Pediatric Sports Medicine for the Practitioner

1 Physiologic Responses to Exercise of the Healthy Child.- Response to Acute Exercise.- Metabolic Responses to Exercise in Children.- Maximal Aerobic Power.- Maximal O2 Uptake.- Maximal O2 Uptake per Kilogram Body Weight.- The Dimensionality Theory and Maximal O2 Uptake.- Mechanical Efficiency and Economy of Movement.- Anaerobic Characteristics.- Mechanical Power Output.- Underlying Biochemical Characteristics.- Anaerobic Threshold.- O2 Uptake Transients.- Metabolic "Specialization".- Cardiovascular Response to Exercise.- Cardiac Output and Stroke Volume.- Heart Rate and Exercise.- Age.- Sex.- Adiposity.- Climatic Stress.- Emotional Stress and Habituation.- Active Muscle Mass.- Conditioning and Deconditioning.- Acclimatization to Heat.- Diseases.- Medication.- Body Position.- Muscle Blood Flow.- Arterial Blood Pressure.- Rhythmic Exercise.- Static Exercise.- Pulmonary Response to Exercise in Children.- Pulmonary Ventilation.- Respiratory Frequency and Tidal Volume.- Ventilatory Equivalent.- Alveolar Ventilation and Gas Exchange.- Vital Capacity and Exercise Performance.- Prolonged Activities.- Warm-up Effect.- Exercise Perception and Age.- Conditioning and Training.- Methodologic Constraints.- Principles of Physical Conditioning.- Specificity of Training.- Dosage of Conditioning.- Intensity.- Frequency.- Duration of Sessions.- Duration of the Program.- Conditioning Effect Related to Preconditioning Fitness.- Trainability of Muscle Power and Force in Childhood and Adolescence.- Maximal Aerobic Power.- Anaerobic Capacity.- Muscle Strength.- Physiologic Effect of Detraining and Deconditioning.- Conditioning and the Cardiovascular System.- Morphologic Changes.- Physiologic Changes.- Conditioning and the Pulmonary System.- Skeletal Muscle Adaptation to Conditioning.- Morphologic Changes.- Biochemical Changes.- Conditioning and Body Composition.- References.- 2 Children and Exercise in a Clinical Context- An Overview.- Habitual Activity and Disease.- Disease as a Direct and Indirect Cause of Hypoactivity.- "Non-Disease" as a Cause of Hypoactivity.- Assessment of Physical Activity.- Effects of Disease on Physical Working Capacity.- Hypoactivity-Detraining-Hypoactivity: The Vicious Circle.- Reduced Maximal Aerobic Power.- High Metabolic Cost of Exercise.- Exercise as a Diagnostic Tool in Pediatrics.- Exercise as Therapy in Pediatrics.- The Exercise Prescription (Case Studies).- Deleterious Effects of Exercise.- References.- 3 Pulmonary Diseases.- Bronchial Asthma.- Exercise-induced Bronchoconstriction (EIB).- Epidemiology.- EIB-Nature of the Exercise Provocation.- Type of Exercise.- Intensity of Exercise.- Duration of Exercise.- Time Since Previous Exercise.- Climatic Conditions and Asthma.- Climate and the Resting Asthmatic.- Climate and EIB.- Mechanisms Underlying EIB.- Possible Triggering Stimuli.- Airway Cooling as a Trigger.- Vagal Pathways vs. Chemical Mediators.- Other Responses of Asthmatics to Exercise.- Habitual Activity of the Asthmatic Child.- Physical Working Capacity of the Asthmatic Child.- Exercise as a Diagnostic Tool in Asthma.- Rationale for Exercise Provocation Tests.- Documentation of EIB.- Evaluation of Medication for EIB.- Diagnosis of Hyperreactive Airways.- Comparison of Asthmogenicity of Different Activities.- Determination of Exercise Tolerance.- Instilling Confidence in Patient and Parent.- Assessment of the Emotional Component.- The Exercise Challenge.- Pretest Preparation.- Withdrawal of Medication.- The Exercise Protocol.- Pulmonary Function Tests.- Interpretation of Post-exertional Bronchoconstriction.- Management of the Child with EIB.- Drug Therapy.- Prophylactic Therapy.- Reversal of EIB.- Nasal Breathing as Protection.- Artificial Means for Warming and Humidifying Inspired Air.- Choosing the Right Activities.- Physical Conditioning and the Asthmatic Child.- Conditioning and Improvement of Fitness.- Conditioning and EIB.- Cystic Fibrosis (CF).- Causes of Deficient Physical Working Capacity.- Exercise in Assessment of the Child.