Geometric and Mechanical Bone Response to a Multidisciplinary Weight Loss Intervention in Adolescents With Obesity: The ADIBOX Study.

The effectiveness of structured multidisciplinary weight loss (WL) programs combining nutrition and physical activity on bone geometry and strength remains uncertain in adolescents with obesity. The study investigated the impact of a structured WL intervention on bone geometry and strength in adolescents with obesity. Thirty-one adolescents with obesity (mean [standard deviation] 13.61 [1.27] yr, body mass index Z-score 2.26 [0.30]) experienced an 8-mo WL program. A group of 23 maturation-matched controls (mean [standard deviation] 15.90 [0.43] yr, body mass index Z-score -0.12 [0.48]) were recruited for calculating Z-scores. Body composition, bone density, geometry, and mechanical properties were assessed using dual-energy X-ray absorptiometry and dual-energy X-ray absorptiometry-derived hip structural analysis. Plasma concentration of leptin, estradiol, collagen type 1 cross-linked C-telopeptide (CTx), and procollagen type 1 N-terminal propeptide were measured. Longitudinal analysis showed that adolescents with obesity reduced body weight and fat mass (total [g, %; p < 0.007]). After 8 mo, body mineral density at total body less head (Δ 3.22 [3.58] % p < 0.001) and lumbar spine (Δ 3.67 [4.04] % p < 0.001) increased. At the narrow neck (NN) of the femur, lower body mineral density (Δ -7.19 [8.79] % p < 0.001) and higher endocortical diameter and width were observed (NN endocortical diameter Δ 2.85 [0.26] %, NN width Δ 5.48 [10.84] %, respectively). An increased buckling ratio (Δ 8.24 [2.00] % p = 0.005) was also evident. Similar concentration of procollagen type 1 N-terminal propeptide and CTx was seen from baseline to 8 mo. However, at 4 mo, lower CTx levels were observed. The 8-mo WL program was associated with some positive adaptations among bone density parameters for the whole body and spine. However, bone geometry and strength estimates appeared to weaken at the NN. Clinically, the buckling ratio score at the NN was close to the fracture threshold. An "androgynous-like" adaptation was observed with bone geometry changes demonstrating periosteal expansion and endocortical resorption.

Creating play opportunities on the school playground: Educator experiences of the Sydney playground project.

INTRODUCTION: Children with disabilities often experience unsupportive environments that restrict their play opportunities and inclusion on the school playground. This exclusion can perpetuate inequities for children with disabilities, with lifelong implications. The Sydney Playground Project uses a simple, innovative intervention consisting of placing recycled materials on the playground and engaging parents and educators in risk reframing sessions to create increased playground choice, control, independence and inclusion for all children. METHODS: The purpose of this study was to learn from participants about the utility of the intervention for promoting choice and control among children with disability on the school playground. Data included evaluative interviews with 27 school staff (teaching assistants, teachers, therapists, school leadership) across five participating schools after completing of the intervention. Analysis was thematic and explored prominent ideas first within schools, and then between schools. RESULTS: Prior to the intervention, participating school staff focused on active supervision to support play and student needs. During the intervention, school staff experienced role shift and confusion as they allowed the children increased independence while using the recycled materials and learned to navigate how much independence to give the children. Children engaged in increased imaginative and social play, and school staff adopted higher expectations of children's capabilities. CONCLUSION: Interventions such as the Sydney Playground Project that collaboratively shift adult perceptions to focus on the capabilities of children with disabilities and increase the supportiveness of the physical environment have great promise in increasing play choice and inclusion on the school playground.

Trunk Exercises Improve Balance in Parkinson Disease: A Phase II Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD. METHODS: Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks. RESULTS: Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (-6.9 ± 3.1 cm; 95% confidence interval [CI] = -13.1 to -0.7; P = 0.029; d = 0.66) and 24 weeks (-7.9 ± 3.1 cm; 95% CI = -14.1 to -1.7; P = 0.013; d = 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.042; d = 0.62) and 24 weeks in the medial-lateral direction (-0.2 ± 0.1 cm; 95% CI = -0.4 to 0.0; P = 0.043; d = 0.62). No changes in quiet standing balance were recorded for the education group. DISCUSSION AND CONCLUSIONS: The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A254).

