The mysterious values of adipose tissue density and fat content in infants: MRI-measured body composition studies.

Adipose tissue is a type of connective tissue composed of closely packed adipocytes with collagenous and elastic fibers. These adipocytes store triglycerides at a high percentage and the estimate of this amount is important for the calculation of body fat mass. For example, magnetic resonance imaging (MRI) measures adipose tissue volume, but adipose tissue density (fat content percentage and density) is required to calculate fat mass. However, in previously published studies, the conversion factor for white adipose tissue density varies from study to study. This paper aimed to investigate the different adipose tissue densities used as conversion factors to clarify differences between studies. Furthermore, we include a new proposal for adipose tissue density and fat content of infants based on the results of recent water-fat MRI studies. IMPACT: Magnetic resonance imaging (MRI) is one of the methods used to measure body composition in infants and the inherent density of tissue/organs is needed in order to calculate the mass of target organs and tissues. The conversion factor used for white adipose tissue density currently varies from study to study. This article includes a new recommendation for the adipose tissue density and fat content of infants based on the results of recent water-fat MRI studies.

The Fat Fraction Percentage of White Adipose Tissue at various Ages in Humans: An Updated Review.

We recently reported the fat fraction percentage of white adipose tissue in adolescents and adults measured by the water-fat separation method, but there was limited discussion about the change in adipose tissue fat fraction with growth. The purpose of this updated review was to examine the fat content of white (subcutaneous) adipose tissue during the process from birth to adulthood by adding the latest available data. A relevant database was searched through November 2020. Nineteen studies were included. We found that calculated mean values of fat fraction percentage in white adipose tissue were 72.2% in neonates, 87.2% in children, and 87.4% in adults. In contrast, fat fraction percentage of truncal white adipose tissue in the fetuses was from 10% to 24% (29 and 34 wk of gestational age, respectively). Our results suggest that the fat fraction percentage of white adipose tissue may not undergo large changes during the process from birth to adulthood (neonates = 72.2%, children = 87.2%, adults = 87.4%), which was different from the results of a study utilizing a biopsy. The mean value and range of fat fraction percentages for children over 7 years old were especially similar to adults. Further, the fat fraction percentage for neonates was relatively close to the results of children and adults. At the moment, the characteristics of the changes in fat fraction percentage of adipose tissue from birth to preschool children are unclear and future research is needed to clarify this issue.

Acute Muscular Responses to Practical Low-Load Blood Flow Restriction Exercise Versus Traditional Low-Load Blood Flow Restriction and High-/Low-Load Exercise.

CONTEXT: Blood flow restriction (BFR) increases muscle size and strength when combined with low loads, but various methods are used to produce this stimulus. It is unclear how using elastic knee wraps can impact acute muscular responses compared with using nylon cuffs, where the pressure can be standardized. OBJECTIVE: Investigate how elastic knee wraps compare with nylon cuffs and high-load (HL)/low-load (LL) resistance exercise. DESIGN: A randomized cross-over experimental design using 6 conditions combined with unilateral knee extension. SETTING: Human Performance Laboratory. PARTICIPANTS: A total of 9 healthy participants (males = 7 and females = 2) and had an average age of 22 (4) years. INTERVENTION: LL (30% of 1-repetition maximum [1-RM]), HL (70% 1-RM), BFR at 40% of arterial occlusion pressure (BFR-LOW), BFR at 80% of arterial occlusion pressure (BFR-HIGH), elastic knee wraps stretched by 2 in (PRACTICAL-LOW), and elastic knee wraps stretched to a new length equivalent to 85% of thigh circumference (PRACTICAL-HIGH). BFR and practical conditions used 30% 1-RM. MAIN OUTCOME MEASURES: Muscle thickness, maximum voluntary isometric contraction, and electromyography amplitude. Bayesian statistics evaluated differences in changes between conditions using the Bayes factor (BF10), and median and 95% credible intervals were reported from the posterior distribution. RESULTS: Total repetitions completed were greater for BFR-LOW versus PRACTICAL-HIGH (BF10 = 3.2, 48.6 vs 44 repetitions) and greater for PRACTICAL-LOW versus BFR-HIGH (BF10 = 717, 51.8 vs 36.3 repetitions). Greater decreases in changes in maximum voluntary isometric contraction were found in PRACTICAL-HIGH versus HL (BF10 = 1035, ∼103 N) and LL (BF10 = 45, ∼66 N). No differences in changes in muscle thickness were found between LL versus PRACTICAL-LOW/PRACTICAL-HIGH conditions (BF10 = 0.32). Greater changes in electromyography amplitude were also found for BFR-LOW versus PRACTICAL-HIGH condition (BF10 = 6.13, ∼12%), but no differences were noted between the other BFR conditions. CONCLUSIONS: Overall, elastic knee wraps produce a more fatiguing stimulus than LL or HL conditions and might be used as an alternative to pneumatic cuffs that are traditionally used for BFR exercise.

