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Associations Among Physical Activity, Adiposity, and Insulin Resistance in Children Exposed In Utero to Maternal Obesity With and Without Gestational Diabetes

Bethany A. Moore, Makenzie L. Callahan, Samantha L. Martin, Alysha Everett, W. Timothy Garvey, and Paula Chandler-Laney

Purpose: Investigate whether obesity risk and current weight status are independently associated with physical activity (PA) and whether PA is associated with adiposity and insulin resistance (homeostatic model assessment of insulin resistance) among children with high versus low obesity risk based on in utero exposure to maternal overweight/obesity with gestational diabetes mellitus (GDM; high risk) or without GDM (overweight/obesity; high risk) or maternal normal weight without GDM (low risk). Method: Secondary analysis of data from children born to women with overweight/obesity and GDM, overweight/obesity without GDM, or normal weight without GDM. PA was assessed with accelerometry, percentage of body fat derived from anthropometrics, and homeostatic model assessment of insulin resistance calculated from glucose and insulin. Results: Among 4- to 10-year-old children (N = 163), analyses of covariance showed that children with a current BMI ≥85th percentile had less vigorous PA than those with BMI <85th percentile, but in utero exposure was not an independent predictor of PA. In linear regression modeling, moderate to vigorous PA was inversely associated with percentage of body fat and homeostatic model assessment of insulin resistance independent of age, Tanner stage, and accelerometer wear time, with stronger associations in high-risk groups. Conclusions: Children’s PA is related to current weight status but not underlying risk for obesity but may be especially important to reduce obesity and insulin resistance in high-risk children.

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Does Regular Exercise Impact the Lung Function of Healthy Children and Adolescents? A Systematic Review and Meta-Analysis

Fernanda Balbinot, Felipe César de Almeida Claudino, Pedro Kazlauckas Lucas, Ana Paula Donadello Martins, Eliana M. Wendland, and Margaret W. Gerbase

Purpose: To assess the quality of the available evidence on the effect of exercise for the improvement of lung function in healthy children and adolescents. Method: We performed a systematic review and meta-analysis of intervention studies examining the effects of regular exercise on spirometric parameters of healthy children and adolescents aged ≤18 years. Results: Within the exercise groups, there were significant improvements in forced vital capacity (mean difference: 0.17 L; 95% confidence interval, 0.07 to 0.26; P < .05) and forced expiratory volume in the first second (mean difference: 0.14 L; 95% confidence interval, 0.06 to 0.22; P < .05). Results were consistent across different age groups and duration of interventions. In the between-group analysis, forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow were higher in the exercise group compared with the nonexercise group, but the differences did not reach statistical relevance. There was significant statistical heterogeneity between studies. Conclusion: Regular exercise has the potential to improve lung function parameters in healthy children and adolescents; however, the small number of studies and the heterogeneity between them raise concern about the quality of the currently available evidence. These findings bring to attention the need for well-designed trials addressing this important public health issue.

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Aqua-Plyometric Exercises-Induced Changes in Muscle Strength, Bone Mineral Properties, and Physical Fitness in Patients With Juvenile Idiopathic Arthritis: A 12-Week, Randomized Controlled Trial

Ragab K. Elnaggar and Mahmoud S. Elfakharany

Purpose: To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. Methods: A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12–18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. Results: A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P = .016, left side: P = .025] or 180°/s [right side: P = .007, left side: P = .029]). Besides, a considerably greater improvement in the areal BMD (P = .0006), volumetric BMD (P = .027), bone mineral content (P = .002), and BMD Z score (P = .0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P < .001) was revealed in the AquaPlyo group. Conclusion: AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis.

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Arterial Structure in 18-Year-Old Males Is Dependent on Physical Activity at 12 Years and Cumulative Cardiorespiratory Fitness From Puberty to Late Adolescence

Juta Kraav, Reeli Tamme, Liina Remmel, Evelin Mäestu, Maksim Zagura, Jaak Jürimäe, and Vallo Tillmann

Purpose: To evaluate the long-term effect of body composition, physical activity, and cardiorespiratory fitness (CRF) from puberty on arterial health in late adolescent males. Methods: The cumulative burden of physical activity (measured with accelerometer), CRF (VO2peak0.82), and body composition (body mass index, fat mass, and fat percentage) from puberty to late adolescence (sum of 4 time points from 12 to 18 y) was assessed in 102 males. Additional analysis on the first (T1) and last (T4) time points was performed. Intima-media thickness (IMT), carotid-femoral pulse wave velocity, and augmentation index adjusted to heart rate of 75 beats per minute (bpm) as dependent variables were measured at T4 and analyzed in multivariable regression models adjusted for known risk factors including maturation, blood pressure, and smoking habits. Results: T1 and cumulative body composition measures were independently associated with IMT, while cumulative (β = −0.011, P = .036) and T4 (β = −0.0.031, P = .001) CRF revealed independent associations with IMT. Individuals with moderate to vigorous physical activity >60 minutes per day at T1 showed relationship (β = −1.091, P = .026) with IMT independently of late adolescent physical activity. No significant relationship was present for arterial function. Conclusion: Arterial structure in adolescent males is associated with physical activity at 12 years while relationship with CRF can be seen in late adolescence and cumulatively from puberty to late adolescence.

