NEP 3450 Exam 2
overtraining
-injuries more common during peak growth velocity -improper biomechanics and technique can be a cause -a sound training regimen is essential -repetition is important to learn skills but it can cause harm -drills that use variety of modalities may provide benefit with less stress to body
PA guidelines for infants (birth-12 months)
-interact with parents and caregivers in daily PA -explore the environment -promote development of motor skills -be active in a safe environment
arm protocols
-intermittent are more common -2 to 3 min stages -lower WL's -less sensitive -good alternative for pts w limitations
speed
-involves several components -neuromuscular capacity -strength -coordination -agility
process of puberty - boys
-age of onset: -2 yrs later than girls -increase in testosterone about 20X greater than before puberty -spermatogenesis: -increase in GnRH causes rise in FSH and LH -LH acts on testes to produce testosterone -FSH acts on testes to produce sperm -spermatogenesis usually evident by 14 y/o
process of puberty - girls
-age of onset: -between 10 and 11 y/o -increased accumulation of adipose tissue and breast development -lasts 4-5 yrs -age of menarche: -about 2 yrs after start of breast development -median age in US is 12.4 y/o -not significantly different than 30 yrs ago
"burnout" or overtraining syndrome
-a series of psychological, and hormonal changes that results in decreased sports performance -common manifestations: -chronic muscle or joint pain -personality changes -elevated resting heart rate -decreased sports performance -fatigue -lack of enthusiasm -burnout is a serious thing -prevent burnout by encouraging athlete to be well rounded in a variety activiites -suggested guidelines: -keep workouts interesting and fun -take time off from organized sports 1-2 days/wk -permit breaks from training 2-3 months a year -focus on wellness and teach athlete to be in tune with their bodies
PA guidelines for toddlers (12-36 months)
-accumulate 30 min of structured PA per day -engage in >60 mind/d of unstructured PA - <60 min of sedentary behavior at a time -develop movement skill -be active in safe indoor and outdoor areas
exercise history info
-activity questionnaire -activity log over several days -directly questioning the child -use of pedometers/accelerometers -use of computers/apps
body changes related to PA and growth
-affected by physiological, anatomical, biochemical, and psychological alterations that parallel growth and maturation -changes that occur due to growth mimic physical training effects
care and treatment of the active adolescent - medical issues
-infectious diseases -asthma -nutritional supplementation
PA guidelines for preschoolers (3-5 yrs)
- 60 min/d of structured PA - 60 min/d of unstructured PA - < 60 min/d of sedentary behavior at a time - develop competence in fundamental movement skills -be active in safe areas
PA guidelines for school age children (5-10 yrs)
- >60 mins of moderate exercise daily (may be broken up into 15 min segments) - vigorous activity 3 days/wk - strength and flexibility exercises 3 days/wk -no more than 60 mins of screen time at one sitting
the american academy of pediatrics guidelines for children's tv viewing
- children < 2 y/o should watch NO tv - children >2 y/o should eatch < 2 hrs/d
exercise deficiency
-"undoubtedly the most prevalent cause of ill health in America" -Dr. George Sheehan -physicians need to view this deficiency just as they would any other deficiency their pts may have
traction injury sites and stages
-10 to 13 years: heel (Sever's disease) -12 to 16 years: knee (Osgood Schlatter's disease) -late adolescence: low back and iliac pain
short burst activity
-95% of intense activity in children is less than 15 sec -children engage in very short bursts of intense activity interspersed with intervals of low and moderate activity -declines as children grow -between 6 and 16 daily energy expenditure declines by 50% -SBA is critical to health outcomes in children -increases caloric expenditure, maintain muscle development, and promote bone health
puberty effects on fitness
-VO2max: -stronger affect on boys -by 16 y/o boys VO2max 60% > than girls -in boys related to increase in body mass -lower levels in girls related to increase in body fat and decrease in habitual activity -strength: -increase in strength related to increase in body size in both boys and girls -testosterone in boys independently increases strength
bicycle protocols
-YMCA, astrand-rhyming, goodfrey, james, ramp -2 to 3 min stages -advantages: portable, less space, less noisy, costs less, better ECG tracings, easier BP measurement -may cause localized leg fatigue and not achieve as high a capacity
exercise metabolism
-anaerobic met. responds rapidly to exercise demand for short period -aerobic met. responds more slowly and lasts longer -short, 15 sec bursts use 88% energy through anaerobic met. -60 to 70 sec all out effort about equals amounts of aerobic and anaerobic contributions -at 4 mins >80% of energy needs from aerobic met.
