Advertisement

Physical Exercise in the Treatment of Obesity and Hypertension: New Approach to Individualize Treatment

  • Pau Redon
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

Childhood obesity is increasing worldwide and consequently its associated comorbidities, such as obesity-related hypertension. All scientific and clinical guidelines recommend weight loss programs as the initial step to prevent or fight against obesity and obesity-related hypertension in youth.

A key component of these programs is the promotion of physical activity. Scientific evidence reveals positive results regarding the prevention of youth overweight/obesity when (1) performing at least 40 min of daily vigorous physical activity or (2) 60 min of daily moderate-to-vigorous activity, with additional benefits for every 15 min of daily vigorous activity.

Unfortunately, there is no “one size fits all” solution, and physical fitness should be taken into consideration for developing personalized interventions. Physical fitness not only impacts on the outcome of performing physical activity but also is a stronger predictor of future development of adiposity or even of metabolic syndrome than vigorous physical activity time.

Cardiorespiratory fitness is a parameter to assess physical fitness. In youth, it has been revealed to be clinically relevant to effectively fight against childhood obesity, and therefore, its assessment is worth implementing in the healthcare system, just as recently suggested by the American Heart Association.

Keywords

Obesity Pediatrics Physical fitness Physical activity Cardiorespiratory fitness VO2max VO2peak Cardiopulmonary exercise test Active lifestyle Obesity-related hypertension 

