Asthma and high-intensity interval training have no effect on clustered cardiometabolic risk or arterial stiffness in adolescents.

PURPOSE: Cardiometabolic risk, including arterial stiffness, is increasing in youth. Those with asthma are suggested to be particularly at risk of cardiovascular disease. Efficient and effective strategies are required to prevent the atherosclerotic process in youth. The purpose of this study was to investigate the effect of 6 months high-intensity interval training (HIIT) on cardiometabolic risk in youth with and without asthma. METHODS: 65 adolescents (31 mild asthma; 34 non-asthma) were recruited, 32 (16 asthma) of whom were randomly allocated to receive HIIT three times per week for 6 months. At baseline, mid-intervention, post-intervention and at a 3-month follow-up, anthropometric, metabolic and vascular determinants of cardiometabolic risk were assessed. Following principal component analysis (PCA), linear mixed models were used to assess the influence of asthma, HIIT and their interaction. RESULTS: Seven factors were identified which explained 88% of the common variance shared among the parameters. Those with asthma demonstrated lower arterial stiffness factor scores mid-intervention (P = 0.047) and lower cholesterol factor scores post-intervention (P = 0.022) but there was no effect of the intervention, or interaction effects, on any PCA-identified factor, at any time-point. HIIT was associated with a lower low-density lipoprotein and diastolic blood pressure at mid-intervention. DISCUSSION: Neither arterial stiffness nor clustered cardiometabolic risk are influenced by HIIT in adolescents with or without asthma, despite important changes in blood lipid and pressure profiles. Blood pressure, augmentation and pulse wave velocity should be considered physiologically distinct constructs and as potential markers of cardiovascular health.

Reduced exertion high-intensity interval training (REHIT) in an adult with Cystic Fibrosis: A mixed-methods case study.

Although aerobic capacity has been identified as an important predictor of mortality in Cystic Fibrosis (CF) individuals, many remain insufficiently active. As a 'lack of time' is a commonly cited barrier to exercise, reduced-exertion high-intensity interval training (REHIT) may provide a truly time-effective method to increase aerobic capacity. Six-weeks of REHIT in a CF individual was assessed by a cardiopulmonary exercise test (CPET) and individual perceptions described using a self-report narrative. Peak oxygen uptake ( V ˙ O2peak) increased by 6% whilst pulmonary function remained unchanged. Qualitative data indicated social support and low-time commitment positively influenced adherence with fatigue and lack of enjoyment noted as a significant barriers. REHIT was demonstrated as a viable, manageable option for a CF individual with moderate-severe pulmonary limitation. Further research is needed to determine the efficacy of REHIT in a large representative sample to ascertain whether it represents an alternative treatment strategy.

Promotion of physical activity for adolescents with cystic fibrosis: a qualitative study of UK multi disciplinary cystic fibrosis teams.

BACKGROUND: The Cystic Fibrosis Trust recently published a standards of care document which stated that patients should be given a physical activity (PA) programme based on their motivations, fitness, and willingness to be active. However, there remains much debate regarding the roles and responsibilities for PA promotion, as well as "optimal" recommendations and advice. This study aimed to qualitatively explore cystic fibrosis (CF) multidisciplinary teams (MDTs) advice, recommendations and practices relating to PA promotion for adolescents with CF. METHOD: Semi-structured interviews were conducted with fifteen members of CF MDTs (11 physiotherapists, two dieticians and two paediatricians). Thematic analysis was used to analyse the data. RESULTS: Major themes identified were: (1) structure of MDTs, (2) recommendations relating to intensities, durations and types of PA, and (3) use of exercise testing. Participants reported variation between MDTs in terms of who is responsible for promoting and supporting PA, the nature of advice given to patients, and the use of exercise testing. Participants consistently lacked confidence in their own or others' knowledge to provide standardised recommendations to patients and highlighted that PA promotion and support was often overlooked during busy periods. CONCLUSIONS: Despite its importance, PA support and promotion is not always prioritised. MDTs lack confidence in their ability to promote PA. Standardised advice and training relating to optimal intensities, durations and types of PA would provide a baseline from which to individualise advice to each patient and could increase confidence in PA promotion among MDTs.

Methodology and reliability of respiratory muscle assessment.

