Sports Medicine

, Volume 33, Issue 9, pp 633–650 | Cite as

Established and Recently Identified Coronary Heart Disease Risk Factors in Young People

The Influence of Physical Activity and Physical Fitness
  • Non Eleri Thomas
  • Julien S. Baker
  • Bruce Davies
Review Article

Abstract

Epidemiological studies have identified several risk factors for coronary heart disease (CHD), many of which are present in young people.1 One such risk factor is hypertension. In adults, exercise is thought to have a positive effect on blood pressure levels; however, findings are inconclusive for young people. Despite its association with CHD, obesity is on the increase in Western society’s young population; prevention and intervention during early years is needed. An active lifestyle is considered to have a beneficial effect on body fatness. Lipoprotein profiles are directly associated with CHD status. In adults, there is some evidence that physical activity and/or fitness have a favourable effect on lipoprotein levels. Although information regarding the younger population is more ambiguous, it tends to concur with these findings. High levels of lipoprotein(a), are considered an independent risk factor for CHD. Relatively little has been written on young people, although some studies have postulated a favourable relationship with physical activity.

An inverse relationship between aerobic fitness and CHD has been confirmed in adults; an association is not as easily verified for young people. Physical activity is similarly deemed to have a beneficial effect on health status. A high-fat diet has been linked to CHD in adults, and evidence to date reports similar findings for young people. Smoking increases the risk of CHD and even moderate smoking during youth could have damaging long-term consequences. There is some evidence that smoking is related to physical activity and fitness levels in young people.

In adults, high levels of homocyst(e)ine have been associated with CHD. As yet, little has been written on the relationship between physical activity or physical fitness and homocysteine status in young people. High levels of plasma fibrinogen have been linked to CHD. Several studies have explored the relationship between plasma fibrinogen and physical activity and/or fitness in adults, but findings are inconclusive; for young people, the ambiguity is even greater. C-reactive protein is a molecular marker for CHD but, to date, little attention has been given to this aspect, especially amongst young people. The link between high levels of plasminogen activator inhibitor-1 and CHD has been confirmed, although the essence of this relationship is not established. There is a paucity of data on the younger population and the relevance of collating such information is questionable.

For the younger population, most research is limited to the established CHD risk factors and further investigations of recently identified CHD risk factors are needed.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

References

  1. 1.
    McMenemy MC. Coronary heart disease still dropping in UK. Lancet 1999; 353: 9164Google Scholar
  2. 2.
    Murray JL, Lopez AD. The global burden of disease. Geneva: World Health Organization, 1996Google Scholar
  3. 3.
    British Heart Foundation. 1998 Coronary heart disease statistics [online]. Available from URL: http://www.dphpc.ox.ac.uk/bhfprg/stats/2000/1998/stats [Accessed 2001 Aug 8]
  4. 4.
    British Heart Foundation. In: Rayner M, Peterson S, editors. European cardiovascular disease statistics. London: British Heart Foundation, 2000Google Scholar
  5. 5.
    Hubert HB, Eaker ED, Garrison RJ, et al. Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring. Am J Epidemiol 1987; 125(5): 812–31PubMedGoogle Scholar
  6. 6.
    Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Paediatrics 1999; 103: 1175–82CrossRefGoogle Scholar
  7. 7.
    Garrison RJ, Kannel WB, Stokes J, et al. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 1987; 16: 235–51PubMedCrossRefGoogle Scholar
  8. 8.
    Boreham CA, Savage M, Primrose D, et al. Cardiovascular risk factors in schoolchildren. Arch Dis Child 1993; 68: 182–6PubMedCrossRefGoogle Scholar
  9. 9.
    Boreham CA, Twisk J, Murray L, et al. Fitness, fatness, and coronary heart disease risk in adolescents: the Northern Ireland Young Hearts Project. Med Sci Sports Exerc 2001; 33(2): 270–4PubMedGoogle Scholar
  10. 10.
    Eliasson M, Evrin P-E, Lundblad D. Fibrinogen and fibrinolytic variables in relation to anthropometry, lipids and blood pressure: the Northern Sweden Monica Study. J Clin Epidemiol 1994; 47(5): 513–24PubMedCrossRefGoogle Scholar
  11. 11.
    Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: a review. JAMA 1998; 279(18): 1477–82PubMedCrossRefGoogle Scholar
  12. 12.
    Bermudez EA, Ridker PM. C-reactive protein (CRP), statins, and the primary prevention of atherosclerotic cardiovascular disease. Prev Cardiol 2002; 5(1): 42–6PubMedCrossRefGoogle Scholar
  13. 13.
    McCully KS. Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol 1969; 56: 111–28PubMedGoogle Scholar
  14. 14.
    Cunnane SC. Childhood origins of lifestyle-related risk factors for coronary heart disease in adulthood. Nutr Health 1993; 9: 107–15PubMedCrossRefGoogle Scholar
  15. 15.
    Twisk JWR, van Mechelen W, Kemper HCG, et al. The relation between long-term exposure to lifestyle during youth and young adulthood and risk factors of cardiovascular disease at adult age. J Adolesc Health 1997; 20: 309–19PubMedCrossRefGoogle Scholar
  16. 16.
    Wilmore JH, McNamara JJ. Prevalence of coronary heart disease risk factors in boys 8–12 years of age. J Pediatr 1972; 84: 527–33Google Scholar
  17. 17.
    Thorland WG, Gilliam TB. Comparison of serum lipids between habitually high and low active pre-adolescent males. Med Sci Sports Exerc 1981; 13(5): 316–21PubMedGoogle Scholar
  18. 18.
    Linder CW, DuRant RH, Mahoney OM. The effect of physical conditioning on serum lipids and lipoproteins in white male adolescents. Med Sci Sport Exerc 1983; 15(3): 232–6CrossRefGoogle Scholar
  19. 19.
