Physical Activity and Fitness in Children with Developmental Disorder

Introduction: Developmental coordination disorder (DCD) is a prevalent condition characterized by poor motor proficiency that interferes with a child‟s activities of daily living. Children with DCD often experience compromised health-related fitness components such as cardiorespiratory fitness (CRF). Purpose: To better understand the physical activity and fitness characteristics of children with probable DCD (pDCD), with a particular focus on CRF. Specifically: (1) to present a synopsis of current literature; (2) to determine the longitudinal trajectories of CRF; (3) to compare the submaximal CRF of children with and without pDCD. Methods: A comprehensive, systematic literature review was conducted of the recent available data on fitness and physical activity and pDCD (Chapter 2). This review provided the background for the other two studies included in this thesis. In Chapter 3, a prospective cohort design was used to assess how CRF in children with pDCD changes over time (56 months) relative to a group of typically developing controls. Using a nested-case control design, 63 subjects with pDCD and 63 matched controls from the larger sample were recruited to participate in the lab-based component of the study (Chapter 4). In this investigation CRF was examined using the oxygen cost of work (VO2) during an incremental test on a cycle ergometer. Results: The literature review showed that fitness parameters, including CRF and physical activity levels, were consistently reduced in children with pDCD. Chapter 3 demonstrated that the difference in CRF between children with pDCD and typically developing children is substantial, and that it tends to increase over time. Results from VO2 assessments showed that children with pDCD utilized more oxygen to sustain the same submaximal workloads compared to typically developing children. Conclusions: Findings from this thesis have made several important contributions to our understanding of children with pDCD. Since differences in CRF between children with and without pDCD tend to worsen over time, this adds to the argument that interventions intended to improve CRF may be appropriate for children with motor difficulties. This thesis also presented the first evidence suggesting that DCD involves higher energy expenditure, and could help explain why children with pDCD perform poorly on tasks requiring CRF.

Fit For Action: A Comparative Case Study of the Implementation of an Adaptive Fitness and Conditioning Program for Moderate Functioning Teens and Transition Age Youth with ASD

The purpose of my research was to develop and refine pedagogic approaches, and establish fitness baselines to adapt fitness and conditioning programs for Moderate-functioning ASD individuals. I conducted a seven-week study with two teens and two trainers. The trainers implemented individualized fitness and conditioning programs that I developed. I conducted pre and post fitness baselines for each teen, a pre and post study interview with the trainers, and recorded semi-structured observations during each session. I used multi-level, within-case and across case analyses, working inductively and deductively. My findings indicated that fundamental movement concepts can be used to establish fitness baselines and develop individualized fitness programs. I tracked and evaluated progressions and improvements using conventional measurements applied to unconventional movements. This process contributed to understanding and making relevant modifications to activities as effective pedagogic strategies for my trainers. Further research should investigate fitness and conditioning programs with lower functioning ASD individuals.

The Clinical Translation Gap in Child Health Exercise Research: A Call for Disruptive Innovation

In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the child health spectrum.

The hypotensive effect of exercise on IOP : an interaction of physical fitness and parasympathetic efficacy

