Physical activity as the main therapeutic tool for metabolic syndrome in childhood

International Journal of Obesity

Volumn 35, Issue 1, 2011, Pages 16-28

  Brambilla, P ^a   Pozzobon, G ^b   Pietrobelli, A ^c  

^a ASL Milano 2   (Italy)

^b SAN RAFFAELE HOSPITAL   (Italy)

^c UNIVERSITY OF VERONA   (Italy)

Author keywords

drugs; exercise; metabolic syndrome; pediatric obesity; review

Indexed keywords

APOPTOSIS SIGNAL REGULATING KINASE 1; ENALAPRIL; GLUCOSE; GLUCOSE TRANSPORTER 4; HIGH DENSITY LIPOPROTEIN; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LOW DENSITY LIPOPROTEIN; LOW DENSITY LIPOPROTEIN CHOLESTEROL; METFORMIN; PRAVASTATIN; SIBUTRAMINE; TETRAHYDROLIPSTATIN; TRIACYLGLYCEROL;

ABDOMINAL PAIN; ABNORMAL FECES; AMINOTRANSFERASE BLOOD LEVEL; ANGIONEUROTIC EDEMA; BODY MASS; CARDIOVASCULAR DISEASE; CHILDHOOD; COMPLIANCE (PHYSICAL); CONSTIPATION; COUGHING; DEFECATION URGENCY; DIZZINESS; DYSLIPIDEMIA; ENDOCRINE DISEASE; EXERCISE; FITNESS; GASTROINTESTINAL DISEASE; GLUCOSE METABOLISM; GLUCOSE TOLERANCE; HEADACHE; HEALTH CARE COST; HUMAN; HYPERKALEMIA; HYPERTENSION; HYPOTENSION; IMPAIRED GLUCOSE TOLERANCE; INSOMNIA; INSULIN RESISTANCE; INSULIN SENSITIVITY; KIDNEY FAILURE; METABOLIC SYNDROME X; MUSCLE CRAMP; MUSCLE EXERCISE; MUSCLE MASS; MUSCULOSKELETAL DISEASE; MYALGIA; NAUSEA; NONHUMAN; OXYGEN CONSUMPTION; PHENOTYPE; PHYSICAL ACTIVITY; PRIORITY JOURNAL; PUBERTY DISORDERS; REVIEW; SIDE EFFECT; TACHYCARDIA; TERATOGENESIS; XEROSTOMIA;

ADOLESCENT; CHILD; CROSS-SECTIONAL STUDIES; EUROPE; EXERCISE; FEEDING BEHAVIOR; FEMALE; HUMANS; INSULIN RESISTANCE; MALE; METABOLIC SYNDROME X; OBESITY; PATIENT COMPLIANCE; PHYSICAL EXERTION; PREVALENCE; UNITED STATES;

EID: 78651328823     PISSN: 03070565     EISSN: 14765497     Source Type: Journal    
DOI: 10.1038/ijo.2010.255     Document Type: Review

References (140)

