Validity of a pictorial perceived exertion scale for effort estimation and effort production during stepping exercise in adolescent children

This is the author's PDF version of an article published in European Physical Education Review ©2002. The definitive version is available at http://epe.sagepub.com.Recent developments in the study of paediatric effort perception have continued to emphasise the importance of child-specific rating scales. The purpose of this study was to examine the validity of an illustrated 1 – 10 perceived exertion scale; the Pictorial Children’s Effort Rating Table (PCERT). 4 class groups comprising 104 children; 27 boys and 29 girls, aged 12.1±0.3 years and 26 boys, 22 girls, aged 15.3±0.2 years were selected from two schools and participated in the initial development of the PCERT. Subsequently, 48 of these children, 12 boys and 12 girls from each age group were randomly selected to participate in the PCERT validation study. Exercise trials were divided into 2 phases and took place 7 to 10 days apart. During phase 1, children completed 5 x 3-minute incremental stepping exercise bouts interspersed with 2-minute recovery periods. Heart rate (HR) and ratings of exertion were recorded during the final 15 s of each exercise bout. In phase 2 the children were asked to regulate their exercising effort during 4 x 4-minute bouts of stepping so that it matched randomly prescribed PCERT levels (3, 5, 7 and 9). Analysis of data from Phase 1 yielded significant (P<0.01) relationships between perceived and objective (HR) effort measures for girls. In addition, the main effects of exercise intensity on perceived exertion and HR were significant (P<0.01); perceived exertion increased as exercise intensity increased and this was reflected in simultaneous significant rises in HR. During phase 2, HR and estimated power output (POapprox) produced at each of the four prescribed effort levels were significantly different (P<0.01). The children in this study were able to discriminate between 4 different exercise intensities and regulate their exercise intensity according to 4 prescribed levels of perceived exertion. In seeking to contribute towards children’s recommended physical activity levels and helping them understand how to self-regulate their activity, the application of the PCERT within the context of physical education is a desirable direction for future research

Social exclusion and transportation in Peachtree City, Georgia

This paper will discuss how, in a small American city, Peachtree City (43km south of Atlanta), the flexibility and relative affordability of electric golf carts, as a viablealternative to the automobile, means that the level at which families and individuals are disadvantaged through their lack of access to public/private transport is effectively lowered. Economic access to golf carts, in of itself, would not be sufficient if it were not for the extensive, highly penetrative and 'ringy' spatial structure of the cart path system, a mostly-segregated, 150 kilometre network. A spatial analysis of this dual transportation system is presented and its implications discussed. The conclusion of this paper is that the duality of the effective spatial structure of the cart path networkand the relative low cost and inherent flexibility of the golf carts combine to reduce transportation-linked social exclusion in Peachtree City. This argument is substantiated, in the final section of the paper, through the evidence of a questionnairedistributed to a random sampling of 1,038 property owners and renters in the city

Protocol for: Sheffield Obesity Trial (SHOT): A randomised controlled trial of exercise therapy and mental health outcomes in obese adolescents [ISRCNT83888112]

Background While obesity is known to have many physiological consequences, the psychopathology of this condition has not featured prominently in the literature. Cross-sectional studies have indicated that obese children have increased odds of experiencing poor quality of life and mental health. However, very limited trial evidence has examined the efficacy of exercise therapy for enhancing mental health outcomes in obese children, and the Sheffield Obesity Trial (SHOT) will provide evidence of the efficacy of supervised exercise therapy in obese young people aged 11–16 years versus usual care and an attention-control intervention. Method/design SHOT is a randomised controlled trial where obese young people are randomised to receive; (1) exercise therapy, (2) attention-control intervention (involving body-conditioning exercises and games that do not involve aerobic activity), or (3) usual care. The exercise therapy and attention-control sessions will take place three times per week for eight weeks and a six-week home programme will follow this. Ninety adolescents aged between 11–16 years referred from a children's hospital for evaluation of obesity or via community advertisements will need to complete the study. Participants will be recruited according to the following criteria: (1) clinically obese and aged 11–16 years (Body Mass Index Centile > 98th UK standard) (2) no medical condition that would restrict ability to be active three times per week for eight weeks and (3) not diagnosed with insulin dependent diabetes or receiving oral steroids. Assessments of outcomes will take place at baseline, as well as four (intervention midpoint) and eight weeks (end of intervention) from baseline. Participants will be reassessed on outcome measures five and seven months from baseline. The primary endpoint is physical self-perceptions. Secondary outcomes include physical activity, self-perceptions, depression, affect, aerobic fitness and BMI