The Bigger the Hand, the Bigger the Difference? Implications for Testing Strength With 2 Popular Handgrip Dynamometers.

CONTEXT: Studies developed the frail elderly handgrip strength (HGS) diagnostic criteria using multiple types of handgrip dynamometers. If different handgrip dynamometers report different values, then this would have the potential to misclassify people into the wrong diagnostic category. OBJECTIVE: To examine the characteristics of HGS measured by 2 standard handgrip dynamometers and to investigate the influence of hand size on HGS. SETTING: University research laboratory. PARTICIPANTS: A total of 87 young and middle-aged adults between the ages of 20 and 60 years participated in this study. MAIN OUTCOME MEASURES: Standard methods of HGS measurements were used for hydraulic and Smedley spring-type dynamometers, although the participants were instructed to maintain an upright standing position in both tests. RESULTS: Test-retest reliability of hydraulic and Smedley dynamometers provided comparable results to that observed with previous studies. However, the difference in HGS between the 2 dynamometers (Hydraulic-Smedley difference) was positively associated (r = .670, P < .001) with the mean of the 2 dynamometers. The participants who had relatively low HGS (at least <35 kg) produced similar HGS values when the 2 dynamometers were compared, whereas persons who had relatively higher HGS (at least >45 kg) produced greater strength values with the hydraulic compared with the Smedley. The hand and palm lengths were weakly correlated (r = .349 and r = .358, respectively, both Ps < .001) with the difference in HGS between the 2 dynamometers. CONCLUSIONS: Test-retest reliability of hydraulic and Smedley dynamometers provides comparable results to previous studies. However, the difference in HGS between the 2 dynamometers was positively associated with the mean of the 2 dynamometers. This Hydraulic-Smedley difference would not affect persons who have relatively low HGS (at least <35 kg), while when HGS is relatively high, the comparison between dynamometers should be done with caution.

Prediction and Validation of DXA-Derived Appendicular Fat-Free Adipose Tissue by a Single Ultrasound Image of the Forearm in Japanese Older Adults.

OBJECTIVES: To develop regression-based equations for estimating dual-energy x-ray absorptiometry (DXA) derived appendicular fat-free adipose tissue (FFAT) using a single ultrasound image in the forearm, and to investigate the validity of those equations to calculate FFAT-free appendicular lean mass (aLM-minus-FFATappendicular ) in 311 Japanese adults aged 60 to 79 years. METHODS: Subjects were randomly separated into two groups: 215 in the model-development group (91 men and 124 women) and 96 in the cross-validation group (42 men and 54 women). Appendicular fat mass and aLM were measured by the DXA, and subcutaneous adipose tissue (AT-forearm) and muscle (MT-ulna) thicknesses were measured by ultrasound. Appendicular FFAT was calculated based on the results of a previous study (appendicular FFAT = appendicular fat mass/0.85 x 0.15). The aLM was estimated from MT-ulna using a previously published equation (aLM = 4.89 x MT-ulna x body height - 9.15). Stepwise linear regression analysis was used to determine predictive models for DXA-derived appendicular FFAT from AT-forearm, sex, age, and anthropometrical variables. The best ultrasound prediction equation for estimation of appendicular FFAT was developed and then cross-validated in a subsample of older adults. RESULTS: There was no significant difference between the DXA-derived and ultrasound-predicted aLM-minus-FFATappendicular . A strong correlation was observed between the DXA-derived and ultrasound-predicted aLM-minus-FFATappendicular (r = 0.935, P < .001). Bland-Altman analysis did not indicate a bias in the prediction of the aLM-minus-FFATappendicular for the validation group. CONCLUSIONS: Our results indicated that a single ultrasound forearm measurement can be used to accurately estimate DXA-derived aLM-minus-FFATappendicular in Japanese older adults, which may be advantageous for community-based physical examinations.

