Gymnastics participation is associated with skeletal benefits in the distal forearm: a 6-month study using peripheral Quantitative Computed Tomography.

OBJECTIVES: Musculoskeletal development of the upper limbs during exposure to weight-bearing loading is under-researched during early pubescent growth. The purpose was to assess the changes in upper body musculoskeletal strength in young girls following 6 months of non-elite gymnastics participation. METHODS: Eighty-four girls, 6-12 years were divided into groups based on gymnastics participation: high-training (HGYM, 6-16 hr/wk), low-training (LGYM, 1-5 hr/wk), and non-gymnasts (NONGYM). Volumetric BMD, bone geometry, estimated bone strength and muscle size were assessed at the non-dominant forearm (4% and 66% radius and ulna) with pQCT. DXA assessed aBMD and body composition. Tests for explosive power, muscle strength, and endurance were also performed. RESULTS: Interaction effects were observed in all variables at the 4% radius. At the 66% ulna, HGYM and LGYM had greater bone mass, size and bone strength than NONGYM, furthermore a dose-response relationship was observed at this location. Body composition was better for HGYM than LGYM and NONGYM, however muscle function was better for HGYM and LGYM than NONGYM. CONCLUSION: The greatest changes were obtained with more than one gymnastics class per week. Separating gymnastics participation-related changes from those associated with normal growth and development remains difficult, particularly at the 4% radius.

Bone health of apprentice jockeys using peripheral quantitative computed tomography.

Our aim was to use Peripheral Quantitative Computed Tomography (pQCT) to assess the bone health of male and female apprentice jockeys and age- and sex-matched peers. 2 groups of 25 young adults (n=50) (age range 15-38 years) were comprised of male and female apprentice jockeys, and male and female controls. We used pQCT to measure the distal tibia and distal radius. After covarying for weight and limb length, apprentice jockeys displayed less tibial cortical area and lower strength strain index at 14% distal shaft, 38% mid shaft and 66% proximal sites measured distally than controls (p=0.001). No between group differences were found in cortical density, trabecular area, and trabecular density at the tibia. Compared with controls, apprentice jockeys displayed greater trabecular density at the distal radial site (p=0.001), greater strength strain index at 66% proximal site measured distally (p=0.01), and a lower strength strain index at the distal radius (p=0.006). In conclusion, only trabecular density at the distal radius and strength strain index at the proximal radius were greater in apprentice jockeys than controls. Strategies to increase bone density and bone strength in apprentice jockeys should be considered by relevant industry stakeholders and their health providers.

Non-elite gymnastics participation is associated with greater bone strength, muscle size, and function in pre- and early pubertal girls.

UNLABELLED: Recent reports indicate an increase in forearm fractures in children. Bone geometric properties are an important determinant of bone strength and therefore fracture risk. Participation in non-elite gymnastics appears to contribute to improving young girls' musculoskeletal health, more specifically in the upper body. INTRODUCTION: The primary aim of this study was to determine the association between non-elite gymnastics participation and upper limb bone mass, geometry, and strength in addition to muscle size and function in young girls. METHODS: Eighty-eight pre- and early pubertal girls (30 high-training gymnasts [HGYM, 6-16 hr/ wk], 29 low-training gymnasts [LGYM, 1-5 h r/wk] and 29 non-gymnasts [NONGYM]), aged 6-11 years were recruited. Upper limb lean mass, BMD and BMC were derived from a whole body DXA scan. Forearm volumetric BMD, bone geometry, estimated strength, and muscle CSA were determined using peripheral QCT. Upper body muscle function was investigated with muscle strength, explosive power, and muscle endurance tasks. RESULTS: HGYM showed greater forearm bone strength compared with NGYM, as well as greater arm lean mass, BMC, and muscle function (+5% to +103%, p < 0.05). LGYM displayed greater arm lean mass, BMC, muscle power, and endurance than NGYM (+4% to +46%, p < 0.05); however, the difference in bone strength did not reach significance. Estimated fracture risk at the distal radius, which accounted for body weight, was lower in both groups of gymnasts. Compared with NONGYM, HGYM tended to show larger skeletal differences than LGYM; yet, the two groups of gymnasts only differed for arm lean mass and muscle CSA. CONCLUSION: Non-elite gymnastics participation was associated with musculoskeletal benefits in upper limb bone geometry, strength and muscle function. Differences between the two gymnastic groups emerged for arm lean mass and muscle CSA, but not for bone strength.

