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“Health and Physical Activity in children – new knowledge and new directions”
Karsten Froberg, Head of RICH CenterDepartment of Sports Science & Clinical Biomechanics
University of Southern Denmark
ENSSEE, Groningen, October 2013
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.
Main objectivesUnderstanding the physical and social benefits of physical activity and fitnessDeveloping better methods for measuring PA and health determinants25 employes – incuding 14 PhD students
185 scientific publications in 5 years
ENSSEE, Groningen, October 2013
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.
ENSSEE, Groningen, October 2013
The human genome
Sedentary lifestyle: Does not maintain required metabolic demands and muscle loading
Human genome: evolved to support a physically active lifestyle
Genome unchanged in past 10,000 years
Insulin resistance in skeletal muscles
Coronary artery diseaseHypertensionSome cancersType 2 diabetes
Depression
Osteoporosis
Weak skeletal muscles
Physical frailty
Booth et al, 2002
Result in:
ENSSEE, Groningen, October 2013
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, 115-129
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Things we are studying in EYHS/RICH
Environment Family/peers influenceSocio-economical statusCultureLeisure time possibilities.
PersonalAgeGenderBirth weightGenotypeSelf efficacyStressBarrieres etc..
LifestylePhysical (in)activityNutrition, smoking and alcohol intake
Physiological risk factoresCardiorespiratory fitnessBloodpressureInsulin/glucoseCholesterol and triglyceridesOverweigth and fatness
Back problemsBone healthInjuriesMuscle strengthArterial stiffnessCognition
ENSSEE, Groningen, October 2013
Study locationsOslo+country 6yr f.u.
Tartu 6 yr f.u.
Odense6 & 12 yr f.u.
Madeira 6and 12 yr f.u.
Madrid
Iceland 6yr f.u.
Lisbon
Bristol Amsterdam
Tirana pilot
Cambridge
Vienna pilot
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 pressureSexual maturity (Tanner stage)Aerobic fitness (maximal power output on bicycle, W/kg) Physical activity (Actigraph)Diet (24-hour assisted recall)
ENSSEE, Groningen, October 2013
15-year olds
27-year olds
Invited: n=658
9-year olds
15-year olds
21-year olds
Invited: n=771
9-year olds
15-year olds
Invited n=709
EYHS-1 1997/98
EYHS-2 2003/04
EYHS-3 2009/10
ENSSEE, Groningen, October 2013
Denmark
ENSSEE, Groningen, October 2013
Some resultsCross-sectional data
Metabolic risk score (mean of SD-score (Z-score))
• Systolic blod pressure• Triglycerides in blood• Total cholesterol/HDL ratio• Insulin sensitivity• Fatness – (Sum of four skinfolds/waist
circumference/BMI/Pondoral Index/DEXA) • Cardiovascular fitness
Po
pu
latio
n (N
)P
op
ula
tion
(N)
0 1-1 0 1-1
DiseasedDiseased
Healthy
Metabolic dysfunction
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Anderssen et.al. Eur J Cardiovasc Prev Rehabil. 2007 Aug;14(4):526-31
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.
ENSSEE, Groningen, October 2013
Odds ratio in quartiles of fitness for risk factoresin 6-7 y and 9-10 y children (the same children)
Bugge et.al. Pediatr Res. 2013 Feb;73(2):245-9
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
Clu
stere
d r
isk
(Z-s
core
)
Aerobic fitness
Physical Activity
CRF; P for trend < 0.0001PA; P for trend = 0.015
-0.2
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
Clu
stere
d r
isk
(non-O
b)
Aerobic fitness
Physical Activity
CRF; P for trend = 0.06PA; P for trend < 0.0001
Z-score including waist circum. Z-score excluding waist circum.
Adjusted for age group, genderand study location
Adjusted for age group, gender, study location and waist circumference
(Ekelund et.al. Diabetologia, 2007;50:1832-40)ENSSEE, Groningen, October 2013
Least fit/active Most fit/activeLeast fit/active Most fit/active
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
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Steene-Johannessen J et.al. Med Sci Sports Exerc. 2009 Jul;41(7):1361-7
The results showed that muscle fitness and cardiorespiratory fitness were independently associated with metabolic risk in youth.