References

  1. 1.
    Erixon F, Brandt L, Krol M. Investing in obesity treatment to deliver significant healthcare savings: estimating the healthcare costs of obesity and the benefits of treatment. European Centre of Intenational Political Economy Occasional Paper 1/2014. https://www.econstor.eu/handle/10419/174724. Last accessed 07/09/2018.
  2. 2.
    Sweeting HN. Measurement and definitions of obesity in childhood and adolescence: a field guide for the uninitiated. Nutr J. 2007;6:32.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Livingstone MB. Childhood obesity in Europe: a growing concern. Public Health Nutr. 2001;4:109–16.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Wang Y. Epidemiology of childhood obesity—methodological aspects and guidelines: What is new? Int J Obes Relat Metab Disord. 2004;28:S21–8.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    McCarthy HD, Jarrett KV, Emmett PM, Rogers I. Trends in waist circumferences in young British children: a comparative study. Int J Obes (Lond). 2005;29:157–62.CrossRefGoogle Scholar
  6. 6.
    Prentice AM, Jebb SA. Beyond body mass index. Obes Rev. 2001;2:141–7.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869–73.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365:1876–85.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115:22–7.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Hall JE, Crook ED, Jones DW, Wofford MR, Dubbert PM. Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci. 2002;324:127–37.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Frohlich ED. Clinical management of the obese hypertensive patient. Cardiol Rev. 2002;10:127–38.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension. 2005;45:602–7.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr. 2005;147:651–6.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Lurbe E, Invitti C, Torro I, Maronati A, Aguilar F, Sartorio A, et al. The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens. 2006;24:1557–64.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175–82.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Salvadori M, Sontrop JM, Garg AX, Truong J, Suri RS, Mahmud FH, et al. Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community. Pediatrics. 2008;122:e821–7.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, et al. Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents. Hypertension. 2008;51:635–41.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Polat M, Yikilkan H, Aypak C, Gorpelioglu S. The relationship between BMI and blood pressure in children aged 7–12 years in Ankara, Turkey. Public Health Nutr. 2014;17:2419–24.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Schwandt P, Scholze JE, Bertsch T, Liepold E, Haas GM. Blood pressure percentiles in 22,051 German children and adolescents: the PEP Family Heart Study. Am J Hypertens. 2015;28:672–9.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35:891–8.CrossRefGoogle Scholar
  22. 22.
    Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Kotsis V, Jordan J, Micic D, Finer N, Leitner DR, Toplak H, et al. Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part A: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment. J Hypertens. 2018;36:1427–40.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. Eur J Public Health. 2013;23:464–9.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Kotsis V, Tsioufis K, Antza C, Seravalle G, Coca A, Sierra C, et al. Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part B: obesity-induced cardiovascular disease, early prevention strategies and future research directions. J Hypertens. 2018;36:1441–55.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Reinehr T, Schaefer A, Winkel K, Finne E, Toschke AM, Kolip P. An effective lifestyle intervention in overweight children: findings from a randomized controlled trial on “Obeldicks light”. Clin Nutr. 2010;29:331–6.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    WHO. Global recommendations on physical activity for health. World Health Organization publication, 2010. http://www.who.int/dietphysicalactivity/global-PA-recs-2010.pdf. Accessed 07/09/2018.
  28. 28.
    Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–920.CrossRefGoogle Scholar
  29. 29.
    Ortega FB, Ruiz JR, Castillo MJ. Physical activity, physical fitness, and overweight in children and adolescents: evidence from epidemiologic studies. Endocrinol Nutr. 2013;60:458–69.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    O’Malley G, Ring-Dimitriou S, Nowicka P, Vania A, Frelut ML, Farpour-Lambert N, et al. Physical activity and physical fitness in pediatric obesity: What are the first steps for clinicians? Expert conclusion from the 2016 ECOG workshop. Int J Exerc Sci. 2017;10:487–96.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Dias KA, Ingul CB, Tjønna AE, Keating SE, Gomersall SR, Follestad T, et al. Effect of high-intensity interval training on fitness, fat mass and cardiometabolic biomarkers in children with obesity: a randomised controlled trial. Sports Med. 2018;48:733–46.PubMedCrossRefGoogle Scholar
  32. 32.
    Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48:1227–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, et al. American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Functional Genomics and Translational Biology; Stroke Council. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation. 2016;134:e653–99.PubMedCrossRefGoogle Scholar
  34. 34.
    Redón P, Grassi G, Redon J, Álvarez-Pitti J, Lurbe E. Sympathetic neural activity, metabolic parameters and cardiorespiratory fitness in obese youths. J Hypertens. 2017;35:571–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S, et al. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet. 2006;368:299–304.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Ruiz JR, Cavero-Redondo I, Ortega FB, Welk GJ, Andersen LB, Martinez-Vizcaino V. Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis. Br J Sports Med. 2016;50:1451–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Guixeres J, Redon P, Saiz J, Alvarez J, Torró MI, Cantero L, et al. Cardiovascular fitness in youth: association with obesity and metabolic abnormalities. Nutr Hosp. 2014;29:1290–7.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Skrede T, Aadland E, Andersen LB, Stavnsbo M, Anderssen SA, Resaland GK, et al. Does cardiorespiratory fitness moderate the prospective association between physical activity and cardiometabolic risk factors in children? Int J Obes (Lond). 2018;42:1029–38.CrossRefGoogle Scholar
