Muscle function and architecture in children with juvenile idiopathic arthritis.

AIM: To assess muscle function and functional abilities in children with juvenile idiopathic arthritis (JIA). METHODS: Fourteen children with JIA and 14 healthy controls matched for age and sex were included. Muscle characteristics, both structural (thickness, cross-sectional area (CSA) and fascicle angle) and qualitative (intermuscular adipose tissue; IMAT), were assessed in thigh muscles using ultrasound and peripheral quantitative computed tomography (pQCT). Muscle function and functional abilities were determined from the assessment of maximal voluntary isometric contraction (MVIC) knee extensors force and vertical jump performance. RESULTS: No significant difference in MVIC force was observed between the two groups. However, squat jump height was significantly reduced in children with JIA (18.3 ± 5.4 vs 24.3 ± 7.9 cm, P < .05). No differences in structural parameters were observed, but IMAT/CSA (0.22 ± 0.02 vs 0.25 ± 0.03; P = .01) was significantly lower in children with JIA than in healthy children. CONCLUSION: Knee extensor muscle architecture and force were comparable between children with and without JIA, but functional abilities (vertical jump performance) were poorer in JIA. The lower IMAT area in JIA could result from a lower physical activity level compared with healthy children.

Neuromuscular Fatigue After Long-Duration Adventure Racing in Adolescent Athletes.

PURPOSE: To characterize the acute effects of a long-duration adventure race on knee extensor (KE) fatigue and the knee functional ratio in adolescent athletes. METHODS: Twenty trained male adolescents (aged 14-17 y) performed an adventure race of 68.5 km. Maximal voluntary isometric contraction (MVIC) KE and knee flexor torques were measured before and immediately after the race. Central and peripheral components of neuromuscular fatigue were quantified from the maximal voluntary activation level and the doublet peak torque (Tw100), respectively. The peak eccentric knee flexor torque to concentric KE torque ratio was also measured to determine functional ratio. RESULTS: The race completion time was 05:38 (00:20) hours. Significant reductions in MVICKE (-14.7%, P < .001) and MVICKF (-17.0%, P < .01) were observed after the race. Voluntary activation level decreased by 8.3% (P < .001) while Tw100 remained unchanged. Peak eccentric knee flexor torque decreased 16.0% (P < .001) while peak concentric KE torque did not change. This resulted in a significant reduction in functional ratio (-12.0%, P < .01). CONCLUSION: The adventure race induced a moderate fatigue, which was mainly explained by central factors without significant peripheral fatigue. However, particular attention should be paid to the knee muscular imbalance incurred by the race, which could increase the risk of ligament injury in adolescent athletes.

Effect of Drop Height on Vertical Jumping Performance in Pre-, Circa-, and Post-Pubertal Boys and Girls.

PURPOSE: To examine the effect of drop height on vertical jumping performance in children with respect to sex and maturity status. METHODS: Thirty-seven pre-pubertal, 71 circa-pubertal, and 69 post-pubertal boys and girls performed, in a randomized order, 2 squat jumps, 2 countermovement jumps, and 2 drop jumps (DJ) from heights of 20, 30, 40, 50, 60, and 70 cm. The trial with the best jump height in each test was used for analysis. RESULTS: No significant sex × maturity status × jump type interaction for jump height was observed. However, on average, the children jumped higher in the countermovement jump than in squat jump and DJs (+1.2 and +1.6 cm, P < .001, respectively), with no significant differences between DJs and squat jumps or between DJs when increasing drop heights. Regarding DJs, 59.3% of the participants jumped higher from drop heights of 20 to 40 cm. CONCLUSIONS: Children, independent of sex and maturity status, performed best in the countermovement jump, and no performance gain was obtained by dropping from heights of 20 to 70 cm. During maturation, the use of drop heights between 20 and 40 cm may be considered in plyometric training, but the optimum height must be obtained individually.

Physical activity and sedentary levels in children with juvenile idiopathic arthritis and inflammatory bowel disease. A systematic review and meta-analysis.

