title: Effects of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Physical training improves insulin resistance syndrome markers in obese adolescents. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. Diet and Exercise Training Restore Blood Pressure and Vasodilatory Responses During Physiological Maneuvers in Obese Children In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity The effect of a combined intervention on body mass index and fitness in obese children and adolescents – a clinical experience Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Aerobic and strength training reduces adiposity in overweight Latina adolescents. A combined dietary-physical activity intervention affects bone strength in obese children and adolescents. Treatment of Childhood Obesity in Obese Families Weight loss associated with exercise training restores ventilatory efficiency in obese children. Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children Effects of 3 hours a week of physical activity on body fat and cardio-respiratory parameters in obese boys. Effect of physical training on total and visceral fat in obese children. Heart rate variability in obese children: relations to total body and visceral adiposity, and changes with physical training and detraining. The effect of diet and strength training on obese children's physical self-concept. Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Physical training of 9- to 10-year-old children with obesity to lactate threshold intensity. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Effects of exercise training on vascular function in obese children. Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Resistance training and diastolic myocardial tissue velocities in obese children. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Effects of a classroom-based weight-control intervention on cardiovascular disease in elementary-school obese children. Hemostatic and inflammatory markers in obese youths: effects of exercise and adiposity. Aerobic-exercise training improves ventilatory efficiency in overweight children.
abstract: Background : The program The combined DAK therapy for obesity in children and adolescents ’ funded and conducted by the Deutsche Angestellten-Krankenkasse ( DAK ) , a German health insurance company , commenced in 2003 . The treatment program lasts for 1 year and comprises of 2 phases : an initial inpatient therapy for 6 weeks followed by a home-based outpatient treatment of the overweight children , adolescents , and their families for 10.5 months . The therapy complies with the guidelines of the German Working Group of Obesity in Childhood and Adolescence ( AGA ) . Participants and Methods : In this study , 162 obese children and adolescents were compared with a control group of 75 obese subjects recruited from the waiting list for the program .  The aim was to analyze whether the changes in weight , eating behavior , and physical fitness during the therapy period are a result of the therapy itself or whether they are attributable to external effects . Body weight , height , and physical fitness were assessed through direct measurements while behavior and quality of life were assessed using self-report question naires . The development of body weight was evaluated using the BMI -SDS which is a measure of how many st and ard deviations an individual BMI is above or below the age- and gender-specific mean . Results : Within the observation period the BMI SDS decreased significantly by 0.36 ± 0.34 in the intervention group , whereas no changes of BMI -SDS were observed in the control group ( 0.04 ± 0.17 ) . The study revealed significant , positive treatment effects in exploratory analyses with regard to weight loss , behavior changes , physical fitness , and development of quality of life as a result of the therapy . These effects were not seen in the control group . Conclusion : We conclude that these positive developments are a result of the treatment program BACKGROUND Little is known about how the intensity of exercise influences cardiovascular fitness and body composition , especially in obese adolescents . OBJECTIVE Our goal was to determine the effects of physical training intensity on the cardiovascular fitness , percentage of body fat ( % BF ) , and visceral adipose tissue ( VAT ) of obese adolescents . DESIGN Obese 13 - 16-y-olds ( n = 80 ) were assigned to 1 ) biweekly lifestyle education ( LSE ) , 2 ) LSE + moderate-intensity physical training , or 3 ) LSE + high-intensity physical training . The intervention lasted 8 mo . Physical training was offered 5 d/wk , and the target energy expenditure for all subjects in physical training groups was 1047 kJ ( 250 kcal)/session . Cardiovascular fitness was measured with a multistage treadmill test , % BF with dual-energy X-ray absorptiometry , and VAT with magnetic resonance imaging . RESULTS The increase in cardiovascular fitness in the high-intensity physical training group , but not in the moderate-intensity group , was significantly greater than that in the LSE alone group ( P = 0.009 ) ; no other comparisons of the 3 groups were significant . Compared with the LSE alone group , a group composed of subjects in both physical training groups combined who attended training sessions > or=2 