Exercise Interventions For Children Research Articles

Effects of different exercise modalities on pediatric and adolescent populations with developmental disorders: a network meta-analysis of randomized controlled trials.

Combat sports, ball sports, neurodevelopmental motor training, and aquatic exercise may be effective exercise modalities for improving symptoms in children and adolescents with developmental disorders. However, the degree of improvement can vary among individuals with specific developmental disorders. Therefore, precise assessment of the individual symptoms of children or adolescents is crucial before selecting specific exercise interventions. PROSPERO (CRD42024545673). • Many studies indicate that exercise as an intervention can have positive effects on individuals with developmental disorders, such as ADHD and autism. However, reported effects vary, and there is no clear consensus on the optimal exercise intervention method yet. • Through a comprehensive network meta-analysis, various exercise interventions for children and adolescents with developmental disorders were compared to determine the optimal approach. The study found that combat sports, ball sports, neurodevelopmental motor training, and aquatic exercise could potentially be effective modalities for improving symptoms in this population.

Designing sport and physical activity interventions for children and adolescents with ADHD: a conceptual framework

PurposeThis paper aims to present a theoretical framework and underpinning evidence to support researchers and practitioners to systematically design sport and exercise interventions.Design/methodology/approachThe framework highlights the theoretical underpinnings and practical feasibility considerations that are important when designing sport and exercise interventions for children and adolescents with attention deficit hyperactivity disorder (ADHD).FindingsFuture research may wish to apply and evaluate the utility of this framework and research and practice and make recommendations for further refinement.Originality/valueThe quality and strength of conclusions from this body of research has been undermined by a lack of methodological quality and clarity in these studies. One criticism has been the lack of an evidence based, transparent and consistent approach to the design of physical activity and sport interventions and selection of outcome measures. This paper will facilitate the transparent and evidence-based decision-making to guide the design of sport/physical activity interventions for children/adolescents with ADHD.

Effect of aerobic exercise on the improvement of executive function in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis.

Aerobic exercise (AE) interventions are beginning to be used as an emerging adjunctive treatment modality in the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD). However, to date, there is no substantial evidence to support the improved effects of aerobic exercise intervention in children with ADHD aged 6-12 years. This study aims to investigate the effect of aerobic exercise therapy on executive function in children with attention deficit hyperactivity disorder aged 6-12 years. We conducted a systematic review and meta-analysis using PubMed and Web of Science. The cut-off date was June 1, 2023. The aim was to assess the impact of aerobic exercise interventions on children with ADHD and all randomized controlled trials eligible for aerobic exercise interventions for children with ADHD were included. Nine randomized controlled trials were screened for eligibility for systematic evaluation, and the nine studies were assessed for risk of bias using the PEDro score and the GRADE Quality of Evidence Evaluation System for quality grading of outcome indicators. After testing for heterogeneity, a random-effects model was selected for analysis. Finally, meta-analyses and regression analyses were performed on the core functions (inhibitory control, cognitive flexibility, and working memory) and subgroups of the nine studies on executive function using Revman 5.4 and Stata 16.0. The risk of bias evaluation showed a mean PEDro score of 7.78, and of the nine studies, two were rated as having excellent methodological quality, while the remaining seven had a good level of evidence, and the GRADE evidence evaluation showed that the outcome indicators were all of moderate quality. Inhibitory control [SMD = 0.83,95% CI (0.37-1.29), Z = 3.51, p = 0.0005], cognitive flexibility [SMD = 0.65,95% CI (0.37-0.93), Z = 4.58, p < 0.00001], and working memory [SMD = 0.48,95% CI (0.02-0.95), Z = 2.03, p = 0.04] were statistically significant, with effect sizes of moderate or higher; furthermore, in subgroup analyses type of intervention, duration, intensity, and medication use had different effects on inhibitory control and cognitive flexibility, and the combined IC, CF statistic found that a single category of aerobic exercise ( β = 0.867, p < 0.001), moderate intensity ( β = 0.928, p < 0.001), 6-12 weeks (β = 0.804, p < 0.001), 60-90 min ( β = 0.894, p < 0.001), and the use of medication ( β = 1.202, p = 0.002) were better for overall improvement in EF. Aerobic exercise therapy significantly improved executive functioning in children with ADHD, showing above moderate effect sizes especially in inhibitory control, cognitive flexibility, and working memory. Aerobic exercise therapy can be used as a reference in improving executive function in children with ADHD, but given the limitations of this study, it should be used with caution when applied in clinical settings.

