Partnering with families known to child protection in an interprofessional context.

BACKGROUND: To meet the diverse needs of children and their families known to child protection, interprofessional collaboration across a range of services is critical. Children and their parents/caregivers are key stakeholders in these collaborations and current research highlights the need to strengthen their participation in these service responses. Practitioners have a critical role in strengthening family member participation in child welfare and protection responses. OBJECTIVE: To explore professional's experiences and perceptions of working in partnership with children and families known to child protection in an interprofessional context. PARTICIPANTS AND SETTING: 14 professionals with extensive experience in the fields of family support and child protection. METHODS: Semi-structured interviews were completed, recorded, transcribed, and then coded using NVivo 12 Pro. Reflexive thematic analysis was used to guide data analysis. RESULTS: Trusting practitioner-family relationships were affirmed to be critical to engaging and partnering with families. Results pertaining to the interprofessional context encourage a more community-oriented perspective of practitioner-family relationships, where practitioners have a collective responsibility to welcome families into an integrated network of community services. Further, the conflict for child protection practitioners between their legislated role and their need to build trusting relationships with families to support partnered work is discussed. CONCLUSIONS: The centrality of practitioner-family relationships needs to be better recognized and supported in policy and practice across all sectors supporting children and families known to child protection. An interprofessional approach to building practitioner-family relationships across this range of services may enhance family engagement and partnerships in their service responses.

Parent and early childhood educator perspectives of unstructured nature play for young children: A qualitative descriptive study.

Nature play is growing in popularity, with many early childhood settings transforming their outdoor play environments to incorporate more natural elements. Current research highlights the benefits of engaging in unstructured nature play for children's health and development; yet little is known about the experiences of key nature play end-users such as parents and early childhood educators, even though they directly impact the application of nature play within early childhood settings. This study aimed to address this knowledge gap by exploring parent and early childhood educator (ECE) perspectives to gain an understanding about their experiences with nature play. Using a qualitative descriptive approach, semi-structured in-person and telephone interviews were conducted with 18 ECE and 13 parents across four early childhood centres (from various socio-economic regions) across metropolitan Adelaide, South Australia during 2019-2020. Interviews were audio-recorded and transcribed verbatim. Thematic analysis identified five main themes; positive affirmations of nature play, factors influencing nature play engagement, defining nature play, outdoor play space design and risky play. Children's connection to the natural world, learning about sustainability, emotional regulation, and children discovering their own capabilities were perceived advantages of engaging in nature play. Despite the benefits, ECE's described institutional barriers such as resourcing, adhering to policies and scheduling conflicts, whereas, parents described time, getting dirty and proximity to nature play spaces as barriers to nature play engagement. Parents and ECEs alike described adults as gatekeepers for play, especially when other daily tasks compete for their time, or when faced with weather-imposed barriers (cold, rain, extreme heat in summer). The findings suggest that parents and ECEs may need additional resources and guidance on how to engage with nature play and how to overcome barriers within early childhood settings and the home environment.

Ratings of perceived exertion from a submaximal 20-m shuttle run test predict peak oxygen uptake in children and the test feels better.

PURPOSE: To determine the validity and test-retest reliability of using ratings of perceived exertion (RPE) elicited during a submaximal 20-m Shuttle Run Test (20mSRT) to predict VO2peak in children and investigate acute affective responses. METHODS: Twenty-five children (14 boys; age, 12.8 ± 0.7 years; height, 162.0 ± 9.3 cm; mass, 49.9 ± 7.7 kg) completed four exercise tests (GXT, 2 submaximal 20mSRT, maximal 20mSRT). The Eston-Parfitt RPE scale was used, and affect was measured with the Feeling Scale. Submaximal 20mSRT were terminated upon participants reporting RPE7. The speed-RPE relationship from the submaximal 20mSRTs was extrapolated to RPE9 and 10 to predict peak speed and then used to estimate VO2peak. RESULTS: Repeated measures ANOVA to examine the validity of using submaximal RPE to predict VO2peak resulted in a Gender main effect (boys = 46.7 ± 5.1 mL kg-1 min-1; girls = 42.0 ± 5.1 mL kg-1 min-1) and Method main effect (p < 0.01). There were significant differences between measured and estimated VO2peak from the maximal 20mSRT, but not between measured and estimated VO2peak at RPE9 and RPE10. Intraclass correlation analysis revealed excellent reliability (~ 0.9) between the two submaximal 20mSRTs. Significant differences (p < 0.05) in end-test affect were reported between submaximal and maximal trials in girls, but not in boys, with girls feeling less negative at the end of the submaximal trials. CONCLUSIONS: The results of this study provide evidence that RPE reported during a submaximal 20mSRT can be used to predict VO2peak accurately and reliably. In this study, the submaximal 20mSRT ending at RPE7, provided better predictions of VO2peak while minimising aversive end-point affect, especially in girls.