d/wk showed favorable changes in cardiovascular fitness ( P < 0.001 ) , % BF ( P = 0.001 ) , and VAT ( P = 0.029 ) . We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition . CONCLUSIONS The cardiovascular fitness of obese adolescents was significantly improved by physical training , especially high-intensity physical training . The physical training also reduced both visceral and total-body adiposity , but there was no clear effect of the intensity of physical training 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 We sought to characterize the impact of obesity on vascular function in adolescents and to determine whether an exercise program reverses abnormalities in endothelial function . BACKGROUND Obesity , a major modifiable risk factor for cardiovascular disease , is epidemic in Western societies , with rapid rates of increase in the young . Atherosclerosis begins in childhood , and endothelial dysfunction is its earliest detectable manifestation . METHODS The influence of eight weeks of circuit training ( CT ) was examined in 19 obese subjects ( 14.3 + /- 1.5 years ) , using a r and omized , crossover protocol . Functional capacity and muscular strength were assessed by st and ard techniques .  Body composition was examined using anthropometric measures and dual-energy X-ray absorptiometry .  Conduit vessel endothelial function was assessed using high-resolution ultrasound and flow-mediated dilation ( FMD ) of the brachial artery . RESULTS Circuit training decreased abdominal and trunk fat and significantly improved fitness and muscular strength ( p < 0.05 ) . In the obese group , FMD was significantly impaired relative to control subjects ( n = 20 ) at entry ( 5.3 + /- 0.9 % vs. 8.9 + /- 1.5 % , p < 0.05 ) and was normalized after CT ( 8.8 + /- 0.8 % , p < 0.05 ) . CONCLUSIONS Circuit training improved functional capacity , muscular strength , and body composition in obese adolescents . Furthermore , conduit vessel function was normalized after exercise training . If vascular dysfunction is an integral component of the pathogenesis of vascular disease , this study supports the value of an exercise program in the management of 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 ) Background —The effects of diet and diet plus exercise training on muscle vasodilatation during physiological maneuvers in obese children are unknown . We tested the hypothesis that ( 1 ) blood pressure ( BP ) and forearm vascular conductance ( FVC ) responses during h and grip exercise and mental stress would be altered in obese children and ( 2 ) diet plus exercise training would restore BP and FVC responses during exercise and mental stress in obese children . Methods and Results —Thirty-nine obese children ( aged 10±0.2 years ) were r and omly divided into 2 groups : diet plus exercise training ( n=21 ; body mass index [ BMI ] = 28±0.5 kg/m2 ) and diet ( n=18 ; BMI = 30±0.4 kg/m2 ) . Ten age-matched lean control children ( BMI = 17±0.5 kg/m2 ) were also studied . Forearm blood flow was measured by venous occlusion plethysmography . BP was monitored noninvasively . H and grip exercise was performed at 30 % maximal voluntary contraction for 3 minutes . Stroop color word test was performed for 4 minutes . Baseline BP was significantly higher and FVC was significantly lower in obese children .  During exercise and mental stress , BP responses were significantly higher and FVC responses were significantly lower in obese children . Diet and diet plus exercise training  significantly reduced body weight  . Diet and diet plus exercise training  significantly decreased BP levels during exercise and mental stress . Diet plus exercise training , in contrast to diet alone , significantly increased FVC responses during exercise ( 3.7±0.3 versus 5.6±0.4 U ; P=0.01 ) and mental stress ( 3.5±0.5 versus 4.5±0.4 U ; P=0.02 ) . After diet plus exercise training , BP and FVC responses during exercise and mental stress were similar between obese children and the control group . Conclusions —Obesity exacerbates BP responses and impairs FVC responses during exercise and mental stress in children . Diet and exercise training restore BP and FVC responses in obese children The aim of the present study was to examine the effect of exercise training on adipokines , inflammatory markers , and oxidative stress in overweight children . Nineteen overweight children were r and omly assigned to an aerobic exercise training or sedentary control group for 8 weeks . Measurements included peak oxygen uptake ( V o(2)max ) , body weight and composition , adipokines ( C-reactive protein , interleukin 6 , tumor necrosis factor alpha , adiponectin , leptin , and resistin ) , and oxidative stress ( 8-isoprostane ) . There were no differences between groups for change in body weight or composition over the 8 weeks . Exercise training improved V o(2)max ( exercise group , 1.64 + /- 0.13 to 1.85 + /- 0.17L/min vs control group , 1.83 + /- 0.12 to 1.60 + /- 0.13 L/min , P < .05 ) but did not change any of the measured adipokines or the marker of systemic oxidative stress , 8-isoprostane . These data suggest that in the absence of weight loss , exercise training alone does not improve the adipokine profile or levels of oxidative stress in overweight children Background . Obesity