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Youth Sports, Young Athletes Evaluation, Implications for Performance and Health

Special Issue Editors


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Guest Editor
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Interests: body composition; young athletes; exercise as medicine; physical activity; sport; youth sport; cardiovascular health
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
Interests: global health; hypertension; ethnicity; cardiovascular risk
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
National Institute of Physical Education of Catalonia (INEFC)
Interests: body composition; nutritional education; youth sports; sports performance

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Guest Editor
TecnoCampus Mataró-Maresme Foundation
Interests: body composition; exercise physiology; strength and conditioning; sports performance

Special Issue Information

Dear Colleagues,

Sedentary lifestyle in childhood induces an elevated likelihood of overweight/obesity, a condition that promotes the development of hypertension, diabetes, and associated non-communicable diseases in adulthood.

Physical activity provides many benefits in children. The participation in organized sport allows these benefits to be maintained in the transition between childhood and adolescence. However, the transition from childhood to adolescence is crucial because the greatest mental health benefits deriving from physical activity are obtained during adolescence, and at this age sporting practice can be not infrequently abandoned.

The purpose of this research collection is to add information on

1) Advantages offered by sports activities in terms of metabolic parameters, performance, cognitive function, and motor coordination;

2) Strategies to avoid the abandonment of physical or sport activity in the transition from childhood to adolescence;

3) The applications of sport in young people in social or mental distress.

Specific research is welcome in this Special Issue in an attempt to focus the attention of researchers, physicians, coaches, athletic trainers, and policy makers on the importance of this issue for the benefit of future generations.

Dr. Gabriele Mascherini
Prof. Pietro Amedeo Modesti
Prof. Alfredo Irurtia
Prof. Jorge Castizo-Olier
Guest Editors

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Keywords

  • physical activity in youth
  • young athletes
  • functional evaluation
  • exercise testing body composition
  • obesity
  • cognitive activity
  • motor ability
  • social or mental distress

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Published Papers (12 papers)