Effects of Family-Professional Partnerships in Adapted Physical Education on the Fundamental Motor Skills, Adaptive Behaviors, and Physical Activity Levels of Children with Autism Spectrum Disorder and on Parent Satisfaction.

This study aimed to explore the effect of family-professional partnerships in adapted physical education on the fundamental motor skills, physical activity levels, and adaptive behaviors of children with autism spectrum disorder (ASD) and on parental satisfaction. A randomized controlled trial design was used, with pre-and post-intervention evaluations. Participants (n = 40), including children with ASD and their parents, were divided into three groups: (a) a family-school group (FSG-A, n = 14), (b) a school group (SG-B, n = 13), and (c) a control group (CG-C, n = 13). After 12 weeks of intervention, the within-group comparison revealed that the FSG-A performed better than the SG-B and CG-C for all variables. The among-group comparison further revealed that the FSG-A had greater fundamental motor skill scores than the SG-B (p = 0.021) and CG-C (p < 0.001), had greater adaptive behavior and family-professional partnership scores than the SG-B and CG-C (p < 0.001 for all), and had higher physical activity levels than the SG-B (p < 0.05) and CG-C (p < 0.001). This study underscores the significance of robust family-professional partnerships in exercise interventions for children with ASD.

Changes in Behaviours Following an Integrative Exercise Intervention in Children with Autism Spectrum Disorder: The Influence of Symptom Severity

ABSTRACT The current study investigated the effects of an integrative exercise intervention on the behaviours in children with autism spectrum disorder (ASD), and if they were influenced by ASD symptom severity. Sixty-six children (7.56 ± 2.03 yrs.) with ASD were enrolled and categorised as having mild (n = 22), moderate (n = 18) or severe (n = 26) symptoms of ASD by teachers using the Gilliam Autism Rating Scale 2nd edition. Participants completed a school-based, eight-week, integrative exercise intervention, consisting of three, one-hour sessions per week. Teachers rated the symptoms of ASD in each participant pre- and post-intervention using the Aberrant Behaviour Checklist. There were significant improvements in behaviours post-intervention for all children (p < 0.05; r = 0.20–0.33); however, sub-group analysis indicated that participants with severe ASD experienced greater improvements in irritability, social withdrawal, stereotypic behaviour, and inappropriate speech (p < 0.05). The findings highlight the benefits of school-based integrative exercise interventions for improving behaviours in children with ASD.

Effects of Group Exercise Intervention on Quality of Life and Physical Parameters in Patients with Childhood Cancer: A Systematic Review.

Although the survival rates of childhood cancer are increasing, children diagnosed as having cancer experience psychological and physical problems and a declining quality of life (QOL). A systematic review of PubMed databases was conducted up to September 2023 to identify studies reporting the effects of group exercise intervention in children with cancer. The inclusion criteria were pre-specified, including children aged ≤19 years old who received group exercise intervention and interventional studies written in English. Studies involving non-exercise intervention or non-group intervention were excluded. Five studies were included in the present review. In three studies, QOL and physical parameters were improved after group exercise intervention, and in two studies, only physical parameters were improved. Improvements in QOL were achieved through psychosocial variables, improved scores of subscales of pain and hurt, nausea, and procedure-related anxiety, and reduced cancer-related fatigue. All studies had high numbers of participants who completed the intervention. However, all studies showed a high risk of bias regarding the selection of the reported results, and most studies showed a high risk of bias regarding deviations from the intended intervention and outcome measurement. The reviewed studies showed that group exercise intervention for children with cancer could improve their QOL and/or physical parameters.

