title: Team sports for overweight children: the Stanford Sports to Prevent Obesity Randomized Trial (SPORT). Effects of Aerobic Versus Resistance Exercise Without Caloric Restriction on Abdominal Fat, Intrahepatic Lipid, and Insulin Sensitivity in Obese Adolescent Boys Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. Football to tackle overweight in children. Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Dance for health: improving fitness in African American and Hispanic adolescents. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program. Effect of physical training on total and visceral fat in obese children. Preventing and treating childhood obesity: time to target fathers Effect of physical training on heart-period variability in obese children. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Effect of Individualized Exercise Training Combined with Diet Restriction on Inflammatory Markers and IGF-1/IGFBP-3 in Obese Children Exercise training improves body composition, blood lipid profile and serum insulin levels in obese children. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. Reliability of the PEDro scale for rating quality of randomized controlled trials. Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Weight Loss in Overweight Mexican American Children: A Randomized, Controlled Trial Effects of a school-based weight maintenance program for Mexican-American children: results at 2 years. New Moves: a school-based obesity prevention program for adolescent girls. Does exercise intensity affect blood pressure and heart rate in obese adolescents? A 6-month multidisciplinary randomized intervention study. The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents. Waist circumference is related to low-grade inflammation in youth.
abstract: OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity 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 The present study aim ed at analyzing the efficacy of a 6-month football training program compared with a st and ard exercise program on health and fitness parameters in overweight children . The study design was a 6-month , two-arm , parallel-group r and omized trial . Twenty-two overweight children were r and omly assigned to two groups ( age=10.8+/-1.2 years , height=1.56+/-0.08 m , weight= 65.1+/-11.4 kg ) . One group conducted a football training program , and the other group an established st and ard sports program . Both interventions took place three times per week from mid-May to mid-November . Before , after 3 months and after the training period , comprehensive testing was conducted : anthropometric characteristics , cycling ergometry , psychometric monitoring as well as several motor ability tests . Maximal performance capacity increased and submaximal heart rate during cycling ergometry decreased significantly . Several motor skills as well as self-esteem also improved considerably . Body composition and other psychometric variables remained nearly unchanged . No relevant differences were observed between both exercise programs . It can be concluded that a 6-month football training is as efficacious in improving the physical capacity , health-related fitness parameters and self-esteem of overweight children as a st and ard exercise program . These results provide further evidence that playing football has significant health effects Abstract Multiple disease-specific systematic review s on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive . To date , there have been two systematic review s that examined manual therapy specifically but both considered effects within diagnoses . The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions . A search of MEDLINE , CINAHL , Web of Science , and Cochrane Central Register of R and omized Controlled Trials for articles date d 1996 to June 2009 was performed . Inclusion for review were  manual therapy performed to the glenohumeral joint only ; non-surgical painful shoulder disorders ; subjects 18 - 80 years ; and outcomes of range of motion , pain , function , and /or quality of life . Quality assessment was performed using the PEDro scale with subsequent data extraction . Seventeen related articles were found with seven fitting the inclusion criteria . The average PEDro score was 7.86 , meeting the cutoff score for high quality . Significant heterogeneity in outcome measures prohibited meta- analysis . Five studies demonstrated benefits utilizing manual therapy for mobility , and four demonstrated a trend towards decreasing pain values . Functional outcomes and quality -of-life measures varied greatly among all studies . Manual therapy appears to increase either active or passive mobility of the shoulder . A trend was found favoring manual therapy for decreasing pain , but the effect on function and quality of life remains inconclusive . Future research utilizing consistent outcome measurements is necessary 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 Cardiovascular disease begins early in life but might be prevented or delayed by primary prevention programs design ed for children and adolescents .  