Canadian Society for Exercise Physiology position paper: resistance training in children and adolescents

Influence of a Moderate-Intensity Exercise Program on Early NK Cell Immune Recovery in Pediatric Patients After Reduced-Intensity Hematopoietic Stem Cell Transplantation

Introduction: After allogeneic hematopoietic stem cell transplantation (HSCT), NK cell reconstitution, which is crucial for positive outcomes, is dominated by the CD56^bright subset with low NK cell cytotoxicity (NKCC) activity. Moderate exercise has been described as a potent NK cell stimulus in adults with cancer. Purpose: To determine the effects of a moderate-intensity exercise program on NK cell recovery early after HSCT and the feasibility of this intervention. Methods: Six children undergoing allogeneic HSCT were randomized to an exercise program (EP) or control (CT) group. The EP group performed a 10-week training combining in-hospital and home-based EP. Results: We observed a significant increase in the posttraining/pretraining ratio of the CD56^dim subset (EP = 1.27 ± 0.07; CT = 0.99 ± 0.08; P < .005) of the EP group. The ratio of NKCC was 8 times greater in the EP group. Conclusion: Data suggest that a moderate-intensity EP program performed early after HSCT is feasible and might redistribute the CD56^dim/CD56^brigh NK cell subset, improving NKCC. The results are still preliminary and must be interpreted with caution.

Evidence of nonlocal muscle fatigue in male youth

Evidence for nonlocal muscle fatigue (NLMF) has been inconsistent in adults, with no studies investigating youth. The objective was to examine NLMF in youth. Forty-two young males (age, 10-13 years) were tested for maximal voluntary isometric contraction (MVIC) force of the ipsilateral and contralateral knee extensors at 90° and 120° knee flexion, elbow flexors at 90°, handgrip, knee extensor isokinetic torque (300°·s^-1 analyzed at 90° and 120° knee flexion), as well as a unilateral countermovement jump (CMJ) and Y Balance test (YBT). Isokinetic fatigue group (n = 15) had unilateral fatigue induced with 10 sets of 20 repetitions of maximal isokinetic knee extensor contractions at 300°·s^-1. Isometric fatigue group (n = 15) used 10 repetitions of 6-s knee extensor MVIC whereas the control group (n = 12) were not fatigued. There was no significant difference in the response to the isometric- or isokinetic-fatigue intervention protocols. Main time effects indicated that NLMF was evident with the contralateral knee extensor MVIC at 90° (p = 0.008; 8.9%), knee extensor isokinetic torque at 90° (p < 0.001; 11.4%), and 120° (p = 0.05; 5.4%), CMJ (p = 0.02; 11.5%), handgrip (p = 0.06; 4.5%), elbow flexors (p < 0.001; 7.7%), and YBT (p = 0.001; 5.6%). Ipsilateral NLMF deficits occurred with handgrip (p < 0.001; 7.3%), elbow flexors MVICs (p < 0.001; 10.7%), CMJ (p = 0.02; 12.2%), and YBT (p = 0.002; 3.8%). NLMF with similar relative fatigue-induced deficits of fatigued and nonfatigued limbs suggest that youth fatigue is highly dependent upon the extent of activation or inhibition of the nervous system. Coaches of young athletes might consider developing technical motor skills before fatiguing exercise components, which might hinder the proficiency of their performance.

A seven-year physical activity intervention for children increased gains in bone mass and muscle strength

AIM

This study evaluated the musculoskeletal effects of increased physical activity on children, starting at six to nine years of age.

METHODS

In one school we increased the physical education of 72 girls and 100 boys to 200 minutes per week over seven years. In three other schools, 45 girls and 47 boys continued to receive 60 minutes per week. We measured areal bone mineral density (aBMD) with dual energy X-ray absorptiometry and muscle strength with computerised dynamometer at baseline and after seven years and tibial cortical thickness with peripheral quantitative computed tomography after seven years.

RESULTS

Girls in the intervention group gained 0.04 g/cm(2) (0.01-0.08) more total spine aBMD (p < 0.05) and 6.2Nm (1.6, 10.7) more knee flexion strength (p < 0.01) than control group girls and had a 0.1 mm (0.0, 0.3) higher tibial cortical thickness at follow-up (p < 0.05). Boys in the intervention group gained 7.3Nm (0.4, 14.2) more knee extension strength (p < 0.05) and 7.4Nm (2.3, 12.4) more knee flexion strength (p < 0.01) than the control group boys, but their aBMD was no higher than the control group.

CONCLUSION

A seven-year, population-based moderately intense exercise intervention enhanced gains in spine bone mass in girls and knee muscle strength in both genders.

The Chronic Effects of Low- and High-Intensity Resistance Training on Muscular Fitness in Adolescents

To compare the effects of high-load, low-repetition maximum (LRM) and low-load, high-repetition maximum (HRM) resistance training regimens on muscular fitness in untrained adolescents. Forty-five untrained adolescents of both sexes (13.7±0.8 years; 161.3±7.5 cm, 56.8±13.4 kg) were randomly assigned into one of three groups: 1) LRM (n = 17): volunteers performed three sets of 4-6-repetition maximum (RM); 2) HRM (n = 16): volunteers performed three sets of 12–15 RM; and 3) control (CON, n = 12). Training was performed two times a week for 9 weeks. After training, there were significant increases in 1 RM chest press (LRM = 14.8% and HRM = 14.2%, p<0.05) and squat (LRM = 26.4% and HRM = 25.7%, p<0.05), with no differences between the LRM and HRM groups (p>0.05). Additionally, muscular endurance increased significantly for the chest press (LRM = 14.5% and HRM = 21.8%, p<0.05) and squat test (LRM = 31.4% and HRM = 32.4%, p<0.05) following resistance training, with no difference between the LRM and HRM groups (p>0.05). These results suggest that both high-load, low-repetition and moderate-load, high-repetition resistance training can be prescribed to improve muscular fitness in untrained adolescents.

Effects of resistance training on cardiovascular health in non-obese active adolescents

AIM: To determine the benefits of a 10-wk resistance training programme on cardiovascular health in non-obese and active adolescents.

