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Perceptual and Cardiorespiratory Responses to High-Intensity Interval Exercise in Adolescents: Does Work Intensity Matter?

Malik AA, Williams CA, Weston KL, Barker AR

J Sports Sci Med, 2019 03;18(1):1-12.
PMID: 30787646

High-intensity interval exercise (HIIE) may not elicit prominent unpleasant feelings even with elevated perceived exertion and physiological stress in adolescents. However, the influence of different HIIE work intensities on the affective experience and cardiorespiratory responses is unknown. This study examined the acute affective, enjoyment, perceived exertion and cardiorespiratory responses to HIIE with different work intensities in adolescents. Participants (n = 16; 8 boys; age 12.0 ± 0.3 years) performed, on separate days, HIIE conditions consisting of 8 x 1-minute work-intervals at 70%, 85%, or 100% peak power separated by 75 seconds recovery at 20 W. Affect, enjoyment and rating of perceived exertion (RPE) were recorded before, during, and after HIIE. Heart rate (HR) and oxygen uptake were collected during HIIE. Affect declined in all conditions (p < 0.01) but 100%HIIE elicited significantly lower affect than 70%HIIE and 85%HIIE at work-interval 8 (all p < 0.02, ES > 1.74; 70%HIIE = 2.5 ± 0.8; 85%HIIE = 1.1 ± 1.5; 100%HIIE = -1.5 ± 1.4 on feeling scale). Similar enjoyment was evident during and after all conditions (all p > 0.44). RPE was significantly higher during 100%HIIE than 70%HIIE and 85%HIIE across all work-intervals (all p < 0.01, ES > 1.56). The majority of the participants attained ≥90%HRmax during 85%HIIE (87%) and 100%HIIE (100%), but not during 70%HIIE (6%). Affect responses during HIIE are dependent on the intensity of the work-interval and are not entirely negative (unpleasant feelings). Despite similar enjoyment, positive affect experienced during 70%HIIE and 85%HIIE could serve as a strategy to encourage exercise adoption and adherence in adolescents, but only 85%HIIE elicits sufficient HR stimulus to facilitate potential health benefits.
Perceptual and prefrontal cortex haemodynamic responses to high-intensity interval exercise with decreasing and increasing work-intensity in adolescents

Malik AA, Williams CA, Weston KL, Barker AR

Int J Psychophysiol, 2018 11;133:140-148.
PMID: 30044953 DOI: 10.1016/j.ijpsycho.2018.07.473

OBJECTIVES: Affect experienced during high-intensity interval exercise (HIIE) is dependent on work-intensity, but the influence of increasing (low-to-high (L-H)) or decreasing (high-to-low (H-L)) work-intensity during HIIE remains unclear in adolescents. The role of prefrontal cortex haemodynamics in mediating changes in affect during HIIE also remains unexplored in adolescents. We examined affect, enjoyment and cerebral haemodynamic responses to HIIE with increasing or decreasing work intensities in adolescents.
METHODS: Participants (N = 16; 8 boys; age 12.5 ± 0.8 years) performed, on separate days, HIIE cycling consisting of 8 × 1-min work-intervals at 100%-to-70% (HIIEH-L), 70%-to-100% (HIIEL-H) or 85% (HIIECON) peak power separated by 75 s recovery. Affect, enjoyment and cerebral haemodynamics (oxygenation (∆O2Hb), deoxygenation (∆HHb) and tissue oxygenation index (TOI)) were recorded before, during, and after all conditions.
RESULTS: Affect and enjoyment were lower during HIIEH-L compared to HIIEL-H and HIIECON at work-intervals 1 to 3 (all P  0.83) but were greater during HIIEH-L than HIIEL-H and HIIECON at work-interval 8 (all P  0.83). ∆O2Hb was similar across conditions (P = 0.87) but TOI and ∆HHb were significantly greater and lower, respectively during HIIEH-L compared to HIIEL-H and HIIECON at work-interval 8 (all P  0.40). Affect was correlated with TOI (all r > 0.92) and ∆HHb (all r > -0.73) across conditions.
CONCLUSIONS: HIIEH-L offers advancement to the HIIECON and HIIEL-H which bring significant greater affect and enjoyment towards the end HIIE work-interval, implicating the feasibility and adoption of this protocol for health promotion in youth. Also, changes in prefrontal cortex haemodynamics are associated with the affect during HIIE.
Fulltext The Role of Speckle Tracking Echocardiography in the Evaluation of Common Inherited Cardiomyopathies in Children and Adolescents: A Systematic Review

