Hans-Georg Predel

Correlation between BMI, leisure habits and motor abilities in childhood (CHILT-Project)

INTRODUCTION: The prevalence of childhood obesity is increasing with its negative medical and psychosocial consequences. This paper examines the association between body mass index (BMI), motor abilities and leisure habits of 668 children within the CHILT (Childrens Health InterventionaL Trial) project.APPROACH: A total of 668 children (51.0% boys; 49.0% girls) and their parents were questioned on sport and leisure behaviour of the children. The anthropometric data were measured. Motor abilities were determined by a body gross motor development test for children (Köperkoordinationstest für Kinder; KTK) and a 6-min run.RESULTS: The children were 6.70±0.42 y old, 122.72±5.36 cm tall and weighed 24.47±4.59 kg, the average BMI was 16.17±2.27 kg/m2. KTK showed an average motor quotient (MQ) of 93.49±15.01, the 6-min run an average of 835.24±110.87 m. Both tests were inversely correlated with BMI (KTK and BMI r=−0.164 (P<0.001); 6-min run and BMI r=−0.201 (P<0.001)); the group of overweight/obese children showed poorer results than the normal/underweight ones, even after adjustment for gender and age (in each case P<0.001). Children with the greatest extent of exercise achieve the highest MQ (P=0.035).SUMMARY: Overweight/obesity is associated with a poorer body gross motor development and endurance performance. On the other hand, an active lifestyle is positively correlated with a better gross motor development in first-grade children. Therefore, to prevent the negative consequences of physical inactivity and overweight/obesity early intervention to support exercise and movement is recommended.

Physical activity, leisure habits and obesity in first-grade children

Background Overweight and obesity are already on the rise in early childhood years. The relationships between genetic factors, malnutrition and physical inactivity are the underlying mechanisms. In this study, we examine the association between body indices, motor abilities and active (sport) and passive (television/computer) leisure time activities in a cohort of first-grade pupils. Methods The study group consisted of 344 children (51.5% male, 48.5% female). They were 6.8 ± 0.4 years old, height was 123.9 ± 4.9 cm, weight 24.8 ± 5.0 kg, body mass index (BMI) 16.1 ± 2.3 kg/m2. After determination of the anthropometric data, a fitness test was performed in order to determine motor abilities. Parents were questioned about their childrens leisure time activities, using a standardized questionnaire. Differences between BMI groups were evaluated using multivariate ANCOVA, adjusted for gender and age. Results Based on German BMI references, overweight and obesity were found in 12% of the children. They had poorer results with respect to endurance (P<0.001), leg strength (P=0.002), co-ordination and balance (P = 0.045) and spent more leisure time in watching television and at the computer (each P<0.001). No differences were found between their active leisure habits such as club sports. Discussion Our examinations with first-grade children show no differences in active leisure habits between obese children and their counterparts, although the former had poorer results in motor abilities, but they spend more time on sedentary leisure habits like audiovisual media. A possible explanation is their fewer regular daily activities.

School-based prevention: Effects on obesity and physical performance after 4 years

Abstract Juvenile obesity is increasing worldwide. Preventive strategies are warranted. The school-based Childrens Health Interventional Trial (the CHILT Project) combines health education and physical activity for children. The effect on obesity and physical performance was studied after four years in 12 primary schools compared with five control schools. Anthropometric data were recorded. Physical performance was measured by a coordination test for children (balancing backwards, one-legged obstacle jumping, lateral jumping, sideways movements) and a 6-min run (endurance). No difference in the prevalence and incidence of overweight and obesity was found between the intervention and control schools before and after the intervention. Remission of overweight was higher in the intervention schools (23.2 vs. 19.2%), but not significant. An increase in coordination related to lateral jumping and balancing backwards was apparent in the intervention schools (30.6, s = 10.8 vs. 26.1, s = 10.8, P = 0.005; 21.8, s = 11.8 vs. 19.4, s = 11.7, P = 0.007), and the increase in endurance performance tended to be higher in intervention schools (100.8, s = 122.7 vs. 92.8, s = 126.0, P = 0.055), adjusted for age, sex, baseline test result, and body mass index at final examination. Therefore, preventive intervention in primary school offers the possibility to improve physical performance in children. The prevalence and incidence of obesity were not affected.

