Transcript Document

“Health and Physical Activity in children – new
knowledge and new directions”
Karsten Froberg, Head of RICH Center
Department of Sports Science & Clinical Biomechanics
University of Southern Denmark
Main objectives
Understanding the physical and social benefits of physical activity and fitness
Developing better methods for measuring PA and health determinants
25 employes – incuding 14 PhD students
185 scientific publications in 5 years
Supported by the TrygFonden Foundation, The Danish Agency for Science, Technology and Innovation, The Health
Foundation, The Heart Foundation, The Nordea Foundation, Team Denmark, The IMK Foundation, The Region of
Southern Denmark, The Foundation of BUPL (Union for Pedagogues), the Communities of Vejle and Odense and the
University of Southern Denmark with around 7 million Euro in the last 5 years.
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HEALTH AND LIFESTYLE
Risk factors underlying Chronic Deseases are partly nonmodifiable,
(age, sex, genetic susceptibility),
and partly modifiable, related to biological factors (overweight,
hypertension, dyslipidemias, hyperinsulinemia),
and particularly to lifestyle
(tobacco, diet, alcohol use and physical (in)activity).
It is on the latter that public health policies are mainly based,
focusing on education to healthy lifestyle at all ages and
particularly from early childhood.
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The human genome
Sedentary lifestyle: Does not
maintain required metabolic
demands and muscle loading
Result in:
Human genome: evolved to support a
physically active lifestyle
Genome unchanged in past 10,000 years
Insulin resistance in skeletal muscles
Coronary artery disease
Hypertension
Some cancers
Type 2 diabetes
Weak skeletal muscles
Depression
Osteoporosis
Physical frailty
Booth et al, 2002
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The European Youth Heart Study - cardiovascular
disease risk factors in children: rationale, aims, study
design and validation of methods.
Chris Riddoch, Dawn Edwards, Angie Page, Karsten Froberg,
Sigmund A. Anderssen, Niels Wedderkopp, Soren Brage, Ashley
Cooper, Luis Sardinha, Maarike Harro, Lena Klasson Heggebø,
Willem van Mechelen, Colin Boreham, Ulf Ekelund, Lars Bo
Andersen.
Journal of Physical Activity and Health, 2005, 2, 115129
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Things we are studying in EYHS/RICH
Environment
Personal
Family/peers influence
Socio-economical status
Culture
Leisure time possibilities.
Lifestyle
Physical (in)activity
Nutrition, smoking and
alcohol intake
Physiological risk factores
Cardiorespiratory fitness
Bloodpressure
Insulin/glucose
Cholesterol and triglycerides
Overweigth and fatness
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Age
Gender
Birth weight
Genotype
Self efficacy
Stress
Barrieres etc..
Back problems
Bone health
Injuries
Muscle strength
Arterial stiffness
Cognition
Iceland 6yr f.u.
Odense
6 & 12 yr f.u.
Study locations
Oslo+country
6yr f.u.
Tartu 6 yr f.u.
Cambridge
Bristol
Amsterdam
Madrid
Lisbon
Vienna pilot
Tirana pilot
Madeira 6and 12 yr f.u.
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Methods
Computerised questionnaire (psychosocial
and environmental factors)
Parental questionnaire (self-reported
health status, SES, family history etc.)
Biochemistry (fasting blood samples)
Anthropometry (height, weight, waist and
hip circumference)
Body composition (skinfolds)
Resting blood pressure
Sexual maturity (Tanner stage)
Aerobic fitness (maximal power output on
bicycle, W/kg)
Physical activity (Actigraph)
Diet (24-hour assisted recall)
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Denmark
Invited: n=771 Invited: n=658
9-year olds
15-year olds
Invited n=709
9-year olds
15-year olds
EYHS-2 2003/04
15-year olds
21-year olds
EYHS-1 1997/98
27-year olds
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EYHS-3 2009/10
Some results
Cross-sectional data
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(mean of SD-score (Z-score))
•
•
•
•
•
Healthy
Population (N)
Metabolic risk score
Diseased
Systolic blod pressure
Metabolic dysfunction
Triglycerides in blood
Total cholesterol/HDL ratio
Insulin sensitivity
Fatness – (Sum of four skinfolds/waist
-1
circumference/BMI/Pondoral Index/DEXA)
• Cardiovascular fitness
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0
1
Cardiorespiratory fitness is strongly associated to clustering of CVD risk factors in children and
youth. - The findings were fairly similar between countries (in different geographical regions) and
between sex and age groups.
Anderssen et.al. Eur J Cardiovasc Prev Rehabil. 2007 Aug;14(4):526-31
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Odds ratio in quartiles of fitness for risk factores
in 6-7 y and 9-10 y children (the same children)
Bugge et.al. Pediatr Res. 2013 Feb;73(2):245-9
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Z-score including waist circum.
Z-score excluding waist circum.
0.5
0.15
Physical Activity
0.3
0.2
0.1
0
-0.1
-0.2
Physical Activity
0.1
Clustered risk (non-Ob)
Clustered risk (Z-score)
0.4
0.05
0
-0.05
-0.1
-0.15
-0.3
-0.4
Aerobic fitness
Aerobic fitness
Least fit/active
Most fit/active
CRF; P for trend < 0.0001
PA; P for trend = 0.015
-0.2
Least fit/active
Most fit/active
CRF; P for trend = 0.06
PA; P for trend < 0.0001
Adjusted for age group, gender
and study location
Adjusted for age group, gender,
study location and waist circumference
(Ekelund et.al. Diabetologia, 2007;50:1832-40)
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CONCLUSIONS/INTERPRETATION:
 PA and CRF are separately and independently associated
with individual and clustered metabolic risk factors in
children.
 The association between CRF and clustered risk is
partly mediated or confounded by adiposity
 The association between activity and clustered risk is
independent of adiposity.
 The results suggest that fitness and activity affect
metabolic risk through different pathways
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The results showed that muscle fitness and cardiorespiratory
fitness were independently associated with metabolic risk in youth.
Steene-Johannessen J et.al. Med Sci Sports Exerc. 2009 Jul;41(7):1361-7
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The European Youth Heart Study: analysis based on Danish, Estonian and Portuguese data
Metabolic Z-’health-score’
Blood Pressure
Triglyceride
Total cholesterol / HDL ratio
Insulin sensitivity
Fat mass
Cardio-respiratory fitness
Data adjusted for age and gender,
in continuous analysis
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Interpretation
 Current guidelines of at least 1 hour
per day of physical activity of at least
moderate intensity may be an
underestimation of the activity
necessary to prevent clustering of
CVD risk factors in children.
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Clinical Cutpoints for CV Fitness
Receiver operating characteristic (ROC)

