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Bert Bond,1 Kathryn L Weston,2 Craig A Williams,1 Alan R Barker1 1Children’s Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK 2School of Health and Social Care, Teesside University, Middlesbrough, UK Abstract: Physical activity lowers future cardiovascular disease (CVD) risk; however, few children and adolescents achieve the recommended minimum amount of daily activity. Accordingly, there is virtue in identifying the efficacy of small volumes of high-intensity exercise for health benefits in children and adolescents for the primary prevention of CVD risk. The purpose of this narrative review is to provide a novel overview of the available literature concerning high-intensity interval-exercise (HIIE) interventions in children and adolescents. Specifically, the following areas are addressed: 1) outlining the health benefits observed following a single bout of HIIE, 2) reviewing the role of HIIE training in the management of pediatric obesity, and 3) discussing the effectiveness of school-based HIIE training. In total, 39 HIIE intervention studies were included in this review. Based upon the available data, a single bout of high-intensity exercise provides a potent stimulus for favorable, acute changes across a range of cardiometabolic outcomes that are often superior to a comparative bout of moderate-intensity exercise (14 studies reviewed). HIIE also promotes improvements in cardiorespiratory fitness and cardiometabolic health status in overweight and obese children and adolescents (10 studies reviewed) and when delivered in the school setting (15 studies reviewed). We thus conclude that high-intensity exercise is a feasible and potent method of improving a range of cardiometabolic outcomes in children and adolescents. However, further work is needed to optimize the delivery of HIIE interventions in terms of participant enjoyment and acceptability, to include a wider range of health outcomes, and to control for important confounding variables (eg, changes in diet and habitual physical activity). Finally, research into the application of HIIE training interventions to children and adolescents of different ages, sexes, pubertal status, and sociocultural backgrounds is required. Keywords: vigorous physical activity, primary prevention, pediatric, cardiometabolic disease

We have compared the decay rates of KL and KS toΠ+ Π- Π0Π0 final states using a subset of the data from the KTeV experiment (E832) at Fermilab. We find that the direct-CP-violation parameter Re (μ’/μ) is equal to [28.0±3.0(stat)±2.8(syst)]×10-4. This result definitively establishes the existence of CP violation in a decay process. © 1999 The American Physical Society.

We have compared the decay rates of KL and KS toΠ+ Π- Π0Π0 final states using a subset of the data from the KTeV experiment (E832) at Fermilab. We find that the direct-CP-violation parameter Re (μ’/μ) is equal to [28.0±3.0(stat)±2.8(syst)]×10-4. This result definitively establishes the existence of CP violation in a decay process. © 1999 The American Physical Society.

Objectives This study tested the hypotheses that (1) secondary criteria (respiratory exchange ratio (RER), heart rate, blood [lactate]) traditionally used to verify the determination of maximum oxygen uptake (VO(2max)) in children can result in the acceptance of a 'submaximal' VO(2max) or falsely reject a 'true' VO(2max) and (2) the VO2(peak) recorded during a ramp test in children is comparable to the VO(2peak) achieved during supramaximal testing. Methods Thirteen children (9-10 years) completed a ramp cycle test to exhaustion to determine their VO(2peak). After 15 min of recovery, the participants performed a supramaximal cycle test to exhaustion at 105% of their ramp test peak power. Results Compared with the VO(2peak) during the ramp test, a significantly lower VO(2) was recorded at a RER of 1.00 (1.293 litre/min (SD 0.265) vs 1.681 litre/min (SD 0.295), p<0.001, n=12), at a heart rate of 195 beats/min (1.556 litre/min (SD 0.265) vs 1.721 litre/min (SD 0.318), p<0.001, n=10) and at 85% of age-predicted maximum (1.345 litre/min (SD 0.228) vs 1.690 litre/min (SD 0.284), p<0.001, n=13). Supramaximal testing yielded a VO(2peak) that was not significantly different from the ramp test (1.615 litre/min (SD 0.307) vs 1.690 litre/min (SD 0.284), p=0.090, respectively). Conclusions The use of secondary criteria to verify a maximal effort in young people during ramp cycling exercise may result in the acceptance of a submaximal VO(2max). As supramaximal testing elicits a VO(2peak) similar to the ramp protocol, thus satisfying the plateau criterion, the use of such tests is recommended as the appropriate method of confirming a 'true' VO(2max) with children. Keywords Children, Aerobic Fitness, Fitness Testing, Supramaximal Exercise. [ABSTRACT FROM AUTHOR]

