Cardiorespiratory and Muscular Fitness in Children and Adolescents with Obesity.

PURPOSE OF REVIEW: Examine the current state of literature related to the impact of obesity in children and adolescents on health-related physical fitness and the resultant cardiometabolic disease risk. RECENT FINDINGS: Cardiorespiratory fitness of children and adolescents has declined over the past few decades which corresponds with an increase in obesity rates. Children with obesity are more likely to have low cardiorespiratory fitness which is associated with higher cardiometabolic disease risk and poorer mental health. The impact of obesity on muscular fitness in children and adolescents is more difficult to ascertain, but in general measures of physical function are lower in children with obesity which has also been associated with higher cardiometabolic disease risk. Components of health-related physical fitness are trending negatively in children and adolescents and appear to be related to the increase in prevalence of obesity. The resultant cardiometabolic disease risk has also risen which suggests a greater disease burden in the future. These disparaging findings highlight the need for aggressive interventions to improve physical fitness in children and adolescents.

Metabolic Flexibility During Exercise in Children with Overweight/Obesity Versus Children who are Lean.

PURPOSE: This study examined metabolic flexibility with respect to fat metabolism during exercise in children who are lean (n=11; 10.9[0.9] y) and overweight/obese (OW/OB; n=9; 10.3[1.2] y). METHOD: Participants were grouped based on body mass index percentiles for age and sex. Groups were mixed in age and sex. Participants completed two 20-minute exercise bouts on a cycle ergometer, separated by a 10-minute rest. Bout 1 consisted of 10 minutes at 50% VO2peak and 10 minutes at 75% VO2peak. Bout 2 was 20 minutes at 50% VO2peak. Absolute fat oxidation rate (FOR), FOR relative to body mass, FOR relative to fat-free mass, and proportional fat use were measured at 10 minutes of bout 1 and 5, 10, 15, and 20 minutes of bout 2. RESULTS: Absolute FOR was higher in the OW/OB group (range: 117.8 [55.1]-206.2 [48.3] mg·min-1) than in the lean group (81.1 [32.2]-152.2 [38.2] mg·min-1); however, there were no significant main effects for group or significant interactions for proportional fat use, FOR relative to body mass, or FOR relative to fat-free mass. CONCLUSION: Children in this age range who are overweight/obese do not display impaired metabolic flexibility with respect to fat metabolism during exercise.

Effect of maturation on parasympathetic modulation during exercise and recovery.

OBJECTIVES: This study examined the effect of maturation on parasympathetic nervous system (PNS) response from rest to light- to moderate-intensity exercise and recovery from maximal exercise in pre- (n = 10; maturity offset = -3.0 ± 1.2 years; age = 10.1 ± 1.9 years), mid- (n = 9; maturity offset = -0.1 ± 0.6 years; age = 13.7 ± 1.0 years), and postpubertal (n = 10; maturity offset = 1.9 ± 0.6 years; age = 15.6 ± 1.2 years) boys and men (n = 10; age = 24.1 ± 2.0 years). DESIGN: Participants completed seated rest, light-intensity exercise (50% HRmax), and moderate-intensity exercise (65% HRmax). Following moderate-intensity exercise, intensity was ramped to elicit maximal HR and followed by 25 min of seated recovery. Log transformed values for root mean square of successive differences (lnRMSSD), high-frequency power (lnHF) and normalized HF power (lnHFnu) assessed PNS modulation during 3 min of rest, light-intensity exercise, moderate-intensity exercise, and 3-min epochs throughout recovery. RESULTS: During light-intensity exercise, lnRMSSD and lnHF were greater in prepubertal (lnRMSSD = 3.4 ± 0.3 ms; lnHF = 5.4 ± 0.7 ms2) compared to men (lnRMSSD = 2.8 ± 0.5 ms; lnHF = 4.0 ± 0.9 ms2). During moderate-intensity exercise, lnHF differed between prepubertal and men (2.8 ± 1.0 vs. 1.4 ± 1.0 ms2). During recovery, HRV variables were greater in prepubertal compared to postpubertal and men. CONCLUSIONS: Prepubertal boys have reduced PNS withdrawal during light-intensity exercise and greater PNS reactivation following exercise.

Carbohydrate Drink Use During 30 Minutes of Variable-Intensity Exercise Has No Effect on Exercise Performance in Premenarchal Girls.