Regular physical activity is an important part of primary prevention programs , and school physical education programs have potential for the promotion of regular physical activity . Cardiovascular disease is the major cause of death among Hispanics and African Americans in the United States . Low levels of fitness and increased body mass index are common in African American and Hispanic adolescents . Increased physical activity and the adoption of healthy eating habits would increase fitness and reduce body mass index among these adolescents . The purpose of the study was to undertake a small-scale controlled trial to determine if Dance for Health , an intervention program design ed to provide an enjoyable aerobic program for African American and Hispanic adolescents , has a significant effect on improving aerobic capacity , helping students maintain or decrease weight , and on improving attitudes toward physical activity and physical fitness . In the first year of the program ( 1990 - 91 ) , approximately 110 boys and girls ages 10 - 13 years participated in an aerobic dance pilot program three times per week for 12 weeks . Dance for Health was revised and continued in the 1992 - 93 school year with seventh grade students and an added culturally sensitive health curriculum . Forty-three students were r and omized to Dance for  Health and 38 to  usual physical activity . Those in the intervention class received a health education curriculum twice a week and a dance oriented physical education class three times a week . The usual physical activity consisted mostly of playground activities . Students in the intervention had a significantly greater lowering in body mass index and resting heart rate than students in regular physical activity OBJECTIVES The primary goals were to underst and the relationship among the inflammatory factors , C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , and fibrinogen , and indices of obesity in normoglycemic , insulin-resistant adolescents and to investigate the impact of a lifestyle-only intervention on these nontraditional risk factors for cardiovascular disease ( CVD ) . STUDY DESIGN R and omized controlled lifestyle-only intervention study in adolescents . Of the 21 adolescents studied , 15 obese subjects ( body mass index [ BMI ] = 37.6 + /- 3.3 kg/m 2 ) were r and omized to either a lifestyle intervention program or usual care .  The lean controls were studied only at baseline . Analysis of variance ( ANOVA ) for repeated measures was used to study intervention effect and t test , one-way ANOVA , and discriminant function analysis for baseline comparisons . RESULTS The intervention group maintained weight , whereas the control group gained weight ( P = .02 ) . A redistribution of body composition and a decrease in insulin resistance were observed . Elevated circulating concentrations of CRP , fibrinogen , and IL-6 were significantly reduced ( all P < or=.02 ) in response to intervention , but not in controls . CONCLUSIONS Modest lifestyle-only change in previously sedentary obese adolescents redistributes the parameters of body composition in the absence of weight loss and reverses , at least in part , the inflammatory state in association with an improvement of insulin resistance OBJECTIVES We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls . METHODS We compared heart health knowledge , health behaviors , cardiovascular risk factors , and physical fitness among a group of 442 multiethnic teenaged girls ( 310 experimental participants vs 132 control participants ) . Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussion s on diet , exercise , stress , and smoking . RESULTS Significant differences in body fat , systolic and diastolic blood pressure , heart health knowledge , and whether breakfast was eaten were observed between experimental participants and control participants . CONCLUSIONS An integrated program of exercise and heart health-related lectures and discussion s had a beneficial effect on health knowledge , health behaviors , and onset of risk factors for coronary artery disease among urban girls 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 : To examine the long-term effects of having one overweight or obese parent on child weight status and determine whether these effects vary according to parent sex . Design : Prospect i ve study : Longitudinal Study of Australian Children (LSAC).Subjects : Two-parent families ( N=3285 ) from the LSAC were included if height and weight data were available for both parents and their child at the 2004 and 2008 time points . Measurements : Child weight status category ( healthy , overweight , obese ) in 2008 when the child was aged 