Mark Perry

The relationship among physical activity, motor competence and health-related fitness in 14-year-old adolescents

Physical activity, physical fitness and motor competence are important health‐related constructs. However, the relationship among them, particularly for children and adolescents, is still unclear. In this study, motor competence (measured by the McCarron Assessment of Neuromuscular Development), pedometer‐determined physical activity and physical fitness (aerobic fitness, muscle strength, muscle endurance, flexibility and body composition) were examined in a cohort of 1585 adolescents (771 girls, 814 boys) of mean age 14.06 years. Significant gender differences were observed for all measures except motor competence. Apart from hip and shoulder flexibility, males outperformed females. For both males and females, motor competence was associated with all fitness measures, physical activity was associated only with aerobic fitness and aerobic fitness was associated with physical activity, motor competence, BMI and chest pass. Among males, aerobic fitness was also associated with all other fitness tests. The correlations were, in general, moderate to weak. The results challenge the current focus on physical activity rather than physical fitness as the preferred intervention.

The effectiveness of arts-based interventions in medical education: a literature review

Medical Education 2011: 45: 141–148

Reliability of sagittal photographic spinal posture assessment in adolescents

Posture and adolescent spinal pain may be linked, so adolescent posture measurement is important. Static photographic analysis of posture is practical for large-scale studies of adolescents, but only one adolescent study has investigated its reliability. The aim was therefore to assess the reliability of photographic spinal posture assessment in adolescents. Inter-rater reliability was measured, as the purpose was to assess the method for large-scale epidemiological studies with multiple raters. Twenty-two healthy adolescent subjects (11 males, 11 females) aged 13–17 were photographed by four different examiners while standing, sitting and slumped. Eight spinal postural angles and four distance measures were derived. Inter-rater reliability was quantified by interclass correlation coefficients (ICCs) for consistency, ICCs for absolute agreement between raters and standard errors of measurement (SEMs). Inter-rater reliability was fair (ICC >0.4) to good (ICC >0.75) for all measures in standing except pelvic tilt and sway angle, and for all measures in sitting except head flexion and craniocervical angle. Poorer ICCs for agreement than consistency were observed, reflecting a significant rater effect for most measures. Photographic analysis of adolescent posture has fair reliability, and is appropriate for large-scale adolescent studies. Future studies should observe several precautions to optimize reliability.

Relationships between prolonged neck/shoulder pain and sitting spinal posture in male and female adolescents

Neck/shoulder pain (NSP) is a common problem for adolescents and posture has been suggested as an important risk factor. The aim of this cross sectional study was to examine the relationship between prolonged NSP and habitual sitting posture in adolescents. The habitual sitting postures of 1593, 14-year-old adolescents with and without prolonged NSP were assessed using sagittal plane digital photographs. Cervicothoracic and lumbopelvic posture angles were calculated from the digital images using motion analysis software. Adolescents reported experience of NSP by questionnaire. Differences between postures of males and females and those with and without prolonged NSP were examined using independent t-tests. The relationships between cervicothoracic and lumbopelvic postures and presence of prolonged NSP were investigated using logistic regression models controlling for gender. Prolonged NSP was reported by 5.3% of the adolescents, with females reporting a higher prevalence rate (6.5%) than males (4.2%). Females also sat more erect with a more lordotic lumbar posture than males. Adolescents with prolonged NSP had more flexed cervicothoracic posture, more erect trunk and more lumbar lordosis. When gender was controlled, only lumbar lordosis was related to the presence of prolonged NSP.

Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls – An observational study

There are no published data on the prevalence of Achilles tendinopathy in gymnasts. 40 elite gymnasts and 41 controls of mean (SD) age 16.3 (2.1) years had bilateral AT thickness (at 3 points along the tendon in longitudinal and transverse views) and abnormality measured using ultrasound (US). Data on a history of AT symptoms were gathered using a questionnaire. Among female gymnasts there were 17.5% of Achilles tendons (ATs) with current symptoms, compared with none of the controls (chi(2)=6.2, p<0.05). Similarly, among male gymnasts 12.5% of ATs were currently symptomatic, compared with none of the controls (chi(2)=6.62, p<0.01). US scanning showed gymnasts had significantly (p<0.001 to p<0.05) thicker ATs for 5 out of 6 measures, and had more irregular longitudinal AT thickness (p<0.05). 32.5% of female gymnast ATs had US abnormalities, compared with 6.2% of female control ATs (chi(2)=7.43, p<0.01). Similarly, 35% of male gymnast ATs had US abnormalities, compared with 4% of male control ATs (chi(2)=7.43, p=0<01). There was no relationship between AT symptoms and US-detected abnormalities in the gymnasts. Achilles tendinopathy is a common problem in gymnasts. The poor correlation between signs and symptoms suggests pathology is not always symptomatic.

Computer Use and Habitual Spinal Posture in Australian Adolescents

Objective. Computer use is common in adolescents, and there is evidence that adolescent spinal posture alters during computer use. However, it is unknown if computer use and habitual postures are associated. The objective of this study was to evaluate associations between adolescent computer use and habitual postures. Methods. Eight hundred eighty-four adolescents (408 females, 476 males, mean age, 14.0 years, standard deviation, 0.2) completed a questionnaire assessing weekly computer use. Habitual spinal posture was assessed by photographic analysis while standing and sitting. Results. Computer use was associated with adolescent habitual postures. In males, increased computer use was associated with increased head flexion and neck flexion. In females, increased computer use was associated with increased lumbar lordosis. Conclusions. The amount of weekly computer use was associated with changes in habitual spinal postures, and these depended on gender. These associations may result from temporary computer postures leading to adaptive neuromusculoskeletal changes, though further multivariate and longitudinal studies are needed to confirm causality. As some habitual posture changes may place a greater strain on the musculoskeletal system, computer use by adolescents should be viewed as a possible health concern.

