Comprehensive Manuals in Pediatrics are designed to broaden the prac titioner's clinical scope by providing a wide range of diagnostic and management skills ordinarily considered to be the exclusive domain of the specialists. Although the series as a whole constitutes a comprehen sive text in pediatrics, each volume stands on its own as a self-contained the busy practitioner. reference for In order to maintain a uniform style and coverage of each subject, each manual is usually written by no more than one or two authors. Each author is an acknowledged expert in his or her field and provides a comprehensive, up-to-date account of the topic under discussion. Practi cally oriented, each volume offers concise guidelines and courses of treatment. Michael Katz E. Richard Stiehm Preface Much knowledge has been generated in recent years by scientists investigating the triad: child-exercise-health. Yet little of this infor mation is available in pediatric textbooks, for application by the clinician. This book is intended to bridge the resulting gap.
1 Physiologic Responses to Exercise of the Healthy Child.- Response to Acute Exercise.- Metabolic Responses to Exercise in Children.- Maximal Aerobic Power.- Maximal O2 Uptake.- Maximal O2 Uptake per Kilogram Body Weight.- The Dimensionality Theory and Maximal O2 Uptake.- Mechanical Efficiency and Economy of Movement.- Anaerobic Characteristics.- Mechanical Power Output.- Underlying Biochemical Characteristics.- Anaerobic Threshold.- O2 Uptake Transients.- Metabolic "Specialization".- Cardiovascular Response to Exercise.- Cardiac Output and Stroke Volume.- Heart Rate and Exercise.- Age.- Sex.- Adiposity.- Climatic Stress.- Emotional Stress and Habituation.- Active Muscle Mass.- Conditioning and Deconditioning.- Acclimatization to Heat.- Diseases.- Medication.- Body Position.- Muscle Blood Flow.- Arterial Blood Pressure.- Rhythmic Exercise.- Static Exercise.- Pulmonary Response to Exercise in Children.- Pulmonary Ventilation.- Respiratory Frequency and Tidal Volume.- Ventilatory Equivalent.- Alveolar Ventilation and Gas Exchange.- Vital Capacity and Exercise Performance.- Prolonged Activities.- Warm-up Effect.- Exercise Perception and Age.- Conditioning and Training.- Methodologic Constraints.- Principles of Physical Conditioning.- Specificity of Training.- Dosage of Conditioning.- Intensity.- Frequency.- Duration of Sessions.- Duration of the Program.- Conditioning Effect Related to Preconditioning Fitness.- Trainability of Muscle Power and Force in Childhood and Adolescence.- Maximal Aerobic Power.- Anaerobic Capacity.- Muscle Strength.- Physiologic Effect of Detraining and Deconditioning.- Conditioning and the Cardiovascular System.- Morphologic Changes.- Physiologic Changes.- Conditioning and the Pulmonary System.- Skeletal Muscle Adaptation to Conditioning.- Morphologic Changes.- Biochemical Changes.- Conditioning and Body Composition.- References.- 2 Children and Exercise in a Clinical Context- An Overview.- Habitual Activity and Disease.- Disease as a Direct and Indirect Cause of Hypoactivity.- "Non-Disease" as a Cause of Hypoactivity.- Assessment of Physical Activity.- Effects of Disease on Physical Working Capacity.- Hypoactivity-Detraining-Hypoactivity: The Vicious Circle.- Reduced Maximal Aerobic Power.- High Metabolic Cost of Exercise.- Exercise as a Diagnostic Tool in Pediatrics.- Exercise as Therapy in Pediatrics.- The Exercise Prescription (Case Studies).- Deleterious Effects of Exercise.- References.- 3 Pulmonary Diseases.- Bronchial Asthma.- Exercise-induced Bronchoconstriction (EIB).- Epidemiology.- EIB-Nature of the Exercise Provocation.- Type of Exercise.- Intensity of Exercise.- Duration of Exercise.- Time Since Previous Exercise.- Climatic Conditions and Asthma.- Climate and the Resting Asthmatic.- Climate and EIB.- Mechanisms Underlying EIB.- Possible Triggering Stimuli.- Airway Cooling as a Trigger.- Vagal Pathways vs. Chemical Mediators.- Other Responses of Asthmatics to Exercise.- Habitual Activity of the Asthmatic Child.- Physical Working Capacity of the Asthmatic Child.- Exercise as a Diagnostic Tool in Asthma.- Rationale for Exercise Provocation Tests.- Documentation of EIB.- Evaluation of Medication for EIB.- Diagnosis of Hyperreactive Airways.- Comparison of Asthmogenicity of Different Activities.- Determination of Exercise Tolerance.- Instilling Confidence in Patient and Parent.- Assessment of the Emotional Component.- The Exercise Challenge.- Pretest Preparation.- Withdrawal of Medication.- The Exercise Protocol.- Pulmonary Function Tests.- Interpretation of Post-exertional Bronchoconstriction.- Management of the Child with EIB.- Drug Therapy.- Prophylactic Therapy.- Reversal of EIB.- Nasal Breathing as Protection.- Artificial Means for Warming and Humidifying Inspired Air.- Choosing the Right Activities.- Physical Conditioning and the Asthmatic Child.- Conditioning and Improvement of Fitness.- Conditioning and EIB.- Cystic Fibrosis (CF).- Causes of Deficient Physical Working Capacity.- Exer
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