Supervised machine learning: A new method to predict the outcomes following exercise intervention in children with autism spectrum disorder

The individual differences among children with autism spectrum disorder (ASD) may make it challenging to achieve comparable benefits from a specific exercise intervention program. A new method for predicting the possible outcomes and maximizing the benefits of exercise intervention for children with ASD needs further exploration. Using the mini-basketball training program (MBTP) studies to improve the symptom performance of children with ASD as an example, we used the supervised machine learning method to predict the possible intervention outcomes based on the individual differences of children with ASD, investigated and validated the efficacy of this method. In a long-term study, we included 41 ASD children who received the MBTP. Before the intervention, we collected their clinical information, behavioral factors, and brain structural indicators as candidate factors. To perform the regression and classification tasks, the random forest algorithm from the supervised machine learning method was selected, and the cross validation method was used to determine the reliability of the prediction results. The regression task was used to predict the social communication impairment outcome following the MBTP in children with ASD, and explainable variance was used to evaluate the predictive performance. The classification task was used to distinguish the core symptom outcome groups of ASD children, and predictive performance was assessed based on accuracy. We discovered that random forest models could predict the outcome of social communication impairment (average explained variance was 30.58%) and core symptom (average accuracy was 66.12%) following the MBTP, confirming that the supervised machine learning method can predict exercise intervention outcomes for children with ASD. Our findings provide a novel and reliable method for identifying ASD children most likely to benefit from a specific exercise intervention program in advance and a solid foundation for establishing a personalized exercise intervention program recommendation system for ASD children.

Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study.

To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.

Comparative effectiveness of different types of exercise in reducing arterial stiffness in children and adolescents: a systematic review and network meta-analysis

ObjectiveArterial stiffness is an early and detectable marker of vascular changes leading to atherosclerotic cardiovascular disease (ACVD). Our objective was to compare the effectiveness of different types of exercise in...

Meta-analysis on the effects of moderate-intensity exercise intervention on executive functioning in children.

We evaluated the effect of moderate-intensity exercise intervention in children and summarized the optimal exercise intervention program. Five significant databases, namely, Web of Science, PubMed, and China National Knowledge Infrastructure, were searched, and the literature was screened strictly according to the inclusion and exclusion criteria and analyzed using Stata 15.1 software. There were 25 studies from 22 articles, with a total of 2118 subjects included in the results. According to the meta-analysis, exercise intervention effectively improved children's working memory [SMD = -1.05, 95% CI (-1.26, -0.84)] and cognitive flexibility [SMD = -0.86, 95% CI (-1.04, -0.69)], with a minor improvement in inhibitory control [SMD = -0.55, 95% CI (-0.68, -0.42)]. a) Improvements in children's working memory and cognitive flexibility by moderate-intensity exercise interventions reached large effect sizes, and improvements in inhibitory control obtained moderate effect sizes. b) Better improvement in working memory for children aged 10 to 12 years than for children aged 6 to 9 years and better cognitive flexibility for children aged 6 to 9 years than for children aged 10 to 12 years. c) Exercise intervention programs lasting 8 to 12 weeks, 3 to 4 times/week, and 30 min/time are most effective in improving executive function in children.

Design and rationale of re-energize fontan: Randomized exercise intervention designed to maximize fitness in fontan patients