PURPOSE: This study examined the physiological, perceptual, and performance effects of a 6% carbohydrate (CHO) drink during variable-intensity exercise (VIE) and a postexercise test in premenarchal girls. METHODS: A total of 10 girls (10.4 [0.7] y) participated in the study. VO2peak was assessed, and the girls were familiarized with VIE and performance during the first visit. The trial order (CHO and placebo) was randomly assigned for subsequent visits. The drinks were given before VIE bouts and 1-minute performance (9 mL/kg total). Two 15-minute bouts of VIE were completed (10 repeated sequences of 20%, 55%, and 95% power at VO2peak and maximal sprints) before a 1-minute performance sprint. RESULTS: The mean power, peak power, heart rate (HR), %HRpeak, and rating of perceived exertion during VIE did not differ between trials. However, the peak power decreased, and the rating of perceived exertion increased from the first to the second bout. During the 1-minute performance, there were no differences between the trial (CHO vs placebo) for HR (190 [9] vs 189 [9] bpm), %HRpeak (97.0% [3.2%] vs 96.6% [3.0%]), rating of perceived exertion (7.8 [2.3] vs 8.1 [1.9]), peak power (238 [70] vs 235 [60] W), fatigue index (54.7% [10.0%] vs 55.9% [12.8%]), or total work (9.4 [2.6] vs 9.4 [2.1] kJ). CONCLUSION: CHO supplementation did not alter physiological, perceptual, or performance responses during 30 minutes of VIE or postexercise sprint performance in premenarchal girls.

Regulatory Fit: Impact on Anxiety, Arousal, and Performance in College-Level Soccer Players.

Sport performance may be facilitated using regulatory fit, which is a match between individuals' situational strategy and their chronic self-regulatory strategy. However, researchers have not examined the impact of regulatory fit on psychological and physiological components of sport performance, such as anxiety and arousal. Therefore, the purpose of this study was to evaluate the psychophysiological reactions to regulatory fit by examining anxiety, arousal, and sport performance. Female college-level soccer players (n = 25) were randomly assigned to the regulatory match or regulatory mismatch conditions and completed anxiety (Competitive Sport Anxiety Inventory-2R, CSAI-2R) and underwent arousal (heart rate variability, HRV; pre-ejection period, PEP) measures pre- and post-regulatory focus manipulation. Subsequently, participants completed a sport performance task (10 penalty kicks). The impact of regulatory fit on the dependent variables was explored through repeated measures ANOVAs. Results revealed a significant time effect for cognitive anxiety and self-confidence subscales of the CSAI-2R, suggesting the penalty kicking task increased cognitive anxiety and reduced self-confidence in all participants. In addition, there was a significant interaction effect of condition on pre-ejection period (PEP), with a greater increase in PEP for those experiencing regulatory fit compared to those who were not. There were non-significant interaction and main effects for all other variables. Since PEP is an inverse measure of sympathetic (SNS) modulation, experiencing regulatory fit may reduce SNS involvement in the heartbeat. Thus, the current results indicate experiencing regulatory fit may influence arousal prior to athletic competition.

Carbohydrate consumption and variable-intensity exercise responses in boys and men.

PURPOSE: The effect of carbohydrate (CHO) supplementation on physiological and perceptual responses to steady-state exercise has been studied in children. However, little is known about these responses to variable-intensity exercise (VIE) and how these responses might differ from adults. This study examined the physiological and perceptual effects of CHO on VIE in boys and men. METHODS: Eight boys (11.1 ± 0.9 years) and 11 men (23.8 ± 2.1 years) consumed CHO or a placebo (PL) beverage before and throughout VIE (three 12-min cycling bouts with intensity varying every 20-30 s between 25, 50, 75, and 125% peak work rate). Pulmonary gas exchange was assessed during the second 12-min bout. RPE was assessed twice per bout. RESULTS: In CHO, blood glucose increased and then decreased more from pre-exercise to 12 min and was higher in this trial at the end of exercise in men versus boys. In boys, blood glucose in CHO was higher at 24 and 36 min of exercise than in PL. RER during the CHO trial was higher in both groups; the other physiological responses were unaffected by CHO. All RPE measures (whole body, legs and chest) increased over time, but were not different between groups or trials. CONCLUSION: Blood glucose patterns during VIE were differentially affected by CHO in boys and men, but most physiological and perceptual responses to VIE were unaffected by CHO in either group. Knowledge of the underlying mechanisms of glucose regulation and effects on physical performance during this type of exercise in children is warranted.