ACE and angiotensinogen gene genotypes and left ventricular mass in athletes

Background Genetic factors may be important in modifying heart size due to long‐term athletic training. The significance of polymorphisms of genes of the renin–angiotensin system in myocardial mass in a population of athletes participating in different disciplines is not known.

Higher endogenous nitrite levels are associated with superior exercise capacity in highly trained athletes

Factors improving exercise capacity in highly trained individuals are of major interest. Recent studies suggest that the dietary intake of inorganic nitrate may enhance athletic performance. This has been related to the stepwise in vivo bioactivation of nitrate to nitrite and nitric oxide (NO) with the modulation of mitochondrial function. Here we show that higher baseline levels of nitrite are associated with a superior exercise capacity in highly trained athletes independent of endothelial function. Eleven male athletes were enrolled in this investigation and each participant reported twice to the testing facility (total of n=22 observations). Venous blood was obtained to determine the levels of circulating plasma nitrite and nitrate. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD). Hereafter, participants completed a stepwise bicycle exercise test until exhaustion. Blood was drawn from the ear lope to determine the levels of lactate. Lactate anaerobic thresholds (LAT) in relation to heart rate were calculated using non-linear regression models. Baseline plasma nitrite levels correlated with LATs (r=0.65; p=0.001, n=22) and with endothelial function as assessed by FMD (r=0.71; p=0.0002). Correlation coefficients from both testing days did not differ. Multiple linear regressions showed that baseline plasma nitrite level but not endothelial function was an independent predictor of exercise capacity. No such correlations were determined for plasma nitrate levels.

Integrated effects of the vasodilating beta-blocker nebivolol on exercise performance, energy metabolism, cardiovascular and neurohormonal parameters in physically active patients with arterial hypertension

Objective: The present study was designed to investigate the integrated effects of the beta-1-selective blocker with vasodilator properties, nebivolol, on systemic haemodynamics, neurohormones and energy metabolism as well as oxygen uptake and exercise performance in physically active patients with moderate essential hypertension (EH).Design and methods: Eighteen physically active patients with moderate EH were included: age: 46.9 ± 2.38 years, weight: 83.9 ± 2.81 kg, blood pressure (BP): 155.8 ± 3.90/102.5 ± 1.86 mm Hg, heart rate: 73.6 ± 2.98 min−1. After a 14-day wash-out period a bicycle spiroergometry until exhaustion (WHO) was performed followed by a 45-min submaximal exercise test on the 2.5 mmol/l lactate-level 48 h later. Before, during and directly after exercise testing blood samples were taken. An identical protocol was repeated after a 6-week treatment period with 5 mg nebivolol/day.Results: Nebivolol treatment resulted in a significant (P < 0.01) decrease in systolic and diastolic BP and heart rate at rest and during maximal and submaximal exercise. Maximal physical work performance, blood lactate and rel. oxygen uptake (rel. VO2) before and after nebivolol treatment at rest and during maximal and submaximal exercise remained unaltered. Free fatty acid, free glycerol, plasma catecholamines, beta-endorphines and atrial natriuretic peptide (ANP) increased before and after treatment during maximal and submaximal exercise but remained unaltered by nebivolol treatment. In contrast, plasma ANP levels at rest were significantly higher in the presence of nebivolol, endothelin-1 levels were unchanged.Conclusions: Nebivolol was effective in the control of BP at rest and during exercise in patients with EH. Furthermore, nebivolol did not negatively affect lipid and carbohydrate metabolism and substrate flow. The explanation for the effects on ANP at rest remain elusive. This pharmacodynamic profile of nebivolol is potentially suitable in physically active patients with EH.