METHODS: This is a pragmatic randomised controlled intervention. The study was carried out in a Hong Kong Government secondary school. Thirty-eight lean and active boys and girls were randomised to either the resistance training group or the control group. Students in the resistance training group received in-school 10-wk supervised resistance training twice per week, with each session lasting 70 min. Main outcome measures taken before and after training included brachial endothelial dependent flow-mediated dilation, body composition, fasting serum lipids, fasting glucose and insulin, high sensitive C-reactive protein, 24-h ambulatory blood pressure and aerobic fitness.

RESULTS: The only training related change was in endothelial dependent flow-mediated dilation which increased from 8.5% to 9.8%. A main effect of time and an interaction (P < 0.005) indicated that this improvement was a result of the 10-wk resistance training. Main effects for time (P < 0.05) in a number of anthropometric, metabolic and vascular variables were noted; however, there were no significant interactions indicating the change was more likely an outcome of normal growth and development as opposed to a training effect.

CONCLUSION: Ten weeks of resistance training in school appears to have some vascular benefit in active, lean children.

A meta-analysis of maturation-related variation in adolescent boy athletes' adaptations to short-term resistance training

This meta-analysis investigated the maturation-related pattern of adaptations to resistance training in boy athletes. We included studies examining the effects of 4-16-week resistance training programmes in healthy boy athletes aged 10-18 years. Pooled estimates of effect size for change in strength across all studies (n = 19) were calculated using the inverse-variance random effects model for meta-analyses. Estimates were also calculated for groups based on likely biological maturity status ("before", "during" and "after" peak height velocity). Using the standardised mean difference, resistance training increased strength across all groups (effect size = 0.98, [CI: 0.70-1.27]). Strength gains were larger during (1.11 [0.67-1.54]) and after (1.01 [0.56-1.46]) peak height velocity than before (0.5 [-0.06-1.07]). Adaptations to resistance training are greater in adolescent boys during or after peak height velocity. These findings should help coaches to optimise the timing of training programmes that are designed to improve strength in boy athletes.

Effects of Resistance Training in Youth Athletes on Muscular Fitness and Athletic Performance: A Conceptual Model for Long-Term Athlete Development

During the stages of long-term athlete development (LTAD), resistance training (RT) is an important means for (i) stimulating athletic development, (ii) tolerating the demands of long-term training and competition, and (iii) inducing long-term health promoting effects that are robust over time and track into adulthood. However, there is a gap in the literature with regards to optimal RT methods during LTAD and how RT is linked to biological age. Thus, the aims of this scoping review were (i) to describe and discuss the effects of RT on muscular fitness and athletic performance in youth athletes, (ii) to introduce a conceptual model on how to appropriately implement different types of RT within LTAD stages, and (iii) to identify research gaps from the existing literature by deducing implications for future research. In general, RT produced small-to-moderate effects on muscular fitness and athletic performance in youth athletes with muscular strength showing the largest improvement. Free weight, complex, and plyometric training appear to be well-suited to improve muscular fitness and athletic performance. In addition, balance training appears to be an important preparatory (facilitating) training program during all stages of LTAD but particularly during the early stages. As youth athletes become more mature, specificity, and intensity of RT methods increase. This scoping review identified research gaps that are summarized in the following and that should be addressed in future studies: (i) to elucidate the influence of gender and biological age on the adaptive potential following RT in youth athletes (especially in females), (ii) to describe RT protocols in more detail (i.e., always report stress and strain-based parameters), and (iii) to examine neuromuscular and tendomuscular adaptations following RT in youth athletes.

Effects and dose-response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis

Objectives

To quantify age, sex, sport and training type-specific effects of resistance training on physical performance, and to characterise dose–response relationships of resistance training parameters that could maximise gains in physical performance in youth athletes.

Design

Systematic review and meta-analysis of intervention studies.

Data sources

Studies were identified by systematic literature search in the databases PubMed and Web of Science (1985–2015). Weighted mean standardised mean differences (SMD_wm) were calculated using random-effects models.

Eligibility criteria for selecting studies

Only studies with an active control group were included if these investigated the effects of resistance training in youth athletes (6–18 years) and tested at least one physical performance measure.

Results

43 studies met the inclusion criteria. Our analyses revealed moderate effects of resistance training on muscle strength and vertical jump performance (SMD_wm 0.8–1.09), and small effects on linear sprint, agility and sport-specific performance (SMD_wm 0.58–0.75). Effects were moderated by sex and resistance training type. Independently computed dose–response relationships for resistance training parameters revealed that a training period of >23 weeks, 5 sets/exercise, 6–8 repetitions/set, a training intensity of 80–89% of 1 repetition maximum (RM), and 3–4 min rest between sets were most effective to improve muscle strength (SMD_wm 2.09–3.40).

Summary/conclusions

Resistance training is an effective method to enhance muscle strength and jump performance in youth athletes, moderated by sex and resistance training type. Dose–response relationships for key training parameters indicate that youth coaches should primarily implement resistance training programmes with fewer repetitions and higher intensities to improve physical performance measures of youth athletes.

Resistance strength training exercise in children with spinal muscular atrophy

INTRODUCTION

Preliminary evidence in adults with spinal muscular atrophy (SMA) and in SMA animal models suggests exercise has potential benefits in improving or stabilizing muscle strength and motor function.

METHODS

We evaluated feasibility, safety, and effects on strength and motor function of a home-based, supervised progressive resistance strength training exercise program in children with SMA types II and III. Up to 14 bilateral proximal muscles were exercised 3 times weekly for 12 weeks.

RESULTS

Nine children with SMA, aged 10.4 ± 3.8 years, completed the resistance training exercise program. Ninety percent of visits occurred per protocol. Training sessions were pain-free (99.8%), and no study-related adverse events occurred. Trends in improved strength and motor function were observed.

CONCLUSIONS

A 12-week supervised, home-based, 3-day/week progressive resistance training exercise program is feasible, safe, and well tolerated in children with SMA. These findings can inform future studies of exercise in SMA.