Human activities and biodiversity opportunities in pre-industrial cultural landscapes: relevance to conservation

1. Conservation practices in Europe frequently attempt to perpetuate or mimic the ‘traditional’ forms of management of semi-natural habitats, but with a limited understanding of what these entailed. 2. We review the emerging understanding of ecological processes, structures and management interventions that enhance biodiversity (wildlife) at diverse scales. These are then examined in the context of pre-industrial (c. 1200-1750) land management systems in lowland England, in order to identify historic practices which are likely to have provided important wildlife resources, but which are relatively neglected in current conservation management. 3. Principles enhancing alpha and beta diversity and the conservation status of threatened species, include: structural complexity and heterogeneity at nested spatial scales; physical disturbance and exposure of mineral substrate; nutrient removal; lengthened successional rotations; and spatial variation in grazing regimes. 4. The available evidence suggests that pre-industrial management was generally characterised by: intense resource exploitation and significant levels of biomass harvest; complex nested structural heterogeneity both between and within landscape elements; overlaying of multiple land-uses; and spatial and temporal variability in management, rendering the concept of long-lived ‘traditional’ practice problematic. Grazing patterns are poorly understood but intensive grazing was probably the norm in most contexts, potentially resulting in simplified sward structures and suppressed ecotonal vegetation. 5. In much of the pre-industrial period, early-successional and disturbed microhabitats were widespread but ungrazed or lightly grazed herb-rich vegetation may have been limited, the converse of current conservation management. The key change since then has been homogenisation at multiple scales, coupled with reduction of specific niches and conditions. 6. Synthesis and applications: In adopting perceived ‘traditional’ management practices, modern conservation rarely achieves the range and complexity of conditions that were present in the past. A better understanding of past practices allows more favourable management of those surviving semi-natural habitats where historic assemblages persist – with greater emphasis on physical disturbance and variability in prescriptions both temporally and spatially. When creating or restoring habitats, after interruption of management sufficiently long for dependent assemblages to be lost, better appreciation of historic management encourages novel forms of intervention to enhance biodiversity, with emphasis on complex structural and spatial heterogeneity at nested scales, biomass removal and nutrient reduction. These two distinct but overlapping approaches are complementary to the use of large herbivores to create and maintain dynamic ecotonal mosaics in the manner advocated by some proponents of ‘rewilding’

Mental Health Through Movement

Children’s mental health: ‘has become an issue of real concern, in the media and to both politicians and NHS leaders, over the last five years in particular. It has prompted numerous inquiries, reports, recommendations and pledges by politicians and NHS leaders to improve the situation’: https://www.theguardian.com/society/2018/nov/22/what-is-happening-withchildrens-mental-health On July 1st 2019, the Local Government Association released statistics to show that: ‘There were 205,720 cases where a child was identified as having a mental health issue in 2017/18, compared with 133,600 in 2014/15- up 54%’: https://www.local.gov.uk/about/news/councils-seeing-more-560-child-mentalhealth-cases-every-day It is within this context that the All-Party Parliamentary Group on A Fit and Healthy Childhood presents its 14th Report: ‘Positive Mental Health Through Movement’. With 1 in 10 children now having a mental health diagnosis and 1 in 4 an undiagnosed mental health issue, this, our third Report on the issue of child mental health, addresses the link between positive mental health and physical activity and movement experiences at a time when, paradoxically, today’s children and young people are more inactive and play less than ever before. The growing recognition of a link between mental health and movement is fortuitous because from September 2019, health education in English schools will be statutory alongside the expectation that they will offer their pupils at least 30 ‘active minutes’ per day. The APPG on A Fit and Healthy Childhood welcomes the change whilst recognising that those responsible for implementing the new strategy (including practitioners and families) will need guidance as they help children to develop individual strategies to address future adverse events and foster the positive sense of self that will enable them to lead fulfilled, healthy lives. This Report is therefore presented as a practical contribution to an essential debate. It offers new strategies against the persistence of historical and traditional ways of thinking; examines and collates best practice in the devolved Home Countries as well as the wider world and discusses exactly what is required to ensure that future child mental health strategy is holistic. It is respectful of equalities and is aware that the successful outcome of policies is entirely dependent upon the expertise and confidence of those tasked with the responsibility of delivering them. As the 21st century advances, we consider the effects of the digital age and its impact on children and young people’s mental health and wellbeing and the crucial role of parents and carers who want the best for their children in a societal climate where, all too often, fears of ‘nanny state’ meddling serve to isolate families who suffer in silence – until a disaster that may have been all too predictable and preventable overtakes them, making a private grief a public concern. The trajectory of progress in mental health policy has been ‘stop start’ rather than linear, with legislative change in 1959 and 1983, an increase in spending from 1997- 2010 and radical changes to child and adolescent mental health services (CAMHS) in 2000. The Wessely Independent Review of the Mental Health Act is another such milestone: https://www.gov.uk/government/groups/independent-review-of-the-mentalhealth-act The APPG on A Fit and Healthy Childhood anticipates that the Government will fulfil its pledge to parents, children and practitioners by introducing much needed mental health legislation - and that our trio of Reports and the holistic theme of this one will help to inform a strategy that works for 21st century children

Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; Impact on weight, physical activity, cardio-respiratory fitness and psychosocial wellbeing.

BACKGROUND: Severe adolescent obesity (BMI>99.6th centile) is a significant public health challenge. Current non-invasive treatments, including community-based lifestyle interventions, are often of limited effectiveness in this population, with NICE guidelines suggesting the use of bariatric surgery as the last line of treatment (NICE, 2013). Health professionals are understandably reluctant to commission bariatric surgery and as an alternative, the use of an intra-gastric balloon as an adjunct to a lifestyle programme might offer a reversible, potentially safer and less invasive option. OBJECTIVES: Explore the use of an intra-gastric balloon as an adjunct to a lifestyle support programme, to promote weight loss in severely obese adolescents. Outcomes included Weight loss, Waist and Hip measurements, psychosocial outcomes including health related quality of life and physical self-perceptions, physical activity and cardiorespiratory fitness. METHOD: Non-randomised pilot study. Results: 12 severely obese adolescents (5 males, 7 females; mean age 15yrs; BMI >3.5 s.d.; puberty stage 4 or more) and their families were recruited. Mean weight loss at 12 months (n=9) was 3.05 kg±14.69; d=0.002, P=0.550, and a BMI Z-score (n=12) change of 0.2 s.d.; d=0.7, P=0.002 was observed at 6 months with a large effect, but was not sustained at 12 months (mean change 0.1 s.d.; d=0.3, P=0.146 ) At 24 months (n=10) there was a weight gain from baseline of +9.9 kg±1.21 (d=0.4; P=0.433). Adolescent and parent HRQoL scores exceeded the minimal clinical important difference between baseline and 12 months for all domains but showed some decline at 24 months. CONCLUSION: An intra-gastric balloon as an adjunct to a lifestyle support programme represents a safe and well tolerated treatment approach in severely obese adolescents, with short-term effects on weight change. Improvements in psychosocial health, physical activity and cardiorespiratory fitness were maintained at 12 months, with varying results at 24 months

Prediction of peak oxygen uptake in children using submaximal ratings of perceived exertion during treadmill exercise

Purpose: This study assessed the utility of the Children’s Effort Rating Table (CERT) and the Eston-Parfitt (EP) Scale in estimating peak oxygen uptake (V• O2peak) in children, during cardiopulmonary exercise testing (CPET) on a treadmill. Methods: Fifty healthy children (n=21 boys; 9.4 ± 0.9 y) completed a continuous, incremental protocol until the attainment of V• O2peak. Oxygen uptake (V• O2) was measured continuously, and Ratings of Perceived Exertion (RPE) were estimated at the end of each exercise stage using the CERT and the EP Scale. Ratings up to- and including RPE 5 and 7, from both the CERT (CERT 5, CERT 7) and EP Scale (EP 5, EP 7), were linearly regressed against the corresponding V• O2, to both maximal RPE (CERT 10, EP 10) and terminal RPE (CERT 9, EP 9). Results: There were no differences between measured- and predicted V• O2peak from CERT 5, CERT 7, EP 5 and EP 7 when extrapolated to either CERT 9 or EP 9 (P &gt; .05). Pearson’s correlations of r = 0.64-0.86 were observed between measured- and predicted V• O2peak, for all perceptual ranges investigated. However, only EP 7 provided a small difference when considering the Standard Error of Estimate, suggesting that the prediction of V• O2peak from EP 7 would be within 10% of measured V• O2peak. Conclusions: Although robust estimates of V• O2peak may be elicited using both the CERT and EP Scale during a single CPET with children, the most accurate estimates of V• O2peak occur when extrapolating from EP 7