fat depsotion
-at birth boys and girls have around 10-12% body fat -pre-pubertal boys and gurls have similar % body fat around 16-18% -post-pubertal girls: 25% -post-pubertal boys: 12-14%
children, adolescents and television
-average 6.5 hrs/day of screen time -65% have tv in their bedrooms -by age 70 will have spent the equivalent of 10 yrs watching tv
how to stop early puberty
-avoid environmental chemicals -reduce obesity and stress -optimize vit D levels -recognize that regular exercise appears to be one of the best known ways to help prevent early puberty
treadmill protocols
-balke, naughton, bruce, ramp -2 to 3 min stages; ramp continuous -more common -higher HR and VO2 then w cycle -8 to 12 mins duration -capacity estimations based on speed and grade
bone development
-bones develop from cartilage growth plate: epiphyseal plate -these plates divide the calcified head of the bone and the calcified shaft -the bone lengthens as cartilage is calcified in the epiphyseal plate -bone growth ends when the entire plate is calcified
acute effects of exercise in children that are lower than adults
-capacity for intense activity lasting 10-90 seconds -heat dissipation and acclimatization -cold tolerance -economy of walking and running -BP response -O2 deficit
growth related injuries
-changes in female body shape during the growth spurt increases risk for injury -specifically, hips widen and place the femur at a greater inward angle -this leads to greater inward rotation at the knee and foot -may cause condromalacai patella -traction injuries are caused by repetitive loading of sensitive tendons -these occur at different sites and different stages of growth
growth rate
-children grow about 5 inches in the first 2 years of life -growth continues from there at a rate of 2.5 inches/year until puberty -peak height velocity typically occurs in girls from 12-15 and boys from 14-17
clinical approaches to the sedentary child
-chronic illness -obesity -sedentary parents -kids who don't like PE -kids who have sedentary hobbies -kids who don't like sports
endurance events
-concerns for safety of kids in these events -modify to be age appropriate -attention to safety and environmental conditions -properly train to avoid thermoregulation issues -no science to support or refute kids participation in marathons -need clearly defined weekly plans on mileage and progression -need education on hydration -no reason to disallow if kid enjoys activity and is asymptomatic
products causing precocious puberty
-deodorants and antiperspiratns -shampoo and conditioner -shaving gel -toothpaste -lotions and sunscreen -make up/cosmetics -pharm drugs -food additives
"turn-offs"
-discomfort -failure -embarrassment -competition -boredom -injuries -regimentation
coaching the ped. athlete - exercise
-does not stunt or promote growth but it does increase bone thinkness -repetitive loading should be avoided -fracture to e. plate can be serious and disrupt bone growth
environmental chemicals and obesity likely factor for precocious puberty
-endocrine disrupters, like "xeno-estrogens" -these compounds behave like steroid hormones and can alter puberty timing
special issues in pediatric research
-ethical and methodological limitations -disconnect between chronological and biological age -mental maturation
motivational keys to exercise - "turn-ons"
-fun -success -peer support -family participation -variety -enthusiastic leaders -freedom
chronic effects of exercise in children
-gains in fitness capacity due to training are lower -in prepubertal children strength gains due to neural adaptations -in older adolescents gains are due to both neural adaptations -in older adolescents gains are due to bother neural adaptations and hypertrophy
compounding issue
-growth rates are not linear during childhood -not all children develop in a similar fashion
changes in girls during puberty
-hips and thighs widen -growth of pubic hair -warmth -visual indication of sexual maturity -collection of secreted pheromones -breast development -female voice deepens
aerobic fitness
-improves CV efficiency -increases caloric expenditure -reduces risk of CV disease or other co-morbidities
anaerobic fitness
-improves as children grow -increases in glycolytic capacity as evidenced by increased lactate levels in older children and adults -sprint speed over a given distance improves w age due to increase in stride length and muscle strength
reasons to stop exercise testing
-in cases in which diagnostic findings have been est; continuing the test would not produce any further info -failure of equipment -appearance of signs/symptoms indicating that continuing the test would put the pt at potential risk for an adverse event
exercise program recommendations
-increase daily activity -join organized community or school activities -participate in individual sports
hormone effects on fitness - testosterone
-increase in heart size -increase in contractility -increase in blood volume -increase in production of RBCs
influence of exercise on puberty
-increases sex hormone release -prolonged exercise decreases hormone levels -intense training in boys does not influence pubertal progression -likewise in girls w exception of gymnasts and dancers
position stand on youth strength training
-increases: -muscles strength and endurance -bone mineral density -body composition -blood lipids -joint flexibility -motor skills -coordination -psychosocial characteristics
flexibility
-lack of may increase risk for sport injuries -poor ____ may increase incidence of low back disease -good ____ may improve performance in certain activities -excessive ___ may cause joint instability and increase risk for sprains and dislocations
American Academy of Pediatrics recommends:
