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“Health and Physical Activity in children – new knowledge and new directions” Karsten Froberg, Head of RICH Center Department of Sports Science & Clinical.

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Presentation on theme: "“Health and Physical Activity in children – new knowledge and new directions” Karsten Froberg, Head of RICH Center Department of Sports Science & Clinical."— Presentation transcript:

1 “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

2 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 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

3 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 physical (in)activity (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.

4 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 disease Hypertension Some cancers Type 2 diabetes Depression Osteoporosis Weak skeletal muscles Physical frailty Booth et al, 2002 ENSSEE, Groningen, October 2013 Result in:

5 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,

6 ENSSEE, Groningen, October 2013

7 Things we are studying in EYHS/RICH Environment Family/peers influence Socio-economical status Culture Leisure time possibilities. Personal Age Gender Birth weight Genotype Self efficacy Stress Barrieres etc.. Lifestyle Physical (in)activity Nutrition, smoking and alcohol intake Physiological risk factores Cardiorespiratory fitness Bloodpressure Insulin/glucose Cholesterol and triglycerides Overweigth and fatness Back problems Bone health Injuries Muscle strength Arterial stiffness Cognition

8 ENSSEE, Groningen, October 2013 Study locations Oslo+country 6yr f.u. Tartu 6 yr f.u. Odense 6 & 12 yr f.u. Madeira 6and 12 yr f.u. Madrid Iceland 6yr f.u. Lisbon Bristol Amsterdam Tirana pilot Cambridge Vienna pilot

9 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) ENSSEE, Groningen, October 2013

10 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 /98 EYHS /04 EYHS /10 ENSSEE, Groningen, October 2013 Denmark

11 Some results Cross-sectional data

12 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 ENSSEE, Groningen, October 2013

13 Anderssen et.al. Eur J Cardiovasc Prev Rehabil Aug;14(4): 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.

14 Odds ratio in quartiles of fitness for risk factores in 6-7 y and 9-10 y children (the same children) ENSSEE, Groningen, October 2013 Bugge et.al. Pediatr Res.Bugge et.al. Pediatr Res Feb;73(2):245-9

15 Clustered risk (Z-score) Aerobic fitness Physical Activity CRF; P for trend < PA; P for trend = Clustered risk (non-Ob) Aerobic fitness Physical Activity CRF; P for trend = 0.06 PA; P for trend < Z-score including waist circum.Z-score excluding waist circum. Adjusted for age group, gender and study location Adjusted for age group, gender, study location and waist circumference (Ekelund et.al. Diabetologia, 2007;50: ) ENSSEE, Groningen, October 2013 Least fit/active Most fit/active Least fit/activeMost fit/active

16 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

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19 Steene-Johannessen JSteene-Johannessen J et.al. Med Sci Sports Exerc Jul;41(7):1361-7Med Sci Sports Exerc. The results showed that muscle fitness and cardiorespiratory fitness were independently associated with metabolic risk in youth.

20 ENSSEE, Groningen, October 2013

21 The European Youth Heart Study: analysis based on Danish, Estonian and Portuguese data Blood Pressure Triglyceride Total cholesterol / HDL ratio Insulin sensitivity Fat mass Cardio-respiratory fitness Metabolic Z-’health-score’ Data adjusted for age and gender, in continuous analysis ENSSEE, Groningen, October 2013

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24 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

25 Clinical Cutpoints for CV Fitness Receiver operating characteristic (ROC) n Adegboye AR et.al. Br J Sports Med Jul;45(9):722-8 n The European Youth Heart Study  ml.kg -1.min -1 (9 and 15 y boys)  ml.kg -1.min -1 (9 and 15 y girls) n Welk GJ et.al. Am J Prev Med. 2011; 41(4 Suppl 2):S111-6 Am J Prev Med. n The National Health and Nutrition Examination Survey  ml/kg/min for boys (11-14 y)  ml/kg/min for girls (11-14 y) ROC curve for boys ENSSEE, Groningen, October 2013

26 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

27 Methods 9 th grade pupils in Odense Municipality n= N=429 (65%) 9 th grade pupils in Odense Municipality n= N=444 (58%) N=281 (43%) N=369 (48%) year old year old year old ENSSEE, Groningen, October 2013

28 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 dynamometerMethods ENSSEE, Groningen, October 2013 Progressive maximal ergometer bicycle test (r=0.9 with VÓ 2 -max assessed directly, highly reproducible) Validation study used to estimate ml O 2 /min based on max watts at peak workload ( Riddoch C et.al. Journal of Physical Activity and Health, 2005, 2, ) Cardiorespiratory fitness (CRP) Normalized to body mass (kg)

29 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 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 CVD risk factors in young adulthood Waist circumference BMI Body mass index Waist circumference BP Triglycerides HDL Fasting glucose ENSSEE, Groningen, October 2013

30 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 fitnessResults Multivariable adjusted incl. cardiorespiratory fitness ENSSEE, Groningen, October 2013

31 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 fitnessResults ENSSEE, Groningen, October 2013

32 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

33 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

34 Screen time viewing behaviors and isometric trunk muscle strength in youth. Grøntved AGrøntved A, et.al. Med Sci Sports Exerc Oct;45(10)Med Sci Sports Exerc. 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 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 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

35 ENSSEE, Groningen, October 2013

36 Where are we going?

37 ENSSEE, Groningen, October 2013 Is there a correlation between physical fitness/activity and cognition?

38 ENSSEE, Groningen, October 2013 PNAS, Dec 2009, Vol. 106, 49

39 ENSSEE, Groningen, October 2013

40 Twins

41 What is cognition? Perception Attention Memory Reasoning Problem-solving Processing thoughts Learning new things, producing and understanding language, math, decision making etc. ENSSEE, Groningen, October 2013

42 Where to ‘find’ it?

43 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 ENSSEE, Groningen, October 2013

44 The effects of physical activity and exercise on brain-derived neurotrophic factor (BDNF) in healthy humans: A review. Huang THuang T, Larsen KT, Ried-Larsen M, Møller NC, Andersen LB.Larsen KTRied-Larsen MMøller NCAndersen 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.Scand J Med Sci Sports Apr 22. [Epub ahead of print]

45 Learning through Movement 0-5 years6-15 years years Work 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 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

46 Acknowledgement The Danish Council for Strategic Research The Danish Heart Foundation, The Danish Health Fund The TrygFond The Danish Council for Sports Research The University of Southern Denmark The Faculty of Health Sciences, SDU Thank you for listening


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