1. Chen W, Srinivasan SR, Elkasabany A, Berenson GS. Cardiovascular risk factor clustering features of insulin resistance syndrome (syndrome X) in a biracial (Black-White) population of children, adolescents, and young adults: the Bogalusa Heart Study. Am J Epidemiol 1999; 150: 667-674. (Pubitemid 29463192)
2. Cook S, Weitsman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescence: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003; 157: 821-827.
3. Goodman E, Dolan LM, Morrison JA, Daniels SR. Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation 2005; 111: 1970-1977.
4. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW et al. Obesity and metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362-2374.
5. Golley RK, Magarey AM, Steinback KS, Baur LA, Daniels LA. Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study. Int J Obes 2006; 30: 853-860.
6. Brambilla P, Lissau I, Flodmark CE, Moreno LA, Widhalm K, Wabitsch M et al. A metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome. Int J Obes 2007; 31: 591-600.
7. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S et al. The metabolic syndrome in children and adolescents. Lancet 2007; 369: 2059-2061.
8. Eisenmann JC. On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol 2008; 7: 17.
9. Ekelund U, Anderssen S, Andersen LB, Riddoch CJ, Sardinha LB, Luan J et al. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr 2009; 89: 90-96.
10. Pan Y, Pratt CA. Metabolic syndrome and its association with diet and physical activity in US adolescents. J Am Diet Assoc 2008; 108: 276-286.
11. Williams D, Prevost A, Whichelow M, Cox B, Day N, Wareham N. A cross-sectional study of dietary patterns with glucose intolerance and other features of the metabolic syndrome. Br J Nutr 2000; 83: 257-266.
12. Pereira MA, Jacobs Jr DR, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 2002; 287: 2081-2089.
13. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005; 28: 2823-2831.
14. Grundy SM, Hansen B, Smith SC, Cleeman JI, Kahn RA. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/ American Diabetes Association conference on scientific issues related to management. Circulation 2004; 109: 551-556.
15. Brown TM, Sanderson BK, Bittner V. Drugs are not enough: metabolic syndromeFa call for intensive therapeutic lifestyle change. J Cardiometabol Syndr 2009; 4: 20-25.
16. Liberman JN, Berger JE, Lewis M. Prevalence of antihyperten-sive, antidiabetic, and dyslipidemic prescription medication use among children and adolescents. Arch Pediatr Adolesc Med 2009; 163: 357-364.
17. Molnar D, Livingstone B. Physical activity in relation to overweight and obesity in children and adolescents. Eur J Pediatr 2000; 159 (Suppl 1): S45-S55.
18. Eisenmann JC. Aerobic fitness, fatness and the metabolic syndrome in children and adolescents. Acta Paediatrica 2007; 96: 1723-1729.
19. Henriksen EJ. Invited review: effects of acute exercise and exercise training on insulin resistance. J Appl Physiol 2002; 93: 788-796.
20. Steele RM, Brage S, Corder K, Wareham NJ, Ekelund U. Physical activity, cardiorespiratory fitness, and the metabolic syndrome in youth. J Appl Physiol 2008; 105: 342-351.
21. Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes 2008; 32: 1-11.
22. Ferguson MA, Gutin B, Le NA, Karp W, Litaker M, Humphries M et al. Effects of exercise training and its cessation on components of the insulin resistance syndrome in obese children. In J Obes 1999; 23: 889-895. (Pubitemid 29378266)
23. Kang HS, Gutin B, Barbeau P, Owens S, Lemmon CR, Allison J et al. Physical training improves insulin resistance syndrome markers in obese adolescents. Med Sci Sports Exerc 2002; 34: 1920-1927.
24. Sung RY, Yu CW, Chang SK, Mo SW, Woo KS, Lam CW. Effects of dietary intervention and strength training on blood lipid level in obese children. Arch Dis Child 2002; 86: 407-410.
25. Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U. A two year family based behaviour treatment for obese children. Arch Dis Child 2005; 90: 1235-1238.
26. Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A. Short- and long-term beneficial effects of a combined dietary-behavioural-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005; 115: e443-e449.
27. Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan J, Allen DB. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Arch Pediatr Adolesc Med 2005; 159: 963-968.
28. Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48: 1865-1870.
29. Shaibi GQ, Cruz ML, Ball GD, Weigensberg MJ, Salem GJ, Crespo NC et al. Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Med Sci Sports Exerc 2006; 38: 1208-1215.
30. Kelley GA, Kelley KS. Aerobic exercise and lipids and lipopro-teins in children and adolescents: a meta-analysis of randomized controlled trials. Atherosclerosis 2007; 191: 447-453.
31. Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009; 25: 2396-2406.
32. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes 2009; 4: 205-214.
33. Janssen J, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 2010; 7: 40.
34. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.
35. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100: 126-131.
36. Bouchard C, Shephard RJ. Physical activity, fitness, and health: the model and key concepts. In: Bouchard C, Shephard RJ, Stephens T (eds). Physical Activity, Fitness, and Health: Interna- tional Proceedings and Consensus Statement. Human Kinetics: Champaign, IL 1994: 77-88.
37. Reaven GM. The metabolic syndrome: is this diagnosis necessary? Am J Clin Nutr 2006; 83: 1237-1247.
38. Caprio S, Hyman LD, Limb C, McCarthy S, Lange R, Sherwin RS et al. Central adiposity and its metabolic correlated in obese adolescent girls. Am J Physiol Endocrinol Metab 1995; 269: E118-E126.
39. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Eng J Med 2002; 346: 802-810.
40. Jiang X, Srinivasan SR, Bao W, Berenson GS. Association of fasting insulin with blood pressure in young individuals: the Bogalusa Heart Study. Arch Intern Med 1993; 153: 323-328.
41. Reddy KJ, Singh M, Bangit JR, Batsell RR. The role of insulin resistance in the pathogenesis of atherosclerotic cardiovascular disease: an updated review. J Cardiovasc Med (Hagerstown) 2010; 11: 633-647.
42. Taksali S, Caprio S, Dziura J, Dufour S, Cali A, Goodman R et al. High visceral and low abdominal subcutaneous fat stores in the obese adolescents: a determinant of an adverse metabolic phenotype. Diabetes 2008; 57: 367-371.
43. Kashyap SR, De Fronzo RA. The insulin resistance syndrome: physiological considerations. Diab Vasc Dis Res 2007; 4: 13-19.
44. Goran MI, Bergman RN, Gower BA. Influence of total vs. visceral fat on insulin action and secretion in African American and white children. Obes Res 2001; 9: 423-431.
45. Ku CY, Gower BA, Hunter GR, Goran MI. Racial differences in insulin secretion and sensitivity in prepubertal children: role of physical fitness and physical activity. Obes Res 2000; 8: 506-515.
46. Thompson PD, Crouse SF, Goodpaster B, Kelley D, Moyna N, Pescatello L. The acute versus the chronic response to exercise. Med Sci Sports Exerc 2001; 33 (Suppl 6): S438-S445.
47. Holloszy JO. Exercise-induced increase in muscle insulin sensitivity. J Appl Physiol 2005; 99: 338-343.
48. Ren JM, Semenkovic CF, Gulve EA, Gao J, Holloszy JO. Exercise induces rapid increases in GLUT4 expression, glucose transport capacity, and insulin-stimulated glycogen storage in muscle. J Biol Chem 1994; 269: 14396-14401.
49. Venables MC, Jeukendrup AE. Endurance training and obesity: effect on substrate metabolism and insulin sensitivity. Med Sci Sports Exerc 2008; 40: 495-502.
50. Dubose KD, Eisenmann JC, Donnelly JE. Aerobic fitness attenuates the metabolic syndrome score in normal-weight, at-risk-for-overweight, and overweight children. Pediatrics 2007; 120: e1262-e1268.
51. Eisenmann JC, Dubose KD, Donnelly JE. Fatness, fitness, and insulin sensitivity among 7- to 9-year-old children. Obesity 2007; 15: 2135-2144.
52. Zhang BB, Zhou G, Li C. AMPK: an emerging drug target for diabetes and the metabolic syndrome. Cell Metab 2009; 9: 407-416.
53. Wong AK, Howie J, Petrie JR, Lang CC. AMP-activated protein kinase pathway: a potential therapeutic target in cardiometa-bolic disease. Clin Sci 2009; 116: 607-620.
54. Aucouturier J, Baker JS, Duché P. Fat and carbohydrate metabolism during submaximal exercise in children. Sports Med 2008; 38: 213-218.
55. Allen DB, Nemeth BA, Randall Clark R, Peterson SE, Eickhoff J, Carrel AL. Fitness is a stronger predictor of fasting insulin levels than fatness in overweight male middle-school children. Pediatrics 2007; 150: 383-387.