- Beneficial Effects of Conditioning.- Precautions to Be Taken During Exercise Programs.- Interstitial Lung Disease.- Pulmonary Tuberculosis.- References.- 4 Cardiovascular Diseases.- Aortic Stenosis (AS).- Physiologic Responses to Acute Exercise.- Hemodynamic Abnormality.- Myocardial Ischemia.- Physical Working Capacity.- Clinically Detrimental Effects of Acute Exercise.- Exercise as a Diagnostic Tool.- Evaluation Based on Hemodynamic Variables.- Systolic Arterial Blood Pressure.- Left Ventricular End-Diastolic Pressure and Stroke Volume.- Peak Left Ventricular Systolic Pressure.- Myocardial O2 Supply: Demand Ratio.- Evaluation Based on Electrocardiography.- Criteria for Successful Surgical Repair.- Permissible Activities.- Coarctation of the Aorta (CA).- Hemodynamic Abnormalities.- Exercise as a Diagnostic Tool.- Hemodynamic Response to Exercise.- Ischemic Changes During Exercise.- Congenital Complete Heart Block (CCHB).- Hemodynamic Response to Exercise.- Ventricular Dysrhythmia During Exercise.- Exercise-induced Syncope.- Physical Working Capacity.- Habitual Activity.- Exercise in the Assessment of CCHB.- Coronary Heart Disease.- Physical Exercise in Childhood: Does It Prevent Coronary Heart Disease?.- Hypertension (HT).- Hemodynamic Response to Rhythmic Exercise.- Hemodynamic Response to Static Exercise.- Physical Working Capacity and Habitual Activity.- Exercise in the Assessment of Juvenile HT.- Beneficial Effects of Chronic Exercise.- Is Exercise in Hypertension Detrimental to Health?.- Neurocirculatory Asthenia (NCA).- Response to Exercise and Physical Working Capacity.- Exercise as a Diagnostic Tool.- Beneficial Effects of Conditioning.- Pulmonary Stenosis (PS).- Hemodynamic Abnormalities in the Preoperative Child.- Hemodynamic Abnormalities Following Pulmonary Valvotomy.- Physical Working Capacity.- Exercise as a Diagnostic Tool.- Isoproterenol as a Substitute for Exercise Testing.- Septal Defect-Atrial (ASD).- Hemodynamic Response to Exercise.- Physical Working Capacity.- Exercise in the Assessment of the Child with ASD.- Septal Defect-Ventricular (VSD).- Hemodynamic Response to Exercise.- Physical Working Capacity.- Exercise in the Assessment of the Child with VSD.- Tetralogy of Fallot (TF).- Hemodynamic Characteristics-The Preoperative Child.- Respiratory Characteristics-The Preoperative Child.- Response to Exercise after Surgical Repair.- Habitual Activity.- Physical Working Capacity.- Exercise as a Diagnostic Tool.- Permissible Activities.- References.- 5 Endocrine Diseases.- Diabetes Mellitus.- Metabolic Response to Acute Exercise.- Blood Glucose Lowering Effect of Exercise.- Route and Site of Insulin Injection.- Insulin Binding to Receptors.- Exercise-induced Hyperglycemia.- Metabolic Response to Chronic Exercise.- Exercise and Insulin-The Synergistic Effect.- Exercise and Control of Diabetes.- Habitual Activity and Diabetes Mellitus.- Physical Working Capacity.- Exercise in Daily Management.- The Triad-Food, Insulin, Exercise.- Exercise Exchange Menu.- Growth Hormone (GH) Deficiency.- Using Exercise in the Diagnosis.- Rationale for Provocation Testing.- Provocation Tests at Rest.- Exercise as a Provocation Test.- Optimizing the Exercise Protocol.- References.- 6 Nutritional Diseases.- Anorexia Nervosa (AN).- Physical Working Capacity.- Exercise Perception.- Habitual Activity.- Malnutrition.- Growth and Exercise Performance.- Habitual Activity.- Effect of Conditioning.- Obesity.- Response to Acute Exercise.- Habitual Activity.- Adiposity, Activity, and Calorie Intake.- Is Hypoactivity a Cause of Childhood Obesity?.- Causes of Hypoactivity.- Physical Working Capacity.- Beneficial Effects of Conditioning.- Effectiveness of Conditioning as a Reducing Regimen.- Dietary Restriction vs. Exercise Therapy.- Exercise Therapy and Changes in Appetite.- Conditioning Effects Other than Fat Reduction.- Conditioning and Adipose Tissue Cellularity.- Lasting Effects of Conditioning.- Recommended Activities.- Effectiveness.- Feasibility.- Recreational Aspects.- References.