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Young Athletes

Register now! Prevention of Sudden Cardiac Death in the Young. CME course (January 17 & 18, 2013)

3 Dec, 12 | by Karim Khan

Nick of Time Foundation invites you to a continuing medical education course (CME) titled “Prevention of Sudden Cardiac Death in the Young” to be held at the Fairmont Olympic Hotel in Seattle, WA on January 17 & 18, 2013.

Sponsored by the University of Washington School of Medicine, Dept. of Family Medicine and Office of Continuing Medical Education. In Collaboration with: Parent Heart Watch and the American Medical Society for Sports Medicine.

Who Should Attend?

Primary care providers – including family physicians, pediatricians, internists, nurse practitioners, and physician assistants – as well as sports medicine physicians, cardiologists and others who conduct pre-participation sports physicals or have an interest in cardiovascular disease in athletes or children and preventing sudden death.

Course Objectives

At the conclusion of this activity, participants should be able to:

  • Define the leading causes of sudden cardiac death (SCD) in children and young athletes
  • Recognize warning symptoms and physical examination findings suggestive of intrinsic cardiovascular disease in the young
  • Describe the added value of electrocardiogram (ECG) as a screening and diagnostic tool in the cardiovascular care of young athletes
  • Apply specific ECG criteria for distinguishing physiologic adaptations in athletes from abnormal ECG findings associated with conditions at risk for sudden death
  • Outline the appropriate evaluation of abnormal ECG findings and the management of identified cardiac disorders

Follow the link for more course and registration details:  http://depts.washington.edu/cme/live/

Register early as space is limited!

 

FIFA’s 11 for health programme launched in Asia

12 Nov, 12 | by Karim Khan

We wanted to share more news about the expansion of FIFA’s global initiative to improve health. Keep up the great work Prof Jiri Dvorak and team!

(Story originally posted in Healthcare Asia via FIFA)

On October 22, Football’s stalwart association, Switzerland headquartered Fédération Internationale de Football Association (FIFA) has launched the first-ever ‘FIFA 11 for Health’ programme in Asia, which encomapsses health education projects, among other activities.

Myanmar haa been chosen to host the said programme because it is a “football country”, according to a FIFA insider.

“It’s not a coincidence that Myanmar is the first Asian country in which we have implemented the ‘FIFA 11 for Health’ programme,” said FIFA’s Chief Medical Officer, Prof Jiri Dvorak. “Myanmar is a football country, and as such we are trying to use the power of our sport to tackle some concrete health issues. Both the Myanmar Football Federation and the country’s authorities have shown a consistent interest in our medical and health initiatives as they are convinced about the positive effect of football can have on health education and prevention.”

Teachers and coaches from 18 pilot schools have gathered in Yangon (Myanmar’s former capital before it has been superseded by Naypyidaw in 2005) for training sessions supervised by Dvorak. An additional three-day course on emergency medicine and anti-doping for member association doctors was also conducted.

The ‘FIFA 11 for Health’ is an innovative programme that promotes 11 simple messages aimed at reducing communicable and non-communicable diseases. The initiative is based on an analysis of risk factors by the World Health Organisation(WHO).

After Botswana, Colombia, Ghana, Kenya, Malawi, Mauritius, Mexico, Namibia, Solomon Islands, South Africa, Tanzania, Tonga, Zambia and Zimbabwe, Myanmar has become the 15th country in which the ‘FIFA 11 for Health’ has been organised.

“Given the fact that HIV, malaria and tuberculosis, to mention just a few examples, represent fundamental threats to public health in Myanmar, we have a concrete chance to make a valuable contribution to the country by conveying some of the key messages of our ‘FIFA 11 for Health’ initiative, such as ‘protect yourself from HIV’, ‘respect girls and women’, ‘avoid drugs, tobacco and alcohol’, ‘wash your hands’, ’and ‘drink clean water,” added Dvorak.

According to recent figures released by UNAIDS, about 216,000 people live with HIV in Myanmar, with the overall population being 55 million. AIDS-related illnesses, tuberculosis and malaria are among the ten leading causes of death in the country.

With an estimated base of over a million active players, Myanmar used to be a football stronghold in South-East Asia in the 1960s and 1970s, although the country has performed less well in international football since then.

Over the past two decades, FIFA has been actively promoting the development of football in Myanmar through a variety of initiatives, including the Goal Programme, the Financial Assistance Programme (FAP) and the PERFORMANCE Programme.