BACKGROUND: Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS: A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS: The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION: Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.

Maturation-related changes in the development and etiology of neuromuscular fatigue.

PURPOSE: The aim of the present study was to investigate the role of maturation on the etiology of neuromuscular fatigue induced by repeated maximal voluntary isometric contractions (MVIC). METHODS: Nine prepubertal boys (9.9 ± 1.3 years), eight male adolescents (13.6 ± 1.3 years) and eleven men (23.4 ± 3.0 years) performed a series of repeated isometric MVICs of the knee extensors until the MVIC torque reached 60% of its initial value. Magnetic stimulations were delivered to the femoral nerve every five MVICs to follow the course of voluntary activation level (VA) and the potentiated twitch torque (Qtwpot). RESULTS: Task failure was reached after 52.9 ± 12.7, 42.6 ± 12.5, and 26.6 ± 6.3 repetitions in boys, adolescents and men, respectively. VA remained unchanged in men whereas it decreased significantly and similarly in boys and adolescents (p < 0.001). In contrast, Qtwpot remained unchanged in boys and decreased significantly less in adolescents than adults (p < 0.05). CONCLUSIONS: Children and adolescents experience less peripheral and more central fatigue than adults. However, adolescents experience more peripheral fatigue than children for a comparable amount of central fatigue. This finding supports the idea that the tolerance of the central nervous system to peripheral fatigue could increase during maturation.

Substrate metabolism in male astronauts onboard the International Space Station: the ENERGY study.

Bedrest shifts fasting and postprandial fuel selection towards carbohydrate use over lipids, potentially affecting astronauts' performance and health. We investigated whether this change occurs in astronauts after at least 3 months onboard the International Space Station (ISS). We further explored the associations with diet, physical activity (PA), and body composition. Before and during spaceflight, respiratory quotient (RQ), carbohydrate, and fat oxidation were measured by indirect calorimetry before and following a standardized meal in 11 males (age = 45.7 [SD 7.7] years, BMI = 24.3 [2.1] kg m-²). Postprandial substrate use was determined by 0-to-260 min postprandial incremental area under the curve (iAUC) of nutrient oxidation and the difference between maximal postprandial and fasting RQ (ΔRQ). Food quotient (FQ) was calculated from diet logs. Fat (FM) and fat-free mass (FFM) were measured by hydrometry and PA by accelerometry and diary logs. Spaceflight increased fasting RQ (P = 0.01) and carbohydrate oxidation (P = 0.04) and decreased fasting lipid oxidation (P < 0.01). An increase in FQ (P < 0.001) indicated dietary modifications onboard the ISS. Spaceflight-induced RQ changes adjusted for ground RQ correlated with inflight FQ (P < 0.01). In postprandial conditions, nutrient oxidation and ΔRQ were unaffected on average. Lipid oxidation changes negatively correlated with FFM changes and inflight aerobic exercise and positively with FM changes. The opposite was observed for carbohydrate oxidation. ΔRQ changes were negatively and positively related to FM and FFM changes, respectively. In conclusion, fasting substrate oxidation shift observed during spaceflight may primarily result from dietary modifications. Between-astronaut variability in postprandial substrate oxidation depends on body composition changes and inflight PA.

The role of physical activity in the regulation of body weight: The overlooked contribution of light physical activity and sedentary behaviors.

The role of physical activity (PA) in the regulation of body weight is still a major topic of debate. This may be because studies have essentially focused on the effects of moderate/vigorous PA (MVPA) on body weight while overlooking the other components of PA, namely, light-intensity PA (LPA, daily life activities) and sedentary behaviors (SB, too much sitting). In this review, we will (i) describe the history of changes in PA behaviors that occurred with modernization; (ii) review data from cross-sectional and longitudinal studies that examined the associations between PA, SB, and measures of obesity; (iii) review interventional studies that investigated the effects of changes in PA and SB on body weight and adiposity; and (iv) discuss experimental studies that addressed potential biological mechanisms underlying the effects of PA and SB on weight regulation. Overall recent findings support the importance of considering all components of PA to better understand the regulation of energy balance and suggest an important role for LPA and SB in addition to MVPA on body weight regulation. Longitudinal large-scale rigorous studies are needed to advance our knowledge of the role of PA/SB in combating the obesity epidemic.