56. Szamosi A, Czinner A, Szamosi T, Sallai A, Hatunic M, Berla Z et al. Effect of diet and physical exercise treatment on insulin resistance syndrome of schoolchildren. J Am Coll Nutr 2008; 27: 177-183.
57. 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. (Pubitemid 44067246)
58. Brage S, Wedderkopp N, Ekelund U, Franks PW, Wareham NJ, Andersen LB et al. Objectively measured physical activity correlates with indices of insulin resistance in Danish children. The European Youth Heart Study. Int J Obes 2004; 28: 1503-1508. (Pubitemid 39481856)
59. Butte NF, Puyau MR, Adolph AL, Vohra FA, Zakeri I. Physical activity in nonoverweight and overweight Hispanic children and adolescents. Med Sci Sports Exerc 2007; 39: 1257-1266.
60. Ekelund U, Anderssen SA, Froberg K, Sardinha LB, Andersen LB, Brage S. Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European Youth Heart Study. Diabetologia 2007; 50: 1832-1840.
61. Ekelund S, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB et al. TV viewing and physical activity are independently associated with metabolic risk in children. The European Youth Heart Study. PLoS Med 2006; 3: e488.
62. Rizzo NS, Ruiz JR, Hurtig-Wennlof A, 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: 388-394. (Pubitemid 46437328)
63. 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.
64. Brunet M, Chaput J-P, Tremblay A. The association between low physical fitness and high body mass index or waist circumference is increasing with age in children: the 'Québec en Forme' Project. Int J Obes 2007; 31: 637-643.
65. Ruiz JR, Rizzo NS, Hurtig-Wennlof A, Ortega FB, Warnberg J, Sjostrom 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: 298-302.
66. Eisenmann JC, Wickel EE, Welk GJ, Blair SN. Association between cardiorespiratory fitness and fatness during adolescence and cardiovascular disease risk factors in adulthood: the Aerobics Center Longitudinal Study. Am Heart J 2005; 149: 46-53.
67. Mark AE, Janssen I. Dose-response relation between physical activity and blood pressure in youth. Med Sci Sports Exerc 2008; 40: 1007-1012.
68. Thomas AS, Greene LF, Ard JD, Oster RA, Darnell BE, Gower BA. Physical activity may facilitate diabetes prevention in adolescents. Diabetes Care 2009; 32: 9-13.
69. Barlow CE, Kohl III HW, Gibbons LW, Blair SN. Physical fitness, mortality and obesity. Int J Obes 1995; 19: S41-S44.
70. Ruderman NB, Schneider SH, Berchtold P. The 'metabolically-obese' normal-weight individual. Am J Clin Nutr 1981; 34: 1617-1621.
71. Conus F, Allison DB, Rabasa-Lhoret R, St-Onge M, St-Pierre DH, Tremblay-Lebeau A et al. Metabolic and behavioural characteristics of metabolically obese but normal-weight women. J Clin Endocrinol Metab 2004; 89: 5013-5020.
72. Lee SL, Kuk JL, Katzmarzyk PT, Blair SN, Church TS, Ross R. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Diabetes Care 2005; 28: 895-901.
73. Lee SL, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and cardiovascular disease mortality in men. Am J Clin Nutr 1999; 69: 373-380.
74. Janiszewski PM, Ross R. The utility of physical activity in the management of global cardiometabolic risk. Obesity 2009; 17 (Suppl 3): 3-14.
75. Church T. The low-fitness phenotype as a risk factor: more than just been sedentary? Obesity 2009; 17 (Suppl 3): 39-42.
76. Slents CA, Houmard JA, Kraus WE. Exercise, abdominal obesity, skeletal muscle, and metabolic risk: evidence for a dose response. Obesity 2009; 17 (Suppl 3): 27-33.
77. Nemet D, Wang P, Funahashi T, Matsuzawa Y, Tanaka S, Engelman L et al. Adipocytokines, body composition, and fitness in children. Pediatr Res 2003; 53: 148-152.
78. Ward DS, Bar Or O. Role of the physician and physical education teacher in the treatment of obesity at school. Pediatrician 1986; 13: 44-51.
79. Barlow SE, The Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 (Suppl 4): 164-192.
80. Hill JO, Wyatt HR. Role of physical activity in preventing and treating obesity. J Appl Physiol 2005; 99: 765-770.
81. Atlantis E, Barnes EH, Singh MA. Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes 2006; 30: 1027-1040.
82. Epstein LH, Goldfield GS. Physical activity in the treatment of childhood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (Suppl 11): S553-S559.
83. Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr 1995; 49: 1-10.