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Metabolic Flexibility During Exercise in Children with Overweight/Obesity Versus Children who are Lean

Brandon Dykstra, Dillon Kuszmaul, and Anthony D. Mahon

Purpose: This study examined metabolic flexibility with respect to fat metabolism during exercise in children who are lean (n=11; 10.9[0.9] y) and overweight/obese (OW/OB; n=9; 10.3[1.2] y). Method: Participants were grouped based on body mass index percentiles for age and sex. Groups were mixed in age and sex. Participants completed two 20-minute exercise bouts on a cycle ergometer, separated by a 10-minute rest. Bout 1 consisted of 10 minutes at 50% VO2peak and 10 minutes at 75% VO2peak. Bout 2 was 20 minutes at 50% VO2peak. Absolute fat oxidation rate (FOR), FOR relative to body mass, FOR relative to fat-free mass, and proportional fat use were measured at 10 minutes of bout 1 and 5, 10, 15, and 20 minutes of bout 2. Results: Absolute FOR was higher in the OW/OB group (range: 117.8 [55.1]–206.2 [48.3] mg·min−1) than in the lean group (81.1 [32.2]–152.2 [38.2] mg·min−1); however, there were no significant main effects for group or significant interactions for proportional fat use, FOR relative to body mass, or FOR relative to fat-free mass. Conclusion: Children in this age range who are overweight/obese do not display impaired metabolic flexibility with respect to fat metabolism during exercise.

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Volume 34 (2022): Issue 4 (Nov 2022)

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Volume 34 (2022): Issue S1 (Nov 2022)

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Adolescent Bone Advantages 3 Years After Resistance Training Trial

Jill Thein-Nissenbaum, Deena M. Weiss, Stephanie A. Kliethermes, and Tamara A. Scerpella

Purpose: We assessed maintenance of skeletal advantages 3 years after completion of a 2-year, school-based, controlled exercise trial in adolescent girls. Method: Middle-school girls participated in a resistance training program embedded in physical education classes. Effort groups (low-effort group [LO] and high-effort group [HI]) were identified; the control group (CON) participated in standard physical education at a separate school. Baseline and follow-up (FU) assessments at 6, 18, and 54 (FU3) months included densitometry, anthropometry, and questionnaires assessing physical maturity and nonintervention organized physical activity. Linear mixed effects models were fit to evaluate bone outcomes across all FU time points for CON versus LO/HI. Results: Sixty-eight girls (23 CON/25 HI/20 LO) were 11.6 (0.3) years at baseline. Bone parameters did not differ at baseline, except femoral neck bone mineral density (LO < HI/CON, P < .05). Forty-seven participants provided FU3 assessment: 17 CON/16 HI/14 LO. After adjusting for height, gynecologic age, baseline bone, and organized physical activity, bone gains across all time points were greater for HI versus CON for legs bone mineral content, femoral neck bone mineral content/bone mineral density, and third lumbar vertebra bone mineral content/bone mineral density (P ≤ .05). At FU3, bone values were greater for HI versus CON at subhead, legs, femoral neck, and third lumbar vertebra (P < .03). Conclusion: Adolescent girls who exerted high effort in a school-based resistance training program demonstrated significant skeletal benefits 3 years after program completion.

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Association of Recess Provision With Elementary School-Aged Children’s Physical Activity, Adiposity, and Cardiorespiratory and Muscular Fitness

Kimberly A. Clevenger, Melitta A. McNarry, Kelly A. Mackintosh, and David Berrigan

Purpose: To identify associations between amount of school recess provision and children’s physical activity (PA), weight status, adiposity, cardiorespiratory endurance, muscular strength, and muscular endurance. Method: Data from 6- to 11-year-old participants (n = 499) in the 2012 National Youth Fitness Survey were analyzed. Parents/guardians reported children’s PA levels and recess provision, categorized as no/minimal (9.0%), low (26.1%), medium (46.0%), or high (18.9%). Children wore a wrist-worn accelerometer for 7 days and completed anthropometric measurements. Fitness was assessed using grip strength and treadmill, pull-up, and plank tests. Cross-sectional linear and logistic regression compared outcomes across levels of recess provision adjusting for the survey’s complex sampling design. Results: Children with high provision of recess were 2.31 times more likely to meet PA guidelines according to parent report than those with no/minimal recess. Accelerometer-measured PA followed a more U-shaped pattern, wherein PA was higher in children with high, compared to low, recess provision but comparable to those with no/minimal recess provision. There were no associations with weight status, adiposity, or fitness. Conclusion: Current recess recommendations (20 min·d−1) may be insufficient as 30 minutes per day of recess was associated with a 2-fold greater likelihood of achieving recommended PA levels. Additional research on recess quantity and quality is needed.

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A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents

Kelsey L. McAlister, Diana Zhang, Kristen N. Moore, Tiffany M. Chapman, Jennifer Zink, and Britni R. Belcher

Purpose: To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. Methods: Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5–17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. Results: Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. Conclusion: While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.