Skip to main content

Advertisement

SpringerLink
Log in

Physical activity and cardiorespiratory fitness, but not sedentary behavior, are associated with carotid intima-media thickness in obese adolescents

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study aimed to analyze the associations between sedentary behavior, physical activity (PA), and cardiorespiratory fitness (CRF), with carotid intima-media thickness (cIMT), a marker of atherosclerosis already present at an early stage among obese adolescents. The associations between anthropometric measures, sedentary time, PA, CRF, and cIMT of 54 Caucasian obese adolescents were analyzed using partial correlations (controlling for age and sex) and multiple linear regressions. Differences between participants with and without a healthy CRF were also analyzed using independent sample t test. Sedentary time did not correlate with any of the variables. Light physical activity correlated positively with mean cIMT (r(38) = 0.36, p = 0.024). Moderate physical activity (MPA) correlated positively with both mean (r(38) = 0.37, p = 0.018) and maximum (r(38) = 0.33, p = 0.039) cIMT. CRF was inversely associated with mean cIMT (r(40) = −0.36, p = 0.019), even when controlling for sedentary time (r(37) = −0.35, p = 0.030). The best predictors of cIMT were MPA and weight. No significant differences in cIMT were found between participants with healthy and unhealthy CRF.

Conclusion: Although we need to be cautious due to the limitations of the study, the results suggest that despite the importance of decreasing sedentary time, increasing PA intensity may be more effective in improving endothelial structural health among obese adolescents.

What is Known:

• Pediatric obesity is associated with increased carotid intima-media thickness (cIMT).

• Physical activity may have a relevant role in cIMT development.

What is New:

• Cardiorespiratory fitness (CRF) may be a key moderator of this process.

• Inherited CRF may be protective against cIMT development in obese adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

cIMT:

Carotid intima-media thickness

CRF:

Cardiorespiratory fitness

LPA:

Light physical activity

MPA:

Moderate physical activity

MVPA:

Moderate-to-vigorous physical activity

PA:

Physical activity

SR:

Shuttle run

VPA:

Vigorous physical activity

WC:

Waist circumference

References

  1. Aires L, Silva P, Silva G, Santos MP, Ribeiro JC, Mota J (2010) Intensity of physical activity, cardiorespiratory fitness, and body mass index in youth. J Phys Act Health 7:54–59

    PubMed  Google Scholar 

  2. American College of Sports Medicine (2005) ACSM’s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins

  3. Arnold C, Wenta D, Müller-Ehmsen J, Sreeram N, Graf C (2010) Progenitor cell number is correlated to physical performance in obese children and young adolescents. Cardiol Young 20:381–386

    Article  PubMed  Google Scholar 

  4. Barlow SE, Committee E (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120(Suppl 4):S164–S192

    Article  PubMed  Google Scholar 

  5. Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksäss A (2012) Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Wkly 142:w13705

    PubMed  Google Scholar 

  6. Beauloye V, Zech F, Tran HT, Clapuyt P, Maes M, Brichard SM (2007) Determinants of early atherosclerosis in obese children and adolescents. J Clin Endocrinol Metab 92:3025–3032

    Article  CAS  PubMed  Google Scholar 

  7. Brodersen NH, Steptoe A, Boniface DR, Wardle J (2007) Trends in physical activity and sedentary behaviour in adolescence: ethnic and socioeconomic differences. Br J Sports Med 41:140–144

    Article  PubMed Central  PubMed  Google Scholar 

  8. Cali AM, Caprio S (2008) Obesity in children and adolescents. J Clin Endocrinol Metab 93:S31–S36

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Carlson JA, Crespo NC, Sallis JF, Patterson RE, Elder JP (2012) Dietary-related and physical activity-related predictors of obesity in children: a 2-year prospective study. Child Obes 8:110–115

    PubMed Central  PubMed  Google Scholar 

  10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Crocker MK, Yanovski JA (2011) Pediatric obesity: etiology and treatment. Pediatr Clin North Am 58:1217–1240, xi

    Article  PubMed Central  PubMed  Google Scholar 

  12. Deckelbaum RJ, Williams CL (2001) Childhood obesity: the health issue. Obes Res 9(Suppl 4):239S–243S

    Article  PubMed  Google Scholar 

  13. Denton SJ, Trenell MI, Plötz T, Savory LA, Bailey DP, Kerr CJ (2013) Cardiorespiratory fitness is associated with hard and light intensity physical activity but not time spent sedentary in 10–14 year old schoolchildren: the HAPPY study. PLoS One 8:e61073

