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This balances physiological training with self-confidence and perceived physical efficacy. In order to provide an overload, every two weeks the clinical exercise physiologist decided if the exercise intensity could be increased by 5 percent during the next exercise class. Obesity was defined according to BMI based international cut off points for body mass index[ 47 ].

Body weight was measured using a platform beam balance Seca, Germany with an accuracy of 0. Height was measured with a stadiometer Holtain, Crymich, UK with an accuracy of 0.

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Fat-free mass FFM and fat mass FM were determined in the morning after an overnight fast by bioelectrical impedance analysis. Bioelectrical impedance analysis has been shown to be a valid and easy to perform method for the assessment of body composition in pediatric obesity[ 35 , 48 — 50 ]. Prior to measurements subjects were asked to empty their bladder. Two electrodes were placed on the dorsal surface of the right hand and foot just proximal to the third metacarpal-phalangeal and metatarsal-phalangeal joints, respectively. Two further electrodes were placed on the dorsal surface of the wrist at the level of the ulnar tubercle, and on the dorsal surface of the right foot between the medial and lateral malleoli.

Aerobic exercise tests were performed on an electronically braked cycle ergometer Lode Excalibur, Groningen, The Netherlands.

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All subjects were familiarized with the test and equipment used. Standardized verbal encouragement was given throughout the test to stimulate maximal performance. Aerobic fitness was assessed by a standard progressive incremental exercise test.

Workload was increased by 20 W at 1-minute intervals[ 51 ]. The maximal workload W max was defined as the highest workload maintained during 30 seconds. Continuous respiratory gas analysis and volume measurements, oxygen uptake VO 2 , and carbon dioxide production VCO 2 , were performed breath by breath with a triple V valve less mouthpiece and stored in a computerized exercise system Oxycon Champion, Jaeger, Breda, The Netherlands. Prior to each test, internal gas and volume calibrations were made with certified gases of known standard concentrations.

Heart rate was monitored continuously during the tests by 3-leads electrocardiogram Hewlett-Packard, Amstelveen, The Netherlands. The highest VO 2 achieved during the last minute of exercise was taken as VO 2 peak. The oxygen pulse is a non-invasive index of the efficiency of the ability of the body to transport oxygen to the working tissue, with more fit subjects having a higher oxygen pulse as compared to less fit subjects.

The MST is a standardized level externally paced test for use in adult cystic fibrosis[ 54 ]. The test requires the subject to walk up and down a meter course identified by two cones with the walking speed dictated by a prerecorded audio signal. The first speed 0. Each level lasts for 1 minute and it continues for 15 levels.

The audio set emits a single bleep at regular intervals.

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The subject should aim to be at the opposite end to the start by the time the bleep sounds. After every minute, the speed of walking is increased by a small increment 0. Subjects are permitted to run at any time during the test. To help the subjects establish the first very slow speed of walking the operator walks alongside for the first minute.

Heart rate was measured at 5-s intervals using a short-range telemetry device Polar Electro Sports Tester S As with the maximal cycle exercise, standardized verbal encouragement was given throughout the test to stimulate maximal performance. The test was ended when 1 the patient was too tired to maintain the required speed or 2 the patient twice failed to complete a shuttle in the time allowed more than 0,5 m away from the cone when the bleep sounded. The MST walking distance is the distance walked up and down the 10 m course to the last fully completed cone. Changes within the aerobic exercise group were analyzed with a two-tailed paired t-test. Pearson correlation analyses and linear regression analyses were performed for the modified shuttle test with aerobic indices. IL, USA. The construct validity of the MST was measured by relating the instrument to a gold standard: peak oxygen uptake in the progressive incremental exercise test.

Correlations between the MST walking distance and aerobic indices were computed. In order to obtain the test-retest reliability the MST was repeated after two days. The test-retest reliability was studied by computing both the intra-class correlation coefficient ICC [ 52 ] and the Pearson correlation coefficient between the two assessments.

Pearson correlations between MST and the independent variables were also computed. In order to study the sensitivity to change, the MST was used as a functional aerobic outcome measure in the aerobic training study.

Sensitivity to change was computed using effect sizes ES : the observed change divided by the standard deviation of that change[ 55 ]. Effect sizes above 0. Anthropometric characteristics and effect sizes of the aerobic training group at baseline and at the end of the week training period.

Since this was a feasibility study, we assured that all adolescents participating in the training program had been exposed to a substantial physical training dose. All 15 participants met the criterion of three times per week and HR equal to or above their individual training HR. The participants enjoyed the program and only one participant missed a training session due to illness. The baseline and end of training anthropometric characteristics are shown in table 1. Comparing pretraining and end of training period, a significant increase was found for height 0.

All variables showed large changes as indicated by the effect sizes see table 1 [ 55 ]. Results and effect sizes for aerobic performance and modified shuttle walk at baseline and at the end of the week training period. HR max cycle ergometer. Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study. Am J Surg. Abrams, S. Iron requirements and iron deficiency in adolescents. December 8, Retrieved August 5, Visit Website. Calcium requirements in adolescents. July 21, Retrieved August 5, from Visit Website.

American Academy of Pediatrics. Promoting Safety and Injury Prevention. Retrieved August 9, from Visit Website. Recommendations for preventive pediatric healthcare. Retrieved August 7, from Visit Website. Developmental milestones. May 6, Retrieved July 17, from Visit Website. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. American Association of Poison Control Centers.

Anderson, G. Optimizing pediatric dosing: a developmental pharmacologic approach. Bailey, R. Do dietary supplements improve micronutrient sufficiency in children and adolescents? J Pediatr. Bar-Oz, B.

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Medications that can be fatal for a toddler with one tablet or teaspoonful: a update. Paediatr Drugs. Basco, W. Opioid prescribing and potential overdose errors among children 0 to 36 months old. Clin Pediatr Phila. Digoxin pharmacokinetics and dosage requirements in pediatric patients.