Early mobilisation in critically ill children: Does routine patient screening reduce time to commencing mobilisation?

OBJECTIVE: The objective of this study was to investigate the impact of daily screening for medical readiness to participate in early mobilisation in the paediatric intensive care unit (PICU), on reducing time to mobilisation and to explore the safety-, feasibility-, and patient-level barriers to the practice. METHODS: An interventional study with a historical control group was conducted in a PICU in a tertiary teaching hospital in Australia. The Early Mobilisation Screening Checklist was applied at 24-48 h of PICU stay with the aim to reduce time to commencing mobilisation. All patients aged term to 18 years admitted to the PICU for >48 h were included in this study. Data on time to mobilisation and patient characteristics were collected by an unblinded case note audit of children admitted to the PICU over 5 months in 2018 for the baseline group and over a corresponding period in 2019 for the intervention group. MEASUREMENTS AND MAIN RESULTS: A total of 71 children were enrolled. Survival analysis was used to compare time to mobilisation between groups, and a cox regression model found that children in the intervention group were 1.26 times more likely to participate in mobility, but this was not statistically significant (P = 0.391, log rank test for equality of survival functions). Early mobilisation was safe, with no adverse events reported in 177 participant mobilisation days. Feasibility was demonstrated by 62% of participants mobilising within 72 h of admission. Mechanical ventilation during stay (P = 0.043) and days receiving sedation infusion (% of days) (P = 0.042) were associated with a decreased likelihood of participating in mobility. CONCLUSIONS: Implementation of routine screening alone does not significantly reduce time to commencing mobility in the PICU. Early mobilisation in the PICU is safe and feasible and resulted in no adverse events during mobilisation. Patient characteristics influencing participation in mobility warrant further exploration.

Monkey see, monkey do? Exploring parent-athlete behaviours from youth athletes' perspective.

Parents are an important social agent that can shape their child's behaviour in sport. However, the association between a youth athlete's perception of their parent's sideline sport behaviour and their own sporting behaviours is currently unclear. Therefore, the purpose of the present study was to explore the relationship between parent and youth athlete behaviours in sport settings. Australian youth athletes (n = 67) participating in team-based sports completed an online survey where they reported their parents positive and negative sideline behaviours and their own prosocial and antisocial sport behaviour during the past month. Linear regression results suggested that parent's positive behaviours were associated with youth prosocial behaviours, whereas parent's negative behaviours were associated with youth antisocial behaviours. Results provide preliminary quantitative evidence that youth athletes' perceptions of their parents' sideline behaviours predict their own on-field behaviours. As antisocial athlete behaviours were positively associated with parent negative behaviours, sport organisations should target, and ideally eliminate, negative parent behaviours. Conversely, to improve prosocial athlete behaviour, encouraging positive parent behaviours should be promoted.

Setting up girls for success in fundamental motor skills: The role of balance in 8-10 year olds.

