{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T12:25:54Z","timestamp":1775219154043,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tung Wah College","award":["2019-02-52-SRG190201"],"award-info":[{"award-number":["2019-02-52-SRG190201"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Patients with adolescent idiopathic scoliosis (AIS) are found to have a lower level of physical activity, and may have reduced exercise capacity due to spinal deformity. Previous study showed the benefits of high-intensity interval training (HIIT), named E-Fit, which is specifically designed for patients with AIS to improve musculoskeletal health and psychological well-being. To optimize the beneficial effects of training, the current study aimed to investigate the appropriate exercise intensity and metabolic demand in patients with AIS when performing E-Fit. Methods: In all, 22 female subjects, 10 diagnosed with AIS and 12 gender-matched healthy controls, aged between 10 and 16 years, were recruited. Subjects were instructed to perform two trials of a seven min E-Fit. Breath-by-breath gas exchange parameters including oxygen consumption (VO2), heart rate (HR) and the rate of perceived exertion (PRE) were measured during exercise. Demographic data and clinical features of AIS and body composition were obtained. Metabolic demand between AIS and control groups was compared using MANOVA with covariates adjustment. Results: Patients with AIS had an earlier onset of menarche (p = 0.01), higher visceral adipose tissue (p = 0.04) and percentage body fat (p = 0.03) as compared to controls. Patients with AIS showed a significantly higher adjusted means of VO2 average in both the first (p = 0.014) and second trials (p = 0.011) of E-Fit. The adjusted mean of the highest measured VO2 was higher than healthy controls and reached statistical significance in the second trial (p = 0.004). Both the AIS and control group exercised at a similar percentage of VO2 peak (64.26% vs. 64.60%). Conclusion: Patients with AIS showed higher oxygen consumption during E-Fit than heathy controls, which might indicate a higher metabolic cost. Patients with AIS could carry out exercise at a moderate exercise intensity similar to that of healthy controls, but special considerations in designing an exercise program, such as frequent rest intervals, would be useful to avoid fatigue among patients with AIS.<\/jats:p>","DOI":"10.3390\/ijerph20032155","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T01:30:30Z","timestamp":1674696630000},"page":"2155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patients with Adolescent Idiopathic Scoliosis Have Higher Metabolic Cost during High-Intensity Interval Training"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2889-1103","authenticated-orcid":false,"given":"Rufina Wing-Lum","family":"Lau","sequence":"first","affiliation":[{"name":"School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China"},{"name":"SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0016-3876","authenticated-orcid":false,"given":"Rachel Lai-Chu","family":"Kwan","sequence":"additional","affiliation":[{"name":"School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8153-364X","authenticated-orcid":false,"given":"Jack Chun-Yiu","family":"Cheng","sequence":"additional","affiliation":[{"name":"SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2462-4622","authenticated-orcid":false,"given":"Stanley Sai-Chuen","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2427-2719","authenticated-orcid":false,"given":"Tsz-Ping","family":"Lam","sequence":"additional","affiliation":[{"name":"SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15030","DOI":"10.1038\/nrdp.2015.30","article-title":"Adolescent idiopathic scoliosis","volume":"1","author":"Cheng","year":"2015","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent idiopathic scoliosis","volume":"371","author":"Weinstein","year":"2008","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1115","DOI":"10.1002\/jsp2.1115","article-title":"Adolescent idiopathic scoliosis: The mechanobiology of differential growth","volume":"3","author":"Smit","year":"2020","journal-title":"JOR Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1097\/01.brs.0000169447.55556.01","article-title":"Significant Ventilatory Functional Restriction in Adolescents With Mild or Moderate Scoliosis During Maximal Exercise Tolerance Test","volume":"30","author":"Barrios","year":"2005","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.prrv.2006.04.009","article-title":"Scoliosis and the respiratory system","volume":"7","author":"Koumbourlis","year":"2006","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S0012-3692(15)51867-9","article-title":"Impact of a physical rehabilitation program on the respiratory function of adolescents with idiopathic scoliosis","volume":"130","author":"Stirbulov","year":"2006","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.prrv.2009.06.004","article-title":"Exercise testing in children with lung diseases","volume":"10","author":"Teoh","year":"2009","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00586-011-2068-z","article-title":"Physical capacity of girls with mild and moderate idiopathic scoliosis: Influence of the size, length and number of curvatures","volume":"21","author":"Czaprowski","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_9","first-page":"103","article-title":"Imbalanced development of anterior and posterior thorax is a causative factor triggering scoliosis","volume":"17","author":"Chen","year":"2019","journal-title":"J. Orthop. Transl."},{"key":"ref_10","first-page":"14","article-title":"Aortic location and flat chest in scoliosis: A prospective study","volume":"102","author":"Doi","year":"2011","journal-title":"Fukuoka Igaku Zasshi"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1748-7161-9-14","article-title":"A shallow chest correlates with the aortic position in the normal spine: Features resembling those observed in structural scoliosis","volume":"9","author":"Doi","year":"2014","journal-title":"Scoliosis"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1097\/00007632-199907010-00007","article-title":"Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with adolescent idiopathic scoliosis","volume":"24","author":"Leong","year":"1999","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/j.1440-1843.2004.00559.x","article-title":"The effect of chest wall restriction on exercise capacity","volume":"9","author":"Coast","year":"2004","journal-title":"Respirology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1378\/chest.99.3.663","article-title":"Impaired exercise capacity in adults with moderate scoliosis","volume":"99","author":"Kesten","year":"1991","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1164\/ajrccm\/148.2.295","article-title":"Factors influencing work capacity in adolescent idiopathic thoracic scoliosis","volume":"148","author":"Kearon","year":"1993","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1183\/09031936.00025509","article-title":"Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis","volume":"36","author":"Colomina","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1016\/j.spinee.2014.01.041","article-title":"Functional aerobic exercise capacity limitation in adolescent idiopathic scoliosis","volume":"14","author":"Sperandio","year":"2014","journal-title":"Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/j.1600-0838.1999.tb00204.x","article-title":"The effect of aerobic training in girls with idiopathic scoliosis","volume":"9","author":"Athanasopoulos","year":"1999","journal-title":"Scand. J. Med. Sci. Sport."