8–9 years . Regression modelling was used to investigate how self-reported parent weight status in 2004 influenced measured child weight status 4 years later . Results : Parent body mass index ( BMI ) was significantly correlated with child BMI , but there was no evidence of sex-specific associations between parent and child BMI correlations . The results from the regression analysis showed that having an overweight or obese father , but a healthy weight mother , significantly increased the odds of child obesity ( odds ratio : 4.18 , 95 % confidence interval ( CI ) : 1.01–17.33 and odds ratio : 14.88 , 95 % CI : 2.61–84.77 , respectively ) , but the reverse scenario ( overweight or obese mother with a healthy weight father ) was not a significant predictor of child overweight or obesity ( odds ratio : 2.52 , 95 % CI : 0.38–16.71 and odds ratio : 2.56 , 95 % CI : 0.31–21.26 , respectively ) . Conclusions : Children with overweight or obese fathers are at a higher risk of becoming obese . This suggests that interventions are urgently required to test the efficacy of treating overweight fathers as a key strategy for childhood obesity prevention and /or treatment OBJECTIVE The beat-to-beat variability in electrocardiogram intervals ( RR , i.e. , heart-period variability ) provides information on cardiac autonomic activity that predicts arrhythmias and mortality rate in animals and adults . We determined the effect of physical training on heart-period variability in obese children . METHODS Thirty-five subjects were r and omly assigned to physical training and control groups . The training involved 4 months of exercise , 5 days per week , 40 minutes per day . Cardiovascular fitness was measured with submaximal heart rate during supine cycling ; percentage of body fat was measured with dual-energy absorptiometry ; and resting heart-period variability  parameters were measured in a supine position . A pretraining to posttraining change score was computed for each variable . The effect of the training was determined by comparing the changes of the training and control groups . RESULTS Compared with the control group , the trained group ( 1 ) reduced submaximal heart rate and percentage of body fat ( p < 0.01 ) ; ( 2 ) increased in the root mean square of successive differences , a time-domain parameter reflective of vagal tone ( p < 0.05 ) ; ( 3 ) decreased in low-frequency power expressed as a percentage of total power , a frequency-domain index of combined sympathetic and vagal activity ( p < 0.03 ) ; and ( 4 ) decreased in the ratio of low- to high-frequency power , an index of sympathetic-parasympathetic balance ( p < 0.01 ) . CONCLUSIONS In obese children , physical training alters cardiac autonomic function favorably by reducing the ratio of sympathetic to parasympathetic activity BACKGROUND Obesity and poor physical fitness constitute a health problem affecting an increasing number of children . Causes include a pervasive " toxic " environment that facilitates increased caloric intake and reduced physical activity . An effective strategy for prevention and treatment of childhood obesity likely includes a collaborative effort in the school setting . OBJECTIVE To determine whether a school-based fitness program can improve body composition , cardiovascular fitness level , and insulin sensitivity in overweight children . DESIGN Fifty overweight middle school children with a body mass index ( BMI ) above the 95th percentile for age were r and omized to lifestyle-focused , fitness-oriented gym classes ( treatment group ) or st and ard gym classes ( control group ) for 9 months . Children underwent evaluation of  fasting insulin and glucose levels , body composition by means of  dual energy absorptiometry , and maximum oxygen consumption ( V0(2)max ) treadmill testing  at baseline ( before the school year ) and at end of the school year . SETTING S Rural middle school and an academic children 's hospital . MAIN OUTCOME MEASURES Baseline test results for cardiovascular fitness , body composition , and fasting insulin and glucose levels . RESULTS At baseline , there were no differences between groups before intervention ( values for age , 12 + /- 0.5 years [ all results , mean + /- SD ] ; BMI [ calculated as weight in kilograms divided by the square of height in meters ] , 31.0 + /- 3.7 ; percentage of body fat , 36.5 % + /- 4.6 % ; lean body mass , 41.4 + /- 8.6 kg ; and V0(2)max , 31.5 + /- 5.1 mL/kg per minute ) . Compared with the control group , the treatment group demonstrated a significantly greater loss of body fat ( loss , -4.1 % + /- 3.4 % vs -1.9 % + /- 2.3 % ; P = .04 ) , greater increase in cardiovascular fitness ( V0(2)max , 2.7 + /- 2.6 vs 0.4 + /- 3.3 mL/kg per minute ; P<.001 ) , and greater improvement in fasting insulin level ( insulin level , -5.1 + /- 5.2 vs 3.0 + /- 14.3 microIU/mL [ -35.4 + /- 36.1 vs 20.8 + /- 99.3 pmol/L ] ; P = .02 ) . CONCLUSIONS Children enrolled in fitness-oriented gym classes showed greater loss of body fat , increase in cardiovascular fitness , and improvement in fasting insulin levels than control subjects . The modification to the school physical education curriculum demonstrates that small but consistent changes in the amount of physical activity has beneficial effects on body composition , fitness , and insulin levels in children . Partnering with school districts should be a part of a public health approach to improving the health of overweight children Aims : The present study was design ed to examine the possible changes in body composition , insulin-like growth factor 1 ( IGF-1 ) , insulin-like growth factor-binding protein-3 ( IGFBP-3 ) and inflammatory markers of obese children in response to a 2-month program of exercise training combined with dietary restriction . Methods : Twenty-eight obese children ( age 13.2 ± 0.7 years , body mass index 30.9 ± 1.3 ) were r and omly assigned to a diet/training group or a control group and were tested two times : once before and once at the end of the experimental period . They performed a progressive cycle ergometer test at each visit . Substrate oxidation was evaluated by indirect calorimetry . Training was individualized at the point when fat oxidation was maximal ( Lipoxmax ) . Results : Diet/training induced a significant decrease in body weight and body fat ( after vs. before , p < 0.01 ) . Plasma concentrations of IGF-1 , IGFBP-3 and inflammatory markers were significantly decreased after the completion of the program . The diet/training program result ed in an increase in VO2maxACSM ( 24.6 ± 2.5 to 33.1 ± 3.1 ml/min/kg , p < 0.001 ) at the end of the intervention period . Conclu- sion : These data suggest that in the presence of weight loss , exercise training improves inflammatory markers and IGF-1 and IGFBP-3 levels in obese children AIM Increasing prevalence of obesity and related diseases especially in children and adolescent has gained more scientific attention . The present study was conducted to determine the effects of regular exercise on childhood obesity often associated with clinical conditions such as hypertension , dyslipidemia and diabetes already at a young age . METHODS The subjects were 40 obese children at 11 ± 1 years and with Body Mass Index ( BMI ) of at least 30 kg/m2 who volunteered to the study and r and omly classified into exercising and non-exercising control group . Physical load of the exercising group was first determined by the Karvonen protocol after which to the subjects underwent a 12-week aerobic exercise training program primary consisting of walking and jogging exercise . Blood pressure , biochemical cardiovascular risk factors and body composition were assessed before and after the exercise-training period and compared to the non-exercising control group . RESULTS In the exercising group , statistically significant changes were observed in the circumference of forearm , elbow , calf , knee , waist , chest and hip , as well as skin fold thickness of chest , subscapulae , calf , abdomen , suprailiac and leg . Similarly , total cholesterol , triglyceride , LDL , VLDL and insulin levels were found to be lower and HDL levels higher than in the non-exercising control group . CONCLUSION While treating obesity in children , a major emphasis should be directed towards increasing regular physical activity and supported with dietary interventions . By this approach the risk of other chronic diseases often associated with obesity could be minimized thereby improving the quality of life 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 BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 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 . Childhood overweight has increased significantly in the past 20 years , with the highest rates noted among Mexican Americans . Although this minority group is in significant need of intervention , few programs have demonstrated actual decreases in weight . In this study we evaluated an intensive healthy lifestyle program design ed to result in weight reduction for overweight Mexican American children . We hypothesized that children r and omly assigned to an intensive intervention would significantly reduce their st and ardized BMI when compared with children r and omly assigned to a self-help condition . PATIENTS AND METHODS . A total of 60 children ( 33 boys ; 55 % ) between the ages of 10 and 14 years at or above the 85th percentile for BMI were r and omly assigned to a 6-month intensive-intervention or self-help condition .  