Today we will wrap up our conversation on sleep discussing sleep quality and sleep hygiene.

References

- Driller MW, Dunican IC, Omond SET, Boukhris O, Stevenson S, Lambing K, Bender AM. Pyjamas, Polysomnography and Professional Athletes: The Role of Sleep Tracking Technology in Sport. Sports. 2023; 11(1):14. https://doi.org/10.3390/sports11010014

- Jaiswal, S.J., Pawelek, J.B., Warshawsky, S. et al. Using New Technologies and Wearables for Characterizing Sleep in Population-based Studies. Curr Sleep Medicine Rep 10, 82–92 (2024). https://doi.org/10.1007/s40675-023-00272-7

- Nelson KL, Davis JE, Corbett CF. Sleep quality: An evolutionary concept analysis. Nurs Forum. 2022 Jan;57(1):144-151. doi: 10.1111/nuf.12659. Epub 2021 Oct 5. PMID: 34610163.

- Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, Dauvilliers Y, Ferri R, Fung C, Gozal D, Hazen N, Krystal A, Lichstein K, Mallampalli M, Plazzi G, Rawding R, Scheer FA, Somers V, Vitiello MV. National Sleep Foundation's sleep quality recommendations: first report. Sleep Health. 2017 Feb;3(1):6-19. doi: 10.1016/j.sleh.2016.11.006. Epub 2016 Dec 23. PMID: 28346153.

- Phillips SR, Johnson AH, Shirey MR, Rice M. Sleep Quality in School-Aged Children: A Concept Analysis. J Pediatr Nurs. 2020 May-Jun;52:54-63. doi: 10.1016/j.pedn.2020.02.043. Epub 2020 Mar 14. PMID: 32179378; PMCID: PMC7285623.

- Rhoda Au, Mary Carskadon, Richard Millman, Amy Wolfson, Paula K. Braverman, William P. Adelman, Cora C. Breuner, David A. Levine, Arik V. Marcell, Pamela J. Murray, Rebecca F. O’Brien, Cynthia D. Devore, Mandy Allison, Richard Ancona, FAAP Stephen E. Barnett, Robert Gunther, Breena Holmes, Jeffrey H. Lamont, Mark Minier, Jeffrey K. Okamoto, Lani S.M. Wheeler, Thomas Young; School Start Times for Adolescents. Pediatrics September 2014; 134 (3): 642–649. 10.1542/peds.2014-1697

- Vitale KC, Owens R, Hopkins SR, Malhotra A. Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. Int J Sports Med. 2019 Aug;40(8):535-543. doi: 10.1055/a-0905-3103. Epub 2019 Jul 9. PMID: 31288293; PMCID: PMC6988893.

Today, we'll begin to discuss sleep and it's impact on the pediatric and adolescent athlete. We'll start with a review of what sleep is and then move to discussing how it impacts recovery, athletic performance, injury, and illness.

Sources abbreviated

- Arora T,Broglia E, Pushpakumar D, Lodhi T, Taheri S. An investigation into the strengthof the association and agreement levels between subjective and objective sleep duration in adolescents. PLoS One. 2013

- Blumert PA, et al. The acute effects of twenty-four hours of sleep loss on the performance of national-caliber male collegiate weightlifters. J Strength Cond Res. 2007

- Brinkman JE, at al. Physiology of Sleep. 2024

- Charest J and Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin. 2020

- Charest J, Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health: An Update. Sleep Med Clin. 2022

- Coel RA, et al. Sleep and the Young Athlete. Sports Health. 2023

- Eugene AR and Masiak J. The Neuroprotective Aspects of Sleep. MEDtube Sci. 2015

- Gao, Burke, et al. Lack of Sleep and Sports Injuries in Adolescents: A Systematic Review and Meta-analysis. Journal of Pediatric Orthopaedics. 2019

- Huang, Kevin and Ihm, Joseph. Sleep and Injury Risk. Current Sports Medicine Reports. 2021

- Lopes TR, et al. How much does sleep deprivation impair endurance performance? A systematic review and meta-analysis. Eur J Sport Sci. 2023

