Kevin R. Short

Playing Active Video Games Increases Energy Expenditure in Children

OBJECTIVE: To compare energy expenditure rates in children playing the physically active video games, Dance Dance Revolution (DDR) and Nintendos Wii Sports in relation to treadmill walking. METHODS: Energy expenditure, heart rate, step rate, and perceived exertion were measured in 14 boys and 9 girls (ages 10–13 years; BMI at 3–98th percentile for age and gender) while watching television at rest, playing DDR at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/h. Arterial elasticity was measured at rest and immediately after gaming. RESULTS: Compared with watching television, energy expenditure while gaming or walking increased 2- to 3-fold. Similarly, high rates of energy expenditure, heart rate, and perceived exertion were elicited from playing Wii boxing, DDR level 2, or walking at 5.7 km/h. This occurred despite variations in step rate among activities, reflecting greater use of upper body during Wii play (lowest step rate) than during walking (highest step rate) or DDR play. Wii bowling and beginner level DDR elicited a 2-fold increase in energy expenditure compared to television watching. Large-artery elasticity declined immediately after both DDR and Wii. The change was inversely related to the increment in energy expenditure above rest achieved during the activity. CONCLUSIONS: Energy expenditure during active video game play is comparable to moderate-intensity walking. Thus, for children who spend considerable time playing electronic screen games for entertainment, physically active games seem to be a safe, fun, and valuable means of promoting energy expenditure.

The Potential for High-Intensity Interval Training to Reduce Cardiometabolic Disease Risk

In the US, 34% of adults currently meet the criteria for the metabolic syndrome defined by elevated waist circumference, plasma triglycerides (TG), fasting glucose and/or blood pressure, and decreased high-density lipoprotein cholesterol (HDL-C). While these cardiometabolic risk factors can be treated with medication, lifestyle modification is strongly recommended as a first-line approach. The purpose of this review is to focus on the effect of physical activity interventions and, specifically, on the potential benefits of incorporating higher intensity exercise. Several recent studies have suggested that compared with continuous moderate exercise (CME), high-intensity interval training (HIT) may result in a superior or equal improvement in fitness and cardiovascular health. HIT is comprised of brief periods of high-intensity exercise interposed with recovery periods at a lower intensity. The premise of using HIT in both healthy and clinical populations is that the vigorous activity segments promote greater adaptations via increased cellular stress, yet their short length, and the ensuing recovery intervals, allow even untrained individuals to work harder than would otherwise be possible at steady-state intensity. In this review, we examine the impact of HIT on cardiometabolic risk factors, anthropometric measures of obesity and cardiovascular fitness in both healthy and clinical populations with cardiovascular and metabolic disease. The effects of HIT versus CME on health outcomes were compared in 14 of the 24 studies featuring HIT. Exercise programmes ranged from 2 weeks to 6 months. All 17 studies that measured aerobic fitness and all seven studies that measured insulin sensitivity showed significant improvement in response to HIT, although these changes did not always exceed responses to CME comparison groups. A minimum duration of 12 weeks was necessary to demonstrate improvement in fasting glucose in four of seven studies (57%). A minimum duration of 8 weeks of HIT was necessary to demonstrate improvement in HDL-C in three of ten studies (30%). No studies reported that HIT resulted in improvement of total cholesterol, low-density lipoprotein cholesterol (LDL-C), or TG. At least 12 weeks of HIT was required for reduction in blood pressure to emerge in five studies of participants not already being treated for hypertension. A minimum duration of 12 weeks was necessary to see consistent improvement in the six studies that examined anthropometric measures of obesity in overweight/obese individuals. In the 13 studies with a matched-exercise-volume CME group, improvement in aerobic fitness in response to HIT was equal to (5 studies), or greater than (8 studies) in response to CME. Additionally, HIT has been shown to be safe and effective in patients with a range of cardiac and metabolic dysfunction. In conclusion, HIT appears to promote superior improvements in aerobic fitness and similar improvements in some cardiometabolic risk factors in comparison to CME, when performed by healthy subjects or clinical patients for at least 8–12 weeks. Future studies need to address compliance and efficacy of HIT in the real world with a variety of populations.