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Research

17 pages, 665 KiB  
Article
Physical Activity Habits and Well-Being among 6-Year-Old Children: The “Improving Umbrian Kids’ Healthy Lifestyle”, an Uncontrolled Pilot Study Project
by Roberto Pippi, Livia Buratta, Alessandro Germani, Carmine Giuseppe Fanelli and Claudia Mazzeschi
Int. J. Environ. Res. Public Health 2020, 17(17), 6067; https://doi.org/10.3390/ijerph17176067 - 20 Aug 2020
Cited by 5 | Viewed by 3514
Abstract
There is evidence that promoting physical activity programs and decreasing sedentary behavior is a potential strategy for improving health-outcomes, peer relationships and social/emotional well-being in at-risk youth. The World Health Organization recommends enhancing physical education and school-based programs with multi-component and evidence-based assessment [...] Read more.
There is evidence that promoting physical activity programs and decreasing sedentary behavior is a potential strategy for improving health-outcomes, peer relationships and social/emotional well-being in at-risk youth. The World Health Organization recommends enhancing physical education and school-based programs with multi-component and evidence-based assessment methodology. In Umbria (Italy) an uncontrolled pilot study project referred to as “Improving Umbrian kids’ healthy lifestyle” was implemented as a systemic school-based intervention directed at 6-year-old primary school children. The intervention applied a consolidated assessment methodology developed by the C.U.R.I.A.Mo. and Eurobis projects that inserted two hours per week of physical education activity into the school curriculum, structured and supervised by specialists with Exercise and Sport Science degrees, for eight months (from October to June) of the school year. We measured anthropometric values (BMI, waist circumference, waist-to-height ratio index) with objective tools. Moreover, we evaluated physical performance variables (speed, strength, and flexibility) using standard tests. Additionally, self-report measures (measured physical activity during the week, sedentary habits, and psychological well-being) were assessed using validated questionnaires. We observed a significant decrease in waist to height ratio, and improvements in physical performance values and self-report questionnaire measures. Our study suggests that the promotion of physical activity in the school setting is likely to result in physically, mentally, and psycho-socially healthier primary-school-age children. Full article
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14 pages, 1282 KiB  
Article
Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players
by Marco Andrés García-Luna, Juan Manuel Cortell-Tormo, Miguel García-Jaén, Manuel Ortega-Navarro and Juan Tortosa-Martínez
Int. J. Environ. Res. Public Health 2020, 17(15), 5608; https://doi.org/10.3390/ijerph17155608 - 4 Aug 2020
Cited by 26 | Viewed by 9501
Abstract
Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of [...] Read more.
Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of this study was to analyze the acute effects of an ACL injury prevention protocol (ACL-IPP) and a soccer-specific fatigue protocol (SSFP) on DKV in youth male soccer players. The research hypothesis was that DKV would be reduced by the ACL-IPP and increased by the SSFP. Eighteen youth male soccer players were divided according to baseline DKV. Those with moderate or large DKV performed a neuromuscular training protocol based on activation of the abductor and external rotator hip muscles. Those with little or no DKV performed a soccer-specific fatigue protocol. DKV was assessed using the single-leg squat pre- and post-protocols in both legs. The ACL-IPP significantly decreased DKV during single-leg squat (p < 0.01, effect size = 1.39), while the SSFP significantly increased baseline DKV in the dominant leg during single-leg squat (p = 0.012; effect size = 1.74). In conclusion, the ACL-IPP appears to acutely reduce the DKV in youth male soccer players, and the SSFP seems to acutely increase the DKV in those players who showed a light or no DKV in a non-fatigue situation. By using the SSFP, it may be possible to determine which players would benefit from injury prevention programs due to increased DKV during game scenarios, while hip abductor and external rotator neuromuscular training may be beneficial for players who have moderate and severe DKV during single-leg squat under non-fatigued scenarios. Full article
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13 pages, 526 KiB  
Article
Gender Differences in Postural Stability among 13-Year-Old Alpine Skiers
by Agnieszka D. Jastrzębska
Int. J. Environ. Res. Public Health 2020, 17(11), 3859; https://doi.org/10.3390/ijerph17113859 - 29 May 2020
Cited by 11 | Viewed by 3200
Abstract
This experiment examined changes in body sway after Wingate test (WAnT) in 19 adolescents practicing alpine skiing, subjected to the same type of training load for 4–5 years (10 girls and nine boys). The postural examinations were performed with eyes open (EO), eyes [...] Read more.
