Skip Navigation LinksHome > January 1996 - Volume 28 - Issue 1 > Physical training, lifestyle education, and coronary risk fa...
Medicine & Science in Sports & Exercise:
Clinical Sciences: Clinical Investigations

Physical training, lifestyle education, and coronary risk factors in obese girls

GUTIN, BERNARD; CUCUZZO, NICHOLAS; ISLAM, SYED; SMITH, CLAYTON; STACHURA, MAX E.

Free Access
Article Outline
Collapse Box

Author Information

Georgia Prevention Institute, Department of Pediatrics; and Department of Medicine; Medical College of Georgia, Augusta, GA 30912

Submitted for publication October 1994.

Accepted for publication August 1995.

This work was supported by grants from the Medical College of Georgia Research Institute and Department of Pediatrics, and the American Heart Association-Georgia Affiliate.

Address for correspondence: Bernard Gutin, Ph.D., Professor of Pediatrics and Physiology, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA 30912-3710; E-mail: deptped.bgutin@mail.mcg.edu.

Collapse Box

Abstract

The effects of supervised physical training (PT) and lifestyle education(LSE) on risk factors for coronary artery disease and non-insulin-dependent diabetes mellitus were compared in obese 7- to 11-yr-old black girls. The subjects were divided into two groups. The PT group (N = 12) completed a 5-d·wk-1, 10-wk, aerobic training program; and the LSE group participated in weekly lifestyle discussions to improve exercise and eating habits. The PT group showed a significant increase in aerobic fitness(P < 0.05) and decrease in percent body fat (P < 0.05), while the LSE group declined significantly more in dietary energy and percent of energy from fat (P < 0.05). Fasting insulin did not change significantly. The LSE group declined significantly more than the PT group in glucose (P < 0.05), and glycohemoglobin declined from baseline in both groups (P < 0.05). Lipid changes were similar in the two groups: total cholesterol/high density lipoprotein cholesterol(P < 0.01) and triglycerides (P < 0.05) declined, the low density lipoprotein (LDL)/apoproteinB ratio increased (which indicates a decrease in small dense LDL) (P < 0.05) and lipoprotein(a) increased (P < 0.05). Thus, the interventions were similarly effective in improving some diabetogenic and atherogenic factors, perhaps through different pathways; i.e., the PT improved fitness and fatness, while the LSE improved diet. Exercise and diet-induced changes in lipoprotein(a) require further investigation.

In both adults (3) and children(8), body fatness is related to risk factors for coronary artery disease (CAD) and non-insulin-dependent diabetes mellitus (NIDDM). Since regular exercise can play an important role in the treatment of childhood obesity (7), it is important to develop and evaluate different ways of helping obese children to exercise. One approach is supervised physical training (PT) without dietary intervention. Another approach is lifestyle education (LSE), which provides children with the knowledge and skills needed to incorporate exercise into their everyday lives; such education may also help the children to improve their eating habits(5). Black females are at especially high risk of obesity(18). Thus, the effects of supervised PT and LSE on CAD/NIDDM risk factors were investigated in obese black girls.

Back to Top | Article Outline

METHODS AND PROCEDURES

Obese black girls 7-11 yr of age (mean = 9.2 yr) were recruited via flyers sent to parents of children attending schools near Medical College of Georgia(MCG) and by advertisements in hospital newspapers. The main enticement was that they would receive without charge an intervention that might improve their body composition and health. In addition, the children were offered $100 for completion of all study requirements. All girls and parents gave informed consent. They agreed to accept assignment to either the formal PT program or to participate in weekly lifestyle discussions designed to improve their exercise and eating habits. Girls who attended the schools from which a bus could pick them up to transport them to the PT center were assigned to the PT group, and the others were assigned to the LSE group. All the schools were in similar socioeconomic neighborhoods.