Sleep in children and adolescents with juvenile idiopathic arthritis: a systematic review and meta-analysis of case-control studies.

STUDY OBJECTIVES: Juvenile idiopathic arthritis (JIA) is one of the most common pediatric rheumatic disease. However, sleep alteration associated with this autoimmune disease remain unclear. We aimed in this systematic review and meta-analysis to compare sleep duration, quality, and architecture in JIA subjects with those in their healthy peers. METHODS: Systematic search performed in PubMed, EMBase, Cochrane, and PsycINFO databases included 19 studies in the qualitative synthesis of which 10 met the inclusion criteria for the meta-analysis. RESULTS: Pooled results from subjective methods indicated pronounced sleep disturbances and complaints in youth with JIA compared with their healthy counterparts. This was further confirmed by increased difficulty maintaining sleep (wake after sleep onset [WASO]; standardized mean differences [SMD]: -0.69; CI: -1.29 to -0.09, p = .02) and a tendency to increased difficulty initiating sleep (sleep onset latency [SOL]; SMD: -0.29; CI: -0.60 to 0.03, p = .07). There were no remarkable differences in sleep duration or sleep architecture between JIA patients and healthy controls. High heterogeneity was found for several outcomes. This could be explained by the different methods used as well as associated sleep disorders, medication, and comorbidities. CONCLUSIONS: Although included studies were methodologically diverse, the summarized results of our review and meta-analysis bring evidence that children with JIA present more fragmented sleep compared to healthy peers. Thereby, the implementation of strategies to manage and improve sleep in this population are needed and might have a beneficial effect on the symptoms and functions of JIA. STATEMENT OF SIGNIFICANCE: We observed that youth with Juvenile idiopathic arthritis (JIA) present pronounced sleep disturbances compared to their healthy counterparts: Meta-analysis found more difficulty maintaining sleep and a tendency to increased sleep latency in youth with JIA. However, results show discrepancies due to the different materials and methods used. Larger sample and further disentanglement of sample composition, considering associated sleep disorders, medication and comorbidities should be addressed in future studies.

Repeated Simulated Match-Induced Changes in Finger Flexor Force and Blood Acid-Base Balance in World-Class Female Judokas.

PURPOSE: The aim of this study was to investigate the time course of maximal isometric finger flexor force and blood acid-base balance during repeated simulated matches in world-class judokas. METHODS: Seven 21- to 28-year-old world-class female judokas (including Olympic and World Championship medalists) repeated four 4-minute judo combats interspersed by 15 minutes of passive recovery. Maximal voluntary isometric finger flexor contraction (MVIC) force was measured in both hands after warm-up and immediately after each combat using a handgrip dynamometer. MVIC force was classified as MVIC hikite force (pulling hand) and MVIC tsurite force (lifting hand). RESULTS: Blood lactate concentration, pH, bicarbonate concentration, partial pressure of oxygen, and oxygen saturation were measured between 3 and 5 minutes after each match. At completion of the fourth combat, mean MVIC hikite and tsurite force decreased by 18% and 12%, respectively (g = 0.23 and 0.29, respectively; P < .05), demonstrating that force production was substantial throughout repeated matches. Blood lactate concentration increased ∼5-fold from 2.69 (1.37) mmol·L-1 after warm-up to 13.10 (2.61) mmol·L-1 after the last match (g = 4.13, P = .018). Concurrently, blood pH decreased slightly from 7.44 (0.03) to 7.26 (0.05) (g = 2.34, P = .018), that is, by only 0.18 units. The decreased blood pH was significantly correlated with a decrease in bicarbonate concentration (R2 = .94, P < .001). Finally, partial pressure of oxygen and oxygen saturation remained unchanged during the judo contest. CONCLUSIONS: Female world-class judokas were able to maintain a high level of grip strength in both hands and efficiently regulate blood acid-base balance during repeated simulated high-intensity matches.