This experiment examined changes in body sway after Wingate test (WAnT) in 19 adolescents practicing alpine skiing, subjected to the same type of training load for 4–5 years (10 girls and nine boys). The postural examinations were performed with eyes open (EO), eyes closed (EC), and sway reverenced vision (SRV) in the medial-lateral (ML) and anterior-posterior (AP) planes. The displacement of center of foot pressure (CoP), range of sway (RS), mean sway velocity (MV), way length, and surface area were measured in bipedal upright stance before and after the WAnT to assess the influence of fatigue on postural balance. There were no significant differences in WAnT parameters between girls and boys. Relative peak power (RPP), relative total work (RWtot) were (girls vs. boys) 8.89 ± 0.70 vs. 9.57 ± 1.22 W/kg, p < 0.05 and 227.91 ± 14.98 vs. 243.22 ± 30.24 W/kg, p < 0.05 respectively. The fatigue index (FI) was also on similar level in both genders; however, blood lactate concentration (BLa) was significantly higher in boys (10.35 ± 1.16 mM) than in girls (8.67 ± 1.35 mM) p = 0.007. In the EO examination, statistically significant differences between resting and fatigue conditions in the whole group and after the division into girls and boys were found. In fatigue conditions, significant gender differences were noted for measurements in the ML plane (sway path and RS) and RS in the AP plane. Comparison of the three conditions shows differences between EO vs. EC and SRV in AP plane measured parameters, and for RS in ML plane in rest condition in girls. The strong correlations between FI and CoP parameters mainly in ML plane in the whole group for all examination conditions were noted. By genders, mainly RS in ML plane strongly correlates with FI (r > 0.7). No correlation was found between BLa and CoP parameters (p > 0.06). The presented results indicate that subjecting adolescents of both genders to the same training may reduce gender differences in the postural balance ability at rest but not in fatigue conditions and that girls are significantly superior in postural balance in the ML plane than boys. It was also shown that too little or too much information may be destructive to postural balance in young adolescents. Full article
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11 pages, 313 KiB  
Article
Passive Drag in Young Swimmers: Effects of Body Composition, Morphology and Gliding Position
by Matteo Cortesi, Giorgio Gatta, Giovanni Michielon, Rocco Di Michele, Sandro Bartolomei and Raffaele Scurati
Int. J. Environ. Res. Public Health 2020, 17(6), 2002; https://doi.org/10.3390/ijerph17062002 - 18 Mar 2020
Cited by 25 | Viewed by 4262
Abstract
The passive drag (Dp) during swimming is affected by the swimmer’s morphology, body density and body position. We evaluated the relative contribution of morphology, body composition, and body position adjustments in the prediction of a swimmer’s Dp. This observational study examined a sample [...] Read more.
The passive drag (Dp) during swimming is affected by the swimmer’s morphology, body density and body position. We evaluated the relative contribution of morphology, body composition, and body position adjustments in the prediction of a swimmer’s Dp. This observational study examined a sample of 60 competitive swimmers (31 male and 29 female) with a mean (±SD) age of 15.4 ± 3.1 years. The swimmer’s Dp was measured using an electro-mechanical towing device and the body composition was assessed using a bioelectrical impedance analyser. Body lengths and circumferences were measured in both the standing position and the simulated streamlined position. Partial correlation analysis with age as a control variable showed that Dp was largely correlated (p < 0.05) with body mass, biacromial- and bi-iliac-breadth, streamline chest circumference and breadth. Body mass, Body Mass Index, chest circumference and streamline chest circumference showed a significant and moderate to strong effect (η2 > 0.55) on Dp. Body mass was the best predictor of Dp explaining 69% of the variability. These results indicate that swimmers with lower Dp values were: (i) slimmer, with lower fat and fat-free mass, (ii) thinner, with lower shoulder breadth, chest circumference, and streamline trunk diameters (iii), shorter, with lower streamline height. These findings can be used for talent identification in swimming, with particular reference to the gliding performance. Full article
12 pages, 352 KiB  
Article
Effects of Neuromuscular Training on Motor Competence and Physical Performance in Young Female Volleyball Players
by Nebojša Trajković and Špela Bogataj
Int. J. Environ. Res. Public Health 2020, 17(5), 1755; https://doi.org/10.3390/ijerph17051755 - 8 Mar 2020
Cited by 28 | Viewed by 6282
Abstract
Although neuromuscular training (NMT) emphasizes injury prevention training, there is little information about its effects on performance in young athletes. This study aimed to investigate the effects of eight-weeks NMT on motor competence and physical performance in 10- to 12-year-old female volleyball players. [...] Read more.