Importance: Interventions are needed to support the long-term needs of stroke survivors when they transition from inpatient rehabilitation to home, where they face new home and community environmental barriers., Objective: To compare the efficacy of a novel, enhanced rehabilitation transition program with attentional control to improve community participation and activity of daily living (ADL) performance and to reduce environmental barriers in the home and community after stroke., Design, Setting, and Participants: This phase 2b, parallel randomized clinical trial assessed patients 50 years or older who had experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in ADLs before stroke, and planned to be discharged home. Patients were assessed at an inpatient rehabilitation facility in St Louis, Missouri, and their homes from January 9, 2018, to December 20, 2023., Intervention: Community Participation Transition after Stroke (COMPASS), including home modifications and strategy training., Main Outcomes and Measures: The primary outcome was community participation (Reintegration to Normal Living Index). Secondary outcomes were daily activity performance (Stroke Impact Scale ADL domain and the In-Home Occupational Performance Evaluation [I-HOPE] activity, performance, and satisfaction scores) and environmental barriers in the home (I-HOPE environmental barriers score)., Results: A total of 185 participants (mean [SD] age, 66.3 [9.0] years; 105 [56.8%] male) were randomized (85 to the COMPASS group and 100 to the control group). The COMPASS and control participants experienced similar improvements in community participation by 12 months, with no significant group (mean difference, 0.3; 95% CI, -4.6 to 5.2; P = .91) or group × time interaction (between-group differences in changes over time, 1.3; 95% CI, -7.1 to 9.6; P = .76) effects. Improvements in I-HOPE performance and satisfaction scores were greater for COMPASS participants than control participants at 12 months (between-group differences in changes for performance: 0.39; 95% CI, 0.01-0.77; P = .046; satisfaction: 0.52; 95% CI, 0.08-0.96; P = .02). The COMPASS participants had greater improvements for I-HOPE environmental barriers than the control participants (P = .003 for interaction), with the largest differences at 6 months (between-group differences in changes: -15.3; 95% CI -24.4 to -6.2)., Conclusions and Relevance: In this randomized clinical trial of stroke survivors, participants in both groups experienced improvements in community participation. COMPASS participants had greater improvements in self-rated performance and satisfaction with performing daily activities as well as a greater reduction in environmental barriers than control participants. COMPASS reduced environmental barriers and improved performance of daily activities for stroke survivors as they transitioned from inpatient rehabilitation to home., Trial Registration: ClinicalTrials.gov Identifier: NCT03485820.

This study investigated the middle cerebral artery blood velocity (MCAv) response to constant work-rate moderate-intensity cycling exercise in 21 children (9.3±0.8 years), 17 adolescents (12.3±0.4 years) and 20 young adults (23.6±2.4 years). Participants completed an incremental ramp test to exhaustion on a cycle ergometer, to determine maximal oxygen uptake and gas exchange threshold (GET), before completing three 6-minute transitions at a moderate-intensity (90% GET), on separate visits. On each visit, bilateral MCAv was measured by transcranial Doppler ultrasonography and breath-by-breath end-tidal carbon dioxide (P ET CO 2 ) via a metabolic cart. Data were ensemble-averaged for each participant and analysed using a mono-exponential model. Absolute MCAv was significantly higher throughout exercise in children and adolescents, compared to adults (P<0.001). Children had a significantly lower relative increase in MCAv from baseline (~12%) compared to adolescents (~20%) and adults (~18%, P<0.040). All adolescents and adults had a mono-exponential rise in MCAv and P ET CO 2 , but this was observed in only eight children. Children and adolescents had a significantly faster MCAv time constant (τ , 12±6 and 14±8 s, respectively) compared to adults (27±9 s, P<0.001). MCAv τ was positively associated with faster P ET CO 2 τ in adolescents (r=0.70, P=0.002) but not children (r=-0.20, P=0.640).Time- and amplitude-based response parameters of MCAv kinetics were significantly associated with P ET CO 2 kinetics in adults (r=0.50 to 0.74, P≤0.025), but not in children (r=-0.19 to -0.48, P>0.227). These findings suggest that the transition from childhood to adulthood impacts the MCAv response to exercise, and the relationships between P ET CO 2 and MCAv kinetics during exercise.

Objective: To compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors., Design: Randomized controlled trial., Setting: Inpatient rehabilitation (IR) to home and community transition., Participants: Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183)., Interventions: Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education., Main Outcome Measures: Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR., Results: Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361)., Conclusions: A home-based occupational therapist-led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This study assessed the knowledge, behavior, and needs of competitive adolescent (16-18 years) distance runners and distance running coaches enrolled as part of England Athletics' Youth Talent Programme in relation to the prevention of running-related injury (RRI). Two online surveys were developed and distributed to the distance runners (survey one) and coaches (survey two). Both surveys included sections related to: (1) current knowledge; (2) current behavior; (3) need and support for RRI prevention measures; and (4) possible content and form of RRI prevention measures. A total of 39 distance runners (36% of total possible sample) completed survey 1, and 29 coaches (32% of total possible sample) completed survey 2. Key findings included that the majority of distance runners and coaches: (1) agreed that it is 'very important' to try to prevent RRI; (2) are currently implementing something in practice (e.g., strength training) to prevent RRI; and (3) view the creation of RRI prevention measures as an important initiative. Differences between distance runners and coaches were identified in relation to their understanding of the most common causes of RRI. Interestingly, distance runners identified a modifiable cause of RRI (i.e., too much training) as the most common cause of RRI, while coaches selected a non-modifiable cause of RRI (i.e., growth and maturation). These key findings were supplemented by competitive adolescent runners and distance running coaches detailing their delivery preferences for such RRI prevention measures. Results from this study will help inform subsequent steps of the larger co-creation process, with an emphasis on developing multifaceted and context-specific RRI prevention measures that are deemed to be feasible and acceptable for real-world implementation.

