Participating in a School-Integrated Daily Exercise Program Improves Motor Performance Significantly in School-Children.

Children's sedentary time has increased, while daily physical activity and motor performance have decreased. We evaluated an integrated school-based exercise program by assessing changes in motor skills after one year and comparing these changes to children who did not participate. We included 303 children from five schools in this longitudinal study and assigned them either to the exercise group (EG; n = 183 with daily exercise program) or the waiting group (WG; n = 120). Motor skills were assessed at baseline and after one year. Mixed modeling was used to analyze inter-group differences of change in motor skills and to determine the effect of sex, age group, and weight status. EG improved more strongly than WG for sprint, side jumps (both p = 0.017), stand and reach (p = 0.012), and ergometry (p ≤ 0.001) when compared to WG. Girls improved more strongly in the sit-ups than boys, second graders more than fifth graders in the backwards balance and the ergometry, and non-overweight children more in the standing long jump than overweight children. The exercise program is effective in increasing motor skills and physical fitness. Girls were not disadvantaged, and overweight children profited as much as their non-overweight peers in all categories but one.

Comparison of Adherence to Mediterranean Diet between Spanish and German School-Children and Influence of Gender, Overweight, and Physical Activity.

BACKGROUND: Poor dietary habits and low levels of physical activity (PA) have a strong tendency to track from childhood into adulthood. The Mediterranean Diet (MD) is known to be extremely healthy, associated with lower BMI and a lower risk of obesity in children and adolescents. Therefore, adherence to the MD was compared between Spanish (n = 182) and German (n = 152) children aged 10 to 13 years to examine a possible more "westernized" diet in Spain with a non-Mediterranean country, that traditionally prefers a "Western diet" and to determine the association between adherence to the MD and gender, body composition, and PA levels. METHODS: In the German observational longitudinal cohort study and the Spanish cohort study, body composition and questionnaires (KIDMED, Diet Quality (IAES)) were obtained, and accelerometers (Actigraph) were applied to detect PA. RESULTS: Girls had higher BMI-standard deviation score (SDS) than boys and Spanish girls were less active than boys. Differences were detected in MD habits, such as favorable fruit-, vegetables-, fish-intakes, and dairy products in Spanish children and unfavorable consumptions of fast food, processed bakery goods, candies, and sweet beverages in German children. Independently of country, girls, children with lower BMI-SDS and children with higher PA level were related with better diet quality. CONCLUSION: Spanish children showed higher adherence to MD and diet quality (IAES) compared to German children, but there was a trend toward a more "westernized" diet. Gender, body composition, and PA influenced nutrition regardless of country.

Impact of Sex and Obesity on Echocardiographic Parameters in Children and Adolescents.

Subclinical alterations in left ventricular structure and function are detectable in adolescents with hypertension or obesity. However, data on early echocardiographic abnormalities in seemingly healthy children are lacking. Sex differences in cardiac structure and function have been previously reported, but sex-specific reference values are not available. Specifically, the potential interaction of sex and overweight has not been addressed at all. Anthropometric data, blood pressure and exercise tests were obtained in 356 healthy children. Echocardiographic parameters comprised peak early (E) and late (A) mitral inflow Doppler velocities, E/A ratio, tissue Doppler peak velocities of early (e') and late diastolic (a') excursion of mitral/septal annulus and isovolumetric relaxation time (IVRT). Left ventricular mass index (LVMI) and LVMI z-score were calculated. Interaction terms between BMI and sex and stratification by sex were used for analysis. We provide values for echocardiographic parameters for children of two age groups separated by BMI. Overweight/obese children had a significant higher LVMI, lower E/A ratio, higher E/e' ratios and a longer IVRT. For a given BMI in the upper ranges we demonstrated a higher LVMI in girls than in boys, the IVRT extended significantly more in girls than in boys with increasing BMI. There are sex differences in structural and functional echocardiographic parameters in children and adolescents. Our data not only confirms the importance of overweight and obesity, but demonstrates important interactions between sex and overweight. The greater susceptibility of overweight girls toward echocardiographic changes associated with potential long-term functional impairment needs further exploration and follow-up.Trial registration number DRKS00012371; Date 18.08.2017.

Relationship between Sprint Velocity and Peak Moment at Shoulder and Elbow in Elite Wheelchair Basketball Players.

