Michal Pantanowitz

Effects of a Multidisciplinary Childhood Obesity Treatment Intervention on Adipocytokines, Inflammatory and Growth Mediators

Background/Aims: To examine the effects of a 3-month multidisciplinary intervention on anthropometric measures, physical activity patterns and fitness, inflammatory cytokines, adipocytokines, and growth mediators in obese children. Methods: 21 obese subjects completed the 3-month intervention and were compared with 20 age-, gender- and maturity-matched controls. Subjects underwent anthropometric measurements (weight, height, BMI percentile and waist circumference), blood tests (IL-6, CRP, leptin, adiponectin, insulin, IGF-I and glucose), a progressive treadmill exercise test to evaluate fitness, and habitual activity assessment before and after the intervention. Results: The intervention led to a significant change of differences in body weight (-1.3 ± 4.1 vs. 2.5 ± 3.3 kg), BMI percentile (-0.96 ± 1.29 vs. 0.19 ± 0.8), waist circumference (-2.1 ± 2.7 vs. 2.9 ± 3.0 cm) and running time (149.9 ± 86.3 vs. -8.2 ± 88.0 s) in the intervention compared to control. There was a significant increase in leisure-time physical activity (Godin questionnaire, 29.04 ± 6.8 vs. -1.3 ± 9.2) and a decrease in sedentary activity (-1.4 ± 0.73 vs. 0.02 ± 0.62 h/day) in the intervention compared to control. Significant change differences in adiponectin (2,308 ± 1,640 vs. -801 ± 465 ng/ml), IGF-I (33.8 ± 37.8 vs. -1.0 ± 36.2 ng/ml), CRP (-0.06 ± 0.29 vs. 0.5 ± 0.86 mg/dl) and HOMA-IR (-0.15 ± 0.57 vs. 0.55 ± 0.84) were found in the intervention group compared to control. Conclusions: Our results highlight the short-term beneficial effects of a childhood obesity multidisciplinary intervention on anthropometrics, habitual activity, fitness, inflammatory and metabolic measures. The longer-term effects of these changes on obesity-associated metabolic risks are yet to be determined.

Health promotion intervention in Arab-Israeli kindergarten children.

Abstract Background: Obesity is the most common chronic pediatric disease in westernized societies, with minorities and children from low socioeconomic status being mostly affected. Arab-Israelis are the largest minority population in Israel. Objective: The aim of this study is to examine the prevalence of obesity and to prospectively study the effects of a health promotion, school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness in Arab-Israeli kindergarten children. Participants: One hundred fifty-four children completed a school year with combined dietary-behavioral-physical activity intervention and were compared with 188 controls (age 4.2–6.5 years). Results: The prevalence of overweight and obesity among Arab-Israeli kindergarten children was 28.9%. Compared with control, the intervention led to a significantly greater (control vs. intervention, respectively, p<0.05) increase in nutrition knowledge (51.2±1.5%–48.9±1.6% vs. 48.9±1.6%–85.9±1.4%) and preferences (47.4±1.5%–47.7±1.6% vs. 45.2±1.8%–87.1±1.4%), increase in physical activity knowledge (47.2±1.3%–47.0±1.7% vs. 49.2±1.7%–90.8±1.3%) and preferences (52.3±1.3%–54.2±1.8% vs. 56.2±1.4%–92.8±1.0%), and improvement in fitness (–10.2±1.6 vs. 11.6±1.4 shuttle run laps). The intervention was associated with favorable changes in height gain (5.0±0.1 vs. 6.2±0.1 cm), body mass index (BMI –0.41±0.06 vs. –0.71±0.06 kg/m2) and BMI percentile (–10.0±1.3% vs. –16.2±1.2%) in the control and intervention groups, respectively. Conclusions: A kindergarten dietary-physical activity intervention applied by the kindergarten teachers led to a decrease in BMI, BMI percentile, improved nutrition and physical activity knowledge and preferences, and improved fitness. Such programs may play important role in health promotion, prevention, and treatment of childhood obesity in minority communities from early age.

