Obesity increases precision errors in total body dual-energy x-ray absorptiometry measurements.

Total body (TB) dual-energy X-ray absorptiometry (DXA) is increasingly being used to measure body composition in research and clinical settings. This study investigated the effect of body mass index (BMI) and body fat on precision errors for total and regional TB DXA measurements of bone mineral density, fat tissue, and lean tissue using the GE Lunar Prodigy (GE Healthcare, Bedford, UK). One hundred forty-four women with BMI's ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the TB with repositioning between examinations. Participants were divided into 3 groups based on their BMI, and the root mean square standard deviation and the percentage coefficient of variation were calculated for each group. The root mean square standard deviation (percentage coefficient of variation) for the normal (<25 kg/m²; n = 76), overweight (25-30 kg/m²; n = 36), and obese (>30 kg/m²; n = 32) BMI groups, respectively, were total BMD (g/cm(2)): 0.009 (0.77%), 0.009 (0.69%), 0.011 (0.91%); total fat (g): 545 (2.98%), 486 (1.72%), 677 (1.55%); total lean (g): 551 (1.42%), 540 (1.34%), and 781 (1.68%). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.

The relationship between sagittal curvature and extensor muscle volume in the lumbar spine.

A previous modelling study predicted that the forces applied by the extensor muscles to stabilise the lumbar spine would be greater in spines that have a larger sagittal curvature (lordosis). Because the force-generating capacity of a muscle is related to its size, it was hypothesised that the size of the extensor muscles in a subject would be related to the size of their lumbar lordosis. Magnetic resonance imaging (MRI) data were obtained, together with age, height, body mass and back pain status, from 42 female subjects. The volume of the extensor muscles (multifidus and erector spinae) caudal to the mid-lumbar level was estimated from cross-sectional area measurements in axial T1-weighted MRIs spanning the lumbar spine. Lower lumbar curvature was determined from sagittal T1-weighted images. A stepwise linear regression model was used to determine the best predictors of muscle volume. The mean lower lumbar extensor muscle volume was 281 cm(3) (SD = 49 cm(3)). The mean lower lumbar curvature was 30 ° (SD = 7 °). Five subjects reported current back pain and were excluded from the regression analysis. Nearly half the variation in muscle volume was accounted for by the variables age (standardised coefficient, B = -3.2, P = 0.03) and lower lumbar curvature (B = 0.47, P = 0.002). The results support the hypothesis that extensor muscle volume in the lower lumbar spine is related to the magnitude of the sagittal curvature; this has implications for assessing muscle size as an indicator of muscle strength.

Influence of training status and maturity on pulmonary O2 uptake recovery kinetics following cycle and upper body exercise in girls.

The influence of training status on pulmonary VO(2) recovery kinetics, and its interaction with maturity, has not been investigated in young girls. Sixteen prepubertal (Pre: trained (T, 11.4 ± 0.7 years), 8 untrained (UT, 11.5 ± 0.6 years)) and 8 pubertal (Pub: 8T, 14.2 ± 0.7 years; 8 UT, 14.5 ± 1.3 years) girls completed repeat transitions from heavy intensity exercise to a baseline of unloaded exercise, on both an upper and lower body ergometer. The VO2 recovery time constant was significantly shorter in the trained prepubertal and pubertal girls during both cycle (Pre: T, 26 ± 4 vs. UT, 32 ± 6; Pub: T, 28 ± 2 vs. UT, 35 ± 7 s; both p < .05) and upper body exercise (Pre: T, 26 ± 4 vs. UT, 35 ± 6; Pub: T, 30 ± 4 vs. UT, 42 ± 3 s; both p < .05). No interaction was evident between training status and maturity. These results demonstrate the sensitivity of VO(2) recovery kinetics to training in young girls and challenge the notion of a "maturational threshold" in the influence of training status on the physiological responses to exercise and recovery.

Obesity increases precision errors in dual-energy X-ray absorptiometry measurements.