RÉSUMÉ Suite à une centaine de publications sur la réduction de la PIO post-exercice, il est connu que parmi un grand nombre de programme d'exercices de différentes durées et intensités, les effets hypotenseurs de l'exercice sur la PIO sont atténués chez les sujets en bonne condition physique. Le mécanisme proposé est l'augmentation potentielle de l'efficacité du système parasympathique avec l'activité physique. Le principal objectif de cette thèse est d'identifier les facteurs contribuants à la réduction de la PIO post-exercice et d'élucider les différents mécanismes possibles. L'étude 1, une méta-analyse, a été menée afin de quantifier les contributions relatives de l'intensité et de la durée de l'effet de l'exercice sur la PIO et la mesure dans laquelle ces variables affectent les sujets sédentaires et normalement actifs. La tendance ressortant des résultats est que la diminution de la PIO suite à de l'exercice aérobie est plus élevée chez les sujets sédentaires que les sujets en bonne condition physique. (ES = -4.198 mm Hg et -2.340 mm Hg, respectivement). L'absence d'un contrôle des liquides ingérés avant l'activité physique est à souligné dans cette étude. L'hyperosmolarité (un effet secondaire de la déshydratation) est l'un des mécanismes proposés influant l'effet hypotenseur de l'exercice. L'étude 2 comparait la réduction de la PIO dans deux conditions, soit hypohydraté et hyperhydraté, avant, pendant et après un effort de 90 minutes sur un ergocycle. Après une diminution initiale pour les deux conditions, la PIO revient aux valeurs de départ pour la condition hypohydratée malgré une perte de poids significative et elle augmente pour la condition hyperhydratée (résultat du protocole d'hydratation). Étant donné le niveau élevé de participants en bonne condition physique dans l'étude 2, la troisième étude a été conçue afin de etude la relation entre la PIO et la condition physique. À l'aide d'analyses corrélationnelles il a été possible d'observer la relation entre le test de vo2max et la moyenne des mesures de PIO prises sur un intervalle de huit semaines. Une relation significative n'existait que pour les participants se situant dans la portion supérieure du continuum de la condition physique. Conclusion: Les résultats de la présente étude suggèrent que l'effet hypotenseur de l'exercice sur la PIO est probablement une réponse homéostatique à la dérégulation de l'humeur aqueuse causée par l'initiation de l'exercice et le protocole d'ingestion de fluides pré-exercice.

Ciclismo saludable bajo techo (Health indoor cycling)

Este manual se convierte en una guía fácil y práctica para la utilización del programa de ejercitación denominado “Ciclismo saludable bajo techo”. Con un lenguaje accesible, permite a las personas profundizar en la técnica de trabajo aeróbico en sala más difundida en el mundo del acondicionamiento físico, o fitness, y del ejercicio. Hace años sentimos la necesidad de realizar un manual que simplificara el entendimiento de esta técnica utilizada por entrenadores personales, educadores físicos y fisioterapeutas, con el fin de fortalecer la concepción del movimiento humano, el autocuidado en las personas y la ejercitación como factores que mejoran la salud y la calidad de vida teniendo como referente las características y necesidades específicas de la población colombiana.

Postnatal development of the mucosal immune system and consequences on health in adulthood

The intestinal microbiota is a dynamic multifaceted ecosystem which has evolved a complex and mutually beneficial relationship with the mammalian host. The contribution to host fitness is evident, but in recent years it has become apparent that these commensal microorganisms may exert far more influence over health and disease than previously thought. The gut microbiota are implicated in many aspects of biological function, such as metabolism, angiogenesis and immune development: disruption, especially during the neonatal period, which may impose life-long penalty. Elimination of the microbiota appears difficult, but manipulation of the ratios and dominance of composite populations can be achieved by alterations in diet, rearing environment, antibiotics and/or probiotics. Components of the intestinal microbiota are frequently documented to affect normal function of the mucosal immune system in experimental animals and in domesticated, agricultural species. However, it is not always clear that the effects described are sufficiently well understood to provide a sound basis for commercial intervention. Some microbial interventions may be beneficial to the host under particular circumstances, while detrimental during others. It is essential that we further our understanding of the complex and intricate host-commensal relationship to avoid causing more long-term damage than advantage

Gender, age, and educational-attainment differences in Australian adults' participation in vigorous sporting and fitness activities

Background: Participation in regular vigorous physical activity could confer health benefits additional to those derived from moderate-intensity physical activities that are currently the focus of public health strategies.
Methods: Sociodemographic differences in reported participation in vigorous sporting and fitness activities over the past 2 weeks were examined using cross-sectional data from an Australian urban population sample.
Results: Participation at least once in any form of vigorous physical activity and regular participation (six or more sessions) both decreased across successive age groups and from high to low levels of education. The most frequently reported types of vigorous physical activity were cycling (13.3%), jogging (10.1%), swimming (8.4%) for men; and, swimming (8.9%), cycling (8.8%) and aerobics (8.6%) for women.
Conclusion: Rates of regular participation in vigorous activities were low. Interventions might focus on ways to encourage younger adults to engage more regularly in these activities and to maintain participation through the lifespan.