Efficacy and safety of comfrey root extract ointment in the treatment of acute upper or lower back pain: results of a double-blind, randomised, placebo controlled, multicentre trial

Objective The objective was to show the superiority of comfrey root extract ointment to placebo ointment in patients with acute upper or lower back pain. Design The study was conducted as a double-blind, multicentre, randomised clinical trial with parallel group design over a period of 5 days (SD 1). The patients (n = 120, mean age 36.9 years) were treated with verum or placebo ointment three times a day, 4 g ointment per application. The trial included four visits. Main Outcome Measures The primary efficacy variable was the area under the curve (AUC) of the visual analogue scale (VAS) on active standardised movement values at visits 1 to 4. The secondary efficacy variables were back pain at rest using assessment by the patient on VAS, pressure algometry (pain–time curve; AUC over 5 days), global assessment of efficacy by the patient and the investigator, consumption of analgesic medication and functional impairment measured using the Oswestry disability index. Results There was a significant treatment difference between comfrey extract and placebo regarding the primary variable. In the course of the trial the pain intensity on active standardised movement decreased on average (median) approximately 95.2% in the verum group and 37.8% in the placebo group. Conclusions The results of this clinical trial were clear-cut and consistent across all primary and secondary efficacy variables. Comfrey root extract showed a remarkably potent and clinically relevant effect in reducing acute back pain. For the first time a fast-acting effect of the ointment (1 h) was also witnessed.

The whey fermentation product malleable protein matrix decreases TAG concentrations in patients with the metabolic syndrome: a randomised placebo-controlled trial.

Animal and human studies suggest that a malleable protein matrix (MPM) from whey decreases plasma lipid concentrations and may positively influence other components of the metabolic syndrome such as glucose metabolism and blood pressure (BP). The primary objective of this double-blind, multi-centre trial was to investigate the effects of a low-fat yoghurt supplemented with whey MPM on fasting TAG concentrations in patients with the metabolic syndrome. A total of 197 patients were randomised to receive MPM or a matching placebo yoghurt identical in protein content (15 g/d). Patients were treated during 3 months with two daily servings of 150 g yoghurt each to compare changes from baseline in efficacy variables. MPM treatment resulted in a significantly larger reduction of TAG concentrations in comparison to placebo (relative change -16%, P=0·004). The difference was even more pronounced in subjects with elevated fasting TAG (≥200 mg/dl) at baseline (-18%, P=0·005). The relative treatment difference in fasting plasma glucose was -7·1 mg/dl (P=0·089). This effect was also more pronounced in subjects with impaired fasting glucose at baseline (-11 mg/dl, P=0·03). In patients with hypertension, the relative treatment difference in systolic BP reached -5·9 mmHg (P=0·054). The relative treatment difference in body weight was -1·7 kg (P=0·015). The most common adverse events were gastrointestinal in nature. Conclusions from the present study are that consumption of a low-fat yoghurt supplemented with whey MPM twice a day over 3 months significantly reduces fasting TAG concentrations in patients with the metabolic syndrome and improves multiple other cardiovascular risk factors.

Änderung der körperlichen Leistungsfähigkeit durch ein vierwöchiges kardiales Rehabilitationsprogramm der Phase II

