title: Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country, age and sex In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Tracking of cardiovascular disease risk factors including maximal oxygen uptake and physical activity from late teenage to adulthood. An 8-year follow-up study. A controlled study of eight months of physical training and reduction of blood pressure in children: the Odense schoolchild study. Training, muscle volume, and energy expenditure in nonobese American girls. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study) Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children 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. Exercise training and cardiovascular risk factors in type 1 diabetic adolescent girls. School-based intervention acutely improves insulin sensitivity and decreases inflammatory markers and body fatness in junior high school students. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. Cardiovascular Risk Factor Prevention in Black School Children: The "Know Your Body" Evaluation Project Effect of 4 weeks of Pilates on the body composition of young girls. A rationale and method for high-intensity progressive resistance training with children and adolescents. The effects of endurance training on selected coronary risk factors in children Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Hemostatic and inflammatory markers in obese youths: effects of exercise and adiposity. Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. Modification of risk factors for coronary heart disease. Five-year results of a school-based intervention trial. Adiposity, lipid levels, and brief endurance training in nonobese adolescent males. How Obesity Causes Diabetes: Not a Tall Tale Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children.
abstract: Background and design Few studies have investigated the association between maximal cardiorespiratory capacity ( fitness ) and the clustered cardiovascular disease ( CVD ) risk in children and youth from culturally diverse countries . This cross-sectional study examined the association between fitness and clustered CVD risk in children and adolescents from three European countries . Methods Participants were 2845 r and omly selected school children aged 9 or 15 years from Portugal ( n = 944 ) , Denmark ( n = 849 ) and Estonia ( n = 1052 ) .  Cardiorespiratory fitness was determined during a maximal test on a cycle ergometer . CVD risk factors selected to assess the degree of clustering were the total cholesterol/high-density lipoprotein cholesterol ratio , plasma triglycerides , insulin resistance ( homeostasis model assessment ) , sum of four skinfolds , and systolic blood pressure . Results There was a strong association between cardiorespiratory fitness and the clustering of CVD risk factors . The odds ratios for clustering in each quartile of fitness , using the quartile with the highest fitness as reference , were 13.0 [ 95 % confidence interval ( CI ) 8.8 - 19.1 ] ; 4.8 ( 95 % CI 3.2 - 7.1 ) and 2.5 ( 95 % CI 1.6 - 3.8 ) , respectively , after adjusting for country , age , sex , socio-economic status , pubertal stage , family history of CVD and diabetes . In stratified analyses by age group , sex and country , similar strong patterns were observed . Conclusion Low cardiorespiratory fitness is strongly associated with the clustering of CVD risk factors in children independent of country , age and sex 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 OBJECTIVES The aim of the study was to analyse changes in coronary heart disease ( CHD ) risk factors from adolescence to young adulthood , and how changes in risk factors relate to changes in lifestyle . DESIGN A r and omized sample of school children was tested in 1983 and followed-up 8 years later . In 1983 a dropout of 0.7 % was found and the sample was representative of 16 - 19-year-old Danes . SUBJECTS Subjects followed-up 8 years later ( two-thirds of the original sample ) were 88 male and 115 female 15 - 19-year-old school children attending 18 high schools , nine vocational and nine trade schools , throughout Denmark . MAIN OUTCOME MEASURES  Height  ,  body weight , body fat , occupation  and  coronary heart  disease  risk factors including physical activity ( PA ) , fitness , blood pressure ( BP ) , serum cholesterol , HDL cholesterol , triglyceride ( TG ) and smoking habits were assessed . RESULTS In males all risk factors increased : the increases in total cholesterol level and systolic and diastolic BP were large , 0.85 mmol l-1 and 11 mmHg , respectively . In females , the risk for some factors increased ( total cholesterol and BP ) , others decreased ( higher HDL cholesterol ) , and triglyceride did not change . Significant tracking was found in both sexes , with the highest correlation coefficients in men . A total risk score was calculated by categorizing risk factors into six groups--1 to 6 - - and then adding the scores . Pearson correlation between the total risk scores in 1983 and 1991 in men was r = 0.67 ( P < 0.001 ) . Only a weak association was found for the total risk score in women . Nearly 50 % of the boys , who were initially in the upper quintile of risk , were still in the upper quintile 8 years later for most risk factors . In men , the changes in risk factors were related to social factors . Blue-collar workers and the unemployed had the highest increase in risk factors , and the largest decrease in VO2max ( ml min-1 kg-1 ) when analysed together . In both sexes the best relationship between 1983 and 1991 values was found in body mass index ( BMI ) . Leisure time physical activity ( PA ) and triglyceride ( TG ) had a low correlation between 1983 and 1991 values . Physical activity had a non-significant correlation over time for women , indicating that PA in 1983 did not predict PA in 1991 at all . CONCLUSION Coronary heart disease risk factors tracked in both males and females , but only in males was a strong relationship found for total risk from adolescence to young adulthood , indicating the influence of a poor lifestyle in high-risk men . Lower social status related to higher risk OBJECTIVE --To examine the effect of physical training on physical fitness and blood pressure in children aged 9 - 11 years . DESIGN -- Prospect i ve r and omised controlled intervention study of a sample of children drawn from a population survey of coronary risk factors in children . SETTING --Odense , Denmark . SUBJECTS--69 children with mean blood pressure greater than or equal to 95th centile ( hypertensive group ) and 68 with mean blood pressure less than 95th centile ( normotensive group ) , r and omly selected from a population of 1369 children . INTERVENTION--67 children were r and omised to receive three extra lessons a week of an ordinary school physical education programme for eight months . MAIN OUTCOME MEASURES --Physical fitness assessed by calculation of maximum oxygen uptake and blood pressure recorded by one unblinded observer . RESULTS --After three months neither blood pressure nor physical fitness had changed significantly . After adjustment for values in weight , height , heart rate , and the variable in question before training physical fitness rose significantly at the end of eight months ' training , by 3.7 mlO2/kg/min ( 95 % confidence interval 2.2 to 5.3 ) in the normotensive training subgroup and by 2.1 mlO2/kg/min ( 0.1 to 4.2 ) in the hypertensive training subgroup compared with that in the controls . Systolic and diastolic blood pressures in the training subgroups fell significantly by 6.5 mm Hg ( 3.2 to 9.9 ) and 4.1 mm Hg ( 1.7 to 6.6 ) respectively in the normotensive group and by 4.9 mm Hg ( 0.7 to 9.2 ) and 3.8 mm Hg ( 0.9 to 6.6 ) respectively in the hypertensive group . CONCLUSIONS --Physical training lowers blood pressure and improves physical fitness in children and might have implication s for an important non-pharmacological approach to primary prevention of essential hypertension Little is known about the relationship among  training  , energy expenditure , muscle volume , and fitness in prepubertal girls . Because physical activity is high in prepubertal children , we hypothesized that there would be no effect of training . Forty pre- and early pubertal ( mean age 9.1 + /- 0.1 yr ) nonobese girls enrolled in a 5 day/wk summer school program for 5 wk and were r and omized to control ( n = 20 ) or training groups ( n = 20 ; 1.5 h/day , endurance-type exercise )  .  Total energy expenditure ( TEE ) was measured using doubly labeled water , thigh muscle volume using magnetic resonance imaging , and peak O(2 ) uptake ( VO(2 peak ) ) using cycle ergometry .  