ENSSEE, Groningen, October 2013
The European Youth Heart Study: analysis based on Danish, Estonian and Portuguese data
Blood PressureTriglycerideTotal cholesterol / HDL ratioInsulin sensitivityFat massCardio-respiratory fitness
Metabolic Z-’health-score’
Data adjusted for age and gender, in continuous analysis
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
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.
ENSSEE, Groningen, October 2013
Clinical Cutpoints for CV FitnessReceiver operating characteristic (ROC)
Adegboye AR et.al. Br J Sports Med. 2011 Jul;45(9):722-8
The European Youth Heart Study 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. Am J Prev Med. 2011; 41(4 Suppl 2):S111-6
The National Health and Nutrition Examination Survey
40-44 ml/kg/min for boys (11-14 y) 38-40 ml/kg/min for girls (11-14 y)
ROC curve for boys
ENSSEE, Groningen, October 2013
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.
New prospective or longitudinal data
ENSSEE, Groningen, October 2013
Aim - To examine the association of isometric trunk muscle strength in youth with cardiovascular risk factors in young adulthood
Methods
9th grade pupilsin Odense Municipality
n=6581997-98
N=429 (65%)
9th grade pupilsin Odense Municipality
n=7712003-04
N=444 (58%)
2009-10N=281 (43%)
2009-10N=369 (48%)
14-16-year old
14-16-year old 20-22-year old
26-28-year old
ENSSEE, Groningen, October 2013
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)
Isometric muscle strength during maximal voluntary contraction (MVC) of abdominal and back muscles using a strain-gauge dynamometer
Methods
ENSSEE, Groningen, October 2013
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)
Cardiorespiratory fitness (CRP)
Normalized to body mass (kg)
Analytical strategy:Prospective analysis, multiple linear regression analysis including n=332 with complete data
Methods
Youth isometric muscle strength of the abdomen
and back
Age Gender
Baseline levels of CVD risk factorRecruitment period
Parental educational levelSmoking status
Family history of CVDFrequency of intake of soft drinksFrequency of intake of fruit and
vegetables Television viewing
Cardiorespiratory fitness
CVD risk factors in young
adulthood
Waist circumferenceBMI
Body mass indexWaist circumferenceBPTriglyceridesHDL Fasting glucose
ENSSEE, Groningen, October 2013
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
Results
Multivariable adjusted incl. cardiorespiratory fitness
ENSSEE, Groningen, October 2013
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
Results
ENSSEE, Groningen, October 2013
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.
ENSSEE, Groningen, October 2013
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.
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
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
Newest articles
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Where are we going?
ENSSEE, Groningen, October 2013
Is there a correlation between physical fitness/activity and cognition?
ENSSEE, Groningen, October 2013
PNAS, Dec 2009, Vol. 106, 49
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Twins
What is cognition?PerceptionAttentionMemoryReasoningProblem-solving
Processing thoughts
Learning new things, producing and understanding language, math, decision making etc.
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
Where to ‘find’ it?
Executive functions (EF)An umbrella term that includes the cognitive processes
responsible for organizing and controlling goal-directed behavior (Banich, 2009)
Three fundamental components:
Cognitive flexibility
Working memory Inhibition
Miyake et al. 2000
ENSSEE, Groningen, October 2013
ENSSEE, Groningen, October 2013
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]
ENSSEE, Groningen, October 2013
Learning through Movement
0-5 years 6-15 years 16 - + yearsWork package 1: Knowledge - translation
Litterature review (Projekt 1)Information and meetings with stakeholders
Work package 2: Kvalitative research
Pre kindergarden /Preeschools (Project-3)
Secondary schools (Project- 4)
High schools (project 5)
Work package 3: Proces evaluation: Implementation of new PA interventions
Implementation and evaluation of RCT (13-15) years (Project 6)
Model-interventions:
High schools (Project 7), Economy high schools (Project 8)
Other high schools (Project 9)
Work package 4: Efficience research 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)
Work package 5: Evaluation of the project ”Learning through movement”
Report, conference and publication of results
ENSSEE, Groningen, October 2013
Acknowledgement
The Danish Council for Strategic ResearchThe Danish Heart Foundation, The Danish Health FundThe TrygFondThe Danish Council for Sports ResearchThe University of Southern DenmarkThe Faculty of Health Sciences, SDU
Thank you for listening