1
|
Chiang HL, Chuang YF, Chen YA, Hsu CT, Ho CC, Hsu HT, Sheu YH, Gau SSF, Liang LL. Physical Fitness and Risk of Mental Disorders in Children and Adolescents. JAMA Pediatr 2024; 178:595-607. [PMID: 38683586 PMCID: PMC11059046 DOI: 10.1001/jamapediatrics.2024.0806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
Importance With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical. Objective To examine the association between physical fitness and mental disorder risks. Design, Setting, and Participants This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024. Exposures Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively. Main Outcomes and Measures Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers. Results The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001). Conclusions and Relevance This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.
Collapse
Affiliation(s)
- Huey-Ling Chiang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Fang Chuang
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- International Health Program, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-An Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Te Hsu
- Department of Sport Management, National Taiwan University of Sport, Taichung, Taiwan
- The Research Center of Sport and Health Industry, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chien-Chang Ho
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, Taiwan
- Sports Medicine Center, Fu Jen Catholic Hospital, New Taipei City, Taiwan
| | - Hsiu-Tao Hsu
- The Research Center of Sport and Health Industry, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Physical and Health Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yi-Han Sheu
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine and Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Lin Liang
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Research Center for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
2
|
Mistry MS, Gauvreau K, Alexander ME, Jenkins K, Gauthier N. Socioeconomic Factors Influencing Pediatric Peak Oxygen Consumption Prediction. J Pediatr 2024; 264:113742. [PMID: 37730107 DOI: 10.1016/j.jpeds.2023.113742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To determine if socioeconomic status (SES) has a greater effect than standard demographic values on predicted peak oxygen consumption (pVO2). STUDY DESIGN We conducted a single-institution, retrospective analysis of maximal cardiopulmonary exercise test (CPET) data from 2010 to 2020 for healthy patients age <19 years with body mass index (BMI) percentile (BMI%) between 5-95. Data were sorted by self-identified race, BMI%, and adjusted gross income (AGI); AGI served as a surrogate for SES. Mean percent predicted pVO2 (pppVO2) was compared between groups. Linear regression was used to adjust for differences. RESULTS A total of 541 CPETs met inclusion criteria. Mean pppVO2 was 97% ± 22.6 predicted (P < .01) with 30% below criterion standard for normal (85% predicted). After excluding unknown AGI and race, 418 CPETs remained. Mean pppVO2 was lower for Blacks (n = 36) and Latinx (n = 26) compared with Whites (n = 333, P < .01). Mean pppVO2 declined as AGI decreased (P < .01). The differences in pppVO2 between racial categories remained significant when adjusted for BMI% (Black r = -7.3, P = .035; Latinx r = -15.4, P < .01). These differences both decreased in magnitude and were no longer significant when adjusted for AGI (Black r = -6.0, P = .150; Latinx r = -9.3, P = .06). CONCLUSIONS Lower SES correlates with lower measured cardiovascular fitness and may confound data interpretation. When using normative reference ranges in clinical decision making, providers should recognize that social determinants of health may influence predicted fitness. Social inequities should be considered when assessing pediatric cardiovascular fitness.
Collapse
Affiliation(s)
- Maanasi S Mistry
- Department of Cardiology, Boston Children's Hospital, Boston, MA.
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Biostatistics, Harvard T. Chan School of Public Health, Boston, MA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Naomi Gauthier
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| |
Collapse
|
3
|
Nezondet C, Gandrieau J, Nguyen P, Zunquin G. Perceived Physical Literacy Is Associated with Cardiorespiratory Fitness, Body Composition and Physical Activity Levels in Secondary School Students. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040712. [PMID: 37189960 DOI: 10.3390/children10040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Overweight and obese adolescents are often associated with lower Physical Activity (PA) levels and low Cardiorespiratory Fitness (CRF). Recently, the concept of Physical Literacy (PL), has been suggested to be associated with higher levels of active behavior and better health in adolescents. The purpose of this study is to investigate the relationships between PL, body composition, cardiorespiratory fitness and physical activity levels in French secondary school students. METHODS The level of PL was assessed in 85 French adolescents using a French version of the Perceived Physical Literacy Instrument (F-PPLI). Cardiorespiratory fitness was measured by the "20 m adapted walk/shuttle run test". The PA level was assessed by the Youth Risk Behavior Surveillance System questionnaire. Weight status was measured by the Body Mass Index (BMI) and the body composition data. RESULTS We find a significant association between the PL and the percentage Fat Mass (%FM) (r = -0.43; p ≤ 0.01), between the PL and moderate to vigorous PA (MVPA) per week (r = 0.38; p ≤ 0.01). The PL was associated (r = 0.36; p ≤ 0.01) with the percentage of Skeletal Muscle Mass (%SMM) and cardiorespiratory fitness (r = 0.40; p ≤ 0.05). CONCLUSIONS Developing the PL for the most disadvantaged secondary school students in a PA program could be a suitable strategy to increase their PA level, reduce their adiposity, and promote better long-term health.