- Mah CD, et al. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 2011

- Milewski MD, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014

- Prather AA, et al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015

- Souissi N, et al. Effects of one night's sleep deprivation on anaerobic performance the following day. Eur J Appl Physiol. 2003

- Thiago RL, et al. How much does sleep deprivation impair endurance performance? A systematic review and meta-analysis, European Journal of Sport Science. 2023

- Reilly T and Piercy M. The effect of partial sleep deprivation on weight-lifting performance. Ergonomics. 1994

- von Rosen, et al. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017

- Schwartz J, Simon RD Jr. Sleep extension improves serving accuracy: A study with college varsity tennis players. Physiol Behav. 2015

- Walsh NP, et al. Sleep and the athlete: narrative review and 2021 expert consensus recommendations BJSM 2021

So you're putting in the physical work via exercise training to get active and become a better athlete, but are you maximizing your beneficial adaptations? Learn how to today when we begin to discuss recovery and periodization.

Sources

Periodization and Rest/Recovery

- González-Ravé, J.M., González-Mohino, F., Rodrigo-Carranza, V. et al. Reverse Periodization for Improving Sports Performance: A Systematic Review. Sports Med - Open 8, 56 (2022). https://doi.org/10.1186/s40798-022-00445-8

- Lorenz D, Morrison S. CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. Int J Sports Phys Ther. 2015 Nov;10(6):734-47. PMID: 26618056; PMCID: PMC4637911.

- Lorenz DS, Reiman MP, Walker JC. Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health. 2010 Nov;2(6):509-18. doi: 10.1177/1941738110375910. PMID: 23015982; PMCID: PMC3438871.

- Moesgaard L., Beck, M.M., Christiansen, L. et al. Effects of Periodization on Strength and Muscle Hypertrophy in Volume-Equated Resistance Training Programs: A Systematic Review and Meta-analysis. Sports Med 52, 1647–1666 (2022). https://doi.org/10.1007/s40279-021-01636-1

- Paul R. Stricker, Avery D. Faigenbaum, Teri M. McCambridge, COUNCIL ON SPORTS MEDICINE AND FITNESS, Cynthia R. LaBella, M. Alison Brooks, Greg Canty, Alex B. Diamond, William Hennrikus, Kelsey Logan, Kody Moffatt, Blaise A. Nemeth, K. Brooke Pengel, Andrew R. Peterson; Resistance Training for Children and Adolescents. Pediatrics June 2020; 145 (6): e20201011. 10.1542/peds.2020-1011

- Stone, Michael H.1; Hornsby, William G.2; Haff, G. Gregory3; Fry, Andrew C.4; Suarez, Dylan G.1; Liu, Junshi5; Gonzalez-Rave, Jose M.6; Pierce, Kyle C.7. Periodization and Block Periodization in Sports: Emphasis on Strength-Power Training—A Provocative and Challenging Narrative. Journal of Strength and Conditioning Research 35(8):p 2351-2371, August 2021. | DOI: 10.1519/JSC.0000000000004050

- Williams TD, Tolusso DV, Fedewa MV, Esco MR. Comparison of Periodized and Non-Periodized Resistance Training on Maximal Strength: A Meta-Analysis. Sports Med. 2017Oct;47(10):2083-2100. doi: 10.1007/s40279-017-0734-y. PMID: 28497285.

Rest/Recovery

- Brenner JS, Watson A, COUNCIL ON SPORTS MEDICINE AND FITNESS; Overuse Injuries, Overtraining, and Burnout in Young Athletes. Pediatrics February 2024; 153 (2): e2023065129. 10.1542/peds.2023-065129

- Lesinski M, Prieske O, Granacher U. Effects and dose-response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med. 2016 Jul;50(13):781-95. doi: 10.1136/bjsports-2015-095497. Epub 2016 Feb 5. PMID: 26851290; PMCID: PMC4941165.