Ratings of Perceived Exertion and Physiological Responses in Children During Exercise.

OMNI ratings of perceived exertion (RPE) and physiological responses in children (n=7 boys, 8 girls, 11.1±1.0 years) were examined during estimation (graded exercise test [GXT] and steady-state) and production (steady-state) trials on a cycle ergometer. Peak oxygen consumption (VO2peak) was determined via a GXT with RPE estimated every 30 s. Later, two 6-min trials were completed: Participants 1) estimated RPE at ~75% of VO2peak, 2) produced a level of exertion corresponding to their RPE at ~75% of VO2peak during the GXT. Data analysis included a one-way MANOVA and a paired t-test. The target intensity during the GXT corresponded to 74.2±2.5% of VO2peak; the steady-state estimation and production trials were performed at 76.5±2.7% and 68.5±14.1% of VO2peak, respectively (p>0.05). Mean RPE at ~75% of VO2peak during the GXT and production trial was 6.7±1.5; during the steady-state estimation trial RPE was 5.8±2.0 (p>0.05). There were no differences (p>0.05) in the physiological responses. Participants estimated RPE similarly at ~75% of VO2peak during both graded and steady-state exercise, but when asked to produce a given RPE, marked variability was observed in physiological responses. These findings may have implications in optimizing exercise prescriptions for children.

Heart Rate Response and Variability Following Maximal Exercise in Overweight Children.

PURPOSE: This study examined heart rate recovery (HRR) and heart rate variability (HRV) following maximal exercise in lean (<85th percentile age- and sex-BMI percentile; n = 11 (♂=5; ♀=6); 10.1 ± 0.7 years) and overweight (≥85th age- and sex-BMI percentile; n = 11 (♂=5; ♀=6); 10.5 ± 1.2 years) children. METHOD: Participants completed a 10-min rest, followed by a graded exercise test to maximal effort. HRV, in the time and frequency domains, was assessed during rest and recovery. Also during recovery, one-minute HRR and the time constant of a monoexponential line of best fit (HRRt) were determined. RESULTS: There were no significant differences in one-minute HRR and HRRt between the lean (56 ± 7 beats∙min-1 and 160.4 ± 80.1 s, respectively) and overweight (51 ± 16 beats∙min-1 and 141.1 ± 58.1 s, respectively) groups. There also were no significant interactions between groups from rest to recovery for any HRV variables. Root mean square of successive differences (RMSSD) and high frequency power (HF) during recovery was 2.05 ± 0.49 ms and 3.30 ± 1.02 ms2 in the lean children, respectively. In the overweight children, RMSSD and HF were 1.88 ± 0.65 ms and 2.94 ± 1.27 ms2, respectively. CONCLUSION: HRR and HRV findings suggest there are no differences in autonomic function during recovery from maximal exercise in lean and obese 8- to 12-year old children.

Heart rate response and parasympathetic modulation during recovery from exercise in boys and men.

The purpose of this study was to examine the influence of postexercise parasympathetic modulation, measured by heart rate variability (HRV), on heart rate recovery (HRR) in boys (n = 13, 10.1 ± 0.8 years) and men (n = 13, 23.9 ± 1.5 years) following maximal and submaximal exercise. Subjects completed 10 min of supine rest, followed by graded exercise on a cycle ergometer to maximal effort. On a separate day, subjects exercised at an intensity equivalent to ventilatory threshold. Immediately following both exercise bouts, 1-min HRR was assessed in the supine position. HRV was analyzed under controlled breathing during the final 5 min of rest and recovery in the time and frequency domains and transformed to natural log (ln) values. Boys had a greater 1-min HRR than men following maximal (58 ± 8 vs. 47 ± 11 beats·min(-1)) and submaximal (59 ± 8 vs. 47 ± 15 beats·min(-1)) exercise (p < 0.05). Following maximal exercise, boys had greater ln root mean square successive differences in R-R intervals (2.52 ± 0.95 ms), ln standard deviation of NN intervals (3.34 ± 0.57 ms), ln high-frequency power (4.32 ± 2.00 ms(2)), and ln low-frequency power (4.98 ± 1.17 ms(2)) than men (1.33 ± 0.37 ms, 2.52 ± 0.24 ms, 1.32 ± 1.06 ms(2) and 2.80 ± 0.74 ms(2), respectively) (p < 0.05). There were no differences in any HRV variables between groups following submaximal exercise (p > 0.05). In conclusion, it appears that greater parasympathetic modulation accounts for greater HRR following maximal exercise in boys versus men. Although submaximal HRR was greater in boys, parasympathetic responses were similar between groups.