Of the 13 girls who started the 5-d·wk-1, 10-wk PT program, one did not actively participate in the PT, despite constant prodding, and was exerting a disruptive influence on the other children. Thus, after 3 wk she was asked to discontinue attending. One girl lived outside of the bus area, but promised to provide her own transportation for 3 d·wk-1; she attended 82% of her scheduled sessions. Each of the 11 girls who took the bus had an attendance rate for the 5-d·wk-1 program that was greater than 93%. For the LSE sessions, 12 girls started, but two dropped out within the first 2 wk. For the other 10, the attendance was 95%. The PT group received no dietary information.

Before and after the 10-wk intervention period, the participants reported in a fasting state at 8 a.m. and a blood sample was drawn. Lipids, lipoproteins, apoproteins, insulin, and glucose were assayed as previously described (8). In the interests of parsimony, this study focused on several key indices of CAD risk; i.e., the ratio of total cholesterol (TC) to high density lipoprotein cholesterol (HDLC), which has been found to be a better predictor of CAD mortality than any other single lipoprotein measurement (6), and triglycerides (TG). Also investigated were the effects of the interventions on two other CAD-associated lipid factors whose relationship to activity and fitness is not well-known: the ratio of low density lipoprotein cholesterol (LDLC) to apoproteinB (apoB), an index of small dense LDL (21); and lipoprotein(a)(19). Lipoprotein(a) [Lp(a)] was determined by an enzyme linked immunosorbent assay (Strategic Diagnostics, Newark, DE). This kit included standards (6 levels) containing Lp(a) in human plasma in buffered solution, which were used to plot a standard curve from which controls and unknowns were calculated. An external source of Lp(a) controls (2 levels), assayed by Northwest Lipid Research Center in Seattle, WA, was also included in the controls. All Lp(a) analyses were done in batches within 1 month and all standards, controls, and plasma samples were run in duplicate. The reproducibility coefficient using a subsample (N = 19) was 0.93. In addition to fasting glucose and insulin values, glycohemoglobin (GHb) was measured to gain insight into the average blood glucose over the previous 4-6 wk (20). GHb was determined in duplicate by affinity chromatography using kits from Isolab (Akron, OH). Our normal range is 3.7-7.1%, with intra- and interassay variation of 3.0 and 4.2%, respectively.

Percent body fat was measured with dual x-ray absorptiometry (DXA) (Hologic QDR-2000, Waltham, MA). This involved a small radiation exposure of 0.5 mRem, about 33% of the amount received in a cross-country airplane trip. Since there are few published data on the DXA for measurement of body composition in children, reliability was determined in 42 children involved in another study(8). In replicate measurements, with repositioning between scans, the mean values were almost identical (and not significantly different), and the reproducibility coefficient was very high (r > 0.99). More complete information about the DXA measurement is provided elsewhere(9).

Diet was assessed with 3-d dietary records, including one weekend day. Only five and seven children returned complete baseline and post-intervention records for the LSE and PT groups, respectively; therefore, these results must be interpreted cautiously. The dietary records were analyzed using Nutritionist III software (N-Squared Computing, Salem OR)(16). The key dietary factors estimated were total energy intake and percent of energy from fat. Free-living physical activity (PA) was measured with a 7-d recall modified for use with children(23). Overall PA included the light, moderate, and hard categories of PA. To derive an estimate of vigorous PA, only the last two categories were used. The energy expenditure data were expressed per unit of body weight to take into account the fact that heavier children use more energy to move their bodies a given amount; thus, the values may be considered“movement units.”

Aerobic fitness was measured on a treadmill. The children walked at 2.5 mph for 3 min. Then the grade was raised to 2% for 1 min and to 4% for another 3 min period. Heart rate (HR) was measured during the last minute of these work stages with an electrocardiograph (Space Labs, Redmond, WA) and the values at the 0% and 4% grades were averaged to provide a stable index of aerobic fitness; a lower submaximal HR indicates better fitness. After the 4% workload, the grade was incremented by 2% every minute, encouragement was given to help elicit a maximal effort, and oxygen consumption was measured with indirect calorimetry. However, a clear maximal effort was not elicited in several children, as indicated by maximal HR less than 190 bpm or respiratory exchange ratios less than 1.00. Thus, submaximal HR, which has previously been shown to be a sensitive indicator of improved aerobic fitness in children(22), was used as the index of aerobic fitness.