In this manuscript, we describe the design and rationale of a randomized controlled trial in pediatric Fontan patients to test the hypothesis that a live-video-supervised exercise (aerobic+resistance) intervention will improve cardiac and physical capacity; muscle mass, strength, and function; and endothelial function. Survival of children with single ventricles beyond the neonatal period has increased dramatically with the staged Fontan palliation. Yet, long-term morbidity remains high. By age 40, 50% of Fontan patients will have died or undergone heart transplantation. Factors that contribute to onset and progression of heart failure in Fontan patients remain incompletely understood. However, it is established that Fontan patients have poor exercise capacity which is associated with a greater risk of morbidity and mortality. Furthermore, decreased muscle mass, abnormal muscle function, and endothelial dysfunction in this patient population is known to contribute to disease progression. In adult patients with 2 ventricles and heart failure, reduced exercise capacity, muscle mass, and muscle strength are powerful predictors of poor outcomes, and exercise interventions can not only improve exercise capacity and muscle mass, but also reverse endothelial dysfunction. Despite these known benefits of exercise, pediatric Fontan patients do not exercise routinely due to their chronic condition, perceived restrictions to exercise, and parental overprotection. Limited exercise interventions in children with congenital heart disease have demonstrated that exercise is safe and effective; however, these studies have been conducted in small, heterogeneous groups, and most had few Fontan patients. Critically, adherence is a major limitation in pediatric exercise interventions delivered on-site, with adherence rates as low as 10%, due to distance from site, transportation difficulties, and missed school or workdays. To overcome these challenges, we utilize live-video conferencing to deliver the supervised exercise sessions. Our multidisciplinary team of experts will assess the effectiveness of a live-video-supervised exercise intervention, rigorously designed to maximize adherence, and improve key and novel measures of health in pediatric Fontan patients associated with poor long-term outcomes. Our ultimate goal is the translation of this model to clinical application as an "exercise prescription" to intervene early in pediatric Fontan patients and decrease long-term morbidity and mortality.

Effectiveness of Physical Exercise Interventions on Pulmonary Function and Physical Fitness in Children and Adults with Cystic Fibrosis: A Systematic Review with Meta-Analysis.

Objective: Physical exercise is associated with several benefits in the treatment of cystic fibrosis (CF), associated with a reduction in patient mortality. The aim of this systematic review was to determine the effectiveness of exercise interventions on physical condition and lung function in children and adults with CF to establish the most appropriate type and dose of physical exercise used so far. Methods: The studies included were randomized controlled trials with physical exercise interventions performed with children or adults with CF, analyzing the effects on pulmonary function, cardiorespiratory capacity, and muscle strength. The variables analyzed in at least four studies in the same population (children or adults) with the same measuring test were included in the meta-analysis. Results:Pulmonary function: There were no changes in the forced expiratory volume 1 s, but mouth expiratory/inspiratory pressures were improved in some studies. Physical fitness: In children, the interventions did not manage to improve the VO2peak (SMD = 0.22; 95%CI: -0.25 to 0.68; p = 0.73) but improved muscle strength. In adults, physical exercise interventions based on high-intensity aerobic training showed positive results in the VO2peak, and in some muscle strength outcomes. Conclusions: Exercise interventions in children and adults with CF are effective in improving muscle strength, cardiovascular capacity, and respiratory muscle function. However, they do not achieve improvements in lung function. The most effective programs are those using strength training or cardiovascular high-intensity interval training, although to date there have been few such interventions.

IMPROVEMENT OF THE HEALTH OF PEOPLE WITH AUTISM SPECTRUM DISORDER BY EXERCISE

ABSTRACT Introduction Autism Spectrum Disorder (ASD) is a typical neurological development disorder of the brain, exhibiting social communication and communication disorders, narrow interests, and repetitive, stereotyped behaviors. Movement development is an important evaluation index for the development of early motor function in children, so exercise intervention in children with ASD is of great significance. Objective This article conducts exercise intervention on children with ASD to stimulate their exercise ability and improve their self-care ability. Methods The article randomly grouped 24 children with an autism spectrum disorder. The experimental group received exercise intervention, and the control group had regular classes. After the experiment is completed, the influence of exercise intervention on children with autism is analyzed. Results The motor skills of the two groups of children were different after the intervention. The motor skills of the experimental group improved more significantly. Conclusion Exercise intervention can significantly improve the motor skills of children with an autism spectrum disorder. To evaluate whether the large-muscle motor skill learning of children with ASD and its influence on basic motor skills can be transferred to provide a reference for related motor intervention. Level of evidence II; Therapeutic studies - investigation of treatment results.

