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Current recommendations for physical activity in children overlook the critical importance of motor skill acquisition early in life. Instead, they focus on the quantitative aspects of physical activity (eg, accumulate 60 min of daily moderate to vigorous physical activity) and selected health-related components of physical fitness (eg, aerobic fitness, muscular strength, muscular endurance, flexibility and body composition). This focus on exercise quantity in youth may limit considerations of qualitative aspects of programme design which include (1) skill development, (2) socialisation and (3) enjoyment of exercise. The timing of brain development and associated neuroplasticity for motor skill learning makes the preadolescence period a critical time to develop and reinforce fundamental movement skills in boys and girls. Children who do not participate regularly in structured motor skill-enriched activities during physical education classes or diverse youth sports programmes may never reach their genetic potential for motor skill control which underlies sustainable physical fitness later in life. The goals of this review are twofold: (1) challenge current dogma that is currently focused on the quantitative rather than qualitative aspects of physical activity recommendations for youth and (2) synthesise the latest evidence regarding the brain and motor control that will provide the foundation for integrative exercise programming that provide a framework sustainable activity for life.

We aimed to (1) compare a subjective and objective measure of habitual physical activity (PA), (2) determine the association of PA and cardiovascular risk factors, and (3) test the hypothesis that PA is an independent determinant of target organ damage in youth.Cross-sectional analysis of youth with and without type 2 diabetes [mean age = 22 (3.9) y]. PA was measured with International Physical Activity Questionnaire and Actical accelerometer. Target organ damage was assessed with echocardiography and peripheral arterial testing. Subjects were stratified into tertiles of total PA, and differences were tested by analysis of variance and χThe correlation between International Physical Activity Questionnaire and accelerometry was weak (r = .23, P = .0003). Less active subjects had worse cardiovascular risk profiles and target organ damage, including stiffer arteries (P .01). These outcome differences did not reach statistical significance when adjusted for covariates, such as lipid levels and glycemic control.Survey assessment of PA is complicated by inaccurate reporting. There is a strong association of habitual PA with cardiovascular risk factor clustering. PA may exert its beneficial effect on arterial stiffness in obese youth through improved glycemic control.

Sudden cardiac death in the young (SCDY) is the leading cause of death in young athletes during sport. Screening young athletes for high-risk cardiac defects is controversial. The purpose of this study was to assess the utility and feasibility of a comprehensive cardiac screening protocol in an adolescent population. Adolescent athletes were recruited from local schools and/or sports teams. Each subject underwent a history and/or physical examination, an electrocardiography (ECG), and a limited echocardiography (ECHO). The primary outcome measure was identification of cardiac abnormalities associated with an elevated risk for sudden death. We secondarily identified cardiac abnormalities not typically associated with a short-term risk of sudden death. A total of 659 adolescent athletes were evaluated; 64% men. Five subjects had cardiac findings associated with an elevated risk for sudden death: prolonged QTc >500 ms (n = 2) and type I Brugada pattern (n = 1), identified with ECG; dilated cardiomyopathy (n = 1) and significant aortic root dilation; and z-score = +5.5 (n = 1). History and physical examination alone identified 76 (11.5%) subjects with any cardiac findings. ECG identified 76 (11.5%) subjects in which a follow-up ECHO or cardiology visit was recommended. Left ventricular mass was normal by ECHO in all but 1 patient with LVH on ECG. ECHO identified 34 (5.1%) subjects in whom a follow-up ECHO or cardiology visit was recommended. In conclusion, physical examination alone was ineffective in identification of subjects at elevated risk for SCDY. Screening ECHO identified patients with underlying cardiac disease not associated with immediate risk for SCDY. Cost of comprehensive cardiac screening is high.

Exercise is a critical component in the management of pediatric obesity. Currently, continuous aerobic exercise (AE) is the standard of care for pediatric weight management programs. The 2008 Physical Activity Guidelines for Americans primarily promote aerobic activity for children, and aerobic-based exercise at a steady intensity (AE) is typically prescribed in pediatric weight management programs1. Several studies in adults, however, show advantages of high-intensity interval exercise (HIIE) over continuous A Eat improving fitness and health in both healthy and obese people2–4. These benefits of HIIE compared to AE have also been demonstrated in some limited studies in children. In a sample of healthy prepubescent children, Borel et al showed the immediate effects on oxygen uptake (VO2) of HIIE to be comparable to continuous AE by continuously monitoring gas exchange of subjects at various points in an exercise protocol Farpour et al showed improved health and fitness measures in healthy children as a result of HIIE5,6. Some of this work in children extends into the obese population. Ingul et al showed that impaired cardiac function in obese adolescents can be improved by 3 months of HIIE training on a treadmill twice a week for 13 weeks7. Tjonna et al studied obese adolescents in twice weekly HIIE intervention for 12 weeks compared to subjects receiving bimonthly education from multidisciplinary health professionals8. HIIE was superior to educational classes at improving subject BMI, body fat, blood pressure, blood glucose, and endothelial function. A study from the Sao Paulo School of Medicine compared HIIE and AE in obese 8–12 year old children with treadmill training protocols twice a week for 12 weeks. Both were found to be equally effective in improving aerobic fitness, insulin sensitivity, and BMI in obese children but the study may have had too few enrolled to show a difference between modes of exercise9. While these few studies of HIIE in obese children have shown benefits on fitness and cardiovascular risk factors, the acceptability and enjoyment of this protocol in children is not clear. Enjoyment of the exercise is a crucial component if our goal is long-term adherence. Another limitation of many HIIE studies in children is restriction of the interval training to treadmill protocols; a more varied exercise protocol would be more comparable to the current standard of care, which includes group games and more variable equipment choices. The purpose of this HIIE study was to measure the enjoyment and acceptability of HIIE as well as the feasibility of a multimodal protocol in obese teenagers enrolled in a multi-disciplinary pediatric weight management program as a precursor for a larger, definitive study.