Application of stable isotope tracers in the study of exercise metabolism in children: a primer.

Exercise metabolism in children has traditionally been assessed using the respiratory exchange ratio (RER) to determine the contributions of fat and carbohydrate to the exercise energy demands. Although easily measured, RER measurements have limitations. Other methods to assess metabolism such as the obtainment of a muscle biopsy and the use of nuclear magnetic resonance spectroscopy carry ethical and feasibility concerns, respectively, which limit their use in studies involving children. Stable isotopes, used routinely in studies involving adults, can also be applied in studies involving children in an ethical and feasible manner. Two common stable isotopes used in metabolic studies involving children include carbon-13 (¹³C) and nitrogen-15 (¹5N). ¹³C-glucose can be used to study carbohydrate metabolism and ¹5N-glycine can be used to assess protein metabolism. This article reviews the use of ¹³C-glucose and ¹5N-glycine to study exercise metabolism in children, considers some of the associated ethical aspects, explains the general methodology involved in administering these isotopes and the resources required, and describes studies involving children utilizing these methods. Finally, suggestions for future research are provided to encourage further use of these techniques.

Application of Stable Isotope Tracers in the Study of Exercise Metabolism in Children: A Primer.

Exercise metabolism in children has traditionally been assessed using the respiratory exchange ratio (RER) to determine the contributions of fat and carbohydrate to the exercise energy demands. Although easily measured, RER measurements have limitations. Other methods to assess metabolism such as the obtainment of a muscle biopsy and the use of nuclear magnetic resonance spectroscopy carry ethical and feasibility concerns, respectively, which limit their use in studies involving children. Stable isotopes, used routinely in studies involving adults, can also be applied in studies involving children in an ethical and feasible manner. Two common stable isotopes used in metabolic studies involving children include carbon-13 (C) and nitrogen-15 (N). C-glucose can be used to study carbohydrate metabolism and N-glycine can be used to assess protein metabolism. This article reviews the use of C-glucose and N-glycine to study exercise metabolism in children, considers some of the associated ethical aspects, explains the general methodology involved in administering these isotopes and the resources required, and describes studies involving children utilizing these methods. Finally, suggestions for future research are provided to encourage further use of these techniques.

The influence of maturation on the oxygen uptake efficiency slope.

This study examined the influence of maturation on the oxygen uptake efficiency slope (OUES) in healthy male subjects. Seventy-six healthy male subjects (8-27 yr) were divided into groups based on maturation status: prepubertal (PP), midpubertal (MP), late-pubertal (LP), and young-adult (YA) males. Puberty status was determined by physical examination. Subjects performed a graded exercise test on a cycle ergometer to determine OUES. Group differences were assessed using a one-way ANOVA. OUES values (VO(2)L·min(-1)/log(10)V(E)L·min(-1)) were lower in PP and MP compared with LP and YA (p < .05). When OUES was expressed relative to body mass (VO(2)mL·kg-1·min(-1)/log(10)V(E)mL·kg(-1)·min(-1)) differences between groups reversed whereby PP and MP had higher mass relative OUES values compared with LP and YA (p < .05). Adjusting OUES by measures of body mass failed to eliminate differences across maturational groups. This suggests that qualitative factors, perhaps related to oxidative metabolism, account for the responses observed in this study.

Effect of stimulant medication use by children with ADHD on heart rate and perceived exertion.

The effect of stimulant medication use by children with attention deficit/hyperactivity disorder (ADHD) on the rating of perceived exertion (RPE)-heart rate (HR) relationship was examined. Children with ADHD (n=20; 11.3±1.8 yrs) and children without ADHD (n=25; 11.2±2.1 yrs) were studied. Children with ADHD were examined while on their usual dose of medication on the day of study. HR and RPE, using the OMNI RPE scale, were assessed during a graded exercise to peak voluntary effort. The RPE-HR relationship was determined individually and the intercept and slope responses were compared between groups. The intercept was 132.4±19.5 bpm for children with ADHD and 120.6±15.7 bpm for children without ADHD. The slope was 7.3±1.9 bpm/RPE for the children with ADHD and 8.1±1.6 bpm/ RPE for the children without ADHD. For the group with ADHD the intercept and slope values fell outside of the 95% CI observed in the control group. The altered relationship between RPE and HR with stimulant medication use in children with ADHD has practical implications with respect to the use of HR and RPE to monitor exercise intensity.