Adegboye AR et.al.

The European Youth Heart Study
Br J Sports Med. 2011 Jul;45(9):722-8

43 - 46 ml.kg-1.min-1 (9 and 15 y boys)

34 - 37 ml.kg-1.min-1 (9 and 15 y girls)

Welk GJ et.al.

The National Health and Nutrition Examination Survey
2):S111-6
Am J Prev Med. 2011; 41(4 Suppl

40-44 ml/kg/min for boys (11-14 y)

38-40 ml/kg/min for girls (11-14 y)
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ROC curve for
boys
New prospective or longitudinal data
Aim - To examine the association of isometric trunk muscle strength in youth with
cardiovascular risk factors in young adulthood
Aim -To examine the independent and combined association of isometric trunk muscle
strength and cardiorespiratory fitness in youth with indices of insulin resistance and
beta-cell function in young adulthood among Danish youth from EYHS.
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Methods
9th grade pupils
in Odense Municipality
14-16-year old
n=658
26-28-year old
1997-98
N=429 (65%)
2009-10
N=281 (43%)
14-16-year old
20-22-year old
2003-04
N=444 (58%)
2009-10
N=369 (48%)
9th grade pupils
in Odense Municipality
n=771
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Methods
Isometric muscle strength during
maximal voluntary contraction (MVC)
of abdominal and back muscles using
a strain-gauge dynamometer
High test-retest reliability of these
particular isometric strength measures
(intraclass correlation coefficient>0.9)
(Andersen et al. 1987, Essendrop et al. 2001)
Moderate- to strong correlation
between isometric- and dynamic muscle
strength (Juneja et al. 2010)
Cardiorespiratory fitness (CRP)
Progressive maximal ergometer bicycle test
(r=0.9 with VÓ2-max assessed directly,
highly reproducible)
Validation study used to estimate ml
O2/min based on max watts at peak
workload
(Riddoch C et.al. Journal of Physical Activity and
Health, 2005, 2, 115-129)
Normalized to body mass (kg)
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Methods
Analytical strategy:
Prospective analysis, multiple linear regression analysis
including n=332 with complete data
Waist circumference
BMI
Youth isometric
muscle strength of
the abdomen and
back
CVD risk factors in
young adulthood
Body mass index
Waist circumference
BP
Triglycerides
HDL
Fasting glucose
Age
Gender
Baseline levels of CVD risk factor
Recruitment period
Parental educational level
Smoking status
Family history of CVD
Frequency of intake of soft drinks
Frequency of intake of fruit and vegetables
Television viewing
Cardiorespiratory fitness
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Results
Multivariable adjusted incl. cardiorespiratory fitness
MV adjustment for: Age at baseline, follow-up time, sex and recruitment period, TV watching,
parental education level, smoking status, intake of soft drinks, fruit and vegetable intake and family
history of CVD, cardiorespiratory fitness
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Results
Adjusted for: Age at baseline, follow-up time, sex and recruitment period, TV watching, parental education
level, smoking status, intake of soft drinks, fruit and vegetable intake and family history of CVD, and
cardiorespiratory fitness
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Results
Insulin sensitivity
Multivariable adjustment (MV). Baseline levels of risk factor, age, sex, and recruitment period, television viewing,
parental education level, smoking status, intake of soft drinks, fruit and vegetable intake, and family history of
diabetes.
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Conclusions
 Greater isometric muscle strength of the abdomen and
back in youth was associated with lower levels of CVD risk
factors in young adulthood independent of
cardiorespiratory fitness and other important
determinant of CVD risk
 Increasing muscle strength and Cardio-Respiratory
Fitness should be targets in youth prevention strategies
of insulin resistance and β-cell dysfunction.
 Prolonged TV- and total screen time viewing during
leisure time in adolescence, and increases in these
behaviors, are associated with unfavorable levels of
several cardiovascular risk factors in young adulthood.
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Newest articles
