Adiposity is related to decrements in cardiorespiratory fitness in obese and normal-weight children

International fitness scale (IFIS): association with motor performance in children with obesity

Background

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health; and compared with their normal-weight peers, these individuals tend to have a lower level of self-confidence, and consequently lower physical activity adherence. Due to these self-perceived barriers, the aim of our study was to evaluate the efficacy of an online training program on self-reported physical fitness (SRPF) in children with obesity (OB).

Methods

A total of 32 children with OB carried out physical fitness (PF) tests and were asked to complete the International Fitness Enjoyment Scale (IFIS) questionnaire. The physical fitness tests were the Standing Broad Jump (SBJ), the 6-Min Walking Test (6MWT) and the 4 × 10 m sprint test. Children participated in a 3-weekly 60-min training session through Zoom platform. Before the beginning of the training protocol, OB children were compared with normal weight (NW) ones for PF batteries and the IFIS questionnaire. Changes in performances after the training were assessed by paired Student t and Wilcoxon tests.

Results

After the online training program children increased their performance in 6MWT (mean difference (MD) = 54.93; p < 0.0001) in SBJ (MD = 10.00; p = 0.0001) and in 4 × 10 m sprint test (MD = -0.78; p < 0.0001). No differences were found in children's physical fitness perception.

Discussion

Our study highlighted how a structured online training program can lead to improvements in PF of children with OB. Instead, the lack of differences in SRPF after the training suggests interesting questions to be explored on the aspects linked to self-perception. Therefore, even if our training protocol could not directly improve SRPF in children with obesity, the enhancement of their PF could be a starting point for achieving this result with a longer training period and consequently improve PA participation for children with OB.

Physical Fitness, Screen Time and Sleep Habits According to Obesity Levels in Schoolchildren: Findings from the Health Survey of the Extreme South of Chile

Obesity is a worry because it is associated with a greater burden of disease, and it has been shown to be related to the health habits and physical condition of children and adolescents.

OBJECTIVE

To associate physical fitness, screen time, and sleep habits with the different categories of obesity in schoolchildren from the extreme south of Chile.

METHODS

583 schoolchildren were included in this cross-sectional analysis. The screen time and sleep habits were measured with the Sleep Self-Report questionnaire, while the physical fitness was assessed with the Alpha Fitness test battery. The Body Mass Index/age (BMI/age) and the Waist-to-Height ratio (WtHr) were used to define adiposity using the following categories: healthy weight/low-risk waist-to-height ratio (H/LR), healthy weight/high-risk waist-to-height ratio (H/HR), overweight/low-risk waist to height ratio (O/LR), and overweight/high-risk waist to height ratio (O/HR).

RESULTS

A considerable number of schoolchildren (23.2%) presented sleep problems, while the mean screen time was 9.3 (95% CI: 8.4; 10.1) hours/day. Schoolchildren classified as H/HR showed better physical fitness than the O/HR group but worse physical fitness than the H/LR group.

CONCLUSIONS

Significant differences were evidenced in the physical fitness between the adiposity categories, which could open future lines of research concerning the characterization of the healthy weight-obese adiposity categories in children.

Association of Body Weight and Physical Fitness during the Elementary School Years

Physical fitness and body weight are key correlates of health. Nevertheless, an increasing number of children display poor physical fitness and high body weight. The aim of this study was to examine the prospective association of physical fitness with body weight throughout the elementary school years with a special emphasis on children with high body weight or poor physical fitness at baseline. A total of 303 Austrian children (55.1% male) completed the German motor test up to eight times over a 4-year time span (between the ages 6 and 10 years). Physical fitness did not differ across quartiles of body weight at baseline. A more pronounced weight gain, however, was associated with an impaired development of physical fitness and this association was more pronounced in children with higher baseline body weight. In addition, the detrimental effects of an impaired development of physical fitness on subsequent body weight were more pronounced in children with higher baseline body weight. No differences in the longitudinal association between body weight and physical fitness, on the other hand, were observed across quartiles of baseline fitness. These results emphasize the importance of the promotion of physical fitness, particularly in children with increased body weight, to ensure future health.