    Máček M, Rutenfranz K, Lange Andersen K, et al. Favourable levels of cardiovascular health and risk indicators during childhood and adolescence. Eur J Pediatr 1985; 144: 360–7PubMedCrossRefGoogle Scholar
  20. 20.
    Hofman A, Walter HJ, Connelly PA, et al. Blood pressure and physical fitness in children. Hypertension 1987; 9: 188–97PubMedCrossRefGoogle Scholar
  21. 21.
    Tell GS, Vellar OD. Physical fitness, physical activity and cardiovascular disease risk factors in adolescents: the Oslo Youth Study. Prev Med 1988; 17: 12–24PubMedCrossRefGoogle Scholar
  22. 22.
    Hofman A, Walter HJ. The association between physical fitness and cardiovascular risk factors in children in a five year follow-up study. Int J Epidemiol 1989; 18(4): 830–5PubMedCrossRefGoogle Scholar
  23. 23.
    Kwee A, Wilmore JH. Cardiorespiratory fitness and risk factors for coronary artery disease in 8 to 15 year old boys. Pediatr Exerc Sci 1990; 2: 372–83Google Scholar
  24. 24.
    Armstrong N, Williams J, Balding J, et al. Cardiopulmonary fitness, physical activity patterns and selected coronary risk factor variables in 11 to 16 year olds. Pediatr Exerc Sci 1991; 3: 219–28Google Scholar
  25. 25.
    Bazzano C, Cunningham LN, Varrasi G, et al. Health-related fitness and blood pressure in boys and girls ages 10 to 17 years. Pediatr Exerc Sci 1992; 4: 128–35Google Scholar
  26. 26.
    Jenner DA, Vandongen R, Beilin LJ. Relationships between blood pressure and measures of dietary energy intake, physical fitness and physical activity in Australian children aged 11–12 years. J Epidemiol Community Health 1992; 46(2): 108–13PubMedCrossRefGoogle Scholar
  27. 27.
    Suter E, Hawes MR. Relationship of physical activity, body fat, diet and blood lipid profile in youths 10–15 years. Med Sci Sports Exerc 1993; 25(6): 748–54PubMedGoogle Scholar
  28. 28.
    Al-Hazzaa HM, Sulaiman MA, Al-Matar AJ. Cardiorespiratory fitness, physical activity patterns and coronary risk factors in preadolescent boys. Int J Sports Med 1994; 15(5): 267–72PubMedCrossRefGoogle Scholar
  29. 29.
    de Visser DC, van Hooft IM, van Doornen LJ, et al. Anthropometric measures, fitness and habitual physical activity in offspring of hypertensive parents: Dutch Hypertension and Offspring Study. Am J Hypertens 1994; 7(3): 242–8PubMedGoogle Scholar
  30. 30.
    Dwyer T, Gibbons LE. The Australian Schools Health and Fitness Survey: physical fitness related to blood pressure but not lipoproteins. Circulation 1994; 89(4): 1539–44PubMedCrossRefGoogle Scholar
  31. 31.
    Raitakari OT, Porkka KVK, Taimela S, et al. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. Am J Epidemiol 1994; 140(3): 95–205Google Scholar
  32. 32.
    Taimela S, Vikari JSA, Porkka KVK, et al. Lipoprotein(a) levels in children and young adults: the influence of physical activity: the Cardiovascular Risk in Young Finns Study. Acta Paediatr 1994; 83(12): 1258–63PubMedCrossRefGoogle Scholar
  33. 33.
    Hager RL, Tucker LA, Seljaas GT. Aerobic fitness, blood lipids and body fat in children. Am J Public Health 1995; 85(12): 1702–6PubMedCrossRefGoogle Scholar
  34. 34.
    Webber LS, Osganian SK, Feldman HA, et al. Cardiovascular risk factors among children after a two and a half year intervention: the CATCH Study. Prev Med 1996; 25: 432–41PubMedCrossRefGoogle Scholar
  35. 35.
    Zahavi I, Yaari S, Salman H, et al. Plasma fibrinogen in Israeli Moslem and Jewish schoolchildren: distribution and relation to other cardiovascular risk factors: the Petah Tikva Project. Isr J Med Sci 1996; 32: 1207–12PubMedGoogle Scholar
  36. 36.
    Boreham CA, Twisk J, Savage MJ, et al. Physical activity, sports participation and risk factors in adolescents. Med Sci Sports Exerc 1997; 29(6): 788–93PubMedCrossRefGoogle Scholar
  37. 37.
    Guillaume M, Lapidus L, Bjorntorp P, et al. Physical activity, obesity and cardiovascular risk factors in children: the Belgian Luxembourg Child Study II. Obes Res 1997; 5: 549–56PubMedGoogle Scholar
  38. 38.
    MacAuley D, McCrum E, Stott G, et al. Physical fitness, lipids and apolipoproteins in the Northern Ireland Health and Activity Survey. Med Sci Sports Exerc 1997; 29(9): 1187–91PubMedCrossRefGoogle Scholar
  39. 39.
    Mahon AD, Cheatham CC, Kelsey KQ, et al. Plasma fibrinogen, physical activity and aerobic fitness in children. In: Armstrong N, Kirby B, Welsman J, editors. London: E & FN Spon, 1997: 117–23Google Scholar
  40. 40.
    Rimmer JH, Looney MA. Effects of an aerobic activity programme on the cholesterol levels of adolescents. Res Q Exerc Sport 1997; 68(1): 74–9PubMedGoogle Scholar
  41. 41.
    Raitakari OT, Taimela S, Porkka KVK, et al. Associations between physical activity and risk factors for coronary heart disease: the Cardiovascular Risk in Young Finns Study. Med Sci Sports Exerc 1997; 29(8): 1055–61PubMedCrossRefGoogle Scholar
  42. 42.
    Torfley K, Batterham AM, Campbell IG. Selected predictor variables and lipid-lipoprotein profile in prepubertal children. In: Armstrong N, Kirby B, Welsman J, editors. Children and exercise XIX. London: E & FN Spon, 1997: 111–16Google Scholar
  43. 43.