The effect of pre-exercise carbohydrate supplementation on anaerobic exercise performance in adolescent males.

Carbohydrate (CHO) consumption before anaerobic exercise was studied in 13 adolescent boys (15.2 ± 0.9 yrs). A within subjects design was employed where subjects consumed a 22% CHO or volume-matched placebo (PL) beverage 30-min before anaerobic exercise on two separate days. Exercise consisted of a Wingate Anaerobic Test (WAnT), ten by 10-s-sprints, and a second WAnT. Fatigue index and peak power (PP) were similar while mean power (MP) was higher (p < .025) in CHO trial; however this difference was ascribed to initial WAnT performance. PP and MP for the 10-s sprints were similar between trials. Intravenous blood glucose and insulin concentrations were higher (p < .05) in the CHO trial while lactate and catecholamine concentrations were similar. Improved performance on a single WAnT was apparent with CHO consumption before exercise; however, this strategy did not attenuate fatigue over time in adolescent boys.

Evaluating the prediction of maximal heart rate in children and adolescents.

In this study, we compared measured maximal heart rate (HRmax) to two different HRmax prediction equations [22 - age and 208 - 0.7(age)] in 52 children ages 7-17 years. We determined the relationship of chronological age, maturational age, and resting HR to measured HRmax and assessed seated resting HR and HRmax during a graded exercise test. Maturational age was calculated as the maturity offset in years from the estimated age at peak height velocity. Measured HRmax was 201 +/- 10 bpm, whereas predicted HRmax ranged from 199 to 208 bpm. Measured HRmax and the predicted value from the 208 - 0.7(age) prediction were similar but lower (p < .05) than the 220 - age prediction. Absolute differences between measured and predicted HRmax were 8 +/- 5 and 10 +/- 8 bpm for the 208 - 0.7 (age) and 220 - age equations, respectively, and were greater than zero (p < .05). Regression equations using resting HR and maturity offset or chronological age significantly predicted HRmax, although the R2 < .30 and the standard error of estimation (8.2-8.5) limits the accuracy. The 208 - 0.7(age) equation can closely predict mean HRmax in children, but individual variation is still apparent.

Exercise responses in boys with attention deficit/hyperactivity disorder: effects of stimulant medication.

OBJECTIVE: The effect of stimulant medication on exercise responses was studied in 14 boys (10.9 +/- 1.1 years) with attention deficit/hyperactivity disorder (ADHD). METHOD: Exercise, with and without medication, was performed at 25 W, 50 W, and 75 W, followed by a peak exercise test. RESULT: Submaximal heart rate (HR) was significantly higher by ~8 to 13 b.min(-1) across the three intensities during the medication trial, but oxygen uptake (VO(2)), respiratory exchange ratio (RER), and perceived exertion were similar (p > .05). At peak exercise, VO(2), HR, and work rate were attenuated (p < or = .05) in the absence of medication but not RER or perceived exertion. The decreased peak exercise responses were apparent in 6 of 13 participants. CONCLUSION: Stimulant medication raises submaximal HR but does not affect other cardiorespiratory measures or perceived exertion. Without medication physiological responses at peak exercise are attenuated in some but not all boys with ADHD.

The relationship between ventilatory and lactate thresholds in boys and men.

The relationship between ventilatory (VT) and lactate threshold (LT) in 8 boys (11.1 +/- 0.7 yrs) and 9 men (24.0 +/- 3.3 yrs) with similar peak VO(2) levels was assessed. Percent peak VO(2) at VT and LT were higher (P < 0.05) in the boys (67.9 +/- 2.6% and 63.9 +/- 5.0%, respectively) compared with men (59.0 +/- 3.2% and 54.8 +/- 2.7%, respectively). VO(2) (mL.kg(-1).min(-1)) at VT was higher (P < 0.05) and at LT tended to be higher in boys. Correlations between VT and LT were r = 0.95 for VO(2) (mL.kg(-1).min(-1)) and r = 0.82 for % peak VO(2) (P < 0.05) in boys and r = 0.87 (P < 0.05) and r = 0.60 (P > 0.05), respectively, in men. The mechanisms mediating VT and LT in children are not established fully and warrant further study.