Vascular health in children and adolescents: effects of obesity and diabetes

The foundations for cardiovascular disease in adults are laid in childhood and accelerated by the presence of comorbid conditions, such as obesity, diabetes, hypertension, and dyslipidemia. Early detection of vascular dysfunction is an important clinical objective to identify those at risk for subsequent cardiovascular morbidity and events, and to initiate behavioral and medical interventions to reduce risk. Typically, cardiovascular screening is recommended for young adults, especially in people with a family history of cardiovascular conditions. Children and adolescents were once considered to be at low risk, but with the growing health concerns related to sedentary lifestyle, poor diet and obesity, cardiovascular screening may be needed earlier so that interventions to improve cardiovascular health can be initiated. This review describes comorbid conditions that increase cardiovascular risk in youth, namely obesity and diabetes, and describes noninvasive methods to objectively detect vascular disease and quantify vascular function and structure through measurements of endothelial function, arterial compliance, and intima-media thickness. Additionally, current strategies directed toward prevention of vascular disease in these populations, including exercise, dietary interventions and pharmacological therapy are described.

Obese Children Have Higher Arterial Elasticity Without a Difference in Endothelial Function: The Role of Body Composition

The childhood obesity epidemic is expected to increase cardiovascular disease risk, but the impact of obesity on vascular function in children is not fully understood. The purpose of this study was to determine the effect of obesity and maturation on vascular function in normal weight (BMI: 25–75 percentile) and obese (BMI: ≥95 percentile) children ages 8–18 years old. Large and small artery elasticity (LAEI and SAEI, respectively), measured by diastolic radial pulsewave contour analysis, and reactive hyperemia index (RHI), measured by peripheral arterial tonometry, were obtained, along with anthropometric and biochemical outcomes, in 61 normal weight and 62 obese children. SAEI and LAEI increased with age and were 30% and 18% higher, respectively, in obese children (P < 0.01). In contrast, reactive hyperemia increased with age in the normal weight group but did not differ between groups. Multivariate modeling was used to select variables that explained differences in vascular outcomes. The best model for LAEI in normal weight children was height alone (r2 = 0.49), whereas for obese children the best model included height + fat mass (r2 = 0.40). For SAEI, there were no significant models for normal weight children, but for obese children the best model included lean mass + fat mass (r2 = 0.36). Obese children had greater lean and fat mass, and more advanced Tanner stages than their normal weight peers. The increased elasticity observed in obese children appears to reflect accelerated growth and maturation without affecting vascular reactivity measured by reactive hyperemia. Longitudinal follow up will be essential in determining effects on future vascular disease risk.

Effect of inosine supplementation on aerobic and anaerobic cycling performance

Ten competitive male cyclists completed a Wingate Bike Test (WIN), a 30-min self-paced cycling performance bout (END), and a constant load, supramaximal cycling spring (SPN) to fatigue following 5 d of oral supplementation (5,000 mg.day-1) with inosine and placebo. Blood samples were obtained prior to and following both supplementation periods, and following each cycling test. Uric acid concentration was higher (P < 0.05) following supplementation with inosine versus placebo, but 2,3-DPG concentration was not changed. The data from WIN demonstrate that there were no significant differences in peak power (8.5 +/- 0.3 vs 8.4 +/- 0.3 W.kg body mass-1), end power (7.0 +/- 0.3 vs 6.9 +/- 0.2 W.kg body mass-1), fatigue index (18 +/- 2 vs 18 +/- 2%), total work completed (0.45 +/- 0.02 vs 0.45 +/- 0.02 kJ.kg body mass-1.30-s-1), and post-test lactate (12.2 +/- 0.5 vs 12.9 +/- 0.6 mmol.l-1) between the inosine and placebo trials, respectively. No difference was present in the total amount of work completed (6.1 +/- 0.3 vs 6.0 +/- 0.3 kJ.kg body mass-1) or post-test lactate (8.4 +/- 1.0 vs 9.9 +/- 1.3 mmol.l-1) during END between the inosine and placebo trials, respectively. Time to fatigue was longer (P < 0.05) during SPN for the placebo (109.7 +/- 5.6 s) versus the inosine (99.7 +/- 6.9 s) trial, but post-test lactate (14.8 +/- 0.7 vs 14.6 +/- 0.8 mmol.l-1) was not different between the treatments, respectively. These findings demonstrate that prolonged inosine supplementation does not appear to improve aerobic performance and short-term power production during cycling and may actually have an ergolytic effect under some test conditions.

