Amanda Gier

The Feasibility of High-Intensity Interval Exercise in Obese Adolescents

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.

Obese Children in a Community YMCA “Fun 2B Fit” Program Have a Reduction in BMI Z-Scores

Childhood obesity continues to be a major health problem in the United States, with more than 30% of children overweight or obese. Pediatric weight management programs have been shown to be effective, but the access to these programs are limited by capacity and regional availability. Given the magnitude of the problem, efforts have been made to educate primary care pediatric providers on the medical management of this disorder. Ancillary services, however, such as dietitian services and exercise programs geared for overweight and obese children, are often lacking in many communities. Some community-based childhood obesity efforts have addressed the physical activity component by establishing YMCA-based exercise programs. The Center for Better Health and Nutrition (CBHN) is a pediatric weight management program that includes medical evaluation and treatment for overweight and obese youth. In addition, it includes a comprehensive intervention program called HealthWorks!, which offers dietitian and exercise services. The HealthWorks! (HW) program was established in 1999 and was offered only at our main campus until 2006 when the program was expanded to include 4 community-based satellite clinics. This created the need for accompanying exercise programs at the satellite locations. We addressed this need by establishing 4 community YMCA-based exercise programs called “Fun 2B Fit” for obese and overweight children in those communities. With this study, we describe the program’s effectiveness and compare the outcome of HW children attending Fun 2B Fit with those enrolled in Fun 2B Fit alone (non-HW).