The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis.

BACKGROUND: Fetal growth is dependent upon utero-placental vascular supply of oxygen and nutrients from the mother and has been proposed to be compromised by vigorous intensity exercise in the third trimester. The aim of this systematic review was to investigate the effects of vigorous intensity exercise performed throughout pregnancy, on infant and maternal outcomes. METHODS: Electronic searching of the PubMed, Medline, EMBASE, Cochrane Library, Web of Science and CINAHL databases was used to conduct the search up to November 2018. Study designs included in the systematic review were randomised control trials, quasi-experimental studies, cohort studies and case-control studies. The studies were required to include an intervention or report of pregnant women performing vigorous exercise during gestation, with a comparator group of either lower intensity exercise or standard care. RESULTS: Ten cohort studies (n = 32,080) and five randomized control trials (n = 623) were included in the systematic review (n = 15), with 13 studies included in the meta-analysis. No significant difference existed in birthweight for infants of mothers who engaged in vigorous physical activity and those who lacked this exposure (mean difference = 8.06 g, n = 8006). Moreover, no significant increase existed in risk of small for gestational age (risk ratio = 0.15, n = 4504), risk of low birth weight (< 2500 g) (risk ratio = 0.44, n = 2454) or maternal weight gain (mean difference = - 0.46 kg, n = 1834). Women who engaged in vigorous physical activity had a small but significant increase in length of gestational age before delivery (mean difference = 0.21 weeks, n = 4281) and a small but significantly reduced risk of prematurity (risk ratio = - 0.20, n = 3025). CONCLUSIONS: Findings from this meta-analysis indicate that vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies. Further research is needed on the effects of vigorous intensity exercise in the first and second trimester, and of exercise intensity exceeding 90% of maximum heart rate. TRIAL REGISTRATION: PROSPERO trial registration CRD42018102109 .

Training and match volume and injury in adolescents playing multiple contact team sports: A prospective cohort study.

Training and competition loads have emerged as valuable injury risk factors but very few studies have explored injury outcomes in adolescent athletes. The aims of this study were to describe injuries and to explore the relationship between training and match load volumes and injury in adolescent athletes participating in multiple contact team sports. One hundred and three male youth rugby athletes aged 14-16 years from 8 rugby union teams were prospectively monitored during a season for weekly training and match volumes and injuries. The relationship between volume and injury was explored by comparing the weekly volume in the week prior to an injury vs weeks without injury. There were 83 time-loss injuries in 58 athletes (62%). Overall injury incidence was 18.5 per 1000 player-hours. Mean weekly injury prevalence was 27% (95% CI 25-30). Average weekly volume was 5.4 (2.2) hours comprising 1.4 (1) match hours and 4 (2.6) training hours. Compared with weeks without injury, weeks prior to an injury had higher match volumes (110 [57] min vs 83 [59] min, P < 0.001). Poisson regression demonstrated that match volume was a predictor of injury with an odds ratio of 1.41 (P = 0.001). The contribution of match volumes to injury risk and the relatively high injury burden in these athletes may be profound. Very high match volumes are unlikely to be in the best interests of young athletes and could be avoided with a systematic approach to load management and athlete development.

The Influence of Contextual Factors on Running Performance in Female Australian Football Match-Play.