FIFA President Joseph S. Blatter visited Mandalay and Yangon in March 2011 to open Myanmar’s Goal project II (Mandalay’s football academy) and to lay the foundation stone for Goal IV (upgrading the stadium at the national youth academy). A total of four Goal projects have been implemented to date in Myanmar, and the construction of a fifth – an academy building at the National Football Training Center – was recently approved (HCA)

Rural sport and exercise medicine in the highlands of Scotland – working with Shinty!

29 Dec, 11 | by Karim Khan

Guest blog by Dr Jonathan Hanson FFSEM


Like many doctors in sport for years I have relied upon the goodwill of colleagues and employers in the remote corner of Scotland I call home.  Last year I felt the time had come to give something back to the local sport in my region, rather than consistently abusing the goodwill to work with sports many miles away in the cities. Not that there is an extensive choice of sports for a physician to become involved in.

The reality of living and working in the North-West Highlands is that most sport is not of the organised variety – climbers, hill walkers and kayakers are the largest proportion and we already play in role  – albeit in an emergency, critical injury and primary care sports medicine role for these visiting “athletes”.

Of the organised sport out here, the extreme weather dictates that summer is outside and winter is inside. In contrast to the rest of the UK, football is a summer sport in the Hebrides and it supports a very competitive local league. A league that the winners of end up in national cup competitions. Despite being the most popular sport in Scotland by a mile, in the Highlands football remains the little brother of the real Daddy – shinty.

Describing shinty to anyone is a bit like trying to explain Cricket to Americans – until you strip in down to the most basic analogy –“imagine full contact golf”.

Shinty is a sport deeply engrained in Gaelic culture and a distant relative of the Irish sport of hurling. A bit like Aussie Rules and Gaelic football, the international version of the sport is a combined rules shinty- hurling affair between the Scots and the Irish that is played home and away each autumn.

The major cup finals (of which the Camanachd cup is the premier event) are televised on the BBC and simultaneously broadcast on national radio. A handful of seasoned campaigners have reluctantly acquired local celebrity status – but all of whom then go back to work on the croft (smallholding) or fishing boats etc.

The sports governing body – the Camanachd association, has a structure not unlike many other sports with development officers, coaching courses and an active junior section. The local papers are filled each week with photos and match reports and it is discussed passionately down the pub, just like its more widely known relations. Despite some modernisation – the sport remains the archetypal “man’s game” with traditional values which the clubs fight fervently to protect.

Injury Prevention –  medical point of view

KYLES V NEWTONMORE


From a medical point of view, living in the islands, we don’t need a comprehensive injury reporting system to note the injury prevention issues of the sport.  As a Doctor in the communities it’s hard not to be aware of club stalwarts with visual problems incurred playing the sport. Working in the emergency department, Saturday afternoons bring a steady procession of wounds around the face caused by the stick (or caman), hand fractures and the occasional hyphema or actual globe injury. Just like any other sportsman, the primary concern of the athlete is “When can I play again?”

So it was with this in mind that I thought about approaching the Camanachd association to see if I could help them in an advisory capacity. From the perspective of the organisation, the response was positive. A meeting was arranged with the lead development officer and we discussed what I thought I could offer them and what they thought they needed.

Not surprisingly the issue in the Celtic stick sports remains that of helmets and facial protection. Having seen many facial injuries, I have also learned a bit about the coaching of the sport and attitude to injury. Essentially, the good players get close enough to the attacker so that they are within his swing circle and avoid being hit. Being hit is looked down upon as something that lesser players do.

At junior level (age 14) helmets with a faceguard are compulsory and the helmets recommended are the brand specific to their hurling counterparts – so it is essentially fit for purpose. However beyond age 14 there is no compulsory regulation and given the image of the sport as a tough working mans game, very few players continue with any protection at all. Recent high profile players such as Ronald Ross have begun wearing one, but as yet this has not spread across a sport where the goalkeeper is often selected by size (and often adiposity) and chooses protection more useful against the cold (a woolly jumper) rather than against a small high velocity projectile.

I had hoped to set up an injury reporting system and look at coaching and injury prevention as well as establishing a minimum standard of first aid. A senior figure of our local club is the patron of a charity that places defibrillators (having himself had an out of hospital cardiac arrest) so the links between shinty and immediate care are strong (www.lucky2bhere.com). However, such is the suspicion around medical involvement and the perceived desire to take away traditional values of the sport by mandating helmets, that every enquiry to clubs about medical support and training, let alone collecting an injury database were either flatly ignored, or returned with aggressive questions about my motives.