Collapse
Affiliation(s)
- Charlie Nezondet
- Laboratoire Mouvement, Equilibre, Performance, Santé (MEPS), Université de Pau et des Pays de l'Adour, Campus Montaury, 64600 Anglet, France
| | - Joseph Gandrieau
- L'unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS), Université de Lille, 59000 Lille, France
- Laboratoire Motricité Humaine Expertise Sport Santé, (LAMHESS), UPR 6312, 06000 Nice, France
| | - Philippe Nguyen
- Departement "Unité Transversale des Activités Physiques pour la Santé" (UTAPS), Centre Hospitalier de la Côte Basque (CHCB), 64100 Bayonne, France
| | - Gautier Zunquin
- Laboratoire Mouvement, Equilibre, Performance, Santé (MEPS), Université de Pau et des Pays de l'Adour, Campus Montaury, 64600 Anglet, France
| |
Collapse
|
4
|
González-Gálvez N, Ribeiro JC, Mota J. Cardiorespiratory Fitness, Obesity and Physical Activity in Schoolchildren: The Effect of Mediation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16262. [PMID: 36498335 PMCID: PMC9736920 DOI: 10.3390/ijerph192316262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
There are only a few studies that have examined the interaction between physical activity (PA), cardiorespiratory fitness (CRF), and overweightness/obesity in adolescents, and these studies have shown some limitations. The objective of this study was to examine whether the association between PA (moderate-vigorous PA [MVPA], moderate PA [MPA], and vigorous PA [VPA]) and obesity is mediated by CRF. This cross-sectional study was conducted in six middle and high-schools in the Porto district (Portugal), comprising 632 children and adolescents. Fat mass (FM), CRF, MVPA, MPA, and VPA were assessed. The Process macro for SPSS was used. CRF was significantly associated with PA for both children and adolescents. Likewise, FM was negatively and significantly associated with CRF for both children (β = -0.337) and adolescents (β = -0.255). FM was associated with PA in children (MVPA: β = -0.102; MPA: β = -0.118; VPA: β = -0.305) and adolescents (MVPA: β: -0.103; MPA: β = -0.082; VPA: β = -0.204). The mediation analysis showed that the association between PA (MVPA//MPA/VPA) and obesity was mediated by CRF, in both children and adolescents, with a significant value in the Sobel test. Obesity is associated with CRF and MVPA, MPA, and VPA. However, CRF acted as a complete mediator between the association of obesity and PA.
Collapse
Affiliation(s)
- Noelia González-Gálvez
- Sports Injury Prevention Research Group, Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Jose Carlos Ribeiro
- Research Center in Physical Activity, Health and Leisure (CIAFEL)—Faculty of Sport—University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-450 Porto, Portugal
| | - Jorge Mota
- Research Center in Physical Activity, Health and Leisure (CIAFEL)—Faculty of Sport—University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-450 Porto, Portugal
| |
Collapse
|
5
|
Carlos BS, Mireia AR, María Reyes BV, Diego MU. Independent and combined influence of physical fitness components on self-esteem in adolescents: DADOS study. Ann Hum Biol 2022; 48:550-556. [DOI: 10.1080/03014460.2022.2032337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bou-Sospedra Carlos
- Universtiy Jaume I, Castellón, Spain.