Normal Weight 6-12 Years Boys Demonstrate Better Cognitive Function and Aerobic Fitness Compared to Overweight Peers

Background and Objectives: This study evaluated and compared the cognitive function (CF) and aerobic fitness (AF) of 15 normal-weight (NW) and 15 overweight (OW) children, aged 6−12 years. In addition, the relationship between CF and AF was evaluated. Materials and Methods: The ANAM4 battery was used to evaluate CF, and a constant treadmill walking exercise (6 km/h for 6 min) and a progressive treadmill exercise (modified Balke test) were used to assess pulmonary oxygen uptake (VO2). Results: The OW children displayed worse attention and visual tracking (88.95 ± 4.45% and 93.75 ± 3.16%), response inhibition (90.27 ± 1.54% and 93.67 ± 2%), and speed of processing (93.65 ± 1.5% and 94.4 ± 1.54%) than the NW children (p < 0.05). The VO2 max was higher and the time constant of VO2 kinetics was shorter in NW children (56.23 ± 3.53 mL/kg/min and 21.73 ± 1.57 s, respectively) than in OW children (45.84 ± 1.89 mL/kg/min and 33.46 ± 2.9 s, respectively; p < 0.05). Conclusion: The OW children aged 6−12 years demonstrated poorer CF and lower AF than their NW peers. An association between AF and CF indicators was identified in both groups.

The Effect of an Intervention with Active Video Games Combined with Multicomponent Exercise on Cardiorespiratory fitness in Children with Overweight and Obesity: A Randomized Controlled Trial. (Preprint)

Background

Childhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure.

Objective

The main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity.

Methods

We recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants.

Results

The AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO_2peak) was found.

Conclusions

A 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO_2peak). Greater benefits were found in children with the highest fat percentage.

Trial Registration

ClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713

Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review

ABSTRACT

Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

Pubertal Physical Activity and Cardiorespiratory Fitness in Relation to Late Adolescent Body Fatness in Boys: A 6-Year Follow-Up Study

There is a lack of studies investigating whether objectively measured physical activity (PA) and cardiorespiratory fitness (CRF) in puberty is associated with healthier body composition in late adolescence. The study sample included 71 boys, who were measured at puberty (mean age of 12.1 years) and again at late adolescence (mean age of 18.1 years). Physical activity was measured by accelerometry, and total PA, moderate-to-vigorous PA (MVPA), and sedentary time (SED) were calculated, while CRF was assessed by a peak oxygen consumption test. Body composition was measured by dual-energy X-ray absorptiometry, and body fat percentage (%BF), fat mass index (FMI), trunk fat mass index (TFMI), and fat-free mass index (FFMI) were calculated. Body mass index (BMI) and SED time increased, while MVPA, total PA, and CRF decreased from puberty to late adolescence. A relatively high degree of tracking for BMI and CRF, and a low tracking for PA from puberty to late adolescence was observed. Only the CRF value at puberty negatively predicted adolescent BF% (β = -0.221; p = 0.015), FMI (β = -0.212; p = 0.006), and TFMI (β = -0.189; p = 0.015) values. Adolescents whose CRF was above the median at puberty had lower BMI, BF%, FMI, and TFMI in comparison to those whose CRF was below the median at puberty. In conclusion, measured CRF and PA values decreased from puberty to late adolescence. Pubertal CRF predicted body fatness indices six years later in healthy adolescents.

The effects of adiposity, muscular strength, cardiorespiratory fitness, and fatigue on gait biomechanics in overweight and obese children

BACKGROUND

Obesity rates continue to increase in the child population. Muscular strength, cardiorespiratory fitness, and fatigue can potentially affect joint stresses in obese children. The purposes are to examine: (1) the relationship between cardiorespiratory fitness and the change in joint stress pre- to post-fatigue; (2) the predictive value of fitness, adiposity, and muscular strength on joint stresses in fatigued and non-fatigued states; and, (3) the relationships between % body fat from skinfold and air displacement plethysmography.

METHODS

Twenty-seven children, with body mass index above the 85th percentile for their age participated in this study. Lower limb joint moments were recorded before and after a fatiguing Progressive Aerobic Cardiovascular Endurance Run protocol. Linear regression was used to assess the relationship between (1) fitness and change in joint stress pre- to post-fatigue, and (2) measures of %body fat using skinfold and plethysmography. Furthermore, Bland-Altman analysis quantified the agreement between measured adiposity using the two methods.

FINDINGS

The strongest relationship was observed between fitness and the change in the knee extensor moment pre- to post-fatigue (R² = 0.24). Regardless of fatigue state, adiposity and strength were identified as the strongest predictors of joint moments. Skinfold estimates were moderately predictive (R² = 0.56) of %body fat from air displacement plethysmography, and these two measures demonstrated instrument agreement with no proportional bias.

INTERPRETATION

Fitness level is not related to changes in biomechanics pre- to post-fatigue in overweight and obese children. Adiposity and lower extremity strength most strongly influenced joint moments in the frontal and sagittal planes.

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review

As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.