Fortunately the Camanachd association have been more supportive. They are fully aware of the challenges of building medical bridges to the clubs and the value of what we were trying to do. They have taken on the F-MARC FIFA 11+ as an injury prevention strategy and introduced it to the coach education sessions. Whether or not it will make any difference to preventing injury I may never be able to measure. They are also trying to use their contacts with coaches to improve the club / medical relationship and start to quantify some of the perceived problems in the sport. Fingers crossed it continues.

Related BJSM articles

McIntosh AS, Andersen TE, and Bahr, R et al. 2011. Sports helmets now and in the future. BJSM. 45:1258-1265.

McIntosh AS, McCrory P, Finch CF, and Wolfe R. 2010. Head, face and neck injury in youth rugby: incidence and risk factors. BJSM. 44:188-193. (Editor’s choice – full text online!)

Mishra A. 2010. Management of soft tissue injury of hand wrist and elbow in sports. BJSM. 44:i3.


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Dr Jonathan Hanson FFSEM is a Sport and Exercise Medicine Physician/Rural Practitioner. Broadford Hospital. Skye

Don’t miss Richard Budgett’s Olympics podcast…

20 Dec, 11 | by Karim Khan

Just a quick alert that Richard Budgett, the Chief Medical Office for the London Olympics, shares his very special insights.

He was an Olympic Gold medal winner in Los Angeles before serving the UK and now the world!

Click here for the podcast

And remember, the IOC, through its Medical Commission, supports the 4 of the 16 issues of British Journal of Sports Medicine (BJSM) annually. See recent editorial about Youth Olympic Games here. The BJSM is the leading clinical source of sports and exercise medicine.

Big Success: 7th Annual Dutch Scientific Congress

6 Dec, 11 | by Karim Khan

Guest blog by Adam Weir

The 7th Annual Scientific Congress of The Netherlands Association of Sports Medicine recently took place on December 1st – 2nd,, 2011. This congress was held for the first time at the Efteling, the largest attraction park in Holland. The atmosphere was great; the fairy tale surroundings gave the congress a new twist.

You can hear more about the congress and sports medicine in the Netherlands listening to this podcast with Hans Tol and myself.  You can also read more about it in the Editorial, by Tol and Visser in the October issue of BJSM.

The opening keynote lecture was from Prof Meeusen, from the Free University in Brussel, who spoke about the facts and fiction surrounding overtraining. He demonstrated the large number of misconceptions surrounding this topic, and gave us a lot to think about. More blood tests are not always the solution.

The closing keynote of the first day was presented by Prof Sundgot-Borgen from Norway, who spoke about eating disorders in young athletes. She gave a great overview of the topic and highlighted the projects they are working on in Norway. She gave useful advice about how to make it acceptable to speak about eating disorders and changing the culture surrounding sports. As many as 45% of athletes in some aesthetic sports have disordered eating and she warned against measuring fat percentage in those under 18 years of age.

My colleague Maarten Moen and I dressed up to chair our session on prevention issues in adults. There is now broad consensus as to the benefits of exercise; however, identifying and removing obstacles remains a big challenge. Some exciting local initiatives were discussed.

In the evening there was a social programme with dinner, music and dancing and then a night in the famous Efteling hotel. Dr van den Hoogenband, the Dutch chief medical officer for London 2012, presented the key note lecture in the morning of the second day on the future of elite sports medicine in the Netherlands. The current vision is to reduce the number of top sports medical centres to four regional locations to centralise care. This stirred up an animated debate, and I am sure we will hear more about this.

After two more parallel sessions the congress closed until next year. Let us hope that this new location is the start of a new era – and that we will all live longer, and more happily ever after!

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Adam Weir is a sports medicine physician who works at the Hague Medical Centre (MCH) department of sports medicine and the sports medicine advice centre (SMA) in Haarlem. He is interested in research in sports medicine and has a PhD on the field of athletic groin injuries. Current projects that he is involved in are RCT’s on stem cells in Achilles tendinopathy, PRP for acute hamstrings ruptures, physical training for type 2 diabetics with complications, ESWT for patella tendinopathy and risk factors for groin injury.