The optimal method for respiratory muscle endurance (RME) assessment remains unclear. This study assessed the test-retest reliability of two RME-test methodologies. Fifteen healthy adults attended the laboratory on four occasions, separated by 5 ± 2 days, and completed each test in a random, "one on two" order. They performed spirometry testing, maximal respiratory pressure assessment and two different RME tests: an inspiratory resistive breathing (IRB) and an isocapnic hyperpnea endurance (IHE) test. Typical error, expressed as coefficient of variation, for IRB maximal inspiratory pressure (MIP) and IHE maximal ventilation were 12.21 (8.85-19.67) % and 10.73 (7.78-17.29) %, respectively. Intraclass correlation coefficients for the same parameters were 0.83 (0.46-0.94) and 0.80 (0.41-0.93), respectively. No correlations were found between RME parameters derived from the IHE and IRB tests (all p > 0.05). Significant positive correlations were found between both IRB and IHE outcomes and spirometry parameters, MIP and maximal expiratory pressure (p < 0.05). Given these results, IRB and IHE appear to be suitable for RME testing in healthy people, although they may reflect different physiological mechanisms (respiratory mechanics and respiratory muscle capacity for IHE test vs. inspiratory muscle capacity for IRB test). Future studies are therefore warranted that compare IRB and IHE tests in clinical settings.

Using photo-elicitation to explore perceptions of physical activity among young people with cystic fibrosis.

BACKGROUND: Physical activity is recommended in the management of cystic fibrosis (CF). The aim of this study was to explore motives, barriers and enablers to physical activity among this population. METHODS: Twelve participants (12-18 years) were recruited via convenience sampling. Photo-elicitation alongside semi-structured interviews were used to explore participants' views and experiences of physical activity. RESULTS: Our findings revealed motives for physical activity including health, enjoyment and autonomy. Those with families who valued physical activity tended to have positive attitudes towards physical activity, and valued and integrated it into their lives. Moreover, they were likely to be intrinsically motivated to be active. Several factors enable and act as barriers to physical activity. Whilst CF influenced physical activity, the majority of enablers and barriers raised where congruent with the general populations. CONCLUSION: This study provides support that healthcare providers should encourage both young people with CF and their families to be active, and subsequently informs the development of clinical interventions to support physical activity among young people with CF and their families.

The effect of constant-intensity endurance training and high-intensity interval training on aerobic and anaerobic parameters in youth.

INTRODUCTION: High-Intensity Interval Training (HIIT) and Constant-Intensity Endurance Training (CIET) improves peak oxygen uptake (V̇O2) similarly in adults; but in children this remains unclear, as does the influence of maturity. METHODS: Thirty-seven boys formed three groups: HIIT (football; n = 14; 14.3 ± 3.1 years), CIET (distance runners; n = 12; 13.1 ± 2.5 years) and a control (CON) group (n = 11; 13.7 ± 3.2 years). Peak V̇O2 and gas exchange threshold (GET) were determined from a ramp test and anaerobic performance using a 30 m sprint pre-and-post a three-month training cycle. RESULTS: The HIIT groups peak V̇O2 was significantly higher than the CON group pre (peak V̇O2: 2.54 ± 0.63 l·min-1 vs 2.03 ± 0.53 l·min-1, d = 0.88; GET: 1.41 ± 0.26 l·min-1 vs 1.13 ± 0.29 l·min-1, d = 1.02) and post-training (peak V̇O2: 2.63 ± 0.73 l·min-1 vs 2.08 ± 0.64 l·min-1, d = 0.80; GET: 1.32 ± 0.33 l·min-1 vs 1.15 ± 0.38 l·min-1, d = 0.48). All groups showed a similar magnitude of change during the training (p > 0.05). CONCLUSION: HIIT was not superior to CIET for improving aerobic or anaerobic parameters in adolescents. Secondly, pre- and post-pubertal participants demonstrated similar trainability.

Effect of asthma and six-months high-intensity interval training on heart rate variability during exercise in adolescents.