A longitudinal study of body change strategies of fitness center attendees

This study evaluated predictors of strategies to change weight and muscles among men and women who attend fitness centers. A questionnaire was completed by 107 men (mean age = 39.17, SD = 13.14), and 151 women (mean age = 35.31, SD = 11.38) who regularly attended fitness centers at two points in time, one year apart. The only unique predictor of body change strategies over time for men was body dissatisfaction predicting drive for thinness; for women, body dissatisfaction predicted strategies to lose weight, drive for thinness, use of food supplements to lose weight and levels of bulimia. Media messages also predicted drive for thinness and bulimia among women. These findings would suggest that attendance body dissatisfaction is an important factor predicting other normative and health risk behaviors among fitness center attendees, particularly women at a fitness center over a 12 month period was not generally associated with adverse health risk behaviors.

Low carbohydrate diets: what are the potential short and long term health implications?

Low-carbohydrate diets for weight loss are receiving a lot of attention of late. Reasons for this interest include a plethora of low-carbohydrate diet books, the over-sensationalism of these diets in the media and by celebrities, and the promotion of these diets in fitness centres and health clubs. The re-emergence of low-carbohydrate diets into the spotlight has lead many people in the general public to question whether carbohydrates are inherently 'bad' and should be limited in the diet. Although low-carbohydrate diets were popular in the 1970s they have resurged again yet little scientific fact into the true nature of how these diets work or, more importantly, any potential for serious long-term health risks in adopting this dieting practice appear to have reached the mainstream literature. Evidence abounds that low-carbohydrate diets present no significant advantage over more traditional energy-restricted, nutritionally balanced diets both in terms of weight loss and weight maintenance. Studies examining the efficacy of using low-carbohydrate diets for long-term weight loss are few in number, however few positive benefits exist to promote the adoption of carbohydrate restriction as a realistic, and more importantly, safe means of dieting. While short-term carbohydrate restriction over a period of a week can result in a significant loss of weight (albeit mostly from water and glycogen stores), of serious concern is what potential exists for the following of this type of eating plan for longer periods of months to years. Complications such as heart arrhythmias, cardiac contractile function impairment, sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of physical activity and lipid abnormalities can all be linked to long-term restriction of carbohydrates in the diet. The need to further explore and communicate the untoward side-effects of low-carbohydrate diets should be an important public health message from nutrition professionals.

The provision of compulsory school physical activity : associations with physical activity, fitness and overweight in childhood and twenty years later

Background
To determine whether the provision of higher levels of compulsory school physical activity is associated with higher physical activity and fitness levels and less overweight in childhood and 20 years later.

Methods
As part of the 1985 Australian Schools Health and Fitness Survey, 109 schools reported how much compulsory physical education (PE) and school sport they provided and were classified as low (<110 and <150 minutes/week for primary and secondary schools, respectively), medium (110–149 and 150–189 minutes/week for primary and secondary schools, respectively) or high (≥150 and ≥190 minutes/week for primary and secondary schools, respectively) compulsory physical activity schools by tertile cutpoints. 6,412 children reported frequency and duration of school (PE and sport) and non-school (commuting and non-organised exercise) physical activity and had height and weight measured; overweight was defined using body mass index (BMI) (m/kg²) cutpoints. 9, 12 and 15 year-olds (n = 2,595) completed a cycle ergometer fitness test (physical working capacity at heart rate 170, PWC₁₇₀). At follow-up in 2004–5, 2,346 participants kept a pedometer record, completed the International Physical Activity Questionnaire and/or a PWC₁₇₀ fitness test; and had height and weight measured (overweight = BMI≥25 m/kg²).