Research into action – AED installed 3 months ago saves life!

17 Nov, 11 | by Karim Khan

Guest Blog by Jon Drezner – Sports Cardiology Senior Associate Editor

I heard some amazing news today and still gathering the details.  Last night at [anonymized] Middle School a 45 yo [anonymized] suffered sudden cardiac arrest during a basketball game.  Witnesses pulled the AED off the wall, delivered two shocks before EMS arrived, and the patient is alive and doing well today!

It is less than 3 months since the Heart of Seattle Schools project installed 136 AEDs into Seattle Public Schools, with at least one in every school.  This was our AED and administered by a school staff member for a member of our community… just how public access defibrillation programs are supposed to work.

From the beginning, University of Washington Medicine has played a major role in the success of this project and the safety of our community.  To think the benefit of this program has been realized so quickly!

Related Publications

Drezner, J, Harmon, K, and Borjesson, M. 2011. Incidence of sudden cardiac death in athletes: where did the science go? BJSM, 45: 947-948.

September 2009 BJSM – deals specifically with cardiac issues and the athlete

Blogs:

Dr. Jonathan Drezner is an Associate Professor of the Department of Family Medicine, Associate Director of the Sports Medicine Fellowship , and Team Physician for the Seattle Seahawks & UW Huskies.

Fitness and health of children through sport: the context for action – Guest Blog Caroline Finch

20 Oct, 11 | by Karim Khan

(follow Caroline Finch on Twitter — @CarolineFinch)

This relates to:

Micheli, L, Mountjoy, M, and Engebretsen, L et al. 2011. Fitness and health of children through sport: the context for action. BJSM. 45:931-936

photo: owenfinn16 via Flickr cc

I read, with great interest, the paper by Micheli et al [1]in the September Injury Prevention and Health Promotion issue of the BJSM,because it outlined  different policy contexts for action.  These contexts are generally consistent with the ecological levels of sports delivery we outlined in the Sports Setting Matrix as a framework for the implementation and evaluation of programs delivered through sport.[2]  It is also consistent with our previous argument that the sports delivery and policy contexts need to be more aligned for global sports safety.[3]

Given that injury is one of the major barriers towards participating in sport,[4] it is surprising that no international policy link for addressing this key factor in children’s sports participation was named in the article.  Many of the organisations named in the paper (e.g. the World Health Organization) have divisions that are concerned with injury prevention as well as NCD (non-communicable disease) prevention, for example. A major way forward to ensuring lifelong participation in sport would surely be to bring together the policy bodies for physical activity/sport promotion together with those concerned with reducing or removing injury risk in such activities.

Whilst there is no doubt that having global policy is a key driver of action and priority attention given to health issues, it is largely practitioners at a more local level who need to implement those policies and to translate them into appropriate acceptable and sustainable programs.  In the sports injury context, we have found a mismatch between what the policy makers want and what the practitioners or implementers need.[5] Moreover, just because there is an international policy/guideline/directive one cannot assume that the desired practice or action at the grass roots level of participation, even at a low level, is achieved.[6]  No matter how much evidence-base there is for a new policy, the end-users will have their own perspectives that will directly influence their readiness to act according to the desired policy result.[7]

Having global, national and local policy responses to fitness and health (including injury prevention) will be crucial for ensuring lifelong participation in sport well into the future.  But not less so than also ensuring both an adequate informed workforce of practitioners to deliver associated programs and end users who are fully receptive to the messages that have been appropriately targeted to reach them.

References

1.         Micheli L, Mountjoy M, Engebretsen L, et al. Fitness and health of children through sport: the context for action. Br J Sports Med. 2011;45:931-6.

2.         Finch CF, Donaldson A. A sports setting matrix for understanding the implementation context for community sport. Br J Sports Med 2010;44:973-8.

3.         Timpka T, Finch CF, Goulet C, et al. Meeting the global demand of sports safety – the role of the science and policy intersection for sports safety. Sports Med. 2008;39:795-805.

4.         Siesmaa E, Blitvich J, Finch CF. Chapter 1. A systematic review of the factors that are most influential in children’s decisions to drop out of organised sport.  In: Farelli A, editor. Sport participation: health benefits, injuries, and psychological effects: Nova Science Publishers Ltd; 2011. p. 1-45.

