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Dr. Christine Graf
Exercise and Vascular Function in Child Obesity: A Meta-Analysis.
Dias KA, et al
Pediatrics. 2015 Sep;136(3):e648-59. doi: 10.1542/peds.2015-0616. Epub 2015 Aug 10.
Although a plateau seems to be reached, the number of overweight and obese children has risen dramatically in the last decades. Juvenile obesity is associated with a great number of comorbidities from orthopaedic and psychosocial disorders to glucose intolerance/diabetes type 2, cardiovascular risk factors and metabolic syndrome. In terms of vascular health and function, endothelial dysfunction and intima media thickening is found in obese children between 9 and 12 years of age. In contrast, physical activity/exercise leads to increased energy consumption and thus acts preventively against weight gain. In addition, the protective role of exercise in terms of cardiovascular health of adults is undisputed.
Dias and colleagues (2015) performed a meta-analysis to analyse the effect of exercise training on the conduit artery flow-mediated dilation (FMD) as a noninvasive index of preclinical atherosclerosis in overweight and obese children and youth. Taken from six studies, 219 participants were integrated between the ages of 7 and 15 years. Exercise training was performed between 6 and 12 weeks, with 2 and 5 sessions per week (median 3) and between 30 and 75 mins/unit.
Compared to controls, no significant change in body mass index (BMI) was found, however, the increase of vascular function (mean diff. 1.5%) and VO2peak was significantly greater (mean diff. 3.6 mL/kg/min). Although there is a high degree of diversity in exercise programs, participant characteristics, and FMD measurement protocols, the findings are conclusive as to the important role of physical activity in terms of cardiovascular (and metabolic) health even when BMI remains the same. For each age group it seems important not only to focus on weight, but also on an increase in physical fitness as a surrogate factor for health.
Further research is necessary to establish the optimum exercise program for maintenance of healthy vascular function in this at-risk pediatric population. An additional challenge is how these children will be motivated to exercise regularly and maintain this regularity over time.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology