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Tsiros MD, Vincent HK, Getchell N, Shultz SP. Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review. Curr Sports Med Rep 2021; 20:374-383. [PMID: 34234093 DOI: 10.1249/jsr.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.
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Affiliation(s)
- Margarita D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, Adelaide, SA, AUSTRALIA
| | - Heather K Vincent
- Department of Orthopaedics and Rehabilitation, Division of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.
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Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
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Stracciolini A, Luz J, Walker G, Edwards N, Faigenbaum AD, Myer GD. Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity? PHYSICIAN SPORTSMED 2020; 48:199-207. [PMID: 31560577 DOI: 10.1080/00913847.2019.1673685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.Study design: Cross-sectional studyMethods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment are important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. Eighty-five percent of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. Eighty-one percent reported a paucity of exercise science education in medical school.Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.
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Affiliation(s)
- Andrea Stracciolini
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jennifer Luz
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Gregory D Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Abstract
OBJECTIVE To investigate CrossFit-related injuries presenting to a pediatric sports medicine clinic. DESIGN Retrospective review of pediatric CrossFit-related injuries from between January 1, 2003, and June 31, 2016. SETTING Pediatric sports medicine clinic at a tertiary-level academic medical center. PATIENTS Patients with injury related to CrossFit participation. INDEPENDENT VARIABLES Sex, age, injury site, diagnosis, diagnostic imaging, and treatment. MAIN OUTCOME MEASURES Annual CrossFit-related injury proportion (%) over time. RESULTS One hundred fifteen medical identified (N = 55 female; mean age, 25.2 ± 10.4 years). Proportion of CrossFit-related injuries presenting to clinic relative to overall clinic volume consistently increased over time (Pearson r = 0.825; P = 0.022). Injury location included head (0.08%), trunk/spine (25.2%), upper extremity (27.0%), and lower extremity (47.0%). Common injured joints included knee (27%), spine (24.3%), and shoulder (16.5%). Nearly half of patients had a single diagnostic imaging (49.6%; 57 of 115). Most common diagnostics included magnetic resonance imaging (60.0%; 69 of 115), plain radiographs (51.3%; 59 of 115), ultrasound (10.4%; 12 of 115), and computerized tomographic scan (9.6%; 11 of 115). Most commonly prescribed treatments included physical/occupational therapy (38.3%; 44 of 115), activity modification (19.1%; 22 of 115), crutches/brace/splinting/compression sleeve (13.0%; 15 of 115), and non-steroidal anti-inflammatory medications (10.4%; 12 of 115). CONCLUSIONS CrossFit-related injury proportion presenting to a pediatric sports medicine clinic increased over time. A notable proportion of injuries occurred to the trunk and spine. Advanced imaging was obtained in approximately half of these youth athletes. Further research in youth CrossFit athletes is required surrounding mechanism of injury to prevent future injury in this mode of training for youth athletes.
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Kiefer AW, Pincus D, Richardson MJ, Myer GD. Virtual Reality As a Training Tool to Treat Physical Inactivity in Children. Front Public Health 2017; 5:349. [PMID: 29376045 PMCID: PMC5770738 DOI: 10.3389/fpubh.2017.00349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/05/2017] [Indexed: 01/29/2023] Open
Abstract
Lack of adequate physical activity in children is an epidemic that can result in obesity and other poor health outcomes across the lifespan. Physical activity interventions focused on motor skill competence continue to be developed, but some interventions, such as neuromuscular training (NMT), may be limited in how early they can be implemented due to dependence on the child's level of cognitive and perceptual-motor development. Early implementation of motor-rich activities that support motor skill development in children is critical for the development of healthy levels of physical activity that carry through into adulthood. Virtual reality (VR) training may be beneficial in this regard. VR training, when grounded in an information-based theory of perceptual-motor behavior that modifies the visual information in the virtual world, can promote early development of motor skills in youth akin to more natural, real-world development as opposed to strictly formalized training. This approach can be tailored to the individual child and training scenarios can increase in complexity as the child develops. Ultimately, training in VR may help serve as a precursor to "real-world" NMT, and once the child reaches the appropriate training age can also augment more complex NMT regimens performed outside of the virtual environment.