Wheelchair Propulsion Biomechanics in Junior Basketball Players: A Method for the Evaluation of the Efficacy of a Specific Training Program

As participation in wheelchair sports increases, the need of quantitative assessment of biomechanical performance indicators and of sports- and population-specific training protocols has become central. The present study focuses on junior wheelchair basketball and aims at (i) proposing a method to identify biomechanical performance indicators of wheelchair propulsion using an instrumented in-field test and (ii) developing a training program specific for the considered population and assessing its efficacy using the proposed method. Twelve athletes (10 M, 2 F, age = 17.1 ± 2.7 years, years of practice = 4.5 ± 1.8) equipped with wheelchair- and wrist-mounted inertial sensors performed a 20-metre sprint test. Biomechanical parameters related to propulsion timing, progression force, and coordination were estimated from the measured accelerations and used in a regression model where the time to complete the test was set as dependent variable. Force- and coordination-related parameters accounted for 80% of the dependent variable variance. Based on these results, a training program was designed and administered for three months to six of the athletes (the others acting as control group). The biomechanical indicators proved to be effective in providing additional information about the wheelchair propulsion technique with respect to the final test outcome and demonstrated the efficacy of the developed program.

Novel Use of the Nintendo Wii Board for Measuring Isometric Lower Limb Strength: A Reproducible and Valid Method in Older Adults

BACKGROUND

Portable, low-cost, objective and reproducible assessment of muscle strength in the lower limbs is important as it allows clinicians to precisly track progression of patients undergoing rehabilitation. The Nintendo Wii Balance Board (WBB) is portable, inexpensive, durable, available worldwide, and may serve the above function.

OBJECTIVE

The purpose of the study was to evaluate (1) reproducibility and (2) concurrent validity of the WBB for measuring isometric muscle strength in the lower limb.

METHODS

A custom hardware and software was developed to utilize the WBB for assessment of isometric muscle strength. Thirty older adults (69.0 ± 4.2 years of age) were studied on two separate occasions on both the WBB and a stationary isometric dynamometer (SID). On each occasion, three recordings were obtained from each device. For the first recording, means and maximum values were used for further analysis. The test-retest reproducibility was examined using intraclass correlation coefficients (ICC), Standard Error of Measurement (SEM), and limits of agreement (LOA). Bland-Altman plots (BAP) and ICC's were used to explore concurrent validity.

RESULTS

No systematic difference between test-retest was detected for the WBB. ICC within-device were between 0.90 and 0.96 and between-devices were from 0.80 to 0.84. SEM ranged for the WBB from 9.7 to 13.9%, and for the SID from 11.9 to 13.1%. LOA ranged for the WBB from 20.3 to 28.7% and for the SID from 24.2 to 26.6%. The BAP showed no relationship between the difference and the mean.

CONCLUSIONS

A high relative and an acceptable absolute reproducibility combined with a good validity was found for the novel method using the WBB for measuring isometric lower limb strength in older adults. Further research using the WBB for assessing lower limb strength should be conducted in different study-populations.

Parâmetros de intensidade e sudorese de jogadores de futsal por posição de jogo

RESUMO Introdução: O número de participantes em programas de treinamento de futsal tem crescido como alter-nativa de prática esportiva entre adolescentes. A aptidão física e o perfil hídrico de adolescentes praticantes de futsal são escassos na literatura científica. Objetivo: Determinar a composição corporal e as característi-cas metabólicas de adolescentes do sexo masculino participantes de programa de treinamento de futsal e relacioná-los com a posição tática. Métodos: Foram avaliados 10 adolescentes do sexo masculino com idades entre 12 e 13 anos e nível de maturação sexual de 3,7 ± 0,7 para pilosidade e 3,6 ± 1,0 no desenvolvimento do genital externo. Os adolescentes foram submetidos à avaliação antropométrica (peso corporal, estatura e composição corporal), neuromotora (teste de impulsão vertical e horizontal e shuttle run) e de demanda metabólica (distância percorrida, gasto calórico, número de passos e variação hídrica). Resultados: Os resul-tados dos atletas foram analisados pelas 4 posições de jogo (goleiros, fixos, alas e pivôs) utilizando análise de variância Anova one-way e post-hoc Scheffé com uma margem de erro de 5%, demonstrando que os goleiros apresentaram maior porcentagem de gordura que as demais posições de jogo, não havendo diferenças entre elas. A massa magra apresentou tendência inversa, com menor valor de muscularidade nos goleiros que nas posições de linha, onde os alas e pivôs apresentaram valores superiores aos fixos. Os goleiros apresentaram demanda metabólica menor em função da intensidade analisada durante os jogos comparado com as demais posições, corroborando com outros estudos similares. Para todos os grupos, a ingestão de água ad libitum foi suficiente para manter o estado de hidratação. Conclusão: Assim pudemos concluir que existem diferenças na demanda metabólica entre as posições de jogo, o que sugere prescrição especifica do treinamento buscando evitar o excesso de estÍmulo ou estímulos abaixo das necessidades dos adolescentes.

Effects of reallocating time in different activity intensities on health and fitness: a cross sectional study

BACKGROUND

The effects of replacing time in specific activity categories for other categories (e.g. replacing sedentary time with light activity) on health and fitness are not well known. This study used isotemporal substitution to investigate the effects of substituting activity categories in an equal time exchange fashion on health and fitness in young people.

METHODS

Participants were drawn from schools in Camden, London (n = 353, mean age 9.3 ± 2.3 years). Time sedentary, in light and in moderate-to-vigorous activity (MVPA) was measured via accelerometry. The effects of substituting time in activity categories (sedentary, light and MVPA) with equivalent time in another category on health and fitness were examined using isotemporal substitution.

RESULTS

In single and partition models, MVPA was favourably associated with body fat %, horizontal jump distance and flexibility. Time sedentary and in light activity were not associated with health and fitness outcomes in these models. In substitution models, replacing one hour of sedentary time with MVPA was favourably associated with body fat % (B = -4.187; 95% confidence interval (CI), -7.233, -1.142), horizontal jump distance (B = 16.093; 95% CI, 7.476, 24.710) and flexibility (B = 4.783; 95% CI, 1.910, 7.656). Replacing time in light activity with MVPA induced similar benefits but there were null effects for replacing sedentary with light intensity.

CONCLUSION

Substituting time sedentary and in light activity with MVPA was associated with favourable health and fitness. Time in sedentary behaviour may only be detrimental to health and fitness when it replaces time in MVPA in young people.

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1-year self-reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross-sectional study was defined as a sport-related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48-51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50-55% vs 46%, 95% CI 43-48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport-related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.

