title: Physical training improves insulin resistance syndrome markers in obese adolescents. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. Effects of dietary intervention and strength training on blood lipid level in obese children Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. The Effect of Exercise on Leptin, Insulin, Cortisol and Lipid Profiles in Obese Children The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. Effects of exercise training on vascular function in obese children. Lipid and lipoprotein distributions in children by ethnic group, gender, and geographic location--preliminary findings of the Child and Adolescent Trial for Cardiovascular Health (CATCH). Lipid-lipoproteins in children: an exercise dose-response study.
abstract: INTRODUCTION The purpose of this study was to test the hypothesis that physical training ( PT ) , especially high-intensity PT , would have a favorable effect on components of the insulin resistance syndrome ( IRS ) in obese adolescents . METHODS Obese 13- to 16-yr-olds ( N = 80 ) were r and omly assigned to one of the following 8-month interventions ; 1 ) lifestyle education (LSE)-alone every 2 wk , 2 ) LSE+moderate-intensity PT , and 3 ) LSE+high-intensity PT . PT was offered 5 d x wk(-1 ) . Plasma triacylglycerol ( TAG ) , total cholesterol ( TC ) , high-density lipoprotein cholesterol ( HDLC ) , very low-density lipoprotein cholesterol ( VLDLC ) , low-density lipoprotein cholesterol ( LDLC ) , low-density lipoprotein ( low density lipoprotein ( LDL ) ) particle size , apolipoproteins AI and B , glucose , insulin , and blood pressure were measured with st and ardized methods . RESULTS The intent-to-treat analyses for all subjects who completed pre- and post-tests regardless of their adherence to the interventions showed that the LSE+high-intensity PT group had more favorable changes than the LSE-alone group in TAG level ( P = 0.012 ) , TC/HDLC ( P = 0.013 ) , and diastolic blood pressure ( P = 0.031 ) . For efficacy analyses , all PT subjects who attended at least 2 d x wk(-1 ) ( 40 % ) were combined into one group ( LSE+PT ) and compared with the LSE-alone group . These two-group analyses showed significant interactions ( P < 0.001 ) between baseline values and group membership for deltaTAG , deltaVLDLC , and deltaTC/HDLC , such that subjects who had the least favorable baseline values showed the most beneficial impact of the PT . Of particular interest was a favorable effect of the PT on LDL particle size . CONCLUSION PT , especially high-intensity PT , had a favorable effect on several IRS markers in obese adolescents OBJECTIVES The aim of this study was to determine the effects of physical activity on systemic blood pressure ( BP ) and early markers of atherosclerosis in pre-pubertal obese children . BACKGROUND Hypertension and endothelial dysfunction are premature complications of obesity . METHODS We performed a 3-month r and omized controlled trial with a modified crossover design : 44 pre-pubertal obese children ( age 8.9 + or - 1.5 years ) were r and omly assigned ( 1:1 ) to an exercise ( n = 22 ) or a control group ( n = 22 ) . We recruited 22 lean children ( age 8.5 + or - 1.5 years ) for baseline comparison . The exercise group trained 60 min 3 times/week during 3 months , whereas control subjects remained relatively inactive . Then , both groups trained twice/week during 3 months . We assessed changes at 3 and 6 months in office and 24-h BP , arterial intima-media thickness ( IMT ) and stiffness , endothelial function ( flow-mediated dilation ) , body mass index ( BMI ) , body fat , cardiorespiratory fitness ( maximal oxygen consumption [ VO(2)max ] ) , physical activity , and biological markers . RESULTS Obese children had higher BP , arterial stiffness , body weight , BMI , abdominal fat , insulin resistance indexes , and C-reactive protein levels , and lower flow-mediated dilation , VO(2)max , physical activity , and high-density lipoprotein cholesterol levels than lean subjects . At 3 months , we observed significant changes in 24-h systolic BP ( exercise -6.9 + or - 13.5 mm Hg vs. control 3.8 + or - 7.9 mm Hg , -0.8 + or - 1.5 st and ard deviation score [ SDS ] vs. 0.4 + or - 0.8 SDS ) , diastolic BP ( -0.5 + or - 1.0 SDS vs. 0 + or - 1.4 SDS ) , hypertension rate ( -12 % vs. -1 % ) , office BP , BMI z-score , abdominal fat , and VO(2)max . At 6 months , change differences in arterial stiffness and IMT were significant . CONCLUSIONS