The influence of fitness on insulin resistance in obese children

  • Aaron L. Carrel
  • David B. Allen


An increasingly pervasive environment of reduced activity and easy access to high caloric food is leading to an epidemic of poor cardiovascular fitness, obesity, insulin resistance and type 2 diabetes (T2DM) in children. Studies have shown that insulin resistance (IR) to be an independent predictor for morbidity as well as mortality. These serve as a strong stimulus for public health strategies to improve fitness in children and adolescents. Methods to assess IR, improve IR and understand complications are increasingly important in children.


Cardiovascular fitness Max VO2 Insulin sensitivity 


  1. 1.
    Katzmarzyk PT, Church TS, Blair SN. Cardiorespiratory fitness attentuates the effects of the metabolic syndrome on all-cause mortality and cardiovascular disease mortality in men. Arch Intern Med. 2004;164:1092–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Obes Relat Metab Disord. 1999;23(Suppl 11):2–11.CrossRefGoogle Scholar
  3. 3.
    Goran MI, Ball GDC, Cruz ML. Obesity and risk of type 2 Diabetes and Cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. 2003;88:1417–27.CrossRefPubMedGoogle Scholar
  4. 4.
    Weiss R, Dzuira J, Burgert TS, Tamborlane WV, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Nader PR, O’Brien MO, Houts R, Bradley R, Mei Z, Susman EJ. Identifying risk for obesity in early childhood. Pediatrics. 2006;118(3):e594–601.CrossRefPubMedGoogle Scholar
  6. 6.
    Goran MI, Reynolds KD, Lindquist CH. Role of physical activity in the prevention of obesity in children. Int J Obes Relat Metab Disord. 1999;23(Suppl 3):S18–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important than defining health benefits? Med Sci Sports Exerc. 2001;33:S379–99.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim SH, Reaven GM. Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care. 2004;27:1998–2002.CrossRefPubMedGoogle Scholar
  9. 9.
    Katzmarzyk PT, Gagnon J, Leon AS, Skinner JS, Wilmore JH, Rao DC, et al. Fitness, fatness, and estimated coronary heart disease risk: the HERITAGE Family Study. Med Sci Sport Exerc. 2001;33(4):585–90.CrossRefGoogle Scholar
  10. 10.
    Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age related diseases. J Clin Endocrinol Metab. 2001;86(8):3574–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Blair SN, Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Suppl):S646–62.PubMedGoogle Scholar
  12. 12.
    Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr. 1999;69(3):373–80.PubMedGoogle Scholar
  13. 13.
    Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative Insulin Sensitivity Check Index: A simple, accurate method for assissing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85:2402–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Laakso M. How good a marker is insulin level for insulin resistance? Am J Epidemiol. 1993;137:959–65.PubMedGoogle Scholar
  15. 15.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Huang TT, Johnson MS, Goran MI. Development of a prediction equation for insulin sensitivity from anthropometry and fasting insulin in prepubertal and early pubertal children. Diabetes Care. 2002;25(7):1203–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Blair SN, Church TS. The fitness, obesity, and health equation: is physical activity the common denominator? JAMA. 2004;292(10):1232–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA. 1992;268:63–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Katzmarzyk PT, Leon AS, Wilmore JH, Skinner JS, Rao DC, Rankinin T, et al. Targeting the metabolic syndrome with exercise: Evidence from the HERITAGE family study. Med Sci Sports Exerc. 2003;35(10):1703–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Anderssen SA, Cooper AR, Riddoch C, Harro M, Brage S, Andersen LB. Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country, age, sex. Eur J Cardiovasc Prev Rehabil. 2007;14:526–31.CrossRefPubMedGoogle Scholar
  21. 21.
    Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study. Diabetes. 2002;51(1):204–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Gutin B, Cucuzzo N, Islam S, Smith C, Stachura ME. Physical training, lifestyle education, and coronary risk factors in obese girls. Med Sci Sports Exerc. 1996;28(1):19–23.CrossRefPubMedGoogle Scholar
  23. 23.