Adiposity Mediates the Association of Objectively Measured Physical Activity with Cardiorespiratory Fitness in Children

Background: The relationship of physical activity (PA) to cardiorespiratory fitness (CRF) is well established in children. However, the extent to which adiposity affects this association remains unclear. Objective: The study aimed to explore whether the relationships of different PA intensities to CRF are explained by adiposity. Methods: Cross-sectional data were collected from 374 children (51.87% boys) aged 7-12 years. The time spent (min/day) in vigorous PA (VPA), moderate PA (MPA), light PA (LPA), and sedentary behavior was objectively measured using triaxial accelerometry. Height, weight, and waist circumference (WC) were objectively measured, from which the BMI was derived. The 20-meter shuttle run test was conducted to estimate maximal oxygen consumption [VO_2max, mL/(kg·min)]. Linear mixed models and mediation analysis with bootstrapping were used to analyze data. Results: VO_2max was positively associated with VPA [β = 0.143, 95% confidence interval (95% CI): 0.091 to 0.194], MPA (β = 0.051, 95% CI: 0.016 to 0.086), and moderate-to-vigorous PA (MVPA) (β = 0.052, 95% CI: 0.029 to 0.075), but not LPA or sedentary time. Both BMI and WC partially mediated the relationships of VPA and MVPA to VO_2max, with the percentage of the total effect mediated by adiposity ranging from 18.0% to 19.6%. Similar results were also observed among boys but not among girls. Conclusions: Only moderate or vigorous intensity of PA is favorably correlated with CRF in children. BMI and WC play a pivotal mediating role in these associations, especially in boys, suggesting that promoting higher intensity of PA might benefit children's CRF through reducing adiposity.

Relationship between body mass index and physical fitness in Italian prepubertal schoolchildren

The objective of this study was to investigate the association between physical fitness and body mass index categories (obesity, OB; overweight, OW; normal-weight, NW; and underweight, UW) in prepubertal children. Anthropometric and physical fitness characteristics were collected from a convenience sample of 30472 Italian schoolchildren (6–11 years old). Six field-based tests were used: Léger, agility shuttle, long jump, frontal throw of the basketball, Sit & Reach and standing balance. Significant differences were found in the anthropometric characteristics, physical fitness and weight status prevalence between girls and boys (p<0.05) and, except for flexibility, by age class (p<0.05). Obese children performed worse than their NW counterparts in aerobic capacity (p<0.001), agility (p<0.001), muscular power of the lower limb (p<0.001) and balance (p<0.001). Conversely, children with obesity showed greater upper limb power than NW children (p<0.001). The discrepancy in physical fitness between OB and NW children increased in older girls (flexibility, p = 0.002; muscular power of the lower and upper limb, p = 0.002 and p = 0.005) and boys (aerobic capacity, p = 0.009; agility, p = 0.006; standing balance, p = 0.019; muscular power of the lower and upper limb, p<0.001 and p = 0.011) compared to their younger counterparts. On the other hand, UW children performed worse than NW children mainly in terms of muscular power of the arms (p<0.001). Additionally, there was an increasing disparity in the frontal throw test scores of UW and NW girls (p = 0.003) and boys (p = 0.011) in older children compared to younger children. In conclusion, the effect of body mass index on children’s physical fitness intensifies with age. OB and OW negatively affect aerobic capacity, agility, lower limb power and balance but positively affect upper limb power. UW negatively affects upper limb power. This study underscores the importance of preventing childhood OW, OB, and UW in early life to promote children’s health and proper fitness development.

Physical fitness and activity, metabolic profile, adipokines and endothelial function in children

OBJECTIVES

The prevalence of obesity is increasing. The aim of this study was to investigate if there is endothelial dysfunction in children with normal or excess weight, and whether the metabolic profile, adipokines, and endothelial dysfunction would be more strongly associated with physical fitness or with physical activity levels.

METHOD

Cross-sectional study involving children aged 5-12 years. The evaluation included venous occlusion plethysmography, serum levels of adiponectin, leptin and insulin, lipid profile, physical activity score (PAQ-C questionnaire), and physical fitness evaluation (Yo-Yo test).

RESULTS

A total of 62 children participated in this study. Based on the body mass index, 27 were eutrophic, 10 overweight and 25 obese. Triglycerides, LDL cholesterol, HOMA-IR, and leptin were higher in the obese and excess-weight groups compared to the eutrophic group (p<0.01). HDL cholesterol and adiponectin levels were higher in the eutrophic group compared to the obese and excess-weight groups (p<0.01). Flow-mediated vasodilation after hyperemia was higher in the eutrophic group in comparison to obese and excess-weight subjects (p<0.05). There was no difference in the physical activity levels among groups measured by PAQ-C. The Yo-Yo test was significantly associated with HDL cholesterol (rho=-0.41; p=0.01), and this association remained after adjusting for body mass index z-score (rho=0.28; p=0.03).