  39. 39.
    Tunstall RJ, Mehan KA, Wadley GD, Collier GR, Bonen A, Hargreaves M, et al. Exercise training increases lipid metabolism gene expression in human skeletal muscle. Am J Physiol Endocrinol Metab. 2002;283:66–72.CrossRefGoogle Scholar
  40. 40.
    Goodpaster BH, Katsisaras A, Kelley DE. Enhanced fat oxidation through physical activity is associated with improvements in insulin sensitivity in obesity. Diabetes. 2003;52:2191–7.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Bruce CR, Kriketos AD, Cooney GJ, Hawley JA. Disassociation of muscle triglyceride content and insulin sensitivity after exercise training in patients with type 2 diabetes. Diabetologia. 2004;47:23–30.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Ouyang P, Sung J, Kelemen MD, Hees PS, DeRegis JR, Turner KL, et al. Relationships of insulin sensitivity with fatness and fitness and in older men and women. J Women’s Health. 2004;13:177–85.CrossRefGoogle Scholar
  43. 43.
    Bruce CR, Thrush AB, Mertz VA, Bezaire V, Chabowski A, Heigenhauser GJ, et al. Endurance training in obese humans improves glucose tolerance and mitochondrial fatty acid oxidation and alters muscle lipid content. Am J Physiol Endocrinol Metab. 2006;291:E99–E107.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Cortright RN, Sandhoff KM, Basilio JL, Berggren JR, Hickner RC, Hulver MW, et al. Skeletal muscle fat oxidation is increased in African-American and White women after 10 days of endurance exercise training. Obesity. 2006;14:1201–10.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Lembo G, Napoli R, Capaldo B, Rendina V, Iaccarino G, Volpe M, et al. Abnormal sympathetic overactivity evoked by insulin in the skeletal muscle of patients with essential hypertension. J Clin Invest. 1992;90:24–9.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Canale MP, Manca di Villahermosa S, Martino G, Rovella V, Noce A, De Lorenzo A, et al. Obesity-related metabolic syndrome: mechanisms of sympathetic overactivity. Int J Endocrinol. 2013;2013:865965.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Cooper KH. A means of assessing maximal oxygen uptake. JAMA. 1968;203:201–4.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Léger LA, Mercier D, Gadoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci. 1988;6:93–101.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Ruiz JR, Castro-Piñero J, Artero EG, Ortega FB, Sjöström M, Suni J, et al. Predictive validity of health-related fitness in youth: a systematic review. Br J Sports Med. 2009;43:909–23.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Batista MB, Romanzini CLP, Castro-Piñero J, Ronque ERV. Validity of field tests to estimate cardiorespiratory fitness in children and adolescents: a systematic review. Rev Paul Pediatr. 2017;35:222–33.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. 3rd ed. Philadelphia: Lippincott, Williams &Wilkins; 1999.Google Scholar
  52. 52.
    Bonen A, Heyward VH, Cureton KJ, Boileau RA, Massey BH. Prediction of maximal oxygen uptake in boys, ages 7–15 years. Med Sci Sports. 1979;11:24–9.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Binyildiz PO. Prediction of maximal oxygen uptake in boys 11–13 years of age. Eur J Appl Physiol Occup Physiol. 1980;43:213–9.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Woynarowska B. The validity of indirect estimations of maximal oxygen uptake in children 11-12 years of age. Eur J Appl Physiol Occup Physiol. 1980;43:19–23.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Cunningham DA, Paterson DH. Age specific prediction of maximal oxygen uptake in boys. Can J Appl Sport Sci. 1985;10:75–80.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Buono MJ, Roby JJ, Micale FG, Sallis JF, Shepard W. Validity and reliability of predicting maximum oxygen uptake via field tests in children and adolescents. Pediatr Exerc Sci. 1991;3:250–5.CrossRefGoogle Scholar
  57. 57.
    McMurray RG, Guion WK, Ainsworth BE, Harrell JS. Predicting aerobic power in children. A comparison of two methods. J Sports Med Phys Fitness. 1998;38:227–33.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Corder K, Brage S, Mattocks C, Ness A, Riddoch C, Wareham NJ, Ekelund U. Comparison of two methods to assess PAEE during six activities in children. Med Sci Sports Exerc. 2007;39:2180–8.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Ekelund U, Sardinha LB, Anderssen SA, Harro M, Franks PW, Brage S, et al. Associations between objectively assessed physical activity and indicators of body fatness in 9- to 10-y-old European children: a population-based study from 4 distinct regions in Europe (the European Youth Heart Study). Am J Clin Nutr. 2004;80:584–90.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Gutin B, Yin Z, Humphries MC, Barbeau P. Relations of moderate and vigorous physical activity to fitness and fatness in adolescents. Am J Clin Nutr. 2005;81:746–50.PubMedCrossRefGoogle Scholar
  61. 61.
    Wittmeier KD, Mollard RC, Kriellaars DJ. Objective assessment of childhood adherence to Canadian physical activity guidelines in relation to body composition. Appl Physiol Nutr Metab. 2007;32:217–24.PubMedCrossRefGoogle Scholar
  62. 62.
    Ness AR, Leary SD, Mattocks C, Blair SN, Reilly JJ, Wells J, et al. Objectively measured physical activity and fat mass in a large cohort of children. PLoS Med. 2007;4:e97.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr. 2006;84:299–303.PubMedCrossRefGoogle Scholar
  64. 64.