Although neuromuscular training (NMT) emphasizes injury prevention training, there is little information about its effects on performance in young athletes. This study aimed to investigate the effects of eight-weeks NMT on motor competence and physical performance in 10- to 12-year-old female volleyball players. Sixty-six participants (mean ± SD; 11.05 ± 0.72 years) were randomized into either the NMT group (NTG; n = 32) or control group (CON; n = 34). Sprint on 10-m, modified T-test, plank, vertical jump, and medicine ball throw tests were used to assess the physical performance. The Körperkoordinationstest für Kinder (KTK) was used to assess the subjects’ motor competence. The NMT was performed twice a week during the first 30 min of each regularly scheduled 90-minute volleyball training. Participants in the CON group attended only their regular volleyball training. A significant group x time interaction was found for Motor Quotient KTK (MQKTK) (p < 0.001), KTK lateral jumps (p < 0.001), and KTK shifting platforms (p < 0.01). There was a significant interaction for modified T-test results (p < 0.001) and vertical jump (p = 0.04). No change was observed in both groups for plank performance (p > 0.05). The NMT promoted significant gains in motor competence and physical performance in youth female volleyball players. Full article
14 pages, 1300 KiB  
Article
Physical and Physiological Profiles of Aerobic and Anaerobic Capacities in Young Basketball Players
by David Mancha-Triguero, Javier García-Rubio, Antonio Antúnez and Sergio J. Ibáñez
Int. J. Environ. Res. Public Health 2020, 17(4), 1409; https://doi.org/10.3390/ijerph17041409 - 21 Feb 2020
Cited by 27 | Viewed by 6306
Abstract
Current trends in the analysis of the physical fitness of athletes are based on subjecting the athlete to requirements similar to those found in competition. Regarding physical fitness, a thorough study of the capacities that affect the development of team sports in different [...] Read more.
Current trends in the analysis of the physical fitness of athletes are based on subjecting the athlete to requirements similar to those found in competition. Regarding physical fitness, a thorough study of the capacities that affect the development of team sports in different ages and gender is required since the demands are not equivalent. The objective of this paper was to characterize the physical-physiological demands of athletes in an aerobic and anaerobic test specific to basketball players, as well as the evolution of the variables according to age and gender. The research was carried out in 149 players from different training categories (n = 103 male; n = 46 female). The athletes performed two field tests that evaluated both aerobic capacity and lactic anaerobic capacity. Each athlete was equipped with an inertial device during the tests. Sixteen variables (equal in both tests) were analyzed. Three of them evaluated technical-tactical aspects, four variables of objective internal load, six kinematic variables of objective external load (two related to distance and four related to accelerometry) and three neuromuscular variables of objective external load. The obtained results show significant differences in the variables analyzed according to the age and gender of the athletes. They are mainly due to factors related to the anthropometric maturation and development inherent in age and have an impact on the efficiency and technical and tactical requirements of the tests carried out and, therefore, on the obtained results in the tests. Full article
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10 pages, 1333 KiB  
Article
Maturity Related Differences in Body Composition Assessed by Classic and Specific Bioimpedance Vector Analysis among Male Elite Youth Soccer Players
by Stefania Toselli, Elisabetta Marini, Pasqualino Maietta Latessa, Luca Benedetti and Francesco Campa
Int. J. Environ. Res. Public Health 2020, 17(3), 729; https://doi.org/10.3390/ijerph17030729 - 22 Jan 2020
Cited by 34 | Viewed by 4577
Abstract
The aim of this study was to analyze the efficiency of classic and specific bioelectrical impedance vector analysis (BIVA) in the assessment of maturity related differences in body composition among male elite youth soccer players, and to provide bioelectrical impedance reference data for [...] Read more.
The aim of this study was to analyze the efficiency of classic and specific bioelectrical impedance vector analysis (BIVA) in the assessment of maturity related differences in body composition among male elite youth soccer players, and to provide bioelectrical impedance reference data for this category. A group of 178 players (aged 12.1 ± 1.6 years) were registered in a professional Italian soccer team participating in the first division (Serie A). They were divided into three groups according to their maturity status while bioelectrical resistance and reactance were obtained. The classic and specific BIVA procedures were applied, which correct bioelectrical values for body height and body geometry, respectively. Percentage of fat mass (FM%) and total body water (TBW (L)) were estimated from bioelectrical values. Age-specific z-scores of the predicted age at peak height velocity identified 29 players as earlier-, 126 as on time-, and 23 as later-maturing. TBW was higher (p < 0.01) in adolescents classified as “early” maturity status compared to the other two groups and classic BIVA confirmed these results. Conversely, no differences in FM% were found among the groups. Specific vector length showed a higher correlation (r = 0.748) with FM% compared with the classic approach (r = 0.493). Classic vector length showed a stronger association (r = −0.955) with TBW compared with specific (r = −0.263). Specific BIVA turns out to be accurate for the analysis of FM% in athletes, while classic BIVA shows to be a valid approach to evaluate TBW. An original data set of bioelectric impedance reference values of male elite youth soccer players was provided. Full article