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Affiliation(s)
- Adam W. Kiefer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Center for Cognition, Action and Perception, University of Cincinnati, Cincinnati, OH, United States
| | - David Pincus
- Department of Psychology, Chapman University, Orange, CA, United States
| | | | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
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Lloyd RS, Cronin JB, Faigenbaum AD, Haff GG, Howard R, Kraemer WJ, Micheli LJ, Myer GD, Oliver JL. National Strength and Conditioning Association Position Statement on Long-Term Athletic Development. J Strength Cond Res 2016; 30:1491-509. [PMID: 26933920 DOI: 10.1519/jsc.0000000000001387] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There has recently been a growing interest in long-term athletic development for youth. Because of their unique physical, psychological, and social differences, children and adolescents should engage in appropriately prescribed exercise programs that promote physical development to prevent injury and enhance fitness behaviors that can be retained later in life. Irrespective of whether a child is involved in organized sport or engages in recreational physical activity, there remains a need to adopt a structured, logical, and evidence-based approach to the long-term development of athleticism. This is of particular importance considering the alarmingly high number of youth who fail to meet global physical activity recommendations and consequently present with negative health profiles. However, appropriate exercise prescription is also crucial for those young athletes who are physically underprepared and at risk of overuse injury because of high volumes of competition and an absence of preparatory conditioning. Whether the child accumulates insufficient or excessive amounts of exercise, or falls somewhere between these opposing ends of the spectrum, it is generally accepted that the young bodies of modern day youth are often ill-prepared to tolerate the rigors of sports or physical activity. All youth should engage in regular physical activity and thus should be viewed as "athletes" and afforded the opportunity to enhance athleticism in an individualized, holistic, and child-centered manner. Because of emerging interest in long-term athletic development, an authorship team was tasked on behalf of the National Strength and Conditioning Association (NSCA) to critically synthesize existing literature and current practices within the field and to compose a relevant position statement. This document was subsequently reviewed and formally ratified by the NSCA Board of Directors. A list of 10 pillars of successful long-term athletic development are presented, which summarize the key recommendations detailed within the position statement. With these pillars in place, it is believed that the NSCA can (a) help foster a more unified and holistic approach to long-term athletic development, (b) promote the benefits of a lifetime of healthy physical activity, and
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Affiliation(s)
- Rhodri S Lloyd
- 1Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 2Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand; 3Center for Exercise and Sport Science Research, Edith Cowan University, Joondalup, Australia; 4Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey; 5Department of Kinesiology, West Chester University, West Chester, Pennsylvania; 6Department of Human Sciences, The Ohio State University, Columbus, Ohio; 7Department of Orthopaedics, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; 8Harvard Medical School, Boston, Massachusetts; 9The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 10Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 11Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and 12Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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Lloyd RS, Oliver JL, Faigenbaum AD, Howard R, De Ste Croix MBA, Williams CA, Best TM, Alvar BA, Micheli LJ, Thomas DP, Hatfield DL, Cronin JB, Myer GD. Long-term athletic development, part 2: barriers to success and potential solutions. J Strength Cond Res 2015; 29:1451-64. [PMID: 25909962 DOI: 10.1519/01.jsc.0000465424.75389.56] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The first installment of this two-part commentary reviewed existing models of long-term athletic development. However, irrespective of the model that is adopted by practitioners, existing structures within competitive youth sports in addition to the prevalence of physical inactivity in a growing number of modern-day youth may serve as potential barriers to the success of any developmental pathway. The second part of this commentary will initially highlight common issues that are likely to impede the success of long-term athletic development programs and then propose solutions that will address the negative impact of such issues.
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Affiliation(s)
- Rhodri S Lloyd
- 1Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 2Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey; 3Department of Kinesiology, Temple University, Philadelphia, Pennsylvania; 4School of Sport and Exercise, University of Gloucestershire, Cheltenham, United Kingdom; 5Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom; 6Department of Family Medicine, Division of Sports Medicine, Sports Health and Performance Institute, Ohio State University, Columbus, Ohio; 7Rocky Mountain University of Health Professions, Provo, Utah; 8Department of Orthopaedics, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; 9Harvard Medical School, Boston, Massachusetts; 10The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 11Department of Trauma and Orthopaedics, University of Wales, Cardiff, United Kingdom; 12Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island; 13Sport Performance Research Institute New Zealand, AUT University, Auckland, New Zealand; 14School of Exercise, Health and Biomedical Sciences, Edith Cowan University, Joondalup, Australia; 15Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 16Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and 17Sports Health and Performance Institute, Ohio State University, Columbus, Ohio
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Faigenbaum AD, Best TM, MacDonald J, Myer GD, Stracciolini A. Top 10 research questions related to exercise deficit disorder (EDD) in youth. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2014; 85:297-307. [PMID: 25141083 DOI: 10.1080/02701367.2014.931179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Exercise deficit disorder (EDD) is a pediatric medical condition characterized by reduced levels of moderate-to-vigorous physical activity (MVPA) that are below current recommendations and inconsistent with positive health outcomes. At present, a majority of children and adolescents meet the diagnostic criteria for EDD because they are not accumulating minimum thresholds of daily MVPA. The purpose of this article is to highlight 10 important research questions related to EDD in youth. The critical research needs to better define the clinical spectrum of EDD to include an assessment of physical activity behaviors to determine the age or stage of maturation at which EDD first emerges; an examination of the kinesiogenesis of movement skills and physical abilities; and an evaluation of lifestyle factors that can influence the MVPA trajectory in youth. Research questions about interventions and policies to treat EDD include evaluating the education and training of health care providers on the importance of exercise medicine; determining the effectiveness of strategies to identify and treat youth with EDD in clinical practice; developing sensitive, specific, and cost-effective methods to diagnose youth with EDD; and assessing methods to promote health care reimbursement for the treatment of this condition. Without future research to optimize identification, treatment, and management strategies for youth with EDD, new health care concerns with significant biomedical, psychosocial, economic, and political ramifications will continue to emerge.
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