    Ewart CK, Young DR, Hagberg JM. Effect of school-based aerobic exercise on blood pressure in adolescent girls at risk of hypertension. Am J Public Health 1998; 88(6): 949–51PubMedCrossRefGoogle Scholar
  44. 44.
    Gallistl S, Sudi KM, Erwa W, et al. Determinants of homocysteine during weight reduction in obese children and adolescents. Metabolism 2001; 50(10): 1220–3PubMedCrossRefGoogle Scholar
  45. 45.
    Abbott RA, Harkness MA, Davies PS. Correlation of habitual physical activity levels with flow-mediated dilation of the brachial artery in 5–10 year old children. Atherosclerosis 2002; 160(1): 233–9PubMedCrossRefGoogle Scholar
  46. 46.
    Clarke WR, Schrott HG, Leaverton PE, et al. Tracking of lipids and blood pressure in school age children: the Muscatine Study. Circulation 1978; 58: 626–34PubMedCrossRefGoogle Scholar
  47. 47.
    Lauer RM, Connor WE, Leaverton PE, et al. Coronary heart disease risk factors in school children: the Muscatine Study. J Paediatr 1975; 86(5): 697–706CrossRefGoogle Scholar
  48. 48.
    Twisk J, Kemper HCG, Snel J. Tracking of cardiovascular risk factors in relation to lifestyle. In: Kemper HCG, editor. The Amsterdam Growth Study: a longitudinal analysis of health, fitness and lifestyle. Champaign (IL): Human Kinetics, 1995Google Scholar
  49. 49.
    Montoye HJ, Metzner HL, Keller JB, et al. Habitual physical activity and blood pressure. Med Sci Sports Exerc 1972; 4: 175–82CrossRefGoogle Scholar
  50. 50.
    Hagberg JM. Exercise, fitness and hypertension. In: Shephard RJ, Stephens T, Sutton, JR, et al., editors. Exercise, fitness and health. Champaign (IL): Human Kinetics, 1990: 455–66Google Scholar
  51. 51.
    Alpert B, Wilmore JH. Physical activity and blood pressure in adolescents. Paediatr Exerc Sci 1994; 6: 361–80Google Scholar
  52. 52.
    Flegal KM. Defining obesity in children and adolescents: epidemiologic approaches. Crit Rev Food Sci 1993; 33(4/5): 307–12CrossRefGoogle Scholar
  53. 53.
    Dietz WH. Childhood obesity. In: Cheung LWY, Richmond JB, editors. Child health, nutrition and physical activity. Champaign (IL): Human Kinetics, 1995: 155–69Google Scholar
  54. 54.
    Jebb SA, Moore MS. Contribution of a sedentary lifestyle and inactivity to the etiology of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (11 Suppl.): 534–41Google Scholar
  55. 55.
    Stern M. Epidemiology of obesity and its link to heart disease. Metabolism 1995; 44 (9 Suppl. 3): 1–3PubMedCrossRefGoogle Scholar
  56. 56.
    Katzmarzyk PT, Gagnon J, Leon AS, et al. Fitness, fatness and estimated coronary heart disease risk: the Heritage Family Study. Med Sci Sports Exerc 2001; 33(4): 585–90PubMedGoogle Scholar
  57. 57.
    Fox K. Active living: a prescription for lifelong health and well-being. Educ Health 1997; 15(4): 56–60Google Scholar
  58. 58.
    Chinn S, Rona RJ. Trends in weight-for-height and triceps skinfold thickness for English and Scottish children, 1972–1982 and 1982–1990. Paediatr Perinat Epidemiol 1994; 8(1): 90–106PubMedCrossRefGoogle Scholar
  59. 59.
    Troiano RP, Flegal KM, Kuczmarski RJ, et al. Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys. Arch Pediatr Adolesc Med 1995; 149: 1085–91PubMedCrossRefGoogle Scholar
  60. 60.
    Freedman DS, Srinivasan SR, Valdez RA, et al. Secular increases in relative weight and obesity among children over two decades: the Bogalusa Heart Study. Pediatrics 1997; 99(3): 420–5PubMedCrossRefGoogle Scholar
  61. 61.
    Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology and demogaphics. Pediatrics 1998; 101(3): 497–504PubMedGoogle Scholar
  62. 62.
    Gortmaker SL, Peterson K, Wiechen J, et al. Reducing obesity via school-based interdisciplinary intervention among youth: planet health. Arch Pediatr Adolesc Med 1999; 153(4): 409–18PubMedCrossRefGoogle Scholar
  63. 63.
    Chinn S, Rona RJ. International definitions of overweight and obesity for children: a lasting solution? Ann Hum Biol 2002; 29(3): 306–13PubMedCrossRefGoogle Scholar
  64. 64.
    Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents: a follow up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992; 327(19): 1350–5PubMedCrossRefGoogle Scholar
  65. 65.
    Clarke WR, Lauer RM. Does childhood obesity track into adulthood? Crit Rev Food Sci Nutr 1993; 33(4/5): 423–30PubMedCrossRefGoogle Scholar
  66. 66.
    Vanhala M, Vanhala P, Kumpusalo E, et al. Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study BMJ 1998; 317: 319–20PubMedCrossRefGoogle Scholar
  67. 67.
    Wright CM, Parker L, Lamont D, et al. Implications of childhood obesity for adult health: findings from Thousand Families Cohort Study. BMJ 2001; 323: 1280–4PubMedCrossRefGoogle Scholar
  68. 68.
    Malina RM, Bouchard C. Growth, maturation, and physical activity. Champaign (IL): Human Kinetics, 1991Google Scholar
  69. 69.
    Freedman DS, Dietz WH, Srinivasan, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart study. Pediatrics 1999; 103(6): 1175–82PubMedCrossRefGoogle Scholar
  70. 70.