has become the most common pediatric chronic disease in the modern era . Early prevention and treatment of childhood and adolescent obesity is m and ated . Surprisingly , however , only a minor fraction of obese children participate in weight reduction interventions , and the longer-term effects of these weight-reduction interventions among children have not been eluci date d. Objective . To examine prospect ively the short- and long-term effects of a 3-month , combined dietary-behavioral-physical activity intervention on anthropometric measures , body composition , dietary and leisure-time habits , fitness , and lipid profiles among obese children . Methods . In this r and omized prospect i ve study , 24 obese subjects completed the 3-month intervention and were compared with 22 obese , age- and gender-matched , control subjects . Results . At 3 months , there were significant differences in changes in body weight ( −2.8 ± 2.3 kg vs 1.2 ± 2.2 kg ) , BMI ( −1.7 ± 1.1 kg/m2 vs −0.2 ± 1.0 kg/m2 ) , body fat percentage ( from skinfold tests ; −3.3 ± 2.6 % vs 1.4 ± 4.7 % ) , serum total cholesterol level ( −24.6 ± 15.1 mg/dL vs 0.8 ± 18.7 mg/dL ) , low-density lipoprotein cholesterol level ( −23.3 ± 15.2 mg/dL vs −3.7 ± 17.3 mg/dL ) , and fitness ( 215 ± 107 seconds vs 50 ± 116 seconds ) in the intervention group versus the control group . After a 1-year follow-up period , there were significant differences between the intervention group ( n = 20 ) and the control group ( n = 20 ) in body weight ( 0.6 ± 6.0 kg vs 5.3 ± 2.7 kg ) , BMI ( −1.7 ± 2.3 kg/m2 vs 0.6 ± 0.9 kg/m2 ) , and body fat percentage . There was a significant increase in leisure-time physical activity among the intervention participants , compared with a decrease among the control subjects . Conclusions . Our data demonstrate the short- and longer-term beneficial effects of a combined dietary-behavioral-physical activity intervention among obese children . These results highlight the importance of multidisciplinary programs for the treatment of childhood obesity and emphasize their encouraging long-term effects Abstract . We assessed the effect of a weight management programme on body weight , body mass index ( BMI ) , and fitness in obese children and adolescents . The study was design ed as a longitudinal , non-r and omised , clinical experience of a 3 and 6 month combined dietary-behavioural-exercise intervention . A total of 177 obese children ( age 6–16 years ) participated in the 3 month programme , of whom 65 completed the 6 month intervention . A group of 25 age- and maturity-matched obese children who did not participate in the structured programme served as controls . Body weight , BMI , and fitness were evaluated at baseline , and after the 3 and 6 months intervention . Body weight and BMI were significantly reduced ( P<0.05 ) , and endurance time significantly increased ( P<0.0005 ) following the 3 months intervention . Obese children who continued the programme for 6 months maintained the decrease in BMI and further improved endurance time . In contrast , obese children who did not participate in the structured programme gained weight , increased their BMI , and improved fitness less significantly . Gender , pubertal status , and the degree of obesity had no influence on BMI changes .  Children without parental overweight had significantly greater decreases in BMI compared to children of obese parents . Conclusion : a combined , structured multidisciplinary intervention for childhood obesity results in decreased body weight , decreased body mass index and improved fitness 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 PURPOSE To date , no study has examined the synergistic effects of a nutrition and combination of aerobic and strength training ( CAST ) on both adiposity and metabolic parameters in overweight Latina adolescent females . The goal was to assess if a 16-wk nutrition plus CAST pilot study had stronger effects on reducing adiposity and on improving glucose/insulin indices compared with control ( C ) , nutrition only ( N ) , and a nutrition plus strength training ( N + ST ) groups . METHODS In a 16-wk r and omized trial , 41 overweight Latina girls ( 15.2 + /- 1.1 yr ) were r and omly assigned to C ( n = 7 ) , N ( n = 10 ) , N + ST ( n = 9 ) , or N + CAST ( n = 15 ) . All intervention groups received modified carbohydrate nutrition classes ( once a week ) , whereas the N + ST also received strength training ( twice a week ) and the N + CAST received a combination of strength and aerobic training ( twice a week ) . The following were measured before and after intervention : strength by one repetition maximum , physical activity by the 7-d accelerometry and the 3-d physical activity recall , dietary intake by 3-d records , body composition by dual-energy x-ray absorptiometry ( DEXA ) , glucose/insulin indices by oral glucose tolerance test , and intravenous glucose tolerance test with minimal modeling . Across intervention group , effects were tested using ANCOVA with post hoc pairwise comparisons . RESULTS There were significant overall intervention effects for all adiposity measures ( weight , body mass index [ BMI ] , BMI z-scores , and DEXA total body fat ) , with a decrease of 3 % in the N + CAST group compared with a 3 % increase in the