Study protocol: a randomized controlled trial study on the effect of a game-based exercise training program on promoting physical fitness and mental health in children with autism spectrum disorder.

BACKGROUND: Suboptimal physical activity levels and tolerance, poor motor skills and poor physical health are demonstrated in children with Autism Spectrum Disorder (ASD). We speculate that social interaction and communication deficits in children with ASD are two major factors that hinder these children from actively participating in group physical activities. While previous studies have demonstrated that exercise intervention improves motor skills and behavioral outcomes in children with ASD, these programs tend to focus only on a single sport, which may not cater to the interests of different children with ASD. In this protocol, a game-based exercise training program designed by a multi-disciplinary team (pediatrics, physical education and psychology) will be implemented by front-line healthcare providers trained following the train-the-trainer (TTT) model and subjected to validation. METHOD: Using a randomized controlled trial design, the effectiveness of the game-based exercise program will be examined for 112 young children with ASD. These children were randomly assigned to two groups, which will be tested and trained in either one of the two arms of the waitlist conditions (control and intervention). The assessment of physical and psychological traits will be conducted at baseline (pre-test), at 16-weeks (post-treatment) and at 32-weeks (follow-up) of the program. DISCUSSION: Most of the interventions designed for ASD children target either their psychological traits or physical conditions, without bridging the two states. With the recognition of bidirectional relations between mental and physical health, the present game-based exercise program which includes multiple level of difficulties was developed to equip ASD children with the necessary skills for engaging in sustainable team sports or even professional sport training. The program, if effective, will provide an entertaining and engaging training for whole-person development among children with ASD. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry ( ChiCTR-IOR-17011898 ). Registered 6th July 2017.

A Bio-mechanical Model for Elbow Isokinetic and Isotonic Flexions.

A new bio-mechanical model for elbow flexions is proposed to quantify the elbow torque generated as a function of the upper-arm circumferential strain and influencing factors of elbow angle and angular velocity. The upper-arm circumferential strain is used to represent the contractile intensity of the dominant flexor, biceps brachii, whose behavior is described by Hill's theory. Experiments with thirteen healthy subjects were conducted to determine the influencing factors. The temporal distributions of torque and elbow angle were measured by Biodex ®3 simultaneously, while the upper-arm circumference was obtained by a wearable anthropometric measurement device. Within the experimental range, the change of angular velocity has been found to have no effect on the torque generated. The new model was further verified experimentally with reasonable agreements obtained. The mean relative error of the torque estimated from the model is 15% and 22%, for isokinetic and isotonic flexions, respectively. The verified model establishes the relationship between the torque generated and circumference strain of the upper arm, for the first time, thus provide a scientific foundation for the anthropometric measurement technology as an alternative to sEMG for monitoring force/torque generation during elbow flexions.

Association Between Leisure Time Physical Activity, Cardiopulmonary Fitness, Cardiovascular Risk Factors, and Cardiovascular Workload at Work in Firefighters.

BACKGROUND: Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters in Hong Kong. METHODS: Male firefighters (n = 387) were randomly selected from serving firefighters in Hong Kong (n = 5,370) for the assessment of cardiovascular disease risk factors (obesity, hypertension, diabetes mellitus, dyslipidemia, smoking, known cardiovascular diseases). One-third (Target Group) were randomly selected for the assessment of off-duty leisure-time physical activity using the short version of the International Physical Activity Questionnaire. Maximal oxygen uptake was assessed, as well as cardiovascular workload using heart rate monitoring for each firefighter for four "normal" 24-hour working shifts and during real-situation simulated scenarios. RESULTS: Overall, 33.9% of the firefighters had at least two cardiovascular disease risk factors. In the Target Group, firefighters who had higher leisure-time physical activity had a lower resting heart rate and a lower average working heart rate, and spent a smaller proportion of time working at a moderate-intensity cardiovascular workload. Firefighters who had moderate aerobic fitness and high leisure-time physical activity had a lower peak working heart rate during the mountain rescue scenario compared with firefighters who had low leisure-time physical activities. CONCLUSION: Leisure-time physical activity conferred significant benefits during job tasks of moderate cardiovascular workload in firefighters in Hong Kong.

