• 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.
    • 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.
    • 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.
    • 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.