute in vivo contraction in rat hindlimb

      Ramos, Sofhia; MacPherson, Rebecca E. K.; Turnbull, Patrick C; Bott, Kirsten N.; LeBlanc, Paul; Ward, Wendy E.; Peters, Sandra J. (American Physiological Society, 2014-08-22)
      Contraction-mediated lipolysis increases the association of lipid droplets and mitochondria, indicating an important role in the passage of fatty acids from lipid droplets to mitochondria in skeletal muscle. PLIN3 and PLIN5 are of particular interest to the lipid droplet–mitochondria interaction because PLIN3 is able to move about within cells and PLIN5 associates with skeletal muscle mitochondria. This study primarily investigated: 1) if PLIN3 is detected in skeletal muscle mitochondrial fraction; and 2) if mitochondrial protein content of PLIN3 and/or PLIN5 changes following stimulated contraction. A secondary aim was to determine if PLIN3 and PLIN5 associate and whether this changes following contraction. Male Long Evans rats (n = 21;age, 52 days; weight = 317 6 g) underwent 30 min of hindlimb stimulation (10 msec impulses, 100 Hz/3 sec at 10–20 V; train duration 100 msec). Contraction induced a ~50% reduction in intramuscular lipid content measured by oil red-O staining of red gastrocnemius muscle. Mitochondria were isolated from red gastrocnemius muscle by differential centrifugation and proteins were detected by western blotting. Mitochondrial PLIN5 content was ~1.6-fold higher following 30 min of contraction and PLIN3 content was detected in the mitochondrial fraction, and unchanged following contraction. An association between PLIN3 and PLIN5 was observed and remained unaltered following contraction. PLIN5 may play a role in mitochondria during lipolysis, which is consistent with a role in facilitating/regulating mitochondrial fatty acid oxidation. PLIN3 and PLIN5 may be working together on the lipid droplet and mitochondria during contraction-induced lipolysis.
    • Does bracing affect bone health in women with adolescent idiopathic scoliosis?

      Akseer, Nasreen; Kish, Kimberly; Rigby, W Alan; Greenway, Matthew; Klentrou, Panagiota; Wilson, Philip M; Falk, Bareket (BioMed Central, 2015)
      Purpose: Adolescent idiopathic scoliosis (AIS) is often associated with low bone mineral content and density (BMC, BMD). Bracing, used to manage spine curvature, may interfere with the growth-related BMC accrual, resulting in reduced bone strength into adulthood. The purpose of this study was to assess the effects of brace treatment on BMC in adult women, diagnosed with AIS and braced in early adolescence. Methods: Participants included women with AIS who: (i) underwent brace treatment (AIS-B, n = 15, 25.6 ± 5.8 yrs), (ii) underwent no treatment (AIS, n = 15, 24.0 ± 4.0 yrs), and (iii) a healthy comparison group (CON, n = 19, 23.5 ± 3.8 yrs). BMC and body composition were assessed using dual-energy X-ray absorptiometry. Differences between groups were examined using a oneway ANOVA or ANCOVA, as appropriate. Results: AIS-B underwent brace treatment 27.9 ± 21.6 months, for 18.0 ± 5.4 h/d. Femoral neck BMC was lower (p = 0.06) in AIS-B (4.54 ± 0.10 g) compared with AIS (4.89 ± 0.61 g) and CON (5.07 ± 0.58 g). Controlling for lean body mass, calcium and vitamin D daily intake, and strenuous physical activity, femoral neck BMC was statistically different (p = 0.02) between groups. A similar pattern was observed at other lower extremity sites (p < 0.05), but not in the spine or upper extremities. BMC and BMD did not correlate with duration of brace treatment, duration of daily brace wear, or overall physical activity. Conclusion: Young women with AIS, especially those who were treated with a brace, have significantly lower BMC in their lower limbs compared to women without AIS. However, the lack of a relationship between brace treatment duration during adolescence and BMC during young adulthood, suggests that the brace treatment is not the likely mechanism of the low BMC.
    • The electromyographic threshold in boys and men