Community fitness programs: what is available for children and youth with motor disabilities and what do parents want?

BACKGROUND

Physical activity is recognized as a rehabilitation approach for individuals with motor disabilities.

OBJECTIVES

To determine whether community fitness programs were accommodating children and youth with motor disabilities, and to understand family perspectives on important outcomes related to fitness programs.

DESIGN

Telephone survey and qualitative interviews.

PARTICIPANTS AND SETTINGS

Representatives of 61 fitness programs/facilities and 13 parents of children with motor disabilities.

METHODS

Telephone survey (facilities) and qualitative interviews (parents).

RESULTS

24.6% of programs reported lack of wheelchair accessibility. Only 9.8% of programs and facilities required their staff to have training to support individuals with disabilities. Parents discussed barriers, including lack of staff support and challenges with finding information about community programs. Parents focused on the social benefits of fitness programs.

CONCLUSIONS/SIGNIFICANCE

Additional efforts toward reducing access barriers are needed. Parents' focus on social outcomes has direct implications on the design and evaluation of fitness programs.

Gait training facilitates central drive to ankle dorsiflexors in children with cerebral palsy

Foot drop and toe walking are frequent concerns in children with cerebral palsy. The main underlying cause of these problems is early damage and lack of maturation of the corticospinal tract. In the present study we investigated whether 4 weeks of daily treadmill training with an incline may facilitate corticospinal transmission and improve the control of the ankle joint in children with cerebral palsy. Sixteen children with cerebral palsy (Gross Motor Classification System I:6, II:6, III:4) aged 5-14 years old, were recruited for the study. Evaluation of gait ability and intramuscular coherence was made twice before and twice after training with an interval of 1 month. Gait kinematics were recorded by 3D video analysis during treadmill walking with a velocity chosen by the child at the first evaluation. Foot pressure was measured by force sensitive foot soles during treadmill and over ground walking. EMG-EMG coherence was calculated from two separate electrode recordings placed over the tibialis anterior muscle. Training involved 30 min of walking daily on a treadmill with an incline for 30 days. Gait training was accompanied by significant increases in gait speed, incline on the treadmill, the maximal voluntary dorsiflexion torque, the number and amplitude of toe lifts late in the swing phase during gait and the weight exerted on the heel during the early stance phase of the gait cycle. EMG-EMG coherence in the beta and gamma frequency bands recorded from tibialis anterior muscle increased significantly when compared to coherence before training. The largest changes in coherence with training were observed for children <10 years of age. Importantly, in contrast to training-induced EMG increases, the increase in coherence was maintained at the follow-up measurement 1 month after training. Changes in the strength of coherence in the beta and gamma band were positively correlated with improvements in the subjects' ability to lift the toes in the swing phase. These data show that daily intensive gait training increases beta and gamma oscillatory drive to ankle dorsiflexor motor neurons and that it improves toe lift and heel strike in children with cerebral palsy. We propose that intensive gait training may produce plastic changes in the corticospinal tract, which are responsible for improvements in gait function.

Development, test-retest reliability, and construct validity of the resistance training skills battery

The aim of this study was to describe the development and assess test-retest reliability and construct validity of the Resistance Training Skills Battery (RTSB) for adolescents. The RTSB provides an assessment of resistance training skill competency and includes 6 exercises (i.e., body weight squat, push-up, lunge, suspended row, standing overhead press, and front support with chest touches). Scoring for each skill is based on the number of performance criteria successfully demonstrated. An overall resistance training skill quotient (RTSQ) is created by adding participants' scores for the 6 skills. Participants (44 boys and 19 girls, mean age = 14.5 ± 1.2 years) completed the RTSB on 2 occasions separated by 7 days. Participants also completed the following fitness tests, which were used to create a muscular fitness score (MFS): handgrip strength, timed push-up, and standing long jump tests. Intraclass correlation (ICC), paired samples t-tests, and typical error were used to assess test-retest reliability. To assess construct validity, gender and RTSQ were entered into a regression model predicting MFS. The rank order repeatability of the RTSQ was high (ICC = 0.88). The model explained 39% of the variance in MFS (p ≤ 0.001) and RTSQ (r = 0.40, p ≤ 0.001) was a significant predictor. This study has demonstrated the construct validity and test-retest reliability of the RTSB in a sample of adolescents. The RTSB can reliably rank participants in regards to their resistance training competency and has the necessary sensitivity to detect small changes in resistance training skill proficiency.

The combination of plyometric and balance training improves sprint and shuttle run performances more often than plyometric-only training with children

Because balance is not fully developed in children and studies have shown functional improvements with balance only training studies, a combination of plyometric and balance activities might enhance static balance, dynamic balance, and power. The objective of this study was to compare the effectiveness of plyometric only (PLYO) with balance and plyometric (COMBINED) training on balance and power measures in children. Before and after an 8-week training period, testing assessed lower-body strength (1 repetition maximum leg press), power (horizontal and vertical jumps, triple hop for distance, reactive strength, and leg stiffness), running speed (10-m and 30-m sprint), static and dynamic balance (Standing Stork Test and Star Excursion Balance Test), and agility (shuttle run). Subjects were randomly divided into 2 training groups (PLYO [n = 14] and COMBINED [n = 14]) and a control group (n = 12). Results based on magnitude-based inferences and precision of estimation indicated that the COMBINED training group was considered likely to be superior to the PLYO group in leg stiffness (d = 0.69, 91% likely), 10-m sprint (d = 0.57, 84% likely), and shuttle run (d = 0.52, 80% likely). The difference between the groups was unclear in 8 of the 11 dependent variables. COMBINED training enhanced activities such as 10-m sprints and shuttle runs to a greater degree. COMBINED training could be an important consideration for reducing the high velocity impacts of PLYO training. This reduction in stretch-shortening cycle stress on neuromuscular system with the replacement of balance and landing exercises might help to alleviate the overtraining effects of excessive repetitive high load activities.

A 3-year school-based exercise intervention improves muscle strength - a prospective controlled population-based study in 223 children

Background

Intense physical activity (PA) improves muscle strength in children, but it remains uncertain whether moderately intense PA in a population-based cohort of children confers these benefits.