    Fulton JE, McGuire MT, Caspersen CJ, et al. Interventions for weight loss and weight gain prevention among youth. Sports Med 2001; 31(3): 153–65PubMedCrossRefGoogle Scholar
  71. 71.
    Griffith M, Rivers JPW, Hoinville EA. Obesity in boys: the distinction between fatness and heaviness. Hum Nutr Clin Nutr 1985; 39c: 259–69Google Scholar
  72. 72.
    Bouchard C, Savard R, Despres JP, et al. Body composition in adopted and biological siblings. Hum Biol 1985; 57: 61–75PubMedGoogle Scholar
  73. 73.
    Lakka HM, Lakka TA, Tuomilehto J, et al. Abdominal obesity is associated with increased risk of acute coronary events in men. Eur Heart J 2002; 23(9): 706–13PubMedCrossRefGoogle Scholar
  74. 74.
    Stern MP, Haffner SM. Body fat distribution and hyperinsulinemia as risk factors for diabetes and cardiovascular disease. Arteriosclerosis 1986; 6(2): 123–30PubMedCrossRefGoogle Scholar
  75. 75.
    Stallones L, Mueller WH, Christensen BL. Blood pressure, fatness and fat patterning among USA adolescents from two ethnic groups. Hypertension 1982; 4(4): 483–6PubMedCrossRefGoogle Scholar
  76. 76.
    Cameron N, Johnston FE, Koample JS, et al. Body fat patterning in rural South African black children. Am J Hum Biol 1992; 4: 433–45CrossRefGoogle Scholar
  77. 77.
    Rebate E, Salces I, Martin LS, et al. Fat distribution in relation to sex and socioeconomic status in children 4–19 years. Am J Hum Biol 1998; 10: 799–806CrossRefGoogle Scholar
  78. 78.
    Bogin B, Sullivan T. Socioeconomic status, sex, age, and ethnicity as determinants of body fat distribution for Guatemalan children. Am J Phys Anthropol 1986; 69: 527–35PubMedCrossRefGoogle Scholar
  79. 79.
    NHLBI. The relationship of the reduction of incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251(3): 365–74CrossRefGoogle Scholar
  80. 80.
    Hickman TB, Briefel RR, Carroll MD, et al. Distributions and trends of serum lipid levels among US children and adolescents ages 4–19 years: data from the Third National Health and Nutrition Examination Survey. Prev Med 1998; 27: 879–90PubMedCrossRefGoogle Scholar
  81. 81.
    Bell RD, Macek M, Rutenfranz J, et al. Health indicators and risk factors of cardiovascular diseases during childhood and adolescence. In: Rutenfranz J, Mocellin R, Klimt F, editors. Children and exercise XII. Champaign (IL): Human Kinetics, 1986: 19–27Google Scholar
  82. 82.
    Gordon T, Castelli WP, Hjortland MC, et al. High density lipoprotein as a protective factor against coronary heart disease. Am J Med 1977; 62: 707–14PubMedCrossRefGoogle Scholar
  83. 83.
    Masopust J, Macek M, Rutenfranz J, et al. Stanoveni referencniho rozmezi lipidovych parametru detske skolni populaci. Biochem Clin Bohemoslovaca 1985; 14: 15–26Google Scholar
  84. 84.
    Kokkinos PF, Fernhall B. Physical activity and high density lipoprotein cholesterol levels: what is the relationship? Sports Med 1999; 28(5): 307–14PubMedCrossRefGoogle Scholar
  85. 85.
    Newsholme EA, Leech AR. Biochemistry for the medical sciences. Chichester (NY): John Wiley and Sons, 1992Google Scholar
  86. 86.
    American Heart Foundation. Conference on the health effects of blood lipids: optimal distributions for populations. Workshop report: epidemiological section. Prev Med 1979; 8: 612–78CrossRefGoogle Scholar
  87. 87.
    Montoye HJ. Risk indicators for cardiovascular disease in relation to physical activity in youth. In: Binkhorst RA, Kemper HCG, Saris WHM, editors. Children and exercise XI. Champaign (IL): Human Kinetics, 1985: 3–25Google Scholar
  88. 88.
    Gaziano JM, Hennekens CH, O’Donnell CJ, et al. Fasting triglycerides, high density lipoprotein and risk of myocardial infarction. Circulation 1997; 96: 2520–5PubMedCrossRefGoogle Scholar
  89. 89.
    Freedman DS, Srinivasan SR, Cresanta JL, et al. Cardiovascular risk factors from birth to seven years of age: the Bogalusa Heart Study. Serum lipids and lipoproteins. Pediatrics 1987; 80 Suppl.: 789–95PubMedGoogle Scholar
  90. 90.
    Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. Pediatrics 1988; 82: 309–18PubMedGoogle Scholar
  91. 91.
    Berenson GS, Srinivasan SR, Nicklas TA, et al. Cardiovascular risk factors in children and early prevention of heart disease. Clin Chem 1988; 34(8): B115–22PubMedGoogle Scholar
  92. 92.
    Barker DJP, Osmond C, Golding J, et al. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298(6673): 564–7PubMedCrossRefGoogle Scholar
  93. 93.
    Twisk JWR. Physical activity, physical fitness, and cardiovascular health. In: Armstrong N, van Mechelen W, editors. Paediatric exercise science and medicine. Oxford (NY): Oxford University Press, 2000: 253–63Google Scholar
  94. 94.
    NIH Consensus Conference. Triglyceride, high density lipoproteins and coronary heart disease: NIH Consensus Development Panel on triglycerides and high density lipoprotein and coronary heart disease. JAMA 1993; 269(4): 505–10Google Scholar
  95. 95.
    Bailey DM, Davies B, Williams S, et al. Blood lipid concentrations in active, sedentary, healthy and diseased men. J Cardiovasc Risk 1998; 5: 309–12PubMedCrossRefGoogle Scholar
  96. 96.