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jphys.2019.11.012","article-title":"Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: A randomised trial","volume":"66","author":"Xavier","year":"2020","journal-title":"J. Physiother."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lau, R.W.-L., Cheuk, K.-Y., Ng, B.K.-W., Tam, E.M.-S., Hung, A.L.-H., Cheng, J.C.-Y., Hui, S.S.-C., and Lam, T.-P. (2021). Effects of a Home-Based Exercise Intervention (E-Fit) on Bone Density, Muscle Function, and Quality of Life in Girls with Adolescent Idiopathic Scoliosis (AIS): A Pilot Randomized Controlled Trial. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010899"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s12966-015-0254-9","article-title":"High-intensity interval exercise training for public health: A big HIT or shall we HIT it on the head?","volume":"12","author":"Biddle","year":"2015","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/00003086-199602000-00004","article-title":"Anthropometric measurements and body proportions among Chinese children","volume":"323","author":"Cheng","year":"1996","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.2106\/JBJS.16.01078","article-title":"Thumb Ossification Composite Index (TOCI) for Predicting Peripubertal Skeletal Maturity and Peak Height Velocity in Idiopathic Scoliosis: A Validation Study of Premenarchal Girls with Adolescent Idiopathic Scoliosis Followed Longitudinally Until Skeletal Maturity","volume":"99","author":"Hung","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kong, A.P., Choi, K.C., Li, A.M., Hui, S.S., Chan, M.H., Wing, Y.K., Ma, R.C., Lam, C.W., Lau, J.T., and So, W.Y. (2010). Association between physical activity and cardiovascular risk in Chinese youth independent of age and pubertal stage. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-303"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S1440-2440(01)80041-4","article-title":"The level of accuracy and agreement in measures of FEO2, FECO2 and VE between the cosmed K4b2 portable, respiratory gas analysis system and a metabolic cart","volume":"4","author":"Pinnington","year":"2001","journal-title":"J. Sci. Med. Sport"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1249\/00005768-198205000-00012","article-title":"Psychophysical bases of perceived exertion","volume":"14","author":"Borg","year":"1982","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_27","first-page":"729","article-title":"The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis","volume":"55","author":"Hommerding","year":"2010","journal-title":"Respir. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1249\/MSS.0000000000000993","article-title":"High-Intensity Interval Training for Cognitive and Mental Health in Adolescents","volume":"48","author":"Costigan","year":"2016","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1210\/jcem.87.6.8565","article-title":"Bone Density and Amenorrhea in Ballet Dancers Are Related to a Decreased Resting Metabolic Rate and Lower Leptin Levels","volume":"87","author":"Kaufman","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.metabol.2018.12.008","article-title":"A low resting metabolic rate in late childhood is associated with weight gain in adolescence","volume":"93","author":"Hohenadel","year":"2019","journal-title":"Metabolism"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4598","DOI":"10.1038\/s41598-020-61493-2","article-title":"Association between sleep quality and time with energy metabolism in sedentary adults","volume":"10","author":"Castillo","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.2106\/00004623-200008000-00014","article-title":"Etiology of idiopathic scoliosis: Current trends in research","volume":"82","author":"Lowe","year":"2000","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00586-011-1902-7","article-title":"Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis","volume":"20","author":"Bas","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0022-3476(85)80487-X","article-title":"Cardiorespiratory status in relation to mild deformity in adolescent idiopathic scoliosis","volume":"106","author":"Leech","year":"1985","journal-title":"J. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1007\/s00586-009-1002-0","article-title":"Gait in adolescent idiopathic scoliosis: Energy cost analysis","volume":"18","author":"Mahaudens","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1097\/00007632-199605150-00005","article-title":"Melatonin. A possible role in pathogenesis of adolescent idiopathic scoliosis","volume":"21","author":"Machida","year":"1996","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E926","DOI":"10.1097\/BRS.0b013e3181afd1b2","article-title":"Objective assessment of the cardiorespiratory function of adolescents with idiopathic scoliosis through the six-minute walk test","volume":"34","author":"Alves","year":"2009","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1136\/thx.33.6.747","article-title":"Pulmonary artery pressure in thoracic scoliosis during and after exercise while breathing air and pure oxygen","volume":"33","author":"Shneerson","year":"1978","journal-title":"Thorax"},{"key":"ref_39","first-page":"198","article-title":"Cardiopulmonary functioning in adolescent patients with mild idiopathic scoliosis","volume":"69","author":"DiRocco","year":"1988","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/00003086-198304000-00032","article-title":"Ultrastructures of nerve fibers and muscle spindles in adolescent idiopathic scoliosis","volume":"174","author":"Low","year":"1983","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1249\/00005768-199205000-00009","article-title":"Endurance training-induced increases in expiratory muscle oxidative capacity","volume":"24","author":"Grinton","year":"1992","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1513\/AnnalsATS.201611-912FR","article-title":"Cardiopulmonary Exercise Testing in Pediatrics","volume":"14","author":"Takken","year":"2017","journal-title":"Ann. Am. Thorac. Soc."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:15:18Z","timestamp":1760120118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,25]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032155"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032155","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,25]]}}}