Methods

We included children aged 6–9 years in four schools where the intervention school increased the school curriculum of PA from 60 minutes/week to 40 minutes/school day while the control schools continued with 60 minutes/week for three years. We measured muscle strength, as isokinetic Peak Torque (PT) (Nm) of the knee flexors in the right leg at speeds of 60°/second and 180°/second, at baseline and at follow-up, in 47 girls and 76 boys in the intervention group and 46 girls and 54 boys in the control group and then calculated annual changes in muscle strength. Data are provided as means with 95% confidence intervals.

Results

Girls in the intervention group had 1.0 Nm (0.13, 1.9) and boys 1.9 Nm (0.9, 2.9) greater annual gain in knee flexor PT at 60°/ second, than girls and boys in the control group. Boys in the intervention group also had 1.5 Nm (0.5, 2.5) greater annual gain in knee flexors PT at 180°/ second than boys in the control group.

Conclusion

A 3-year moderately intense PA intervention program within the school curriculum enhances muscle strength in both girls and boys.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-353) contains supplementary material, which is available to authorized users.

Development and implementation of a smartphone application to promote physical activity and reduce screen-time in adolescent boys

PURPOSE

To describe the development and implementation of a smartphone application (app) designed to promote physical activity and reduce screen-time in adolescent boys considered "at-risk" of obesity.

METHODS

An app was developed to support the delivery of a face-to-face school-based obesity prevention program known as the "Active Teen Leaders Avoiding Screen-time" (ATLAS) program. ATLAS was guided by self-determination theory and social cognitive theory and evaluated using a cluster randomized controlled trial with 361 boys (12.7 ± 0.5 years) in 14 secondary schools. Following the completion of the study, participants in the intervention group completed a process evaluation questionnaire and focus groups were conducted with 42 students to explore their general perceptions of the ATLAS program and their experience with the smartphone app. Barriers and challenges encountered in the development, implementation, and evaluation of the app are also described.

RESULTS

Participation in the study was not contingent on ownership of a smartphone, but 70% of participants in the intervention group reported having access to a smartphone or tablet device. Focus group participants reported an enjoyment of the program, and felt that it had provided them with new skills, techniques, and routines for the future. However, their engagement with the smartphone app was limited, due to a variety of reasons. Barriers to the implementation and evaluation of the app included limited access to smartphone devices, technical problems with the push notifications, lack of access to usage data, and the challenges of maintaining participants' interest in using the app.

CONCLUSION

Although participants reported high levels of satisfaction with the ATLAS program in general, the smartphone app was not used extensively. Additional strategies and features may be needed to enhance engagement in adolescent boys.

GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol

BACKGROUND

Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years.

METHODS/DESIGN

An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health.

DISCUSSION

This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus individual models of physiotherapy following intramuscular injections of Botulinum Toxin-A to the lower limbs for ambulant children with cerebral palsy.

TRIAL REGISTRATION

ACTRN12611000454976.

An increase in school-based physical education increases muscle strength in children

PURPOSE

Children and adolescents are encouraged to maintain a habitually active lifestyle because of the known health benefits associated with regular physical activity, but there are some reports that a high level of activity may be associated with increased fracture risk. This prospective controlled exercise intervention study in prepubertal children evaluated if a school-based exercise intervention could enhance growth-related gains in muscle strength and muscular function without affecting fracture risk.

METHODS

Fractures were registered in 417 girls and 500 boys age 7-9 yr in the intervention and in 836 age-matched girls and 872 boys. The intervention included 40 min·d of school physical education for 2 yr, whereas the controls achieved 60 min·wk. In a subsample consisting of 49 girls and 80 boys in the intervention and 50 girls and 53 boys in the control group, body composition was measured by dual-energy x-ray absorptiometry, muscle strength by isokinetic peak torque (PT) of the knee extensors, and flexors at 60 and 180°·s by a computerized dynamometer and neuromuscular performance by vertical jump height.

RESULTS

The rate ratio (95% confidence interval) for children in the intervention group to sustain a fracture was 1.07 (0.66-1.68). The annual gain in knee extensor PT at 180°·s was significantly higher for both girls (P < 0.001) and boys (P < 0.01) in the intervention compared with the control group. Boys in the intervention group also had a greater annual gain in knee flexion PT at 180°·s (P < 0.001), and girls had a greater gain in vertical jump height (P < 0.05).

CONCLUSION

An increase in school-based physical education from 60 to 200 min·wk enhanced muscle strength in prepubertal children without affecting fracture risk.

Effects of weight-bearing activities on bone mineral content and density in children and adolescents: a meta-analysis

Osteoporosis and associated fractures are a major health concern in Western industrialized nations. Exercise during growth is suggested to oppose the involutional bone loss later in life by increasing peak bone mass. The primary aim of the present meta-analysis was to provide a robust estimate of the effect of weight-bearing activities (WBAs) on bone mineral content (BMC) and areal bone mineral density (aBMD), during childhood and adolescence. To locate relevant studies up to June 2012, computerized searches of multiple bibliographic databases and hand searches of key journals and reference lists were performed. Results were extracted by two independent reviewers. The quality of the included trials was assessed via the Physiotherapy Evidence Database (PEDro) score. The study group effect was defined as the difference between the standardized mean change for the treatment and control groups divided by the pooled pretest SD. From 109 potentially relevant studies, only 27 met the inclusion criteria. The analyzed training programs were capable of significantly increasing BMC and aBMD during growth. However, the weighted overall effect sizes (ESs) for changes in BMC (ES 0.17; 95% confidence interval [CI], 0.05-0.29; p < 0.05) and aBMD (ES 0.26; 95% CI, 0.02-0.49) were small. Stepwise backward regression revealed that more than one-third of the observed variance (r(2)  = 0.35) between subgroups of the BMC dataset could be explained by differences in the amount of habitual calcium intake per day (beta 0.54, p < 0.01) and the maturational stage (beta -0.28, p < 0.01) at baseline. No significant moderators were identified for aBMD, possibly due to the small number of trials investigating WBAs on aBMD. The results of this meta-analysis conclude that WBAs alongside high calcium intake provide a practical, relevant method to significantly improve BMC in prepubertal children, justifying the application of this exercise form as an osteoporosis prophylaxis in this stage of maturity.