- Morán-Navarro R, Pérez CE, Mora-Rodríguez R, de la Cruz-Sánchez E, González-Badillo JJ, Sánchez-Medina L, Pallarés JG. Time course of recovery following resistance training leading or not to failure. Eur J Appl Physiol. 2017 Dec;117(12):2387-2399. doi: 10.1007/s00421-017-3725-7. Epub 2017 Sep 30. PMID:28965198.

- Sánchez Pastor, A.; García-Sánchez, C.; Marquina Nieto, M.; de la Rubia, A. Influence of Strength Training Variables on Neuromuscular and Morphological Adaptations in Prepubertal Children: A Systematic Review. Int. J. Environ. Res. Public Health 2023, 20, 4833. https://doi.org/10.3390/ijerph20064833

- Schoenfeld BJ, Pope ZK, Benik FM, Hester GM, Sellers J, Nooner JL, Schnaiter JA, Bond-Williams KE, Carter AS, Ross CL, Just BL, Henselmans M, Krieger JW. Longer Interset Rest Periods Enhance Muscle Strength and Hypertrophy in Resistance-Trained Men. J Strength Cond Res. 2016 Jul;30(7):1805-12. doi: 10.1519/JSC.0000000000001272. PMID: 26605807.

In today's podcast we'll move further into exercise training discussing plyometrics, dynamic stabilization, proprioception, and injury resistance. We'll then wrap it up by returning to resistance training and focusing in on how to advance to a more specialized and individualized approach after mastering the 1-2 sets of 8-12 reps.

Sources (abbreviated due to character restraints)

Plyometrics

- Behm DG, et al. Effectiveness of Traditional Strength vs. Power Training on MuscleStrength, Power and Speed with Youth: A Systema tic Review and Meta-Analysis. Front Physiol.

- Chen L, et al. Maximizing plyometric training for adolescents: a meta-analysis of ground contact frequency and overall intervention time on jumping ability: a systematic review and meta-analysis. Sci Rep.

- Chen L, et al. Meta-Analysis of the Effects of Plyometric Training on Lower Limb Explosive Strength in Adolescent Athletes. Int J Environ Res Public Health.

- Davies G, et al. CURRENT CONCEPTS OF PLYOMETRIC EXERCISE. Int J Sports Phys Ther.

-Johnson, et al. A Systematic Review: Plyometric Training Programs for Young Children. Journal of Strength and Conditioning Research

- Morris SJ, et al. Comparison of Weightlifting, Traditional Resistance Training and Plyometrics on Strength, Power and Speed: A Systematic Review with Meta-Analysis. Sports Med.

- Oliver JL, et al. The Effects of Strength, Plyometric and Combined Training on Strength, Power and Speed Characteristics in High-Level, Highly Trained Male Youth Soccer Players: A Systematic Review and Meta-Analysis. Sports Med.

- Zghal F et al. Combined Resistance and Plyometric Training Is More Effective Than Plyometric Training Alone for Improving Physical Fitness of Pubertal Soccer Players. Front Physiol.

- Sadigursky D, et al. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Sci Med Rehabil.

- Silvers-Granelli HJ et al. Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players? Clin Orthop Relat Res.

- Steib S, et al. Dose-Response Relationship of Neuromuscular Training for Injury Prevention in Youth Athletes: A Meta-Analysis. Front Physiol.

Eccentric Exercises

- Hu C, et al. Effects of Different Hamstring Eccentric Exercise Programs on Preventing Lower Extremity Injuries: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health.

- Okobi OE et al. A Meta-Analysis of Randomized Controlled Trials on the Effectiveness of Exercise Intervention in Preventing Sports Injuries. Cureus.

Repetition Continuum/strength gains

- Brigatto FA et al. Multi-joint vs. Single-joint Resistance Exercises Induce a Similar Strength Increase in Trained Men: A Randomized Longitudinal Crossover Study. Int J Exerc Sci.