    Armstrong N, Simons-Morton B. Physical activity and blood lipids in adolescents. Pediatr Exerc Sci 1994; 6: 381–405Google Scholar
  97. 97.
    Von Duvillard SP. Symposium: lipids and lipoproteins in diet and exercise: introduction. Med Sci Sports Exerc 1997; 29(11): 1414–5Google Scholar
  98. 98.
    Clavel S, Leaute S, Jouanel P, et al. Lipid and lipoprotein(a) as atherosclerois factors in young athletes. In: Armstrong N, Kirby B, Welsman J, editors. Children and exercise XIX. London: E & FN Spon, 1997: 105–10Google Scholar
  99. 99.
    Glowinska B, Urban M, Koput A. Correlation between body mass index, lipoprotein(a) level and positive family history of cardiovascular diseases in children and adolescents with obesity, hypertension and diabetes. Pol Merkuriusz Lek 2002; 12(68): 1085–14Google Scholar
  100. 100.
    Mackinnon LT, Hubinger LM. Effects of exercise on lipoprotein (a). Sports Med 1999; 28(1): 11–24PubMedCrossRefGoogle Scholar
  101. 101.
    Scanu AM. Lipoprotein(a): a genetic risk factor for premature coronary heart disease. JAMA 1992; 267(24): 3326–9PubMedCrossRefGoogle Scholar
  102. 102.
    Kronenberg F, Steinmetz A, Kostner GM, et al. Lipoprotein(a) in health and disease. Crit Rev Clin Lab Sci 1996; 33(6): 495–543PubMedCrossRefGoogle Scholar
  103. 103.
    Ridker PM, Hennekens CH, Stampfer MJ. A prospective study of lipoprotein(a) and the risk of myocardial infarction. JAMA 1993; 270(18): 2195–9PubMedCrossRefGoogle Scholar
  104. 104.
    Genzel-Boroviczeny O, Philipp E, Kuhnle-Krahl U, et al. Lipoprotein(a) in children. Pediatr Cardiol 1997; 145(9): 911–7Google Scholar
  105. 105.
    Sveger T, Flodmark C-E, Nordborg K, et al. Hereditary dyslipidaemias and combined risk factors in children with a family history of premature coronary artery disease. Arch Dis Child 2000; 82: 292–6PubMedCrossRefGoogle Scholar
  106. 106.
    Jenner JL, Ordovas JM, Laman-Fava S, et al. Effects of age, sex and menopausal status on plasma lipoprotein(a) levels: the Framingham Offspring Study. Circulation 1993; 87: 1135–41PubMedCrossRefGoogle Scholar
  107. 107.
    Laskowska-Klita T, Szymczak E, Radomyska B. Serum homocysteine and lipoprotein(a) concentrations in hypercholesterolemic and normocholesterolemic children. Clin Pediatr (Phila) 2001; 40(3): 149–54CrossRefGoogle Scholar
  108. 108.
    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers of Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273(5): 402–7PubMedCrossRefGoogle Scholar
  109. 109.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100(2): 126–31PubMedGoogle Scholar
  110. 110.
    Farrell SW, Kampert JB, Kohl III, et al. Influences of cardiorespiratory fitness levels and other predictors on cardiovascular disease mortality in men. Med Sci Sports Exerc 1998; 30: 899–905PubMedCrossRefGoogle Scholar
  111. 111.
    McMurray RG, Ainsworth BE, Harreil JS, et al. Is physical activity or aerobic power more influential at reducing cardiovascular disease risk factors? Med Sci Sports Exerc 1998; 30(10): 1521–9PubMedCrossRefGoogle Scholar
  112. 112.
    Hansen HS, Hyldebrandt N, Froberg K, et al. Blood pressure and physical fitness, in a population of children: the Odense schoolchild study. J Hum Hypertens 1990; 4: 615–20PubMedGoogle Scholar
  113. 113.
    Bouziotas C, Koutedakis Y, Shiner R, et al. The prevalence of selected modifiable coronary heart disease risk factors in 12-year-old Greek boys and girls. Pediatr Exerc Sci 2001; 13: 173–84Google Scholar
  114. 114.
    Baranowski T, Bouchard C, Bar-Or O, et al. Assessment, prevalence and cardiovascular benefits of physical activity and fitness in youth. Med Sci Sports Exerc 1992; 24 (6 Suppl.): 237–47Google Scholar
  115. 115.
    Davies B. The effects of exercise on primary and secondary coronary heart disease. Coronary Health Care 1997; 1: 60–78CrossRefGoogle Scholar
  116. 116.
    Glenmark B, Hedberg G, Jansson E. Prediction of physical activity level in adulthood by physical performance and physical activity in adolescence: an 11 year follow-up study. Eur J Appl Physiol 1994; 69: 530–8CrossRefGoogle Scholar
  117. 117.
    Riddoch CJ, Savage JM, Murphy N, et al. Long term health implications of fitness and physical activity patterns. Arch Dis Child 1991; 66: 1426–33PubMedCrossRefGoogle Scholar
  118. 118.
    Brill PA, Burkhalter HE, Kohl HW, et al. The impact of previous athleticism on exercise habits, physical fitness and coronary heart disease risk factors in middle-aged men. Res Q Exerc Sport 1989; 60(3): 209–15PubMedGoogle Scholar
  119. 119.
    Sallis JF, Buono MJ, Roby JJ, et al. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc 1993; 25(1): 99–108PubMedCrossRefGoogle Scholar
  120. 120.
    Armstrong N. Young people’s physical activity patterns as assessed by heart rate monitoring. J Sports Sci 1998; 16 Suppl.: 9–16CrossRefGoogle Scholar
  121. 121.
    Kelly LE. Patterns of physical activity in 9–10 year old American children as measured by heart rate monitoring. Pediatr Exerc Sci 2000; 12: 101–10Google Scholar
  122. 122.