The PT program was designed to exceed minimal criteria for a training effect: i.e., intensity above 60% of maximal HR, for 20 min, three times·wk-1 (1). The aerobic phase of the session was comprised of activities such as: group aerobics, cycle ergometry, minitramp, walking/jogging around the room or on a treadmill, circuit training with light weights, rope jumping, bench stepping, and using a cross-country ski machine. To assure that girls went beyond the minimal criteria, the girls were encouraged to keep their HR over 70% of maximal for the entire aerobic phase of the PT session (approximately 30 min), and to attend 5 d·wk-1. HR was monitored during two sessions·wk-1 for each girl, using a portable monitor (Polar Vantage XL, Port Washington, NY). The average time for which the girls kept their HR in their target zones was 28 min, and the average HR during this phase of the PT sessions was 163 bpm, well over the minimal levels prescribed. Thus, the PT group clearly obtained an adequate training stimulus.

The LSE group provided their own transportation and came to MCG one evening·wk-1 for 60-90 min. Behavioral techniques used for self-management of PA and eating habits were adapted for the 7-11 yr old girls(5). These included written record keeping, goal setting, relapse prevention, and reinforcement techniques.

Between group comparisons of preintervention values were made witht-tests for unpaired comparisons. Within groups analyses of variance(ANOVA) showed significant changes from pre- to post-intervention within the separate groups. Differences between group changes were compared with treatments by time, repeated measures ANOVAs; a significant treatment by time interaction indicated that the groups responded differently. When the interaction was not significant, a significant F-ratio for the time factor indicated that both groups taken together showed a significant change from baseline.

Back to Top | Article Outline

RESULTS

The groups were similar at baseline, as shown by the nonsignificant differences in baseline means for all variables except vigorous PA; this difference may suggest that some of the children who agreed to participate in the controlled PT may have been more inclined to vigorous PA at baseline.

Table 1 shows the baseline and post-intervention values for fitness, PA, fatness, and diet. Submaximal HR declined significantly in the PT group, indicating improved aerobic fitness, while it remained stable in the LSE group. Although overall PA increased somewhat in both groups, the changes did not achieve significance. However, both groups increased significantly in vigorous PA.

Table 1
Table 1
Image Tools

At baseline, the mean body mass indices (weight in kg·height-2 in meters) for the PT and LSE groups (27.9 and 26.8, respectively) were greater than the 95th percentile for black 10-yr-old girls(15). Percent body fat declined significantly in the PT group, but the decline in the LSE group was not significant. A complete description of total and regional body composition changes is provided elsewhere (9).

For those who provided dietary data, the LSE group declined significantly more than the PT group in intake of total energy and percent of energy from fat. No significant changes occurred in the percent of energy from saturated fat (data not shown).

Table 2 shows that fasting insulin concentrations did not change significantly and that glucose concentrations declined significantly more in the LSE group than in the PT group. GHb declined significantly in both groups taken together. None of the lipid changes differed significantly for the groups. For the groups taken together, significant reductions were found for TG and the TC/HDLC ratio. No significant change was seen for the separate components of the ratio, although the increase in HDLC approached significance (P = 0.08). The significant increase in the LDLC/apoB ratio indicated a reduction in small dense LDL. LP(a) increased significantly across both groups.

Table 2
Table 2
Image Tools
Back to Top | Article Outline

DISCUSSION

The PT group improved in aerobic fitness and body composition, suggesting that supervised PT was effective in improving these factors. Neither group increased overall PA significantly. For the PT group, this suggests that they may have compensated for the PT by reducing their activity at other times during the week. With respect to vigorous activity, both groups increased significantly and similarly. Any conclusions about changes in vigorous activity must be tempered in light of the higher baseline values for the PT group; i.e., it is possible that the change for the LSE group actually constituted a greater proportion of their baseline activity. Nonetheless, the lack of improvement in fitness and body composition for the LSE group implies that their increased PA may not have been sufficiently systematic to elicit a clear training effect in 10 wk. When the children were questioned about their free-living PA 4 wk after termination of the interventions, the PT subjects had dropped off rather sharply, implying that they had come to depend on the formal PT for their exercise, while the LSE subjects maintained the higher level; therefore, the long-term effect of these two approaches to increasing PA and fitness needs to be studied. Since the PT group received no instruction concerning diet while some of the lifestyle sessions did focus on diet, it is appropriate that the limited dietary data suggested that the LSE group decreased more in total energy and fat intake.