N + ST group ( P < or = 0.05 ) . There was also an intervention effect for fasting glucose with the N group increasing by 3 % and the N + CAST group decreasing by 4 % ( P < or = 0.05 ) . CONCLUSION The CAST was more effective than nutrition alone or nutrition plus strength training for reducing multiple adiposity outcomes and fasting glucose in overweight Latina girls . However , further research investigating and identifying intervention approaches that improve both adiposity and insulin indices , particularly in high-risk population s , are warranted Obesity has become the most common pediatric chronic disease in the modern era . Recent data suggests that unlike obese adults , obese children and adolescents may have decreased bone strength . It was the objective to prospect ively examine the short term effects of a 3 month combined dietary-physical activity intervention on anthropometric measures , body composition , fitness and bone strength in obese children . Twelve obese subjects completed the 3 m intervention  and were compared to 12 obese age and gender matched controls .  Bone strength was measured using quantitative ultrasound measurements of bone speed of sound ( SOS ) . There were significant differences in changes of body weight ( 0.01 + /- 0.7 vs. 2.3 + /- 0.6 kg , p = 0.033 ) , BMI percentiles ( - 2.8 + /- 1.1 vs. - 0.2 + /- 0.2 % , p = 0.037 ) , body fat percent ( by skinfolds , - 1.5 + /- 0.8 vs. 0.7 + /- 0.5 % , p = 0.035 ) , and endurance time ( 170 + /- 42 vs. 50 + /- 27 s , p = 0.045 ) in the intervention vs. control subjects , respectively . In addition , we found a significant difference in the change of bone SOS between the intervention and control group subjects ( 21.5 + /- 21.6 vs. - 87.0 + /- 37 m/s , p = 0.023 ) . During the critical period of bone development of childhood and adolescence , a combined dietary-physical activity intervention leads to increased bone strength in obese children . These results highlight the importance of multi-disciplinary programs for the treatment of childhood obesity and its complications BACKGROUND Parental obesity reduces the likelihood of a multidisciplinary childhood obesity program to succeed , suggesting that special family-based interventions should be constructed for obese children from obese families . AIM To examine the effects of an intense combined 3-month familial dietary-behavioral-physical activity intervention for a subgroup of obese children ( BMI > 95th percentile ) from obese families ( parental BMI > 27 kg/m2 ) compared to a control group of obese children and obese parents who did not participate in the combined intervention . CHILDREN Twenty-two obese children were r and omly assigned to the  intervention  ( n = 11 ) or control  ( n = 11 ) group . Anthropometric measurements , body composition , dietary and activity habits and fitness levels were measured before and at the end of a 3-month intervention . RESULTS The intervention led to a significant difference in change in body weight ( -0.2 + /- 0.3 vs 1.7 + /- 0.6 kg ; p < 0.05 ) , BMI percentiles ( -1.4 + /- 0.5 vs -0.1 + /- 0.2 % ; p < 0.05 ) , and to a decrease in screen ( television and computer ) time ( -2.2 + /- 0.6 vs 0.1 + /- 0.3 h/day ; p < 0.05 ) in the intervention group compared to the controls . In addition , the intervention led to a significant improvement in fitness level determined by endurance time ( 181 + /- 30 vs 26 + /- 63 seconds in the intervention vs control group , respectively ; p < 0.05 ) . CONCLUSION Obese children from obese families pose a therapeutic challenge to health care providers . Intense family-oriented multidisciplinary weight management intervention should be design ed for treatment in this unique population The purpose of this study was to test the hypothesis that in obese children : 1 ) Ventilatory efficiency ( VentE ) is decreased during grade d exercise ; and 2 ) Weight loss through diet alone ( D ) improves VentE , and 3 ) diet associated with exercise training ( DET ) leads to greater improvement in VentE than by D. Thirty-eight obese children ( 10+/-0.2 years ; BMI > 95th percentile ) were r and omly divided into two study groups : D ( n=17 ; BMI = 30+/-1 kg/m ( 2 ) ) and DET ( n=21 ; 28+/-1 kg/m ( 2 ) ) . Ten lean children were included in a control group ( 10+/-0.3 years ; 17+/-0.5 kg/m ( 2 ) ) . All children performed maximal treadmill testing with respiratory gas analysis ( breath-by-breath ) to determine the ventilatory anaerobic threshold ( VAT ) and peak oxygen consumption ( VO ( 2 ) peak ) . VentE was determined by the VE/VCO ( 2 ) method at VAT . Obese children showed lower VO ( 2 ) peak and lower VentE than controls ( p<0.05 ) . After interventions , all obese children reduced body weight ( p<0.05 ) . D group did not improve in terms of VO ( 2 ) peak or VentE ( p>0.05 ) . In contrast , the DET group showed increased VO ( 2 ) peak ( p=0.01 ) and improved VentE ( DeltaVE/VCO (2)=-6.1+/-0.9 ; p=0.01 ) . VentE is decreased in obese children , where weight loss by means of DET , but not D alone , improves VentE and cardiorespiratory fitness during grade d exercise 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 The prevalence of overweight or fat children and adolescents has markedly increased in Hungary during the past three decades . Among