- LIFE Research Group, University Jaume I, Castellon, Spain
| | - Adelantado-Renau Mireia
- Universtiy Jaume I, Castellón, Spain.
- LIFE Research Group, University Jaume I, Castellon, Spain
| | | | | |
Collapse
|
6
|
Moore SA, Cumming SP, Balletta G, Ramage K, Eisenmann JC, Baxter-Jones ADG, Jackowski SA, Sherar LB. Exploring the relationship between adolescent biological maturation, physical activity, and sedentary behaviour: a systematic review and narrative synthesis. Ann Hum Biol 2020; 47:365-383. [PMID: 32996818 DOI: 10.1080/03014460.2020.1805006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Across adolescence, there is a notable decline in physical activity in boys and girls. Maturational timing may be a risk factor for disengagement from physical activity and increased sedentary behaviours during adolescence. OBJECTIVE This systematic review aimed to summarise literature that examined the relationship between maturational timing, physical activity and sedentary behaviour in adolescents. METHODS Six electronic databases were searched for articles that assessed biological maturation and physical activity (including sports participation and active transportation) or sedentary behaviours in adolescents. Two reviewers conducted title, abstract, and full-text screening, reference and forward citation searches. Included articles were evaluated for quality using a standardised tool. A narrative synthesis was used to analyse the findings due to the heterogeneity of the studies. RESULTS Searches yielded 78 articles (64 unique studies) that met the inclusion criteria, representing 242,316 participants (153,179 unique). Studies ranged from 30.0% (low) to 91.7% (high) in quality. An inverse relationship between maturational timing and physical activity (in 50 and 60% of studies in boys and girls, respectively) and a positive relationship between maturational timing and sedentary behaviour (in 100% and 53% of studies in boys and girls, respectively) was most commonly reported. Evidence supporting an association between maturational timing, sports participation, and active transportation was inconsistent. CONCLUSIONS While this review demonstrates some evidence for early maturational timing as a risk factor for disengagement from physical activity and increase in sedentary behaviours, the reviewed literature also demonstrates that this relationship is complex. Future research that tracks maturity-related variations in physical activity and sedentary behaviours over adolescence is warranted.
Collapse
Affiliation(s)
- Sarah A Moore
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Canada.,Department of Therapeutic Recreation, Faculty of Child, Family, and Community Studies, Douglas College, Coquitlam, Canada
| | - Sean P Cumming
- Sport, Health, and Exercise Research Group, Department of Health, University of Bath, Bath, UK
| | | | | | - Joey C Eisenmann
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | | | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| |
Collapse
|
7
|
Bou-Sospedra C, Adelantado-Renau M, Beltran-Valls MR, Moliner-Urdiales D. Association between Health-Related Physical Fitness and Self-Rated Risk of Depression in Adolescents: Dados Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124316. [PMID: 32560324 PMCID: PMC7345278 DOI: 10.3390/ijerph17124316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 01/23/2023]
Abstract
Depression is the most common mental disorder, affecting around 5% of adolescents. Physical fitness is considered a powerful marker of physical and mental health. The scientific results on the relationship between physical fitness and depression in the adolescent population are mixed. Therefore, the aim of the current study was to analyse the association between objectively assessed physical fitness and self-rated risk of depression in a group of adolescents. A total of 225 participants (44% girls), aged 13.9 ± 0.3 years, from the Deporte, ADOlescencia y Salud (DADOS) study were included in the analyses. Field-based Assessing Levels of Physical fitness and Health in Adolescents (ALPHA) health-related fitness test battery was used to objectively assess physical fitness components. The Behavior Assessment System for Children (BASC) level 3 was used to evaluate self-rated risk of depression. Our results showed that self-rated risk of depression was inversely associated with cardiorespiratory fitness (β = −0.172), as well as positively associated with body mass index (β = 0.146) and waist circumference (β = 0.137) (all p < 0.05). Adolescents with low levels of cardiorespiratory fitness had significantly higher odds of self-rated risk of depression (OR = 7.17; 95% CI, 1.51–33.95). These findings suggest that health-related physical fitness, particularly cardiorespiratory fitness and body composition, is associated with depression in adolescents.