Influences of exercise interventions on overweight and obesity in children and adolescents.

Conflicting findings of the effects of exercise on body fat, free fat mass, insulin, insulin resistance, and physical fitness for overweight and obesity in children and adolescents. The purpose of this meta-analysis was to investigate the effects of exercise interventions in children and adolescents with overweight and obesity depending on exercise type and to build effective exercise interventions to reduce risks of metabolic disorders. Databases were used to find eligible studies regarding the effects of exercise interventions on overweight and obesity in children and adolescents in randomized controlled trails. Effect size was calculated using the standardized mean difference statistic and heterogeneity across studies was estimated using the Q statistic. A total of 27 studies met the inclusion criteria. Children and adolescents with overweight and obesity who participated in aerobic exercise had reduced body mass index, % body fat, fasting insulin, free fat mass, TNF-α, and IL-6, and increased physical fitness compared with control groups. Reduced free fat mass in resistance exercise was not found. Glucose, insulin resistance, blood pressure, C-reactive protein (CRP), and blood markers including total cholesterol (TC), triglyceride, LDL, and HDL did not have significant change. Average exercise interventions were aerobic exercise, 3 times/week, 60min, and 36weeks of exercise period. Aerobic exercise may be beneficial to reduce body fat, fasting insulin, and inflammatory markers, and increased physical fitness for overweight and obesity in childhood and adolescence, but resistance exercise may be added, which can help avoid muscle loss in children and adolescents with overweight and obesity.

A Participation-Focused Exercise Intervention for Children with Neurodevelopmental Disorders: Feasibility, Acceptability, and Impact on Sleep and Wellbeing

Sleep-related difficulties are common in children with neurodevelopmental disabilities. Poor sleep health is associated with detrimental impacts not only for the child/young person, but also their family members. Exercise is considered to be important for sleep health, improving duration and quality of sleep in adult studies, however there is limited literature on impact in children with neurodevelopmental disabilities, and barriers to participation exist for this group. We set out to test the feasibility and acceptability of an exercise-intervention for children with neurodevelopmental disorders and troublesome sleep, whilst also evaluating impact on child’s sleep and whole family wellbeing. Design: Feasibility study. Setting: Community-based Sleep Clinic for children with neurodevelopmental disorders. Patients: Total 15 children aged 5 years 0 months to 15 years 11 months. Intervention: A 10-week exercise intervention, providing one swimming session, and one dry-sports session (1.5 hours per session) per week (overall 20 x 1.5 hours). Main outcome measures: Mixed-methods design; primary outcomes of feasibility and acceptability measured by ability to run intervention, attrition rate, and semi-structured parent-completed questionnaire of acceptability, appropriateness, and free-text comments. Secondary outcomes of impact on sleep and wellbeing measured by pre-and post-intervention parent-reported diary of child’s sleep (14-nights) and semi-structured parent-reported Likert-scale questionnaire for impact on child’s sleep, wellbeing, mood and behaviour, and family wellbeing. Descriptive analyses applied to the generated data. Primary outcomes: Twelve of 15 recruited participants took part on a regular basis; attendance rate remained high throughout the 10 weeks at swimming sessions, but was lower at dry-sports sessions. Parent-reported Likert-scale measures found the intervention to be acceptable to families and appropriate to their child’s needs. All attending families were interested in future sessions if these were to be offered. Secondary outcomes: Average parent-reported sleep-onset latency, night-wakings, and estimated overall sleep duration of child improved over the course of the intervention. Families’ perceived impact on child and family wellbeing was overwhelmingly positive. Provision of a participation-focused exercise intervention for children with neurodevelopmental disorders in our area has been possible, and has been well-received by families. Families reported positive impacts on child’s sleep, wellbeing, and family wellbeing over the course of the intervention. Perceived barriers to completing the intervention included competing family priorities, family stressors, language barriers, and transport barriers. Overcoming such barriers to participation in physical activity for children with neurodevelopmental disorders continues to be important.