the possible factors insufficient physical activity and a relative or absolute excess of calorie intake associated to it can be regarded as the most important ones . The aim of the study was to analyse the effects of a 20-week aerobic exercise on body composition and on the exercise tested cardio-respiratory functions in 10-year-old obese boys . Obesity was defined by a BMI greater than the cut-off value reported by Cole and co-workers ( 5 ) and a relative body fat content above 30 % ( 13 ) . Of the study group 21 volunteer children completed the program ; the contrast group contained 28 obese boys . Mean calendar age was 10.03 + /- 0.26 in the study group ( S ) and 9.88 + /- 0.29 in the control group ( C ) . The members of group S had two curricular physical education ( PE ) classes a week and three extracurricular aerobic physical activity sessions of 60 min net time in the afternoon , on Mondays ( swimming and water games ) , Wednesdays ( folk dance ) and Fridays ( soccer ) . Group C had only 2 PE classes a week . Anthropometric and spiroergometric data were collected in the middle of January and June of 2004 . Relative body fat content and BMI did not increase during the observation period in contrast to the significant increase of both in the control group . Peak minute ventilation , aerobic power , oxygen pulse , and running distance ( performed on a treadmill ) increased in group S , and did not change in group C. The program was considered successful despite that the changes in the observed physiological and physical indicators appeared to be slight . However , the 5-month elevated level of physical activity brought about such development in the physical status of the obese subjects that might be an appropriate basis for regular training . Fortunately , the cardio-respiratory functions of the investigated boys were not affected yet by obesity , consequently the really dramatic change in their further lifestyle exclusively depends on their decision PURPOSE Children with high levels of total body fat mass ( TFM ) and visceral adipose tissue ( VAT ) have elevated levels of certain risk factors for coronary artery disease and non-insulin-dependent diabetes mellitus . We tested the hypothesis that controlled physical training , without dietary intervention , would have a favorable impact on VAT and percent body fat ( % BF ) in obese children . METHODS A volunteer sample of 74 obese children , 7 - 11 yr of age , accepted r and om assignment to physical training  or  control groups .  Before and after 4 months of intervention , measurements were obtained for VAT , TFM , % BF , daily physical activity , and cardiovascular fitness . The intervention involved 4 months of controlled physical training 5 d x wk(-1 ) , 40 min per session , at a mean heart rate ( HR ) of 157 beats x min(-1 ) . The estimated energy expenditure ( EE ) per training session was 925+/-201 kJ. RESULTS Compared with the control group , the physical training group declined significantly in % BF ( delta = -2.2 % ) ( P < 0.01 ) , TFM ( delta = -3.1 % ) ( P < 0.01 ) , and subcutaneous abdominal adipose tissue ( delta = - 16.1 % ) ( P < 0.05 ) , and increased significantly in fat-free mass ( delta = + 6.1 % ) ( P < 0.05 ) and moderate-to-very hard physical activity ( delta = + 14.1 % ) ( P < 0.05 ) . The increase in VAT was significantly less in the physical training group ( delta = + 0.5 % ) as compared with that in the control group ( delta = + 8.1 % ) ( P < 0.05 ) . CONCLUSIONS This study showed that during physical training  obese children : 1 ) were capable of participating in a substantial amount of high intensity physical training over a 4-month period : 2 ) accumulated significantly less VAT as compared with nonexercising controls ; and 3 ) experienced other beneficial changes in total and regional body composition OBJECTIVE Heart rate variability provides non-invasive information about cardiac parasympathetic activity ( PSA ) . We determined in obese children : ( 1 ) relations of baseline PSA to body composition and hemodynamics ; ( 2 ) effects of physical training ( PT ) and cessation of PT ; and ( 3 ) which factors explained individual differences in responsivity of PSA to the PT . RESEARCH METHODS AND PROCEDURES The root mean square of successive differences ( RMSSD ) was the index of PSA . Obese children ( n = 79 ) were r and omly assigned to groups that participated in PT during the first or second 4-month periods of the study . RESULTS Baseline RMSSD was significantly ( p<0.05 ) associated with lower levels of : fat mass , fat-free mass , subcutaneous abdominal adipose tissue , resting heart rate ( HR ) , resting systolic blood pressure , and exercise HR . Stepwise multiple regression produced a final model ( R2 = 0.36 ) that included only resting HR . The analysis of changes over the three time points of the study found a significant ( p = 0.026 ) time by group interaction , such that RMSSD increased during periods of PT and decreased following cessation of PT . Greater individual increases in response to the PT ( p<0.05 ) were seen in those who had lower pre-PT RMSSD levels , showed the greatest decreases in resting HR , and increased most in vigorous physical activity . The final regression model retained only the change in resting HR as a significant predictor of the changes in the RMSSD ( R2 = 0.23 ) . DISCUSSION Regular exercise that improved fitness and body composition had a favorable effect on PSA in obese children AIM The aim of this study was to examine the effects of a 6-week diet and exercise program , with emphasis on strength training , on the physical self-concept , body composition , and physical fitness of young overweight and obese children . METHODS Eighty-two overweight and obese children aged 8 - 11 years were r and omized into a  diet-only or a diet- and -strength training group .  