-limiting 1 sport training to < 5 days/week -take at least 1 day off per week from organized activity -take 2 to 3 months off per year from a particular sport - allows injuries to heal, reduces risk for burnout, can work on strength, proprioception
early puberty can set the stage for emotional and behavioral problems and is linked to:
-lower self esteem -depression -eating disorders -alcohol use -earlier loss of virginity -more sexual partners -increased risk of STI -increased risk of diabetes, heart disease, and other CVD as well as cancer, later in life
acute effects of exercise in children that are higher than adults
-max HR -ventilation at an absolute VO2
hormone effects on fitness - estrogen
-more effect on CNS -decrease pain tolerance -decrease in motivation and persistence -increase in depression/anxiety -reduced DOMS -increase in fat deposition
evidence shows that PA is essential for high quality of life throughout the lifespan. However:
-most research on fitness is in YA -most studies on PA and improved health outcomes is on older adults -despite these challenges, PA tracts well from childhood into young adulthood -increasing evidence supported the development of the US PA guidelines
muscles
-muscles mass increases steadily and equally in boys and girls until puberty -during puberty boys show much faster muscle growth
obesity another likely factor in early puberty
-obesity exposes girls to more estorgen bc it is stored and produced in fat tissue -fatter girls have higher level of lepitn -can lead to early puberty, which leads to higher estrogen levels, which leads to greater insulin resistance -can cause girls to have more fat tissue, more leptin, and more estrogen
ACSM indications to stop exercise testing
-onset of angina -drop in SBP w increase in work load -increase in BP > 250/115 -dyspnea, wheezing, leg pain -failure of HR increase w increase work load -changes in heart rhythm -subject requests to stop
care and treatment of the active adolescent - other issues
-overtraining -concussions
issues with the pediatric athlete
-overuse injuries -overtraining -"burnout" or overtraining syndrome -endurance events -weekend tournaments -year round training -multisport athlete
early exercise interventions
-positive health habits early in life provide for lifelong well-being -parents need to be involved -goal is to make exercise a habitual activity that is fun and stimulating
special considerations
-protect from overemphasizing specific sport or activity -emphasize variety and fun -take extra precaution when exercising in extreme heat or cold -screen for CV problems
PHV
-pubertal growth spurts lasts about two years and is accompanied by sexual development -normal growth stops when the growing ends and the bones fuse
precocious puberty
-puberty now occurs in 7- 8- and 9- y/o -10x more common in girls than boys
exercise and children's health
-regular PA is essential for quality of life through out the life span -children need activity as an integral part of their lifestyle -children respond to exercise, often in similar ways as adults
acute effects of exercise in children that are similar to adults
-relative VO2max ml/kg/min (endurance capacity) -CP and ATP -ventilatory threshold
strength
-resistance training improves muscular strength -little, if any, effect on CV system -primary purpose to improve performance and reduce injuries in sports
strategies to improve exercise habits - who is responsible?
-school systems -family -sport coaches -older athletes -scout leaders -government officials -media (not on the list - physicians)
how do we access puberty?
-secondary sex characteristics -menarche -spermarche -testosterone levels in males
care and treatment of the active adolescent - musculoskeletal issues
-shoulders -elbows -knees -spine
changes in boys during puberty
-shoulders widen -voice deepens/breaks -adam's apple -facial hair -increase in muscle mass -growth of testes and penis
year-round training
-single sport, year round training has become more common -motivation for this over-involvement may come from child, parent, or coach -want to grab a piece of the "professional pie" -reality: only .5% of high school athletes ever make it to the pro level -young athletes who participate in a variety of sports have fewer injuries and play sports longer than those that specialize before puberty
increasing animation
-stand more -use the body instead of machines -add movement during idle time -do more household chores
training the young athlete
-start w conservative programming to avoid injury, burnout, and overtraining -strength training is relatively safe -aerobic training is effective in increasing endurance anaerobic capacity increases w anaerobic training -training may decrease BF and increase LM -training does not alter normal growth rates -sports performance improves dramatically in children and adolescence
there is no evidence that properly performed strength training causes:
-stunted growth -growth plate damage -musculoskeletal injury -pain
process of puberty
-succession of anatomic and physiological changes in early adolescence -marks transition from sexually immature to fully fertile -noticeable changes in body size, composition and function
strength training - general recommendations
-supervision by qualified fitness professionals -individualized training programs -safe environment -5 to 10 min dynamic warm up -sessions scheduled 2-3 non-consecutive d/wk -8 to 12 exercises to include upper, lower and midsection muscles -1 to 3 sets with 8-15 reps using moderate load (60%max) -emphasize correct technique and safe procedures NOT how much weight one can lift -include balance and coordination exercises -progress to power production exercises -cool down and stretch -periodized variations in program
can physicians really alter the exercise habits of their pts?