Black, GM, Gabbett, TJ, Naughton, G, Cole, MH, Johnston, RD, and Dawson, B. The influence of contextual factors on running performance in female Australian football match-play. J Strength Cond Res 33(9): 2488-2495, 2019-Given the recent growth of the professional status among multiple female football codes, the aim of this study is to investigate the effects of contextual factors on activity profiles and pacing strategies in female Australian football (AF) players. Thirty-five female AF players participated in this study. Global positioning system analysis was completed over 1 competitive season. Matches were separated into eight 10-minute periods. Greater distances were covered during the first half irrespective of playing position (effect size [ES] = 0.39-0.50, Likelihood ≥90%). Throughout a number of periods half-backs (defensive players) covered greater distances during losses (ES ≥ 0.74, Likelihood ≥92%) and against top 3 opponents (ES ≥ 1.0, Likelihood ≥97%). Midfielders and half-backs covered greater distances (ES ≥ 0.49, Likelihood ≥89%) in the final match period in winning compared with losing matches. A reduction in player work rate is evident during the second half of matches. The influence of contextual factors varied across positional groups. However, it is clear that coaches could use player rotation both early in the match in an attempt to delay the effect of fatigue and more frequently during the second half to increase running intensity.

Sex Differences in Physical Fitness Characteristics and Match-Play Demands in Adolescent Netball: Should Male and Female Adolescents Co-compete in Netball?

Tissera, KM, Naughton, GA, Gabbett, TJ, Krause, LM, Moresi, MP, and Benson, AC. Sex differences in physical fitness characteristics and match-play demands in adolescent netball: Should male and female adolescents co-compete in netball? J Strength Cond Res 33(3): 846-856, 2019-Sports participation offers multifaceted benefits, especially during adolescence. However, policies relating to male and female adolescents co-competing in team sports can be prohibitive and lack an evidence base. This study aimed to strengthen evidence on coparticipation of male and female adolescents playing recreational netball. Off-court fitness characteristics (power, speed, agility, and high-speed intermittent running) and match-play performances from global positioning system (GPS) and video analysis were compared in adolescent males (n = 34, mean ± SD, age, 15.2 ± 0.8 years) and females (n = 45, mean ± SD, age, 14.9 ± 0.7 years), with previous recreational netball experience. Independent t-tests showed adolescent men outperforming females in all off-court fitness characteristics (p < 0.001). Two-way analyses of variance explored sex-based interactions in match-play (GPS accelerometer data and notational analyses) and type of competition (mixed-/single-sex formats) in forty-two 7-minute matches. Overall, no differences in match-play performances were found between males and females (p > 0.05). Notational skill-based comparisons showed that male skills were better in mixed- than single-sex matches. Conversely, competition format did not alter skills of females. Despite more netball experience in females and superior off-court fitness characteristics in males, on-court performance differences between males and females were minimal in these recreational adolescent netball players. Coparticipation in netball was not detrimental to the performance of either sex.

Construct Validity and Test-Retest Reliability of the Coping Inventory (CI) for Children With Developmental Disabilities.

OBJECTIVE: A reliable, valid, and readily usable method of measuring coping is essential for occupational therapy practitioners and researchers working with children with developmental disabilities. The aim of this study was to examine evidence for the construct validity and internal and test-retest reliability of the Coping Inventory (CI), a 48-item survey designed for use with children. METHOD: School staff (N = 39) completed CIs for 79 students with developmental disabilities age 5-13 yr (mean = 8.0, standard deviation = 2.0) who were primarily boys (n = 52; 68%) with autism spectrum disorder (n = 40 of 47 diagnoses provided). We used Rasch analysis to examine construct validity, internal reliability, and possible redundancy of items and intraclass correlations, Pearson correlations, Bland-Altman plots, and t tests were used to examine test-retest reliability. RESULTS: Rasch analysis provided evidence of construct validity: All items correlated positively with the overall measure; data from 94% of items conformed with Rasch expectations, and the items form a logical hierarchy. Intraclass correlations revealed an average coefficient of .96, providing evidence of test-retest reliability. CONCLUSION: The CI demonstrated good evidence for construct validity and internal and test-retest reliability. Redundancy of items suggests that some items could be eliminated after further research.

Confident and Understanding Parents (CUPs) - a child nutrition and active play pilot intervention for disadvantaged families attending Supported Playgroups in Victoria, Australia.