Specific wheelchair basketball (WB) skills on the court have been poorly analyzed in relation to improving players' performance according to their functional class. The purpose of this study was to evaluate the associations between maximum velocity (Vmax) and peak moment (PM) in the shoulder and elbow joints in specific WB skills and to compare performance between the main two groups by functional class. Twelve male WB players, divided in categories A (functional classes 1.0-2.5) and B (class 3.0-4.5), performed a sprint test battery composed by four tests (with and without ball) and isokinetic tests. A significant relationship between PM of the internal and external shoulder rotation and the flexion and extension elbow with Vmax (p < 0.05) was found. During a 5 m backward sprint test, category B was faster in the last three meters than category A (p < 0.05) and also for the rest of the test but p = NS. Category B showed higher PM than category A for internal shoulder rotation (ISR) at 60 °/s and at 180 °/s on the dominant side (DS) (p < 0.05). In conclusion, ISR on the DS was found different for both groups and showed significant relationship with Vmax in all of the tests performed. Moreover, at higher speeds the elbow flexion and extension in DS were correlated with Vmax in all the actions with ball (passing, bouncing, and braking) reflected the importance of these joints movements in acquiring speed when performing sport specific WB skills.

Impact of aerobic exercise on muscle mass in patients with major depressive disorder: a randomized controlled trial.

OBJECTIVE: Sarcopenia leads to physical function impairment and at least to increasing all-cause mortality. There are notes on reduced muscle mass in patients with major depressive disorder (MDD). Whether an exercise intervention counteracts low muscle mass in patients with MDD has not been studied so far. Therefore, our study aimed at examining effects of regular aerobic exercise training on muscle mass in patients with MDD. PARTICIPANTS AND METHODS: Thirty inpatients with MDD were included in the study, of which 20 received an additional supervised exercise program. Ten patients obtained treatment as usual. Muscle mass was measured using MRI before and 6 weeks after the training period (3 times per week for 45 minutes). RESULTS: We found a significant effect of the exercise intervention on the amount of muscle mass depending on age, body mass index, and the physical activity score (P=0.042). CONCLUSION: Among other positive effects, regular exercise increases muscle mass in patients with MDD and, therefore, should be recommended as an additional treatment tool.

The congenital clubfoot - immunohistological analysis of the extracellular matrix.

PURPOSE: Congenital clubfoot is one of the most common limb disorders in humans and its etiology is still unclear. In order to better understand the pathogenesis of patients with primary clubfoot, we examined whether there are quantitative changes in the extracellular matrix (ECM; based on common interstitial collagens [C] like CI and CIII, microfilamentous collagens like CVI, noncollagenous proteins like undulin, and enzymes like matrixmetalloproteinase [MMP]-2 and tissue inhibitor of matrixmetalloproteinase [TIMP]-2 that are known to play a role in fibrogenesis and fibrolysis) of muscles involved in the foot deformity of patients with primary clubfoot corresponding to fibrosis. PATIENTS AND METHODS: Thirty patients (age ranging from 4 months to 5 years and 7 months) with primary clubfoot were examined (23 male and 7 female patients), among whom 18 patients were affected on one side and 12 affected on both sides. Twenty-five biopsies were taken during the first operative foot correction (Crawford-McKay) and 5 in the context of relapses. Muscle biopsies were taken from the muscles involved in the defect (Musculus [M.] gastrocnemius and M. tibialis anterior) and from the M. vastus lateralis of the M. quadriceps femoris, which were treated as healthy comparison muscles. Quantitative analysis of the components of the ECM was performed using a computer-assisted fibrosis measurement of the immunohistochemically processed tissue samples. RESULTS: We found higher values for M. gastrocnemius for CI, CIII, CVI and undulin in comparison with M. vastus lateralis. However, values for TIMP-2 were reduced. We found no significant differences for the components of M. tibialis anterior and M. vastus lateralis. There were no quantitative differences between male and female or between patients affected on one side and both sides. In patients who underwent relapse surgery, CI, CIII, CVI, and undulin of the gastrocnemius were significantly higher, while TIMP-2 was significantly lower. CONCLUSION: In the present study, we found manifest fibrosis in gastrocnemius due to quantitative changes in the ECM. In contrast to other studies, we found increasing fibrosis not just in contracted tissues but also in the muscle itself. Further studies are needed to clarify whether these changes are primarily responsible for the malfunction or whether they occur secondarily in the consequence of the dysfunction.

Nutritional Habits and Performance in Male Elite Wheelchair Basketball Players During a Precompetitive Period.