- Gentil P, et al. Single vs. Multi-Joint Resistance Exercises: Effects on Muscle Strength and Hypertrophy. Asian J Sports Med

- Lesinski M, et al. Effects and dose–response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. BJSM

- Loenneke, J.P et al. Exercise-Induced Changes in Muscle Size do not Contribute to Exercise-Induced Changes in Muscle Strength. Sports Med

- Schoenfeld BJ, et al. Loading Recommendations for Muscle Strength, Hypertrophy, and Local Endurance: A Re-Examination of the Repetition Continuum. Sports (Basel)

- Schoenfeld, BJ. et al. Longer Interset Rest Periods Enhance Muscle Strength and Hypertrophy in Resistance-Trained Men. Journal of Strength and Conditioning Research

- Spiering, B. et al. Maximizing Strength: The Stimuli and Mediators of Strength Gains and Their Application to Training and Rehabilitation. Journal of Strength and Conditioning Research

- Stien N, et al. Training specificity performing single-joint vs. multi-joint resistance exercises among physically active females: A randomized controlled trial. PLoS One

In this episode we begin to shine a light on how to build a proper exercise training program for the young athlete. We define important terms involved in exercise training and start to understand how to apply these terms to a an exercise training routine.

Sources

Integrative neuromuscular training

- Fort-Vanmeerhaeghe, Azahara PhD; Romero-Rodriguez, Daniel PhD; Montalvo, Alicia M. MS, LAT, ATC, CSCS; Kiefer, Adam W. PhD; Lloyd, Rhodri S. PhD, CSCS*D; Myer, Gregory D. PhD, CSCS*D. Integrative Neuromuscular Training and Injury Prevention in Youth Athletes. Part I: Identifying Risk Factors. Strength and Conditioning Journal 38(3):p 36-48, June 2016. | DOI: 10.1519/SSC.0000000000000229

- Fort-Vanmeerhaeghe, Azahara PhD1,2,3; Romero-Rodriguez, Daniel PhD1; Lloyd, Rhodri S. PhD, CSCS*D4; Kushner, Adam BS, CSCS5; Myer, Gregory D. PhD, CSCS*D5,6,7,8. Integrative Neuromuscular Training in Youth Athletes. Part II: Strategies to Prevent Injuries and Improve Performance. Strength and Conditioning Journal 38(4):p 9-27, August 2016. | DOI: 10.1519/SSC.0000000000000234

- Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, Beynnon BD. Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports Health. 2012 Jan;4(1):69-78. doi: 10.1177/1941738111428281. PMID: 23016072; PMCID: PMC3435896.

Strength in youth/adolescents

- Dahab KS, McCambridge TM. Strength training in children and adolescents: raising the bar for young athletes? Sports Health. 2009 May;1(3):223-6. doi: 10.1177/1941738109334215. PMID: 23015875; PMCID: PMC3445252.

- Evans JW. Periodized Resistance Training for Enhancing Skeletal Muscle Hypertrophy and Strength: A Mini-Review. Front Physiol. 2019 Jan 23;10:13. doi: 10.3389/fphys.2019.00013. PMID: 30728780; PMCID: PMC6351492.

- Granacher U, Lesinski M, Büsch D, Muehlbauer T, Prieske O, Puta C, Gollhofer A, Behm DG. Effects of Resistance Training in Youth Athletes on Muscular Fitness and Athletic Performance: A Conceptual Model for Long-Term Athlete Development. Front Physiol. 2016 May 9;7:164. doi: 10.3389/fphys.2016.00164. PMID: 27242538; PMCID: PMC4861005.

- Lesinski M, Prieske O, Granacher U. Effects and dose–response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. British Journal of Sports Medicine 2016;50:781-795.

-Lloyd R.S., Faigenbaum A.D., Stone M.H., Oliver J., Jeffreys I., Moody J.A., Brewer C., Pierce K.C., McCambridge T.M., Howard R., et al. Position statement on youth resistance training: The 2014 International Consensus. Br. J. Sport. Med. 2014;48:498–505. doi: 10.1136/bjsports-2013-092952.