Self-concept , body composition and physical fitness were measured before and after the 6-week study period using the Physical Self Description Question naires ( PSDQ ) , dual-energy X-ray absorptiometry ( DXA ) , and st and ard fitness tests .  Dietary intake was assessed with a food frequency question naire . Total daily energy intake was significantly reduced in both groups with a trend of more reduction in the diet-only group . RESULTS Both groups developed greater confidence in strength . Those in the diet- and -strength training group also improved their endurance self-concept . Body Mass Index ( BMI ) decreased significantly in both groups . Lean mass increased significantly in both groups but significantly more in the diet- and -strength training group ( + 0.8 kg vs + 0.3 kg , P<0.05 ) . H and grip , shuttle run , sit-up , and push-up were significantly improved in both groups , to a significantly greater extent in the diet- and -strength training group . CONCLUSION These findings confirm the 6-week program of either diet-only or diet- and -strength training  improved overweight/obese children 's  self-perception of muscular strength and body composition . With the diet- and -strength training program , self-concept in endurance also improved and the gain in lean body mass was more than double that of the diet only group The aim of this study was to evaluate the effectiveness of the Mind , Exercise , Nutrition , Do it ( MEND ) Program , a multicomponent community-based childhood obesity intervention ( www.mend central .org ) . One hundred and sixteen obese children ( BMI > or= 98 th percentile , UK 1990 reference data ) were r and omly assigned to intervention or waiting list control ( 6-month delayed intervention ) . Parents and children attended eighteen 2-h group educational and physical activity sessions held twice weekly in sports centers and schools , followed by a 12-week free family swimming pass .  Waist circumference , BMI , body composition , physical activity level , sedentary activities , cardiovascular fitness , and self-esteem were assessed at baseline and at 6 months . Children were followed up 12 months from baseline ( 0 and 6 months postintervention for the control and intervention group , respectively ) . Participants in the intervention group had a reduced waist circumference z-score ( -0.37 ; P < 0.0001 ) and BMI z-score ( -0.24 ; P < 0.0001 ) at 6 months when compared to the controls . Significant between-group differences were also observed in cardiovascular fitness , physical activity , sedentary behaviors , and self-esteem . Mean attendance for the MEND Program was 86 % . At 12 months , children in the intervention group had reduced their waist and BMI z-scores by 0.47 ( P < 0.0001 ) and 0.23 ( P < 0.0001 ) , respectively , and benefits in cardiovascular fitness , physical activity levels , and self-esteem were sustained . High-attendance rates suggest that families found this intensive community-based intervention acceptable . Further larger controlled trials are currently underway to confirm the promising findings of this initial trial The purpose of this study was to apply the lactate threshold concept to develop a more evidence -informed exercise program for obese children . 60 obese children ( 26 girls and 34 boys , age : 9 - 10 years , BMI : 25.4 + /- 2.2kg/m(2 ) ) were recruited and half of them were r and omly selected to be trained for eight weeks with a controlled exercise intensity at lactate threshold . The trained children achieved significant improvements on their body composition and functional capacity compared with the control group . The findings suggested that the training program with intensity at lactate threshold  is effective and safe for 9 - 10 year old children with obesity The aim of the present study was to compare the effects of a multidisciplinary approach ( MTG ) and aerobic interval training ( AIT ) on cardiovascular risk factors in overweight adolescents . A total of 62 overweight and obese adolescents from Trøndelag County in Norway , referred to medical treatment at St Olav 's Hospital , Trondheim , Norway , were invited to participate . Of these , 54 adolescents ( age , 14.0 + /- 0.3 years ) were r and omized to either AIT ( 4 x 4 min intervals at 90 % of maximal heart rate , each interval separated by 3 min at 70 % , twice a week for 3 months ) or to MTG ( exercise , dietary and psychological advice , twice a month for 12 months ) . Follow-up testing occurred at 3 and 12 months . VO(2max ) ( maximal oxygen uptake ) increased more after AIT compared with MTG , both at 3 months ( 11 compared with 0 % ; P<0.01 ) and 12 months ( 12 compared with -1 % ; P<0.01 ) .  