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12 pages, 668 KiB  
Article
Effects of Motivational Climate on Fear of Failure and Anxiety in Teen Handball Players
by Manuel Gómez-López, Carla Chicau Borrego, Carlos Marques da Silva, Antonio Granero-Gallegos and Juan González-Hernández
Int. J. Environ. Res. Public Health 2020, 17(2), 592; https://doi.org/10.3390/ijerph17020592 - 16 Jan 2020
Cited by 29 | Viewed by 8560
Abstract
The aim of this study was to examine the effects of the motivational climate created by the coach and perceived by a group of young, high-performance handball players on their fear of failure and precompetitive anxiety. The study participants were 479 young handball [...] Read more.
The aim of this study was to examine the effects of the motivational climate created by the coach and perceived by a group of young, high-performance handball players on their fear of failure and precompetitive anxiety. The study participants were 479 young handball players. The age range was 16–17 years old. Players were administered a battery composed of a Perceived Motivational Climate in Sport Questionnaire, a Performance Failure Appraisal Inventory, and Competitive State Anxiety Inventory-2R, to measure the aforementioned theoretical constructs. Using structural equation modelling (SEM), the results showed that the handball players experienced high levels task-involving climate and moderate values of self-confidence. In contrast, players experienced lower levels of ego-involving climate, fear of failure, and cognitive and somatic anxiety. The obtained model shows that fear of failure positively mediates the association between an ego-involving climate with both cognitive and somatic anxiety, and negatively in terms of self-confidence. In contrast, fear of failure does not mediate the associations between a task-involving climate and both somatic and cognitive anxiety and self-confidence. Full article
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14 pages, 634 KiB  
Article
The Effect of Respiratory Muscle Training on the Pulmonary Function, Lung Ventilation, and Endurance Performance of Young Soccer Players
by Krzysztof Mackała, Monika Kurzaj, Paulina Okrzymowska, Jacek Stodółka, Milan Coh and Krystyna Rożek-Piechura
Int. J. Environ. Res. Public Health 2020, 17(1), 234; https://doi.org/10.3390/ijerph17010234 - 28 Dec 2019
Cited by 36 | Viewed by 9511
Abstract
This study investigated whether the addition of eight weeks of inspiratory muscle training (IMT) to a regular preseason soccer training program, including incremental endurance training (IET), would change pulmonary function, lung ventilation, and aerobic performance in young soccer players. Sixteen club-level competitive junior [...] Read more.
This study investigated whether the addition of eight weeks of inspiratory muscle training (IMT) to a regular preseason soccer training program, including incremental endurance training (IET), would change pulmonary function, lung ventilation, and aerobic performance in young soccer players. Sixteen club-level competitive junior soccer players (mean age 17.63 ± 0.48 years, height 182 ± 0.05 cm, body mass 68.88 ± 4.48 kg) participated in the study. Participants were randomly assigned into two groups: experimental (n = 8) and control (n = 8). Both groups performed regular preseason soccer training, including endurance workouts as IET. In addition to this training, the experimental group performed additional IMT for eigght weeks with a commercially available respiratory muscle trainer (Threshold IMT), with a total of 80 inhalations (twice per day, five days per week). Pre- and post-intervention tests of pulmonary function, maximal inspiratory pressure, and the Cooper test were implemented. Eight weeks of IMT had a positive impact on expiratory muscle strength (p = 0.001); however, there was no significant effect on respiratory function parameters. The results also indicate increased efficiency of the inspiratory muscles, contributing to an improvement in aerobic endurance, measured by VO₂max estimated from running distance in the cardiorespiratory Cooper test (p < 0.005). Full article
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10 pages, 331 KiB  
Article
Effect of 12-Week Functional Training Intervention on the Speed of Young Footballers
by Jakub Baron, Anna Bieniec, Andrzej S. Swinarew, Tomasz Gabryś and Arkadiusz Stanula
Int. J. Environ. Res. Public Health 2020, 17(1), 160; https://doi.org/10.3390/ijerph17010160 - 24 Dec 2019
Cited by 19 | Viewed by 6141
Abstract
The aim of the research was to verify the functional state of young football players using selected tests of the Functional Movement Screen (FMS) protocol, as well as the impact of the 12 weeks of functional training on the speed parameters. The research [...] Read more.