Skeletal differences at the ulna and radius between pre-pubertal non-elite female gymnasts and non-gymnasts.

OBJECTIVE: To compare skeletal parameters between the ulna and radius in pre-pubertal non-elite gymnasts and non-gymnasts. METHODS: Fifty-eight non-elite artistic gymnasts, aged 6-11 years, were compared with 28 non-gymnasts for bone mineral content (BMC), total and cortical bone area (ToA, CoA), trabecular and cortical volumetric density (TrD, CoD) and estimated bone strength (BSI and SSIp), obtained by pQCT at the distal and proximal forearm. RESULTS: Gymnasts had greater estimated bone strength than non-gymnasts at both sites of the forearm. At the distal forearm, the gymnastics-induced skeletal benefits were greater at the radius than ulna (Z-scores for BMC, TrD and BSI +0.40 to +0.61 SD, p<0.05 vs. +0.15 to +0.48 SD, NS). At the proximal forearm, the skeletal benefits were greater at the ulna than the radius (Z-scores for BMC, ToA, CoA and SSIp +0.59 to +0.82 SD, p<0.01 vs. +0.35 (ToA) and +0.43 SD (SSIp), p<0.01). CONCLUSION: Skeletal benefits at the distal and proximal forearm emerged in young non-elite gymnasts. Benefits were larger when considering skeletal parameters at both the ulna and radius, than the radius alone as traditionally performed with pQCT. These findings suggest the ulna is worth investigating in future studies aiming to accurately quantify exercise-induced skeletal adaptations.

Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: a randomised controlled trial.

UNLABELLED: A randomised controlled trial was used in assessing the impact of 6 months of daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using peripheral quantitative computed tomography (pQCT). Daily supplementation was associated with increased bone density and bone strength at the distal tibia and radius. INTRODUCTION: pQCT has not been used to assess bone responses to calcium and vitamin-D supplementation on peripubertal children. This randomised controlled trial aimed to assess the impact of a 6-month daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using pQCT. METHODS: Twenty pairs of peripubertal female identical twins, aged 9 to 13 years, were randomly assigned to receive either 800 mg of calcium and 400 IU of vitamin D3, or a matched placebo. Bone structural properties at the distal tibia and distal radius were acquired at baseline and 6 months. RESULTS: The calcium-supplemented group showed greater gains in trabecular density, trabecular area and strength strain index at the 4% of distal tibial and radial sites compared with the placebo group (p=0.001). Greater gains in cortical area at the 38% and 66% of tibial sites were also found in twins receiving the calcium supplement (p=0.001). CONCLUSIONS: Daily supplementation for a period of 6 months was associated with increased trabecular area, trabecular density and strength strain index at the ultra-distal tibia and radius and increased cortical area at tibial mid-shaft.

Relationship between indices of adiposity obtained by peripheral quantitative computed tomography and dual-energy X-ray absorptiometry in pre-pubertal children.

BACKGROUND/AIM: The study investigated the relationship between indices of adiposity measured by peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) in pre-pubertal children. SUBJECTS AND METHODS: DXA-derived per cent body fat (%BF) was measured in 284 boys and 288 girls, aged 7-10 years. Cross-sections of the forearm (n=427) and lower leg (n=560) were obtained by pQCT to measure total cross-sectional area of the limb (Total CSA), Muscle CSA, Fat CSA, %Fat CSA (Fat CSA/Total CSAx100) and muscle density. RESULTS: Peripheral QCT-derived %Fat CSA in the forearm and lower leg correlated strongly with DXA-derived %BF (r=0.83-0.89, p<0.01) in both boys and girls. However, forearm and lower leg %Fat CSA were higher than whole body %BF by 5% and 10%, respectively. A better prediction of whole-body %BF was achieved by including %Fat CSA, muscle density and height into a hierarchical regression model. Using sex-specific regression equations, 87.7% of the boys and 83.7% of the girls had a predicted %BF within 3% units of the %BF obtained by DXA. CONCLUSION: In pre-pubertal children, pQCT measures of adiposity are strongly associated with whole-body per cent body fat. This reproducible method could be an alternative technique to estimate body composition in this population.

Reducing the risk of heat-related decrements to physical activity in young people.

