School-based high-intensity interval training programs in children and adolescents: A systematic review and meta-analysis

Purpose1) To investigate the effectiveness of school-based high-intensity interval training (HIIT) interventions in promoting health outcomes of children and adolescents compared with either a control group or other exercise modality; and 2) to explore the intervention characteristics and process outcomes of published school-based HIIT interventions.MethodsWe searched Medline, Embase, CINAHL, SPORTDiscus, and Web of Science from inception until 31 March 2021. Studies were eligible if 1) participants aged 5–17 years old; 2) a HIIT intervention within a school setting ≥ 2 weeks duration; 3) a control or comparative exercise group; 4) health-related, cognitive, physical activity, nutrition, or program evaluation outcomes; and 5) original research published in English. We conducted meta-analyses between HIIT and control groups for all outcomes with ≥ 4 studies and meta-regressions for all outcomes with ≥ 10 studies. We narratively synthesised results between HIIT and comparative exercise groups.ResultsFifty-four papers met eligibility criteria, encompassing 42 unique studies (35 randomised controlled trials; 36 with a high risk of bias). Meta-analyses indicated significant improvements in waist circumference (mean difference (MD) = -2.5cm), body fat percentage (MD = -1.7%), body mass index (standardised mean difference (SMD) = -1.0), cardiorespiratory fitness (SMD = +1.0), resting heart rate (MD = -5bpm), homeostatic model assessment–insulin resistance (MD = -0.7), and low-density lipoprotein cholesterol (SMD = -0.9) for HIIT compared to the control group. Our narrative synthesis indicated mixed findings between HIIT and other comparative exercise groups.ConclusionSchool-based HIIT is effective for improving several health outcomes. Future research should address the paucity of information on physical activity and nutrition outcomes and focus on the integration and long-term effectiveness of HIIT interventions within school settings

A functional variant in NEPH3 gene confers high risk of renal failure in primary hematuric glomerulopathies. Evidence for predisposition to microalbuminuria in the general population.

BACKGROUND: Recent data emphasize that thin basement membrane nephropathy (TBMN) should not be viewed as a form of benign familial hematuria since chronic renal failure (CRF) and even end-stage renal disease (ESRD), is a possible development for a subset of patients on long-term follow-up, through the onset of focal and segmental glomerulosclerosis (FSGS). We hypothesize that genetic modifiers may explain this variability of symptoms. METHODS: We looked in silico for potentially deleterious functional SNPs, using very strict criteria, in all the genes significantly expressed in the slit diaphragm (SD). Two variants were genotyped in a cohort of well-studied adult TBMN patients from 19 Greek-Cypriot families, with a homogeneous genetic background. Patients were categorized as "Severe" or "Mild", based on the presence or not of proteinuria, CRF and ESRD. A larger pooled cohort (HEMATURIA) of 524 patients, including IgA nephropathy patients, was used for verification. Additionally, three large general population cohorts [Framingham Heart Study (FHS), KORAF4 and SAPHIR] were used to investigate if the NEPH3-V353M variant has any renal effect in the general population. RESULTS AND CONCLUSIONS: Genotyping for two high-scored variants in 103 TBMN adult patients with founder mutations who were classified as mildly or severely affected, pointed to an association with variant NEPH3-V353M (filtrin). This promising result prompted testing in the larger pooled cohort (HEMATURIA), indicating an association of the 353M variant with disease severity under the dominant model (p = 3.0x10-3, OR = 6.64 adjusting for gender/age; allelic association: p = 4.2x10-3 adjusting for patients' kinships). Subsequently, genotyping 6,531 subjects of the Framingham Heart Study (FHS) revealed an association of the homozygous 353M/M genotype with microalbuminuria (p = 1.0x10-3). Two further general population cohorts, KORAF4 and SAPHIR confirmed the association, and a meta-analysis of all three cohorts (11,258 individuals) was highly significant (p = 1.3x10-5, OR = 7.46). Functional studies showed that Neph3 homodimerization and Neph3-Nephrin heterodimerization are disturbed by variant 353M. Additionally, 353M was associated with differential activation of the unfolded protein response pathway, when overexpressed in stressed cultured undifferentiated podocyte cells, thus attesting to its functional significance. Genetics and functional studies support a "rare variant-strong effect" role for NEPH3-V353M, by exerting a negative modifier effect on primary glomerular hematuria. Additionally, genetics studies provide evidence for a role in predisposing homozygous subjects of the general population to micro-albuminuria