Influence of relative blood flow restriction pressure on muscle activation and muscle adaptation.

INTRODUCTION: The aim of this study was to investigate the acute and chronic skeletal muscle response to differing levels of blood flow restriction (BFR) pressure. METHODS: Fourteen participants completed elbow flexion exercise with pressures from 40% to 90% of arterial occlusion. Pre/post torque measurements and electromyographic (EMG) amplitude of each set were quantified for each condition. This was followed by a separate 8-week training study of the effect of high (90% arterial occlusion) and low (40% arterial occlusion) pressure on muscle size and function. RESULTS: For the acute study, decreases in torque were similar between pressures [-15.5 (5.9) Nm, P = 0.344]. For amplitude of the first 3 and last 3 reps there was a time effect. After training, increases in muscle size (10%), peak isotonic strength (18%), peak isokinetic torque (180°/s = 23%, 60°/s = 11%), and muscular endurance (62%) changed similarly between pressures. CONCLUSION: We suggest that higher relative pressures may not be necessary when exercising under BFR.

Effects of age on arterial stiffness and central blood pressure after an acute bout of resistance exercise.

PURPOSE: To investigate the influence of age on arterial stiffness and blood pressure after performing a resistance exercise bout. METHODS: Recreationally active men were separated into young (YG, n = 12, 26.5 ± 3.3 years), middle (MG, n = 14, 49.4 ± 5.7 years), and old (OG, n = 10, 67.4 ± 6.3 years)-aged groups. In a randomized cross-over design, participants performed control and exercise conditions with at least 3 days separating conditions. The exercise condition consisted of leg press, chest press, knee flexion, lat pulldown and knee extension at ~65% one-repetition maximum for three sets of 10 repetitions. Brachial and central blood pressures, augmented pressure, augmentation index, central and peripheral pulse wave velocities were measured prior to each condition and starting at 5 min post-exercise. RESULTS: Brachial systolic blood pressure (SBP) significantly increased similarly after exercise for all age groups (YG, 8 ± 8 mmHg; MG, 5 ± 5 mmHg; OG, 5 ± 6 mmHg; p < 0.05). However, central SBP did not significantly increase for any age group after exercise. Augmentation index significantly increased after exercise only in the YG (11 ± 8%, p < 0.05). Central pulse wave velocity did not significantly increase in any age group after exercise when compared to the control condition. CONCLUSIONS: When performing a whole body moderate resistance exercise bout, acute changes in arterial stiffness and blood pressure appear to be minimally affected by age.

Comparative Effects of Vigorous-Intensity and Low-Intensity Blood Flow Restricted Cycle Training and Detraining on Muscle Mass, Strength, and Aerobic Capacity.