RESULTS . Children in the intensive-intervention condition significantly reduced their st and ardized BMI when compared with the children in the self-help condition . The change in st and ardized BMI was significantly different at both 3 and 6 months , with intensive-intervention participants showing greater decreases in weight . CONCLUSIONS . Overall , the results were promising , suggesting that an intensive , individualized intervention may be an effective means for promoting weight loss in overweight Mexican American children The prevalence of childhood overweight has increased significantly , with the highest rates noted among Mexican Americans . Many negative health outcomes are associated with overweight ; thus , there is a need for effective weight-loss interventions tailored to this group . This study evaluated 24-month outcomes of a r and omized , controlled trial involving an intensive lifestyle-based weight maintenance program targeting overweight Mexican-American children at a charter school in Houston , Texas . A total of 60 children ( 33 males , 55 % ) between the ages of 10 and 14 at or > 85th percentile for BMI were recruited . Participants were r and omized to an instructor-led intervention ( ILI ) or a self-help ( SH ) program , both aim ed at modifying eating and physical activity behaviors using behavior modification strategies . Changes in participants ' st and ardized BMI ( z BMI ) were assessed at baseline , 1 , and 2 years . Tricep skinfold , total cholesterol , triglycerides , high-density lipoprotein cholesterol , and calculated low-density lipoprotein were assessed at baseline and 1 year . ILI participants showed significantly greater decreases in z BMI at 1 and 2 years ( F = 26.8 , P < 0.001 , F = 4.1 , P < 0.05 , respectively ) compared to SH controls . ILI participants showed greater improvements in body composition , as measured by tricep skinfold ( F = 9.75 , P < 0.01 ) . Children in the ILI condition experienced benefits with respect to total cholesterol ( F = 7.19 , P < 0.05 ) and triglycerides ( F = 4.35 , P < 0.05 ) compared to children in the SH condition . Overall , the school-based intervention result ed in improved weight and clinical outcomes in overweight Mexican-American children , and z BMI was maintained over 2 years BACKGROUND This study tests the feasibility of an innovative school-based program for  obesity prevention  among adolescent girls . New Moves was implemented as a multicomponent , girls-only , high-school physical education class . METHODS Six schools were equally r and omized into intervention and control conditions . Data were collected at baseline , postintervention , and 8-month follow-up to assess program impact on physical activity , eating patterns , self-perceptions , and body mass index ( BMI ) among 89 girls in the intervention and 112 girls in the control conditions . Program evaluation also included interviews with school staff , parent surveys , and participant interviews and process evaluation surveys . RESULTS The feasibility of implementing New Moves was high , as indicated by strong satisfaction among participants , parents , and school staff , and by program sustainability . Participants perceived a positive program impact on their physical activity , eating patterns , and self-image . Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up . However , for the majority of outcome variables , differences between intervention and control schools at postintervention and follow-up were not statistically significant . CONCLUSIONS New Moves was well received and fills a needed niche within school physical education programs . An exp and ed intervention and evaluation is needed to enhance and assess long-term program effectiveness BACKGROUND Aerobic exercise improves cardiovascular health in general , but whether the impact varies with exercise intensity is not clear . OBJECTIVE The aim of the current study was to compare the effects of a high-intensity aerobic exercise training ( HIT ) vs. a low-intensity aerobic exercise training ( LIT ) on blood pressure ( BP ) , heart rate ( HR ) and heart rate variability ( HRV ) in obese adolescents . METHODS Forty-three ( 13 - 18 years ) Tanner stage ( III-IV ) matched obese adolescents were studied in a r and omized trial of either HIT ( corresponding to the ventilatory threshold I ; n = 20 ) or LIT ( corresponding to 20 % below the ventilatory threshold I ; n = 23 ) programme for a period of 6 months . All participants also received a multidisciplinary therapy that included nutritional , psychological and clinical counselling . Both HIT and LIT sessions were isocaloric , with energy expenditure set at 350 kcal . BP , HR and HRV were measured along with markers of body adiposity and insulin resistance before and after the respective interventions . RESULTS The participants in both groups had similar physical and clinical characteristics . After the 6-month intervention , systolic , diastolic and mean BP decreased ( P < 0.05 , for all ) similarly in both groups , whereas waist circumference , HR and HRV showed beneficial changes only in the HIT group ( P < 0.05 ) . CONCLUSION Aerobic exercise training set at a high intensity compared