Posturography Characteristics of Obese Children with and without Associated Disorders

A group of 59 obese children ages 6–12 years were interviewed for current medical diagnoses (e.g., Attention Deficit Hyperactivity Disorder- ADHD, and clumsiness) and later were examined posturographically for balance and stability. General stability of all the obese children deviated significantly from norms. 32.2% of the obese children had a pattern of balance that could indicate orthopedic problems. Obese children with ADHD or perceived clumsiness had significantly worse balance and postural performance compared to other obese children. Balance and posture among obese children without suspicion of problems were similar to non-obese controls. In conclusion, obese children with associated disorders (such as ADHD and perceived clumsiness) manifested disturbance in balance control. Thus, physical activity interventions for these children should include safety measures to decrease the chances of falling and subsequent injury.

Effect of gender on the GH-IGF-I response to anaerobic exercise in young adults.

Abstract Eliakim, A, Nemet, D, Most, G, Rakover, N, Pantanowitz, M, and Meckel, Y. Effect of gender on the GH-IGF-I response to anaerobic exercise in young adults. J Strength Cond Res 28(12): 3411–3415, 2014—Exercise-associated effects on the growth hormone–insulin-like growth factor-I (GH-IGF-I) axis were studied, mainly after aerobic exercise. We determined the gender effect on the GH-IGF-I axis response to a standard all-out Wingate anaerobic test (WAnT) in healthy active young adult men and women (men = 12 and women = 16; age range: 24–34 years). Blood samples for GH and IGF-I, key elements of the GH-IGF-I axis, were collected before and 20, 30, 40, and 60 minutes after the beginning of exercise. In addition, we collected postexercise blood lactate levels. Postexercise lactate levels were higher among men; however, this difference did not reach statistical significance (13.8 ± 1.3 vs. 11.1 ± 1.0 mmol·L−1, respectively; p = 0.1). The WAnT was associated with a significant increase in GH in both genders. However, GH peak was greater among women (10.8 ± 1.8 vs. 5.6 ± 1.4 ng·ml−1, in women and men, respectively; p < 0.01). In addition, postexercise GH peak occurred significantly earlier in female (20 minutes) compared with male participants (40 minutes). Exercise was associated with a significant increase in IGF only among men (from 166.8 ± 8.4 to 186.9 ± 9.3; p < 0.02); however, no significant between-gender effect was found. In summary, supramaximal anaerobic exercise was associated with a greater and earlier postexercise GH peak in women compared with men. All together, the results suggest anaerobic exercise-related anabolic-type hormonal response.

A combined nutritional-behavioral-physical activity intervention for the treatment of childhood obesity--a 7-year summary.

Abstract We assessed the effect of a weight management program on body weight, body mass index (BMI), BMI percentile, and fitness in obese children and adolescents. The study was designed as a longitudinal, non-randomized, clinical experience of 3, 6, and 12 months combined dietary-behavioral-exercise intervention. Seven hundred and forty-nine obese children (age, 6–16 years) participated in a 3 months program. Three hundred and fifty-nine of them completed a 6 months intervention and 147 completed a 1 year intervention. Sixty-seven age- and maturity-matched obese children who did not participate in the structured program served as controls. Body weight, BMI, and fitness were evaluated at baseline, and after 3, 6, and 12 months intervention. Body weight, BMI, and BMI percentiles were significantly reduced (p<0.05) and endurance time significantly increased (p<0.0005) following the 3 months intervention. Obese children who continued the program for 6 months maintained decreases in BMI percentiles and further improved endurance time. In contrast, obese children in the control group gained weight, increased their BMI, and had a less significant improvement in fitness. Parental obesity (both parents), degree of obesity (BMI >97%), and more than one prior weight loss attempt were associated with lower decreases, whereas sex and pubertal status had no influence, on BMI percentiles changes. Children without parental overweight had significantly greater decreases in BMI compared with children with both parents showing obesity. In summary, a combined, structured multidisciplinary intervention for childhood obesity led to decreased body weight, BMI, and BMI percentiles, and to improved fitness.

Longitudinal Study Evaluating Postural Balance of Young Athletes.