The effect of exercise and motor interventions on physical activity and motor outcomes during and after medical intervention for children and adolescents with acute lymphoblastic leukemia: A systematic review.

Children with acute lymphoblastic leukemia (ALL) experience detrimental effects on motor function during and after chemotherapy. The objective of this systematic review was to evaluate the effect of exercise and motor interventions on physical activity and motor outcomes of children with ALL during and after chemotherapy. Ten databases were searched. Nineteen studies were included: 11 randomized clinical trials (RCT), 2 controlled clinical trials (CCT), and 6 cohort studies. Participants included 508 children with ALL. Between-group results from RCTs and CCTs supported that exercise and motor intervention improved: fatigue during acute chemotherapy; physical activity, range of motion (ROM), strength, bone mineral density, aerobic capacity, and fatigue during maintenance chemotherapy; functional mobility, ROM, strength, and aerobic capacity during post-treatment survivorship; and participation, physical activity, ROM, strength, and coordination during multiple-phase interventions. Low quality evidence supports the efficacy of motor and exercise interventions for children and adolescents with ALL.

자폐성장애 아동의 사회성 증진을 위한 운동 중재 연구 분석

본 연구의 목적은 국내에서 발표된 자폐성장애 아동의 사회성 증진을 위한 운동 중재 연구를 분석하여 자폐성장애 아동의 사회성 증진을 위한 운동 중재 연구의 방향을 제안하는 것이다. 이를 위해 최근 20년간 (2010년∼2019년 4월) 국내에서 발표된 연구 741편을 Systematic review 방법을 활용하여 분석 준거에 따라 분류하고 실태를 분석 하였다. 그 결과 총 9편의 관련 연구가 선정되었고, 만 8∼12세 자폐성장애 아동을 대상으로 하는 단일 집단 연구 가 다수를 차지하고 있었다. 운동 중재는 감각운동, 심리운동, 신체운동, 재활체육의 형태로 제공되고 있었으며, 사 회성 변인으로 상동행동, 문제행동, 자해행동, 자발적 언어행동, 부적응 행동, 의사소통기능의 변화가 관찰되고 있 었다. 운동 중재는 문제행동과 의사소통 기능에 효과적인 것으로 나타났으며, 자폐성장애 정도가 심각할수록 참여 자의 나이가 어릴 수도 운동 중재의 효과가 크게 나타나는 것으로 분석되었다. 이러한 결과를 반영하여 자폐성장애 아동의 사회성 증진을 위한 운동 중재의 시사점을 논의하고 관련 연구의 방향을 제안하였다.

Assessment of the effects of walking as an exercise intervention for children and adolescents with cancer: A feasibility study.

To examine the effects of walking exercise on exercise tolerance, fatigue, sleep quality, and quality of life (QOL) for children and adolescents with cancer. A 6-week walking exercise regimen was implemented in pediatric hematological and oncological wards and in clinics of a medical center in Taiwan. A 6-min walk test (6MWT), fatigue, sleep quality, and QOL were measured at baseline and for six subsequent weeks. Adherence to the walking exercise regimen was achieved by 72-89% of the participants in this study. Significant improvements in exercise tolerance were observed after two weeks and they continued through week 6 (F = 17.07, p < 0.001). Both cognitive fatigue and general fatigue were significantly improved after six weeks of walking exercise (t = 2.41, p = 0.02; t = 2.76, p = 0.01), while sub-scores for sleep/rest fatigue did not improve. No significant impact on sleep quality or QOL was observed. Walking exercise is a feasible and tolerable intervention that should be considered for children and adolescents with cancer. Here, a 6-week walking exercise regimen increased exercise tolerance and improved fatigue. We recommend that walking exercise should be promoted during hospitalization and at home to alleviate fatigue.