The precision errors of dual-energy X-ray absorptiometry (DXA) measurements are important for monitoring osteoporosis. This study investigated the effect of body mass index (BMI) on precision errors for lumbar spine (LS), femoral neck (NOF), total hip (TH), and total body (TB) bone mineral density using the GE Lunar Prodigy. One hundred two women with BMIs ranging from 18.5 to 45.9 kg/m(2) were recruited. Participants had duplicate DXA scans of the LS, left hip, and TB with repositioning between scans. Participants were divided into 3 groups based on their BMI and the percentage coefficient of variation (%CV) calculated for each group. The %CVs for the normal (<25 kg/m(2)) (n=48), overweight (25-30 kg/m(2)) (n=26), and obese (>30 kg/m(2)) (n=28) BMI groups, respectively, were LS BMD: 0.99%, 1.30%, and 1.68%; NOF BMD: 1.32%, 1.37%, and 2.00%; TH BMD: 0.85%, 0.88%, and 1.06%; TB BMD: 0.66%, 0.73%, and 0.91%. Statistically significant differences in precision error between the normal and obese groups were found for LS (p=0.0006), NOF (p=0.005), and TB BMD (p=0.025). These results suggest that serial measurements in obese subjects should be treated with caution because the least significant change may be larger than anticipated.

The influence of training and maturity status on girls' responses to short-term, high-intensity upper- and lower-body exercise.

A maturational threshold has been suggested to be present in young peoples' responses to exercise, with significant influences of training status evidenced only above this threshold. The presence of such a threshold has not been investigated for short-term, high-intensity exercise. To address this, we investigated the relationship between swim-training status and maturity on the power output, pulmonary gas exchange, and metabolic responses to an upper- and lower-body Wingate anaerobic test (WAnT). Girls at 3 stages of maturity participated:, prepubertal (Pre: 8 trained (T), 10 untrained (UT)), pubertal (Pub: 9 T, 15 UT), and postpubertal (Post: 8 T, 10 UT). At all maturity stages, T exhibited higher peak power (PP) and mean power (MP) during upper-body exercise (PP: Pre, T, 163 ± 20 vs. UT, 124 ± 29; Pub, T, 230 ± 42 vs. UT, 173 ± 41; Post, T, 245 ± 41 vs. UT, 190 ± 40 W; MP: Pre, T, 130 ± 23 vs. UT, 85 ± 26; Pub, T, 184 ± 37 vs. UT, 123 ± 38; Post, T, 200 ± 30 vs. UT, 150 ± 15 W; all p < 0.05) but not lower-body exercise, whilst the fatigue index was significantly lower in T for both exercise modalities. Irrespective of maturity, the oxidative contribution, calculated by the area under the oxygen uptake response profile, was not influenced by training status. No interaction was evident between training status and maturity, with similar magnitudes of difference between T and UT at all 3 maturity stages. These results suggest that there is no maturational threshold which must be surpassed for significant influences of training status to be manifest in the "anaerobic" exercise performance of young girls.

Influence of training status and exercise modality on pulmonary O2 uptake kinetics in pubertal girls.

The influence of training status on the oxygen uptake (VO2) response to heavy intensity exercise in pubertal girls has not previously been investigated. We hypothesised that whilst training status-related adaptations would be evident in the VO2, heart rate (HR) and deoxyhaemoglobin ([HHb]) kinetics of pubertal swimmers during both lower and upper body exercise, they would be more pronounced during upper body exercise. Eight swim-trained (T; 14.2 ± 0.7 years) and eight untrained (UT; 14.5 ± 1.3 years) girls completed a number of constant-work-rate transitions on cycle and upper body ergometers at 40% of the difference between the gas exchange threshold and peak VO2. The phase II VO2 time constant (τ) was significantly shorter in the trained girls during both cycle (T: 21 ± 6 vs. UT: 35 ± 11 s; P < 0.01) and upper body exercise (T: 29 ± 8 vs. UT: 44 ± 8 s; P < 0.01). The VO2 slow component was not influenced by training status. The [HHb] τ was significantly shorter in the trained girls during both cycle (T: 12 ± 2 vs. UT: 20 ± 6 s; P < 0.01) and upper body exercise (T: 13 ± 3 vs. UT: 21 ± 7 s; P < 0.01), as was the HR τ (cycle, T: 36 ± 5 vs. UT: 53 ± 9 s; upper body, T: 32 ± 3 vs. UT: 43 ± 2; P < 0.01). This study suggests that both central and peripheral factors contribute to the faster VO2 kinetics in the trained girls and that differences are evident in both lower and upper body exercise.