- 7 Neuromuscular Diseases.- Cerebral Palsy (CP).- Physical Working Capacity.- Mechanical Efficiency and Economy of Movement.- Habitual Activity.- Exercise Testing.- In the Laboratory.- In the Field.- Conditioning.- The Physiologic Effect.- The Functional Effect.- Recommended Activities.- Epilepsy.- Fatigue.- Hyperventilation and Exercise.- Head Trauma.- Accidents to the Child and Others.- A Physician's Dilemma.- Recommendations for Physical Activity.- McArdle's Syndrome.- Progressive Muscular Dystrophy (PMD).- Exercise Limitations.- Muscle Strength.- Muscle Endurance.- Maximal Aerobic Power.- Habitual Activity.- Exercise in Management of the Child.- Scoliosis.- Functional and Physiologic Deficiencies.- Is Conditioning Beneficial?.- References.- 8 Hematologic Diseases.- Anemia.- Compensatory Mechanisms.- Physical Working Capacity.- Conditioning-Induced Iron Deficiency.- Hemoglobinuria-Exertional.- The Phenomenon.- Possible Mechanism.- Management.- Hemophilia.- Rationale for Conditioning.- Recommended Activities.- Risk of Bleeds and Their Prevention.- Sickle-cell Anemia.- Thalassemia Major.- References.- 9 Climate and the Exercising Child.- Some Concepts in Thermoregulation.- Heat Stress and Heat Strain.- Heat Production and Heat Exchange.- Physiologic and Behavioral Means of Thermoregulation.- Characteristics of Children Relevant to Thermoregulation.- Sweating Pattern.- Sweating Rate.- Heat-activated Sweat Glands.- Functional Implications.- Heat Tolerance.- What Is Heat Tolerance?.- Heat Tolerance-Children vs. Adults.- Cold Tolerance.- Acclimatization to Exercise in the Heat.- Heat Acclimatization-What and How?.- Acclimatization-Children vs. Adults.- Perceptual Changes with Acclimatization.- Fluid and Electrolyte Balance.- Water Shifts During Exercise.- Electrolyte Loss During Exercise.- Hypohydration.- Voluntary Dehydration.- Deliberate Dehydration.- Implications for Performance and Health.- Water and Electrolyte Replenishment.- Pediatric Health Hazards in Hot Climates.- Heat-related Illness.- Epidemiologie Studies on Children's Health in Hot Climates.- Populations at High Risk for Heat-related Illness.- Anorexia Nervosa (AN).- Congenital Heart Disease (CHD).- Cystic Fibrosis (CF).- Diabetes Mellitus or Insipidus.- Diarrhea and Vomiting.- Excessive Eagerness.- Fever.- Hypohydration.- Insufficient Acclimatization.- Insufficient Conditioning.- Malnutrition.- Mental Deficiency.- Obesity.- Prior Heat-related Illness.- Sweating Insufficiency Syndromes.- Guidelines for Conduct of Athletic Events in the Heat.- References.- Appendix I "Norms".- References.- Peak Mechanical Power.- Endurance Time-Bruce Treadmill.- Power at Heart Rate of 170.- Distance Traveled- 12-Min Run-Walk.- Anaerobic Capacity.- Peak Anaerobic Power.- Appendix II Procedures for Exercise Testing in Children.- Choice of Ergometer.- The Exercise Protocol.- Prototypes of Exercise Tests.- Examples of Exercise Protocols.- The Bruce All-Out Progressive Continuous Treadmill Test.- The McMaster All-Out Progressive Continuous Cycling Test.- The McMaster All-Out Progressive Continuous Arm Test.- The Cumming Ail-Out Progressive Intermittent Cycling Test.- The Adams Submaximal Progressive Continuous Cycling Test.- The Hanne Submaximal Progressive Intermittent Step Test.- The Wingate Anaerobic Cycling Test.- Measurements Taken During Exercise Tests.- Heart Rate.- Ventilation.- Systemic Arterial Blood Pressure.- Electrocardiogram (ECG).- Skin Preparation.- Choice of Electrodes.- Choice of Leads.- Indications for Exercise ECG.- Exercise-induced Electrocardiographic Changes.- Exercise ECG Test vs. Long-term ECG Monitoring.- Cardiac Output.- Rating of Perceived Exertion (RPE).- Determination of Maximal Aerobic Power.- Direct Determination.- Indirect Determination-Submaximal Tests.- Indirect Determination-All-Out Tests.- Safety Precautions.- Personnel.- Contraindications for Exercise Testing.- Termination of An Exercise Test.- References.- Appendix III Activity Questionnaire.- Appendix IV Calorie Equivalents.- Appendix V Glossary of Terms.