TEE was significantly greater ( 17 % , P < 0.02 ) in the training girls . Training increased thigh muscle volume ( + 4.3 + /- 0.9 % , P < 0.005 ) and VO(2 peak ) ( + 9.5 + /- 6 % , P < 0.05 ) , effects surprisingly similar to those observed in adolescent girls using the same protocol ( Eliakim A , Barstow TJ , Brasel JA , Ajie H , Lee W-NP , Renslo R , Berman N , and Cooper DM , J Pediatr 129 : 537 - 543 , 1996 ) . We further compared these two sample population s : thigh muscle volume per weight was much lower in adolescent compared with prepubertal girls ( 17.0 + /- 0.3 vs. 27.8 + /- 0.6 ml/kg body mass ; P < 0.001 ) , and allometric analysis revealed remarkably low scaling factors relating muscle volume ( 0.34 + /- 0.05 , P < 0.0001 ) , TEE ( 0.24 + /- 0 . 06 , P < 0.0004 ) , and VO(2 peak ) ( 0.28 + /- 0.07 , P < 0.0001 ) to body mass in all subjects . Muscle and cardiorespiratory functions were quite responsive to brief training in prepubertal girls . Moreover , a retrospective , cross-sectional analysis suggests that increases in muscle mass and VO(2 peak ) may be depressed in nonobese American girls as they mature Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren . Design Cluster r and omised controlled trial . Setting 28 classes from 15 elementary schools in Switzerl and r and omly selected and assigned in a 4:3 ratio to an intervention ( n=16 ) or control arm ( n=12 ) after stratification for grade ( first and fifth grade ) , from August 2005 to June 2006 . Participants 540 children , of whom 502 consented and presented at baseline . Intervention Children in the intervention arm ( n=297 ) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week , daily short activity breaks , and physical activity homework . Children ( n=205 ) and parents in the control group were not informed of an intervention group . For most outcome measures , the assessors were blinded . Main outcome measures Primary outcome measures included body fat ( sum of four skinfolds ) , aerobic fitness ( shuttle run test ) , physical activity ( accelerometry ) , and quality of life ( question naires ) . Secondary outcome measures included body mass index and cardiovascular risk score ( average z score of waist circumference , mean blood pressure , blood glucose , inverted high density lipoprotein cholesterol , and triglycerides ) . Results 498 children completed the baseline and follow-up assessment s ( mean age 6.9 ( SD 0.3 ) years for first grade , 11.1 ( 0.5 ) years for fifth grade ) . After adjustment for grade , sex , baseline values , and clustering within classes , children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds ( −0.12 , 95 % confidence interval −0.21 to −0.03 ; P=0.009 ) . Likewise , their z scores for aerobic fitness increased more favourably ( 0.17 , 0.01 to 0.32 ; P=0.04 ) , as did those for moderate-vigorous physical activity in school ( 1.19 , 0.78 to 1.60 ; P<0.001 ) , all day moderate-vigorous physical activity ( 0.44 , 0.05 to 0.82 ; P=0.03 ) , and total physical activity in school ( 0.92 , 0.35 to 1.50 ; P=0.003 ) . Z scores for overall daily physical activity ( 0.21 , −0.21 to 0.63 ) and physical quality of life ( 0.42 , −1.23 to 2.06 ) as well as psychological quality of life ( 0.59 , −0.85 to 2.03 ) did not change significantly . Conclusions A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children . Trial registration Current Controlled Trials IS RCT N15360785 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 BACKGROUND Atherosclerosis develops from early childhood ; physical activity could positively affect this process . This study 's aim was to assess the associations of objective ly measured physical activity with clustering of cardiovascular disease risk factors in children and derive guidelines on the basis of this analysis . METHODS We did a cross-sectional study of 1732 r and omly selected 9-year-old and 15-year-old school children from Denmark , Estonia , and Portugal . Risk factors included in the composite risk factor score ( mean of Z scores ) were systolic blood pressure , triglyceride , total cholesterol/HDL ratio , insulin resistance , sum of four skinfolds , and aerobic fitness . Individuals with a risk score above 1 SD of the composite variable were defined as being at risk . Physical activity was assessed by accelerometry . FINDINGS Odds ratios for having clustered risk for ascending quintiles of  physical activity  ( counts per min ; cpm ) were 3.29 ( 95 % CI 1.96 - 5.52 ) , 3.13 ( 1.87 - 5.25 ) , 2.51 ( 1.47 - 4.26 ) , and 2.03 ( 1.18 - 3.50 ) , respectively , compared with the most active quintile . The first to the third quintile of physical activity had a raised