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

“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

kfroberg

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


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.


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:


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



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


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)


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


Denmark


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



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.


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





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.

http://www.ncbi.nlm.nih.gov/pubmed?term=Steene-Johannessen%20J%5BAuthor%5D&cauthor=true&cauthor_uid=19516166


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




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.


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


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


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


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


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


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


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


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.


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.



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

http://www.ncbi.nlm.nih.gov/pubmed?term=Gr%C3%B8ntved%20A%5BAuthor%5D&cauthor=true&cauthor_uid=24048320

http://www.ncbi.nlm.nih.gov/pubmed?term=Gr%C3%B8ntved%20A%5BAuthor%5D&cauthor=true&cauthor_uid=24048320



Where are we going?


Is there a correlation between physical fitness/activity and cognition?


PNAS, Dec 2009, Vol. 106, 49



Twins

What is cognition?PerceptionAttentionMemoryReasoningProblem-solving

Processing thoughts

Learning new things, producing and understanding language, math, decision making etc.



Where to ‘find’ it?

http://www.womensinternational.com/connections/cognition.html

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



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]

http://www.ncbi.nlm.nih.gov/pubmed?term=Huang%20T%5BAuthor%5D&cauthor=true&cauthor_uid=23600729

http://www.ncbi.nlm.nih.gov/pubmed?term=Larsen%20KT%5BAuthor%5D&cauthor=true&cauthor_uid=23600729

http://www.ncbi.nlm.nih.gov/pubmed?term=Ried-Larsen%20M%5BAuthor%5D&cauthor=true&cauthor_uid=23600729

http://www.ncbi.nlm.nih.gov/pubmed?term=M%C3%B8ller%20NC%5BAuthor%5D&cauthor=true&cauthor_uid=23600729

http://www.ncbi.nlm.nih.gov/pubmed?term=Andersen%20LB%5BAuthor%5D&cauthor=true&cauthor_uid=23600729


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


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

Documents

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