    Riddoch CJ, Boreham CAG. The health-related physical activity of children. Sports Med 1995; 19(2): 86–102PubMedCrossRefGoogle Scholar
  123. 123.
    Rowland TW. Is there a scientific rationale supporting the value of exercise for the present and future cardiovascular health of children? Pediatr Exerc Sci 1996; 8: 303–9Google Scholar
  124. 124.
    Paffenbarger Jr RS, Wing AL, Hyde RT. Chronic disease in former college students: XVI. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 1978; 108: 161–75PubMedGoogle Scholar
  125. 125.
    Bergstrom E, Herneil O, Persson LA. Dietary changes in Swedish adolescents. Acta Paediatr 1993; 82: 472–80PubMedCrossRefGoogle Scholar
  126. 126.
    McGinnis JM. The public health burden of a sedentary lifestyle. Med Sci Sports Exerc 1992; 24 (6 Suppl.): 196–200Google Scholar
  127. 127.
    Slattery ML, Schumacher MC, West DW, et al. Food composition trends between adolescent and adult years and subsequent risk of prostate cancer. Am J Clin Nutr 1990; 52: 752–7PubMedGoogle Scholar
  128. 128.
    Millner JA, Allison RG. The role of dietary fat in child nutrition development: summary of ASNS workshop. J Nutr 1999; 129: 2094–105Google Scholar
  129. 129.
    World Health Organization. Study group on diet, nutrition and prevention of non-communable diseases: diet, nutrition and the prevention of chronic disease: report of a World Health Organization Study Group. Geneva: Technical Report Series 797, 1990Google Scholar
  130. 130.
    National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents: overview and summary. Pediatrics 1992; 89: 525–7Google Scholar
  131. 131.
    World Health Organization. Food-based dietary guidelines: a staged approach. Br J Nutr 1999; 81Suppl. 2: S49–55Google Scholar
  132. 132.
    Post GB, Welten DC. The development of nutritional intake during 15 years of follow up. In: Kemper HCG, editor. The Amsterdam Growth Study: a longitudinal analysis of health, fitness, and lifestyle. Champaign (IL): Human Kinetics, 1995: 108–34Google Scholar
  133. 133.
    Woteki CE, Filer LJ. Dietary issues and nutritional status of American children. In: Cheung LWT, Richmond JB, editors. Child health, nutrition, and physical activity. Champaign (IL): Human Kinetics, 1995: 3–44Google Scholar
  134. 134.
    Study Group of Atherosclerosis Society. Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerotic Society. Eur Heart J 1987; 8: 77–88Google Scholar
  135. 135.
    Shea S, Basch CE, Irigoyen M, et al. Relationships of dietary fat consumption to sreum total and low-density lipoprotein cholesterol in Hispanic pre-school children. Prev Med 1991; 20: 237–49PubMedCrossRefGoogle Scholar
  136. 136.
    Pate RR, Heath GW, Dowda M, et al. Associations between physical activity and other health behaviours in a representative sample of US adolescents. Am J Public Health 1996; 86: 1577–81PubMedCrossRefGoogle Scholar
  137. 137.
    Raitakari OT, Leino M, Raikkonen K, et al. Clustering of risk habits in young adults: the Cardiovascular Risk in Young Finns Study. Am J Epidemiol 1995; 142(1): 36–44PubMedGoogle Scholar
  138. 138.
    National Health Forum. Coronary heart disease: estimating the impact of changes in risk factors. London: The Stationery Office, 2002Google Scholar
  139. 139.
    Armstrong N, Davies B. The prevalence of coronary risk factors in children: a review. Acta Paediatr Belg 1980; 33: 209–17PubMedGoogle Scholar
  140. 140.
    Office for National Statistics. Drug use, smoking and drinking among young people in England in 2001 [online]. Available from URL: http://www.doh.gov.uk/public/sddsurvey01summary.pdf [Accessed 2003 May 25]
  141. 141.
    Johnston LD, O’Malley PM, Bachman JG. Prevalence of drug use among high school seniors, college students and young adults. Vol. 1 High School Series. Rockville (MD): National Institute on Drug Abuse Services, US Department of Health and Human Services, 1991: 27–49Google Scholar
  142. 142.
    Andersen LB, Henckel P, Saltin B. Risk factors for cardiovascular disease in 16–19 year old teenagers. J Intern Med 1989; 225(3): 157–63PubMedCrossRefGoogle Scholar
  143. 143.
    Wold B, Hendry L. Social and environmental factors associated with physical activity in young people. In: Biddle S, Sallis J, Cavill N, editors. Young and active? Young people and health-enhancing physical activity: evidence and implications. London: Health Education Authority, 1998: 119–32Google Scholar
  144. 144.
    Cheung LWY. Current views and future perspectives. In: Cheung LWY, Richmond JB, editors. Child health, nutrition, and physical activity. Champaign (IL): Human Kinetics, 1995: 301–19Google Scholar
  145. 145.
    Freeman W, Weir DC, Whitehead JE, et al. Association between risk factors for coronary heart disease in schoolboys and adult mortality rates in the same localities. Arch Dis Child 1990; 65: 78–83PubMedCrossRefGoogle Scholar
  146. 146.
    de Swiet M, Fayers P, Shinebourne EA. Blood pressure in the first ten years of life: the Brompton Study. BMJ 1992; 304: 23–6PubMedCrossRefGoogle Scholar
  147. 147.
    Whincup PH, Cook DG, Adshead F, et al. Cardiovascular risk factors in British children from towns with widely differing cardiovascular mortality. BMJ 1996; 313: 79–84PubMedCrossRefGoogle Scholar
  148. 148.
    Choy PC, Mymin D, Zhu Q, et al. Atherosclerosis risk factors: the possible role of homocysteine. Mol Cell Biochem 2000; 207(1–2): 143–8PubMedCrossRefGoogle Scholar
  149. 149.
    Malinow MR, Sexton G, Averbuch M, et al. Homocys-t(e)inemia in daily practice: levels in coronary artery disease. Coron Artery Dis 1990; 1: 215–20CrossRefGoogle Scholar
  150. 150.
