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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CLINICAL RESEARCH: ATHEROSCLEROSIS MARKERS AND PHYSICAL ACTIVITY IN CHILDREN

Physical Activity Reduces Systemic Blood Pressure and Improves Early Markers of Atherosclerosis in Pre-Pubertal Obese Children

Nathalie J. Farpour-Lambert, MD^_*,_*, Yacine Aggoun, MD^_*, Laetitia M. Marchand, MS^_*, Xavier E. Martin, MS^_*, François R. Herrmann, MD, MPH and Maurice Beghetti, PD^_*

^_* Pediatric Cardiology Unit, Department of Child and Adolescent, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
Biostatistics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland

Manuscript received April 25, 2009; revised manuscript received July 27, 2009, accepted August 6, 2009.

^_* Reprint requests and correspondence: Dr. Nathalie J. Farpour-Lambert, Pediatric Cardiology Unit, Department of Child and Adolescent, University Hospitals of Geneva, 6 rue Willy-Donze, 1211 Geneva 14, Switzerland (Email: nathalie.farpourlambert{at}hcuge.ch).

Objectives: The aim of this study was to determine the effects of physical activity on systemic blood pressure (BP) and early markers of atherosclerosis in pre-pubertal obese children.

Background: Hypertension and endothelial dysfunction are premature complications of obesity.

Methods: We performed a 3-month randomized controlled trial with a modified crossover design: 44 pre-pubertal obese children (age 8.9 ± 1.5 years) were randomly assigned (1:1) to an exercise (n = 22) or a control group (n = 22). We recruited 22 lean children (age 8.5 ± 1.5 years) for baseline comparison. The exercise group trained 60 min 3 times/week during 3 months, whereas control subjects remained relatively inactive. Then, both groups trained twice/week during 3 months. We assessed changes at 3 and 6 months in office and 24-h BP, arterial intima-media thickness (IMT) and stiffness, endothelial function (flow-mediated dilation), body mass index (BMI), body fat, cardiorespiratory fitness (maximal oxygen consumption [VO₂max]), physical activity, and biological markers.

Results: Obese children had higher BP, arterial stiffness, body weight, BMI, abdominal fat, insulin resistance indexes, and C-reactive protein levels, and lower flow-mediated dilation, VO₂max, physical activity, and high-density lipoprotein cholesterol levels than lean subjects. At 3 months, we observed significant changes in 24-h systolic BP (exercise –6.9 ± 13.5 mm Hg vs. control 3.8 ± 7.9 mm Hg, –0.8 ± 1.5 standard deviation score [SDS] vs. 0.4 ± 0.8 SDS), diastolic BP (–0.5 ± 1.0 SDS vs. 0 ± 1.4 SDS), hypertension rate (–12% vs. –1%), office BP, BMI z-score, abdominal fat, and VO₂max. At 6 months, change differences in arterial stiffness and IMT were significant.

Conclusions: A regular physical activity program reduces BP, arterial stiffness, and abdominal fat; increases cardiorespiratory fitness; and delays arterial wall remodeling in pre-pubertal obese children. (Effects of Aerobic Exercise Training on Arterial Function and Insulin Resistance Syndrome in Obese Children: A Randomized Controlled Trial; NCT00801645)

Key Words: atherosclerosis • child • hypertension • obesity • physical activity

Abbreviations and Acronyms   ANCOVA = analysis of covariance   ANOVA = analysis of variance   BMI = body mass index   CVD = cardiovascular disease   DBP = diastolic blood pressure   Einc = incremental elastic modulus   FMD = flow-mediated dilation   HDL-C = high-density lipoprotein cholesterol   HOMA-IR = homeostasis assessment model of insulin resistance   HTN = hypertension   IMT = intima-media thickness   LDL-C = low-density lipoprotein cholesterol   NTGMD = nitroglycerin-mediated dilation   SBP = systolic blood pressure   SDS = standard deviation score   TC = total cholesterol   TG = triglyceride   VO2max = maximal oxygen consumption

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