Metabolic profile in women differs between high versus low energy spenders during a low intensity exercise on a cycle-desk.

Active-desks are emerging strategies aiming at reducing sedentary time while working. A large inter-individual variability in energy expenditure (EE) profile has been identified and has to be explored to better optimize and individualize those strategies. Thus the present study aimed at comparing the metabolic and physical profile of individuals characterized as high spenders (H-Spenders) versus low spenders (L-Spenders) based on EE during a cycle-desk low intensity exercise. 28 healthy women working in administrative positions were enrolled. Anthropometric, body composition and fasting metabolic profile parameters were assessed. EE was determined by indirect calorimetry, at rest and during a 30-min cycle-desk use. Participants were categorized as H-Spenders and L-Spenders using the median of the difference between EE at rest and during the 30-min exercise. H-Spenders had higher mean EE (p < 0.001) and carbohydrate oxidation (p = 0.009) during exercise. H-Spenders displayed higher values for fasting plasma insulin (p = 0.002) and HOMA-IR (p = 0.002) and lower values for HDL-cholesterol (p = 0.014) than L-Spenders. The percentage of body fat mass was significantly higher in H-Spenders (p = 0.034). Individuals expending more energy during a low intensity cycling exercise presented a less healthy metabolic profile compared with L-Spenders. Future studies will have to explore whether the chronic use of cycle-desks during work time can improve energy profile regarding metabolic parameters.

Effect of Exercise on Energy Expenditure and Body Composition in Astronauts Onboard the International Space Station: Considerations for Interplanetary Travel.

OBJECTIVE: Body mass (BM) loss and body composition (BC) changes threaten astronauts' health and mission success. However, the energetic contribution of the exercise countermeasure to these changes has never been investigated during long-term missions. We studied energy balance and BC in astronauts during 6-month missions onboard the International Space Station. METHODS: Before and after at least 3 months in space, BM, BC, total and activity energy expenditure (TEE and AEE) were measured using the doubly labeled water method in 11 astronauts (2011-2017). Physical activity (PA) was assessed by the SensewearPro® activity-device. RESULTS: Three-month spaceflight decreased BM (- 1.20 kg [SE 0.5]; P = 0.04), mainly due to non-significant fat-free mass loss (FFM; - 0.94 kg [0.59]). The decrease in walking time (- 63.2 min/day [11.5]; P < 0.001) from preflight was compensated by increases in non-ambulatory activities (+ 64.8 min/day [18.8]; P < 0.01). Average TEE was unaffected but a large interindividual variability was noted. Astronauts were stratified into those who maintained (stable_TEE; n = 6) and those who decreased (decreased_TEE; n = 5) TEE and AEE compared to preflight data. Although both groups lost similar BM, FFM was maintained and FM reduced in stable_TEE astronauts, while FFM decreased and FM increased in decreased_TEE astronauts (estimated between-group-difference (EGD) in ΔFFMindex [FFMI] 0.87 kg/m2, 95% CI + 0.32 to + 1.41; P = 0.01, ΔFMindex [FMI] - 1.09 kg/m2, 95% CI - 2.06 to - 0.11 kg/m2; P = 0.03). The stable_TEE group had higher baseline FFMI, and greater baseline and inflight vigorous PA than the decreased_TEE group (P < 0.05 for all). ΔFMI and ΔFFMI were respectively negatively and positively associated with both ΔTEE and ΔAEE. CONCLUSION: Both ground fitness and inflight overall PA are associated with spaceflight-induced TEE and BC changes and thus energy requirements. New instruments are needed to measure real-time individual changes in inflight energy balance components.

Impact of long-duration adventure racing on hydration status, blood electrolytes and biomarkers of kidney function in trained adolescent athletes.