A regular physical activity program reduces BP , arterial stiffness , and abdominal fat ; increases cardiorespiratory fitness ; and delays arterial wall remodeling in pre-pubertal obese children . ( Effects of Aerobic Exercise Training on Arterial Function and Insulin Resistance Syndrome in Obese Children : A R and omized Controlled Trial ; NCT00801645 ) Aims : To evaluate effects of a low energy diet , with or without strength training , on blood lipid profile in obese children . Methods : Eighty two obese children were enrolled into a six week dietary programme , and were r and omly allocated to a training group or a non-training group . The training group underwent regular exercise sessions with emphasis on strength training . Results : Height increased significantly , with a non-significant reduction in body mass index . Fat free mass increased significantly in the training group . Serum total cholesterol was significantly reduced in both groups . The LDL : HDL ratio significantly decreased in the training group . Conclusion : Results support the potentially beneficial effects of both diet and physical training . Further and longer term evaluation of such programmes is required INTRODUCTION Developing effective exercise programmes for the paediatric population is a strategy for decreasing obesity and is expected to help in eventually limiting obesity-associated long-term health and societal impact . In this study , the effects of a 12-week twice weekly additional exercise training , which comprised a combination of circuit-based resistance training and aerobic exercises , in additional to typical physical education sessions , on aerobic fitness , body composition and serum C-reactive protein ( CRP ) and lipids were analysed in 13- to 14-year-old obese boys contrasted with a control group . MATERIAL S AND METHODS Both the exercise group ( EG , n = 12 ) and control group ( CG , n = 12 ) participated in the typical 2 sessions of 40-minute physical education ( PE ) per week in schools , but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of exercise training , which comprised a combination of circuit-based resistance training and aerobic exercises maintained at 65 % to 85 % maximum heart rate ( HRmax = 220 - age ) . Body composition was measured using dual energy X-ray absorptiometry ( DEXA ) . Fasting serum CRP and blood lipids were analysed pre- and postexercise programme . Aerobic fitness was measured by an objective laboratory submaximal exercise test , PWC170 ( Predicted Work Capacity at HR 170 bpm ) . RESULTS Exercise training significantly improved lean muscle mass , body mass index , fitness , resting HR , systolic blood pressure and triglycerides in EG . Serum CRP concentrations were elevated at baseline in both groups , but training did not result in a change in CRP levels . In the CG , body weight increased significantly at the end of the 12-week period . CONCLUSION This study supports the value of an additional exercise training programme , beyond the typical twice weekly physical education classes , to produce physiological benefits in the management of obesity in adolescents , including prevention of weight gain This prospect i ve , r and omized study investigated the effect of exercise on leptin , insulin , cortisol and lipid profiles in obese children . A total of 40 obese boys aged 10 - 12 years with a body mass index ( BMI ) ≥ 30 kg/m2 were r and omly separated into an exercise group ( n = 20 ) that underwent a 12-week aerobic exercise programme and a non-exercise ( control ) group ( n = 20 ) . The BMI , low-density lipoprotein , cortisol , leptin and insulin levels were significantly lower in the exercise group after 12 weeks compared with baseline values , whereas high-density lipoprotein levels were significantly higher . In contrast , in the control group , low-density lipoprotein , cortisol and leptin levels were significantly higher after 12 weeks compared with baseline values while high-density lipoprotein levels were significantly lower . These findings indicate the importance of regular exercise in the regulation of body weight and protection against cardiovascular risk factors in obese children Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists OBJECTIVE : To determine the effect of exercise training ( ET ) on components of the insulin resistance syndrome ( IRS ) in obese children . DESIGN : R and omized , modified cross-over study , with subjects assigned to one of