      Pitt, Brynlynn; Dotan, Raffy; Millar, Jordan; Long, Devon; Tokuno, Craig; O'Brien, Thomas (Springer, 2015-01-15)
      Abstract Background Children have been shown to have higher lactate (LaTh) and ventilatory (VeTh) thresholds than adults, which might be explained by lower levels of type-II motor-unit (MU) recruitment. However, the electromyographic threshold (EMGTh), regarded as indicating the onset of accelerated type-II MU recruitment, has been investigated only in adults. Purpose To compare the relative exercise intensity at which the EMGTh occurs in boys versus men. Methods Participants were 21 men (23.4 ± 4.1 years) and 23 boys (11.1 ± 1.1 years), with similar habitual physical activity and peak oxygen consumption (VO2pk) (49.7 ± 5.5 vs. 50.1 ± 7.4 ml kg−1 min−1, respectively). Ramped cycle ergometry was conducted to volitional exhaustion with surface EMG recorded from the right and left vastus lateralis muscles throughout the test (~10 min). The composite right–left EMG root mean square (EMGRMS) was then calculated per pedal revolution. The EMGTh was then determined as the exercise intensity at the point of least residual sum of squares for any two regression line divisions of the EMGRMS plot. Results EMGTh was detected in 20/21 of the men (95.2 %) and only in 18/23 of the boys (78.3 %). The boys’ EMGTh was significantly higher than the men’s (86.4 ± 9.6 vs. 79.7 ± 10.0 % of peak power output at exhaustion; p < 0.05). The pattern was similar when EMGTh was expressed as percentage of VO2pk. Conclusions The boys’ higher EMGTh suggests delayed and hence lesser utilization of type-II MUs in progressive exercise, compared with men. The boys–men EMGTh differences were of similar magnitude as those shown for LaTh and VeTh, further suggesting a common underlying factor.
    • The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

      Ashish, Naveen; Bamman, Marcas; Cerny, Frank; Cooper, Dan; d'Memecourt, Pierre; Eisenmann, Joey; Ericson, Dawn; Fahey, John; Falk, Bareket; Gabriel, Davera; et al. (Wiley, 2015-02)
      In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the child health spectrum.
    • Comparison of different wheelchair seating on thermoregulation and perceptual responses in thermoneutral and hot conditions in children

      Mallette, Matthew M.; Hodges, Gary J.; Klentrou, Panagiota; Cheung, Stephen S.; Falk, Bareket (Elsevier Ltd, 2019-04-24)
      We examined the effects of 4 different wheelchair seatings on physiological and perceptual measures in 21 healthy, pre-pubertal children (9 ± 2 years). Participants were able-bodied and did not regularly use a wheelchair. Participants sat for 2 h in Neutral (∼22.5 °C, ∼40%RH) and Hot (∼35 °C, ∼37%RH) conditions. Four seating technologies were: standard incontinent cover and cushion (SEAT1); standard incontinent cover with new cushion (SEAT2) were tested in Neutral and Hot; new non-incontinent cover with new cushion (SEAT3); new incontinent cover and new cushion (SEAT4) were tested in Neutral only. Measurements included skin blood flow (SkBF), sweating rate (SR) and leg skin temperature (TlegB) on the bottom of the leg (i.e. skin-seat interface), heart rate (HR), mean skin temperature, tympanic temperature, thermal comfort, and thermal sensation. During Neutral, SkBF and TlegB were lower (∼50% and ∼1 °C, respectively) and SR higher (∼0.5 mg cm−2·min−1) (p < 0.05) with SEAT3 compared to all other seats. SkBF was ∼30% lower (p p > 0.05). During Hot, HR and temperatures were higher than in Neutral but there were no differences (p > 0.05) between SEATs. New cover and cushion improved thermoregulatory responses during Neutral but not Hot. An impermeable incontinent cover negated improvements from cushion design. Seat cover appears more important than seat cushion during typical room conditions.
    • Predicting Lower Quarter Y-Balance Test Performance from Foot Characteristics