Instability resistance training across the exercise continuum

Context:

Instability resistance training (IRT; unstable surfaces and devices to strengthen the core or trunk muscles) is popular in fitness training facilities.

Objective:

To examine contradictory IRT recommendations for health enthusiasts and rehabilitation.

Data Sources:

A literature search was performed using MEDLINE, SPORT Discus, ScienceDirect, Web of Science, and Google Scholar databases from 1990 to 2012.

Study Selection:

Databases were searched using key terms, including “balance,” “stability,” “instability,” “resistance training,” “core,” “trunk,” and “functional performance.” Additionally, relevant articles were extracted from reference lists.

Data Extraction:

To be included, research questions addressed the effect of balance or IRT on performance, healthy and active participants, and physiologic or performance outcome measures and had to be published in English in a peer-reviewed journal.

Results:

There is a dichotomy of opinions on the effectiveness and application of instability devices and conditions for health and performance training. Balance training without resistance has been shown to improve not only balance but functional performance as well. IRT studies document similar training adaptations as stable resistance training programs with recreationally active individuals. Similar progressions with lower resistance may improve balance and stability, increase core activation, and improve motor control.

Conclusion:

IRT is highly recommended for youth, elderly, recreationally active individuals, and highly trained enthusiasts.

Prepubescent males are less susceptible to neuromuscular fatigue following resistance exercise

PURPOSE

To determine if prepubescent and adult males have similar fatigue profiles following high and lower intensity knee extensions.

METHODS

Ten male children and ten adults completed two sessions of three sets of high repetition (17 typical muscle endurance training) high repetition (High RM) or low repetition (seven typical strength training) maximum (Low RM) dynamic knee extensions. Voluntary and evoked contractile properties, heart rate (HR), and rating of perceived exertion (RPE) were assessed before and after each knee extension RM.

RESULTS

Knee extension RM measures revealed that boys performed more (children set 2, 6.7 ± 0.5; set 3, 5.7 ± 0.5 vs. adult set 2, 5.2 ± 0.4; set 3, 3.5 ± 0.5; P < 0.001) repetitions, had a faster (children 39.9 ± 8.6 vs. adult 9.4 ± 3.7 bpm; P < 0.001) HR recovery and lower (6.4 ± 0.43; P < 0.001) RPE compared to adults (8.0 ± 0.4). Post-knee extension measures also revealed a smaller MVC force decrement (P < 0.001) with boys (94.3 % ± 6.1 vs. 76.3 % ± 4.1). Unlike adults, there were no significant decrements to children's evoked contractile properties or EMG. The greater boys' antagonist activation (children 125.7 % ± 9.2 vs. adult: 103.5 % ± 6.7; P < 0.001) post-knee extension would suggest muscle coordination changes as a primary mechanism for MVC force decrements. The lower RPE and similar agonist EMG activity may also indicate an inability of boys to perceive or produce a maximal effort.

CONCLUSION

Independent of High or Low RM knee extensions, boys had greater neuromuscular fatigue resistance and recovered faster than adults.

Rater agreement of a test battery designed to assess adolescents' resistance training skill competency

OBJECTIVES

The study aim was to assess rater agreement of the Resistance Training Skills Battery (RTSB) for adolescents. The RTSB provides an assessment of resistance training skill competency and includes six exercises. The RTSB can be used to assess performance and progress in adolescent resistance training programmes and to provide associated feedback to participants. Individual skill scores are based on the number of performance criteria successfully demonstrated and an overall resistance training skill quotient (RTSQ) is created by summing the six skill scores.

DESIGN/METHODS

The eight raters had varying experience in movement skill assessment and resistance training and completed a 2-3h training session in how to assess resistance training performance using the RTSB. The raters then completed an assessment on six skills for 12 adolescents (mean age=15.1 years, SD=1.0, six male and six female) in a randomised order.

RESULTS

Agreement between seven of the eight raters was high (20 of the 21 pairwise correlations were greater than 0.7 and 13 of the 21 were greater than 0.8). Correlations between the eighth rater and each of the other seven raters were generally lower (0.45-0.78). Most variation in the assigned RTSB scores (67%) was between cases, a relatively small amount of the variation (10%) was between raters and the remainder (23%) was between periods within raters. The between-raters coefficient of variation was approximately 5%.

CONCLUSIONS

The RTSB can be used reliably by those with experience in movement skill assessment and resistance training to assess the resistance skill of adolescents.

Independent and combined association of muscle strength and cardiorespiratory fitness in youth with insulin resistance and β-cell function in young adulthood: the European Youth Heart Study

OBJECTIVE

To examine the independent and combined association of isometric muscle strength of the abdomen and back and cardiorespiratory fitness (CRF) in youth with indices of glucose metabolism in young adulthood among boys and girls from the European Youth Heart Study.

RESEARCH DESIGN AND METHODS

We used data from a population-based prospective cohort study among youth followed up for up to 12 years (n = 317). In youth, maximal voluntary contractions during isometric back extension and abdominal flexion were determined using a strain-gauge dynamometer and CRF was obtained from a maximal cycle ergometer test. Insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]) and β-cell function (homeostasis model assessment of β-cell function [HOMA-B]) were estimated from fasting serum insulin and glucose that were obtained in youth and at follow-up in young adulthood.

RESULTS

For each 1-SD difference in isometric muscle strength (0.16 N/kg) in youth, fasting insulin, HOMA-IR, and HOMA-B in young adulthood changed by -11.3% (95% CI -17.0 to -5.2), -12.2% (-18.2 to -5.7), and -8.9% (-14.4 to -3.0), respectively, in young adulthood after adjustment for CRF and personal lifestyle and demographic factors. Results for CRF were very similar in magnitude, and the magnitude of associations for both exposures was unchanged with additional adjustment for general or abdominal adiposity in youth. Combined associations of muscle strength and CRF with fasting insulin, HOMA-IR, and HOMA-B were additive, and adolescents in the highest sex-specific tertile for both isometric muscle strength and CRF had the lowest levels of these glucose metabolism outcomes.

CONCLUSIONS

Increasing muscle strength and CRF should be targets in youth primordial prevention strategies of insulin resistance and β-cell dysfunction.