Follow up of aerobic capacity in children affected by severe acute respiratory syndrome.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the aerobic capacity of children 3 years after they were diagnosed with severe acute respiratory syndrome (SARS). METHODS: Twenty-seven patients who completed both pulmonary function and maximal aerobic capacity tests at 6 and 15 months after the acute illness were invited to return for reassessment. RESULTS: Twenty-one patients (median age 18.2 years, interquartile range (IQR) 16.5-19.7) completed all investigations at 36 months. Pulmonary function was normal in all patients. Maximal aerobic capacity, peak oxygen pulse (peak VO(2) ) and ventilatory anaerobic threshold showed significant improvements compared with values measured at 6 months in both boys and girls. In girls, ventilatory efficiency (ventilatory equivalents for oxygen and carbon dioxide) and perfusion of the lungs (end-tidal partial carbon dioxide pressure) had not increased further compared with the values measured at 15 months. Although peak VO(2) improved further at 36 months in patients with or without persistent radiological abnormalities, the values were 68% (IQR 50-84) and 74% (IQR 60-99), respectively, of those for normal control subjects. CONCLUSIONS: There were improvements in aerobic capacity at 36 months in children affected by SARS; however, the measured values remained suboptimal.

EMG wavelet analysis of quadriceps muscle during repeated knee extension movement.

PURPOSE: Wavelet transform is a time-frequency analysis method that quantifies temporal changes of the frequency content of nonstationary signals without losing resolution in time or frequency. It may be used to analyze surface EMG (sEMG) signals under dynamic conditions. However, this method is difficult to apply clinically because it generates large quantity of data in a very short time, and the change in muscle fiber length and diameter during dynamic contraction induces a large variability of the data at various wavelet domains and joint positions. This study aimed to determine a wavelet domain and a joint range that has the lowest variance and highest sensitivity to document the shift of the frequency intensity that relates to the decline of dynamic muscle power. METHODS: Eleven active young males were tested for maximal isokinetic knee extension and flexion exercise for 50 repetitions at 180 degrees x s and at a range of 100 degrees-0 degrees x sEMG measurement of vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) were recorded during the exercise. Wavelet transform was used to filter the sEMG data into 11 wavelet domains. The movement was divided into five 20 degrees-angle range groups. RESULTS: On the basis of the statistical analysis, the most significant and consistent trend of decrease in sEMG intensity power under maximal dynamic exercise for VM, VL, and RF was identified at the angle range of 40 degrees -20 degrees in wavelet domain 4. CONCLUSION: We concluded that the shift in intensity within this angle range and wavelet domain might be used to document fatigue of the quadriceps during dynamic maximal knee extension exercise.

Application of surface electromyography in assessing muscle recruitment patterns in a six-minute continuous rowing effort.

Specific sequences of muscle coordination exist in movements of every sport. In particular, sports involving repetitive movement patterns such as rowing may rely more heavily on coordinated muscle contraction sequencing in order to produce optimal performance. The aim of this study was to monitor the fatigue patterns of the major muscles engaged during the rowing stroke in rowers of varying abilities during a 6-minute continuous maximal rowing effort on a Concept II rowing ergometer. Sixteen male rowers were categorized into 5 groups based on years of training and their average pace of the 6-minute continuous maximal rowing effort. Continuous surface electromyography signals, recorded from brachioradialis, biceps brachii, middeltoid, rectus abdominis, erector spinae, rectus femoris, biceps femoris, and medial gastrocnemius, were used to investigate the influence of local muscle fatigue on optimal muscle coordination sequences during the rowing exercise. Rowers who performed better on the ergometer test and had more rowing experience tended to portray muscle recruitment patterning, which alternately emphasized different major muscle groups in a form of sharing of workload. This sharing allowed mean peak frequency restitution to take place in some muscles, while others took on more of the workload. The muscles of rowers with less experience and lower levels of performance did not appear to exhibit this same phenomenon known as biodynamic compensation. If coaches have a clearer picture of the fatigue patterns and recruitment strategies occurring in their athletes during a maximal effort row, strength training program adaptations could be made to compensate for weaker areas, which may assist rowers in attaining and sustaining more optimal patterns and strategies throughout the exercise effort.

Effect of transcutaneous electrical acupoint stimulation on fatigue recovery of the quadriceps.