Traditional high-intensity aerobic training has been shown to improve muscle protein synthesis and aerobic capacity; however, recent research indicates that low-intensity aerobic training with blood flow restriction (BFR) may have similar effects. The purpose of this study was to compare the effects of vigorous-intensity (VI) cycling vs. low-intensity cycling with BFR (LI-BFR) on muscle mass, strength, and aerobic capacity after training and subsequent detraining. Thirty-one physically active subjects were assigned to one of 3 groups: VI (n = 10, 60-70% heart rate reserve [HRR]), LI-BFR (n = 11, 30% HRR with BFR at 160-180 mm Hg), and no exercise control (n = 10, no exercise). Subjects in VI and LI-BFR cycled 3 times per week for 6 weeks (total 18 sessions). Body composition, muscle mass, strength, and aerobic capacity were measured pre, post, and after 3 weeks of detraining. A group × time interaction (p = 0.019) effect for both knee flexion and leg lean mass was found. For both VI and LI-BFR groups, knee flexion strength was significantly increased between pre and post (p = 0.024, p = 0.01) and between pre and 3 week-post (p = 0.039, p = 0.003), respectively. For the LI-BFR group, leg lean mass was significantly increased between pre and 3 week-post (p = 0.024) and between post and 3 week-post (p = 0.013). However, there were no significant differences between groups for any variables. The LI-BFR elicits an increase in the knee flexion muscle strength over time similar to the VI. An increase in the leg lean mass over time was seen in the LI-BFR, but not in VI and CON.

Effects of exercise with and without different degrees of blood flow restriction on torque and muscle activation.

INTRODUCTION: An unresolved question in resistance training combined with blood flow restriction (BFR) is what percentage of estimated arterial occlusion pressure provides the most robust acute muscular response. METHODS: Forty participants were assigned to Experiments 1, 2, or 3. Each experiment completed exercise protocols differing by pressure, exercise load, and/or volume. Torque was measured pre- and postexercise, and muscle activation was measured pre- and during each set. RESULTS: Pressure and load did not affect torque greatly. Muscle activation increased in all conditions (P < 0.05) and was higher with 30% 1RM compared with 20% 1RM. Pressure appeared to increase muscle activation from 40% to 50% arterial occlusion [66% vs. 87% maximal voluntary contraction (30% 1RM)] but was not further increased with higher pressure. CONCLUSION: Different levels of BFR may alter the acute muscular response to a degree, although higher pressures do not appear to augment these changes.

Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure.

PURPOSE: To determine what factors should be accounted for when setting the blood flow restriction (BFR) cuff pressure for the upper and lower body. METHODS: One hundred and seventy one participants visited the laboratory for one testing session. Arm circumference, muscle (MTH) and fat (FTH) thickness were measured on the upper arm. Next, brachial systolic (SBP) and diastolic (DBP) blood pressure measurements were taken in the supine position. Upper body arterial occlusion was then determined using a Doppler probe. Following this, thigh circumference and lower body arterial occlusion were determined. Models of hierarchical linear regression were used to determine the greatest predictor of arterial occlusion in the upper and lower body. Two models were employed in the upper body, a Field (arm size) and a Laboratory model (arm composition). RESULTS: The Laboratory model explained 58 % of the variance in arterial occlusion with SBP (ß = 0.512, part = 0.255), MTH (ß = 0.363, part = 0.233), and FTH (ß = 0.248, part = 0.213) contributing similarly to explained variance. The Field model explained 60 % of the variance in arterial occlusion with arm circumference explaining the greatest amount (ß = 0.419, part = 0.314) compared to SBP (ß = 0.394, part = 0.266) and DBP (ß = 0.147, part = 0.125). For the lower body model the third block explained 49 % of the variance in arterial occlusion with thigh circumference (ß = 0.579, part = 0.570) and SBP (ß = 0.281, part = 0.231) being significant predictors. CONCLUSIONS: Our findings indicate that arm circumference and SBP should be taken into account when determining BFR cuff pressures. In addition, we confirmed our previous study that thigh circumference is the greatest predictor of arterial occlusion in the lower body.

The effects of resistance exercise with and without different degrees of blood-flow restriction on perceptual responses.