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Eisenmann JC, Welk GJ, Ihmels M, Dollman J (2007) Fatness, fitness, and cardiovascular disease risk factors in children and adolescents. Med Sci Sports Exerc 39:1251–1256

    Article  PubMed  Google Scholar 

  15. Ekelund U, Luan J, Sherar LB, Esliger DW, Griew P, Cooper A, Collaborators ICsADI (2012) Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 307:704–712

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Fang J, Zhang JP, Luo CX, Yu XM, Lv LQ (2010) Carotid intima-media thickness in childhood and adolescent obesity relations to abdominal obesity, high triglyceride level and insulin resistance. Int J Med Sci 7:278–283

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Fonseca H, Palmeira AL, Martins SC, Falcato L, Quaresma A (2014) Managing paediatric obesity: a multidisciplinary intervention including peers in the therapeutic process. BMC Pediatr 14:89

    Article  PubMed Central  PubMed  Google Scholar 

  18. Green DJ, Maiorana A, O’Driscoll G, Taylor R (2004) Effect of exercise training on endothelium-derived nitric oxide function in humans. J Physiol 561:1–25

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Gutin B, Yin Z, Humphries MC, Barbeau P (2005) Relations of moderate and vigorous physical activity to fitness and fatness in adolescents. Am J Clin Nutr 81:746–750

    CAS  PubMed  Google Scholar 

  20. Huang K, Zou CC, Yang XZ, Chen XQ, Liang L (2010) Carotid intima-media thickness and serum endothelial marker levels in obese children with metabolic syndrome. Arch Pediatr Adolesc Med 164:846–851

    PubMed  Google Scholar 

  21. Iannuzzi A, Licenziati MR, Acampora C, Salvatore V, Auriemma L, Romano ML, Panico S, Rubba P, Trevisan M (2004) Increased carotid intima-media thickness and stiffness in obese children. Diabetes Care 27:2506–2508

    Article  PubMed  Google Scholar 

  22. Kozàkovà M, Palombo C, Morizzo C, Nolan JJ, Konrad T, Balkau B, Investigators R (2010) Effect of sedentary behaviour and vigorous physical activity on segment-specific carotid wall thickness and its progression in a healthy population. Eur Heart J 31:1511–1519

    Article  PubMed  Google Scholar 

  23. Lewis TV, Dart AM, Chin-Dusting JP, Kingwell BA (1999) Exercise training increases basal nitric oxide production from the forearm in hypercholesterolemic patients. Arterioscler Thromb Vasc Biol 19:2782–2787

    Article  CAS  PubMed  Google Scholar 

  24. Martínez-Gómez D, Eisenmann JC, Gómez-Martínez S, Veses A, Marcos A, Veiga OL (2010) Sedentary behavior, adiposity and cardiovascular risk factors in adolescents. The AFINOS study. Rev Esp Cardiol 63:277–285

    Article  PubMed  Google Scholar 

  25. Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W (2006) Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 48:1865–1870

    Article  PubMed  Google Scholar 

  26. Nassis GP, Papantakou K, Skenderi K, Triandafillopoulou M, Kavouras SA, Yannakoulia M, Chrousos GP, Sidossis LS (2005) Aerobic exercise training improves insulin sensitivity without changes in body weight, body fat, adiponectin, and inflammatory markers in overweight and obese girls. Metabolism 54:1472–1479

    Article  CAS  PubMed  Google Scholar 

  27. Ortega FB, Ruiz JR, Castillo MJ, Sjöström M (2008) Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes (Lond) 32:1–11

    Article  CAS  Google Scholar 

  28. Ortega FB, Tresaco B, Ruiz JR, Moreno LA, Martin-Matillas M, Mesa JL, Warnberg J, Bueno M, Tercedor P, Gutiérrez A, Castillo MJ, Group AS (2007) Cardiorespiratory fitness and sedentary activities are associated with adiposity in adolescents. Obesity (Silver Spring) 15:1589–1599

    Article  Google Scholar 

  29. Prior BM, Yang HT, Terjung RL (2004) What makes vessels grow with exercise training? J Appl Physiol (1985) 97:1119–1128

    Article  Google Scholar 

  30. Ruiz JR, Ortega FB, Martínez-Gómez D, Labayen I, Moreno LA, De Bourdeaudhuij I, Manios Y, Gonzalez-Gross M, Mauro B, Molnar D, Widhalm K, Marcos A, Beghin L, Castillo MJ, Sjöström M, Group HS (2011) Objectively measured physical activity and sedentary time in European adolescents: the HELENA study. Am J Epidemiol 174:173–184

    Article  PubMed  Google Scholar 

  31. Sardinha LB, Baptista F, Ekelund U (2008) Objectively measured physical activity and bone strength in 9-year-old boys and girls. Pediatrics 122:e728–e736