Collapse
|
8
|
Comparative Cardiorespiratory Fitness in Children: Racial Disparity May Begin Early in Childhood. Pediatr Cardiol 2019; 40:1183-1189. [PMID: 31177302 DOI: 10.1007/s00246-019-02129-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
African American (AA) adults are reported to have lower levels of cardiorespiratory fitness (CRF) as compared to Caucasian adults. CRF is linked to cardiovascular morbidity and mortality. We hypothesized that the disparities start early in childhood. This was a retrospective analysis of the cardiopulmonary exercise test (CPET). We included normal healthy children, ≤ 18 years of age, who had normal electrocardiograms and normal cardiac function. We excluded patients with congenital heart disease, obesity and suboptimal exercise test. The entire cohort was divided into two groups based on race (Caucasian vs. AA) and then further subcategorized by gender. The cohort of 248 patients had a mean ± SD age of 14.4 ± 2.1 years. 158 (60.8%) were males and 158 (60.8%) were Caucasians. Oxygen consumption was higher among Caucasian children when compared to the AA children (48.7 ± 7.9 vs. 45.4 ± 7 mL/kg/min, p = 0.01). This racial disparity continued to persist when comparisons were performed separately for girls and boys. Upon comparing the four groups, the AA females were found to have the lowest values of VO2max, exercise time and METS (p = 0.001). Thus, in conclusion, the AA children have significantly lower level of CRF, as measured by VO2max and exercise time. The racial disparity is independent of gender. African American females show the lowest level of aerobic capacity. The findings of our study suggest that the racial disparity in the CRF levels seen in the adult population may begin early in childhood.
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an updated summary on the unique aspects of caring for female youth and adolescent athletes. RECENT FINDINGS Recent research on female athletes has led to a better understanding of injuries and conditions that are more likely to occur in female youth and adolescent athletes, including the frequency and severity of concussions, musculoskeletal injury such as involving the anterior cruciate ligament, and the female athlete triad. Social factors, such as the growing pressure to specialize in a sport particularly at an early age, also put young female athletes at risk for issues such as overuse injuries. Researchers continue to explore the benefits of athletic participation that extend beyond physical fitness. SUMMARY Female participation in youth sports has increased dramatically during the past 50 years. This has led to greater research on how to manage risks and maximize benefits for young female athletes, although there is still much to be learned. Providers should educate patients, parents, and coaches on both the increased risks for female athletes and ways to provide better support and accessibility of youth sports to all children.
Collapse
|
10
|
Ha AS, Ng JYY. Rope skipping increases bone mineral density at calcanei of pubertal girls in Hong Kong: A quasi-experimental investigation. PLoS One 2017; 12:e0189085. [PMID: 29220384 PMCID: PMC5722366 DOI: 10.1371/journal.pone.0189085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/07/2017] [Indexed: 11/18/2022] Open
Abstract
Bone mineral accrual during puberty is important, especially in girls, because it is related to reduced risks of osteoporosis in adulthood. Previous research has shown that jumping or plyometric exercises may be effective in increasing bone mineral density in adolescents. Rope skipping is a form of activity that involves jumping, thus regular skipping may also increase bone mineral density in pubertal girls. To this end, we conducted a quasi-experimental to examine the effects of rope skipping on girls' bone mineral density and cardiovascular fitness. 176 Hong Kong girls (age = 12.23 ± 1.80 years at baseline) were recruited to take part in the study. Bone density at their forearms and calcanei were measured twice over two academic years (mean time between visits was 10.3 months). Using multilevel modeling analyses and adjusting for participants' height and physical activity, we found that girls who participated in weekly rope skipping activities, compared to those who did not, had higher levels of bone density at the calcanei (B = 0.023, p < .01). However, no differences were found for bone density at forearms or participants' cardiovascular fitness. The rates of change of these variables across time were also not significantly different. Results suggest that regular rope skipping may increase girls' bone density at the lower extremities, irrespective of the amount of self-report physical activity. However, further research is required to examine the potential dose-response relation between skipping behaviors and the measured outcomes.
Collapse
Affiliation(s)
- Amy S. Ha
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
- * E-mail:
| | - Johan Y. Y. Ng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|