risk in all analyses . The mean time spent above 2000 cpm in the fourth quintile was 116 min per day in 9-year-old and 88 min per day in 15-year-old children . INTERPRETATION  Physical activity  levels should be higher than the current international guidelines of at least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors OBJECTIVE : To determine the effect of exercise training ( ET ) on components of the insulin resistance syndrome ( IRS ) in obese children . DESIGN : R and omized , modified cross-over study , with subjects assigned to one of two conditions : ( 1 ) 4 months of ET followed by 4 months of no-ET ; or ( 2 ) 4 months of no-ET followed by 4 months of ET . Measurements were made at three time points : 0 , 4 and 8 months . SUBJECTS : 79 obese , but otherwise healthy children ( age : 7–11 y , percent fat ( % fat ) 27–61 % ) . MEASUREMENTS : Plasma lipid and lipoprotein concentrations , plasma insulin and glucose concentrations ; % fat ; submaximal heart rate ( HR ) as an index of fitness . EXERCISE TRAINING : ET was offered 5 d/week 40 min/d . For the 73 children who completed 4 months of ET , the mean attendance was 80 % ( that is , 4 d/week ) and the average HR during ET was 157 bpm . RESULTS : Significant ( P<0.05 ) group x time interactions were found for plasma triglyceride ( TG ) and insulin concentrations and % fat . The average change for both groups , from just before ET to just after the 4 month ET was −0.24 mmolċl−1 for TG , −25.4 pmolċl−1 for insulin and −1.6 units for % fat . When Group 1 ceased ET , over the following 4 month period the average change for insulin was + 26.6 pmolċl−1 and for % fat + 1.3 units . CONCLUSION : Some components ( plasma TG , insulin , % fat ) of the IRS are improved as a result of 4 months of ET in obese children . However , the benefits of ET are lost when obese children become less active OBJECTIVES 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 Sixteen postmenarcheal Type 1 diabetic adolescent girls were r and omized into training ( involving aerobic and strength exercises ) and nontraining groups .  Body composition ( skinfold thickness ) , aerobic fitness ( PWC170 ) , plasma lipids , serum apolipoproteins , lipoprotein(a ) , leptin , and adiponectin were assessed before and after the 6-month period . After the 6-month period , fat mass and leptin increased significantly in the nontraining group but not in the training group . Conversely , in the latter group , fat-free mass increased ( P < .01 ) . Moreover , PWC170 improved and apolipoproteinB : apolipoproteinA-1 ratio decreased with physical training ( P < .05 ) . Thus , physical training reduces cardiovascular risks and the increase of insulin resistance risk factors in diabetic adolescent girls CONTEXT Risk factors for type 2 diabetes mellitus ( T2DM ) include obesity , family history , dyslipidemia , a proinflammatory state , impaired insulin secretory capacity , and insulin resistance . OBJECTIVE The aim of this study was to examine the effects of a 3- to 4-month school-based intervention consisting of health , nutrition , and exercise classes plus an aerobic exercise program on diabetes risk . DESIGN This study was a r and omized before/after controlled trial . METHODS Seventy-three eighth- grade students in a predominantly Hispanic New York City public school were divided into a control group ( studied twice without receiving the intervention ) and an experimental group ( studied before and after the intervention ) . OUTCOME MEASURES We measured body fatness ( bioelectrical impedance ) , insulin sensitivity , beta-cell function ( insulin release in response to an iv glucose load corrected for insulin sensitivity ) , lipid profiles , and circulating concentrations of IL-6 , C-reactive protein , adiponectin , and TNF-alpha . RESULTS Participation in the intervention was associated with significant reductions in body fatness , insulin resistance , and circulating concentrations of C-reactive protein and IL-6 , irrespective of somatotype on enrollment . CONCLUSION Short-term school-based health , nutrition , and exercise intervention is beneficial to all students and affects multiple diabetes risk factors 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 A longitudinal study of the effectiveness of the " Know Your Body " ( KYB ) program in reducing coronary heart disease risk factors was begun among black students in the District of Columbia in 1983 . Subjects were