The purpose of this review is to highlight differences in thermoregulatory responses during activity of children and adolescents compared with adults. Some differences are due to movement inefficiency and physical size such as body surface area to body mass ratio, and body composition. Identified physiological differences in sweat rates appear to alter with maturation, at least in boys, but the research remains incomplete. A number of findings from hydration studies with young people exercising in the heat are also discussed. The research on clothing is adult-based, but key concepts from this research also apply to children. The final section addresses the limited research on acclimatization of children to hot conditions. Specific recommendations for children who are active in the heat conclude this review.

Predictability of physiological testing and the role of maturation in talent identification for adolescent team sports.

Entrepreneurial marketing of sport increases demands on sport development officers to identify talented individuals for specialist development at the youngest possible age. Talent identification results in the streamlining of resources to produce optimal returns from a sports investment. However, the process of talent identification for team sports is complex and success prediction is imperfect. The aim of this review is to describe existing practices in physiological tests used for talent identification in team sports and discuss the impact of maturity-related differences on the long term outcomes particularly for male participants. Maturation is a major confounding variable in talent identification during adolescence. A myriad of hormonal changes during puberty results in physical and physiological characteristics important for sporting performance. Significant changes during puberty make the prediction of adult performance difficult from adolescent data. Furthermore, for talent identification programs to succeed, valid and reliable testing procedures must be accepted and implemented in a range of performance-related categories. Limited success in scientifically based talent identification is evident in a range of team sports. Genetic advances challenge the ethics of talent identification in adolescent sport. However, the environment remains a significant component of success prediction in sport. Considerations for supporting talented young male athletes are discussed.

Exercise for type 2 diabetes mellitus.

BACKGROUND: Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials. OBJECTIVES: To assess the effects of exercise in type 2 diabetes mellitus. SEARCH STRATEGY: Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies. Date of last search was March 3, 2005. SELECTION CRITERIA: All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials. MAIN RESULTS: Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA(1c), 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm(2), 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure. AUTHORS' CONCLUSIONS: The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.

Assessment of bone strength at differentially-loaded skeletal regions in adolescent middle-distance runners.

Bone adaptations to loading extend beyond mineral accrual to geometric markers of bone strength. Available technology and regional differences in cortical bone dictate how bone strength is reported. Examination of bone strength at two differentially-loaded skeletal sites using hip structure analysis (HSA) and bone strength index (BSI) is under-explored in adolescent sporting populations. The purpose of this study was to compare HSA at the femoral neck and BSI at the distal tibia in adolescent middle-distance runners and age- and gender-matched controls. Four groups of 20 adolescents aged 14-18 years were composed of male and female middle-distance runners, and male and female controls. Distal tibial BSI was calculated using data from dual energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). Calculations for femoral neck strength were acquired from DXA-derived HSA software. Female athletes displayed greater distal tibial BSI than controls t(38)=3.4, p=0.002, but femoral neck bone measures did not differ. In males, no group differences were found at either the distal tibia or femoral neck. In conclusion, exposure to similar high training loads may advantage female adolescent athletes more than male adolescent athletes compared with less active peers in bone strength at the distal tibia.

A challenge to fitness testing in primary schools.

We challenge the tradition of fitness testing in schools on the basis of purpose, procedures and outcomes. A number of assumptions about validity of selected tests are raised. The need to be able to track fitness through childhood into adulthood is challenged with limited scientific evidence of longitudinal tracking. Supporters of wide-scale fitness testing of children in schools include researchers whose intention is to promote public health awareness and policy. But a variety of confounding factors can affect field-based testing and lower the confidence in intra and inter group comparisons. Confounders include variability in motivation, familiarisation, external conditions, group dynamics, self-efficacy in testing, and perceived value of testing and likely outcomes. With acknowledged limitations, a more appropriate context for fitness testing for young people who have a strong commitment to physical activity may lie more in a professionally delivered sports-specific setting rather than in large-scale school-based testing. Given the less than desirable participation in activity outside of school and the distressing prevalence of childhood overweight and obesity, it is unlikely that fitness testing experiences will provide children with much needed positive encouragement for lifelong physical activity. Alternative strategies for school-based assessment of the promotion of child health through physical activity are proposed.

Bone strength index in adolescent girls: does physical activity make a difference?