Results
At baseline and follow-up, median total physical activity, fitness and BMI were similar in participants who attended low, medium and high physical activity schools, and those attending high physical activity schools reported only modestly higher school physical activity. There was no difference in the prevalence of high total physical activity and fitness levels in childhood or adulthood across compulsory school physical activity categories. The prevalence of overweight in childhood and adulthood was similar across low, medium and high compulsory physical activity schools.

Conclusion
The amount of compulsory physical activity reported by schools was not associated with total physical activity, fitness or overweight in childhood or in adulthood. Policies promoting amounts of compulsory school physical activity in this range may not be sufficient to increase physical activity and fitness or reduce the prevalence of obesity in children.

A comparison of subjective and objective measures of physical activity and fitness in identifying associations with cardiometabolic risk factors

Purpose
To compare the ability of alternative measures of physical activity and fitness to quantify associations with health outcomes.

Methods
Associations between a range of subjective and objective physical activity and fitness measures and cardiometabolic risk factors were examined using data from 1,631 Australians aged 26–36 years. Anthropometry, fitness, blood pressure, and fasting blood glucose, insulin, and lipids were measured at study clinics. Participants completed the International Physical Activity Questionnaire (IPAQ) and 7-day pedometer diaries; they also reported sedentary behavior (sitting, television viewing).

Results
In men and women, associations were strongest for fitness, with those in the highest (vs. lowest) fitness quarter having a 75% to 80% lower prevalence of two or more primary risk factors (waist circumference, high-density lipoprotein cholesterol, and insulin resistance). In men, a 60% to 70% reduced prevalence of two or more risk factors was observed across extreme quarters of IPAQ leisure, IPAQ vigorous, sitting duration, and pedometer measures. Similar reductions in prevalence were observed only across extreme quarters of pedometer activity and television viewing in women.

Conclusions
Associations between alternative measures and cardiometabolic risk were relatively independent, suggesting that a range of physical activity and fitness measures may be needed to most accurately quantify associations between physical activity and health.

The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Strategies to change body shape among men and women who attend fitness centre

The current study examined the association between exercise behaviors, disordered eating, and other behaviors to change body shape among fitness center attendees. The participants were 520 adults (245 men, 275 women) who attended fitness centers. Data were gathered using an anonymous questionnaire. Women who attended fitness centers were generally trying to lose weight and improve fitness; men were generally trying to increase their muscles and improve their fitness level. Reasons for exercise predicted the nature of the body change strategies adopted by respondents. Regression analyses demonstrated that exercises performed by people who attend fitness centers are a reflection of whether or not they want to lose weight, increase muscle or improve fitness. All groups were equally likely to engage in health risk behaviors, but the specific nature of these behaviors varied by group. The implications of these findings for health-related messages among people who attend fitness centers are discussed.

Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults

To examine how fitness in both childhood and adulthood is associated with adult obesity and insulin resistance. A prospective cohort study set in Australia in 2004-2006 followed up a cohort of 647 adults who had participated in the Australian Schools Health and Fitness Survey in 1985 and who had undergone anthropometry and cardiorespiratory fitness assessment during the survey. Outcome measures were insulin resistance and obesity, defined as a homeostasis model assessment index above the 75th sex-specific percentile and BMI ≥30 kg/m^sup 2^, respectively. Lower levels of child cardiorespiratory fitness were associated with increased odds of adult obesity (adjusted odds ratio [OR] per unit decrease 3.0 [95% CI 1.6- 5.6]) and insulin resistance (1.7 [1.1-2.6]). A decline in fitness level between childhood and adulthood was associated with increased obesity (4.5 [2.6-7.7]) and insulin resistance (2.1 [1.5- 2.9]) per unit decline. A decline in fitness from childhood to adulthood, and by inference a decline in physical activity, is associated with obesity and insulin resistance in adulthood. Programs aimed at maintaining high childhood physical activity levels into adulthood may have potential for reducing the burden of obesity and type 2 diabetes in adults.