CONCLUSION

This study showed that endothelial dysfunction is already present in obese children, suggesting a predisposition to atherosclerotic disease. Moreover, HDL cholesterol levels were correlated with physical fitness, regardless of body mass index.

Effect of obesity on oxygen uptake and cardiovascular dynamics during whole-body and leg exercise in adult males and females

Obesity has been associated with a slowing of V˙O₂ dynamics in children and adolescents, but this problem has not been studied in adults. Cardiovascular mechanisms underlying this effect are not clear. In this study, 48 adults (18 males, 30 females) grouped according to body mass index (BMI) (lean < 25 kg·m⁻², overweight = 25–29.9 kg·m⁻², obese ≥30 kg·m⁻²) provided a fasting blood sample, completed a maximal graded exercise test and six bouts of submaximal exercise on a cycle ergometer, and performed two protocols of calf exercise. Dynamic response characteristics of V˙O₂ and leg vascular conductance (LVC) were assessed during cycling (80% ventilatory threshold) and calf exercise (30% MVC), respectively. Dynamic responses of cardiac output, mean arterial pressure and total systemic vascular conductance were also assessed during cycling based on measurements at 30 and 240 sec. The time constant of the second phase of the V˙O₂ response was significantly greater in obese than lean subjects (39.4 (9.2) vs. 29.1 (7.6) sec); whereas dynamic responses of cardiac output and systemic vascular conductance were not affected by BMI. For calf exercise, the time constant of the second growth phase of LVC was slowed significantly in obese subjects (22.1 (12.7) sec) compared with lean and overweight subjects (11.6 (4.5) sec and 13.4 (6.7) sec). These data show that obesity slows dynamic responses of V˙O₂ during cycling and the slower phase of vasodilation in contracting muscles of male and female adults.

Cardiorespiratory Fitness Attenuates the Obesity Risk in Chinese Children Who Have Parents with Overweight/Obesity

OBJECTIVE

To evaluate the impact of parental weight status and offspring cardiorespiratory fitness on the risk of obesity among Chinese children.

STUDY DESIGN

This cross-sectional study was conducted in Wuhan, China from May to June 2010. Children's height, weight, and waist circumference were measured for assessing their total and central obesity. Their cardiorespiratory fitness was determined by the 20-m shuttle-run test. We calculated parental body mass index according to self-reported height and weight, and divided it into normal weight or overweight/obesity. Multivariable logistic regression model was applied to estimate the combined relationships of cardiorespiratory fitness and parental weight status with the risk of obesity of children.

RESULTS

A total of 587 Chinese children (343 boys and 244 girls) aged 9.6 (0.7) years participated in this study. Compared with those who had low cardiorespiratory fitness and at least 1 parent with overweight/obesity, children who had high cardiorespiratory fitness and at least 1 parent with overweight/obesity reported lower risks of total obesity (OR 0.12, 95% CI .05-0.30) and central obesity (OR .09, 95% CI .04-0.20), and children who had high cardiorespiratory fitness and no parent with overweight/obesity were 89% (OR 0.11, 95% CI .05-0.24) less likely to have total obesity and 92% (OR .08, 95% CI .04-0.16) less likely to have central obesity (all P < .001).

CONCLUSIONS

High level of cardiorespiratory fitness among children could attenuate the influence of parental obesity on their offspring's weight status.

Dietary Patterns, Cardiorespiratory and Muscular Fitness in 9⁻11-Year-Old Children from Dunedin, New Zealand

Research shows that cardiorespiratory (CRF) and muscular fitness in childhood are associated with a healthier cardiovascular profile in adulthood. Identifying factors associated with measures of fitness in childhood could allow for strategies to optimize cardiovascular health throughout the lifecourse. The aim of this study was to examine the association between dietary patterns and both CRF and muscular fitness in 9⁻11-year-olds. In this study of 398 children, CRF and muscular fitness were assessed using a 20-m shuttle run test and digital hand dynamometer, respectively. Dietary patterns were derived using principal component analysis. Mixed effects linear regression models were used to assess associations between dietary patterns and CRF and muscular fitness. Most children had healthy CRF (99%, FITNESSGRAM) and mean ± SD muscular fitness was 15.2 ± 3.3 kg. Two dietary patterns were identified; &ldquo;Snacks&rdquo; and &ldquo;Fruit and Vegetables&rdquo;. There were no significant associations between either of the dietary patterns and CRF. Statistically significant but not clinically meaningful associations were seen between dietary patterns and muscular fitness. In an almost exclusively fit cohort, food choice is not meaningfully related to measures of fitness. Further research to investigate diet-fitness relationships in children with lower fitness levels can identify key populations for potential investments in health-promoting behaviors.