Training programs for children: literature review

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

Sports Participation, Physical Activity, and Health-Related Fitness in Youth With Chronic Diseases or Physical Disabilities: The Health in Adapted Youth Sports Study

ABSTRACT

Lankhorst, K, Takken, T, Zwinkels, M, van Gaalen, L, Velde, St, Backx, F, Verschuren, O, Wittink, H, and de Groot, J. Sports participation, physical activity, and health-related fitness in youth with chronic diseases or physical disabilities: the health in adapted youth sports study. J Strength Cond Res 35(8): 2327-2337, 2021-Youth with chronic diseases or physical disabilities (CDPD) often show reduced fitness and physical activity (PA) levels and participate less in organized sports compared with healthy peers. The purpose of this study was to examine the associations between participation in sports and health-related fitness and PA in youth with CDPD. A total of 163 subjects (mean age 14 years; range 8-19 years) with CDPD were included in this cross-sectional study, with 81 participating in organized sports and 82 not. Subjects were recruited between October 2014 and November 2016. Aerobic and anaerobic fitness, agility, and muscle strength were assessed in the laboratory, whereas PA was monitored in daily life using accelerometry during 1 week. Linear regression analyses were used to assess the associations of sports participation (independent variable) with health-related fitness and PA (dependent variables). Results show that youth with CDPD participating in organized sports 2 times a week performed better on all outcome measures. They reached a higher peak oxygen uptake (difference of 4.9 ml O2·kg-1·min-1, P = 0.001) compared with their peers not participating in sports. Also, anaerobic fitness, agility, muscle strength, and PA were all positively associated with sports participation. Moreover, the association between sports participation and aerobic fitness was mediated by PA for 31% (P = 0.045). In conclusion, participation in sports is associated with both higher levels of PA and health-related fitness in youth with CDPD. Promotion and stimulation of participation in sports seems a good way to promote health-related fitness as well as a healthy active lifestyle in youth with CDPD.

Cardiorespiratory endurance in relation to body mass in Polish rural children: Preliminary report

Physical fitness is generally viewed as having morphological, muscular, motor, cardiovascular and metabolic components. Cardiorespiratory fitness describes the capacity of the cardiovascular and respiratory systems to carry out prolonged strenuous exercise. It is often considered as the most important indicator of health status. The place of residence is seen as a factor that may influence the feasibility of physically active lifestyles, and thus shaping cardiorespiratory fitness. The study group consisted of 121 children aged 10-16 years, including 60 girls and 61 boys. All of the children lived in rural areas. The investigated group was divided according to age and sex; body height and weight were measured and body mass index (BMI) calculated. All children performed the Cooper's run test and the Ruffier's test. The analysis of BMI for the nutritional status of children in relation to the entire study group demonstrated that 81 children had normal weight, 20 children were overweight and 11 were obese, while 9 children were underweight. The studied group of children showed on average very good and good performance in the Cooper's test, regardless of body weight, whereas the results of the Ruffier's test showed merely weak or medium cardiorespiratory endurance, which was even worse in overweight or obese children.

Treadmill training for a child with spina bifida without functional ambulation

PURPOSE

To describe and report the effect of an 8-week individualized, progressive, treadmill training program on the ambulatory ability of a 4-year-old child with myelomeningocele without functional ambulation.

SUMMARY OF KEY POINTS

Heart rate and speed on the 2-minute walk test (2MWT) were used to individualize training. Ambulatory outcome measures taken at baseline, postintervention, and 6 weeks postintervention included the 2MWT and the Timed "Up and Go" (TUG). The Pediatric Evaluation of Disability Index was used to measure functional mobility. Improvements were noted in ambulatory ability after training (2MWT, 64.10%; TUG, 34.66%) and at the 6-week follow-up (2MWT, 58.97%; TUG, 34.24%). The Pediatric Evaluation of Disability Index showed no significant difference.

CONCLUSION AND RECOMMENDATIONS

Use of an individualized treadmill training program may have improved the ambulatory skills of a preschooler with myelomeningocele. More rigorous studies are needed to determine the effects of treadmill training with the spina bifida population and identify optimal training parameters.

Physical activity of children with a mitochondrial disease compared to children who are healthy

PURPOSE

To compare the physical activity of a group of children with mitochondrial myopathy (MM) with children who are healthy and to evaluate the suitability of different measurement tools.

METHODS

The physical activity of 6 children with MM and 10 children who are healthy was measured using accelerometry, heart rate monitoring, video observation, rating of their fatigue, and 2 questionnaires about their physical activity and quality of life.

RESULTS

The children with MM spent less time in moderate to vigorous activity, and their activity level measured with the accelerometer was lower than the children who are healthy. Also, the children with MM indicated a higher level of fatigue and a lower quality of life.