Dorobantu DM, Wadey CA, Amir NH, Stuart AG, Williams CA, Pieles GE

Diagnostics (Basel), 2021 Apr 01;11(4).
PMID: 33915862 DOI: 10.3390/diagnostics11040635

Speckle tracking echocardiography (STE) has gained importance in the evaluation of adult inherited cardiomyopathies, but its utility in children is not well characterized. We conducted a systematic review to evaluate the role of STE in pediatric inherited cardiomyopathies. PubMed, EMBASE, Web of Science, Scopus, CENTRAL and CINAHL databases were searched up to May 2020, for terms related to inherited cardiomyopathies and STE. Included were dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (ACM). A total of 14 cohorts were identified, of which six were in DCM, four in HCM, three in LVNC and one in ACM. The most commonly reported STE measurements were left ventricular longitudinal strain (Sl), circumferential strain (Sc), radial strain (Sr) and rotation/torsion/twist. Sl, Sc and were abnormal in all DCM and LVNC cohorts, but not in all HCM. Apical rotation and twist/torsion were increased in HCM, and decreased in LVNC. Abnormal STE parameters were reported even in cohorts with normal non-STE systolic/diastolic measurements. STE in childhood cardiomyopathies can detect early changes which may not be associated with changes in cardiac function detectable by non-STE methods. Longitudinal and circumferential strain should be introduced in the cardiomyopathy echocardiography protocol, reflecting current practice in adults.
Exercise training in paediatric congenital heart disease: fit for purpose?

Amir NH, Dorobantu DM, Wadey CA, Caputo M, Stuart AG, Pieles GE, et al.

Arch Dis Child, 2021 Sep 17.
PMID: 34535443 DOI: 10.1136/archdischild-2020-321390

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
Acute cardiorespiratory, perceptual and enjoyment responses to high-intensity interval exercise in adolescents

Malik AA, Williams CA, Bond B, Weston KL, Barker AR

Eur J Sport Sci, 2017 Nov;17(10):1335-1342.
PMID: 28859545 DOI: 10.1080/17461391.2017.1364300

This study aimed to examine adolescents' acute cardiorespiratory and perceptual responses during high-intensity interval exercise (HIIE) and enjoyment responses following HIIE and work-matched continuous moderate intensity exercise (CMIE). Fifty-four 12- to 15-year olds (27 boys) completed 8 × 1-min cycling at 90% peak power with 75-s recovery (HIIE) and at 90% of the gas exchange threshold (CMIE). Absolute oxygen uptake ([Formula: see text]), percentage of maximal [Formula: see text] (%[Formula: see text]), heart rate (HR), percentage of maximal HR (%HRmax) and ratings of perceived exertion (RPE) were collected during HIIE. Enjoyment was measured using the physical activity enjoyment scale (PACES) following HIIE and CMIE. Boys elicited higher absolute [Formula: see text] during HIIE work (p 1.22) and recovery (p 0.51) intervals but lower %[Formula: see text] during HIIE recovery intervals compared to girls (p 0.67). No sex differences in HR and %HRmaxwere evident during HIIE and 48 participants attained ≥90% HRmax. Boys produced higher RPE at intervals 6 (p = .004, ES = 1.00) and 8 (p = .003, ES = 1.00) during HIIE. PACES was higher after HIIE compared with CMIE (p = .003, ES = 0.58). Items from PACES "I got something out of it", "It's very exciting" and "It gives me a strong feeling of success" were higher after HIIE (all p 0.32). The items "I feel bored" and "It's not at all interesting" were higher after CMIE (all p 0.46). HIIE elicits a maximal cardiorespiratory response in most adolescents. Greater enjoyment after HIIE was due to elevated feelings of reward, excitement and success and may serve as a strategy to promote health in youth.
Fulltext The Role of Speckle-Tracking Echocardiography in Predicting Mortality and Morbidity in Patients With Congenital Heart Disease: A Systematic Review and Meta-analysis