- Paul R. Stricker, Avery D. Faigenbaum, Teri M. McCambridge, COUNCIL ON SPORTS MEDICINE AND FITNESS, Cynthia R. LaBella, M. Alison Brooks, Greg Canty, Alex B. Diamond, William Hennrikus, Kelsey Logan, Kody Moffatt, Blaise A. Nemeth, K. Brooke Pengel, Andrew R. Peterson; Resistance Training for Children and Adolescents. Pediatrics June 2020; 145 (6): e20201011. 10.1542/peds.2020-1011

- Sánchez Pastor A, García-Sánchez C, Marquina Nieto M, de la Rubia A. Influence of Strength Training Variables on Neuromuscular and Morphological Adaptations in Prepubertal Children: A Systematic Review. Int J Environ Res Public Health. 2023 Mar 9;20(6):4833. doi: 10.3390/ijerph20064833. PMID: 36981742; PMCID: PMC10049541.

Nature vs nurture? Find out more in terms of the pediatrics and adolescent athlete.

Sources

- Baltazar-Martins G, Gutiérrez-Hellín J, Aguilar-Navarro M, Ruiz-Moreno C, Moreno-Pérez V, López-Samanes Á, Domínguez R, Del Coso J. Effect of ACTN3 Genotype on Sports Performance, Exercise-Induced Muscle Damage, and Injury Epidemiology. Sports (Basel). 2020 Jul 13;8(7):99. doi: 10.3390/sports8070099. PMID: 32668587; PMCID: PMC7404684.

- De Moor MH, Spector TD, Cherkas LF, Falchi M, Hottenga JJ, Boomsma DI, De Geus EJ. Genome-wide linkage scan for athlete status in 700 British female DZ twin pairs. Twin Res Hum Genet. 2007 Dec;10(6):812-20. doi: 10.1375/twin.10.6.812. PMID: 18179392.

- Ehlert T, Simon P, Moser DA. Epigenetics in sports. Sports Med. 2013 Feb;43(2):93-110. doi: 10.1007/s40279-012-0012-y. PMID: 23329609.

- Fraga MF, Ballestar E, Paz MF, Ropero S, Setien F, Ballestar ML, Heine-Suñer D, Cigudosa JC, Urioste M, Benitez J, Boix-Chornet M, Sanchez-Aguilera A, Ling C, Carlsson E, Poulsen P, Vaag A, Stephan Z, Spector TD, Wu YZ, Plass C, Esteller M. Epigenetic differences arise during the lifetime of monozygotic twins. Proc Natl Acad SciU S A. 2005 Jul 26;102(30):10604-9. doi: 10.1073/pnas.0500398102. Epub 2005 Jul 11. PMID: 16009939; PMCID: PMC1174919.

- John R, Dhillon MS, Dhillon S. Genetics and the Elite Athlete: Our Understanding in 2020. Indian J Orthop. 2020 Mar 11;54(3):256-263. doi: 10.1007/s43465-020-00056-z. PMID: 32399143; PMCID: PMC7205921.

- Jonsson, H., Magnusdottir, E., Eggertsson, H.P. et al. Differences between germline genomes of monozygotic twins. Nat Genet 53, 27–34 (2021). https://doi.org/10.1038/s41588-020-00755-1

- Kristman VL, Tator CH, Kreiger N et al. Does the apolipoprotein epsilon 4 allele predispose varsity athletes to concussion? A prospective cohort study. Clin. J. Sport Med. 18(4), 322–328 (2008).

-Pickering C, Kiely J. ACTN3: More than Just a Gene for Speed. Front Physiol. 2017 Dec 18;8:1080. doi: 10.3389/fphys.2017.01080. PMID: 29326606; PMCID: PMC5741991.

- Naureen Z, Perrone M, Paolacci S, Maltese PE, Dhuli K, Kurti D, Dautaj A, Miotto R, Casadei A, Fioretti B, Beccari T, Romeo F, Bertelli M. Genetic test for the personalization of sport training. Acta Biomed. 2020 Nov 9;91(13-S):e2020012. doi: 10.23750/abm.v91i13-S.10593. PMID: 33170162; PMCID: PMC8023127.