with the low intensity appears to have additional benefits on abdominal obesity and cardiovascular health in that it enhances the parasympathetic and autonomic modulation of the heart in obese adolescents INTRODUCTION There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents . Therefore , two intervention studies were conducted to : ( a ) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment ( COPE ) Healthy Lifestyles Thinking , Emotions , Exercise , and Nutrition ( TEEN ) program with overweight adolescents ; ( b ) obtain feedback that could be used to refine the program ; and ( c ) examine the preliminary efficacy of the COPE program on the adolescents ' weight and body mass index ( BMI ) . METHOD Phase I and Phase II clinical trials were conducted with 23 overweight teens . The Phase 1 trial used a pre-experimental design with one group of 11 urban adolescents . The Phase 2 trial was conducted with 12 suburban teens using a r and omized controlled pilot study . COPE teens received a 15-session cognitive-behavioral skills building program that included physical activity , while the control group received an attention control program .  Weight change and BMI were the key outcomes . RESULTS COPE teens experienced a significantly greater reduction in weight and BMI than did teens in the control group , who gained weight over time . Although the COPE program was well received by all of the teens , retention of subjects across time and parent involvement in the program were challenges in the urban high school . DISCUSSION These studies provide preliminary data to indicate that the implementation of COPE is feasible and may lead to a reduction in weight and BMI in overweight teens . Implementing COPE within the context of the school day may be more successful in sustaining adolescent involvement in the program versus using an after-school format OBJECTIVES To examine markers of inflammation in 9- and 15-year-olds with high waist circumference and compare these with controls , and to examine the relationships between inflammatory markers and cardiovascular disease ( CVD ) risk factors . METHODS Cross-sectional analysis of data from 2 299 Norwegian 9- and 15-year-olds participating in the " Physical activity among Norwegian Children Study " . In each sex and age group , the 10 participants with the highest waist circumference ( HW ) were selected ( n=40 ) for analyses , and a r and om sample of 40 participants within the same groups were included as controls . Inflammatory markers included C-reactive protein ( CRP ) , leptin , adiponectin , plasminogen activator inhibitor-1 ( PAI-1 ) , tumor necrosis factor-alpha ( TNF-alpha ) , hepatocyte growth factor ( HGF ) , resistin and interleukin-6 ( IL-6 ) . The CVD risk factors included blood pressure , glucose , insulin , triglycerides and high density lipoprotein cholesterol . RESULTS HW participants had elevated levels of CRP ( mean difference 1.50 mg/l ; 95 % confidence interval [ CI ] 0.33 to 2.66 ) , PAI-1 ( mean difference 13.3 ng/ml ; 95 % CI 4.1 to 22.5 ) and HGF ( mean difference 0.29 ng/ml ; 95 % CI 0.07 to 0.51 ) compared with controls . All CVD risk factors differed between the HW group and controls . The CVD risk factors were not associated with TNFalpha or IL-6 , but CRP , HGF and PAI-1 were related to the metabolic risk score . CONCLUSIONS Low grade systemic inflammation is already present in youth with high waist circumference . CRP , HGF and PAI-1 may be related to the adverse overall metabolic risk profile observed in these children and adolescents
target: The review was registered ( Number CRD42013004632 ) on PROSPERO , the International Prospect i ve Register of Systematic Review s. Results The results indicated that PA is associated with significant and beneficial changes in fat percentage , waist circumference , systolic blood pressure , insulin , low-density lipoprotein cholesterol , and total cholesterol , as well as with small non-significant changes in diastolic blood pressure , glucose , and high-density lipoprotein cholesterol .
  Conclusion Although limited , results from controlled trials suggest that PA intervention may improve physical fitness and risk factors for cardiovascular disease in adolescents who are overweight or obese
background: Background The increasing prevalence of obesity in the pediatric age range has become a major concern .
  Studies have investigated the role of physical activity ( PA ) to prevent obesity in this population .
  However , previous review s did not focus on the effects of PA in overweight/obese adolescents on physical fitness and risk factors for cardiovascular disease altogether .
  Objective The present systematic review analyzed trials investigating the effect of PA on aerobic capacity , muscle strength , body composition , hemodynamic variables , biochemical markers , and endothelial function in obese/overweight adolescents .