AIT enhanced endothelial function compared with MTG at both 3 months ( absolute change , 5.1 compared with 3.9 % ; P<0.01 ) and 12 months ( absolute change , 6.3 compared with 1.0 % ; P<0.01 ) . AIT was favourable compared with MTG in reducing BMI ( body mass index ) , percentage of fat , MAP ( mean arterial blood pressure ) and increasing peak oxygen pulse . In addition , AIT induced a more favourable regulation of blood glucose and insulin compared with MTG . In conclusion , the novel findings of the present proof-of-concept study was that 3 months of twice weekly high-intensity exercise sessions reduced several known cardiovascular risk factors  in obese adolescents more than that observed after a multitreatment strategy , which was initiated as hospital treatment . Follow-up at 12 months confirmed that AIT improved or maintained these risk factors to a better degree than MTG 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 PURPOSE Insulin resistance is thought to be a core defect in the pathophysiology of obesity-related comorbidities in children , such as type 2 diabetes . Exercise training is known to improve insulin resistance and reduce the risk of type 2 diabetes in adults . However , very little is known regarding the effects of exercise on insulin resistance in youth . Therefore , we examined the effects of a 16-wk resistance training exercise intervention on insulin sensitivity in youth at high risk for developing type 2 diabetes . METHODS Twenty-two overweight Latino adolescent males were r and omly assigned to either a twice-per-week resistance training group ( RT=11 ) or a nonexercising control group ( C=11 ) for 16 wk . Strength was assessed by one-repetition maximum , body composition was quantified by dual-energy x-ray absorptiometry , and insulin sensitivity was determined by the frequently sample d intravenous glucose tolerance test with minimal modeling . RESULTS Significant increases in upper- and lower-body strength were observed in the RT compared with the C group . The RT group significantly increased insulin sensitivity compared with the C group ( P<0.05 ) , and this increase remained significant after adjustment for changes in total fat mass and total lean tissue mass ( P<0.05 ) . Compared with baseline values , insulin sensitivity increased 45.1+/-7.3 % in the RT group versus -0.9+/-12.9 % in controls ( P<0.01 ) . CONCLUSION A twice-per-week 16-wk resistance training program can significantly increase insulin sensitivity in overweight Latino adolescent males independent of changes in body composition PURPOSE The primary purpose of this study was to determine the effects of resistance exercise training on early diastolic myocardial velocities ( E ' ) in an obese pediatric population . METHODS Twenty-three obese adolescents were selected to participate in either a  resistance-based training program ( RT ; n = 13 , 12.2 + /- 0.4 yr , body mass index [ BMI ] = 32.5 + /- 1.9 kg m(-2 ) ) or a nonexercise control intervention ( n = 10 , 13.6 + /- 0.7 yr , BMI = 30.2 + /- 2.6 kg m(-2 ) ) for 8 wk . All subjects had repeated echocardiographic assessment s to determine left ventricular ( LV ) geometry , early transmitral flow velocity ( E ) , and E ' . RESULTS LV mass and wall thicknesses did not significantly change with training or in controls . RT improved E ' ( 11.9 + /- 0.5 to 13.3 + /- 0.5 cm s(-1 ) , P < 0.01 ) in the presence of a decrease in E/E ' ( 8.17 + /- 0.39 to 7.06 + /- 0.30 cm s(-1 ) , P < 0.01 ) , a marker of left atrial pressure . No changes were evident in the inactive control subjects . CONCLUSIONS A supervised 8-wk RT exercise program improved early diastolic tissue velocity in obese children , independent of changes in LV morphology OBJECTIVE To determine whether an exercise intervention using an active video game ( Dance Dance Revolution [ DDR ] ) is effective in improving endothelial dysfunction ( EDF ) and other risk factors in overweight children . DESIGN Thirty-five children ( Body mass index > or = 85(th ) percentile , mean age 10.21+/-1.67 years , 17 females ) with EDF were assessed for flow-mediated dilation ( FMD ) , lipids , insulin , glucose , NO(2)+NO(3 ) , asymmetric dimethylarginine , symmetric dimethylarginine , l-arginine , height , weight , aerobic fitness , and blood pressure . In a sub sample , tumor necrosis factor alpha , interleukin-6 , C-reactive protein , and adiponectin were also assessed . Subjects were r and omly assigned to 12-weeks of aerobic exercise ( EX ) using DDR or to a non-exercising delayed-treatment control group ( DTC ) . RESULTS EX had significant improvements in FMD ( 5.56+/-5.04 % compared with 0.263+/-4.54 % , p=0.008 ) , exercise time on the grade d exercise test ( 53.59+/-91.54 compared with -12.83+/-68.10 seconds , p=0.025 ) , mean arterial pressure ( MAP ) ( -5.62+/-7.03 compared with -1.44+/-2.16 mmHg , p=0.05 ) , weight ( 0.91+/-1.53 compared with 2.43+/-1.80 kg , p=0.017 ) and peak VO(2 ) ( 2.38+/-3.91 compared with -1.23+/-3.18 mg/kg/min , p=0.005 ) compared with the DTC . Thirteen EX subjects achieved normal EDF while ten did not . These groups differed at baseline with regard to total cholesterol ( TC ) and low-density lipoprotein ( LDL ) . CONCLUSION Twelve weeks of DDR-use improved FMD , aerobic fitness , and MAP in overweight children . Improvements occurred without changes in