84. Wing R. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issue. Med Sci Sports Exerc 1999; 31: S547-S552.
85. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41: 459-471.
86. Garrow JS. Effect of exercise on obesity. Acta Med Scand 1986; 711: 67-73.
87. American Academy of Pediatrics. Physical fitness and activity in schools. Pediatrics 2000; 105: 1156-1157.
88. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for American 2000. Available at: http://www.health.gov/ dietaryguidelines. Accessed 10 January 2010.
89. Center for Disease Control and Prevention. Physical activity for everyone: recommendations. Available at: http://www.cdc. gov/nccdphp/dnpa/ physical/recommendations/young.htm Accessed 10 January 2010.
90. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146: 732-737.
91. 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: 217-224.
92. Armstrong N, Bray S. Physical activity patterns defined by continuous heart rate monitoring. Arch Dis Child 1991; 66: 245-247.
93. Maffeis C. Physical activity in the prevention and treatment of childhood obesity: physio-pathologic evidence and promising experiences. Int J Pediatr Obes 2008; 3 (Suppl 2): 29-32.
94. 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.
95. Riddoch CJ, Boreham CAG. The health-related physical activity of children. Sports Med 1995; 19: 86-102.
96. Telama R, Yang X, Laakso L, Viikari J. Physical activity in childhood and adolescence as a predictor of physical activity in young adulthood. Am J Prev Med 1997; 13: 317-323.
97. Gutin B, Yin Z, Humphries M, Barbeau P. Relations of moderate & vigorous physical activity to fitness and fatness in adolescents. Am J Clin Nutr 2005; 81: 746-750. (Pubitemid 41724979)
98. Molinar-Urdiales D, Riuz JR, Ortega FB, Rey-Lopez JP, Vicente-Rodriguez G, Espana-Romero V et al. Association of objectively assessed physical activity with total and central body fat in Spanish adolescents: the HELENA study. Int J Obes 2009; 33: 1126-1135.
99. Steele R, van Sluijs E, Cassidy A, Griffin S, Ekelund U. Targeting sedentary time or moderate- and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children. Am J Clin Nutr 2009; 90: 1185-1192.
100. Hopkins ND, Stratton G, Tinken TM, McWhannell N, Ridgers ND, Graves LEF et al. Relationships between measures of fitness, physical activity, body composition and vascular function in children. Atherosclerosis 2009; 204: 244-249.
101. Zunquin G, Theunynck D, Sesboué B, Arhan P, Bouglé D. Comparison of fat oxidation during exercise in lean and obese pubertal boys: clinical implications. Br J Sports Med 2009; 43: 869-870.
102. Manders RJ, Van Dijk JW, van Loon LJ. Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc 2010; 42: 219-225.
103. Leary SD, Ness AR, Smith GD, Mattocks C, Deere K, Blair SN et al. Physical activity and blood pressure in childhood: findings from a population-based study. Hypertension 2008; 51: 92-98.
104. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ et al. Breaks in sedentary time: beneficial association with metabolic risk. Diabetes Care 2008; 31: 661-666.
105. Spinks AB, Macpherson AK, Bain C, McClure RJ. Compliance with the Australian national physical activity guidelines for children: relationship to overweight status. J Sci Med Sport 2007; 10: 156-163.
106. Vona M, Codeluppi GM, Iannino T, Ferrari MD, Bogousslavsky J, von Segesser E. Effects of different types of exercise training followed by detraining on endothelium-dependent dilatation in patients with recent myocardial infarction. Circulation 2009; 119: 1601-1608.
107. Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985; 75: 807-812.
108. Faith MS, Berman N, Heo M, Pietrobelli A, Gallagher D, Epstein LH et al. Effects of contingent television on physical activity and television viewing in obese children. Pediatrics 2001; 107: 1043-1048.
109. Lemmon CR, Ludwig DA, Howe CA, Ferguson-Smith A, Barbeau P. Correlates of adherence to a physical activity program in young African-American girls. Obesity 2007; 15: 695-703.
110. Epstein LH, Wrotniak BH. Future direction for pediatric obesity treatment. Obesity 2010; 18: 8-12.
111. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32: S498-S504.
112. Harrell JS, McMurray RG, Baggett CD, Pennell ML, Pearce PF, Bangdiwala SI. Energy costs of physical activities in children and adolescents. Med Sci Sports Exerc 2005; 37: 329-336.