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

School-based sports development and the role of NSOs as ‘boundary spanners’: benefits, disbenefits and unintended consequences of the Sporting Schools policy initiative

The focus of this paper is on Sporting Schools, a $100 million policy initiative intended to increase children’s sport participation in Australia. Our account seeks to proffer a critical analysis of this federal policy, and the way it functions as part of the new heterarchical or networked form of sports governance in Australia. Using a network ethnography methodology, we analyse Sporting Schools from the perspective of National Sporting Organisations (NSOs), who have the key responsibility for enacting this policy. Using their perceptions, we reflect on their role as policy ‘boundary spanners’ and outline the complexities they face in creating ‘win-win’ scenarios so that schools, students, government and NSOs themselves all benefit from the Sporting Schools initiative. We argue that NSOs have to balance benefits and disbenefits and face tension between their desire for tight quality control of their school-based sports programmes and the need to have a cost-effective funding model for maximum exposure to schools and students. In conclusion, we reflect on the unintended consequences of enacting the policy in its current form, including issues of teaching and coaching expertise, the potential displacement of the educative value of PE in favour of school sport, and the opening of this public policy space to commercial providers on a for-profit basis

An assessment of Australian school physical activity and nutrition policies

This study's objective was to identify and assess existing physical activity and nutrition policies for Australian schools.Policies were identified through a search of the websites of national and state/territory education departments and school associations, and were subsequently assessed against specific criteria.Policies were identified for government schools, but only for one non-government school association. Physical activity policies were identified at the national level and for six of eight state/territories. The national policy was mandated, and most state/territory physical activity policies were mandated and consistent with the national policy. Several physical activity policies did not meet expert recommendations for time and instructor qualifications. Nutrition policies were identified at the national level and all eight states/territories. The national policy was not mandated, but all state/territory nutrition policies were mandated and consistent with the national policy and relevant guidelines. Most physical activity and nutrition policies lacked information about implementation monitoring.To improve school practices, policies are needed that are mandated and consistent with expert recommendations, use clear language, and specify monitoring and accountability mechanisms. Implications for public health: Improvements in school policies can promote physical activity and healthy eating behaviours to positively influence student outcomes across Australia

Youth sport policy: the enactment and possibilities of ‘soft policy’ in schools

Youth sport policies are increasingly driven by health concerns and social issues, and focus on broad participation outcomes. Given the significant financial investment in, and critique of, such policies internationally, this study aimed to examine the implementation of Sporting Schools (SS), a $100 million programme intended to increase children’s sport participation in Australia. In addressing the limited research in this area in the Australian context, we draw on the notion of policy as process [Penney & Evans, 2005 Policy, power and politics in physical education. In K. Green, & K. Hardman (Eds.), Physical education: Essential issues (pp. 21–38). London: SAGE] and Fullan's [Fullan (2015) The new meaning of educational change (5th ed.). New York, NY: Teachers College Press] work on educational change. This analysis employed a qualitative methodology. Data collection included interviews with 32 sporting organisation (SO) representatives, coaches, and teachers involved in the implementation of SS. Data were analysed using a combination of inductive and deductive approaches, and the trustworthiness of the findings was supported using several strategies. Findings indicated divergent understandings of the need for the SS programme by stakeholders, as well as a lack of clarity of the policy aims and the means for realising them. There was little indication that SOs, coaches and teachers were engaged in a meaningful, working relationship to accomplish the reform objectives of SS; however, each saw benefit in the programme. Youth sport policy implementation in schools is a complex process. The dynamic interplay among the various factors influencing such policies makes realising their stated intentions nigh on impossible. While working to enhance the enactment of SS as intended is important, we propose that youth sport policies written for enactment in schools need to be viewed as ‘soft policies’. The simplicity and limited accountability associated with ‘soft policies’ can be viewed as an opportunity to recognise the expertise of those who work, learn and move in schools, and trust them to use resources effectively and reconcile tensions based on their unique knowledge of their local school contexts

Learning to be researchers in physical education and sport pedagogy: the perspectives of doctoral students and early career researchers