Muscle strength in youth and cardiovascular risk in young adulthood (the European Youth Heart Study)

BACKGROUND

Whether muscle strength in youth is related to cardiovascular risk later in life independent of cardiorespiratory fitness is unclear.

METHODS

We examined the independent association of isometric muscle strength in youth with cardiovascular risk factors in young adulthood using data from the Danish European Youth Heart Study; a population-based prospective cohort study among boys and girls (n=332) followed for up to 12 years. In youth maximal voluntary contractions during isometric back extension and abdominal flexion were determined using a strain-gauge dynamometer and cardiorespiratory fitness was obtained from a maximal cycle ergometer test. Cardiovascular risk factors were obtained in youth and in young adulthood. Associations were examined using multivariable-adjusted regression models including major confounding factors.

RESULTS

Each 1 SD difference in isometric muscle strength in youth (0.17 N/kg) was inversely associated with body mass index (BMI; -0.60 kg/m(2), 95% CI -0.97 to -0.22), triglyceride (-0.09 mmol/l, 95% CI -0.16 to -0.02), diastolic blood pressure (BP) (-1.22 mm Hg, 95% CI -2.15 to -0.29) and a composite cardiovascular risk factor score (-0.61 SD, 95% CI -1.03 to -0.20) in young adulthood in multivariable-adjusted analyses including fitness. Associations to triglyceride, diastolic BP and the cardiovascular risk factor score remained with additional adjustment for waist circumference or BMI. Each 1 SD difference in isometric muscle strength in youth was significantly associated with 0.59 (95% CI 0.40 to 0.87) lower odds of general overweight/obesity in young adulthood (p=0.007) and was marginally associated with incident raised BP, raised triglyceride and low high-density lipoprotein cholesterol.

CONCLUSIONS

This study suggests that greater isometric muscle strength in youth is associated with lower levels of cardiovascular risk factors in young adulthood independent of fitness, adiposity and other confounding factors.

The effects of resistance training on explosive strength indicators in adolescent basketball players

The purpose of this study was to assess the effects of a lower- and upper-body 10-week in-season resistance training program on explosive strength development in young basketball players. Twenty-five adolescent male athletes, aged 14-15 years old, were randomly assigned to an experimental group (EG; n = 15) and a control group (CG; n = 10). The subjects were assessed at baseline and after training for squat jump (SJ), countermovement jump (CMJ), Abalakov test, drop jump, and seated medicine ball throw (MBT). The EG showed significant increases (p < 0.05) in all the variable scores. Conversely, the CG significantly decreased (p < 0.05) in SJ, CMJ, and Abalakov test scores and significantly increased in the results of MBT test (p < 0.05). The groups were similar on pretest, but significant differences (p < 0.05) occurred on posttest in all the variables. The results of this study show that a 10-week in-season resistance training program with moderate volume and intensity loads increased vertical jump and MBT performance in adolescent male basketball players. Coaches should know that such a short resistance training program specifically designed for young basketball players induce increased explosivity levels, which are essential to a better basketball performance, with no extra overload on adolescents' skeletal muscle development.

Explosive sport training and torque kinetics in children

A high rate of force development (RFD) is often more important than maximal force in daily and sports activities. In children, resistance training has been shown to increase maximal force. It is unclear whether, or to what extent, can children improve RFD and force kinetics. For this study, we compared strength and force kinetics of boy gymnasts with those of untrained boys and untrained men. Eight boy gymnasts (age, 9.5 ± 1.2 y), 20 untrained boys (age, 10.1 ± 1.3 y), and 20 untrained men (age, 22.9 ± 4.4 y) performed maximal, explosive, isometric elbow flexions (EF) and knee flexions (KF). Peak torque (maximal voluntary contraction (MVC)), elapsed times to 10%-100% MVC, peak rate of torque development (RTDpk), and other kinetics parameters were determined. When gymnasts were compared with untrained boys, size-normalized EF MVC was 11%-20% higher, RTDpk was 32% higher, and times to 30% and 80% MVC were 16% and 55% shorter, respectively (p < 0.05). No corresponding differences were observed in KF. Furthermore, although the normalized EF MVC was 28% lower in gymnasts than in men (p < 0.001), their torque kinetics parameters were similar. These findings highlight the specificity of gymnastics training, which markedly elevated the torque kinetics of young, prepubertal boys to adult levels, but only moderately affected peak torque. It is suggested that neurologic adaptations, such as enhanced firing and activation rates or increased type II motor-unit recruitment, as well as changes in musculotendinous stiffness, could explain these findings.

Effect of a Physical Fitness Program on Physical Self-Concept and Physical Fitness Elements in Primary School Students

The purpose of this study was to assess the short-term effect of a physical fitness program on physical self-concept and physical fitness elements among primary school students. Spanish boys and girls ( N = 75; M age = 11.1 yr., SD = 0.4) were divided into an experimental group and a control group. During physical education classes, the experimental group performed an 8-week program including two circuits of 8 exercises done for 15 to 35 sec. each with 45 to 25 sec. of rest between them. Physical self-concept (Physical Self-Description Questionnaire) and physical fitness (EUROFIT battery tests) were measured at the beginning and at the end of the physical fitness program. The results showed that the improvements in physical fitness were not accompanied by major changes in physical self-concept, even though the physical fitness program seemed to maintain the Experimental group's previous physical appearance, strength, and self-esteem perceptions, all of which statistically significantly decreased in the control group after the intervention.

Physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis

Arthritis in childhood can be associated with low levels of physical activity and poor physical fitness. Children with arthritis may have decreased aerobic and anaerobic fitness, muscle weakness, low bone mass, and low bone strength. Suboptimal physical activity and exercise capacity may contribute to further deconditioning and disability, placing children with arthritis at risk for poor health outcomes. Recent studies suggest that exercise therapy is safe and does not worsen arthritis. Exercise therapy may improve function, quality of life, and physical fitness. However, little is known about the exercise prescription that is most effective to improve clinical outcomes in children with arthritis. This article reviews the current literature on physical activity, physical fitness, and exercise therapy in children with juvenile idiopathic arthritis.