Während eines 4wöchigen ambulanten Rehabilitationsprogramms wurden 262 KHK-Patienten, 235 Männer und 27 Frauen, Durchschnittsalter 53,6±10,2 Jahre, im Mittel 30,5±2,9 Therapiestunden im Bereich der Bewegungs- und Sporttherapie unterzogen. Inhaltlicher Schwerpunkt war ein dosiertes Ergometertraining 5mal pro Woche. Im Mittel wurden 18,4±1,8 Trainingseinheiten auf dem Ergometer absolviert. Vor und nach der Rehabilitation wurde die Leistungsfähigkeit mittels einer Belastungsuntersuchung auf dem Fahrradergometer überprüft. Auf jeder Belastungsstufe wurde neben Pulsfrequenz- und Blutdruckmessung auch eine Blutprobe aus dem hyperämisierten Ohrläppchen entnommen für die Bestimmung der Laktatkonzentration im arterialisierten Blut. Die Bestimmung der Laktatkonzentration bei ansteigender Belastung ermöglicht eine exakte Beurteilung der Ausdauerleistungsfähigkeit und dadurch eine gezielte Intensitätssteuerung während der Therapie. Weiter kann durch die Kontrolle des Laktatwertes der Therapieerfolg objektiv nachgewiesen werden. Die Ergebnisse der Vor- und Nachuntersuchung zeigten eine hochsignifikante Steigerung der maximalen Ergometerleistung von 105,3±32,3 auf 121,9±37,3 Watt. Die relative Leistungsfähigkeit wurde von 1,30±0,39 auf 1,51±0,44 Watt/kg Körpergewicht erhöht. Die mittlere Leistung bei 2,0 mmol/l Laktat im Blut wurde von 72,2±23,5 auf 86,4±25,8 Watt um 19,7%, bei 2,5 mmol/l von 83,5±23,2 auf 97,4±26,4 Watt um, 16,6% und bei 3,0 mmol/l von 93,1±23,0 auf 106,6±26,1 Watt um 14,5% jeweils hochsignifikant gesteigert. Die Herzfrequenz bei der Belastung von 2,0, 2,5 und 3,0 mmol/l Laktat blieb trotz erhöhter Wattleistung unverändert. Die Leistung für definierte Herzfrequenzwerte wurde bei allen definierten Herzfrequenzwerten (85, 90, 95, 100, 105, 110) jeweils hochsignifikant erhöht. Am deutlichsten war die Steigerung bei Herzfrequenz 110/min mit 22,8%. Die Ergebnisse zeigen, daß durch die Rehabilitation die Leistungsfähigkeit der Patienten verbessert wurde. Wie die Veränderung der erreichten Wattleistung für definierte Laktat- und Herzfrequenzwerte zeigt, basiert die beobachtete Leistungssteigerung auf einer Verbesserung der Ausdauerleistungsfähigkeit mit Ökonomisierung der Herzkreislauffunktion, verbunden mit einer für den Herzpatienten wertvollen Senkung der Herzfrequenz, und nicht lediglich auf dem psychologischen Effekt einer gesteigerten Ausbelastung auf Grund einer stärkeren Motivation des untersuchten Patietnen bzw. der Untersucher. Der Bezug auch auf die Laktatwerte ließ diesen Effekt auch unabhängig von eventueller medikamentöser Einwirkung (β-Rezeptoren-Blocker) nachweisen. During a 4-week ambulatory cardiacc rehabilitation program, 262 patients with coronary artery disease (CAD), 235 men and 27 women, 53.6±10.2 years, performed 30.5±2,9 exercise units. Before and after the rehabilitation program exercise, capacity was assessed by bicycle ergometry. There was a significant (p<0.001) increase in the maximum exercise capacity at the end of the program (105.3±32.3 vs. 121.9±37.3 W). Physical work capacity on the 2.0 mmol lactate level improved (p<0.001) from 72.2±23.5 to 86.4±25.8 W, on the 2.5 mmol/l level (p<0.001) from 83.5±23.2 to 97.4±26.4 W, and on the 3.0 mmol/l level (p<0.001) from 93.1±23.0 to 106.6±26.1 W. Despite enhanced performance, heart rate remained unaltered on the 2.0, 2.5, and 3.0 mmol/l lactate level. Furthermore, ergometric performance on predefined heart rate levels was significantly (p<0.001) increased: 85/min: from 56.0±24.1 to 65.8±24.5 W; 90/min: from 62.0±27.3 to 71.2±26 W; 95/min: from 67.2±26.4 to 77.5±27.6 W; 100/min: from 71.1±29.6 to 80.6±28.1 W; 105/min: from 69.8±26.2 to 81.9±28.2 W and 110/min: from 73.6±28.9 to 90.4±29.4 W. The results demonstrate that physical performance in patients with CAD was improved by our novel ambulatory cardiac rehabilitation program. This improvement included an increase in maximum as well as endurance work capacity; furthermore, this increase was accompanied by a decrease in resting and exercise heart rates. The results demonstrate an absolute increase of physical performance, more importantly an increase of physical performance at defined lactate levels in the presence of unchanged heart rates mediated by the rehabilitation program. Thus, this increase was independent of motivational factors in the patients and/or the investigators during the re-exercise test. On the contrary, our data demonstrate that it is based on an improvement of aerobic endurance capacity associated with a therapeutically beneficial significant decrease of heart rate for a defined workload. The effects were independent of pharmacological influences (e.g., β-receptor antagonists). These findings are of clinical importance with respect to reduction of myocardial oxygen consumption in patients with CAD.