The purpose of this study was to explore the relationship between postural control and fundamental motor skills in girls. An observational cross-sectional study was conducted in 47 girls, aged 8-10 years. Postural control (postural sway centre of pressure) was evaluated during tandem stance, leading with dominant and non-dominant limbs with eyes open and closed, using an AMTI force platform. Fundamental motor skills were assessed using the Test of Gross Motor Development 2nd Edition, examining total, locomotor and object control scores. Data were analysed using linear regression, adjusted for body mass index percentile and household income. For locomotor skills, significant relationships were found with a number of postural sway outcomes for adjusted and unadjusted analyses (r - 0.287 to r - 0.425, p ≤ 0.042). Total motor skill score was significantly related to postural sway in the tandem dominant eyes closed condition for unadjusted and adjusted analyses (r ≥ -0.294, p ≤ 0.04). In conclusion, our findings indicate that postural control may be important for fundamental motor skill proficiency and movement quality in pre-adolescent girls, particularly for locomotor skills. Our study provides evidence supporting the clinical practice of assessing postural control in girls presenting with motor skill deficits.

Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination.

PURPOSE OF REVIEW: The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice. RECENT FINDINGS: A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.

Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review.

ABSTRACT: Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

Physiotherapy and related management for childhood obesity: A systematic scoping review.

INTRODUCTION: Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD: A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS: From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION: When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

The Use of Ratings of Perceived Exertion in Children and Adolescents: A Scoping Review.

In adults, ratings of perceived exertion (RPE) can be used to predict maximal oxygen uptake, estimate time to exhaustion, assess internal training load and regulate exercise intensity. However, the utility of RPE in children is less researched and therefore, warrants investigation. The purpose of this scoping review is to map out the literature around the application of RPE specifically during aerobic exercise in paediatric populations. Seven bibliographic databases were systematically searched. Grey literature searching and pearling of references were also conducted. To be included for the review, studies were required to comply with the following: (1) participants aged ≤ 18 years asymptomatic of any injuries, disabilities or illnesses; (2) applied RPE in aerobic exercise, testing and/or training; (3) included at least one measure of exercise intensity; and (4) be available in English. The search identified 22 eligible studies that examined the application of RPE in children. These studies involved a total of 718 participants across ten different countries. Nine different types of RPE scales were employed. Overall, the application of RPE in paediatric populations can be classified into three distinct themes: prediction of cardiorespiratory fitness/performance, monitoring internal training loads, and regulation of exercise intensity. The utility of RPE in paediatric populations remains unclear due to the small body of available research and inconsistencies between studies. However, findings from the included studies in this scoping review may show promise. Further research focussing on child-specific RPE scales across various sports, subgroups, and in field-based settings is needed.

Obesity, the new childhood disability? An umbrella review on the association between adiposity and physical function.

The adverse physical impacts of childhood obesity are increasingly being recognized. The objective of this study is to examine relationships between physical function and adiposity in youth. An umbrella review searched seven databases from inception to May 2019 for systematic reviews examining associations between adiposity and physical function in 0-20-year-olds. Findings were synthesized using the International Classification of Functioning, Disability and Health Framework and NHMRC FORM. Seventeen of 21 systematic reviews reported impairments to body function, including cardiorespiratory fitness (CRF), muscle function, balance/coordination, gait biomechanics, pain and injury. Six reviews reported activity restrictions in motor skills, running speed/agility and functional mobility, and two found inverse associations between adiposity and physical health-related quality of life (p-HRQOL). Some causal relationships indicated that adiposity inversely predicted p-HRQOL/CRF and CRF/muscle function inversely predicted adiposity. Assessments of physical function were heterogeneous and impacts on participation in life situations meaningful to the individual were largely unknown. Substantial evidence associates childhood overweight/obesity with reduced physical function. Associations were mainly cross-sectional, with causative evidence for some outcomes. Comprehensive physical function assessments by qualified health professionals are needed, along with targeted interventions to address deficits. Research should further examine causality of relationships, underlying mechanisms and participation challenges in real-life contexts.

The Physiotherapy in Preschools Program: Describing a Student-Led Assessment Service for Children With Possible Motor Skill Difficulties.