Influence of training and maturity status on the cardiopulmonary responses to ramp incremental cycle and upper body exercise in girls.

It has been suggested that the potential for training to alter the physiological responses to exercise in children is related to a "maturational threshold". To address this, we investigated the interaction of swim-training status and maturity on cardiovascular and metabolic responses to lower and upper body exercise. Twenty-one prepubertal [Pre: 11 trained (T), 10 untrained (UT)], 30 pubertal (Pub: 14 T, 16 UT), and 18 postpubertal (Post: 8 T, 10 UT) girls completed ramp incremental exercise on a cycle and an upper body ergometer. In addition to pulmonary gas exchange measurements, stroke volume and cardiac output were estimated by thoracic bioelectrical impedance, and muscle oxygenation status was assessed using near-infrared spectroscopy. All T girls had a higher peak O(2) uptake during cycle (Pre: T 49 ± 5 vs. UT 40 ± 4; Pub: T 46 ± 5 vs. UT 36 ± 4; Post: T 48 ± 5 vs. UT 39 ± 8 ml·kg(-1)·min(-1); all P < 0.05) and upper body exercise (Pre: T 37 ± 6 vs. UT 32 ± 5; Pub: T 36 ± 5 vs. UT 28 ± 5; Post: T 39 ± 3 vs. UT 28 ± 7 ml·kg(-1)·min(-1); all P < 0.05). T girls also had a higher peak cardiac output during both modalities, and this reached significance in Pub (cycle: T 21 ± 3 vs. UT 18 ± 3; upper body: T 20 ± 4 vs. UT 15 ± 4 l/min; all P < 0.05) and Post girls (cycle: T 21 ± 4 vs. UT 17 ± 2; upper body: T 22 ± 3 vs. UT 18 ± 2 l/min; all P < 0.05). None of the measured pulmonary, cardiovascular, or metabolic parameters interacted with maturity, and the magnitude of the difference between T and UT girls was similar, irrespective of maturity stage. These results challenge the notion that differences in training status in young people are only evident once a maturational threshold has been exceeded.

Prolonged unilateral disuse osteopenia 14 years post external fixator removal: a case history and critical review.

Disuse osteopenia is a complication of immobilisation, with reversal generally noted upon remobilisation. This case report focuses on a patient who was seen 18 years following a road traffic collision when multiple fractures were sustained. The patient had an external fixator fitted for a tibia and fibula fracture, which remained in situ for a period of 4 years. Following removal, the patient was mobilised but, still required a single crutch to aid walking. Fourteen years post removal of the fixator, the patient had a DXA scan which, demonstrated a T-score 2.5 SD lower on the affected hip. This places the patient at an increased risk of hip fracture on this side, which requires monitoring. There appear to be no current studies investigating prolonged disuse-osteopenia in patients following removal of long-term external fixators. Further research is required to quantify unilateral long-term effects to bone health and fracture risk in this population.

Longitudinal changes in the oxygen uptake kinetic response to heavy-intensity exercise in 14- to 16-year-old boys.

This study examined longitudinal changes in the pulmonary oxygen uptake (pVO(2)) kinetic response to heavy-intensity exercise in 14-16 yr old boys. Fourteen healthy boys (age 14.1 +/- 0.2 yr) completed exercise testing on two occasions with a 2-yr interval. Each participant completed a minimum of three 'step' exercise transitions, from unloaded pedalling to a constant work rate corresponding to 40% of the difference between the pVO(2) at the gas exchange threshold and peak pVO(2) (40% Delta). Over the 2-yr period a significant increase in the phase II time constant (25 +/- 5 vs. 30 +/- 5 s; p = .002, omega(2) = 0.34), the relative amplitude of the pVO(2) slow component (9 +/- 5 vs. 13 +/- 4%; p = .036, omega(2) = 0.14) and the pVO(2) gain at end-exercise (11.6 +/- 0.6 vs. 12.4 +/- 0.7 mL x min(-1) x W(-1); p < .001, omega(2) = 0.42) were observed. These data indicate that the control of oxidative phosphorylation in response to heavy-intensity cycling exercise is age-dependent in teenage boys.

Influence of training status and exercise modality on pulmonary O(2) uptake kinetics in pre-pubertal girls.