The aim of the research was to verify the functional state of young football players using selected tests of the Functional Movement Screen (FMS) protocol, as well as the impact of the 12 weeks of functional training on the speed parameters. The research was conducted on 20 highly competitive young (U17) football players. Research project was conducted in two stages: in the first part of the study, the functional assessment was made by using the FMS test, then the measurement of the speed parameters was done with the Microgate photocells system. Results showed a significant improvement in the functional state of young football players: FMS 1 (45.2% of difference, p = 0.004), FMS 2 (24.3% of difference, p = 0.012), FMS 3 (48.5% of difference, p = 0.001). After the functional training program, there was also an improvement in the parameters of the acceleration and velocity: acceleration between 5–10 m and speed between 10–30 m shows significant improvement (expressed during covering a given distance) of the footballers, amounting to 0.02 s (2.4%) and 0.04 s (1.5%). But there was no improvement in acceleration between 0–5 m. An appropriate training schedule, based on FMS results, should be adopted in the annual training program to improve basic motor skills of the football players and minimize their injuries. Full article
8 pages, 846 KiB  
Article
Growth Charts for Height, Weight, and BMI (6–18 y) for the Tuscany Youth Sports Population
by Gabriele Mascherini, Giorgio Galanti, Luciano Massetti, Piergiuseppe Calà and Pietro Amedeo Modesti
Int. J. Environ. Res. Public Health 2019, 16(24), 4975; https://doi.org/10.3390/ijerph16244975 - 6 Dec 2019
Cited by 8 | Viewed by 3433
Abstract
Overweight during youth is a large-scale public health issue. Engaging in regular physical activity generally reduces weight status. The hypothesis of the study is that organized sport plays an active role in maintaining a correct body weight during youth. The purpose of this [...] Read more.
Overweight during youth is a large-scale public health issue. Engaging in regular physical activity generally reduces weight status. The hypothesis of the study is that organized sport plays an active role in maintaining a correct body weight during youth. The purpose of this study is to trace growth charts by height, weight, and body mass index (BMI) to be applied to the youth sports population. A retrospective study was conducted on 14,700 young athletes (10,469 males and 4231 females) aged between 6 and 18 years from surveillance carried out during the pre-participation screening of sports eligibility. The calculation of the prevalence of overweight and obesity was also performed. The new percentiles for the youth sports population show BMI values at 18 years 21.9 kg/m2 for males and 20.7 kg/m2 for females at the 50th percentile. The male sample shows 12.3% of the subjects were overweight and 1.5% were obese, while the female sample shows 9.8% are overweight and 1.1% obese. The higher prevalence of excess weight is evident up to 12 years old in both sexes and then gradually decreases. The development of the new specific growth charts for the youth sports population could reduce the risk of error in identifying the correct weight status of young athletes. Full article
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11 pages, 2199 KiB  
Article
The Role of Somatic Maturation on Bioimpedance Patterns and Body Composition in Male Elite Youth Soccer Players
by Francesco Campa, Analiza Monica Silva, Vincenzo Iannuzzi, Gabriele Mascherini, Luca Benedetti and Stefania Toselli
Int. J. Environ. Res. Public Health 2019, 16(23), 4711; https://doi.org/10.3390/ijerph16234711 - 26 Nov 2019
Cited by 40 | Viewed by 4446
Abstract
The purpose of this study was to examine the influence of chronological age (CA) and somatic maturation on body composition (BC) and bioimpedance parameters in male elite soccer players. BC and bioimpedance variables were measured in a sample of 249 players aged 9−18 [...] Read more.
The purpose of this study was to examine the influence of chronological age (CA) and somatic maturation on body composition (BC) and bioimpedance parameters in male elite soccer players. BC and bioimpedance variables were measured in a sample of 249 players aged 9−18 years of age and registered in two professional Italian soccer teams. Results from segmental analysis showed transition time points where the influence of CA and somatic maturation on bioimpedance patterns and BC characteristics increased or subsided. The accelerated phases were assessed for fat free mass, total body water, and upper muscle area, with a starting time point at approximately −2.00 years from peak at velocity (YPHV), and for body cell mass, whose developmental tempo sped up around −1.00 YPHV. An increase in the rate of development was also observed close to −2.00 YPHV for phase angle (PA), although without accelerated phases. From a CA point of view, significant slope changes were found for all BC and bioimpendance variables, except for the calf muscle area. Although the starting points and the span of the accelerated phases were different, they subsided or disappeared at ~ 15 years, except for PA, whose growth waned at ~ 17 years. Full article
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