Repeated anaerobic conditions during athletic performance may cause general and local fatigue that result in postural balance deficit. Evidence suggests that improved postural balance during athletic training may decrease the risk for fallings and traumatic injuries among athletes. Twenty athletes (12 girls, 8 boys) and 20 controls (12 girls, 8 boys) ages 10–15 years participated in the current study. All athletes were active in an 8-month physical activity program, 3 times per week for 90 min., specific to basketball, soccer, or athletic training. The control children participated in physical education at school only, with no involvement in organized extracurricular sports. All participants were evaluated for postural balance in three assessments over one year (at 4-mo intervals); the Interactive Balance System machine (Tetrax device) was used to assess balance at three test times (pre-, post-, and 10 min) after a session of a repeated sprint anaerobic test, consisting of 12 × 20 m run starting every 20 sec. The athletes had better postural balance than controls. There were different group patterns of change over the sessions; a significant interaction of session and group indicated that postural balance of the groups differed. The contribution of low sway frequencies (F1) and high sway frequencies (F6) differed between the controls and the athletes group. Results suggested that although athletes had better postural balance, improvement should be encouraged during training over the sessions and seasons, with special awareness of the balance deficit that occurs immediately after anaerobic stress and at the end of the season, to decrease the risk of injuries.

Postural Balance Following Aerobic Fatigue Tests: A Longitudinal Study Among Young Athletes

ABSTRACT General fatigue can cause aggravation of postural balance, with increased risk for injuries. The present longitudinal study aimed to evaluate the postural balance of young athletes following field aerobic tests throughout 1 year of training. Thirty children from a sports center in Nazareth, participating in a 3 times/week training program (specific to basketball, soccer, or athletic training), were assessed. Postural balance parameters were taken before, immediately after, and 10 min after a 20 m shuttle-run aerobic test, at 3 time points during 1 training year (Start/Y, Mid/Y, and End/Y). Fitness improved at the Mid/Y and End/Y compared to Start/Y. Postural balance significantly deteriorated immediately after the aerobic test and improved significantly in the 10-min testing in all 3 time points, with significant deterioration in the End/Y compared with the Start/Y. In conclusions, postural balance deteriorates immediately after aerobic exercises, and at the end of the year. To better practice drills related to postural balance and possibly to prevent injuries, it is best for young athletes to properly rest immediately following aerobic exercises and to practice postural balance mainly at the beginning and at the middle of the training year.

Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese

Purpose: To investigate the influence of a weight-reduction program with locomotion-emphasis on improving biomechanical characteristics of children who are obese (OW). Methods: Ten children who are OW participated in a 6-month multidisciplinary childhood obesity management program (GRP1); another 10 children who are OW participated in the same multidisciplinary childhood obesity management program with additional locomotion-emphasis exercises for improving biomechanical characteristics (GRP2); and 10 control children who are OW with no intervention program. Outcomes were anthropometric measurements and temporal and foot pressure parameters. Results: GRP2 had significantly improved foot pressure in the different walking/running speeds compared with GRP1. In the temporal parameters, pretests by speed by group interactions were significantly improved for GRP2 compared with GRP1. Conclusions: We found evidence to support beneficial effects of combined dietary and physical activity/locomotion-emphasis exercises on the movement characteristics of children who are OW.

Biomechanical characteristics of overweight and obese children during five different walking and running velocities

The characterization of activity patterns of overweight and obese (OW) children and adolescents is essential, and should be carried out before they join an exercise training programme and increase their physical activity in order to maintain or reduce body weight. The purpose of this study is to verify whether the biomechanical parameters characterizing frequently used walking and running speeds vary between OW and normal-weight (NW) children. Thirty-one prepubescent OW children (9.9 y ± 1.3) and 10 prepubescent NW children (9.9 y ± 1.2) participated in this study. All participants were evaluated for temporal parameters (e.g. cycle length, cycle time, stance phase time, double support phase time, etc.) and for foot pressure parameters (e.g. contact area, duration of contact, peak pressure, etc.) in six different foot areas, at three walking velocities, and two running velocities. A group effect (p < .05) was found for the peak pressure, duration of contact percentile, maximum force, foot pressure–time integral, cycle length, cycle time, stance phase time, double support phase time, relative stance phase, and relative double support phase, indicating that the OW children manifested significantly higher values compared with the NW children. Assessment of the movement characteristics of OW children indicated an elongation of gait parameters, such as step cycle and support stage, compared to NW children, in different walking and running speeds. These changes suggest that OW children develop different walking/running patterns with increased foot pressure, which may predispose them to foot pain and overuse injuries.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review

The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.