ISSUE ADDRESSED: Health and nutrition inequalities are prevalent among families from socio-economically disadvantaged backgrounds. However, there is limited evidence of targeted early childhood nutrition and active play approaches due to the methodological challenges in engaging vulnerable families in research. METHODS: The aim of this paper was to report findings from a pilot intervention called Confident and Understanding Parents (CUPs). CUPs aims to improve child nutrition and active play-related outcomes for children in vulnerable families. The intervention was delivered in six Supported Playgroups (SPs) in two disadvantaged locations in Victoria. Surveys incorporated knowledge and confidence measures and were administered pre- and post-training of SP facilitators along with pre-, immediately post and and 3 months postintervention to SP facilitators and parents. Qualitative data were collected via debriefing discussions with SP facilitators and ethnographic observations during SP sessions. Thematic analyses of qualitative data and statistical quantitative analyses were conducted. RESULTS: Nine SP facilitators completed training, of whom six delivered CUPs in SPs with 64 parents of children aged 0 to 4 years from socially disadvantaged backgrounds. Forty-three parents (66%) attended a minimum of 50% of SP sessions with CUPs delivery. SP facilitators and parents demonstrated improved knowledge and confidence following the pilot. Learnings for implementation were identified. CONCLUSION: Overall, the CUPs intervention reached and engaged vulnerable families. A strength of the intervention is the flexibility offered to SP facilitators in selecting key messages and the strong focus on "local" translation of key child nutrition and active play messages within existing early childhood settings. A further strength was the adaptation of evaluation methodology to optimise the engagement of vulnerable families. SO WHAT?: This pilot study provides insights about engaging vulnerable families in a nutrition and active play intervention to promote child health. These promising findings warrant further implementation and rigorous evaluation of CUPs.

Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis.

Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.

Equity of Physical Characteristics Between Adolescent Males and Females Participating in Single- or Mixed-Sex Sport.

Krause, LM, Naughton, GA, Benson, AC, and Tibbert, S. Equity of physical characteristics between adolescent males and females participating in single- or mixed-sex sport. J Strength Cond Res 32(5): 1415-1421, 2018-Policies on single- or mixed-sex junior sports participation continue to be challenged publically and legally. Often challenges relate to perceptions of size and performance variability between adolescent males and females, yet the evidence base behind these challenges lacks recent review and rigor. Physical performance was compared between males and females from 2 groups of younger (<13 years, n = 109, 67% females, 33% males) and older (≥13 years, n = 108, 43% females, 57% males) adolescents. Using a cross-sectional design, adolescents were tested for speed, strength, power, and endurance. No sex differences were found for most of the physical test results in the <13 years age group, although males showed greater endurance (p = 0.020) and upper-body strength (p = 0.010) than females. However, among adolescents aged ≥13 years, males scored better than females in all physical tests, without exception (p > 0.05). Further explorations comparing how many females in the same age grouping shared test results equal to or greater than the top third of males were fewer in the older than younger age group. Equality of participation in mixed-sex sport becomes more difficult to guarantee for older adolescents when results from generic sport-related physical test performances are considered.

Maximal tachycardia and high cardiac strain during night shifts of emergency physicians.