Compared with the normal range in our laboratory (7-179 pmol·l-1), the baseline values of insulin were quite high for these obese children, suggesting that they were insulin resistant(14). The fasting glucose values and GHb were well within the normal range, suggesting that the elevated insulin was maintaining normal glucose disposal. Contrary to our expectations, no significant changes occurred in fasting insulin values as a result of the interventions; in fact, the mean values increased slightly. Perhaps a longer period of PT(17) and/or a more substantial change in body composition(13) are required for reductions to be produced. The LSE group declined more than the PT group in fasting glucose values, perhaps because of the combination of diet change and increased informal PA. Taken together, both groups reduced GHb significantly from the upper portion to the middle of the normal range. Since this was accomplished without a significant change in insulin concentration, it suggests that insulin sensitivity was improved. Although little is known about the effects of PT or diet on Ghb in nondiabetic children, regular PT reduces GHb levels in insulin-dependent diabetics (20).

Both groups changed similarly in lipid profiles. The reductions in TC/HDLC and TG, along with the increase in the LDLC/apoB ratio, suggest an improved lipid profile. However, the increases in Lp(a) suggest an unfavorable change. Little is known about the relation of exercise and Lp(a). A recent paper(12) reported no association of aerobic fitness and body composition to Lp(a) in adults; we obtained a similar result in 7- to 11-yr-old children (11). One paper reported that Lp(a), measured 24 h after the last bout of exercise, was elevated in high-level athletes, perhaps because it plays a role in wound repair following vigorous exercise (4). However, an inverse relationship between aerobic fitness and Lp(a) in adolescents with insulin-dependent diabetes mellitus has been reported (2), and a letter to the editor(10) reported a decrease in Lp(a) after 8 d of cross-country skiing. More research is needed to clarify the acute and chronic effects of exercise on Lp(a).

There are several limitations to this preliminary study which require that conclusions be drawn very cautiously, including the small number of subjects and the incomplete dietary data. The fact that the subjects were paid to encourage compliance also limits the extent to which the results can be generalized to typical clinical settings in which payment is not provided.

In conclusion, it appears that supervised PT, without dietary intervention, helped the obese girls to improve their aerobic fitness and body composition, while lifestyle education helped the girls to improve their diets. Thus, the similar changes in the other CAD/NIDDM risk factors may have been elicited through different pathways, suggesting that a combination of PT and lifestyle education may be more effective than either alone.

Back to Top | Article Outline

REFERENCES

1. American College of Sports Medicine. Guidelines for Exercise Testing and Prescription. Baltimore: Williams & Wilkins, 1995, pp. 153-176.

2. Austin, A., V. Warty, J. Janosky, and S. Arslanian. The relationship of physical fitness to lipid and lipoprotein(a) levels in adolescents with IDDM. Diabetes Care 16:421-425, 1993.

3. Björntorp, P. Visceral obesity: a “Civilization Syndrome”. Obesity Res. 1:206-222, 1993.

4. Cardoso G., C. Posadas, O. Orvananos, et al. Long distance runners and bodybuilders exhibit elevated plasma lipoprotein(a). Chem. Phys. Lipids 67-68:207-221, 1994.

5. Epstein, L. and R. Wing. Behavioral treatment of childhood obesity. Psych. Bull. 101:331-42. 1987.

6. Grover, S., C. Palmer, and L. Coupal. Serum lipid screening to identify high-risk individuals for coronary death. The results of the Lipid Research Clinics prevalence cohort. Arch. Intern. Med. 154:679-84, 1994.