The aim was to compare exercise with and without different degrees of blood-flow restriction on perceived exertion (RPE) and discomfort. Participants were assigned to Experiment 1, 2, or 3. Each completed protocols differing by pressure, load, and/or volume. RPE and discomfort were taken before and after each set. For pressure and RPE, the 20% one repetition maximum (1RM) blood-flow restriction conditions were affected by increasing the pressure from 40% to 50% blood-flow restriction (~12 vs. ~14). This did not appear to happen within the 30% 1RM blood-flow restriction conditions or the higher pressures in the 20% 1RM conditions. The similar RPE between 20% and 30% 1RM to failure was expected given both were to failure. For discomfort, ratings were primarily affected by load at the lowest pressure. Increasing pressure to 50% blood-flow restriction increased discomfort at 20% 1RM (~2.6 vs. ~4). There was a further increase when increasing to 60% blood-flow restriction (~4 vs. ~4.8). The high-load condition had the lowest discomfort, while ratings were highest with 20% 1RM to failure. In conclusion, exercise with blood-flow restriction does not appear to augment the perceptual response observed with low-load exercise to failure.

Association between toe grasping strength and accelerometer-determined physical activity in middle-aged and older women.

[Purpose] To test the hypothesis that toe grasping strength is associated with daily physical activity in older adults. [Subjects] Fifty-seven Japanese women, aged 52-78 years, volunteered. [Methods] Toe grasping and knee extension strength were measured. Physical activity was also measured, using an accelerometer, and the total duration of each level of exercise intensity (light, moderate, and vigorous) and average step counts were calculated. Subjects were separated into two groups on the basis of accelerometer-determined step counts: LOW (n=28, <8000 steps/day) and HIGH (n=29, ≥8000 steps/day). [Results] Body mass index and body composition (% fat and fat-free mass) were similar between the two groups. Absolute and relative toe grasping strengths (divided by body weight) were greater in HIGH than in LOW. However, both absolute and relative knee extension strength were similar between the groups. Relative toe grasping and knee extension strength correlated with all 3 intensities of physical activity and average step count. After adjusting for age, the duration of light plus moderate physical activity and average step counts correlated to toe grasping strength but not to knee extension strength. [Conclusion] Our results suggest that toe grasping strength may be associated with the amount of light intensity daily physical activity.

Vascular adaptations to low-load resistance training with and without blood flow restriction.

PURPOSE: To examine the effects of low-load knee extensor training to fatigue with and without blood flow restriction (BFR) on calf vascular conductance, calf venous compliance, and peripheral arterial stiffness in middle-aged individuals. METHODS: Eleven men (55 ± 8 years) and five post-menopausal women (57 ± 5 years) completed 6 weeks of unilateral knee extensor training with one limb exercising with BFR (BFR limb) and the contralateral limb exercising without BFR (free flow, FF limb). Before and after the training, femoral pulse wave velocity (PWV), calf blood flow (normalized as conductance), and calf venous compliance were measured in each limb. RESULTS: PWV increased following training in both limbs (main effect of time, p = 0.036; BFR limb 8.9 ± 0.8 vs. 9.5 ± 0.9 m/s, FF limb 9.0 ± 1.2 vs. 9.0 ± 1.1; Pre vs. Post). Calf blood flow increased (p = 0.026) in the FF limb (25.0 ± 7.0 vs. 31.8 ± 12.0 flow/mmHg; Pre vs. Post) but did not change (p = 0.831) in the BFR limb (29.1 ± 11.3 vs. 28.7 ± 11.5 flow/mmHg; Pre vs. Post). Calf venous compliance did not change in either limb following training. CONCLUSIONS: These results suggest low-load BFR resistance training to fatigue elicits small increases in peripheral arterial stiffness without eliciting concomitant changes in venous compliance. In addition, unlike low-load knee extensor training without BFR, training with BFR did not enhance calf blood flow.

Relationship between thigh muscle mass and augmented pressure from wave reflections in healthy adults.