PURPOSE: To compare tachycardia and cardiac strain between 24-hour shifts (24hS) and 14-hour night shifts (14hS) in emergency physicians (EPs), and to investigate key factors influencing tachycardia and cardiac strain. METHODS: We monitored heart rate (HR) with Holter-ECG in a shift-randomized trial comparing a 24hS, a 14hS, and a control day, within a potential for 19 EPs. We also measured 24-h HR the third day (D3) after both shifts. We measured perceived stress by visual analog scale and the number of life-and-death emergencies. RESULTS: The 17 EPs completing the whole protocol reached maximal HR (180.9 ± 6.9 bpm) during both shifts. Minutes of tachycardia >100 bpm were higher in 24hS (208.3 ± 63.8) than in any other days (14hS: 142.3 ± 36.9; D3/14hS: 64.8 ± 31.4; D3/24hS: 57.6 ± 19.1; control day: 39.2 ± 11.6 min, p < .05). Shifts induced a cardiac strain twice higher than in days not involving patients contact. Each life-and-death emergency enhanced 26 min of tachycardia ≥100 bpm (p < .001), 7 min ≥ 110 bpm (p < .001), 2 min ≥ 120 bpm (p < .001) and 19 min of cardiac strain ≥30% (p = .014). Stress was associated with greater duration of tachycardia ≥100, 110 and 120 bpm, and of cardiac strain ≥30% (p < .001). CONCLUSION: We demonstrated several incidences of maximal HR during shifts combined with a high cardiac strain. Duration of tachycardia were the highest in 24hS and lasted several hours. Such values are comparable to those of workers exposed to high physical demanding tasks or heat. Therefore, we suggest that EPs limit their exposure to 24hS. We, furthermore, demonstrated benefits of HR monitoring for identifying stressful events. ClinicalTrials.gov identifier: NCT01874704.

Bone Health of Young Male Gymnasts: A Systematic Review.

PURPOSE: To synthesize existing literatures on the impact of gymnastics participation on the skeletal health of young male gymnasts. METHODS: Following a systematic search, 12 studies were included in this review. Quality of included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE modified) criteria. RESULTS: Assessment of skeletal health varied between and within imaging modality protocols. Gymnasts had higher total bone content, greater total and trabecular bone density, larger bone size, a thicker cortex, and higher estimates of bone strength than controls. Recreational studies reported no difference in height or weight between gymnasts and controls; however, elite gymnasts were shorter and lighter than nongymnasts. STROBE scores ranged from 65% to 95%. CONCLUSION: Gymnastics participation may be beneficial to the bone health of young males as gymnasts had higher bone density and bone mineral content, larger bones, and greater estimates of bone strength than controls.

Metabolic syndrome individuals with and without type 2 diabetes mellitus present generalized vascular dysfunction: cross-sectional study.

OBJECTIVES: The first objective of this study was to demonstrate differences within endothelial-dependent and endothelial-independent vasoreactivity in macro- and microcirculation beds among patients with metabolic syndrome (MetS) with and without type 2 diabetes mellitus (T2D) compared with healthy counterparts. The second objective was to determine relationships among the function of macro- and microvascular systems and abdominal adiposity, as well as inflammatory markers in the 3 groups. APPROACH AND RESULTS: Cross-sectional analyses of 53 patients with MetS without T2D and 25 with T2D, as well as aged 40 years and sex-matched healthy controls included microvascular (cutaneous blood flow measured with laser Doppler flowmetry in response to iontophoresis of acetylcholine and sodium nitroprusside), and macrovascular reactivity (flow-mediated dilation and nitrate-mediated dilation) along with anthropometric measures, plasma glucose, and insulin and inflammatory markers. Compared with controls, MetS participants showed depressed endothelial function of both micro- and macrocirculation beds. T2D in patients with MetS revealed an exacerbated vascular smooth muscle dysfunction in micro- and macrocirculation compared with MetS without T2D. Indices of micro- and macrocirculation were predominantly inversely related to abdominal fat and inflammatory markers. CONCLUSIONS: MetS was associated with endothelial-dependent and endothelial-independent dysfunction, affecting both the macro- and the microvascular systems. Participants with diabetes mellitus demonstrated the most severe smooth muscle dysfunction. The presence of central abdominal fat and systemic inflammation seems implicated in the pathogenesis of vascular dysfunctions in MetS.

Use of a Short-Form Balance Confidence Scale to Predict Future Recurrent Falls in People With Parkinson Disease.