in grade s four through six at nine schools stratified on socioeconomic status and r and omized into one control and two intervention groups . At baseline , 1,041 students were measured for systolic and diastolic blood pressure , ponderosity , triceps skinfold thickness , postexercise pulse recovery rate , serum thiocyanate , serum total cholesterol , and serum HDL cholesterol . Significant net changes in individual values occurred in the favorable direction at one or all four annual follow-up reexaminations for systolic blood pressure , diastolic blood pressure , HDL cholesterol , HDL/total cholesterol ratio , serum thiocyanate , and fitness . Favorable changes in diastolic blood pressure and serum thiocyanate were observed at all reexaminations , and these were substantiated by analyses that used the school grade as the unit of analysis . Intervention students who were judged to have had the best  KYB  teachers showed significant favorable net changes in total serum cholesterol after one year . Results are consistent with other evaluations of the Know Your Body program suggesting that KYB may reduce chronic disease risk in diverse school population s , and that increased efforts should be made to improve implementation methods BACKGROUND There is a need to find ways to increase the physical activity levels and improve the body composition and blood pressure of girls . METHODS Thirty 11-year-old girls were recruited from two after school programs in Houston Texas in Spring 2005 . Participants from one program ( 16 ) were r and omly assigned to intervention , the other ( 14 ) served as controls .  BMI , BMI percentile , waist circumference and blood pressure were assessed before and after the intervention . Pilates classes were provided free of charge for an hour per day at the intervention site , 5 days a week , for 4 weeks . Four participants wore  heart rate monitors  during every session and completed enjoyment and perceived exertion question naires . Repeated measures analysis of variance with time ( within ) and group ( between ) as factors was performed . RESULTS Mean attendance was 75 % , mean heart rate 104 bpm , mean perceived exertion 5.9 ( 1 - 10 scale ) and enjoyment 4.4 ( 1 - 5 scale ) . There was a significant ( P = 0.039 ) time by group interaction for BMI percentile . Graphs indicated that this difference was influenced by large reductions in the BMI percentile of healthy girls . CONCLUSIONS Girls enjoyed Pilates , and participation for 4 weeks lowered BMI percentile .  Pilates holds promise as a means of reducing obesity BACKGROUND The rising prevalence of obesity in children and adolescents is implicated in the metabolic abnormalities that track into adulthood . The associated increased incidence of insulin resistance , metabolic syndrome and type 2 diabetes being identified in younger cohorts has given rise to a critical global health issue . Muscular strength is a vital component of metabolic fitness that provides protection from insulin resistance in adults , and we have recently shown this to be true in children as well . Targeting muscular strength deficiencies at an early age may be an effective preventative strategy for metabolic syndrome and type 2 diabetes . PURPOSE There is limited evidence -based best practice for progressive resistance training ( PRT ) , adiposity and metabolic fitness in children and adolescents . The purpose of this paper is to describe the methodology we utilized for implementing a PRT program to avoid publication bias , enable replication of the study and share a novel program that we have found safe and suitable for use with youth . METHODS We conducted the first r and omized controlled trial ( RCT ) prescribing high-intensity PRT to children and adolescents ( 10 - 15 years ) as a community-based primary prevention program to address adiposity and metabolic health . Participants were instructed to complete 2 sets of 8 repetitions of 11 exercises targeting all the major muscle groups twice a week at an RPE of 15 - 18 for 8 weeks . RESULTS Primary outcome was waist circumference ; secondary outcomes included insulin resistance , lipid levels , muscle strength , cardiorespiratory fitness , body composition , self-efficacy , self-concept , habitual physical activity , nutritional and sedentary behavior patterns . CONCLUSION The supervised PRT program that we used with children and adolescents has been described in detail . The efficacy of