two conditions : ( 1 ) 4 months of ET followed by 4 months of no-ET ; or ( 2 ) 4 months of no-ET followed by 4 months of ET . Measurements were made at three time points : 0 , 4 and 8 months . SUBJECTS : 79 obese , but otherwise healthy children ( age : 7–11 y , percent fat ( % fat ) 27–61 % ) . MEASUREMENTS : Plasma lipid and lipoprotein concentrations , plasma insulin and glucose concentrations ; % fat ; submaximal heart rate ( HR ) as an index of fitness . EXERCISE TRAINING : ET was offered 5 d/week 40 min/d . For the 73 children who completed 4 months of ET , the mean attendance was 80 % ( that is , 4 d/week ) and the average HR during ET was 157 bpm . RESULTS : Significant ( P<0.05 ) group x time interactions were found for plasma triglyceride ( TG ) and insulin concentrations and % fat . The average change for both groups , from just before ET to just after the 4 month ET was −0.24 mmolċl−1 for TG , −25.4 pmolċl−1 for insulin and −1.6 units for % fat . When Group 1 ceased ET , over the following 4 month period the average change for insulin was + 26.6 pmolċl−1 and for % fat + 1.3 units . CONCLUSION : Some components ( plasma TG , insulin , % fat ) of the IRS are improved as a result of 4 months of ET in obese children . However , the benefits of ET are lost when obese children become less active OBJECTIVES The present study aim ed to assess the effect of a 6-month exercise program  in obese children on flow-mediated vasodilation ( FMD ) carotid intima-media thickness ( IMT ) and cardiovascular risk factors ( RF ) . BACKGROUND Childhood obesity contributes to adult obesity and subsequent cardiovascular disease . Physical inactivity is a major RF for obesity , endothelial dysfunction , and elevated carotid IMT , culminating in early atherosclerotic disease . METHODS Sixty-seven obese subjects ( age 14.7 + /- 2.2 years ) were r and omly assigned to 6 months ' exercise or non-exercise protocol . We examined the influence of exercises ( 1 h , 3 times/week ) on FMD , IMT , and cardiovascular risk profile . RESULTS Compared with lean control subjects , obese children demonstrated at baseline significantly impaired FMD ( 4.09 + /- 1.76 % vs. 10.65 + /- 1.95 % , p < 0.001 ) , increased IMT ( 0.48 + /- 0.08 mm vs. 0.37 + /- 0.05 mm , p < 0.001 ) , and a number of obesity-related cardiovascular RF . Significant improvements were observed in the exercise group for IMT ( 0.44 + /- 0.08 mm , p = 0.012 , -6.3 % ) and FMD ( 7.71 + /- 2.53 % , p < 0.001 , + 127 % ) . This improvement correlated with reduced RF , such as body mass index st and ard deviation scores , body fat mass , waist/hip ratio , ambulatory systolic blood pressure , fasting insulin , triglycerides , low-density lipoprotein/high-density lipoprotein ratio , and low-degree inflammation ( C-reactive protein , fibrinogen ) . CONCLUSIONS The present study documented increased IMT , impaired endothelial function , and various elevated cardiovascular RF in young obese subjects . Regular exercise over 6 months restores endothelial function and improves carotid IMT associated with an improved cardiovascular risk profile in obese children OBJECTIVES Atherosclerosis is a disease that begins in childhood ; endothelial dysfunction is its earliest detectable manifestation , and primary prevention strategies are likely to be most effective if instituted early . The aim of this study was to characterize the impact of obesity on vascular function in young children and to determine whether an exercise program improves abnormalities in vascular function . STUDY DESIGN The influence of 8 weeks of exercise training was examined in 14 obese subjects , 8.9 + /- 0.4 years of age , with the use of a r and omized crossover protocol . Conduit vessel endothelial function was assessed by means of high-resolution ultrasound and flow-mediated dilation of the brachial artery ( FMD ) . RESULTS Exercise training did not change subcutaneous fat mass , body weight , or body mass index . FMD in the obese group was significantly impaired relative to matched control subjects at entry ( 6.00 % + /- 0.69 % to 12.32 % + /- 3.14 % , P < .0001 ) . FMD significantly improved with exercise training ( 7.35 % + /- 0.99 % , P < .05 ) in the obese group . CONCLUSIONS Conduit vessel FMD , a vali date d surrogate measure of early atherosclerosis , was impaired in obese children but improved as a result of exercise training . This study supports the value of an exercise program in the treatment of obese