    Eikelboom JW, Lonn E, Genest J, et al. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med 1999; 131(5): 363–75PubMedGoogle Scholar
  151. 151.
    Malinow MR, Bostom AG, Krauss RH. Homocyst(e)ine, diet, and cardiovascular diseases: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation 1999; 99: 178–82PubMedCrossRefGoogle Scholar
  152. 152.
    Chambers JC, McGregor A, Jean-Marie J, et al. Acute hyperhomocysteinaemia and endothelial dysfunction. Lancet 1998; 351: 36–7PubMedCrossRefGoogle Scholar
  153. 153.
    Warsi AA, Hullin D, Lewis MH, et al. Plasma homocysteine, vitamins and abdominal aortic aneurysms. Proceedings from the 37th Congress of the European Society for Surgical Research; 2002 May 23–25; Szeged, 373Google Scholar
  154. 154.
    Boushey CJ, Beresford SAA, Omenn GS, et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA 1995; 274(13): 1049–57PubMedCrossRefGoogle Scholar
  155. 155.
    Reddy MN. Reference ranges for total homocysteine in children. Clin Chim Acta 1997; 262: 153–5PubMedCrossRefGoogle Scholar
  156. 156.
    Osganian SK, Stampfer MJ, Spiegelman O, et al. Distribution of and factors associated with serum homocysteine levels in children: child and adolescent trial for cardiovascular health. JAMA 1999; 281(13): 1189–96PubMedCrossRefGoogle Scholar
  157. 157.
    Fortin LJ, Genest J. Measurement of homocyst(e)ine in the prediction of arteriosclerosis. Clin Biochem 1995; 28: 155–62PubMedCrossRefGoogle Scholar
  158. 158.
    Tonstad S, Refsum H, Siversten M, et al. Relation of total homocysteine and lipid levels in children to premature cardiovascular death in male relatives. Pediatr Res 1996; 40(1): 47–52PubMedCrossRefGoogle Scholar
  159. 159.
    Greenlund KJ, Srinivasan SR, XU J-H, et al. Plasma homocysteine distribution and its association with parental history of coronary heart disease in black and white children: the Bogalusa Heart Study. Circulation 1999; 99(16): 2144–9PubMedCrossRefGoogle Scholar
  160. 160.
    Szymczak E, Chelchowska M, Radomyska B, et al. Homocysteine and some lipid parameters in hypercholesterolemic children. Med Wieku Rozwoj 2001; 5(2): 158–64PubMedGoogle Scholar
  161. 161.
    Krobot K, Hense HW, Cremer P, et al. Determinants of plasma fibrinogen: relation to body weight, waist-to-hip ratio, smoking, alcohol, age, and sex. Arterioscler Thromb 1992; 12: 780–8PubMedCrossRefGoogle Scholar
  162. 162.
    El-Sayed MS. Fibrinogen levels and exercise. Sports Med 1996; 21(6): 402–8PubMedCrossRefGoogle Scholar
  163. 163.
    Eriksson M, Egberg N, Wamala S, et al. Relationship between plasma fibrinogen and coronary heart disease in women. Arterioscl Thromb Vasc Biol 1999; 19(1): 67–72PubMedCrossRefGoogle Scholar
  164. 164.
    Lofmark R. Fibrinogen derivatives and recurrent myocardial infarction. Acta Med Scand 1982; 212: 293–4PubMedCrossRefGoogle Scholar
  165. 165.
    Cantin B, Despres JP, Lamarche B, et al. Association of fibrinogen and lipoprotein(a) as a coronary heart disease risk factor in men (The Quebec Cardiovascular Study). Am J Cardiol 2002; 89(6): 662–6PubMedCrossRefGoogle Scholar
  166. 166.
    Bao W, Srinivasan SR, Berenson GS. Plasma fibrinogen and its correlates in children from a biracial community: the Bogalusa Heart Study. Pediatr Res 1993; 33(4): 323–6PubMedGoogle Scholar
  167. 167.
    Sanchez-Bayle M, Cocho P, Baeza J, et al. Fibrinogen as a cardiovascular risk factor in Spanish children and adolescents. Am Heart J 1993; 126: 322–6PubMedCrossRefGoogle Scholar
  168. 168.
    MacAuley D, McCrum EE, Stott S, et al. Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland Health and Activity Survey. J Epidemiol Community Health 1996; 50(3): 258–63PubMedCrossRefGoogle Scholar
  169. 169.
    Balagopal P, Sweeten S, Mauras N. Increased synthesis rate of fibrinogen as a basis for its elevated plasma levels in obese female adolescents. Am J Physiol Endocrinol Metab 2002; 282(4): E899–904PubMedGoogle Scholar
  170. 170.
    Lee AJ, Smith WCS, Lowe GDO, et al. Plasma fibrinogen and coronary risk factors: the Scottish Heart Study. J Clin Epidemiol 1990; 43(9): 913–9PubMedCrossRefGoogle Scholar
  171. 171.
    Elwood PC, Yarnell JWG, Pickering J, et al. Exercise, fibrinogen, and other risk factors for ischaemic heart disease: Caerphilly Prospective Heart Study. Br Heart J 1993; 69(2): 183–7PubMedCrossRefGoogle Scholar
  172. 172.
    Pankow JS, Folsam AR, Province MA, et al. Segregation analysis of plasminogen activator inhibitor-1 and fibrinogen levels in the NHLBI Family Heart Study. Arterioscl Thromb Vasc Biol 1998; 18(10): 1559–67PubMedCrossRefGoogle Scholar
  173. 173.
    Carroll S, Cooke CB, Butterly RJ. Leisure time physical activity, cardiorespiratory fitness, and plasma fibrinogen concentrations in non-smoking middle-aged men. Med Sci Sports Exerc 2000; 32(3): 620–6PubMedCrossRefGoogle Scholar
  174. 174.