Little is known regarding the influence of asthma and exercise, and their interaction, on heart rate variability (HRV) in adolescents. Thirty-one adolescents with asthma (13.7±0.9 years; 21.9±3.9 kg·m-2; 19 boys, 12 girls) and thirty-three healthy adolescents (13.8±0.9 years; 20.3±3.2 kg·m-2; 16 boys, 17 girls) completed an incremental ramp test and three heavy-intensity constant-work-rate cycle tests. Thirteen adolescents (7 boys, 6 girls; 6 asthma, 7 control) completed six-months high-intensity interval training (HIIT) and were compared to age- and sex-matched controls. Standard time-domain, frequency-domain and non-linear indices of HRV were derived at baseline, three- and six-months. Asthma did not influence HRV at baseline or following HIIT. Total power, low frequency and normalised low frequency power, and sympathovagal balance increased at three-months in HIIT, subsequently declining towards baseline at six-months. Normalised high frequency power was reduced at three-months in both groups, which was sustained at six-months. No effects of HIIT were observed in the time-domain nor in the non-linear indices. HRV was not influenced by asthma, potentially because such derangements are a function of disease progression, severity or duration. HIIT may be associated with a short-term shift towards greater sympathetic predominance during exercise, perhaps caused by physiological overload and fatigue.

The reliability of force-velocity-power profiling during over-ground sprinting in children and adolescents.

Anaerobic performance in youth has received little attention partly due to the lack of a "gold-standard" measurement. However, force-velocity-power (F-v-P) profiling recently showed high reliability and validity in trained adults. Therefore, the aim was to determine the reliability of F-v-P profiling in children and adolescents. Seventy-five children (60 boys, 15 girls; age: 14.1 ± 2.6 years) completed three 30 m sprints. Velocity was measured at 46.875 Hz using a radar device. The F-v-P profile was fitted to a velocity-time curve allowing instantaneous power variables to be calculated. Reliability was assessed using the intra-class correlation coefficient (ICC), coefficient of variation (CV), standard error of measurement (SEM) and smallest worthwhile change (SWC). High reliability was evident for absolute peak (Ppeak) and mean power (Pmean), Ppeak and Pmean expressed relative to body mass, peak and mean velocity, 30 m sprint time, peak horizontal force (F0), relative F0, mechanical efficiency index and fatigue rate (ICC: 0.75-0.88; CV: 1.9-9.4%) with time to peak power demonstrating moderate reliability (ICC: 0.50; CV: 9.5%). The F-v-P model demonstrated at least moderate reliability for all variables. This therefore provides a potential alternative for paediatric researchers assessing sprint performance and the underlying kinetics.

Perceptions of asthma and exercise in adolescents with and without asthma.

OBJECTIVE: To elicit the views of adolescents, with and without asthma, about exercise and asthma, and the perceived benefits of and barriers to participation. The adolescent views elicited would subsequently inform the design of a high-intensity exercise intervention to improve asthma control. METHODS: Fifty-four adolescents (age 13.1 ± 0.9 years; 26 with asthma) participated in twelve semi-structured group interviews. Questions were structured around knowledge, attitudes and beliefs towards asthma and its impact on exercise participation and lifestyle. The interviews were transcribed verbatim, thematically analysed and presented via diagrams of emergent themes. Ethical approval was granted by the institutional research ethics committee. RESULTS: Fear of an asthma attack emerged as the main barrier to exercise, with many adolescents with asthma withdrawing from exercise as a coping strategy; many healthy adolescents perceived this withdrawal as laziness or an excuse. Despite this, the majority (81%) of adolescents with asthma reported exercise to be their most enjoyable activity. Adolescents suggested incorporating mixed activities, such as team games (e.g., rounders, football, netball), for future interventions to ensure adherence. CONCLUSIONS: Whilst exercise is important in the management of asthma, the tendency of those with asthma to withdraw from exercise to avoid adverse events could be addressed through a games-based high-intensity exercise intervention. Furthermore, educating all adolescents on asthma could simultaneously reduce stigmatisation and enhance exercise engagement.

Investigating the relationship between energy expenditure, walking speed and angle of turning in humans.

Recent studies have suggested that changing direction is associated with significant additional energy expenditure. A failure to account for this additional energy expenditure of turning has significant implications in the design and interpretation of health interventions. The purpose of this study was therefore to investigate the influence of walking speed and angle, and their interaction, on energy expenditure in 20 healthy adults (7 female; 28±7 yrs). On two separate days, participants completed a turning protocol at one of 16 speed- (2.5, 3.5, 4.5, 5.5 km∙h-1) and angle (0, 45, 90, 180°) combinations, involving three minute bouts of walking, interspersed by three minutes seated rest. Each condition involved 5 m of straight walking before turning through the pre-determined angle with the speed dictated by a digital, auditory metronome. Tri-axial accelerometry and magnetometry were measured at 60 Hz, in addition to gas exchange on a breath-by-breath basis. Mixed models revealed a significant main effect for speed (F = 121.609, P < 0.001) and angle (F = 19.186, P < 0.001) on oxygen uptake ([Formula: see text]) and a significant interaction between these parameters (F = 4.433, P < 0.001). Specifically, as speed increased, [Formula: see text] increased but significant increases in [Formula: see text] relative to straight line walking were only observed for 90° and 180° turns at the two highest speeds (4.5 and 5.5 km∙hr-1). These findings therefore highlight the importance of accounting for the quantity and magnitude of turns completed when estimating energy expenditure and have significant implications within both sport and health contexts.