Purpose: To examine the effect of normobaric hypoxia on pulmonary oxygen uptake (V˙O2) and muscle oxygenation kinetics during incremental and moderate-intensity exercise in children., Methods: Eight prepubertal boys (9-11 y) performed incremental cycle tests to exhaustion in both normoxia and hypoxia (fraction of inspired O2 of 15%) followed by repeat 6-minute transitions of moderate-intensity exercise in each condition over subsequent visits., Results: Maximal oxygen uptake (V˙O2max) was reduced in hypoxia compared with normoxia (1.69 [0.20] vs 1.87 [0.26] L·min-1, P = .028), although the gas exchange threshold was not altered in absolute terms (P = .33) or relative to V˙O2max (P = .78). During moderate-intensity exercise, the phase II V˙O2 time constant (τ) was increased in hypoxia (18 [9] vs 24 [8] s, P = .025), with deoxyhemoglobin τ unchanged (17 [8] vs 16 [6], P ≥ .28)., Conclusions: In prepubertal boys, hypoxia reduced V˙O2max and slowed V˙O2 phase II kinetics during moderate-intensity exercise, despite unchanged deoxyhemoglobin kinetics. These data suggest an oxygen delivery dependence of V˙O2max and moderate-intensity V˙O2 kinetics under conditions of reduced oxygen availability in prepubertal boys.

Objective: We sought to evaluate how implementing a thoracic enhanced recovery after surgery (ERAS) protocol impacted surgical outcomes after elective anatomic lung resection., Background: The effect of implementing the ERAS Society/European Society of Thoracic Surgery thoracic ERAS protocol on postoperative outcomes throughout an entire health care system has not yet been reported., Methods: This was a prospective cohort study within one health care system (January 2019-March, 2023). A thoracic ERAS protocol was implemented on May 1, 2021 for elective anatomic lung resections, and postoperative outcomes were tracked using the electronic health record and Vizient data. The primary outcome was overall morbidity; secondary outcomes included individual complications, length of stay, opioid use, chest tube duration, and total cost. Patients were grouped into pre-ERAS and post-ERAS cohorts. Bivariable comparisons were performed using independent t -test, χ 2 , or Fisher exact tests, and multivariable logistic regression was performed to control for confounders., Results: There were 1007 patients in the cohort; 450 (44.7%) were in the post-ERAS group. Mean age was 66.2 years; most patients were female (65.1%), white (83.8%), had a body mass index between 18.5 and 29.9 (69.7%), and were ASA class 3 (80.6%). Patients in the postimplementation group had lower risk-adjusted rates of any morbidity, respiratory complication, pneumonia, surgical site infection, arrhythmias, infections, opioid usage, ICU use, and shorter postoperative length of stay (all P <0.05)., Conclusions: Postoperative outcomes were improved after the implementation of an evidence-based thoracic ERAS protocol throughout the health care system. This study validates the ERAS Society/European Society of Thoracic Surgery guidelines and demonstrates that simultaneous multihospital implementation can be feasible and effective., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: We examined the longitudinal associations of sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous PA (MVPA) from childhood with carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness and carotid intima-media thickness (cIMT)., Methods: We studied 1339 children, aged 11 years from Avon Longitudinal Study of Parents and Children, UK, followed up for 13 years. Accelerometer-based ST, LPA, and MVPA were assessed at ages 11, 15, and 24 years clinic visits. cfPWV and cIMT were measured with Vicorder and ultrasound, respectively, at ages 17 and 24 years., Results: Among 1339 [56.4% female] participants, mean ST increased from ages 11 through 24 years, while mean LPA and MVPA decreased. Persistently high ST tertile from childhood was associated with increased cfPWV progression, effect estimate 0.047 m/s; [(95% CI 0.005 to 0.090); p = 0.030], but not cIMT progression. Persistently high LPA tertile category was associated with decreased cfPWV progression in males -0.022 m/s; [(-0.028 to -0.017); p < 0.001] and females -0.027 m/s; [(-0.044 to -0.010); p < 0.001]. Cumulative LPA exposure decreased the odds of progressively worsening cfPWV [Odds ratio 0.994 (0.994-0.995); p < 0.0001] and cIMT. Persistent exposure to ≥60 min/day of MVPA was paradoxically associated with increased cfPWV progression in males 0.053 m/s; [(0.030 to 0.077); p < 0.001] and females 0.012 m/s; [(0.002 to 0.022); p = 0.016]. Persistent exposure to ≥60 min/day of MVPA was inversely associated with cIMT progression in females -0.017 mm; [(-0.026 to -0.009); p < 0.001]., Conclusion: LPA >3 h/day from childhood may attenuate progressively worsening vascular damage associated with increased ST in youth., (© 2024 The Authors. Acta Physiologica published by John Wiley & Sons Ltd on behalf of Scandinavian Physiological Society.)