The limited available evidence suggests that endurance training does not influence the pulmonary oxygen uptake (V(O)(2)) kinetics of pre-pubertal children. We hypothesised that, in young trained swimmers, training status-related adaptations in the V(O)(2) and heart rate (HR) kinetics would be more evident during upper body (arm cranking) than during leg cycling exercise. Eight swim-trained (T; 11.4 +/- 0.7 years) and eight untrained (UT; 11.5 +/- 0.6 years) girls completed repeated bouts of constant work rate cycling and upper body exercise at 40% of the difference between the gas exchange threshold and peak V(O)(2). The phase II V(O)(2) time constant was significantly shorter in the trained girls during upper body exercise (T: 25 +/- 3 vs. UT: 37 +/- 6 s; P < 0.01), but no training status effect was evident in the cycle response (T: 25 +/- 5 vs. UT: 25 +/- 7 s). The V(O)(2) slow component amplitude was not affected by training status or exercise modality. The time constant of the HR response was significantly faster in trained girls during both cycle (T: 31 +/- 11 vs. UT: 47 +/- 9 s; P < 0.01) and upper body (T: 33 +/- 8 vs. UT: 43 +/- 4 s; P < 0.01) exercise. The time constants of the phase II V(O)(2)and HR response were not correlated regardless of training status or exercise modality. This study demonstrates for the first time that swim-training status influences upper body V(O)(2) kinetics in pre-pubertal children, but that cycle ergometry responses are insensitive to such differences.

Quadriceps muscle energetics during incremental exercise in children and adults.

PURPOSE: This study tested the hypothesis that the muscle metabolic responses of 9- to 12-yr-old children and young adults during incremental quadriceps exercise are dependent on age and sex. METHODS: Fifteen boys, 18 girls, 8 men, and 8 women completed a quadriceps step-incremental test to exhaustion inside a magnetic resonance scanner for determination of the muscle metabolic responses using P-magnetic resonance spectroscopy. Quadriceps muscle mass was determined using magnetic resonance imaging scans enabling comparison of metabolic data at a normalized power output. RESULTS: The power output and the energetic state at the Pi/PCr and pH intracellular thresholds (IT) were independent of age and sex. The rate of change in Pi/PCr against power output after the ITPi/PCr (S2) was lower in boys (0.158 +/- 0.089) and girls (0.257 +/- 0.110) compared with men (0.401 +/- 0.114, P < 0.001) and women (0.391 +/- 0.133, P = 0.014), respectively, with sex differences present for children only (P = 0.003). Above the ITpH, S2 was more rapid in the men (-0.041 +/- 0.022, P = 0.003) and girls (-0.030 +/- 0.013, P = 0.011) compared with boys (-0.019 +/- 0.007), with no differences between the girls and the women (-0.035 +/- 0.015, P = 0.479). The increase in Pi/PCr at exhaustion was lower in boys (0.85 +/- 0.38) than that in men (1.86 +/- 0.65, P < 0.001) and in girls (1.78 +/- 1.25) than that in women (4.97 +/- 3.52, P = 0.003), with sex differences in both the child (P = 0.005) and the adult groups (P = 0.019). CONCLUSIONS: During moderate-intensity exercise, muscle metabolism appears adult-like in 9- to 12-yr-old children, although both age- and sex-related differences in the "anaerobic" energy turnover are present during high-intensity exercise.

Sex difference in peak oxygen uptake in prepubertal children.