children in a primary prevention setting BACKGROUND The Child and Adolescent Trial for Cardiovascular Health is a school-based study design ed to test the effectiveness of dietary , physical activity , and educational interventions for reducing cardiovascular disease risk and teaching healthful behaviors to children . METHODS As part of a pilot phase in 1989 , lipid , lipoprotein , and anthropometric measures were taken in black ( n = 90 ) , Hispanic ( n = 68 ) , and white ( n = 265 ) 8- to 10-year-old schoolchildren in California , Louisiana , Minnesota , and Texas . RESULTS There were no significant differences in mean lipoprotein cholesterol values between fasting and nonfasting children . Therefore data from fasting and nonfasting children were pooled . Males and females within the same ethnic groups had similar mean levels of total cholesterol , low-density lipoprotein cholesterol , and very low-density lipoprotein cholesterol . However , levels of high-density lipoprotein cholesterol were higher among white and black males than among females from the same ethnic groups . Black males had higher total cholesterol than white males and higher high-density lipoprotein cholesterol than white males and Hispanic males . Similarly , black females had higher high-density lipoprotein cholesterol than white and Hispanic females . In all children combined high-density lipoprotein cholesterol was inversely correlated and low-density lipoprotein cholesterol was positively correlated with subscapular and tricep skinfold thickness , weight , and body mass index . There were significant differences in mean lipoprotein cholesterol levels between geographic sites . Total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol were highest in children from California followed by children from Texas , Minnesota , and Louisiana . CONCLUSION Our results suggest that body fatness total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol differ in children by gender , ethnicity , and geographic location PURPOSE To study the effect of exercise volume on pre- and early-pubertal children 's lipid-lipoprotein profile .  METHODS Thirty-four children ( 15 girls ) completed 12 wk of exercise training , preceded by a 12-wk control period . Sixteen ( 7 girls and 9 boys ) expended an additional 422 + /- 5 kJ.kg BM ( LOW , 100 kcal.kg ) , whereas 18 ( 8 girls and 10 boys ) expended an additional 586 + /- 7 kJ.g ( MOD , 140 kcal.kg ) as a result of the training program . They all exercised on three nonconsecutive days per week at 80 + /- 1 % HRpeak . Exercise duration was individualized to match energy expenditure targets . Plasma TG , TC , and HDL-C were measured precontrol , pretraining , and posttraining . LDL-C , TC/HDL-C , and LDL-C/HDL-C were also calculated . RESULTS Group mean lipid-lipoprotein concentrations did not change as a result of training energy expenditure in either of the groups ( P > 0.05 ) . Dietary composition , habitual physical activity , and body composition were also relatively stable over the intervention period ( P > 0.05 ) . In the LOW , but not the MOD group , peak VO2 ( mL.kg.min ) tended to increase over the intervention period ( P = 0.07 ) . Pearson 's product moment correlation analyses indicated that pretraining concentrations of TG , TC , LDL-C , TC/HDL-C , and LDL-C/HDL-C were all related to the small changes seen in the lipid-lipoprotein profile ( P < 0.01 ) . CONCLUSION Additional energy expenditure of 422 or 586 kJ.kg , as a direct result of aerobic exercise training over a 12-wk period , did not cause significant alterations in the lipid-lipoprotein profile  in pre- and early-pubertal children . This may indicate that the exercise volume was insufficient , the lipoprotein profiles of the majority of children in this study were classified as " desirable , " or more likely a combination of these factors
target: The programs based on aerobic exercise ( 60 min , 3 times/week , ≤75 % maximum heart rate ) improve the LDL-C and TG concentrations .
  Moreover , the programs based on combined exercise ( ≥60 min , > 75 % maximum heart rate ) also improve the HDL-C concentration
background: OBJECTIVE The objective of this systematic review was to assess the effectiveness of different physical exercise interventions on the lipid profile ( high-density lipoprotein cholesterol ( HDL-C ) , low-density lipoprotein cholesterol ( LDL-C ) , total cholesterol ( TC ) , and triglycerides ( TG ) ) of obese children .