Investigating optimal accelerometer placement for energy expenditure prediction in children using a machine learning approach.

Accurate measurement of energy expenditure (EE) is imperative for identifying and targeting health-associated implications. Whilst numerous accelerometer-based regression equations to predict EE have been developed, there remains little consensus regarding optimal accelerometer placement. Therefore, the purpose of the present study was to validate and compare artificial neural networks (ANNs) developed from accelerometers worn on various anatomical positions, and combinations thereof, to predict EE. Twenty-seven children (15 boys; 10.8 ± 1.1 years) participated in an incremental treadmill test and 30 min exergaming session wearing a portable gas analyser and nine ActiGraph GT3X+ accelerometers (chest and left and right wrists, hips, knees, and ankles). Age and sex-specific resting EE equations (Schofield) were used to estimate METs from the oxygen uptake measures. Using all the data from both exergames, incremental treadmill test and the transition period in between, ANNs were created and tested separately for each accelerometer and for combinations of two or more using a leave-one-out approach to predict EE compared to measured EE. Six features (mean and variance of the three accelerometer axes) were extracted within each 15 s window as inputs in the ANN. Correlations and root mean square error (RMSE) were calculated to evaluate prediction accuracy of each ANN, and repeated measures ANOVA was used to statistically compare accuracy of the ANNs. All single-accelerometer ANNs and combinations of two-, three-, and four-accelerometers performed equally (r = 0.77-0.82), demonstrating higher correlations than the 9-accelerometer ANN (r = 0.69) or the Freedson linear regression equation (r = 0.75). RMSE did not differ between single-accelerometer ANNs or combinations of two, three, or four accelerometers (1.21-1.31 METs), demonstrating lower RMSEs than the 9-accelerometer ANN (1.46 METs) or Freedson equation (1.74 METs). These findings provide preliminary evidence that ANNs developed from single accelerometers mounted on various anatomical positions demonstrate equivalency in the accuracy to predict EE in a semi-structured setting, supporting the use of ANNs in improving EE prediction accuracy compared with linear regression.

Longitudinal investigation of training status and cardiopulmonary responses in pre- and early-pubertal children.

PURPOSE: The presence of a maturational threshold that modulates children's physiological responses to exercise training continues to be debated, not least due to a lack of longitudinal evidence to address this question. The purpose of this study was to investigate the interaction between swim-training status and maturity in nineteen trained (T, 10 ± 1 years, -2.4 ± 1.9 years pre-peak height velocity, 8 boys) and fifteen untrained (UT, 10 ± 1 years, -2.3 ± 0.9 years pre-peak height velocity, 5 boys) children, at three annual measurements. METHODS: In addition to pulmonary gas exchange measurements, stroke volume (SV) and cardiac output ([Formula: see text]) were estimated by thoracic bioelectrical impedance during incremental ramp exercise. RESULTS: At baseline and both subsequent measurement points, trained children had significantly (P < 0.05) higher peak oxygen uptake (year 1 T 1.75 ± 0.34 vs. UT 1.49 ± 0.22; year 2 T 2.01 ± 0.31 vs. UT 1.65 ± 0.08; year 3 T 2.07 ± 0.30 vs. UT 1.77 ± 0.16 l min(-1)) and [Formula: see text] (year 1 T 15.0 ± 2.9 vs. UT 13.2 ± 2.2; year 2 T 16.1 ± 2.8 vs. UT 13.8 ± 2.9; year 3 T 19.3 ± 4.4 vs. UT 16.0 ± 2.7 l min(-1)). Furthermore, the SV response pattern differed significantly with training status, demonstrating the conventional plateau in UT but a progressive increase in T. Multilevel modelling revealed that none of the measured pulmonary or cardiovascular parameters interacted with maturational status, and the magnitude of the difference between T and UT was similar, irrespective of maturational status. CONCLUSION: The results of this novel longitudinal study challenge the notion that differences in training status in young people are only evident once a maturational threshold has been exceeded.