- Semenova EA, Hall ECR, Ahmetov II. Genes and Athletic Performance: The 2023 Update. Genes (Basel). 2023 Jun 8;14(6):1235. doi: 10.3390/genes14061235. PMID: 37372415; PMCID: PMC10298527.

- Pickering C, Kiely J. ACTN3: More than Just a Gene for Speed. Front Physiol. 2017 Dec18;8:1080. doi: 10.3389/fphys.2017.01080. PMID: 29326606; PMCID: PMC5741991.

- Sharples AP, Stewart CE, Seaborne RA. Does skeletal muscle have an 'epi'-memory? The role of epigenetics in nutritional programming, metabolic disease, aging and exercise. Aging Cell. 2016 Aug;15(4):603-16. doi: 10.1111/acel.12486. Epub 2016 Apr 22. PMID: 27102569; PMCID: PMC4933662.

- Semenova EA, Hall ECR, Ahmetov II. Genes and Athletic Performance: The 2023 Update. Genes (Basel). 2023 Jun 8;14(6):1235. doi: 10.3390/genes14061235. PMID: 37372415; PMCID: PMC10298527.

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- Terrell TR, Bostick RM, Abramson R et al. APOE, APOE promoter, and Tau genotypes and risk for concussion in college athletes. Clin. J. Sport Med. 18(1), 10–17 (2008).

- Turner, D.C., Seaborne, R.A. & Sharples, A.P. Comparative Transcriptome and Methylome Analysis in Human Skeletal Muscle Anabolism, Hypertrophy and Epigenetic Memory. Sci Rep 9, 4251 (2019). https://doi.org/10.1038/s41598-019-40787-0

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How can we promote life long physical literacy? What can I do to help support my young athlete become the best they an be? What is the long-term athlete development model? Find some answers to these questions and more in the episode today.

Sources

- From Flag to Friday Night—Long-Term Athlete Development in Youth American Football by Joe Eisenmann, PhD and Clive J. Brewer, MS, CSCS. NSCA Coach February 2019

- LONG-TERM DEVELOPMENT IN SPORT AND PHYSICAL ACTIVITY 3.0. Colin Higgs, PhD Richard Way, MBA Vicki Harber, PhD Paul Jurbala, PhD Istvan Balyi, MA

- https://sportforlife.ca/blog/a-brief-history-of-sport-for-life/

- Youth Athlete Development Models: A Narrative Review Mathew Varghese, MD, Sonia Ruparell, MD, and Cynthia LaBella, MD

- A FUNDAMENTAL APPROACH FOR TREATING PEDIATRIC DYNAPENIA IN KIDS. by Avery D. Faigenbaum, Ed.D., CSCS, FACSM and Laura E. Bruno, Ed.D

In this episode, we'll review what the general physical activity recommendations are in the pediatric and adolescent athlete, we'll review how we are doing as a nation in terms of meeting these recommendations, and we'll start building a foundation on how to improve our physical activity grade.

Sources for the episode - Brockman R,Jago R, Fox KR. Children's active play: self-reported motivators, barriers and facilitators. BMC Public Health. 2011;11:461-461.

-Huang TTK, Borowski LA, Liu B, et al. Pediatricians’ and family physicians’ weight-related care of children in the U.S. Am J Prev Med. 2011;41(1):24-32. doi:10.1016/j.amepre.2011.03.016

-Gordia AP, de Quadros TMB, Silva LR, dos Santos GM. Knowledge of pediatricians regarding physical activity in childhood and adolescence. Rev Paul Pediatr. 2015;33(4):400-406. doi:10.1016/j.rpped.2015.02.001

- Veitch J, Bagley S, Ball K, Salmon J. Where do children usually play? A qualitative study of parents’ perceptions of influences on children's active free-play. Health Place. 2006;12(4):383-393.

- https://health.gov/sites/default/files/2019-10/National_Youth_Sports_Strategy.pdf - https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

- https://paamovewithus.org/wp-content/uploads/2022/10/2022-US-Report-Card-on-Physical-Activity-for-Children-and-Youth.pdf