\u201cI just want to get better\u201d: experiences of children and youth with juvenile idiopathic arthritis in a home-based exercise intervention

BackgroundPhysical activity is essential for ensuring optimal physical function and fitness in children with juvenile idiopathic arthritis (JIA). Although exercise intervention trials informed current clinical practice, few studies addressed why children with JIA do or do not participate in exercise interventions. We aimed to describe perceived barriers and facilitators to the uptake and adherence to a 6-month home-based exercise intervention for children diagnosed with JIA and their parents.MethodsA convenience sample of children (n = 17) and their parents (n = 17) were recruited from a group of 23 child-parent dyads participating in an exercise intervention study; the Linking Exercise, Activity and Pathophysiology Exercise Intervention (LEAP-EI) study. Child-parent dyads completed in-depth semi-structured one-to-one interviews with a trained interview moderator prior to starting the exercise program and 11 dyads completed follow-up interviews at the end of the 6-month program. We also conducted ‘exit’ interviews with one child-parent dyad, one child and one parent following three participants’ withdrawal from the exercise intervention. Interviews were transcribed and transcripts were analyzed using a five-step framework analysis to categorize data into themes.ResultsThematic analysis of pre-exercise program interview transcripts revealed three reasons child-parent dyads initiated the exercise program: 1) potential health benefits, 2) selflessness and 3) parental support. Analysis of post-exercise intervention transcripts identified four main themes within a priori themes of barriers and facilitators to program adherence (median of 46.9%; 5.4, 66.7 IQR): 1) parental support, 2) enjoyment, 3) time pressures (subthemes: time requirement of exercise, scheduling, forgetting) and 4) physical ailments.ConclusionMajor barriers to and facilitators to exercise for children with JIA fell into three categories: personal, social and programmatic factors. These barriers were not unlike those that emerged in previous exercise intervention trials with healthy children and youth. There is a need to develop effective strategies to engage children in physical activity and to overcome barriers that prevent them from doing so. Future initiatives may potentially engage children in developing solutions to enhance their participation in and commitment to physical activity.

Web-Based Motor Intervention to Increase Health-Related Physical Fitness in Children With Congenital Heart Disease: A Study Protocol.

Objective: Exercise interventions are underutilized in children with congenital heart disease (CHD) especially when the primary outcome is not peak oxygen uptake. Most of the studies are restricted to a low sample size and proximity of the patients to the study centers. Now eHealth approaches bear a promising but also challenging opportunity to transmit such intervention programs to participants, and check progress and compliance from remote. This study will aim to improve health-related physical fitness (HRPF) with a 24 weeks web-based exercise intervention.Methods and Design: The current study is planned as a randomized control trial (RCT) with a crossover design and the aim to improve functional outcome measures. It also estimates adherence and feasibility in patients with CHD in this web-based exercise/motor intervention over 24 weeks. Primary outcome will be the improvement of HRPF. Secondary outcomes are, functional and structural arterial stiffness measures and health-related quality of life. Thus, 70 children from 10 to 18 years with CHD of moderate and complex severity will be recruited and allocated randomly 1:1 in two study arms after baseline testing for their HRPF, arterial stiffness measures and health-related quality of life. For 24 weeks, participants in the intervention arm will receive three weekly exercise video clips of 20 min each. Every video clip comprises 20 child-oriented exercises which have to be executed for 30 s followed by a recovery period of 30 s. Each session will start with 3–4 warming-up exercises, followed by 10–12 strength and flexibility exercises, and ending with 3–4 min of cool down or stretching tasks. Continuous video clips will be streamed from a web-based e-Learning platform. The participant simply has to imitate the execution and follow some short advices. After each session, a brief online survey will be conducted to assess perceived exertion and feasibility.Discussion: The study will help to determine the efficacy and applicability of a web-based exercise intervention in children with CHD in regard to functional outcome measures. In addition, it will outline the effectiveness of remote monitoring, which provides a cost effective approach to reach patients with CHD that are low in prevalence and often do not live in close proximity to their tertiary center.Trial Registration: https://ClinicalTrials.gov Identifier: NCT03488797.