Physical condition and an optimized diet are relevant to enhance performance and recovery. The diet composition and meal frequency of eleven elite wheelchair basketball players were estimated using a 3-day food-weighing diary in two months during the precompetitive-period. Performance was determined through a 20 m sprint test. The players consumed 4.2 ± 0.8 meals/day in May and 4.5 ± 0.9 meals/day in June, resulting in total energy intakes of 2492 ± 362 kcal/d and 2470 ± 497 kcal/d, respectively. The macronutrient distribution was 3.8 ± 1.3 g/kg carbohydrates, 1.7 ± 0.6 g/kg protein, and 36 ± 5% of energy derived from fat in May, and 4.2 ± 1.9 g/kg carbohydrates, 1.5 ± 0.5 g/kg protein and 32 ± 5% of energy derived from fat in June. The maximum velocity of the sprint test improved from 4.77 ± 0.31 m/s in May to 5.19 ± 0.23 m/s in June. Our results revealed carbohydrate intake below and fat intake above recommendations, but improvements of dietary patterns. Further nutritional advice is necessary to ensure health and performance improvements.

Peak fat oxidation during self-paced activities of daily life: influence of sex and body composition.

BACKGROUND: Increasing physical activity is a cornerstone in the treatment of overweight individuals and self-selected exercise intensity leads to higher adherence to physical activity. However, information on differences in energy expenditure and fat oxidation between sexes regarding common self-paced activities of daily living are rare. METHODS: We divided 33 subjects into normal weight (NW, N.=21) and overweight (OW, N.=12). Energy expenditure and substrate oxidation was measured during six self-paced physical activities of daily living using a portable spirometric system. We also determined maximum aerobic capacity (VO2max) and estimated free-living physical activity with a multi-sensor device. RESULTS: For all six activities, total energy expenditure was not different between NW and OW subjects in both sexes. The peak fat oxidation during physical activities was reached at higher intensities for women (NW 57±15%; OW 53±8% of VO2max) compared to men (NW 41±8%; OW 42±9% of VO2max) with no differences between NW and OW subjects. The majority of OW (92%) but not NW (42%) subjects reached their highest fat oxidation during walking. The self-selected walking speed was not significantly different between NW and OW men (NW 5.25±0.48 km/h, OW 5.52±0.42 km/h) and NW and OW women (NW 5.16±0.89 km/h, OW 5.01±0.42 km/h). CONCLUSIONS: When physical activity aims to maximizing fat oxidation, women should exercise at higher relative intensities than men, regardless of being normal weight or overweight. Self-paced walking is a suitable activity for overweight subjects to achieve high rates of both total energy expenditure and fat oxidation.

Marginal Micronutrient Intake in High-Performance Male Wheelchair Basketball Players: A Dietary Evaluation and the Effects of Nutritional Advice.

Wheelchair basketball has evolved into a high-performance sport over several years, and small variations in player performance can determine the difference between winning and losing. Therefore, adequate micronutrient intake may influence this difference if performance-promoting macronutrient intake and physical fitness are equal between teams. Seventeen elite male wheelchair basketball players belonging to the Spanish National Team participated in this study. Macro- and micronutrient intake were determined using a food-weighing diary over three consecutive days during three training camps in two consecutive years. Current Dietary Reference Intake levels were used to determine the adequacy of intake of seventeen micronutrients of particular interest for athletes. After categorizing the consumed foods into fourteen food groups according to the National Nutrient Database for Standard References (USDA) these groups were used to identify the best predictors of the adequacy of intake for each micronutrient. Total energy intake correlated positively with the adequacy of all micronutrient intake levels, except for vitamins A and E. Five B vitamins and phosphorus, selenium, and iron showed 100% adequacy. All other micronutrient intake levels were found to be inadequate, e.g., vitamin E (51% adequacy) and calcium (73%). The fruit, fish and cereal food groups were found to be predictors of adequate intake of most micronutrients. Together with energy intake (p = .009, η2 = 0.49), the intake of the fruit (p = .032, η2 = 0.39) and egg (p = .036, Kendall's W = 0.42) food groups increased significantly over time, along with improved iodine (p = .008, W = 0.61) and magnesium (p = .030, W = 0.44) adequacy levels. Because the adequacy of micronutrient intake correlates positively with energy intake (R = 0.64, p < .001), a varied diet that includes cereals, fish and fruits is especially important for players with low levels of energy intake. Supplements may be a possible solution if adequate micronutrient intake cannot be achieved through regular dietary intake alone. However, dietary analyses should be conducted on a regular basis throughout the year to improve the nutritional knowledge of the athletes and assure adequate micronutrient intake.

Exercise therapy improves aerobic capacity of inpatients with major depressive disorder.