Skeletal muscle may be viewed as an endocrine organ that releases numerous factors with the potential to influence vascular tone. Previous cross-sectional studies have shown an inverse relationship between muscle mass and arterial stiffness. We examined the relationship between muscle mass, arterial pressure in the aorta and brachial artery, and pressure from wave reflections [characterized as heart rate corrected augmentation pressure (AP)] and augmentation index (AIx). Twenty-seven (13 male, 14 female) subjects who were non-smokers and had no known cardiovascular or metabolic diseases visited the laboratory for two sessions of testing. Upon arriving for the first session, mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area were assessed using peripheral Quantitative Computed Tomography. Following this, concentric one-repetition maximum (1-RM) testing was completed to assess knee extensor strength. The second visit consisted of taking brachial and aortic blood pressure measurements. A significant positive relationship was found between mCSA and brachial systolic blood pressure (r = 0.47, p = 0.02), but not between mCSA and aortic systolic blood pressure (r = 0.35, p = 0.09). There was an inverse association between mCSA and AP75 (-0.49, p = 0.01) and AIx75 (-0.49, p = 0.01). In conclusion, muscle mass is associated with brachial systolic blood pressure and inversely associated with pressure from wave reflections. Our findings suggest a link between global musculo-skeletal integrity and cardiovascular hemodynamics in young healthy adults.

Blood flow restriction does not result in prolonged decrements in torque.

We sought to determine if blood flow restriction (BFR) by itself or in combination with exercise would result in prolonged decrements in torque when using restriction pressures relative to the participants' limb size. Sixteen participants were randomized into Experiment A (n = 9) or Experiment B (n = 7). Experiment A participants performed unilateral knee extensions at 30 % of their one repetition maximum (1RM) with moderate blood flow restriction on one leg (BFR + Exercise) and exercised the other leg without BFR (CON + Exercise). Experiment B participants rested for 4 min with BFR applied to one leg and rested for 4 min without any treatment on the other leg (CON). Maximal voluntary isometric torque (MVC) was measured before and immediately after the exercise or 4 min of rest, 1 h post, and 24 h post. Ratings of perceived exertion (RPE) and discomfort were taken before and after each set. MVC was significantly reduced following both exercise conditions with BFR + Exercise having the largest reduction in torque. However, torque quickly recovered by 1 h post exercise and was back to baseline by 24 h. No changes in torque were observed in Experiment B. RPE and discomfort were rated consistently higher for those in the BFR + Exercise and BFR conditions compared to control. In conclusion, BFR + Exercise does not result in prolonged decrements in torque. The acute changes in torque are due to fatigue and quickly recover back to baseline within 24 h of exercise. In addition, BFR in the absence of exercise has no effect on torque at any time point.

Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise.

The purpose of this study was to determine the difference in cuff pressure which occludes arterial blood flow for two different types of cuffs which are commonly used in blood flow restriction (BFR) research. Another purpose of the study was to determine what factors (i.e., leg size, blood pressure, and limb composition) should be accounted for when prescribing the restriction cuff pressure for this technique. One hundred and sixteen (53 males, 63 females) subjects visited the laboratory for one session of testing. Mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area of the right thigh were assessed using peripheral quantitative computed tomography. Following the mid-thigh scan, measurements of leg circumference, ankle brachial index, and brachial blood pressure were obtained. Finally, in a randomized order, arterial occlusion pressure was determined using both narrow and wide restriction cuffs applied to the most proximal portion of each leg. Significant differences were observed between cuff type and arterial occlusion (narrow: 235 (42) mmHg vs. wide: 144 (17) mmHg; p = 0.001, Cohen's D = 2.52). Thigh circumference or mCSA/fCSA with ankle blood pressure, and diastolic blood pressure, explained the most variance in the cuff pressure required to occlude arterial flow. Wide BFR cuffs restrict arterial blood flow at a lower pressure than narrow BFR cuffs, suggesting that future studies account for the width of the cuff used. In addition, we have outlined models which indicate that restrictive cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.

Lower body site-specific sarcopenia and accelerometer-determined moderate and vigorous physical activity: the HIREGASAKI study.