this modality of exercise for metabolic fitness and other health outcomes is now under investigation The effects of regular aerobic exercise on blood concentrations on high‐density lipoprotein cholesterol and prostacyclin were studied in 18 healthy sedentary boys who exercised on a bicycle ergometer for 1 h , four times per week , for 2 months at 75 % of their physical working capacity . The results were compared with those of 10 control boys who did not participate in any specific program . The exercise group revealed a significantly higher mean high‐density lipoprotein cholesterol and 6‐keto‐PGF1a concentration at the end of the training program ( p < 0:005 and p < 0:001 , respectively ) . These results suggest that regular aerobic exercise has beneficial effects upon the high‐density lipoprotein cholesterol and 6‐keto‐PGF1a in healthy young boys and may be beneficial in the long term , by preventing atherosclerosis of coronary artery disease in adulthood OBJECTIVE To assess the outcomes of health behavior interventions , focusing on the elementary school environment , classroom curricula , and home programs , for the primary prevention of cardiovascular disease . DESIGN A r and omized , controlled field trial at four sites with 56 intervention and 40 control elementary schools . Outcomes were assessed using prer and omization measures ( fall 1991 ) and follow-up measures ( spring 1994 ) . PARTICIPANTS A total of 5106 initially third- grade students from ethnically diverse background s in public schools located in California , Louisiana , Minnesota , and Texas . INTERVENTION Twenty-eight schools participated in a third- grade through fifth- grade intervention including school food service modifications , enhanced physical education ( PE ) , and classroom health curricula .  Twenty-eight additional schools received these components plus family education . MAIN OUTCOME MEASURES At the school level , two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs . At the level of the individual student , serum cholesterol change was the primary end point and was used for power calculations for the study . Individual level secondary end points included psychological factors , recall measures of eating and physical activity patterns , and other physiologic measures . RESULTS In intervention school lunches , the percentage of energy intake from fat fell significantly more ( from 38.7 % to 31.9 % ) than in control lunches ( from 38.9 % to 36.2%)(P<.001 ) . The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) intervention increased significantly in the intervention schools compared with the control schools ( P<.02 ) . Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced ( from 32.7 % to 30.3 % ) compared with that among students in the control schools ( from 32.6 % to 32.2%)(P<.001 ) . Intervention students reported significantly more daily vigorous activity than controls ( 58.6 minutes vs 46.5 minutes ; P<.003 ) . Blood pressure , body size , and cholesterol measures did not differ significantly between treatment groups . No evidence of deleterious effects of this intervention on growth or development was observed . CONCLUSION The CATCH intervention was able to modify the fat content of school lunches , increase moderate-to-vigorous physical activity in PE , and improve eating and physical activity behaviors in children during 3 school years BACKGROUND No national policy for health education in schools exists to date in Greece . The first attempt to apply a school-based health education intervention program was launched in 1992 on all 4,171 pupils registered in the first grade in two counties of Crete . The 1,510 pupils registered in a third county served as controls . METHODS The school-based intervention and the seminars organized for parents were primarily aim ed at improving children 's diet , fitness , and physical activity . Pupils in the first grade in a representative sample of 40 schools were examined prior to the intervention program on a variety of health knowledge , dietary , physical activity , fitness , anthropometric , and biochemical indices . The same measurements were taken after 3 years of the program on 288 intervention group and 183 control group pupils . RESULTS Positive serum lipid level changes occurred to a greater extent in the intervention group than the control group . BMI increased less in the intervention group than for controls . The increase in health knowledge