Purpose:The objective of this study was to characterize the relationship between objectively-measured physical activity (PA) and cardiovascular risk factors in 7-year-old children and test the hypothesis that it differs by race.Methods:Cross-sectional study of 308 7-year-old children drawn from a major US metropolitan community. PA (moderate-to-vigorous, MVPA; light, LPA; and inactivity, IA) was measured by accelerometry (RT3). Cardiovascular risk factors included BMI, blood pressure, and serum lipids, glucose and insulin concentrations. General linear modeling was used to evaluate the independent associations between PA measures and cardiovascular risk factors and interactions by race.Results:In black children, greater time spent in PA was independently associated with lower levels of triglycerides (MVPA and LPA, both p < .01), glucose (MVPA, p < .05), and insulin (MVPA, p < .01); these associations were not evident in white children. Across races, greater inactivity was independently associated with greater low-density lipoprotein cholesterol in overweight participants (p < .01) but not in normal weight participants. No PA measure was associated with BMI, systolic blood pressure, or high-density lipoprotein cholesterol.Conclusions:In this cohort of 7-year-old children, the relationship between PA and some cardiovascular risk factors differed by race. These findings may have implications for targeting of PA promotion efforts in children.

Physical activity (PA) is associated with decreased levels of arterial stiffness in adults, but the relationship between PA and multiple measures of arterial stiffness in adolescents and young adults is not clear. The objective of this study was to test the hypothesis that PA is an independent predictor of multiple measures of arterial stiffness in adolescents and young adults. A total of 548 participants were enrolled in a study of the cardiovascular effects of obesity and type 2 diabetes mellitus (T2DM) (lean, 201; obese, 191; T2DM, 156). Anthropometrics, blood pressure, central and peripheral measures of arterial stiffness (pulse wave velocity, brachial distensibility, and augmentation index), blood (lipids and metabolic tests), and accelerometry data were collected. General linear modeling was performed to test for the independent relationship of PA on arterial stiffness. The mean age of the participants was 17.9 years (standard deviation, 3.5 years). After adjusting for other cardiovascular disease risk factors such as age, sex, body size, mean arterial pressure, and the presence of obesity or T2DM, PA was an independent predictor of augmentation index and brachial distensibility (P < .001). A greater effect of PA on pulse wave velocity was found in participants with T2DM (P = .009) compared with participants in the lean or obese groups. Physical activity is significantly and independently associated with multiple measures of arterial stiffness in adolescents and young adults. The role of PA in the prevention of cardiovascular disease target organ damage in youth, independent of energy balance, merits further exploration.

Objective: The goal of this study was to examine weight misperception among overweight adolescents in recent years and compare the demographic characteristics and weight-related behaviors of overweight adolescents who accurately and inaccurately perceive their weight status. Methods: We used data from the nationally representative Youth Risk Behavior Surveillance System, collected every 2 years from 1999 through 2007. On the basis of self-reported height and weight, BMI percentile for age and sex was calculated. Overweight and obese respondents (BMI ≥ 85th percentile) were classified into 2 groups: (1) misperceivers (weight perception “about right” or “underweight”) or (2) accurate perceivers (weight perception “overweight”). We examined the proportion of misperceivers at each time point. Using the 2007 data, we compared demographic characteristics and weight-related behaviors of accurate perceivers and misperceivers with bivariate and multivariate analyses. Results: Among overweight adolescents, the overall proportion of misperceivers ranged between 29% and 33% from 1999 through 2007. In 2007, 23% of overweight girls and 40% of overweight boys were misperceivers (P < .001). Both male and female accurate perceivers were significantly more likely than misperceivers to report trying to maintain or lose weight, exercising for weight control, and eating less for weight control. Adjusting for age, race/ethnicity, and BMI percentile, no significant differences in unhealthy weight-related behaviors were found between accurate perceivers and misperceivers in boys or girls. Male accurate perceivers were significantly less likely to report achieving recommended levels of fruit and vegetable intake and physical activity. Conclusions: Nearly 3 in 10 overweight adolescents do not consider themselves overweight. Those with an accurate weight perception reported some healthy weight-related behaviors but not higher levels of unhealthy weight-related behaviors. With the substantial prevalence of weight misperception, clinicians should consider their patients' perceived weight status when pursuing patient-centered counseling of overweight adolescents.