5.         Poulos R, Donaldson A, Finch C. Towards evidence informed sports safety policy for NSW, Australia: assessing the readiness of the sector. Inj Prev. 2010;16:127-31.

6.         Hollis S, Stevenson M, McIntosh A, et al. Compliance with return-to-play regulations following mild traumatic brain injury in Australian schoolboy and community rugby union players. 2011;On line First, published on June 24, 2011 as 10.1136/bjsm.2011.085332.

7.         Donaldson A, Leggett S, Finch CF. Community perceptions of a draft policy and training structure for Australian football sports trainers at the community level: a qualitative analysis. 2011;In press. Published online 16 September 2011 as DOI: 10.1177/1012690211422009.

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Caroline Finch is an injury prevention researcher specialising in implementation and dissemination science applications for sports injury prevention.  She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group.  Caroline can be followed on Twitter @CarolineFinch

Football as Global Health Promotion: FIFA’s 11 for Health Programme

8 Jun, 11 | by Karim Khan

“Prevention is better than a cure, no matter what disease we look at…football is an ideal platform to promote a healthy lifestyle and prevent disease.”       – Professor Jiri Dvorak, FIFA’s Chief Medical Officer

This month’s BJSM Editor’s Choice (free online) highlights an innovative approach to health and exercise promotion in Africa. Authors Colin Fuller, Astrid Junge, Cadrivel Dorasami, Jeff DeCelles, and Jiri Dvorak investigated how FIFA’s 11 for Health programme (watch promo video) impacted 10 to 15 year old children’s health knowledge in Mauritius and Zimbabwe. They conclude that the collaborative implementation model was successful and that post-programme analyses showed significant increases in most of the participants’ health knowledge.

Photo courtesy of: StephenandMelanie, Flickr Creative Commons

As an outcome of these successful pilot projects and the 2011 nationwide implementation of the programme in Mauritius, over the last 2 months Dr Junge and Dr Fuller worked with Dr. Dvorak on a four-week programme expansion initiative. This involved ‘training the trainers’ in Nairobi (Kenya), and Windhoek (Namibia), and making presentations to Football Associations in Botswana and Malawi. (Read more about the nationwide implementation initiative here).

Dr. Dvorak also presented the results of successful nationwide implementation of the programme to the 61st FIFA Congress on June 1st, 2011 in Zurich. This congress received global media attention. Following the presentation, officials from many countries around the world approached FIFA’s medical team (F-MARC) to express their desire to partner in this initiative.


This project team exemplifies commitment to combining scientific rigour with social responsibility to create an exercise-based tool for health promotion. The potential for scaling up this programme means is has tremendous public health significance. BJSM will highlight ‘success stories’ from around the world as part of the journal’s promotion of ‘implementation’ as a key issue for sports medicine in the 2010s.

Would you like to share successful implementation stories?

Leave a comment below, or send an email: karim.khan@ubc.ca

Oslo Sports Trauma Research Centre website — Great online resource

26 Feb, 11 | by Karim Khan

The Oslo Sports Trauma Research Centre, located at the Norwegian School of Sports Sciences has a diverse team of experts from the fields of exercise medicine, ortheopedics, epidemiology, biostatistics, and physiotherapy. Its led by professors Lars Engebretsen and Roald Bahr who are both renowned for their experience with national team and Olympic sports medicine. Cutting-edge researchers and advocates for evidence-based practice.

Want to know more about:

  • Injury patterns in World Cup freestyle skiing
  • Risk of injury in female youth football players
  • Outcomes of the first meeting of the 4 IOC Research Centres in Capetown

Check out their website NOW!  It’s a great online resource.

Also see:

Bahr’s warm up discussion on ACL injuries in BJSM

and

Engebresten’s insights on platelet-rich plasma and The importance of sports medicine for the Vancouver Olympic Games — also in past issues BJSM.

Debate: Benefits of High Intensity Anaerobic Exercise for Adolescents and School Children

26 Nov, 10 | by Karim Khan


Duncan S Buchan 1, Julien S Baker 1, Robert M Malina 2, Non E. Thomas 3

1. University of the West of Scotland

2. The University of Texas at Austin

3. Swansea University

Dear Editor,

We read with interest the recent statement released by BASEM on 26th November 2010 which criticises the way physical education (PE) is being taught in the United Kingdom.  Previous authors suggest that youth spend less than 50% of PE time in moderate intensity activity and thus fail to procure health related benefits [1].  Interestingly, a recent investigation demonstrated a positive role for brief, interval training as a means of improving the health status of obese and overweight adolescents with unfavourable cardiometabolic profiles [2]. With this in mind we successfully developed and implemented a novel 7 week exercise intervention which aimed to determine the effects of PA programmes of different intensities and duration on three components of physical fitness, namely: cardiorespiratory fitness, muscular fitness and speed/agility [3]. Full details of the protocol can be found elsewhere [4,5].