-survey of 779 primary care pediatricians: - >50% thought it important to counsel kids >6 y/o on exercise -only 25% thought they might be able to change pts habits
exercise testing
-testing may be difficult -child's body size in relation to testing equipment may be problematic -peak performance may be poor -may have poor attention spans and poor motivation during testing, most often with longer protocols -children should be familiarized w the test modality and protocol; this will help reduce test anxiety and improve outcomes -children may require more motivation and support than older people to complete the test
history and physical examination
-the 1st step is to obtain a complete medical history and physical exam -this info will help evaluate the child for risk of exercise and to determine contraindications to exercise testing and exercise participation
contraindications to exercise testing
-the safety of the child is always #1 priority -unstable angina -uncontrolled cardiac dysrhythmias w symptoms -aortic stenosis -heart failure -pulmonary embolus -pericarditis or myocarditis -acute systemic infection -changes in ECG indicating ischemia
common reasons for pediatric stress testing
-to evaluate specific signs that are induced or aggravated by exercise -to identify abnormal responses to exercise in children with cardiac, pulmonary, or other organ disorders -to assess efficacy of specific medical or surgical treatments -to assess functional capacity for recreational, athletic, and vocational activities -to evaluate prognosis, including both baseline and serial testing measurements
mode of testing
-treadmill -cycle ergometer -arm ergometer -important to have ergometer that can adjust to child's size
weekend tournaments
-typical in soccer, baseball, tennis, softball -often young athletes participate 6 hrs/day -additional 2-3 hours of environmental exposure -risk of heat-related injuries, nutrition deficiencies, overuse injuries, and burnout are real!!!
goals and guidance
-ultimate goal should be to promote lifelong activity, recreation, and skill development useful in all facets of future endevours -education of parents, athletes, and coaches must be part of the plan -athletes must be mentored to prevent overuse and burnout -encourage athlete to have a least 1-2 days/week off from competition -don't increase workload more than 10%/week -encourage 2-3 months/year away from a specific sport -focus on fun, skills, safety, and sportsmanship -be alert for possible burnout -help develop educational opportunities for athlete, parent, and coach -watch out for long tournaments over a short period of time
explosive power
-vertical jump height used to indicate explosive muscular power -vertical jump performance improves as child gets older -genetics may play a role
multisport athlete
-well rounded, multisport athletes have greater potential to enjoy activity throughout their life -at risk for overuse injury if they don't appropriate rest and some time off
overuse injuries four stages
1. pain in area after PA 2. pain during PA w/o performance change 3. pain during PA that affects performance 4. chronic, unremitting pain, even at rest
cardiorespiratory fitness standards for children
42 ml/kd/min - boys 35 ml/kg/min - girls
stress and early puberty
a stressful childhood inclines a body toward early reproduction; if life is hard, best to mature young
most research focuses on:
aerobic fitness
challenges facing researcher
defining the relationship between changes in anaerobic met., lab measures of power production, and practical outcomes of SBA
identifying youth at risk for injuries
educate parents, coaches, and athletes
effects of exercise on health is related to:
habitual activity not physical fitness
bone growth similar in both sexes. why?
males produce some estrogen
overuse injuries definiton
micro-traumatic injury to bone, muscles, or tendon without time to heal or repair, 50% of all injuries seen in pediatric sports medicine are related to overuse, risks are more serious in the pediatric population: kid's bones can't handle the same stresses as adults
tv positive benefits
promotes positive aspects of social behavior (sharing, manners, cooperation)
tv negative effects
promotes violence, aggressive behavior, sex, substance abuse
exercise habits of children are most likely:
short burst activity
we should promote:
short burst activity in children
field types
should be limited to children who are free of contraindications
physicians help set:
specific, realistic goals for inactive children AND counsel parents about the importance of PA in their early years
PA for what?
strength speed flexibility/balance agility/reflex edurance