Prepubertal boys' greater aerobic fitness (peak V O(2)) has been attributed to their larger lean body mass (LBM); this bestowing a greater heart size and consequent larger maximum cardiac output. No difference in peak arterio-venous (A-VO(2)) difference is thought to exist. However other work indicates that boys' aerobic fitness remains 5% higher even after controlling for differences in LBM. Consequently the purpose of this study was to investigate whether peak V O(2), heart size, peak cardiac output and peak A-VO(2) difference would be comparable between a group of boys and girls with a similar LBM. A group of 9 prepubertal boys and 9 prepubertal girls with a similar mean LBM (27.0+/-1.4 boys vs. 27.0+/-2.0 kg girls) were selected. Left ventricular mass (LVM) and end diastolic volume (LVEDV) were measured using cardiac magnetic resonance imaging. Peak V O(2) was determined on a cycle ergometer following an incremental exercise protocol to exhaustion, and cardiac output was recorded using thoracic bioimpedance. Boys' peak V O(2) (1.41+/-0.18 L min(-1) vs. 1.23+/-0.08 L min(-1)) and A-VO(2) difference (14.8+/-2.1 mL 100mL(-1) vs. 12.6+/-1.6 mL 100mL(-1)) were significantly (p<0.05) higher than girls' values, but there were no significant sex differences in peak cardiac output (10.0+/-1.4 L min(-1) vs. 9.9+/-1.40 L min(-1)), LVM (97+/-13g vs. 93+/-20g) or LVEDV (77+/-8 mL vs. 70+/-13 mL). Central factors of heart size and peak cardiac output are proportional to the LBM of the individual and sex independent. Sex differences in peripheral factors such as muscle fibre type profile, may affect A-VO(2) difference and underlie prepubertal boys' higher peak V O(2).

Muscle phosphocreatine kinetics in children and adults at the onset and offset of moderate-intensity exercise.

The splitting of muscle phosphocreatine (PCr) plays an integral role in the regulation of muscle O2 utilization during a "step" change in metabolic rate. This study tested the hypothesis that the kinetics of muscle PCr would be faster in children compared with adults both at the onset and offset of moderate-intensity exercise, in concert with the previous demonstration of faster phase II pulmonary O2 uptake kinetics in children. Eighteen peri-pubertal children (8 boys, 10 girls) and 16 adults (8 men, 8 women) completed repeated constant work-rate exercise transitions corresponding to 80% of the Pi/PCr intracellular threshold. The changes in quadriceps [PCr], [Pi], [ADP], and pH were determined every 6 s using 31P-magnetic resonance spectroscopy. No significant (P>0.05) age- or sex-related differences were found in the PCr kinetic time constant at the onset (boys, 21+/-4 s; girls, 24+/-5 s; men, 26+/-9 s; women, 24+/-7 s) or offset (boys, 26+/-5 s; girls, 29+/-7 s; men, 23+/-9 s; women 29+/-7 s) of exercise. Likewise, the estimated theoretical maximal rate of oxidative phosphorylation (Qmax) was independent of age and sex (boys, 1.39+/-0.20 mM/s; girls, 1.32+/-0.32 mM/s; men, 2.36+/-1.18 mM/s; women, 1.51+/-0.53 mM/s). These results are consistent with the notion that the putative phosphate-linked regulation of muscle O2 utilization is fully mature in peri-pubertal children, which may be attributable to a comparable capacity for mitochondrial oxidative phosphorylation in child and adult muscle.

Muscle phosphocreatine and pulmonary oxygen uptake kinetics in children at the onset and offset of moderate intensity exercise.

To further understand the mechanism(s) explaining the faster pulmonary oxygen uptake (p(VO)(2)) kinetics found in children compared to adults, this study examined whether the phase II p(VO)(2) kinetics in children are mechanistically linked to the dynamics of intramuscular PCr, which is known to play a principal role in controlling mitochondrial oxidative phosphorylation during metabolic transitions. On separate days, 18 children completed repeated bouts of moderate intensity constant work-rate exercise for determination of (1) PCr changes every 6 s during prone quadriceps exercise using (31)P-magnetic resonance spectroscopy, and (2) breath by breath changes in p(VO)(2) during upright cycle ergometry. Only subjects (n = 12) with 95% confidence intervals

Aerobic fitness: what are we measuring?

Aerobic fitness depends upon the components of oxygen delivery and the oxidative mechanisms of the exercising muscle. Peak oxygen uptake is recognised as the best single criterion of aerobic fitness but it is strongly correlated with body size. Methods of controlling for body size are discussed and it is demonstrated how inappropriate use of ratio scaling has clouded our understanding of aerobic fitness during growth and maturation and across time. Changes in aerobic fitness over time are reviewed but no published study of peak oxygen uptake, appropriately adjusted for body mass and maturation, has investigated secular changes in aerobic fitness. Data expressed in direct ratio with body mass provide limited insights into secular changes in aerobic fitness but aerobic performance appears to be decreasing in accord with the secular increase in body mass. Cross-sectional and longitudinal peak oxygen uptake data are analysed in relation to age, maturation and sex. Muscle lactate production and blood lactate accumulation are outlined and young people's blood lactate responses to submaximal and maximal exercise are examined. However, exercise of the intensity and duration required to monitor conventional laboratory measures of aerobic fitness are rarely experienced in young people's lives. In many situations it is the oxygen uptake kinetics of the non-steady state which best assess the integrated responses of the oxygen delivery system and the metabolic requirements of the exercising muscle. The chapter therefore concludes with a discussion of insights into aerobic fitness provided by the emerging database on young people's oxygen uptake kinetics responses to exercise of different intensities.