BACKGROUND: Bone strength index (BSI) combines bone mineral and bone biomechanical properties to measure resistance to bending. This index may have greater clinical significance than the more often described markers of bone mineral content (BMC), areal density, or geometry alone and, in turn, may show a stronger relation to fracture risk. The BSI is the product of volumetric cortical bone mineral density (BMD) and cross sectional moment of inertia within a region of interest. Calculations combine dual energy x ray absorptiometry and magnetic resonance imaging technologies and provide a useful, non-invasive measure of in vivo bone strength. OBJECTIVES: (a) To compare BSI in adolescent female middle distance runners and age matched controls; (b) to examine factors predictive of BSI in adolescent girls. METHODS: Twenty adolescent female middle distance runners (mean (SD) age 16 (1.7) years, physical activity 8.9 (2.1) hours a week) and 20 female controls (age 16 (1.8) years, physical activity 2.0 (0.07) hours a week) were recruited. To calculate BSI, a region of interest representing 10% of the mid-distal tibia was analysed for dual energy x ray absorptiometry derived BMC and was combined with bone geometry and biomechanical properties obtained by magnetic resonance imaging assessments. Potential predictors of BSI were also examined. RESULTS: Independent t tests showed that BMC (p = 0.028), cortical bone volume (p = 0.002), volumetric cortical BMD (p = 0.004), cross sectional moments of inertia (p = 0.005), and BSI (p = 0.002) were higher in the distal tibia of athletes than of controls. The strongest predictor of BSI was hours of physical activity a week (R2 = 0.46). CONCLUSIONS: Athletes habitually exposed to high training loads displayed greater BSI at the distal tibia than controls. The results further confirm BSI as a significant and discerning marker in musculoskeletal health in adolescent girls engaged in high and low mechanical loading.

Musculoskeletal health in elite male adolescent middle-distance runners.

The impact of high training volumes on musculoskeletal adaptations of male adolescents is poorly understood. We compared bone mineral content (BMC) of total body, lumbar spine and proximal femur using Dual X-ray Absorptiometry (Lunar Prodigy, GE Medical Systems, Madison WI) in elite level (n=20), male adolescent middle distance runners (mean 16.8 yrs, range 14-18 yrs) and age-matched (n=20) controls. Athletes averaged 14 hrs of physical activity per week and controls reported participating in physical activity an average of two hrs per week. Total body mass was 10.97 kg less in athletes than controls (p=0.005). Within the total body mass difference, fat tissue mass of athletes was 10.93 kg less in athletes than controls (p= 0.001). Multiple regression analysis identified total body lean mass and total body fat mass as the strongest predictors of total body BMC (R2 0.71). After adjusting for lean tissue mass per kg of body weight (p=0.07), no difference in BMC was detected. Lower limb muscle strength and macronutrient intakes were also measured but no between group differences were found. The number of weeks of training and/or competition missed through injury was not associated with total body BMC (R2=0.19) among athletes. Our results imply high training volumes in middle distance running are not detrimental to musculoskeletal health and are associated with positive body composition profiles in elite adolescent male athletes.

Cardiorespiratory responses and circulating metabolite concentrations in male and female adolescents during a simulated duathlon.

This study compared markers of the metabolic processes occurring in male and female adolescent triathletes from two age groups (over 15 years of age [O15] and under 15 years of age [U15]) during a laboratory based duathlon. Participants were tested on three separate occasions; two peak VO2 tests on a treadmill and cycle ergometer, and a third session involved a simulated duathlon (2 km run, 12 km ride and 4 km run for the O15 group or 1 km run, 8 km ride and 2 km run for the U15). Data collection included performance speed, cardiorespiratory responses and blood borne markers of exercise metabolism. The performance speeds selected by the two age groups did not differ. The mean relative percentage of VO2peak at which subjects participated were 79+/-3, 77+/-4%, for the O15 males and females, and 71+/-5 and 82+/-2%, for the U15 males and females, respectively. While the plasma metabolites of ammonia [NH3] and lactate [La] were not different between age groups and sex (p>0.05) there were however, higher concentrations recorded during the cycling phase when compared with the running phases (p < 0.05). The respective mean concentrations for NH3 and La were 80.5+/-5.6 microM, and 4.9+/-0.3 microM for cycling, and 56.3+/-2.7 microM, and 2.7+/-0.2 microM for the combined running phases.

Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass.