    Saelens BE, Seeley RJ, van Schaick K, Donnelly LF, O’Brien KJ. Visceral abdominal fat is correlated with whole-body fat and physical activity among 8-y-old children at risk of obesity. Am J Clin Nutr. 2007;85:46–53.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Ortega FB, Ruiz JR, Sjöström M. Physical activity, overweight and central adiposity in Swedish children and adolescents: the European Youth Heart Study. Int J Behav Nutr Phys Act. 2007;4:61.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Dencker M, Thorsson O, Karlsson MK, Linden C, Wollmer P, Andersen LB. Daily physical activity related to aerobic fitness and body fat in an urban sample of children. Scand J Med Sci Sports. 2008;18:728–35.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Martinez-Gomez D, Ruiz JR, Ortega FB, Veiga OL, Moliner-Urdiales D, Mauro B, Galfo M, Manios Y, Widhalm K, Béghin L, Moreno LA, Molnar D, Marcos A, Sjöström M, HELENA Study Group. Recommended levels of physical activity to avoid an excess of body fat in European adolescents: the HELENA Study. Am J Prev Med. 2010;39:203–11.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Ortega FB, Ruiz JR, Hurtig-Wennlöf A, Vicente-Rodríguez G, Rizzo NS, Castillo MJ, et al. Cardiovascular fitness modifies the associations between physical activity and abdominal adiposity in children and adolescents. The European Youth Heart Study. Br J Sports Med. 2008;44:256–62.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Jimenez-Pavon D, Kelly J, Reilly JJ. Associations between objectively measured habitual physical activity and adiposity in children and adolescents: systematic review. Int J Pediatr Obes. 2009;5:3–18.CrossRefGoogle Scholar
  70. 70.
    Moore LL, Gao D, Bradlee ML, Cupples LA, Sundarajan-Ramamurti A, Proctor MH, et al. Does early physical activity predict body fat change throughout childhood. Prev Med. 2003;37:10–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Stevens J, Murray DM, Baggett CD, Elder JP, Lohman TG, Lytle LA, et al. Objectively assessed associations between physical activity and body composition in middle-school girls: the Trial of Activity for Adolescent Girls. Am J Epidemiol. 2007;166:1298–305.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Janz KF, Burns TL, Levy SM. Tracking of activity and sedentary behaviours in childhood: the Iowa Bone Development Study. Am J Prev Med. 2005;29:171–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Ortega FB, Ruiz JR, Castillo MJ, Sjöström M. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes (Lond). 2008;32:1–11.CrossRefGoogle Scholar
  74. 74.
    Winsley RJ, Armstrong N, Middlebrooke AR, Ramos-Ibanez N, Williams CA. Aerobic fitness and visceral adipose tissue in children. Acta Paediatr. 2006;95:1435–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Deforche B, Lefevre J, de Bourdeaudhuij I, Hills AP, Duquet W, Bouckaert J. Physical fitness and physical activity in obese and nonobese Flemish youth. Obes Res. 2003;11:434–41.PubMedCrossRefGoogle Scholar
  76. 76.
    Artero EG, España-Romero V, Ortega FB, Jiménez-Pavón D, Ruiz JR, Vicente-Rodríguez G, et al. Health-related fitness in adolescents: underweight, and not only overweight, as an influencing factor. The AVENA study. Scand J Med Sci Sports. 2010;20:418–27.PubMedCrossRefGoogle Scholar
  77. 77.
    Johnson MS, Figueroa-Colon R, Herd SL, Fields DA, Sun M, Hunter GR, et al. Aerobic fitness, not energy expenditure, influences subsequent increase in adiposity in black and white children. Pediatrics. 2000;106:E50.PubMedCrossRefGoogle Scholar
  78. 78.
    Twisk JW, Kemper HC, van Mechelen W. Tracking of activity and fitness and the relationship with cardiovascular disease risk factors. Med Sci Sports Exerc. 2000;32:1455–61.PubMedCrossRefGoogle Scholar
  79. 79.
    Barnekow-Bergkvist M, Hedberg G, Janlert U, Jansson E. Adolescent determinants of cardiovascular risk factors in adult men and women. Scand J Public Health. 2001;29:208–17.PubMedCrossRefGoogle Scholar
  80. 80.
    Twisk JW, Kemper HC, van Mechelen W. The relationship between physical fitness and physical activity during adolescence and cardiovascular disease risk factors at adult age. The Amsterdam Growth and Health Longitudinal Study. Int J Sports Med. 2002;23:S8–14.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Boreham C, Twisk J, Neville C, Savage M, Murray L, Gallagher A. Associations between physical fitness and activity patterns during adolescence and cardiovascular risk factors in young adulthood: the Northern Ireland Young Hearts Project. Int J Sports Med. 2002;23:S22–6.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Hasselstrøm H, Hansen SE, Froberg K, Andersen LB. Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood. Danish Youth and Sports Study. An eight-year follow-up study. Int J Sports Med. 2002;23:S27–31.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Janz KF, Dawson JD, Mahoney LT. Increases in physical fitness during childhood improve cardiovascular health during adolescence: the Muscatine Study. Int J Sports Med. 2002;23:S15–21.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Koutedakis Y, Bouziotas C, Flouris AD, Nelson PN. Longitudinal modelling of adiposity in periadolescent Greek schoolchildren. Med Sci Sports Exerc. 2005;37:2070–4.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Psarra G, Nassis GP, Sidossis LS. Short-term predictors of abdominal obesity in children. Eur J Public Health. 2006;16:520–5.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    McMurray RG, Bangdiwala SI, Harrell JS, Amorim LD. Adolescents with metabolic syndrome have a history of low aerobic fitness and physical activity levels. Dyn Med. 2008;7:5.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Byrd-Williams CE, Shaibi GQ, Sun P, Lane CJ, Ventura EE, Davis JN, et al. Cardiorespiratory fitness predicts changes in adiposity in overweight Hispanic boys. Obesity. 2008;16:1072–7.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Brennan AM, Lam M, Stotz P, Hudson R, Ross R. Exercise-induced improvement in insulin sensitivity is not mediated by change in cardiorespiratory fitness. Diabetes Care. 2014;37:e95–7.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Arad AD, DiMenna FJ, Thomas N, Tamis-Holland J, Weil R, Geliebter A, et al. High-intensity interval training without weight loss improves exercise but not basal or insulin-induced metabolism in overweight/obese African American women. J Appl Physiol. 2015;119:352–62.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Ko G, Davidson LE, Brennan AM, Lam M, Ross R. Abdominal adiposity, not cardiorespiratory fitness, mediates the exercise-induced change in insulin sensitivity in older adults. PLoS One. 2016;11:e0167734.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Pau Redon
    • 1
    • 2
  1. 1.Pediatric DepartmentConsorcio Hospital General Universitario de ValenciaValenciaSpain
  2. 2.CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadridSpain

Personalised recommendations