inflammatory markers or nitric oxide production . The results document the need to explore relationships between obesity , endothelial function , inflammation , lipids , exercise intensity , and gender in a larger sample of overweight children BACKGROUND Childhood obesity has become a growing public health issue in Taiwan . Obese children have risk factors for type 2 diabetes and cardiovascular disease . In this prospect i ve study , we investigated the effect of a twelve-week heart health education and physical activity program on body weight and risk factors for type 2 diabetes and cardiovascular disease . METHODS Subjects were 120 obese fifth grade rs ( 65 boys and 55 girls , aged 10 - 13 years ( mean 10.6 yrs ) , body mass index ( BMI ) at the 95th percentile or more ) and were r and omly assigned to an intervention group ( n=60 ) or control group ( n=60 ) . The intervention group received a twelve-week heart health education and physical activity program , while the control group did not . In both groups , a series of examinations were done at baseline and post-test , including height , weight , BMI , body fat , blood pressure ( BP ) , physical fitness ( 800-meter running test ) , heart health knowledge , and serum biochemistry . Differences for baseline and post-test data were compared between both groups . RESULTS Mean changes in the intervention group versus control group were significant for weight ( P = 0.024 ) , BMI ( P = 0.047 ) , percentage body fat ( P = 0.008 ) , physical fitness ( 800-meter running test ) ( P = 0.025 ) , heart health knowledge ( P = 0.006 ) , total cholesterol ( P = 0.027 ) , triglycerides ( P = 0.018 ) , high-density lipoprotein cholesterol ( HDL-C ) ( P = 0.009 ) , low-density lipoprotein cholesterol ( LDL-C ) ( P = 0.041 ) , sugar ( P = 0.035 ) , insulin ( P = 0.007 ) , and insulin resistance ( HOMA-IR ) ( P = 0.028 ) . At post-test , weight , BMI , body fat , total cholesterol , triglycerides , LDL-C , sugar , insulin and HOMA-IR had decreased , but HDL-C had increased in the intervention group . CONCLUSIONS A classroom-based weight-control intervention provides educational programs to promote cardiovascular health in children . This intervention is simple , practical , and beneficial for elementary school children OBJECTIVES To determine the relation of hemostatic markers to cardiovascular fitness and adiposity and the effect of physical training ( PT ) on these markers . STUDY DESIGN Seventy-four obese teenagers were r and omly assigned to 8 months of lifestyle education ( LSE ) , LSE plus moderate-intensity PT , or LSE plus high-intensity PT . Measures included fibrinogen , plasminogen activator inhibitor-1 ( PAI-1 ) , D-dimer , C-reactive protein ( CRP ) , fitness , percent body fat ( % BF ) , and visceral adiposity ( VAT ) . RESULTS At baseline , fibrinogen and CRP were significantly correlated with % BF and VAT ( 0.27 < /= r < /= 0.51 ) , and fitness ( r = -0.39 , r = -0.43 , respectively ) ; PAI-1 with % BF ( r = 0.30 ) and VAT ( r = 0.48 ) ; D-dimer with fitness ( r = -0.24 ) . Although PT produced significant changes in fitness and adiposity , there were no significant group differences in the hemostatic markers . Change in PAI-1 was significantly correlated with its baseline value ( r = -0.47 ) and change in % BF ( r = 0.38 ) . Changes in D-dimer and CRP were significantly correlated with their respective baseline values ( r = -0.68,r = -0.48 , respectively ) . CONCLUSIONS Unfavorable levels of fitness and adiposity were associated with higher levels of hemostatic markers , putting individuals with this profile at greater risk for future cardiovascular disease . No evidence was provided that 8 months of PT had a direct influence on these markers in obese youths The objective of this study was to investigate the effect of an 8-week aerobic-exercise training program on ventilatory threshold and ventilatory efficiency in overweight children . Twenty overweight children ( BMI > 85th percentile ) performed a grade d cycle exercise test at baseline and were then r and omly assigned to 8 weeks of stationary cycling ( n = 10 ) or a nonexercising control group ( n = 10 ) . Ventilatory variables were examined at ventilatory threshold ( VT ) , which was determined via the Dmax method . After 8 weeks , significant improvements occurred in the exercise group compared with the control group for oxygen uptake at VT ( exercise = 1.03 + /- 0.13 to 1.32 + /- 0.12 L/min vs. control = 1.20 + /- 0.10 to 1.11 + /- 0.10 L/min , p < .05 ) and ventilatory equivalent of carbon dioxide ( VE/VCO2 ) at VT ( exercise = 32.8 + /- 0.80 to 31.0 + /- 0.53 vs. control = 30.3 + /- 0.88 to 31.7 + /- 0.91 , p < .05 ) . Aerobic-exercise training might help reverse the decrements in cardiopulmonary function observed over time in overweight children
target: In conclusion , overweight and obese youth can improve physical fitness across a variety of test measures .
  When fitness improves , beneficial health effects are observed in some , but not all chronic disease risk factors
background: A systematic review of literature was conducted to examine the association between changes in health-related fitness ( e.g. aerobic capacity and muscular strength /endurance ) and chronic disease risk factors in overweight and /or obese youth .