    Gutin B, Yin Z, Humphries MC, Hoffman WH, Gower B, Barbeau P. Relations of fatness and fitness to fasting insulin in black and white adolescents. J Pediatr. 2004;145:737–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefGoogle Scholar
  25. 25.
    Ibanez L, Potau N, Marcos MV, de Zegher F. Exaggerated adrenarche and hyperinsulinism in adolescent girls born small for gestational age. J Clin Endocrinol Metab. 1999;84(12):4739–41.CrossRefPubMedGoogle Scholar
  26. 26.
    Srinivasan SR, Bao W, Wattigney WA, GS B. Adolescent overweight is asociated with adult overweight and related multiple cardiovascular risk factors: The Bogalusa Heart Study. Metabolism. 1996;45:235–40.CrossRefPubMedGoogle Scholar
  27. 27.
    Tuomilehto J, Lindstrom J, Eriksson J, Valle T. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Jamner MS, Spruijt-Metz D, Bassin S, Cooper DM. A controlled evaluation of a school-based intervetnion to promote phyical activity among sedentary adolescent females: Project FAB. J Adolesc Health. 2004;34(4):279–89.PubMedGoogle Scholar
  29. 29.
    Kelley DE, Goodpaster BH. Effects of physical activity on insulin action and glucose tolerance in obesity. Med Sci Sports Exerc. 1999;31(11):23.Google Scholar
  30. 30.
    Lakka H-M, Laaksonen DE, Lakka TA. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709–16.CrossRefPubMedGoogle Scholar
  31. 31.
    Travers SH, Labarta JI, Gargosky SE, Rosenfield RG, Jeffers BW, Eckel RH. Insulin-like growth factor binding protein-1 levels are associated with insulin sensitivity and obesity in prepubertal children. J Clin Endocrinol Metab. 1998;83(6):1935–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Eliakim A, Scheet T, Newcomb R, Cooper DM. Fitness training and the growth hormone/IGF-1 axis in prepubertal girls. J Clin Endocrinol Metab. 2001;86(6):2797–802.CrossRefPubMedGoogle Scholar
  33. 33.
    Kasa-Vubu JZ, Lee CC, Rosenthal A, Singer K, Halter JB. Cardiovascular fitness and exercise as determinants of insulin resistance in postpubertal adolescent females. J Clin Endocrinol Metab. 2005;90:849–54.CrossRefPubMedGoogle Scholar
  34. 34.
    Sinha R, Dufour S, Petersen KF, LeBon V, Enoksson S, Shulman GI, et al. Assessment of skeletal muscle triglyceride content by (1) H nuclear magnetic resonance spectroscopy in lean and obese adolescents: relationships to insulin sensitivity, total body fat, and central adiposity. Diabetes. 2002;51(4):1022–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128(2 Suppl):411S–4.PubMedGoogle Scholar
  36. 36.
    Gutin B, Owens S, Treiber F, Islam S, Karp W, Slavens G. Weight-independent cardiovascular fitness and coronary risk factors. Arch Pediatr Adolesc Med. 1997;151:462–5.PubMedGoogle Scholar
  37. 37.
    Goran MI, Treuth MS. Energy expenditure, physical activity, and obesity in children. Pediatr Clin North Am. 2001;48(4):931–53.CrossRefPubMedGoogle Scholar
  38. 38.
    Wei M, Kampert JB, Barlow CE. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999;282:1547–53.CrossRefPubMedGoogle Scholar
  39. 39.
    Wessel TR, Arant CB, Olson MB, Pepine CJ, Merz CNB. Relationship of physical fitness vs. body mass index with coronary heart disease and cardiovascular events in women. JAMA. 2004;292(10):1179–87.CrossRefPubMedGoogle Scholar
  40. 40.
    Allen DB, Clark RR, Peterson SE, Nemeth BA, Eickhoff J, Carrel AL. Fitness is a stronger predictor of fasting insulin than fatness in overweight male middle-school children. J Pediatr. 2007;150:383–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Anderson KK, Frystyk J, Wolthers OD, Heuck C, Flyvbjerg A. Gender differences of oligomers and total adiponectin during puberty: A cross-sectional study of 859 Danish School Children. J Clin Endocrinol Metab. 2007(Feb 6 [epub ahead of print]).Google Scholar
  42. 42.