7. Gutin, B. and T. Manos. Physical activity in the prevention of childhood obesity. In: Prevention and treatment of childhood obesity. Ann. N. Y. Acad. Sci. 699:115-126, 1993.

8. Gutin, B., S. Islam, T. Manos, N. Cucuzzo, C. Smith, and M. Stachura. The relations of percent body fat and maximal aerobic capacity to risk factors for atherosclerosis and diabetes in black and white seven- to eleven-year-old children. J. Pediatr. 125:847-852, 1994.

9. Gutin, B., N. Cucuzzo, S. Islam, C. Smith, R. Moffatt, and D. Pargman. Physical training improves body composition of black obese 7- to 11-year-old girls. Obesity Res. 3:305-312, 1995.

10. Hellsten, G., K. Boman, G. Hallmans, and G. Dahlen. Lipids and endurance physical activity (Letter). Atherosclerosis 75:93-94, 1989.

11. Islam, S., B. Gutin, C. Smith, F. Treiber, and M. Kamboh. Association of apolipoprotein(a) phenotypes in children with family history of premature coronary artery disease. Arterioscler. Thromb 14:1609-1616, 1994.

12. Israel, R., M. Sullivan, R. Marks, R. Cayton, and T. Chenier. Relationship between cardiorespiratory fitness and lipoprotein(a) in men and women. Med. Sci. Sports Exerc. 26:425-431, 1994.

13. Knip, M. and O. Nuutinen. Long-term effects of weight reduction on serum lipids and plasma insulin in obese children. Am. J. Clin. Nutr. 57:490-493, 1993.

14. Laakso, M. How good a marker is insulin level for insulin resistance? Am. J. Epidemiol. 137:959-965, 1993.

15. Must, W., G. Dallal, and W. Dietz. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am. J. Clin. Nutr. 53:839-846, 1991.

16. Nieman, D., D. Butterworth, C. Nieman, and R. Lee. Comparison of six microcomputer dietary analysis systems with the USDA nutrient database for standard reference. J. Am. Diet. Assoc. 92:48-57, 1992.

17. Oshida, Y., K. Yamanouchi, S. Hayamizu, and Y. Sato. Long-term mild jogging increases insulin action despite no influence on body mass or VO2 max. J. Appl. Physiol. 66:2206-2210, 1989.

18. Pi-Sunyer, F. Obesity and diabetes in blacks.Diabetes Care 13:1144-1149, 1990.

19. Rhoads, G., G. Dahlen, K. Berg, N. Morton, and A. Dannenbert. Lp(a) lipoprotein as a risk factor for myocardial infarction.J.A.M.A. 256:2540-2544, 1986.

20. Rowland, T. Exercise and Children's Health. Champaign, IL: Human Kinetics, 1990, pp. 223-224.

21. Sniderman, A., S. Shapiro, D. Marpole, B. Skinner, B. Teng, and P. Kwiterovich. Association of coronary atherosclerosis with hyperapobetalipoproteinemia (increased protein but normal cholesterol levels in human low density (β) lipoprotein). Proc. Natl. Acad. Sci. USA 77:604-608, 1980.

22. Stewart K. and Gutin B. Effects of physical training on cardiorespiratory fitness in children. Res. Q. 47:110-120, 1976.

23. Wallace, J., T. McKenzie, and P. Nader. Observed vs recalled exercise behavior: a validation of a seven day exercise recall for boys 11 to 13 years old. Res. Q. Exerc. Sport 56:161-165, 1985.

EXERCISE; DIET; INSULIN; GLUCOSE; GLYCOHEMOGLOBIN; LIPIDS; LIPOPROTEINS; OBESITY; CHILDREN

Cited By:

This article has been cited 42 time(s).