CONCLUSIONS

Children with MM are on average less physically active, report a higher level of fatigue, and a lower quality of life than children who are healthy.

Randomized controlled study of home-based treadmill training for ambulatory children with spina bifida

BACKGROUND

Many ambulatory children with spina bifida (SB) decline in their walking despite stable or even improved motor function.

OBJECTIVE

The authors evaluated the effects of a home-based treadmill training program on both ambulatory function and aerobic fitness.

METHODS

This randomized clinical trial of 34 ambulatory children with SB allocated 18 to supervised treadmill training for 12 weeks at home and 14 to usual care. Patients in home training exercised twice a week at an intensity of 66% of HR(peak) (peak heart rate) and gradually progressed from 70% to 140% of their individual walking speed. Main outcome measures were obtained at baseline, after intervention, and 3 months postintervention. Ambulation was measured using the 6-minute walk test (6MWT), during which gross energy consumption (ECS(gross)) and energy cost were calculated. Maximal exercise capacity was measured using an incremental treadmill test. Both VO(2peak) and speed(peak) were recorded as outcome parameters.

RESULTS

After training, significant changes were seen between the groups for 6MWT (P = .002; d = 1.08), speed(peak) (P = .001; d = 1.14), VO(2peak) (P = .034; d = 0.78), and ECS(gross) (P = .004; d = 1.01). Long-term effects were recorded for 6MWT (P = .003; η = 0.34), speed(peak) (P = .003; η = 0.35), and ECS(gross) (P = .014; η = 0.29) but not for VO(2peak).

CONCLUSION

A home-based, progressive treadmill training program for ambulatory children with SB has a large long-term effect on ambulation, with a moderate short-term effect on VO(2peak).

The Utrecht approach to exercise in chronic childhood conditions: the decade in review

PURPOSE

To summarize and discuss current evidence and understanding of clinical pediatric exercise physiology focusing on the work the research group at Utrecht and others have performed in the last decade in a variety of chronic childhood conditions as a continuation of the legacy of Dr Bar-Or.

KEY POINTS

The report discusses current research findings on the cardiopulmonary exercise performance of children (and adolescents) with juvenile idiopathic arthritis, osteogenesis imperfecta, achondroplasia, hemophilia, cerebral palsy, spina bifida, cystic fibrosis, and childhood cancer. Exercise recommendations and contraindications are provided for each condition. Implications for clinical practice and future research in this area are discussed for each of the chronic conditions presented.

CLINICAL IMPLICATIONS

The authors provide a basic framework for developing an individual and/or disease-specific training program, introduce the physical activity pyramid, and recommend a core set of clinical measures to be used in clinical research.

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease

BACKGROUND/OBJECTIVES

The purpose of this study was to develop an activity energy expenditure (AEE) prediction equation for the Actiheart activity monitor for use in children with chronic disease.

SUBJECTS/METHODS

In total, 63 children, aged 8-18 years with different types of chronic disease (juvenile arthritis, hemophilia, dermatomyositis, neuromuscular disease, cystic fibrosis or congenital heart disease) participated in an activity testing session, which consisted of a resting protocol, working on the computer, sweeping, hallway walking, steps and treadmill walking at three different speeds. During all activities, actual AEE was measured with indirect calorimetry and the participants wore an Actiheart on the chest. Resting EE and resting heart rate were measured during the resting protocol and heart rate above sleep (HRaS) was calculated.

RESULTS

Mixed linear modeling produced the following prediction equation: This equation results in a nonsignificant mean difference of 2.1 J/kg/min (limits of agreement: -144.2 to 148.4 J/kg/min) for the prediction of AEE from the Actiheart compared with actual AEE.

CONCLUSIONS

The Actiheart is valid for the use of AEE determination when using the new prediction equation for groups of children with chronic disease. However, the prediction error limits the use of the equation in individual subjects.

Exercise training in pediatric patients with end-stage renal disease

The objective of this study was to determine the feasibility and efficacy of an exercise training program to improve exercise capacity and fatigue level in pediatric patients with end-stage renal disease (ESRD). Twenty children on dialysis intended to perform a 12-week graded community-based exercise program. Exercise capacity and fatigue level were studied; muscle force and health-related quality of life were secondary outcomes. All outcomes were measured at baseline (T = 0) and after intervention (T = 1). Fourteen of the 20 patients (70%) either did not start the program or did not complete the program. Of these patients, seven did not complete or even start the exercise program because of a combination of lack of time and motivational problems. Six patients were not able to continue the program or were unable to do the follow-up measurements because of medical problems. Exercise capacity and muscle strength was higher after the exercise program in the children who completed the training. In conclusion, exercise training is difficult to perform in children with ESRD and is not always feasible in real-life situations for many children with ESRD.