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Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.Study design: Cross-sectional studyMethods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment are important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. Eighty-five percent of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. Eighty-one percent reported a paucity of exercise science education in medical school.Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

Introduction Current strategies focused on mitigating concussion in sport have demonstrated limited effectiveness. There is a paucity of research on the optimization of intracranial brain dynamics to mitigate concussion; in the present study, we investigate a novel device that provides mild jugular vein compression and may provide adjunctive protection to protect the brain internally from concussive and sub-concussive impacts. The purpose of this study was to assess the tolerance and acceptance of this device in a population of normal, healthy adults undergoing exertion similar to that is experienced while participating in sports-related competition, while monitoring changes in their biomechanical, strength, power, and postural stability capabilities. Material and Methods A total 18 participants (8 females, 10 males) were tested and included in the final analysis. Laboratory data collection consisted of two separate testing sessions for all participants. During the first testing session, participants were tested while wearing either the mild jugular vein compression neck device or a sham arm device (Sham) that was worn on the upper arm and did not alter venous return; participants exchanged devices for the second session. Participants underwent a battery of physical and neurological tests that included three-dimensional (3-D) biomechanical analysis, dynamic postural control testing using a stabilometer, isokinetic strength testing using a dynamometer, and a maximum vertical jump test. Results Evaluation of vital biomechanics, postural control and dynamic stabilization, isokinetic strength, and power in this population showed no statistically significant effect of wearing a mild jugular vein compression neck device compared with a Sham armband. Conclusions The data evaluated in the current project indicate that the device is safe during high intensity and dynamic postural stabilization exercise and does not alter normal physical or neuromuscular capabilities during physical activity.

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.

Introduction: The prevalence of cardiovascular (CV) risk factors in young people has increased related to the pediatric obesity epidemic. An association between physical activity (PA) and target organ damage has been firmly established in adults, and such damage confers increased CV event risk. There is an urgent need to implement prevention strategies for CV disease in youth. Promoting PA holds promise in this regard. However, in order to be a useful marker, PA needs to be quantified accurately and feasibly in the clinical setting, and its relationship to preclinical CV disease in youth needs to be understood. Objective: We aimed to 1) examine the relationship between a subjective measure of PA and an objective measure in a young cohort, 2) determine the association of PA and other CV risk factors, and 3) test the hypothesis that PA is an independent determinant of target organ damage. Methods: Adolescents and young adults were recruited from an ongoing study of the effects of risk factors on CV aging. At baseline adolescents with type 2 diabetes mellitus were matched by age, sex, and race to lean and obese control subjects without diabetes. These analyses were performed at 5 years follow-up on 249 subjects (mean age 22 ± 3.9 years). PA was measured with the International Physical Activity Questionnaire (IPAQ) and the Actical accelerometer. Target organ damage was assessed with echocardiography and vascular structure and function testing. Subjects were stratified into tertiles of average PA with the lean group as the standard. Differences in endpoints by PA tertile were tested by analysis of variance and χ2 tests. General linear models were constructed and used to test for independent associations. Results: Responses to the IPAQ differed greatly from objective accelerometry. There was a weak trend toward increased CV risk factors and target organ damage in those with the lowest IPAQ scores. When subjects were stratified into tertiles of by accelerometry the less active subjects had significantly worse CV risk profiles as indicated by higher Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores, and more signs of target organ damage including stiffer arteries as indicated by greater carotid-femoral pulse wave velocities. These differences did not reach statistical significance when adjusted for metabolic variables. Conclusion: PA is associated with CV risk factor clustering and target organ damage in young people. Measuring PA in this population is feasible, but has limitations. This study confirms the utility of PA in predicting the presence of target organ damage. Our study is the first to demonstrate a negative, cross-sectional relationship between PA and PDAY score. Future opportunities for research include examining the contribution of different levels of PA on CV aging as well as the effect of increasing PA over time.

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.

Introduction: Our previous cross-sectional studies demonstrated a relationship between elevated cardiovascular risk factors and arterial stiffness in adolescents. Other investigators showed longitudinal associations between cardiovascular risk factors at age 9 and adult arterial stiffness. Therefore we sought to determine if risk factor-related increase in arterial stiffness could be demonstrated even earlier in childhood. Hypothesis: In 10-year-old children, elevated blood pressure and BMI will be associated with less brachial distensibility (greater arterial stiffness). Methods: A community sample of 232 children (age 9.6 ± 0.5 years, 52% male, 83% white) in follow up from a longitudinal study were enrolled and had the following measures collected: height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), brachial distensibility (BrachD, PulseMetric, San Diego, CA). Pearson correlation coefficients were calculated and general linear modeling was performed to evaluate the relationships between cardiovascular risk factors and arterial stiffness. Results: Participants had a mean BMI of 18.6 ± 3.4 kg/m^2, waist-to-hip ratio (WHR) of 0.9 ± 0.05, BMI z-score of 0.5 ± 1.1, SBP of 96 ± 9 mm Hg, DBP of 53 ± 11 mm Hg, SBP z-score of -0.5 ± 0.8, DBP z-score of -0.7 ± 1, and BrachD of 7.4 ± 2.2 percent change per mm Hg. The following cardiovascular risk factors were significantly associated with BrachD: WHR (r = -0.19, p = 0.005), BMI z-score (r = -0.16, p = 0.01), and SBP z-score (r = -0.14, p = 0.04). Modeling revealed both WHR and BMI z-score but not SBP z-score were associated with BrachD independent of age, sex, and race. After reducing a model simultaneously adjusting for all multiple risk factors and demographic variables, WHR, race, and age remained independently associated with BrachD. Conclusions: Associations between multiple cardiovascular risk factors (WHR, BMI, SBP) and arterial stiffness (brachial distensibility) are present in children as young as 10 years old, with WHR maintaining an independent association in a model adjusted for multiple covariates. These findings build on previous evidence that early exposure to cardiovascular risk factors can affect vascular health and support the contention that threats to cardiovascular health should be met aggressively in childhood.

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.

Background: Exercise is a key component in treating childhood obesity. Group exercise sessions with a trained instructor are ideal, but most treatment programs cannot offer these often enough to meet physical activity guidelines. At-home options that provide a similar-intensity workout are needed. Objective: To determine if exercise videos are a feasible at-home option for obese youth to meet recommended physical activity guidelines for moderate-to-vigorous exercise. Methods: Obese youth attended a summer camp focused on weight management. Subjects wore accelerometers to assess physical activity levels at camp. During camp, all subjects completed four exercise activities: three separate exercise sessions led by exercise physiologists (EP), as well as an exercise video (EV). Each exercise session utilized a different format: high intensity interval training (HIIT), group games (GG) and yoga. The EV, created by the same EP, included aerobic exercise and yoga. Data was analyzed to determine intensity associated with each exercise session. Results: Data was obtained from 16 (50%) accelerometers (9 girls, 7 boys). There was no difference in sedentary (SED) minutes per hour between activities. HIIT and GG had more moderate-vigorous physical activity (MVPA) than yoga (p

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.

In order to successfully address the problem of childhood obesity, effective weight management programs must be established by a variety of clinicians to treat the increasing numbers of overweight and obese children and adolescents. An effective program will: 1) identify children and adolescents with health risks related to excess fat, 2) help families make permanent healthy lifestyle changes, and 3) provide ongoing care to optimize long-term health. Building a pediatric weight management program which achieves these goals requires attention to several aspects, including location, personnel, equipment, institutional support, marketing, referral base, focus of the overall approach, and billing & reimbursement. Maintaining the program after it is established can be enhanced by concentrating on team communication, continuing education, continuous quality improvement, and improving adherence.

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.

Introduction: Rapid infant weight gain has been linked with higher childhood body mass index (BMI) and risk of obesity. However, because BMI cannot distinguish lean from fat mass, the role of infant weight or length trajectories on childhood body composition is unclear. Hypothesis: This study aimed to evaluate how specific aspects of infant growth trajectories are associated with fat mass, lean mass and % body fat at age 3. Methods: Total 323 children age 3 y (46% female, 20% African-American) had body composition measured by dual-energy x-ray absorptiometry, and weight and length measurements from birth to age 2 y from pediatrician growth charts. Growth trajectories were characterized using the SuperImposition by Translation And Rotation (SITAR) model. This technique estimates an average growth curve with random effects that allow individual growth curves to shift up or down (size), shift right or left on the age axis (tempo) or rotate to steepen/flatten the growth curve (velocity). Tempo did not improve model fit so was excluded. Size and velocity parameters for weight and length trajectories were regressed against fat mass (FM), lean mass (LM) and % body fat measurements at age 3. Results: On average, girls had higher FM (3.9 vs. 3.4 kg) and lower LM (8.8 vs. 9.5 kg) than boys. Adjusting for sex, LM at age 3 was significantly higher with greater weight velocity and with longer length size between ages 0-2 (Table), but were not related to length velocity or weight size. Adjusting for sex, higher FM was seen for those with higher weight size between ages 0-2, but was not related to either weight or length velocities. Percent body fat at age 3 was associated with both larger weight size and shorter length size between 0-2 years of age, but not with either growth velocities. Conclusions: Weight and length size and velocity differ in their impact on children’s body composition by age 3. This study suggests that faster early weight gain (higher weight velocity) and longer lengths but not higher overall weight may lead to leaner body composition by age 3.