Current Diabetes Reports
Lessons Learned From the HEALTHY Primary Prevention Trial of Risk Factors for Type 2 Diabetes in Middle School Youth
Marcus, MD; Hirst, K; Kaufman, F; Foster, GD; Baranowski, T
Current Diabetes Reports, 13(1): 63-71.
10.1007/s11892-012-0333-0
CrossRef
Pediatric Exercise Science
Moderate-Intensity Aerobic Training Program Improves Insulin Sensitivity and Inflammatory Markers in a Pilot Study of Morbidly Obese Minority Teens
Many, G; Hurtado, ME; Tanner, C; Houmard, J; Gordish-Dressman, H; Park, JJ; Uwaifo, G; Kraus, W; Hagberg, J; Hoffman, E
Pediatric Exercise Science, 25(1): 12-26.

International Journal of Sports Medicine
Adiposity, lipid levels, and brief endurance training in nonobese adolescent males
Eliakim, A; Makowski, GS; Brasel, JA; Cooper, DM
International Journal of Sports Medicine, 21(5): 332-337.

Pediatric Exercise Science
Activity patterns and correlates among youth: Differences by weight status
Taylor, WC; Sallis, JF; Dowda, M; Freedson, PS; Eason, K; Pate, RR
Pediatric Exercise Science, 14(4): 418-431.

Obesity Reviews
The impact of child and adolescent obesity treatment interventions on physical activity: a systematic review
Cliff, DP; Okely, AD; Morgan, PJ; Jones, RA; Steele, JR
Obesity Reviews, 11(7): 516-530.
10.1111/j.1467-789X.2009.00625.x
CrossRef
Obesity Research
Insulin sensitivity, cardiorespiratory fitness, and physical activity in overweight hispanic youth
Ball, GDC; Shaibi, GQ; Cruz, ML; Watkins, MP; Weigensberg, MJ; Goran, MI
Obesity Research, 12(1): 77-85.

International Journal of Obesity
Effects of distraction on treadmill running time in severely obese children and adolescents
De Bourdeaudhuij, I; Crombez, G; Deforche, B; Vinaimont, F; Debode, P; Bouckaert, J
International Journal of Obesity, 26(8): 1023-1029.
10.1038/sj.ijo.0802052
CrossRef
Quest
Exercise interventions for prevention of obesity and related disorders in youths
Gutin, B; Barbeau, P; Yin, ZO
Quest, 56(1): 120-141.

Journal of Clinical Endocrinology & Metabolism
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
August, GP; Caprio, S; Fennoy, I; Freemark, M; Kaufman, FR; Lustig, RH; Silverstein, JH; Speiser, PW; Styne, DM; Montori, VM
Journal of Clinical Endocrinology & Metabolism, 93(): 4576-4599.
10.1210/jc.2007-2458
CrossRef
Pediatrics
School-based interventions improve heart health in children with multiple cardiovascular disease risk factors
Harrell, JS; Gansky, SA; McMurray, RG; Bangdiwala, SI; Frauman, AC; Bradley, CB
Pediatrics, 102(2): 371-380.

International Journal of Obesity
Objectively measured physical activity correlates with indices of insulin resistance in Danish children. The European Youth Heart Study (EYHS)
Brage, S; Wedderkopp, N; Ekelund, U; Franks, PW; Wareham, NJ; Andersen, LB; Froberg, K
International Journal of Obesity, 28(): 1503-1508.
10.1038/sj.ijo.0802772
CrossRef
American Journal of Health Behavior
School-based obesity prevention: A blueprint for taming the epidemic
Baranowski, T; Cullen, KW; Nicklas, T; Thompson, D
American Journal of Health Behavior, 26(6): 486-493.

Archives of Pediatrics & Adolescent Medicine
Weight-independent cardiovascular fitness and coronary risk factors
Gutin, B; Owens, S; Treiber, F; Islam, S; Karp, W; Slavens, G
Archives of Pediatrics & Adolescent Medicine, 151(5): 462-465.

Journal of Sports Sciences
The physical activity, fitness and health of children
Boreham, C; Riddoch, C
Journal of Sports Sciences, 19(): 915-929.

Obesity Research
Influence of an interpersonal laboratory stressor on youths' choice to be physically active
Roemmich, JN; Gurgol, CM; Epstein, LH
Obesity Research, 11(9): 1080-1087.