    Article  PubMed  Google Scholar 

  32. Sardinha LB, Santos R, Vale S, Silva AM, Ferreira JP, Raimundo AM, Moreira H, Baptista F, Mota J (2011) Prevalence of overweight and obesity among Portuguese youth: a study in a representative sample of 10–18-year-old children and adolescents. Int J Pediatr Obes 6:e124–e128

    Article  PubMed  Google Scholar 

  33. Network SBR (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab 37:540–542

    Article  Google Scholar 

  34. Silva G, Oliveira NL, Aires L, Mota J, Oliveira J, Ribeiro JC (2012) Calculation and validation of models for estimating VO2max from the 20-m shuttle run test in children and adolescents. Arch Exerc Health Dis 3:145–152

    Google Scholar 

  35. Stabouli S, Kotsis V, Karagianni C, Zakopoulos N, Konstantopoulos A (2012) Blood pressure and carotid artery intima-media thickness in children and adolescents: the role of obesity. Hellenic J Cardiol 53:41–47

    PubMed  Google Scholar 

  36. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, Force ASoECI-MTT (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 21:93–111, quiz 189-190

    Article  PubMed  Google Scholar 

  37. Teran-Garcia M, Rankinen T, Bouchard C (2008) Genes, exercise, growth, and the sedentary, obese child. J Appl Physiol (1985) 105:988–1001

    Article  Google Scholar 

  38. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Fatar M, Hernandez Hernandez R, Jaff M, Kownator S, Prati P, Rundek T, Sitzer M, Schminke U, Tardif JC, Taylor A, Vicaut E, Woo KS, Zannad F, Zureik M (2007) Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 23:75–80

    Article  PubMed  Google Scholar 

  39. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, Goldfield G, Connor Gorber S (2011) Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 8:98

    Article  PubMed Central  PubMed  Google Scholar 

  40. Trost SG, Pate RR, Sallis JF, Freedson PS, Taylor WC, Dowda M, Sirard J (2002) Age and gender differences in objectively measured physical activity in youth. Med Sci Sports Exerc 34:350–355

    Article  PubMed  Google Scholar 

  41. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374

    Article  CAS  PubMed  Google Scholar 

  42. Welk GJ, Laurson KR, Eisenmann JC, Cureton KJ (2011) Development of youth aerobic-capacity standards using receiver operating characteristic curves. Am J Prev Med 41:S111–S116

    Article  PubMed  Google Scholar 

  43. Woo KS, Chook P, Yu CW, Sung RY, Qiao M, Leung SS, Lam CW, Metreweli C, Celermajer DS (2004) Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening. Int J Obes Relat Metab Disord 28:852–857

    Article  CAS  PubMed  Google Scholar 

  44. Wunsch R, de Sousa G, Toschke AM, Reinehr T (2006) Intima-media thickness in obese children before and after weight loss. Pediatrics 118:2334–2340

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The original trial is registered in clinicaltrials.gov (NCT02024061), and was funded by the Foundation of Science and Technology (FCT—Fundação para a Ciência e a Técnologia, Av. D. Carlos I, 126, 1249-074 Lisboa, Portugal. Tel. 213924300, Fax. 213907481) (PTDC/DES/113591/2009).

Author information

Authors and Affiliations

  1. Faculty of Physical Education and Sports, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal

    António Ascenso, António Palmeira & Sandra Martins

  2. Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal

    António Ascenso & Luís Mendes Pedro

  3. Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, Universidade de Lisboa, Lisbon, Portugal

    António Palmeira

  4. Pediatric Obesity Clinic, Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal

    Helena Fonseca

Authors
  1. António Ascenso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. António Palmeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luís Mendes Pedro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandra Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helena Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to António Ascenso.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

This research was conceived and directed by HF, AP, and SM. LP performed all the cIMT assessments. AA performed the data analysis and contributed in the CRF and anthropometric assessments. All authors contributed to writing and reviewing the manuscript and approved the manuscript prior to submission. Each of our authors meets the standard criteria for authorship.

Ethical statement

This study was approved by the research ethics committee of the Faculty of Medicine of the University of Lisbon, Portugal, and is in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

Additional information

Communicated by Jaan Toelen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ascenso, A., Palmeira, A., Pedro, L.M. et al. Physical activity and cardiorespiratory fitness, but not sedentary behavior, are associated with carotid intima-media thickness in obese adolescents. Eur J Pediatr 175, 391–398 (2016). https://doi.org/10.1007/s00431-015-2654-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-015-2654-x

Keywords

Search

Navigation