Introduction: The beneficial effects of vigorous physical activity (VPA) on arterial stiffness have been established, but the effect of changes in VPA over time on these vascular measures is unclear. Hypothesis: Increases in VPA will be associated with improvement in measures of arterial stiffness. Methods: As part of a longitudinal study of the effects of obesity & diabetes on cardiovascular health, 317 subjects (mean age 17.2 years at baseline, 38% male, 63% non-Caucasian) were enrolled and followed up 5 years later. Anthropometrics, accelerometer-measured physical activity, blood pressure, central and peripheral measures of arterial stiffness (pulse wave velocity (PWV), brachial distensibility (BrachD), and augmentation index (AI)), and blood (lipids & metabolic tests) were collected. General linear modeling was performed to test for the independent relationship of change in VPA with change of arterial stiffness. Results: Overall, VPA increased slightly (0.2 minutes) from baseline to follow up. Increased VPA from baseline to follow up was significantly associated (P = 0.0364) with a decrease in PWV but was not associated with a change in BrachD nor AI. The effect of change in VPA on change in PWV was independent of change in glucose (P = 0.024), but not independent of changes in BMI, blood pressure, lipids, or CRP. Conclusions: Increase in vigorous physical activity during late adolescence is significantly associated with improved pulse wave velocity. This relationship may be mediated through improvements in other cardiovascular risk factors such as body mass index, blood pressure, and lipids.

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.

Importance Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. Objective To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. Design, Setting, and Participants The Teen – Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015. Interventions Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). Main Outcomes and Measures Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). Results Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P Conclusions and Relevance These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.

To determine the relationship between relative body composition and body mass to height, anterior knee pain, or patellofemoral pain (PFP) in adolescent female athletes.Patellofemoral pain is common in female athletes and has an undefined etiology. The purpose of this study was to examine whether there was an association among higher body mass index (BMI), BMI z-scores, and relative body fat percentage in the development of PFP in an adolescent female athlete population. We hypothesized that female athletes who developed PFP over the course of a competitive basketball season had higher relative body mass or body fat percentage compared with those who did not develop PFP.Fifteen middle school basketball teams that consisted of 248 basketball players (mean age, 12.76 ± 1.13 years; height, 158.43 ± 7.78 cm; body mass, 52.35 ± 12.31 kg; BMI, 20.73 ± 3.88 kg/m(2)) agreed to participate in this study over the course of 2 basketball seasons, resulting in 262 athlete-seasons. Testing included the completion of the Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) form, standardized history, physician-administered physical examination, maturational estimates, and anthropometrics.Of the 262 athlete-seasons monitored, 39 athletes developed PFP over the course of the study. The incidence rate of new PFP was 1.57 per 1000 athlete-exposures. The cumulative incidence of PFP was 14.9%. There was no difference in BMI between those who developed PFP (mean body mass, 20.2 kg/m(2); 95% CI,18.9-21.4) and those who did not develop PFP (mean body mass, 20.8 kg/m(2); 95% CI, 20.3-21.3;P0.05). Body mass index z-scores were not different between those who developed PFP (mean, 0.3; 95% CI, 0.7-0.6) and those who did not develop PFP (mean, 0.4; 95% CI, 0.3-0.6;P0.05). A similar trend was noted in relative body fat percentage, with mean scores of similar ranges in those who developed PFP (mean body fat percentage, 22.2%; 95% CI, 19.4-24.9) to the referent group who did not (mean body fat percentage, 22.9%; 95% CI, 21.8-24.1;P0.05).Our results do not indicate a relationship between relative body composition or relative body mass to height to the propensity to develop PFP in middle school-aged female basketball players. Although previous data indicate a relationship between higher relative body mass and overall knee injury, these data did not support this association with PFP specifically. These data suggest the underlying etiology of PFP may be neuromuscular in nature. Further research is needed to understand the predictors, etiology, and ultimate prevention of this condition.

Determine the influenza immunization practices of Wisconsin pediatricians in response to evolving influenza prevention strategy in the United States.Two hundred fifty members of the Wisconsin Chapter of the American Academy of Pediatrics were surveyed prior to the 2004-2005 influenza season about their expectations for implementing the latest and future influenza vaccination recommendations for children and their use of trivalent inactivated influenza vaccines free of thimerosal as a preservative.Ninety-two percent of respondents expected to vaccinate most medically high-risk children against influenza, but only 53% would recommend influenza vaccine for most of their household contacts. Although 57% planned to vaccinate most healthy children ages 6 months to 23 months, just 27% thought the majority of household contacts of healthy infants under 23 months of age would be vaccinated. Fewer than 24% favored universal influenza vaccination for the majority of healthy school-aged children. Seventy percent had little or no concern about recommending thimerosal-containing influenza vaccines, but 60% agreed or strongly agreed thimerosal-free vaccine availability would increase parental acceptance of vaccinating their children.Although Wisconsin pediatricians are aware of the importance of preventing influenza disease in children, barriers to universal influenza vaccination of children and key household contacts remain.

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.