Reliability of the one-repetition-maximum power clean test in adolescent athletes

Although the power clean test is routinely used to assess strength and power performance in adult athletes, the reliability of this measure in younger populations has not been examined. Therefore, the purpose of this study was to determine the reliability of the 1-repetition maximum (1RM) power clean in adolescent athletes. Thirty-six male athletes (age 15.9 ± 1.1 years, body mass 79.1 ± 20.3 kg, height 175.1 ±7.4 cm) who had >1 year of training experience in weightlifting exercises performed a 1RM power clean on 2 nonconsecutive days in the afternoon following standardized procedures. All test procedures were supervised by a senior level weightlifting coach and consisted of a systematic progression in test load until the maximum resistance that could be lifted for 1 repetition using proper exercise technique was determined. Data were analyzed using an intraclass correlation coefficient (ICC[2,k]), Pearson correlation coefficient (r), repeated measures analysis of variance, Bland-Altman plot, and typical error analyses. Analysis of the data revealed that the test measures were highly reliable demonstrating a test-retest ICC of 0.98 (95% confidence interval = 0.96-0.99). Testing also demonstrated a strong relationship between 1RM measures in trials 1 and 2 (r = 0.98, p < 0.0001) with no significant difference in power clean performance between trials (70.6 ± 19.8 vs. 69.8 ± 19.8 kg). Bland-Altman plots confirmed no systematic shift in 1RM between trials 1 and 2. The typical error to be expected between 1RM power clean trials is 2.9 kg, and a change of at least 8.0 kg is indicated to determine a real change in lifting performance between tests in young lifters. No injuries occurred during the study period, and the testing protocol was well tolerated by all the subjects. These findings indicate that 1RM power clean testing has a high degree of reproducibility in trained male adolescent athletes when standardized testing procedures are followed and qualified instruction is present.

Influence of resistance training on cardiorespiratory endurance and muscle power and strength in young athletes

The purpose of this study was to investigate the influence of additional resistance training on cardiorespiratory endurance in young (15.8 ± 0.8 yrs) male basketball players. Experimental group subjects (n=23) trained twice per week for 12 weeks using a variety of general free-weight and machine exercises designed for strength acquisition, beside ongoing regular basketball training program. Control group subject (n=23) participated only in basketball training program. Oxygen uptake (VO(2max)) and related gas exchange measures were determined continuously during maximal exercise test using an automated cardiopulmonary exercise system. Muscle power of the extensors and flexors was measured by a specific computerized tensiometer. Results from the experimental group (VO(2max) 51.6 ± 5.7 ml.min(-1).kg(-1) pre vs. 50.9 ± 5.4 ml.min(-1).kg(-1) post resistance training) showed no change (p>0.05) in cardiorespiratory endurance, while muscle strength and power of main muscle groups increased significantly. These data demonstrate no negative cardiorespiratory performance effects on adding resistance training to ongoing regular training program in young athletes.

Rate of muscle activation in power- and endurance-trained boys

Previous studies in adults have demonstrated power athletes as having greater muscle force and muscle activation than nonathletes. Findings on endurance athletes are scarce and inconsistent. No comparable data on child athletes exist.

PURPOSE

This study compared peak torque (Tq), peak rate of torque development (RTD), and rate of muscle activation (EMG rise, Q30), in isometric knee extension (KE) and flexion (KF), in pre- and early-pubertal power- and endurance-trained boys vs minimally active nonathletes.

METHODS

Nine gymnasts, 12 swimmers, and 18 nonathletes (7-12 y), performed fast, maximal isometric KE and KF. Values for Tq, RTD, electromechanical delay (EMD), and Q30 were calculated from averaged torque and surface EMG traces.

RESULTS

No group differences were observed in Tq, normalized for muscle cross-sectional area. The Tq-normalized KE RTD was highest in power athletes (6.2 ± 1.9, 4.7 ± 1.2, 5.0 ± 1.5 N·m·s-1, for power, endurance, and nonathletes, respectively), whereas no group differences were observed for KF. The KE Q30 was significantly greater in power athletes, both in absolute terms and relative to peak EMG amplitude (9.8 ± 7.0, 5.9 ± 4.2, 4.4 ± 2.2 mV·ms and 1.7 ± 0.8, 1.1 ± 0.6, 0.9 ± 0.5 (mV·ms)/(mV) for power, endurance, and nonathletes, respectively), with no group differences in KF. The KE EMD tended to be shorter (P = .07) in power athletes during KE (71.0 ± 24.1, 87.8 ± 18.0, 88.4 ± 27.8 ms, for power, endurance, and nonathletes), with no group differences in KF.

CONCLUSIONS

Pre- and early-pubertal power athletes have enhanced rate of muscle activation in specifically trained muscles compared with controls or endurance athletes, suggesting that specific training can result in muscle activation-pattern changes before the onset of puberty.

When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth?

Regular participation in organized youth sports does not ensure adequate exposure to skill- and health-related fitness activities, and sport training without preparatory conditioning does not appear to reduce risk of injury in young athletes. Current trends indicate that widespread participation in organized youth sports is occurring at a younger age, especially in girls. Current public health recommendations developed to promote muscle strengthening and bone building activities for youth aged 6 yr and older, along with increased involvement in competitive sport activities at younger ages, has increased interest and concern from parents, clinicians, coaches, and teachers regarding the optimal age to encourage and integrate more specialized physical training into youth development programs. This review synthesizes the latest literature and expert opinion regarding when to initiate neuromuscular conditioning in youth and presents a how-to integrative training conceptual model that could maximize the potential health-related benefits for children by reducing sports-related injury risk and encouraging lifelong, regular physical activity.

Body Composition of Young Athletes

Absolute and relative components of body mass are a primary focus in studies of body composition. Components change with growth and maturation, requiring care in selecting methods of assessment in children and adolescents. Although sex differences are apparent in fat-free mass (FFM), fat mass (FM), and relative fatness (% Fat) during childhood, they are more clearly defined during adolescence and adulthood. Body composition is one of many determinants of sport performance, but % Fat tends to be the primary focus of discussion in young athletes. The influence of training for sport on bone mineral has received more attention in recent years because of methodological advances in assessment and concern for potential negative effects of altered menstrual function on bone. Relative fatness of young athletes in several sports is summarized, and issues related to sport training and body composition in young athletes are considered. Suggestions for dealing with body composition in young athletes are provided.