Screen time viewing behaviors and isometric trunk muscle strength in youth.
Grøntved A, et.al. Med Sci Sports Exerc. 2013 Oct;45(10)
CONCLUSIONS
Screen time use was inversely associated with isometric trunk muscle strength
independent of CRF and other confounding factors
Associations between objectly measured physical activity intensity in childhood (9-10 y)
and measures of subclinical cardiovascular disease in adolescence (15-16 y): prospective
observations from the European Youth Heart Study. Ried-Larsen M et.al. Br J Sports Med. 2013
Apr 13. [Epub ahead of print]
CONCLUSIONS
A high mean exposure to, or changes in, minutes spent at higher PA intensities
across childhood was not associated to thickness or stiffness in the carotid arteries
in adolescence. But a high volume of vigorous PA across childhood is independently
associated with lower metabolic cardio-vascular disease risk in adolescence.
Moderate and vigorous physical activity from adolescence to adulthood and subclinical
atherosclerosis in adulthood: prospective observations from the European Youth Heart
Study. Ried-Larsen M et.al. Br J Sports Med. 2013 Apr 13. [Epub ahead of print]
CONCLUSIONS:
High mean exposure to moderate-and-vigorous PA levels and increases herein were
independently associated with lower levels of carotid arterial stiffness in adulthood
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Where are we going?
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Is there a correlation between physical
fitness/activity and cognition?
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PNAS, Dec 2009, Vol. 106, 49
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Twins
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What is cognition?
Perception
Attention
Memory
Reasoning
Problem-solving
Processing
thoughts
Learning new things, producing and
understanding language, math,
decision making etc.
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Where to ‘find’ it?
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Executive functions (EF)
An umbrella term that includes the cognitive processes
responsible for organizing and controlling goal-directed
behavior (Banich, 2009)
Three fundamental components:
Inhibition
Working memory
Cognitive
flexibility
Miyake et al.
2000
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The effects of physical activity and exercise on
brain-derived neurotrophic factor (BDNF) in
healthy humans: A review.
Huang T, Larsen KT, Ried-Larsen M, Møller NC, Andersen LB.
Centre of Research in Childhood Health, Institute of Sports Science and Clinical
Biomechanics, University of Southern Denmark, Odense, Denmark.
Most observational studies suggested an
inverse relationship between the peripheral
BDNF level and habitual physical activity or
cardiorespiratory fitness.
More research is needed to confirm the
findings from the observational studies.
Scand J Med Sci Sports. 2013 Apr 22. [Epub ahead of print]
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Learning through Movement
0-5 years
Work package 1:
Knowledge - translation
Work package 2:
Kvalitative research
6-15 years
16 - + years
Litterature review (Projekt 1)
Information and meetings with stakeholders
Pre kindergarden
Secondary schools
/Preeschools (Project-3) (Project- 4)
Work package 3:
Proces evaluation:
Implementation of new
PA interventions
High schools (project 5)
Model-interventions:
Implementation and
evaluation of RCT (13-15)
years (Project 6)
High schools (Project 7),
Economy high schools
(Project 8)
Other high schools (Project
9)
Work package 4:
Efficience research
Work package 5:
Evaluation of the project
”Learning through
movement”
The Odense Preschool
Study (TOPS) (Project
10)
RCT 6-7 years: (projekt 11)
RCT 13-14 years: (project
6)
Lab research:
Acute effect of PA (projekt12)
Effect of longer training
(project 13)
Report, conference and publication of results
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Acknowledgement
The
The
The
The
The
The
The
Danish Council for Strategic Research
Danish Heart Foundation,
Danish Health Fund
TrygFond
Danish Council for Sports Research
University of Southern Denmark
Faculty of Health Sciences, SDU
Thank you for listening
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