BACKGROUND: Little is known about the biochemical consequences of endurance activities in adolescents. The present study aimed to examine the impact of a long-duration adventure race (>5 h) on hydration status, blood electrolytes and biomarkers of kidney function in adolescent athletes. METHODS: Twenty male adolescents aged 14 to 17 y (mean±SD; body mass: 59.7±9.1 kg and maximal O2 uptake: 56.2±4.6 mL∙kg-1∙min-1) volunteered to participate in a competitive adventure race of 68.5 km. Volunteers could drink ad libitum and fluid intake was monitored throughout the race. Blood samples were collected before, within 15 minutes after, and 24 hours after the race to monitor blood electrolytes (sodium, potassium, chloride), creatinine and blood urea nitrogen (BUN). Body mass and urine specific gravity (USG) were also measured across the same time points. RESULTS: The race was completed on average in 05:38±00:20 h:min under cold and rainy conditions (10-15 °C and 83-93% of relative humidity). Fluid intake was 1.45±0.66 L and body mass decreased by 1.2% compared to before the race (P<0.001). Blood sodium concentrations remained stable after the race (140.4±2.1 mmol∙L-1) despite an expansion in the plasma volume of 8.9±15.6%. No significant variations in BUN or BUN-to-creatinine ratio occurred. A significant increase in creatinine (+13.5%, P=0.003) was observed immediately after the race but remained within the reference range. CONCLUSIONS: The long-duration race completed under cold and humid conditions seems not to have exposed adolescents to hypohydration, hyponatremia or clinically significant alterations in kidney function.

Effect of Long-Duration Adventure Races on Cardiac Damage Biomarker Release and Muscular Function in Young Athletes.

The aim of the present study was to examine the effect of 1- and 2-day adventure races on cardiac muscle damage and skeletal muscle soreness and function in young athletes. Twelve male trained adolescents (14-15 years) completed both 1-day (48.2 km) and 2-day (66.0 km) races that included trail running, mountain biking, kayaking, and in-line skating separated by 10 weeks. Myocardial damage biomarker concentrations (cTnI and CK-MB), maximal voluntary isometric contraction (MVIC) torque, perceived knee extensor (KE) muscle soreness (PMS), and drop and squat jump heights were measured before and after each race. Heart rate was also monitored throughout. Mean heart rate (% cardiac reserve) was higher during the 1-day (66.6 ± 6.4%) than 2-day (62.6 ± 7.8%, p = 0.038) race. The amplitude of cardiac damage biomarker release was also higher following the 1-day than the 2-day race (peak cTnI: 0.14 vs. 0.03 ng/mL, p = 0.045; peak CK-MB: 20.30 vs. 11.98 ng/mL, p = 0.020). However, cardiac biomarker concentrations returned to baseline at 24-48 h post-exercise, except for CK-MB after the 2-day race (p = 0.017). Eight and three participants exceeded the cTnI cut-off for myocardial injury in 1- and 2-day races, respectively, but none exceeded the cut-off for acute myocardial infarction. While there was a significant decrease in drop jump height (-5.9%, p = 0.003), MVIC torque and squat jump height remained unchanged after both races. PMS was increased at 24 h after both races (p < 0.001) but returned to baseline levels by 72 h post-race. In conclusion, the shorter, more intense race produced more cardiac damage, although this probably represents a standard exercise intensity-dependent response rather than pathological response. Skeletal muscle functional and soreness responses were moderate and similar between races.

TNF blockade contributes to restore lipid oxidation during exercise in children with juvenile idiopathic arthritis.