OBJECTIVES: To assess whether the 16-item Activities-specific Balance Confidence scale (ABC-16) and short-form 6-item Activities-specific Balance Confidence scale (ABC-6) could predict future recurrent falls in people with Parkinson disease (PD) and to validate the robustness of their predictive capacities. DESIGN: Twelve-month prospective cohort study. SETTING: General community. PARTICIPANTS: People with idiopathic PD (N=79). INTERVENTIONS: Clinical tests were conducted to assess symptom severity, balance confidence, and medical history. Over the subsequent 12 months, participants recorded any falls on daily fall calendars, which they returned monthly by reply paid post. MAIN OUTCOME MEASURES: Logistic regression and receiver operating characteristic analyses estimated the sensitivities and specificities of the ABC-16 and ABC-6 for predicting future recurrent falls in this cohort, and "leave-one-out" validation was used to assess their robustness. RESULTS: Of the 79 patients who completed follow-up, 28 (35.4%) fell more than once during the 12-month period. Both the ABC-16 and ABC-6 were significant predictors of future recurrent falls, and moderate sensitivities (ABC-16: 75.0%; ABC-6: 71.4%) and specificities (ABC-16: 76.5%; ABC-6: 74.5%) were reported for each tool for a cutoff score of 77.5 and 65.8, respectively. CONCLUSIONS: The results have significant implications and demonstrate that the ABC-16 and ABC-6 independently identify patients with PD at risk of future recurrent falls.

Stress among nurses working in emergency, anesthesiology and intensive care units depends on qualification: a Job Demand-Control survey.

BACKGROUND: The nurse stress literature reports an overwhelming culture of acceptance and expectation of work stressors, ironically linked to the control of the workplace to effectively and proactively manage stress. The stressors involved in delivering "stress management" have been well studied in nursing-related workplaces, especially in acute care settings in accordance with the Karasek Job Demand-Control-Support (JDCS) model. However, little is known about the effects of specificity of an acute care unit and the level of qualifications on stress experienced by nurses. METHODS: A survey using the JDCS model was conducted among 385 nurses working in three different acute care units (anesthesiology, emergency and intensive care unit) from a university hospital. Specific questions explored variables such as gender, acute care units, level of qualification and working experience. RESULTS: Two hundred questionnaires were returned. A high level of job strain was highlighted without a gender effect and in the absence of isostrain. Nurses from acute care units were located in the high stress quadrant of the JDCS model. Conversely, other nurses were commonly located in the "active" quadrant. Independent of acute care settings, the highest level of education was associated with the highest job strain and the lowest level of control. CONCLUSIONS: In an acute care setting, a high level of education was a key factor for high job stress and was associated with a perception of a low control in the workplace, both of which may be predictors of adverse mental health. In particular, the lack of control has been associated with moral distress, a frequently reported characteristic of acute care settings. To enhance the personal and professional outcomes of the advanced registered nurses, strategies for supporting nurses manage daily stressors in acute care are urgently required.

Validity and Reliability of a Submaximal Intermittent Running Test in Elite Australian Football Players.

Veugelers, KR, Naughton, GA, Duncan, CS, Burgess, DJ, and Graham, SR. Validity and reliability of a submaximal intermittent running test in elite Australian football players. J Strength Cond Res 30(12): 3347-3353, 2016-The aim of this article was to determine the validity and reliability of a submaximal intermittent running (SIR) test in elite Australian rules football (ARF) players. Heart rate (HR) responses of 38 elite ARF players to both the SIR and the yo-yo intermittent recovery 2 (YYIR2) tests were compared over 2 trials. Linear regression analysis was used to examine the relationship between SIR test HR responses and YYIR2 test performance. Heart rate responses of 25 elite ARF players to the SIR test were monitored over 3 trials. Day-to-day reliability was determined using intraclass correlation coefficient (ICC), typical error of measurement, coefficient of variation (CV), and smallest worthwhile change. Large inverse correlations were reported between 2-, 3-, and 4-minute HR during the SIR test and YYIR2 test distance (r = -0.58 to -0.61, p < 0.01). Heart rate recovery after 2 and 3 minutes of the SIR test was moderately correlated to YYIR2 distance (r = 0.32-0.35, p ≤ 0.05). Strong correlations for ICC (r = 0.90-0.97) and low CV (1.3-9.2%) were reported for all HR variables. Monitoring HR during the SIR test is a valid and reliable indicator of YYIR2 test performance in elite ARF players. These findings support the use of the SIR test as a regular and non-fatiguing indicator of intermittent running capacity.