The aim of this study was to describe and undertake an initial evaluation of a student-led assessment service for children with possible motor-skill difficulties. A secondary analysis of cross-sectional descriptive clinical data collected from 2015 to 2016 was undertaken. Children (N = 102) were assessed in preschools by physiotherapy students (supervised by qualified physiotherapists). Key outcomes included the following: Children's Activities Scale, Movement Assessment Battery for Children-2, and demographic/service-usage/onward referral statistics. The results highlighted that for every five children referred/assessed, two were at risk of motor-skill difficulties (∼43%). About 66% of children were subsequently referred on or monitored (40% requiring multidisciplinary follow-up). Conversely 34% of children did not require further services. In conclusion, a student-led assessment service may be a sustainable and feasible option to assist children at risk of motor-skill difficulties, enabling onward referral. Additional evaluation is required to garner stakeholder feedback.

The impacts of unstructured nature play on health in early childhood development: A systematic review.

BACKGROUND: Nature play is growing in popularity as children's play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children's play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development. AIM: To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2-12 years. METHODS: Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2-12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework. RESULTS: Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used. CONCLUSIONS: While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children's play spaces in different contexts.

Relationships between adiposity and postural control in girls during balance tasks of varying difficulty.

OBJECTIVE: This study aimed to examine associations between postural control and body composition in 8-10-year-old girls. METHODS: An observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling. RESULTS: BMI percentile was positively associated with COP sway area (p=0.034) and principal axis (p=0.030) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open (p=0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes (p≤0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed; tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)]. CONCLUSIONS: Girls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls' postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).

Longer-term effects of minimalist shoes on running performance, strength and bone density: A 20-week follow-up study.

This study investigated whether male runners improve running performance, running economy, ankle plantar flexor strength, and alter running biomechanics and lower limb bone mineral density when gradually transitioning to using minimalist shoes for 100% of weekly running. The study was a planned follow-up of runners (n = 50) who transitioned to minimalist or conventional shoes for 35% of weekly structured training in a previous 6-week randomised controlled trial. In that trial, running performance and economy improved more with minimalist shoes than conventional shoes. Runners in each group were instructed to continue running in their allocated shoe during their own preferred training programme for a further 20 weeks while increasing allocated shoe use to 100% of weekly training. At the 20-week follow-up, minimalist shoes did not affect performance (effect size: 0.19; p = 0.218), running economy (effect size: ≤ 0.24; p ≥ 0.388), stride rate or length (effect size: ≤ 0.12; p ≥ 0.550), foot strike (effect size: ≤ 0.25; p ≥ 0.366), or bone mineral density (effect size: ≤ 0.40; p ≥ 0.319). Minimalist shoes increased plantar flexor strength more than conventional shoes when runners trained with greater mean weekly training distances (shoe*distance interaction: p = 0.036). After greater improvements with minimalist shoes during the initial six weeks of a structured training programme, increasing minimalist shoe use from 35% to 100% over 20 weeks, when runners use their own preferred training programme, did not further improve performance, running economy or alter running biomechanics and lower limb bone mineral density. Minimalist shoes improved plantar flexor strength more than conventional shoes in runners with greater weekly training distances.

Not all sedentary behaviour is equal: Children's adiposity and sedentary behaviour volumes, patterns and types.

OBJECTIVE: The importance of different constructs of sedentary behaviours in relation to childhood obesity is uncertain. Thus, this study aimed to investigate relationships between volume, patterns and types of sedentary behaviour and adiposity in children. METHODS: A case-control study was undertaken involving 234 children aged 10-13years who were either of a healthy-weight (74 boys, 56 girls) or classified as obese (56 boys, 48 girls). Percent body fat (by dual-energy X-ray absorptiometry) and waist-to-height ratio were assessed. Time, type (television, videogame, computer, eating, passive transport) and bout length of sedentary behaviours were measured using accelerometry and the Multimedia Activity Recall for Children and Adolescents. Time use (total daily energy expenditure, sleep, physical activity), age, household income and Tanner stage were covariates in sex-stratified partial least squares analyses. RESULTS: Daily energy expenditure and income were negatively associated with adiposity for both sexes. Television time was consistently positively associated with adiposity. In boys only, prolonged bouts of sedentary behaviour and time spent playing video games/computer were positively linked with adiposity. Non-screen sedentary behaviour was negatively associated with adiposity in girls. Independent of total energy expenditure, total sedentary time was only inconsistently associated with fatness. CONCLUSIONS: These data suggest that (1) characteristics of sedentary time other than duration are associated with adiposity in children, and (2) associations may be sex-specific.