      Chimera, Nicole J.; Larson, Mallorie (Human Kinetics, 2020)
      The lower quarter Y-Balance Test (YBT-LQ) is associated with injury risk; however, ankle range of motion impacts YBT-LQ. Arch height and foot sensation impact static balance, but these characteristics have not yet been evaluated relative to YBT-LQ. Determine if arch height index (AHI), forefoot sensation (SEN), and ankle dorsiflexion predict YBT-LQ composite score (CS). Descriptive cohort. Athletic training laboratory. Twenty general population (14 females and 6 males; mean [SD]: age 35 [18] y, weight 70.02 [16.76] kg, height 1.68 [0.12] m) participated in this study. AHI measurement system assessed arch height in 10% (AHI10) and 90% (AHI90) weight-bearing. Two-point discrim-a-gon discs assessed sensation (SEN) at the plantar great toe, third and fifth metatarsal heads. Biplane goniometer and weight-bearing lunge tests were used to measure static and weight-bearing dorsiflexion, respectively. The YBT-LQ assessed dynamic single-leg balance. For right-limb dynamic single-leg balance, AHI90 and SEN were included in the final sequential prediction equation; however, neither model significantly (P = .052 and .074) predicted variance in YBT-LQ CS. For left-limb dynamic single-leg balance, both SEN and weight-bearing lunge test were included in the final sequential prediction equation. The regression model (SEN and weight-bearing lunge test) significantly (P = .047) predicted 22% of the variance in YBT-LQ CS. This study demonstrates that foot characteristics may play a role in YBT-LQ CS. The authors did not assess limb dominance in this study; therefore, the authors are unable to determine which limb would be the stance versus kicking limb. However, altered SEN and weight-bearing dorsiflexion appear to be contributing factors to YBT-LQ CS.
    • Association of Functional Screening Tests and Noncontact Injuries in Division I Women Student-Athletes

      Warren, Meghan; Lininger, Monica R.; Smith, Craig A.; Copp, Adam J.; Chimera, Nicole J. (Lippincott, Williams & Wilkins, 2020)
      To determine the association between functional screening tests and lower-body, noncontact injuries in Division I women basketball, soccer, and volleyball student-athletes (SA). Sixty-eight injury-free women SA (age19.1 ± 1.1 years, height171.3 ± 8.7 cm, and mass68.4 ± 9.5 kg) were tested preseason with single hop (SH), triple hop (TH), and crossover hop (XH) for distance, and isometric hip strength (abduction, extension, and external rotation) in randomized order. The first lower-body (spine and lower extremity), noncontact injury requiring intervention by the athletic trainer was abstracted from the electronic medical record. Receiver operating characteristic and area under the curve (AUC) were calculated to determine cut-points for each hopping test from the absolute value of between-limb difference. Body mass–adjusted strength was categorized into tertiles. Logistic regression determined the odds of injury with each functional screening test using the hopping tests cut-points and strength categories, adjusting for previous injury. Fifty-two SA were injured during the sport season. The cut-point for SH was 4 cm (sensitivity = 0.77, specificity = 0.43, and AUC = 0.53), and for TH and XH was 12 cm (sensitivity = 0.75 and 0.67, specificity = 0.71 and 0.57, AUC = 0.59 and 0.41, respectively). A statistically significant association with TH and injuries (adjusted odds ratio = 6.50 [95% confidence interval1.69–25.04]) was found. No significant overall association was found with SH or XH, nor with the strength tests. Using a clinically relevant injury definition, the TH showed the strongest predictive ability for noncontact injuries. This hopping test may be a clinically useful tool to help identify increased risk of injury in women SA participating in high-risk sports.