Bone-adiposity cross-talk: implications for pediatric obesity. A narrative review of literature.

The rising prevalence of overweight and obesity among pediatric populations has become a major global concern. The objective of this review is to demonstrate potential interactions between the products released by fat tissue and the hormonal production of bone tissue in obese children and adolescents. Advancing the understanding of the complex interactions between adipocyte and osteocyte activities may contribute to the mechanistic understanding of the body's responses to weight loss during adolescence. This knowledge could also reveal any side effects encountered with these interventions. Currently, the concept of bone-adiposity crosstalk has not been fully elucidated, and the mechanisms remain controversial. Understanding the local interactions between the released products by fat tissue and hormones produced in bone tissue requires further investigations.

The Sydney playground project--levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability.

BACKGROUND: Providing children and adults with opportunities to engage in manageable risk taking may be a stepping stone toward closing the gap in life conditions currently experienced by young people with disabilities. We aim to demonstrate the effectiveness of a simple, innovative program for 1) changing the way parents and teachers view manageable risk-taking for children with disabilities and 2) increasing the level of responsibility that children take for their own actions, as seen on the school playground. METHODS/DESIGN: We will employ a cluster repeated measures trial with six Sydney-area primary-school-based programs for children with disabilities. The intervention comprises two arms. 1) Risk-reframing--teachers and parents will participate together in small group intervention sessions focusing on the benefits of manageable risk-taking; 2) Introduction of play materials--materials without a defined purpose and facilitative of social cooperation will be introduced to the school playground for children to use at all break times. A control period will be undertaken first for two school terms, followed by two terms of the intervention period. Outcome measures will include playground observations, The Coping Inventory, qualitative field notes, and The Tolerance of Risk in Play Scale. DISCUSSION: New national programs, such as Australia's National Disability Insurance Scheme, will place increasing demands on young people with disabilities to assume responsibility for difficult decisions regarding procuring services. Innovative approaches, commencing early in life, are required to prepare young people and their carers for this level of responsibility. This research offers innovative intervention strategies for promoting autonomy in children with disabilities and their carers. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number ACTRN12614000549628 (registered 22/5/2014).

Early childhood nutrition, active outdoor play and sources of information for families living in highly socially disadvantaged locations.

AIMS: To compare nutrition and active play of children aged 0-4 years attending Supported Playgroups and mainstream services and to compare access, understanding and application of health information within these families. METHODS: A cross-sectional study of children aged 0-4 years attending early childhood services. Following stratified random sampling, 81 parents of children attending Supported Playgroups in two highly disadvantaged municipalities of Victoria, Australia were surveyed about children's nutrition, active outdoor play/screen time and access to health information. Responses were dichotomised based on national recommendations and compared with 331 children attending maternal and child health and childcare centres (mainstream services). All outcomes except age were dichotomous and analysed using chi-square, relative risk and 95% confidence intervals. RESULTS: More children from Supported Playgroups consumed sweet drinks (P = 0.005), 'packaged' foods (P = 0.012) and tea/coffee (P = 0.038) than mainstream children. Supported Playgroup families reported more food insecurity (P = 0.016) and excessive 'screen time' for children under 2 years (P = 0.03). Fewer Supported Playgroups parents sought advice from family members (P < 0.001) and the Internet (P = 0.014) and more experienced difficulties accessing (P < 0.001), understanding (P = 0.002) and applying health information (P < 0.001). CONCLUSION: Despite comparable availability of child health information, Supported Playgroups children demonstrated more concerning child health practices, and families experienced greater difficulties accessing, understanding and applying advice than families from mainstream services despite living in the same highly disadvantaged locations.