Dorobantu DM, Amir NH, Wadey CA, Sharma C, Stuart AG, Williams CA, et al.

J Am Soc Echocardiogr, 2024 Feb;37(2):216-225.
PMID: 37972793 DOI: 10.1016/j.echo.2023.11.003

BACKGROUND: Speckle-tracking echocardiography (STE) is now routinely included in cardiac evaluations, but its role in predicting mortality and morbidity in congenital heart disease (CHD) is not well described. We conducted a systematic review to evaluate the prognostic value of STE in patients with CHD.
METHODS: The EMBASE, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to January 2023 for terms related to all CHD, STE, and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV Sl and LV Sl, respectively) with major adverse cardiovascular events (MACEs) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF), and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups.
RESULTS: A total of 33 studies (30 cohorts, n = 8,619 patients, children, and adults) were included. Meta-analysis showed the following parameters as being associated with MACE: RV Sl in asTGA/ccTGA (hazard ratio [HR] = 1.1/%; CI, [1.03; 1.18]), RV Sl and LV Sl in ToF (HR = 1.14/%; CI, [1.03; 1.26] and HR = 1.14/%; CI, [1.08; 1.2], respectively), and LV Sl in cAS/BAV (HR = 1.19/%; CI, [1.15; 1.23]). The RV Sl and strain rate were associated with outcomes also in single ventricle/hypoplastic left heart syndrome (at all palliation stages except before Norwood stage 1) and LV Sl in Ebstein's anomaly.
CONCLUSIONS: This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD, highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.
Validation and Calibration for Embedding Rating of Perceived Exertion Into High-Intensity Interval Exercise in Adolescents: A Lab-Based Study

Liu Y, Williams CA, Weston KL, Duncombe SL, Malik AA, Barker AR

Pediatr Exerc Sci, 2024 Jan 08.
PMID: 38194950 DOI: 10.1123/pes.2023-0084

PURPOSE: Rating of perceived exertion (RPE) is a convenient and cost-effective tool that can be used to monitor high-intensity interval exercise (HIIE). However, no methodological study has demonstrated the validity of RPE in this context. Therefore, the aim of this study was to validate and calibrate RPE for monitoring HIIE in adolescents.
METHODS: RPE, heart rate (HR), and oxygen uptake (V˙O2) data were retrospectively extracted from 3 lab-based crossover studies, with a pooled sample size of 45 adolescents, performing either cycling-based or running-based HIIE sessions. Within-participant correlations were calculated for RPE-HR and RPE-V˙O2, and receiver operator characteristic curve analysis was used to establish RPE cut points.
RESULTS: The results showed that RPE-HR demonstrated acceptable criterion validity (r = .53-.74, P < .01), while RPE-V˙O2 had poor validity (r = .40-.48, P < .01), except for HIIE at 100% peak power (r = .59, P < .01). RPE cut points of 4 and 5 were established in corresponding to HR/V˙O2 based thresholds.
CONCLUSION: RPE has some utility in evaluating intensity during lab-based running or cycling HIIE in adolescents. Future studies should expand the validation and calibration of RPE for prescribing and monitoring HIIE in children and adolescents in field-based contexts.