Briefly, a cohort of adolescent school youth (N = 47 boys and 10 girls, 16.4 ± 0.7 years of age) volunteered to participate in the study. Ethical approval was received from the University of the West of Scotland Ethics committee. Maturation status was obtained prior to experimental data collection. Participants were recruited from two PE classes in years 5 and 6. Year 5 pupils acted as the control group whereas year 6 pupils were randomly assigned to a high intensity training group (HIT) or a moderate (MOD) intensity group. Participants in the HIT group (15 boys, 2 girls) were required to complete a 30 s maximal effort sprint within a 20 m distance separated by cones. Participants were instructed to sprint from the midpoint to the first marker, turn, and then sprint 20 m in the opposite direction to the second marker. Participants repeated the protocol four times with a 30 s recovery period between sprints. This equated to 2 mins of maximal effort sprinting interspersed with 2 min recovery.  The protocol was performed 3 times weekly. Training progression was implemented by increasing the number of repetitions from four during weeks 1 and 2, to five during weeks 3 and 4, to six during weeks 5 and 6. During week 7, participants still performed six repetitions but each was interspersed by only 20 s recovery.

Participants in the MOD group (12 boys and 4 girls) were instructed to exercise at a moderate intensity of 70% VO2max as utilized in other studies [6], by running steadily for a period of 20 mins. The speed of exercise was determined by each participant’s performance in the 20 metre multistage fitness test (MSFT). Participants were instructed to keep pace with a CD that emitted a continuous audio signal for a period of 20 min. All participants had indices of obesity and blood pressure recorded in addition to four physical performance measures pre and post intervention. These included the 20 MSFT, the counter movement jump (CMJ), agility and the 10m sprint test.

Overall, it was apparent that specific physiological adaptations occurred relative to the stimulus provided. Participants in the MOD group experienced a 26.8% improvement in 20 MSFT and a 7.3% improvement in CMJ performance. Participants in the HIT group experienced an 8.3% and a 5.1% improvement in both the 20 MSFT and CMJ. Participants in the HIT group also experienced a 1.5% and 5% improvement in 10-m sprint and 505-agility performance though no improvements were noted in the MOD group. Though the participants in both groups experienced improvements, it should be noted that these improvements in the HIT group occurred in 85% less exercise time compared to that of the MOD group. Participants in the HIT group also experienced a significant reduction in systolic blood pressure SBP post-intervention (112 ± 10 vs. 106 ± 11 mm Hg) (P=0.017).  Thus, significant improvements in physical fitness were found in both groups after exercising for only seven weeks (3 times per week).

Despite overwhelming evidence supporting the health benefits of regular PA, many youth fail to meet minimal recommendations. This study has demonstrated that HIT is a time efficient means of improving components of health in youth. Given the time constraints of school curricula, incorporating a HIT protocol into the PE curriculum may function to improve PA levels and health status of adolescents. Further research investigating the effects of HIT on markers of health status in youth seems recommended.

References

1. Fairclough SJ, Stratton G (2006) A review of physical activity levels during elementary school physical education. J Teach Phys Educ 25: 239-257

2. Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, Odegard R, Skogvoll E, Wisloff U (2009) Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci 116: 317-326

3. Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M (2008) Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes 32: 1-11

4. Buchan, D. S., Ollis, S., Thomas, N. E., & Baker, J. S. (2010). The influence of a high intensity physical activity intervention on a selection of health related outcomes: an ecological approach. BMC Public Health, 10(1), 8.

5. Buchan, D.S. Ollis, S. Thomas, N.E. Cooper, S.M. Malina, R.M and Baker, J.S. Physical Activity Interventions: Effects of Duration and Intensity. Scand J Med Sci Spor (Under Review).

6. Tabata I, Nishimura K, Kouzaki M, Hirai Y, Ogita F, Miyachi M, Yamamoto K (1996) Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Med Sci Sports Exerc 28: 1327-1330

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