BACKGROUND AND AIMS: It is unknown if the site-specific muscle loss of ageing muscle is associated with accelerometer-determined daily step count and/or intensity of physical activity. The purpose of this study was to examine the relationships between accelerometer- determined physical activity and lower body muscle size in women. METHODS: Forty-eight women aged 52 to 76 years had their muscle thickness (MTH) measured by B-mode ultrasound at seven sites on the anterior and posterior aspects of their upper- and lower-leg. Daytime physical activity was measured using an accelerometer on 30 consecutive days and the total duration of each level of exercise intensity (light-PA, moderate-PA and vigorous-PA), average step count, and physical activity-related energy expenditure were calculated. RESULTS: Age was inversely correlated with anterior 30% upper-leg MTH (r=-0.296, p<0.05), but not with other measured MTH sites. Light-PA was not significantly (p>0.05) correlated with measured lower body MTH. However, moderate-PA was correlated (p<0.05) with lower-leg MTH, while vigorous-PA was correlated (p<0.05) with lower-leg and anterior 30% upper- leg MTH. Following adjustment for confounding factors, the anterior and posterior lower-leg MTH was positively correlated (p<0.05) with duration of moderate- PA and vigorous-PA, as well as average step count. CONCLUSIONS: Thus daily moderate and vigorous physical activity was associated with higher muscle mass in the lower leg, but not in the upper-leg muscle, suggesting that the site-specific upper-leg muscle loss may not be prevented or attenuated by daily physical activity.

Children with Low Handgrip Strength: A Narrative Review of Possible Exercise Strategies to Improve Its Development.

BACKGROUND: Handgrip strength (HGS) is a predictor of health in both children and adults. Evidence suggests that without a possible strategy, children with low HGS may become adults with low HGS. However, little is known about what strategies are effective for children with low HGS to achieve a higher baseline level in adulthood. This narrative review aimed to investigate whether physical exercise interventions could improve HGS in children. METHODS: The relevant databases/search engine was searched using keywords related to the main topics discussed throughout this review. RESULTS: Our findings suggest that it may not be possible to improve HGS over that observed from normal development with physical education or traditional resistance-training programs. However, if the training program includes exercises that directly stimulate the forearm/hand muscle groups to grip, it may be possible to obtain changes in HGS that exceed the changes due to normal developmental growth. CONCLUSION: Although there are associations between HGS and markers of health, no research could be identified that examined whether increasing HGS would lead to an improvement in health. If an increase in HGS really does represent an improvement in long-term health, then gripping exercise may need to be included into physical activity programs during the growth/development phase.

Fat-Free Adipose Tissue Mass: Impact on Peak Oxygen Uptake (VO2peak) in Adolescents with and without Obesity.

Fat-free body mass (FFM) is a surrogate for skeletal muscle mass and is often used for the normalization of several physiological variables (e.g., oxygen uptake). However, FFM includes non-skeletal muscle components such as the fat-free component of adipose tissue fat cells. As the amount of adipose tissue mass increases, the FFM will also increase and be included in the measurement of FFM. Therefore, FFM may not be an appropriate indicator of muscle mass when targeting individuals with a large amount of body fat. This review aimed (1) to examine the fat-free adipose tissue (FFAT) in adolescents with and without obesity and (2) to investigate the impact of FFAT on peak oxygen uptake (VO2peak) by comparing VO2peak expressed relative to FFM and FFM minus FFAT between adolescents with and without obesity. Calculated FFAT was threefold higher in adolescents with obesity compared to those without obesity (mean ± SD; 6.94 ± 1.40 vs. 2.22 ± 0.58 kg). The VO2peak expressed relative to FFM-FFAT was similar between the two groups (56.5 ± 6.7 vs. 57.4 ± 8.9 ml min-1 kg-1 FFM-FFAT, respectively). On the other hand, VO2peak expressed relative to FFM was approximately 8% different between groups. When normalizing VO2peak by FFM, eliminating the FFAT component from FFM may be needed, especially when comparing groups with different body fat mass.