Effects of precooling on thermoregulation during subsequent exercise

PURPOSE The purpose of this study was to examine the effect of a decreased body core temperature before a simulated portion of a triathlon (swim,15 min; bike, 45 min) and examine whether precooling could attenuate thermal strain and increase subjective exercise tolerance in a warm environment (26.6 degrees C/60% relative humidity (rh)). METHODS Six endurance trained triathletes (28+/-2 yr, 8.2+/-1.7% body fat) completed two randomly assigned trials 1 wk apart. The precooling trial (PC) involved lowering body core temperature (-0.5 degrees C rectal temperature, Tre) in water before swimming. The control trial (CON) was identical except no precooling was performed. Water temperature and environmental conditions were maintained at 25.6 degrees C and 26.6 degrees C/60% rh, respectively, throughout all testing. RESULTS Mean time to precool was 31+/-8 min and average time to reach baseline Tre during cycling was 9+/-7 min. Oxygen uptake (VO2), HR, skin temperature (Tsk), Tre, RPE, and thermal sensation (TS) were recorded following the swim segment and throughout cycling. No significant differences in mean body (Tb) or Tsk were noted between PC and CON, but a significant difference (P < 0.05) in Tre between treatments was noted through the early phases of cycling. No significant differences were reported in HR, VO2, RPE, TS, or sweat rate (SR) between treatments. Body heat storage (S) was negative following swimming in both PC (-92+/-6 W x m2) and CON (-66+/-9 W x m2). A greater S occurred in PC (109+/-6 W x m2) vs CON (79+/-4 W x m2) during cycling (P < 0.05). CONCLUSIONS Precooling attenuated the rise in Tre, but this effect was transient. Therefore, precooling is not recommended before a triathlon under similar environmental conditions.

Thermoregulatory responses to cycling with and without a helmet.

This study examined the effects of wearing a helmet on selected body temperatures and perceived heat sensation of the head and body while cycling in a hot-dry (D) (35 degrees C, 20% relative humidity (RH) and hot-humid (H) (35 degrees C, 70% RH) environment. Ten male and four female cyclists (mean +/- SD: males = age 27 +/- 7 yr, peak O2 uptake (VO2) 4.10 +/- 0.54 L.min-1; females = age 26 +/- 3 yr, peak O2 uptake (VO2) 3.08 +/- 0.49 L.min-1) performed four randomized 90-min cycling trials at 60% of peak VO2 both with (HE) and without (NH) a commercially available cycling helmet in both D and H environments. VO2, core (Te), skin (Tsk), and head skin temperatures, heart rate (HR), rating of perceived exertion (RPE), and perceived thermal sensation of head (TSH) and body (TSB) were measured throughout exercise. For all measured variables, no significant difference was evident between HE and NH. However, Tc, Tsk, and mean head skin temperatures were higher (P < 0.001) in H than D. Likewise, RPE, TSH, TSB (P < 0.001), and sweat rates (H = 1.33 +/- 0.32, D = 1.14 +/- 0.23 L.h-1) (P < 0.01) were higher in H versus D. Results indicate that use of a commercially available cycling helmet while riding in a hot-dry or hot-humid environment does not cause the subjects to become more hyperthermic or increase perceived heat sensation of the head or body.