    Anderson LB, Hasselstrom H, Gronfelt V, Hansen SE, Karsten F. The relationship between physical fitness and clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sport Study. Int J Behav Nutr Phys Act. 2004;1:1–4.CrossRefGoogle Scholar
  43. 43.
    Treuth MS, Butte NF, Adolph AL, Puyay MR. A longitudinal study of fitness and activity in girls predisposed to obesity. Med Sci Sport Exercise. 2004;36(2):198–204.CrossRefGoogle Scholar
  44. 44.
    Bessesen DH. Update on obesity. J Clin Endo Metab. 2008;93:2027–34.CrossRefGoogle Scholar
  45. 45.
    Rizzo NS, Ruiz JR, Ortega FB, Sjostrom M. Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: The European Youth Heart Study. J Pediatr. 2007;150:388–94.CrossRefPubMedGoogle Scholar
  46. 46.
    Klasson-Heggebo L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children. Br J Sports Med. 2006;40:25–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Morrow JR, Freedson PS. Relationship between habitual physical activity and aerobic fitness in adolescents. Pediatr Exerc Sci. 1994;6:315–29.Google Scholar
  48. 48.
    Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M. Physical fitness in childhood: A powerful marker of helath. Int J Obes. 2008;32:1–11.CrossRefGoogle Scholar
  49. 49.
    Andersen LB, Hasselstrom H, Hansen SE, Froberg K. The relationship between physical fitness and clustered risk, and the tracking of clustered risk from adolescence to adulthood. Int J Behav Nutrit Phys Act. 2004;1:6–12.CrossRefGoogle Scholar
  50. 50.
    Morena LA, Joyanes M, Mesana MI, Gil CM, Sarria A. Harmonization of anthropometric measurements for a multicenter nutrient survey in Spanish adolescents. Nutrition. 2003;19:481–6.CrossRefGoogle Scholar
  51. 51.
    Institute of Medicine. Children’s health, the nation’s wealth: Assessing and improving child health. Washington, DC; 2004.Google Scholar
  52. 52.
    Barlow SE, Committee E. Expert committee recommendations regarding the prevention, assessment and treatment of child overweight and obesity: summary report. Pediatrics. 2007;120(supp 4):s164–92.CrossRefPubMedGoogle Scholar
  53. 53.
    United States Department of Health and Human Services. Healthy People 2010: Understanding and improving Health. In: Washington, DC: Government Printing Office; 2000. p. 1–1272.Google Scholar
  54. 54.
    Council for Physical Education for Children. Physical Activity Guidelines for Children. 1998:1–21.Google Scholar
  55. 55.
    Ross JG, Gilbert GG. Children and youth fitness study: a summary of findings. J Phys Educ Recreat Dance. 1985;56(1):45–50.Google Scholar
  56. 56.
    Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell MF. Effects of a 2-year Physical Education Program (SPARK) on physical activity and fitness in elementary school students, Sallis. Am J Publ Health. 1997;87(8):1328–34.CrossRefGoogle Scholar
  57. 57.
    Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annu Rev Public Health. 2001;22:337–53.CrossRefPubMedGoogle Scholar
  58. 58.
    Schmitz KH, Jacobs DR, Hong C-P, Steinberger J, Moran A, Sinaiko AR. Association of physical activity with insulin sensitivity in children. Int J Obes. 2002;26:1310–6.CrossRefGoogle Scholar
  59. 59.
    Knowler WC, Narayan KMV, Hanson RL. Preventing non-insulin dependent diabetes. Diabetes. 1995;44:483–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Owens S, Gutin B. Exercise testing of the child with obesity. Pediatr Cardiol. 1999;20(1):79–83.CrossRefPubMedGoogle Scholar
  61. 61.
    Gutin B, Barbeau P, Owens S, Lemmon CR, Bauman M, Allison J. Effects of exercise intensity on cardiovascular fitness, body composition, and visceral adiposity in obese adolescents. Am J Clin Nutr. 2002;75(5):818–26.PubMedGoogle Scholar
  62. 62.
    Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan JC, Allen DB. School-based exercise program improves fitness, body composition and insulin sensitivity in overweight children: A randomized, controlled study. Arch Pediatr Adolesc Med. 2005.Google Scholar
  63. 63.
    Williamson DA, Champagne CM, Harsha D, Han H, Martin CK, Newton R Jr, et al. Louisiana (LA) Health: Design and methods for a childhood obesity prevention program in rural schools. Contemp Clin Trials. 2008(March 26 (epub)).Google Scholar
  64. 64.
    Gortmaker SL, Peterson KE, Wiecha J. Reducing obesity via a school-based interdisciplinary intervention among youth (Planet Health). Arch Pediatr Adolesc Med. 1999;153:409–18.PubMedGoogle Scholar
  65. 65.
    Robinson TN. Reducing Children’s Television Viewing to Prevent Obesity: A Randomized Controlled Trial. JAMA. 1999;282(16):1561–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Caballero B, Clay T, Davis SM, Ethelbah B, Lohman T, Norman J, et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003;78:1030–8.PubMedGoogle Scholar
  67. 67.
    Goran MI. Metabolic precursors and effects of obesity in children: a decade of progress, 1990–1999. Am J Clin Nutr. 2001;73(2):158–71.PubMedGoogle Scholar
  68. 68.
    Shaya FT, Flores D, Gbarayor CM, Wang J. School-based obesity interventions: A literature review. J Sch Health. 2008;78(4):189–96.CrossRefPubMedGoogle Scholar
  69. 69.
    Pate RR, Wang CY, Dowda M, Farrell SW, O’Neill JR. Cardiorespiratory fitness levels among US youth 12 to 19 years of age. Arch Pediatr Adolesc Med. 2006;160:1005–12.CrossRefPubMedGoogle Scholar
  70. 70.
    Bertucci W, Duc S, Villerius V, Grappe F. Validity and reliability of the PowerTap mobile cycling powermeter when compared with the SRM device. Int J Sports Med. 2005;26(10):868–73.CrossRefPubMedGoogle Scholar
  71. 71.
    Crocker PR, Bailey DA, Faulker RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: prelimanary evidence for the Physical Activity Questionnaire in Older Children. Med Sci Sports Exerc. 1997;29(10):1344–9.PubMedGoogle Scholar
  72. 72.
    Carrel AL, Sledge JS, Ventura SJ, Clark RR, Peterson SE, Allen DB. Measuring Power as an Assessment of Childhood Fitness. J Strength Cond Res. 2007.Google Scholar
  73. 73.
    Carrel AL, Clark RR, Peterson SE, Nemeth BA, Eickhoff J, Allen DB. Improvements in fitness from a school-based intervention are lost during the summer in overweight middle-school children. Arch Pediar Adolesc Med. 2007.Google Scholar
  74. 74.
    Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during submaximal work. J Appl Phys. 1954;7:218–21.Google Scholar
  75. 75.
    Gore C, Booth M, Bauman A, Neville O. Utility of PWC75% as an estimate of aerobic power in epidemiological and population-based studies. Med Sci Sports Exerc. 1999;31:348–51.CrossRefPubMedGoogle Scholar
  76. 76.
    Huerta M, Grotto I, Shmela S, Askenazi I, Kark JD. Cycle Ergometry Estimation of Physical Fitness among Israeli Soldiers. Mil Med. 2004;169(3):217–20.PubMedGoogle Scholar
  77. 77.
    Varness TS, Carrel AL, Eickhoff J, Allen DB. Prediction of insulin resistance by a field-based fitness test in middle-school children. Paper presented at: Pediatric Academic Society Annual Meeting, Honolulu, HI. 2008.Google Scholar
  78. 78.
    Balde A, Figueras J, Hawking DA, Miller JR. Physician advice to the elderly about physical activity. J Aging Phys Act. 2003;11:90–7.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Pediatrics, American Family Children’s HospitalUniversity of WisconsinMadisonUSA
  2. 2.Department of PediatricsUniversity of WisconsinMadisonUSA

Personalised recommendations