BACKGROUND: Children with juvenile idiopathic arthritis (JIA) have impaired physical abilities. TNF-α plays a crucial role in this pathogenesis, but it is also involved in the use of lipids and muscle health. Objective of this study was to explore substrate oxidation and impact of TNF blockade on energy metabolism in children with JIA as compared to healthy children. METHODS: Fifteen non-TNF-blockaded and 15 TNF-blockaded children with JIA and 15 healthy controls were matched by sex, age, and Tanner stage. Participants completed a submaximal incremental exercise test on ergocycle to determine fat and carbohydrate oxidation rates by indirect calorimetry. RESULTS: The maximal fat oxidation rate during exercise was lower in JIA children untreated by TNF blockade (134.3 ± 45.2 mg.min- 1) when compared to the controls (225.3 ± 92.9 mg.min- 1, p = 0.007); but was higher in JIA children under TNF blockade (163.2 ± 59.0 mg.min- 1, p = 0.31) when compared to JIA children untreated by TNF blockade. At the same relative exercise intensities, there was no difference in carbohydrate oxidation rate between three groups. CONCLUSIONS: Lipid metabolism during exercise was found to be impaired in children with JIA. However, TNF treatment seems to improve the fat oxidation rate in this population. TRIAL REGISTRATION: In ClinicalTrials.gov, reference number NCT02977416 , registered on 30 November 2016.

Impaired Muscular Fat Metabolism in Juvenile Idiopathic Arthritis in Inactive Disease.

Objectives: The objective of this study was to evaluate muscular metabolic function in children with inactive juvenile idiopathic arthritis (JIA). Methods: Fifteen children with inactive JIA and fifteen healthy controls were matched by sex, biological age, and Tanner stage. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates. Results: Between the two groups, heart rate values and carbohydrate oxidation rates were the same, regardless of the relative intensity of exercise. Lipid oxidation rates were lower in JIA patients, regardless of the percentage of VO2 peak (p < 0.05). Respiratory exchange ratios beyond 50% of VO2 peak were higher in patients with JIA (p < 0.05). Respective maximal fat oxidation rates (MFO) for controls and children with JIA were 218.7 ± 92.2 vs. 157.5 ± 65.9 mg ⋅ min-1 (p = 0.03) and 4.9 ± 1.9 vs. 3.4 ± 1.2 mg ⋅ min-1 ⋅ kg-1 (p = 0.04). There was no difference between the two groups in heart rate, percentage of VO2 peak, or power of exercise to achieve MFO. Controls reached their MFO at an exercise power significantly higher than did JIA subjects (42.8 ± 16.8 and 31.9 ± 9.8 W, p = 0.004). Conclusion: Children with JIA show metabolic disturbance during exercise, even when the disease is considered inactive. This disturbance is seen in a lower lipid oxidation rate during submaximal exercise.

Metabolic and Fatigue Profiles Are Comparable Between Prepubertal Children and Well-Trained Adult Endurance Athletes.

The aim of this study was to determine whether prepubertal children are metabolically comparable to well-trained adult endurance athletes and if this translates into similar fatigue rates during high-intensity exercise in both populations. On two different occasions, 12 prepubertal boys (10.5 ± 1.1 y), 12 untrained men (21.2 ± 1.5 y), and 13 endurance male athletes (21.5 ± 2.7 y) completed an incremental test to determine the power output at VO2max (PVO2max) and a Wingate test to evaluate the maximal anaerobic power (Pmax) and relative decrement in power output (i.e., the fatigue index, FI). Furthermore, oxygen uptake (VO2), heart rate (HR), and capillary blood lactate concentration ([La]) were measured to determine (i) the net aerobic contribution at 5-s intervals during the Wingate test, and (ii) the post-exercise recovery kinetics of VO2, HR, and [La]. The Pmax-to-PVO2max ratio was not significantly different between children (1.9 ± 0.5) and endurance athletes (2.1 ± 0.2) but lower than untrained men (3.2 ± 0.3, p < 0.001 for both). The relative energy contribution derived from oxidative metabolism was also similar in children and endurance athletes but greater than untrained men over the second half of the Wingate test (p < 0.001 for both). Furthermore, the post-exercise recovery kinetics of VO2, HR, and [La] in children and endurance athletes were faster than those of untrained men. Finally, FI was comparable between children and endurance athletes (-35.2 ± 9.6 vs. -41.8 ± 9.4%, respectively) but lower than untrained men (-51.8 ± 4.1%, p < 0.01). To conclude, prepubertal children were observed to be metabolically comparable to well-trained adult endurance athletes, and were thus less fatigable during high-intensity exercise than untrained adults.