Use-of-time and health-related quality of life in 10- to 13-year-old children: not all screen time or physical activity minutes are the same.

PURPOSE: To investigate associations between aspects of time use and health-related quality of life (HRQoL) in youth. METHODS: 239 obese and healthy-weight 10- to 13-year-old Australian children completed the Pediatric Quality of Life Inventory (PedsQL™) quantifying their health-related quality of life. Time use was evaluated over four days using the Multimedia Activity Recall for Children and Adolescents (MARCA), a validated 24 h recall tool. The average number of minutes/day spent in physical activity (divided into sport, active transport and play), screen time (divided into television, videogames and computer use), and sleep were calculated. Percent fat was measured using dual-energy X-ray absorptiometry, Tanner stage by self-report, and household income by parental report. Sex-stratified analysis was conducted using Partial Least Squares regression, with percent fat, Tanner stage, household income, and use-of-time as the independent variables, and PedsQL™ total, physical and psychosocial subscale scores as the dependent variables. RESULTS: For boys, the most important predictors of HRQoL were percent fat (negative), videogames (negative), sport (positive), and Tanner stage (negative). For girls, the significant predictors were percent fat (negative), television (negative), sport (positive), active transport (negative), and household income (positive). CONCLUSION: While body fat was the most significant correlate of HRQoL, sport was independently associated with better HRQoL, and television and videogames with poorer HRQoL. Thus, parents and clinicians should be mindful that not all physical activity and screen-based behaviours have equivocal relationships with children's HRQoL. Prospective research is needed to confirm causation and to inform current activity guidelines.

Six-week transition to minimalist shoes improves running economy and time-trial performance.

OBJECTIVES: This study investigated if gradually introducing runners to minimalist shoes during training improved running economy and time-trial performance compared to training in conventional shoes. Changes in stride rate, stride length, footfall pattern and ankle plantar-flexor strength were also investigated. DESIGN: Randomised parallel intervention trial. METHODS: 61 trained runners gradually increased the amount of running performed in either minimalist (n=31) or conventional (n=30) shoes during a six-week standardised training program. 5-km time-trial performance, running economy, ankle plantar-flexor strength, footfall pattern, stride rate and length were assessed in the allocated shoes at baseline and after training. Footfall pattern was determined from the time differential between rearfoot and forefoot (TDR-F) pressure sensors. RESULTS: The minimalist shoe group improved time-trial performance (effect size (ES): 0.24; 95% confidence interval (CI): 0.01, 0.48; p=0.046) and running economy (ES 0.48; 95%CI: 0.22, 0.74; p<0.001) more than the conventional shoe group. There were no minimalist shoe training effects on ankle plantar-flexor concentric (ES: 0.11; 95%CI: -0.18, 0.41; p=0.45), isometric (ES: 0.23; 95%CI: -0.17, 0.64; p=0.25), or eccentric strength (ES: 0.24; 95%CI: -0.17, 0.65; p=0.24). Minimalist shoes caused large reductions in TDR-F (ES: 1.03; 95%CI: 0.65, 1.40; p<0.001) but only two runners changed to a forefoot footfall. Minimalist shoes had no effect on stride rate (ES: 0.04; 95%CI: -0.08, 0.16; p=0.53) or length (ES: 0.06; 95%CI: -0.06, 0.18; p=0.35). CONCLUSIONS: Gradually introducing minimalist shoes over a six-week training block is an effective method for improving running economy and performance in trained runners.