Numerous academics have argued that if a field is to progress, attention needs to be paid to how future generations of researchers are being prepared. To date, data generated on research training in physical education and sport pedagogy (PESP) have primarily focused on students undertaking doctoral programmes with a formal coursework component, which is the model predominantly used in the USA. The traditional master-apprentice model is still, however, the dominant model in many countries, including Australia, and there is a dearth of research on this model of research preparation. Hence, this study was an effort to capture the perspectives and experiences of doctoral students (DSs) and early career researchers (ECRs) who are/were engaged in programmes employing the apprentice model of training. The question we sought to examine was ‘what do PESP doctoral students and early career researchers perceive as the facilitators and challenges associated with learning to be researchers?’. The participants in this study included eight DSs and seven ECRs who were based in Australian and New Zealand institutions. Data were generated through a questionnaire that sought to identify participants’ various research training experiences, a workshop that brought participants together to discuss their research training, and follow-up individual semi-structured interviews. While much of the data generated through this study related to the importance of developing such generic research skills as writing, grant writing and presenting at conferences, participants also discussed PESP-specific skills and dispositions, including particular orientations towards research impact, and the development of research culture. Findings are discussed in reference to the neoliberalisation of education and questions are raised about the forms of research training developing researchers in PESP might need if they are to thrive as researchers within and beyond the field

Youth sport policy: the enactment and possibilities of ‘soft policy’ in schools

Youth sport policies are increasingly driven by health concerns and social issues, and focus on broad participation outcomes. Given the significant financial investment in, and critique of, such policies internationally, this study aimed to examine the implementation of Sporting Schools (SS), a $100 million programme intended to increase children’s sport participation in Australia. In addressing the limited research in this area in the Australian context, we draw on the notion of policy as process [Penney &amp; Evans, 2005 Policy, power and politics in physical education. In K. Green, &amp; K. Hardman (Eds.), Physical education: Essential issues (pp. 21–38). London: SAGE] and Fullan's [Fullan (2015) The new meaning of educational change (5th ed.). New York, NY: Teachers College Press] work on educational change. This analysis employed a qualitative methodology. Data collection included interviews with 32 sporting organisation (SO) representatives, coaches, and teachers involved in the implementation of SS. Data were analysed using a combination of inductive and deductive approaches, and the trustworthiness of the findings was supported using several strategies. Findings indicated divergent understandings of the need for the SS programme by stakeholders, as well as a lack of clarity of the policy aims and the means for realising them. There was little indication that SOs, coaches and teachers were engaged in a meaningful, working relationship to accomplish the reform objectives of SS; however, each saw benefit in the programme. Youth sport policy implementation in schools is a complex process. The dynamic interplay among the various factors influencing such policies makes realising their stated intentions nigh on impossible. While working to enhance the enactment of SS as intended is important, we propose that youth sport policies written for enactment in schools need to be viewed as ‘soft policies’. The simplicity and limited accountability associated with ‘soft policies’ can be viewed as an opportunity to recognise the expertise of those who work, learn and move in schools, and trust them to use resources effectively and reconcile tensions based on their unique knowledge of their local school contexts.</p

'... because there’s nobody who can just sit that long': teacher perceptions of classroom-based physical activity and related management issues

Classroom teachers are increasingly called upon to help increase pupils’ physical activity (PA). Grounded in Guskey’s model of teacher change, this study was part of an intervention that provided classroom teachers with training for implementing classroom-based PA (CBPA). The study examined teachers’ attempts to implement CBPA and focused on their self-reported practices (number of CBPAs implemented and management routines used) as well as their perceptions of this process. Participants (N = 13) were teachers from a U.S. primary school. Data collection included self-reported number of CBPAs implemented (in the year prior to, and the year of, the intervention), self-assessment of management routines used, semi-structured interviews, self-reflection cards, and field notes from classroom observations. Descriptive statistics were calculated and group mean comparison tests were performed for the number of CBPAs implemented and the use of management routines. Qualitative data analysis involved constant comparison and analytic induction techniques, along with several trustworthiness techniques. Teachers implemented a significantly greater number of CBPAs on most days during the study compared to the year before (M = 2.55, SD = 1.36, Cohen’s d = 1.88) and indicated a high level of consistency relative to the use of management strategies taught. Four themes were generated from the qualitative data: (a) positive teacher perceptions of CBPA; (b) perceived positive pupil outcomes and responses; (c) common management routines and common challenges; and (d) teacher support and valuable feedback for the intervention. Findings suggest that sustained professional development can provide classroom teachers with the knowledge and skills needed to regularly implement CBPAs. Also, findings indicate the usefulness of Guskey’s model of teacher change in studying classroom teachers’ involvement in PA promotion programmes and provide valuable insights that can inform similar future projects