Preexercise carbohydrate consumption and repeated anaerobic performance in pre- and early-pubertal boys.

This study examined the effect of preexercise carbohydrate (CHO) feeding on performance on a Wingate anaerobic test (WAnT) in 11 boys (10.2 +/- 1.3 y old). Four WAnTs with 2 min recovery were performed 30 min after consuming a CHO (1 g CHO/kg) or placebo drink. Peak power (PP) and mean power (MP) were similar between trials. PP ranged from 241.1 +/- 82.2 to 223.1 +/- 57.9 W with carbohydrate and from 238.2 +/- 76.1 to 223.4 +/- 52.3 W with placebo. MP ranged from 176.3 +/- 58.4 to 151.1 +/- 37.5 W with carbohydrate versus 178.0 +/- 45.8 to 159.1 +/- 32.7 W with placebo. Preexercise glucose was significantly higher in CHO versus placebo (7.0 +/- 1.0 vs. 5.5 +/- 0.5 mmol/L), but postexercise values were not different. Blood lactate was similar between trials but increased over time. This study found that the ingestion of a CHO solution before exercise did not influence power output during repeated performances of the WAnT.

Perceived exertion : influence of age and cognitive development.

Because little is known about the effects of aging on perceived exertion, the aim of this article is to review the key findings from the published literature concerning rating of perceived exertion (RPE) in relation to the developmental level of a subject. The use of RPE in the exercise setting has included both an estimation paradigm, which is the quantification of the effort sense at a given level of exercise, and a production paradigm, which involves producing a given physiological effort based on an RPE value. The results of the review show that the cognitive developmental level of children aged 0-3 years does not allow them to rate their perceived exertion during a handgrip task. From 4 to 7 years of age, there is a critical period where children are able to progressively rate at first their peripheral sensory cues during handgrip tests, and then their cardiorespiratory cues during outdoor running in an accurate manner. Between 8 and 12 years of age, children are able to estimate and produce 2-4 cycling intensities guided by their effort sense and distinguish sensory cues from different parts of their body. However, most of the studies report that the exercise mode and the rating scale used could influence their perceptual responsiveness. During adolescence, it seems that the RPE-heart rate (HR) relationship is less pronounced than in adults. Similar to observations made in younger children, RPE values are influenced by the exercise mode, test protocol and rating scale. Limited research has examined the ability of adolescents to produce a given exercise intensity based on perceived exertion. Little else is known about RPE in this age group. In healthy middle-aged and elderly individuals, age-related differences in perceptual responsiveness may not be present as long as variations in cardiorespiratory fitness are taken into account. For this reason, RPE could be associated with HR as a useful tool for monitoring and prescribing exercise. In physically deconditioned elderly persons, a rehabilitation training programme may increase the subject's ability to detect muscular sensations and the ability to utilise these sensory cues in the perception of effort. RPE appears to be a cognitive function that involves a long and progressive developmental process from 4 years of age to adulthood. In healthy middle-aged and elderly individuals, RPE is not impaired by aging and can be associated with HR as a useful tool to control exercise intensity. While much is known about RPE responses in 8- to 12-year-old children, more research is needed to fully understand the influence of cognitive development on perceived exertion in children, adolescents and elderly individuals.

The influence of biological maturation on fat and carbohydrate metabolism during exercise in males.

This study examined substrate use during exercise in early-pubertal (EP), mid-pubertal (MP), late-pubertal (LP), and young-adult (YA) males. Fuel use was calculated using the RER and VO2 response during cycling exercise at 30 to 70% of VO2speak. Significant group by intensity interactions were found for lactate, RER, percent CHO, and fat use, in addition to fat and CHO oxidation rates, which suggest a maturation effect on substrate use during exercise. While significance was not achieved at all intensities, post hoc analyses revealed greater fat use, lower CHO use, and lower lactate concentrations in EP and MP compared to LP or YA. No differences were noted between EP and MP or LP and YA at any intensity, suggesting the development of an adult-like metabolic profile occurs between mid- to late-puberty and is complete by the end of puberty.