113. Reilly JJ, Penpraze V, Hislop J, Davies G, Grant S, Paton JY. Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child 2008; 93: 614-619.
114. Byrne NM, Hills AP, Hunter GR, Weinsier RL, Schutz Y. Metabolic equivalent: one size does not fit all. J Appl Physiol 2005; 99: 1112-1119.
115. Steptoe A, Rink E, Kerry S. Psychosocial predictors of change in physical activity in overweight sedentary adults following counseling in primary care. Prev Med 2000; 31: 183-194.
116. Kushner RF, Jackson Blatner D, Jewell DE, Rudloff K. The PPET Study: people and pets exercising together. Obesity 2006; 14: 1762-1770.
117. Yanovski SZ. Pharmacotherapy for obesity: promise and uncertainty. N Engl J Med 2005; 353: 2187-2189.
118. Leung WYS, Thomas N, Chan JCN, Tomlinson B. Weight management and current options in pharmacotherapy: orlistat and sibutramine. Clin Ther 2003; 25: 58-80.
119. Berkowitz RI, Fujioka K, Daniels SR, Hoppin AG, Owen S, Perry AC et al. Effects of sibutramine treatment in obese adolescents: a randomized trial. Ann Intern Med 2006; 145: 81-90.
120. Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 2005; 293: 2873-2883.
121. Zhou G, Meyers R, Li Y, Chen Y, Shen X, Fenyk-Melody J et al. Role of AMP-activated protein kinase in mechanism of metfor-min action. J Clin Invest 2001; 108: 1167-1174.
122. Park MH, Kinra S, Ward KJ, White B, Viner RM. Metformin for obesity in children and adolescents: a systematic review. Diabetes Care 2009; 32: 1743-1745.
123. Love-Osborne K, Sheeder J, Zeitler P. Addition of metformin to a lifestyle modification program in adolescents with insulin resistance. J Pediatr 2008; 152: 817-822.
124. Srinivasan S, Ambler GR, Baur LA, Garnett SP, Tepsa M, Yap F et al. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvements in body composition and fasting insulin. J Clin Endocrinol Metab 2006; 91: 2074-2080.
125. Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD et al. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improved insulin resistance. Endocrine 2009; 36: 141-146.
126. Ott C, Schmieder RE. The role of statins in the treatment of the metabolic syndrome. Curr Hypertens Rep 2009; 11: 143-149.
127. Lande MB, Flynn JT. Treatment of hypertension in children and adolescents. Pediatr Nephrol 2009; 24: 1939-1949.
128. Flynn JT, Daniels SR. Pharmacologic treatment of hypertension in children and adolescents. J Pediatr 2006; 149: 746-754.
129. Ekeland E, Heian F, Hagen KB, Abbott J, Nordheim L. Exercise to improve self-esteem in children and young people. Cochrane Database Syst Rev 2004; Supplement: (1) CD003683.
130. Forwood MR, Baxter-Jones AD, Beck TJ, Mirwald RL, Howard A, Bailey DA. Physical activity and strength of the femoral neck during the adolescent growth spurt: a longitudinal analysis. Bone 2006; 38: 576-583.
131. Eliakin A, Nemet D, Zaldivar F, McMurray RG, Culler FL, Galassetti P et al. Reduced exercise-associated response of the GH-IGF-I axis and catecholamines in obese children and adolescents. J Appl Physiol 2006; 100: 1630-1637.
132. Wigal SB, Nemet D, Swanson JM, Regino R, Trampush J, Ziegler MG et al. Catecholamine in response to exercise in children with attention deficit hyperactivity disorder. Pediatr Res 2003; 53: 756-761.
133. Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal disorders associated with obesity: a biomecha-nical perspective. Obes Rev 2006; 7: 239-250.
134. Malina RM. Physical growth and biological maturation of young athletes. Exerc Sport Sci Rev 1994; 22: 339-343.
135. Alpert BS. Exercise as a therapy to control hypertension in children. Int J Sports Med 2000; 21 (Suppl 2): S94-S97.
136. Alpert BS. Exercise in hypertensive children and adolescents: any harm done? Pediatr Cardiol 1999; 20: 66-69.
137. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555-576.
138. Johnson WG, Hinkle LK, Carr RE, Anderson DA, Lemmon CR, Engler LB et al. Dietary and exercise interventions for juvenile obesity: long-term effect of behavioural and public health models. Obes Res 1997; 5: 257-261.
139. Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990- 2005. Obesity 2008; 16: 275-284.
140. Celermajer DS. Wait for weight or "waste" the waist: the benefits of early intervention in childhood obesity. J Am Coll Cardiol 2009; 54: 2407-2408.