Objective:Evaluate effects of local weather conditions on physical activity in early childhood.Methods:Longitudinal prospective cohort study of 372 children, 3 years old at enrollment, drawn from a major US metropolitan community. Accelerometer-measured (RT3) physical activity was collected every 4 months over 5 years and matched with daily weather measures: day length, heating/cooling degrees (degrees mean temperature < 65°F or ≥ 65°F, respectively), wind, and precipitation. Mixed regression analyses, adjusted for repeated measures, were used to test the relationship between weather and physical activity.Results:Precipitation and wind speed were negatively associated with total physical activity and moderate-vigorous physical activity (P < .0001). Heating and cooling degrees were negatively associated with total physical activity and moderate-vigorous physical activity and positively associated with inactivity (all P < .0001), independent of age, sex, race, BMI, day length, wind, and precipitation. For every 10 additional heating degrees there was a 5-minute daily reduction in moderatevigorous physical activity. For every additional 10 cooling degrees there was a 17-minute reduction in moderate-to-vigorous physical activity.Conclusions:Inclement weather (higher/lower temperature, greater wind speed, more rain/snow) is associated with less physical activity in young children. These deleterious effects should be considered when planning physical activity research, interventions, and policies.

Avondale, a disadvantaged neighborhood in Cincinnati, lags behind on a number of indicators of child well-being. Childhood obesity has become increasingly prevalent, as one third of Avondale’s kindergarteners are obese or overweight. The study objective was to determine perceptions of the quantity of and obstacles to childhood physical activity in the Avondale community. Caregivers of children from two elementary schools were surveyed to assess their child’s physical activity and barriers to being active. Three hundred forty surveys were returned out of 1,047 for a response rate of 32%. On school days, 41% of caregivers reported that their children spent more than 2 hours watching television, playing video games, or spending time on the computer. While over half of respondents reported that their children get more than 2 hours of physical activity on school days, 14% of children were reported to be physically active less than 1 hour per day. Caregivers identified violence, cost of extracurricular activities, and lack of organized activities as barriers to their child’s physical activity. The overwhelming majority of caregivers expressed interest in a program to make local playgrounds safer. In conclusion, children in Avondale are not participating in enough physical activity and are exposed to more screen time than is recommended by the AAP. Safety concerns were identified as a critical barrier to address in future advocacy efforts in this community. This project represents an important step toward increasing the physical activity of children in Avondale and engaging the local community.

Establishing and maintaining healthy physical activity (PA) levels is important throughout life. The purpose of this study was to determine the extent of PA tracking between ages 3 and 7 y. Objective measures of PA (RT3, triaxial accelerometer) were collected every 4 mo from ages 3–7; data from 234 children with PA measures available during each year of age were analyzed. Mean PA (total, moderate/vigorous (MV), and inactivity [IA]) was calculated for each year of age and adjusted for wear time. Correlations with age 3 PA were moderate at age 4 (r = .42−.45) but declined by age 7 (r = .19−.25). After classification into sex-specific tertiles of PA at age 3, boys in the high age 3 MVPA tertile maintained significantly higher PA at all subsequent ages, while girls in the high age 3 MVPA tertile were not significantly higher at age 6 and 7. Boys and girls in the high age 3 IA tertile had significantly higher IA at multiple subsequent years of age (p < .05 at ages 5 and 6). In conclusion, boys who were relatively more active at age 3 remained more active for several subsequent years. These findings highlight early-childhood differences in physical activity patterns between boys and girls.

To investigate trends in mortality from chronic obstructive pulmonary disease (COPD) in Wisconsin.COPD mortality data for those 45 years of age and older were extracted from the Centers for Disease Control and Prevention WONDER database and analyzed. Rates were adjusted to the 2000 US Census.In Wisconsin, the mortality rate from COPD increased by 88% between 1980 and 2000. A similar increase in COPD mortality occurred in the United States during this same period. Among Wisconsin males, the 33% increase from 1980-2000 was higher than the increase for US males. Likewise, the rate among Wisconsin females increased 3.9 times compared to an increase of 2.8 among US females. Unlike men, mortality increased in all age groups of women from 1980 to 2000.COPD mortality rates are increasing dramatically in Wisconsin, especially among women. Long-term trends in smoking do not explain the increases in COPD death rates among women. Other possible reasons include changes in the pattern of smoking or in the type of cigarette smoked, or women may be more susceptible to lung disease. Wisconsin physicians should target women for diagnosis and treatment of COPD and for smoking cessation and prevention.