Archives of Pediatrics & Adolescent Medicine
Juvenile obesity - Is school-based enhanced physical activity relevant?
Bar-Or, O
Archives of Pediatrics & Adolescent Medicine, 159(): 996-997.

International Journal of Obesity
Rationale, design and methods of the HEALTHY study physical education intervention component
McMurray, RG; Bassin, S; Jago, R; Bruecker, S; Moe, EL; Murray, T; Mazzuto, SL; Volpe, SL
International Journal of Obesity, 33(): S37-S43.
10.1038/ijo.2009.115
CrossRef
Hormone and Metabolic Research
Individuals with extreme inactivity do not have abnormal serum lipoprotein (a) levels
Bauman, WA; Adkins, RH; Spungen, AM; Herbert, R; Schechter, C; Smith, D; Kemp, BJ; Gambino, R; Maloney, P; Waters, RL
Hormone and Metabolic Research, 30(9): 601-603.

Archives of Pediatrics & Adolescent Medicine
Decreasing sedentary behaviors in treating pediatric obesity
Epstein, LH; Paluch, RA; Gordy, CC; Dorn, J
Archives of Pediatrics & Adolescent Medicine, 154(3): 220-226.

Child and Adolescent Psychiatric Clinics of North America
Childhood obesity
Morgan, CM; Tanofsky-Kraff, M; Wilfley, DE; Yanovski, JA
Child and Adolescent Psychiatric Clinics of North America, 11(2): 257-+.
PII S1056-4993(01)00007-4
CrossRef
Cochrane Database of Systematic Reviews
Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups
Hawthorne, K; Robles, Y; Cannings-John, R; Edwards, AGK
Cochrane Database of Systematic Reviews, (3): -.
ARTN CD006424
CrossRef
Cochrane Database of Systematic Reviews
Interventions for treating obesity in children
Luttikhuis, HO; Baur, L; Jansen, H; Shrewsbury, VA; O'Malley, C; Stolk, RP; Summerbell, CD
Cochrane Database of Systematic Reviews, (1): -.
ARTN CD001872
CrossRef
Pediatrics
Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: A randomized, controlled trial
Goldfield, GS; Mallory, R; Parker, T; Cunningham, T; Legg, C; Lumb, A; Parker, K; Prud'homme, D; Gaboury, I; Adamo, KB
Pediatrics, 118(1): E157-E166.
10.1542/peds.2005-3052
CrossRef
Journal of Atherosclerosis and Thrombosis
Low-density lipoprotein sub-fraction profiles in obese children before and after attending a residential weight loss intervention
King, RFGJ; Hobkirk, JP; Cooke, CB; Radley, D; Gately, PJ
Journal of Atherosclerosis and Thrombosis, 15(2): 100-107.

Reviews in Endocrine & Metabolic Disorders
The influence of fitness on insulin resistance in obese children
Carrel, AL; Allen, DB
Reviews in Endocrine & Metabolic Disorders, 10(3): 189-196.
10.1007/s11154-009-9109-5
CrossRef
International Journal of Obesity
Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children
Ferguson, MA; Gutin, B; Le, NA; Karp, W; Litaker, M; Humphries, M; Okuyama, T; Riggs, S; Owens, S
International Journal of Obesity, 23(8): 889-895.

Journal of Human Movement Studies
The relationship between physical activity levels and physical fitness of 13-15 year old girls in the North-West Province of South Africa
Engelbrecht, C; Pienaar, AE; Coetzee, B
Journal of Human Movement Studies, 43(2): 87-106.

Pediatric Diabetes
Clinical presentation and treatment of type 2 diabetes in children
Pinhas-Hamiel, O; Zeitler, P
Pediatric Diabetes, 8(): 16-27.

Journal of School Health
Guidelines for school and community programs to promote lifelong physical activity among young people (Reprinted from MMWR, vol 46, 1997)
[Anon]
Journal of School Health, 67(6): 202-219.