Ambulante kardiale Rehabilitation der Phase II — „Kölner Modell“ — einschließlich der Ergebnisse drei Jahre nach Abschluß der Rehabilitation

ZusammenfassungVom 1. 1. 1992 bis 31. 12. 1994 wurde in Köln ein Modell der ambulanten kardialen Rehabilitation (AR) der Phase II durch- und bis heute fortgeführt. Ziel des „Kölner Modells“ war es, zu überprüfen, inwieweit und unter welchen Bedingungen sich die Inhalte der stationären Rehabilitation ohne Qualitätsverlust in den ambulanten Bereich übertragen lassen. Die Ergebnisse sollen der Standardisierung und der Qualitätskontrolle einer zukünftigen AR dienen.1992 bis 1994 haben 108 Patienten mit koronarer Herzkrankheit, die den Modellkriterien entsprachen, (94 Männer und 14 Frauen, 52,3±8 Jahre alt, kardiale Indikation in 74 Fällen Herzinfarkt, in 34 Fällen koronare Herzkrankheit mit invasiver Gefäßerweiterung) die AR begonnen. Hinzu kamen 45 „Nichtmodellpatienten“ mit höherem kardialen Risiko. Sieben Modellpatienten brachen die AR vorzeitig ab, davon zwei aus kardialen Gründen. Für die Wahl der AR nannten 40,6% der Patienten Abneigung gegen die Klinikatmosphäre, 43,6% familiäre und 12,9% berufliche Gründe.Während der vierwöchigen AR absolvierten die Patienten im Mittel 72,9±6,7 Therapiestunden. Durch die AR wurde die Belastbarkeit von 116,4±28,8 auf 129,9±34,6 Watt hochsignifikant (**) gesteigert. Dieser Effekt war sowohl ein als auch drei Jahre nach AR (128,7±35,8**) noch nachweisbar. Ein Jahr nach AR gaben 77% der Patienten an, in der ambulanten Herzgruppe (AHG) (27,6%) oder selbständig (49,4%) Sport zu treiben. Drei Jahre nach AR waren immer noch 59,2% der Patienten regelmäßig körperlich aktiv. Durch die AR wurde das Ernährungsverhalten verändert. Unter anderem wurden die Fettzufuhr um 20,8%, die Zufuhr von gesättigten Fettsäuren um 30,7% und die von Cholesterin um 30,5% reduziert. Die Cholesterinwerte wurden von 231±49,8 auf 213,2±35,9 mg%** reduziert. Sechs (und zwölf) Monate nach AR waren sie auf 225,6±39,4 mg% wieder angestiegen. Drei Jahre nach AR lagen die Cholesterinwerte im Mittel bei 219,1±39,3 mg%. In der Risikogruppe (>220 mg%) wurden sie von 266±44 auf 232±31,9 mg%** gesenkt. Sechs und zwölf Monate nach AR lagen sie mit 239,7±35,8 mg% bzw. 245,8±32,6 mg% immer noch hochsignifikant niedriger als vor AR, obwohl nur 19% der Patienten mit Lipidsenkern behandelt wurden. Drei Jahre nach AR lagen sie in dieser Gruppe bei 234,6±37,7 mg%**. 34,2% der Patienten wurden zu diesem Zeitpunkt mit Lipidsenkern behandelt. Das Körpergewicht konnte im Mittel nicht beeinflußt werden. Das Rauchverhalten wurde im akuten Verlauf unwesentlich verändert: Vor dem Ereignis hatten 67,3% der Patienten geraucht. Zu Beginn und am Ende der AR rauchten 20,8%. Ihr Konsum war von 32,4±15,2 auf 6,9±5,2 Zigaretten pro Tag gesunken. Ein Jahr nach AR rauchten 23%. Drei Jahre nach AR war der Raucheranteil auf 30,3% angestiegen. Vor der AR waren 73,3% der Patienten berufstätig. Von diesen waren sechs Monate nach AR 68,2% und ein Jahr nach AR 73% berufstätig.Die Ergebnisse zeigen, daß es gelingt, die Inhalte der bewährten stationären Rehabilitation für bestimmte Patientengruppen ohne Qualitätsverlust oder erhöhtes Risiko in den ambulanten Bereich zu übertragen und daß hierdurch vergleichbar gute Resultate erzielt werden können. Die Befunde bestätigen die Notwendigkeit von generellen Langzeitkontrollen der Rehabilitationserfolge. Hierdurch können Defizite des derzeitigen Rehabilitationssystems und der ambulanten Weiterversorgung der Patienten