and physical activity and fitness levels occurred to a higher extent in the intervention group compared to controls . CONCLUSIONS The short-term changes observed in the present study are markedly encouraging and indicate great potential for progressive improvement . Continuation and expansion of such a program may prove to be beneficial in initiating long-term changes 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 OBJECTIVES This study evaluated the effects of aerobic exercise physical education on blood pressure in high-risk , predominantly African-American , adolescent girls . METHODS Ninth- grade girls ( n = 99 ) with blood pressure above the 67th percentile were r and omized to 1 semester of aerobic exercise classes or st and ard physical education classes . RESULT The study was completed by 88 girls . At posttest , only members of the aerobic exercise group increased their estimated cardiorespiratory fitness . The aerobic exercise group had a greater decrease in systolic blood pressure than the st and ard physical education group ( P < .03 ) . CONCLUSIONS Aerobic exercise physical education is a feasible and effective health promotion strategy for high-risk adolescent girls We conducted a study of the effectiveness of an educational intervention design ed to modify risk factors associated with coronary heart disease among 3388 children in 37 schools in two demographically dissimilar areas ( the Bronx and Westchester County ) in and around New York City . Schools within each area were r and omly assigned to either intervention or nonintervention groups . In schools targeted for intervention , children in the fourth through eighth grade s were taught a teacher-delivered curriculum focusing on diet , physical activity , and cigarette smoking .  Risk-factor levels were measured in all schools at base line and at four follow-up points . A total of 1769 of the children qualified for analysis of the intervention effect . After five years , the net mean change in plasma levels of total cholesterol was -1.7 mg per deciliter per year ( -0.04 mmol per liter ) ( 95 percent confidence interval , -2.7 to -0.7 mg per deciliter [ -0.07 to -0.02 mmol per liter ] ) in the Westchester County schools , or -8.5 mg per deciliter ( -0.22 mmol per liter ) ( 5.1 percent ) over a period of five years . In the schools in the Bronx , the net mean change was -1.0 mg per deciliter per year ( -0.03 mmol per liter ) ( 95 percent confidence interval , -2.3 to + 0.3 mg per deciliter [ -0.06 to + 0.01 mmol per -2.3 to + 0.3 mg per deciliter [ -0.06 to + 0.01 mmol per liter ] ) , or -5.0 mg per deciliter ( -0.13 mmol per liter ) ( 2.9 percent ) over a period of five years . Favorable trends in dietary intake and health knowledge were also observed , whereas the other targeted risk factors were not significantly altered . If these findings can be replicated , this will suggest that educational programs to modify coronary risk factors are feasible and may have a favorable ( albeit small ) effect on blood levels of cholesterol in children Physical activity during childhood and adolescence may influence the development of childhood obesity and cardiovascular disease later in life . Research focused prospect ively on the effects of training on lipid levels in nonobese subjects , and studies using noninvasive measurements of subcutaneous and intraabdominal fat are lacking . It was hypothesized in nonobese sedentary adolescent males that a brief endurance-type exercise training intervention would reduce body fat and improve lipid profiles .  Thirty-eight healthy , nonobese sedentary adolescent males ( mean age 16 + /- 0.7 years old ; 18 controls , 20 trained ) completed a 5-week prospect i ve , r and omized , controlled study . Adiposity was measured using magnetic resonance images of the thigh and abdomen ( subcutaneous abdominal adipose tissue [ SAAT ] and intraabdominal adipose tissue [ IAAT ] ) . Lipid measurements included serum triglycerides ( TG ) , total cholesterol ( TC ) , HDL and LDL cholesterol . There was no change in body weight in either control or training groups . Training led to small but significant reductions in thigh fat ( -4.6 + /- 1.5 % , p < 0.03 ) and SAAT% ( 1.7 + /- 0.8 % , p < 0.02 ) . There was no change in IAAT% . Unexpectedly in the control group there were significant increases in thigh fat ( 5.2 + /- 1.7 % , p<0.01 ) , SAAT% ( 1.8 + /- 0.6 , p < 0.007 ) and IAAT% ( 4.5 + /- 1.1 , p < 0.0007 ) . Training-induced changes in adiposity were not accompanied by changes in circulating lipids . In nonobese adolescent males a brief period of endurance training led to reductions in body fat depots without weight change while body fat increased rapidly in the control group . Exercise training did not change lipid levels , the latter may require more sustained alterations in patterns of physical activity The epidemic of obesity-associated diabetes is a major crisis in modern societies , in which food is plentiful and exercise is optional . The biological basis of this problem has been explored from evolutionary and mechanistic perspectives . Evolutionary theories , focusing on the potential survival advantages of “ thrifty ” genes that are now maladaptive , are of great interest but are inherently speculative and difficult to prove . Mechanistic studies have revealed numerous fat-derived molecules and a link to inflammation that , together , are hypothesized to underlie the obesity-diabetes connection and thereby represent prospect i ve targets for therapeutic intervention OBJECTIVE Our primary objective was to determine whether a novel ' active school ' model -- Action Schools ! BC -- improved the cardiovascular disease ( CVD ) risk profile in elementary-school children . Our secondary objective was to determine the percentage of children with elevated CVD risk factors . METHODS We undertook a cluster-r and omized controlled school-based trial with 8 elementary schools across 1 school year , in British Columbia , Canada , beginning in 2003 . Boys and girls ( n=268 , age 9 - 11 years ) were r and omly assigned ( by school ) to usual practice ( UP , 2 schools ) or intervention ( INT , 6 schools ) groups . We assessed change between groups in cardiovascular fitness ( 20-m Shuttle Run ) , blood pressure ( BP ) , and body mass index ( BMI , wt/ht(2 ) ) . We evaluated total cholesterol ( TC ) , total : high-density cholesterol ( TC : HDL-C ) , low-density lipoprotein , apolipoprotein B , C-reactive protein and fibrinogen on a subset of volunteers ( n=77 ) . RESULTS INT children had a 20 % greater increase in fitness and a 5.7 % smaller increase in BP compared with children attending UP schools ( P<0.05 ) . Forty five percent of children had at least one elevated risk factor ( fitness , BP or BMI ) at baseline . There were no significant differences between groups for change in BMI or in any of the blood variables . CONCLUSION Action Schools ! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children . Our multi-component intervention exposed children to fitness enhancing physical activity . It may be important for education stakeholders to adequately re source the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis
target: METHODS The results of recent systematic review s are discussed and supplemented with relevant literature not included in these review s. PubMed was search ed for the years 2006 - 2011 for additional topics not sufficiently covered by the review s. RESULTS PA was associated with lower blood pressure and a healthier lipid blood profile in children .
  The association was stronger when a composite risk factor score was analysed , and the associations between physical fitness and cardiovascular disease ( CVD ) risk factors were even stronger .
  Muscle strength and endurance exercise each had an effect on blood lipids and insulin sensitivity even if the effect was smaller for muscle strength than for aerobic exercise .
  New evidence suggests possible effects of PA  on C-reactive protein .
  CONCLUSION There is accumulating evidence that PA can have beneficial effects on the risk factors of CVD in children .
background: BACKGROUND A number of recent systematic review s have result ed in changes in international recommendations for children 's participation in physical activity ( PA ) for health .
  The World Health Authority ( WHO ) has recently released new recommendations .
  The WHO still recommends 60 min of moderate to vigorous physical activity ( MVPA ) , but also emphasises that these minutes should be on top of everyday physical activities .
  Everyday physical activities total around 30 min of MVPA in the quintile of the least active children , which means that the new recommendations constitute more activity in total compared with earlier recommendations .
  OBJECTIVE To summarise evidence justifying new PA recommendation for cardiovascular health in children .