BACKGROUND: Unipolar depression is one of the most common diseases worldwide and is associated with a higher cardiovascular risk partly due to reduced aerobic capacity. OBJECTIVES: Therefore, the aim of our study was to examine whether a structured aerobic training program can improve aerobic capacity in inpatients with MDD (major depressive disorder). METHODS: Overall, 25 patients (13 women, 12 men) diagnosed with MDD were included in the study. Parameters of aerobic capacity, such as maximum performance, maximum oxygen consumption, and VAT (ventilatory anaerobic threshold), were assessed on a bicycle ergometer before and 6 weeks after a training period (three times per week for 45 min on two endurance machines). In addition, a constant load test was carried out at 50% of the maximum performance prior to and after the training period. The performance data were compared with 25 healthy controls matched for sex, age, and body mass index before and after the training period. RESULTS: Compared to controls, patients with MDD had significantly lower aerobic capacity. After training, there was a significant improvement in their performance data. A significant difference remained only for VAT between patients with MDD and healthy controls. CONCLUSION: With regard to the coincidence of MDD with cardiovascular and cardiometabolic disorders, a structured supervised exercise program carried out during hospitalization is a useful supplement for patients with MDD.

Effects of a Short Physical Exercise Intervention on Patients with Multiple Sclerosis (MS).

BACKGROUND: The aim of this prospective randomized controlled trial was to investigate if a short-term endurance or combined endurance/resistance exercise program was sufficient to improve aerobic capacity and maximum force in adult patients (18-65 years) with multiple sclerosis (MS). METHODS: All patients performed a three-month exercise program consisting of two training sessions per week, lasting 40 min each, with moderate intensity. All patients had a maximum value of 6 (low to moderate disability) on the Expanded Disability Status Scale (EDSS). One group (combined workout group (CWG); 15 females, 4 males) completed a combined endurance/resistance workout (20 min on a bicycle ergometer, followed by 20 min of resistance training), while the other group (endurance workout group (EWG); 13 females, 5 males) completed a 40 min endurance training program. Aerobic capacity was assessed as peak oxygen uptake, ventilatory anaerobic threshold, and workload expressed as Watts. Maximum force of knee and shoulder extensors and flexors was measured using isokinetic testing. Quality of life was assessed with the SF-36 questionnaire, and fatigue was measured using the Modified Fatigue Impact Scale. RESULTS: Both training groups increased in aerobic capacity and maximum force. EWG, as well as CWG, showed improvement in several subscales of the SF-36 questionnaire and decrease of their fatigue. CONCLUSION: A short exercise intervention increased both aerobic capacity and maximum force independent of whether endurance or combined endurance/resistance workouts were performed.

Exercise capacity and quality of life in patients with schizophrenia.

The aim of this study was to resolve the relationship between physical capacity (PC) and quality of life (Qol) in schizophrenic patients and healthy controls. 31 patients (PG: 18 male, 13 female) and a control group (CG) of 50 healthy subjects (15 male, 35 female) were involved. PC was assessed as peak oxygen uptake [VO2peak, (ml (min kgKG)(-1))] and power output expressed as watts per kilogram (W kg(-1)). Qol was assessed using the SF-36 questionnaire. Patients with schizophrenia showed reduced VO2peak (male: PG 29 ± 5 vs. CG 44 ± 10; female: PG 21 ± 4 vs. CG 30 ± 8) and power output (male: PG 2.04 ± 0.47 vs. CG 3.43 ± 0.70; female PG 1.40 ± 0.28 vs. CG 2.43 ± 0.52). Scales of the SF-36 questionnaire were lower in the PG. While in the CG correlations were found between PC and several subscales of Qol, this was not the case in the PG. The restricted PC seen in the PG showed no relation to their subjectively assessed worsened Qol, which would indicate that schizophrenic patients evaluate limitations arising from this differently than healthy control subjects.

Quality of care in chronic leg ulcer in the community: introduction of quality indicators and a scoring system.

BACKGROUND: Treatment of chronic wounds is complex, particularly as a standard for the assessment and evaluation of quality of care is missing. OBJECTIVES: To develop indicators for quality of care in chronic wounds in general, and to evaluate the quality of care in leg ulcers in Hamburg, Germany, in particular. METHODS: Twenty indicators were derived from a national Delphi expert consensus to compute a single index of quality of care. This index was applied in a cross-sectional study involving a large spectrum of care providers and leg ulcer patients in the community. Trained wound experts interviewed and examined the patients, who had to complete standardized questionnaires. RESULTS: On average, 64% of the quality criteria were met in the consecutive sample of 502 patients with chronic leg ulcers of any origin; 75% of the patients were satisfied with their wound care. Predictors of quality of care are presented. CONCLUSIONS: This instrument is feasible, valid and ready for comparisons of patient groups, regions and care systems, and for optimization processes in wound care.