Prevalence and Significance of Cardiometabolic Risk Factors in Children With Type 1 Diabetes

Type 1 diabetes (T1D) is a common disease of childhood with a current prevalence of almost 2 cases per 1000 adolescents, according to the third National Health and Nutrition Examination Survey. Modern insulin treatment has resulted in improved quality of life for children with this chronic disorder. However, T1D continues to carry a long-term burden of increased microvascular and macrovascular complications and mortality risk. Compared to the nondiabetic population, patients with T1D are more likely to have >or=1 cardiovascular risk factor and often at an earlier age. Since the prevalence of cardiovascular risk factors increases with age in young persons with T1D, there is a clear need for early screening and counseling to prevent their occurrence and manage long-term health ramifications. The purpose of this review is to describe how traditional risk factors for cardiovascular disease such as an abnormal lipid profile, hypertension, obesity, and insulin resistance contribute to the accelerated atherosclerosis seen in young persons with T1D. A summary is given of the guidelines and recommendations published for clinical care for these patients.

The Acute and Residual Effect of a Single Exercise Session on Meal Glucose Tolerance in Sedentary Young Adults

The study goals were to (1) establish the variability in postprandial glucose control in healthy young people consuming a mixed meal and, then (2) determine the acute and residual impact of a single exercise bout on postprandial glucose control. In study 1, 18 people completed two similar mixed meal trials and an intravenous glucose tolerance test (IVGTT). There were strong test-retest correlations for the post-meal area under the curve (AUC) for glucose, insulin, and Cpeptide (r = 0.73–0.83) and the Matsuda insulin sensitivity index (ISI, r = 0.76), and between meal and IVGTT-derived ISI (r = 0.83). In study 2, 11 untrained young adults completed 3 trials. One trial (No Ex) was completed after refraining from vigorous activity for ≥3 days. On the other 2 trials, a 45-min aerobic exercise bout was performed either 17-hours (Prior Day Ex) or 1-hour (Same Day Ex) before consuming the test meal. Compared to No Ex and Prior Day Ex, which did not differ from one another, there were lower AUCs on the Same Day Ex trial for glucose (6%), insulin (20%) and C-peptide (14%). Thus, a single moderate intensity exercise session can acutely improve glycemic control but the effect is modest and short-lived.

Postprandial improvement in insulin sensitivity after a single exercise session in adolescents with low aerobic fitness and physical activity.

The purpose of this study was to determine the acute and residual impact of a single exercise bout on meal glucose control in adolescents with habitually low physical activity. Twelve adolescents (seven females/five males, 14 ± 2 yr) completed three trials. One trial [No Exercise (No Ex)] was completed after refraining from vigorous activity for ≥3 d. On the other two trials, a 45‐min aerobic exercise bout at 75% peak heart rate was performed either 17‐h Prior Day Exercise (Prior Day Ex) trial or 1‐h Same Day Exercise (Same Day Ex) trial before consuming the test meal (2803 kJ, 45/40/15% energy as carbohydrate/fat/protein, respectively). Compared to No Ex, insulin sensitivity (SI) (minimal model analysis) was increased by 45% (p < 0.03) and 78% (p < 0.01) on the Prior Day Ex and Same Day Ex trials, respectively. This improvement in glucose control was supported by corresponding reductions in the net area under the curve for glucose, insulin, and c‐peptide, although there was no change in postprandial suppression of fatty acids. These results show that SI is improved with a single bout of moderate intensity exercise in adolescents with habitually low physical activity and that the residual beneficial effect of exercise lasts at least 17 h. This finding highlights the plasticity of exercise responses in youth and the importance of daily exercise for metabolic health.