Obesity Reviews
Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations
Flynn, MAT; McNeil, DA; Maloff, B; Mutasingwa, D; Wu, M; Ford, C; Tough, SC
Obesity Reviews, 7(): 7-66.

Elementary School Journal
Research on the outcomes of elementary school physical education
Shephard, RJ; Trudeau, F
Elementary School Journal, 108(3): 251-264.

International Journal of Obesity
Decrease of Lp(a) during weight reduction in obese children is modified by the apo(a) kringle-IV copy number variation
Brandstatter, A; Lingenhel, A; Zwiauer, K; Strobl, W; Kronenberg, F
International Journal of Obesity, 33(): 1136-1142.
10.1038/ijo.2009.144
CrossRef
International Journal of Obesity
Mini review: Physical activity and fitness and its relations to cardiovascular disease risk factors in children
Froberg, K; Andersen, LB
International Journal of Obesity, 29(): S34-S39.
10.1038/sj.ijo.0803096
CrossRef
International Journal of Obesity
Efficacy of exercise for treating overweight in children and adolescents: a systematic review
Atlantis, E; Barnes, EH; Singh, MAF
International Journal of Obesity, 30(7): 1027-1040.
10.1038/sj.ijo.0803286
CrossRef
Journal of Clinical Endocrinology & Metabolism
Exercise alone reduces insulin resistance in obese children independently of changes in body composition
Bell, LM; Watts, K; Siafarikas, A; Thompson, A; Ratnam, N; Bulsara, M; Finn, J; O'Driscoll, G; Green, DJ; Jones, TW; Davis, EA
Journal of Clinical Endocrinology & Metabolism, 92(): 4230-4235.
10.1210/jc.2007-0779
CrossRef
Diabetes Care
Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children - the European Youth Heart Study (EYHS)
Brage, S; Wedderkopp, N; Ekelund, U; Franks, PW; Wareham, NJ; Andersen, LB; Froberg, K
Diabetes Care, 27(9): 2141-2148.

Annual Review of Nutrition
Pediatric obesity and insulin resistance: Chronic disease risk and implications for treatment and prevention beyond body weight modification
Cruz, ML; Shaibi, GQ; Weigensberg, MJ; Spruijt-Metz, D; Ball, GDC; Goran, MI
Annual Review of Nutrition, 25(): 435-468.
10.1146/annurev.nutr.25.050304.092625
CrossRef
Pediatrics
Treatment of pediatric obesity
Epstein, LH; Myers, MD; Raynor, HA; Saelens, BE
Pediatrics, 101(3): 554-570.

Journal of Clinical Endocrinology & Metabolism
Cardiovascular endocrinology 2 - Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents
Goran, MI; Ball, GDC; Cruz, ML
Journal of Clinical Endocrinology & Metabolism, 88(4): 1417-1427.
10.1210/jc.2002-021442
CrossRef
European Journal of Pediatrics
Changes in fat mass, fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme
Deforche, B; De Bourdeaudhuij, I; Debode, P; Vinaimont, F; Hills, AP; Verstraete, S; Bouckaert, J
European Journal of Pediatrics, 162(9): 616-622.
10.1007/s00431-003-1247-2
CrossRef
Journal of Science and Medicine in Sport
Looking for the evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth
MacKay, M; Scanlan, A; Olsen, L; Reid, D; Clark, M; McKim, K; Raina, P
Journal of Science and Medicine in Sport, 7(1): 58-73.

Medicine & Science in Sports & Exercise
Aerobic and Strength Training Reduces Adiposity in Overweight Latina Adolescents
DAVIS, JN; TUNG, A; CHAK, SS; VENTURA, EE; BYRD-WILLIAMS, CE; ALEXANDER, KE; LANE, CJ; WEIGENSBERG, MJ; SPRUIJT-METZ, D; GORAN, MI
Medicine & Science in Sports & Exercise, 41(7): 1494-1503.
10.1249/MSS.0b013e31819b6aea
PDF (176) | CrossRef
Back to Top | Article Outline

©1996The American College of Sports Medicine

Login

Article Tools

Images

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.

Connect With Us