aufgedeckt und konstruktive Verbesserungsvorschläge erarbeitet werden.AbstractFrom January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performed and is still in progress. In Germany until 1992 the cardiac rehabilitation was exclusively performed stationary. The objective of the “Cologne model” was to evaluate, whether the transfer of the stationary cardiac rehabilitation programs into the ambulatory setting is achievable without deficits in efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory cardiac rehabilitation programs in Germany.From 1992 to 1994 108 patients (94 men, 14 women; 52.3±8.0 years old) with coronary artery disease (CAD) which were compatible with the criteria of the “Cologne model” (Table 1) participated in the 4-week ACR. The indications for inclusion into the ACR were in 74 cases a myocardial infarction (MI), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Seven patients discontinued the ACR prematurely, 2 patients because of cardiovascular reasons. Reasons for the preference of the ambulatory over a stationary cardiac rehabilitation program were in 40.6% of the patients refusal of “hospital ambience”, in 43.6% familiar or in 12.9% professional reasons.During the 4-week ACR patients participated in a mean of 72.9±6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4±28.8 to 129.9±34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7±35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stated to be physically active in ambulatory heart groups (AHG) (27.6%) or on their own (49.4%). Three years after ACR the rate of regularly physically active patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly. There was a reduction in the consumption of lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 30.5%. The plasma concentrations of cholesterol decreased from 231±49.8 to 213.2±35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6±39.4 mg%. Three years after ACR the mean cholesterol level was 219.1±39.3 mg%. In the high risk group (cholesterol at the initial visit >220 mg%) cholesterol levels were reduced from 266±44 to 232±31.9 mg%**. Six and 12 months after ACR they were 239.7±35.8 mg% and 245.8 ± 32.6 mg%, respectively, (Tables 6 and 7) and still significantly lower than before ACR, though only 19% of the patients were treated with lipid lowering agents. Three years after ACR cholesterol were 234.6±37.7 mg%** in the high-risk group. 34.2% of the patients received lipid lowering agents. Mean body weight remained unaltered over the 3-year period. Smoking behavior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes. At the beginning and at the end of ACR 20.8% of the patients still smoked. During the ACR the number of smoked cigarettes was reduced significantly from 32.4±15.2 to 6.9±5.2 cigarettes per day. One year after ACR 23% of the patients were smokers, 3 years after ACR the percentage of smokers increased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percent-age increased to 73% in the following 6 months.The results demonstrate that it is achievable to transfer the contents of the established stationary cardiac rehabilitation programs into the ambulatory setting without loss of efficiency, safety and overall quality. It is further confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. This will allow to identify deficits in the existing system of cardiac rehabilitation and the subsequent ambulatory rehabilitation treatment and to work out constructive strategies for further improvement.