The physical activity patterns of European youth with reference to methods of assessment.

This article reviews the habitual physical activity of children and adolescents from member countries of the European Union in relation to methods of assessing and interpreting physical activity. Data are available from all European Union countries except Luxembourg and the trends are very similar. European boys of all ages participate in more physical activity than European girls and the gender difference is more marked when vigorous activity is considered. The physical activity levels of both genders are higher during childhood and decline as young people move through their teen years. Physical activity patterns are sporadic and sustained periods of moderate or vigorous physical activity are seldom achieved by many European children and adolescents. Expert committees have produced guidelines for health-related physical activity for youth but they are evidence-informed rather than evidence-based and where there is evidence of a relationship between physical activity during youth and health status there is little evidence of a particular shape of that relationship. The number of children who experience physical activity of the duration, frequency and intensity recommended by expert committees decreases with age but accurate estimates of how many girls and boys are inactive are clouded by methodological problems. If additional insights into the promotion of health through habitual physical activity during youth are to be made, methods of assessment need to be further refined and recommended guidelines re-visited in relation to the existing evidence base.

Short-term appetite and energy intake following imposed exercise in 9- to 10-year-old girls.

Short-term effects of different intensities of exercise-induced energy expenditure on energy intake and hunger were compared in 19 girls (10.0 +/- 0.6 years) in three conditions: sedentary, low-intensity exercise and high-intensity exercise. The exercise conditions involved cycling at 50 and 75% of peak oxygen uptake, respectively, but were designed to evoke approximately 1.50 MJ of total expenditure, as estimated from continuously monitored heart rate. A maintenance breakfast of controlled energy intake was provided and ad libitum energy intake was measured at lunch and dinner. Differences in energy intake relative to expenditure, between 09:30 and 17:00, were calculated by subtracting energy expenditure from energy intake (energy difference). Hunger, fullness and prospective consumption were rated before and after meals and exercise sessions. Lunch energy intake was significantly less after low-intensity exercise than after high-intensity exercise. Energy expenditure was greater in the exercise conditions than when sedentary and the energy difference was more positive in the sedentary condition than in each of the exercise conditions. At mid-afternoon, rated prospective consumption was less after the high-intensity exercise. The imposition of energy expenditure through exercise of either low or high intensity resulted in no detectable increase in energy intake in the short term.

Oxygen uptake kinetics in children and adults after the onset of moderate-intensity exercise.

The literature suggests that the oxygen uptake (VO2) response to the onset of moderate-intensity exercise may be both mature from childhood and independent of sex. Yet the cardiorespiratory response to exercise and the metabolic profile of the muscle appear to change with growth and development and to differ between the sexes. The aim of this study was to investigate further changes in the VO2 kinetic response with age and sex. Participants completed a series of no less than four step change transitions, from unloaded pedalling to a constant work rate corresponding to 80% of their previously determined ventilatory threshold. Each participant's breath-by-breath responses were interpolated to 1 s intervals, time aligned and then averaged. A single exponential model that included a time delay was used to analyse the averaged response following phase 1 (15 s). Participants with parameter confidence intervals more than +/- 5 s were removed from the sample; the results for the remaining 13 men and 12 women (age 19-26 years), 12 boys and 11 girls (age 11-12 years) were used for statistical analysis. Children had a significantly shorter time constant than adults, both for males (19.0+/-2.0 and 27.9+/-8.6 s respectively; P<0.01) and females (21.0+/-5.5 and 26.0+/-4.5 s respectively; P<0.05). There were no significant differences in the time constant between the sexes for either adults or children (P>0.05). A significant relationship between the time constant and peak VO2 was found only in adult males (P<0.05). A shorter time constant in children may reflect an enhanced potential for oxidative metabolism.