The Effect of Tumor Necrosis Factor-α Antagonists on Arterial Stiffness in Rheumatoid Arthritis: A Literature Review

BACKGROUND There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-α (TNF-α) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-α antagonists have been found to reduce inflammatory markers in RA; however, it is debatable if they have favorable effects on the cardiovascular system. This review evaluates the effect of TNF-α antagonists on arterial stiffness, a predictor of cardiovascular disease, in RA patients. SEARCH STRATEGY A search of Ovid MEDLINE and ISI Web of Knowledge databases was conducted to identify studies into the effect of TNF-α antagonists on arterial stiffness in RA patients. Eight studies matching the search criteria were included for analysis. FINDINGS Two methods were used to assess arterial stiffness: pulse wave velocity and augmentation index. Despite inconsistencies in augmentation index values, aortic pulse wave velocity in all but one study was significantly reduced following TNF-α antagonist treatment. Most studies had methodological limitations, including inadequate sample size, nonblinding of those involved in the measurements, and inadequate inclusion/exclusion criteria. Variation in results could be due to the use of different TNF-α antagonists, different outcome measures being used, and differences in follow-up. CONCLUSIONS The balance of evidence suggests that TNF-α antagonists may have a beneficial effect on arterial stiffness and therefore cardiovascular risk. However, larger more robust longer term studies are warranted to confirm recent findings.

Carer Experience of Back Pain Is Associated With Adolescent Back Pain Experience Even When Controlling for Other Carer and Family Factors

ObjectivesThe study objectives were (1) to determine if adolescent back pain is related to carer back pain; and (2) to examine whether other carer and family factors accounted for any such relationship. MethodsBack pain experience was collected independently from 1608 fourteen-year-old adolescents and their care givers by questionnaire. Measures of back pain impact on carers were also collected (modified activities, missed work, sought professional help, took medication). Other carer factors examined were age, sex, smoking habits, depression, anxiety, and stress. Familial factors examined included income, stressful events, and family functioning. Odds ratios were calculated to describe familial associations with multivariate modeling used to examine the influence of other carer and family factors. ResultsLifetime prevalence of back pain was 46.5% for adolescents and 72% for their carers. Having a carer with back pain increased the risk of back pain for adolescents, and this was magnified if both carers had back pain (odds ratio 1.61). Adolescent back pain was not associated with primary carer age, sex, depression, anxiety, or stress but was related to family stressful events. However, these other factors did not diminish the association between carer back pain and adolescent back pain. DiscussionCarer experience of back pain is clearly associated with adolescent experience of back pain. Although other carer and family factors are also associated, the carers back pain experience is not a surrogate measure of these other factors suggesting other genetic and behavioral mechanisms may be important for adolescent back pain development.

Achilles tendinopathy in club runners.

Ultrasound (US) changes within the Achilles tendon are present in asymptomatic Achilles individuals. We assessed the association of US signs with symptoms of Achilles tendinopathy in a study group of club level running athletes and in a control group of athletes training at least 2 times per week. The Achilles tendon was assessed in its entirety on longitudinal US scans, at the musculotendinous junction (MTJ), the calcaneal insertion site, and at a midtendon point. 25 middle distance runners, 19 males and 6 females, aged from 18 to 58, were enrolled in each group. When compared to control athletes, club level runners presented significantly increased tendon thickness (p=0.046) at the musculo-tendinous junction, and increased tendon thickness, with no statistical significance, at the other landmarks points. Although club level runners were significantly more symptomatic and predisposed to develop signs of tendinopathy than control athletes (p=<0.001), ultrasound abnormalities were not significantly associated with local symptoms complained at the US investigation time. Prospective studies on asymptomatic athletes are needed to define the predictive value of US signs of Achilles tendinopathy in the development of symptoms in the long-term.

Fitness, motor competence and body composition as correlates of adolescent neck/shoulder pain: an exploratory cross-sectional study

BackgroundAdolescent neck/shoulder pain (NSP) is a common and sometimes debilitating problem. Several risk factors for this condition have been investigated, but no studies have previously evaluated associations between fitness, motor competence, body composition and adolescent NSP.Methods1608 males and females of mean age 14 years answered questions on their history of NSP (4 measures), and were tested for aerobic fitness, upper and lower limb power, trunk endurance, grip strength, shoulder flexibility, motor competence and anthropometric factors. Univariate and multivariate logistic regressions were used to test for associations between NSP and physical variables.ResultsThere were significant gender differences for most physical and pain variables. After multivariate analysis, males had lower odds of NSP if they had reduced back endurance [OR: 0.66 (95% CI: 0.46–0.97)], reduced persistent control [0.42 (0.19–0.95], and increased muscle power [0.33 (0.12–0.94)], and higher odds of NSP if they had a higher basketball throw [2.47 (1.22–5.00)] and jump performance [3.47 (1.55–7.74)]. Females had lower odds for NSP if they had a reduced jump performance [0.61(0.41–0.92)], a better basketball throw [0.60(0.40–0.90)], lower shoulder flexibility [0.54 (0.30–0.98)] and a higher aerobic capacity [0.61 (0.40–0.93)], and higher odds for NSP if they had greater abdominal endurance [1.57(1.07–2.31)] and greater bimanual dexterity [1.77(1.18–2.65)]. Females showed a U shaped relationship between NSP and back endurance [low: 2.12 (1.20–3.74); high 2.12 (1.18–3.83)].ConclusionAdolescent NSP was associated with fitness and motor competence, although the associations varied with gender, and their strength was limited.