Enhancement of bone mineral acquisition during growth may be a useful preventive strategy against osteoporosis. The aim of this study was to explore the lean mass, strength, and bone mineral response to a 10-month, high-impact, strength-building exercise program in 71 premenarcheal girls, aged 9-10 years. Lean body mass, total body (TB), lumbar spine (LS), proximal femur (PF), and femoral neck (FN) bone mineral were measured using the Hologic QDR 2000+ bone densitometer. Strength was assessed using a grip dynamometer and the Cybex isokinetic dynamometer (Cybex II). At baseline, no significant difference in body composition, pubertal development, calcium intake, physical activity, strength, or bone mineral existed between groups. At completion, there were again no difference in height, total body mass, pubertal development, calcium intake, or external physical activity. In contrast, the exercise group gained significantly more lean mass, less body fat content, greater shoulder, knee and grip strength, and greater TB, LS, PF, and FN BMD (exercise: TB 3.5%, LS 4.8%, PF 4.5%, and FN 12.0%) compared with the controls (controls: TB 1.2%, LS 1.2%, PF 1.3%, and FN 1.7%). TB bone mineral content (BMC), LS BMC, PF BMC, FN BMC, LS bone mineral apparent density (BMAD), and FN bone area also increased at a significantly greater rate in the exercise group compared with the controls. In multiple regression analysis, change in lean mass was the primary determinant of TB, FN, PF, and LS BMD accrual. Although a large proportion of bone mineral accrual in the premenarcheal skeleton was related to growth, an osteogenic effect was associated with exercise. These results suggest that high-impact, strength building exercise is beneficial for premenarcheal strength, lean mass gains, and bone mineral acquisition.

Accumulated oxygen deficit measurements during and after high-intensity exercise in trained male and female adolescents.

The purpose of this study was to compare accumulated oxygen deficits and markers of anaerobic metabolism [plasma ammonia (NH3) and lactate (La-) concentrations] in anaerobically trained male [n = 8, age 14.8 (0.5) years; maximal oxygen consumption VO2max 61.74 (2.23) ml x kg(-1) x min(-1)] and female [n = 8, age 14.5 (0.2) years; VO2max 49.62 (3.52) ml x kg(-1) x min(-1)] adolescents. The exercise protocol consisted of runs to exhaustion at speeds predicted to represent 120% and 130% of VO2max. Arterialised blood samples were obtained from a pre-warmed hand via a catheter inserted into a forearm vein. Samples were taken at rest and after 1, 3, 5, 7, 10, 15 and 20 min of recovery. The high-intensity exercise resulted in mean accumulated oxygen deficits that were less (P < 0.05) in females (52.3 ml x kg(-1)) than in males (68.6 ml x kg(-1)). Lower (P < 0.05) plasma concentrations of NH3 and La(-1), and a higher pH were evident in females compared with males during various stages of the 20-min recovery period. The increase in anaerobic performance in the male adolescent athletes when compared with their female counterparts was associated with an increased plasma concentration of selected plasma and blood metabolites. The observed results may reflect well-established differences between the sexes in the morphology and metabolic power of muscle.

Anaerobic capacity assessment in male and female children with all-out isokinetic cycling exercise.

Anaerobic capacity was assessed by calculating the maximal accumulated oxygen deficit (AOD) in 7 male and 6 female children (aged 10.8 and 10.7 years, respectively) who exercised "all-out" to fatigue on a CYBEX TM (Met, 100) isokinetic cycle ergometer. Each child performed a series of submaximal steady state oxygen uptake tests and a peak oxygen uptake test. Data from submaximal and peak oxygen uptake tests were used to predict the oxygen demand for each child as they worked under "all-out" isokinetic cycling to volitional fatigue. The AOD was calculated as the difference between the predicted oxygen demand and the actual oxygen uptake for the duration of the test. In order to examine the repeatability of the testing the children performed two "all-out" tests on an isokinetic cycle ergometer. The absolute (I) and relative (ml kg1) AOD values for the males were not significantly different between trials (1.34 + or - .13 and 1.41 + or - 16 litres, and 35.6 + or - 3.7 and 37.7 + or - 4.7 ml-kg1, for trials one and two, respectively) (Mean +SEM). Similarly there were no significant differences in the AOD values for the female children between trials (1.40 + or -.13 and 1.37 + or -.16 litres and 35.6 + or - 3.8 and 34.6 + or - 3.6 for ml-kg1, for trials one and two, respectively). Over the two tests the respective peak and mean power results revealed no significant differences between the sexes (307.4 and 192.4 W for males and 274.3 and 192.6 W for females). Intraclass correlation coefficients (R) for the AOD results in litres and ml-kg in the tests were higher in the males (.96 and .95) than the females (.86 and .89), respectively. It was concluded that the isokinetic testing produced AOD results which were repeatable in this group of children, showed no sex differences and were comparable to those from children who had been tested using a constant power to exhaustion protocol.