The aim of this study was to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) at selected acupoints on enhancing the rate of muscle force recovery after strenuous knee extension/flexion exercise. Ten male and seven female healthy young adults participated in this study in which they performed isokinetic knee fatigue exercise on the Biodex System 3 ergometer on three separate days. After the familiarization trial on day 1, subjects underwent 15 min of either TEAS or pseudo-TEAS recovery treatment after the isokinetic exercise in the following two trials on days 2 and 3, respectively. The TEAS treatment was applied on four selected acupoints [Zusanli (ST36), Chenshan (BL57), Yanglingquan (GB34) and Sanyinjiao (SP6)] while the pseudo-TEAS treatment was applied to the points away from the true acupoints. Isometric knee extension peak torque was measured before and immediately after the test exercise, and again during the 15-min recovery period at 5-min intervals. Blood lactate and median power frequency (MF) of the vastus medialis, vastus lateralis and rectus femoris were also measured at the same time points. The results indicated that the TEAS treatment was significantly more effective than the pseudo-TEAS treatment in enhancing the rate of muscle force recovery (knee extension peak torque recovery after 15 min, from 155 to 195 Nm in TEAS group and from 155 to 182 Nm in the pseudo-TEAS group), but had no effect on lactate removal and MF restitution rate. It is proposed that pain control is a plausible mechanism to explain the benefit of TEAS treatment. As TEAS is a non-invasive and simple treatment, it is feasible to apply it during and immediately after training.

Effects of strength training on body composition and bone mineral content in children who are obese.

The purpose of this study was to test the hypothesis that strength training benefits diet-controlled obese children with respect to lean mass and bone mineral acquisition. Eighty-two Hong Kong school children (aged 10.4 +/- 1.0 years, 70 in Tanner stage 1, 12 in stage 2) who were obese/overweight were randomly assigned to receive either a balanced low-energy (900-1200 cal) diet plus strength training (n = 41) (training group) or the diet alone (n = 41) (control group). The training group attended a 75-minute strength exercise program 3 times/week for 6 weeks (phase 1), after which they were offered and 22 children opted to continue a once-weekly program for a further 28 weeks (phase 2). All children were evaluated at baseline, after 6 weeks, and at the end of the 36-week study (including an intervening 2-week introduction to phase 2). Body composition and bone mineral content were measured by dual-energy X-ray absorptiometry, and diet was assessed by food-frequency questionnaire. The results showed that the exercise programs were well accepted, with good attendance at the exercise classes. After 6 weeks, the children in the training group showed significantly larger increases in lean body mass (+ 0.8 kg [2.4%] vs. +0.3 kg [1.0%], p < 0.05) and total bone mineral content (+46.9 g [3.9%] vs. +33.6 g [2.9%], p < 0.05) than those in the control group. At the end of the study, these trends were maintained in the continued-training subgroup, though no longer reaching statistical significance. We conclude that in diet-controlled prepubertal obese/overweight children, participation in an exercise program with emphasis on strength training resulted in improved lean mass and bone mineral accrual.

Severe Acute Respiratory Syndrome and sport: facts and fallacies.

Severe Acute Respiratory Syndrome (SARS) not only paralysed economic activities in SARS-affected cities, it also affected sporting activities. SARS was identified in Hong Kong in late February 2003 and the WHO issued a global alert on 12 March, 2003. The incubation period of SARS is usually 4-6 days and patients commonly present with high fever (temperature >38 degrees C), dry cough, chills and rigor, dyspnoea and diarrhoea. Although a specific antiviral agent and vaccines for SARS are not available at the time of writing, a standard treatment protocol for SARS has been developed. The average mortality rate is about 16% in Hong Kong.The coronavirus is a common pathogen for upper respiratory tract infection and is the most probable pathogen for SARS. Transmission methods may, therefore, be similar for both these infections. Transmission is possible when aerosolised viral particles come into contact with the susceptible host's mucous membrane, most commonly the nose, but also the mouth and eyes. With appropriate preventive measures to avoid contact with virus, the probability of infection is minimal. Isolation of those who have had close contact with confirmed or suspected SARS patients and/or who have persistent fever will be the most effective and practical method of avoiding contact. Maintaining personal hygiene and frequent hand washing can also reduce the risk of infection. Using diluted bleach (1 part bleach in 99 parts water) to cleanse training areas and equipment is also recommended. With proper event planning to conform with quarantine measures, special travel arrangements, facility sterilisation and use of venues with good ventilation and filtering systems, sport competition can still proceed.