    Karp JE, Bell WR. Fibrinogen-fibrin degradation products and fibrinolysis following exercise in humans. Am J Physiol 1974; 227(5): 1212–5PubMedGoogle Scholar
  175. 175.
    Ernst E. Regular exercise reduces fibrinogen: a review of longitudinal studies. Br J Sports Sci 1993; 27: 175–6Google Scholar
  176. 176.
    El-Sayed MS, Davies B. A physical conditioning program does not alter fibrinogen concentration in young healthy subjects. Med Sci Sports Exerc 1995; 27(4): 485–9PubMedGoogle Scholar
  177. 177.
    Ridker PM, Buring JE, Shih J, et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731–3PubMedCrossRefGoogle Scholar
  178. 178.
    Margaglione M, Cappucci M, Colaizzo D, et al. C-reactive protein in offspring is associated with the occurrence of myocardial infarction in first-degree relatives. Arterioscler Thromb Vasc Biol 2000; 20(1): 198–204PubMedCrossRefGoogle Scholar
  179. 179.
    Tracy RP, Psaty BM, Macy E, et al. Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arterioscler Thromb Vasc Biol 1997; 17: 2167–76PubMedCrossRefGoogle Scholar
  180. 180.
    Mendall MA, Patel P, Ballam L, et al. C-reactive protein and its relation to cardiovascular risk factors: a population based cross-sectional study. BMJ 1996; 312(7038): 1061–5PubMedCrossRefGoogle Scholar
  181. 181.
    Forouhi NG, Sattar N, McKeigue PM. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes 2001; 25: 1327–31CrossRefGoogle Scholar
  182. 182.
    Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002; 162(11): 1286–92PubMedCrossRefGoogle Scholar
  183. 183.
    de Maat MPM, de Bart ACW, Hennis BC, et al. Interindividual and intraindividual variability in plasma fibrinogen, TPA antigen, PAI activity and C-reactive protein in healthy, young volunteers and patients with angina pectoris. Arterioscler Thromb Vasc Biol 1996; 16: 1156–62PubMedCrossRefGoogle Scholar
  184. 184.
    Sormunen P, Kallio MJT, Kilpi T, et al. C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children. J Pediatr 1999; 134(6): 725–9PubMedCrossRefGoogle Scholar
  185. 185.
    Ford ES, Galuska DA, Gillespie C, et al. C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. J Pediatr 2001; 138(4): 486–92PubMedCrossRefGoogle Scholar
  186. 186.
    Hamsten A, Wiman B, de Faire U, et al. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors or myocardial infarction. N Engl J Med 1985; 313: 1557–63PubMedCrossRefGoogle Scholar
  187. 187.
    Hamsten A, de Faire U, Walldius G, et al. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet 1987; II: 3–9CrossRefGoogle Scholar
  188. 188.
    Keijer J, Linders M, van Zonneveld A-J, et al. The interaction of plasminogen activator inhibitor 1 with plasminogen activators and fibrin. Blood 1991; 78(2): 401–9PubMedGoogle Scholar
  189. 189.
    Kohler HP, Grant PJ. Plasminogen activator inhibitor type 1 and coronary artery disease. N Engl J Med 2000; 342(24): 1792–801PubMedCrossRefGoogle Scholar
  190. 190.
    Landin K, Stigendal L, Eriksson E, et al. Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1. Metabolism 1990; 39: 1044–8PubMedCrossRefGoogle Scholar
  191. 191.
    Stratton JR, Chandler WL, Schwartz RS, et al. Effects of physical conditioning in fibrinolytic variables and fibrinogen in young and old healthy adults. Circulation 1991; 83: 1692–7PubMedCrossRefGoogle Scholar
  192. 192.
    Sudi K, Gallistl S, Payerl D, et al. Interrelationship between estimates of adiposity and body fat distribution with metabolic and hemostatic parameters in obese children. Metabolism 2001; 50(6): 681–7PubMedCrossRefGoogle Scholar
  193. 193.
    Celermayer DS, Sorensen KE, Gooch VM, et al. Non invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340(8828): 1111–5CrossRefGoogle Scholar
  194. 194.
    Hornig B, Arakawa N, Kohler C, et al. Vitamin C improves endothelial function of conduit arteries in patients with chronic heart failure [abstract]. Circulation 1998; 97: 363–8PubMedCrossRefGoogle Scholar
  195. 195.
    Quyymi AA. Endothelial function in health and disease: new insights into the genesis of cardiovascular disease. Am J Med 1998; 105 (1A Suppl.): 32–9CrossRefGoogle Scholar
  196. 196.
    Sorensen KE, Celermajer DS, Georgakopoulos D, et al. Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein(a) level. J Clin Invest 1994; 93(1): 50–5PubMedCrossRefGoogle Scholar
  197. 197.
    de Jongh S, Lilien MR, Bakker HD, et al. Family history of cardiovascular events and endothelial dysfunction in children with familial hypercholesterolemia. Atherosclerosis 2002; 163(1): 193–7PubMedCrossRefGoogle Scholar
  198. 198.
    Raitakari OT, Porkka KVK, Räsänen L, et al. Clustering and six year cluster-tracking of serum total cholesterol, HDL-cholesterol and diastolic blood pressure in children and young adults: the cardiovascular risk in young Finns study. J Clin Epidemiol 1994; 47: 1085–93PubMedCrossRefGoogle Scholar
  199. 199.
    Twisk JWR, Boreham C, Cran G, et al. Clustering of biological risk factors for cardiovascular disease and the longitudinal relationship with lifestyle of an adolescent population: the Northern Ireland Young Hearts Project. J Cardiovasc Risk 1999; 6(6): 355–62PubMedGoogle Scholar
  200. 200.
    Assmann G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle aged men. Am J Cardiol 1996; 77: 1179–84PubMedCrossRefGoogle Scholar
  201. 201.
    Riddoch C, Boreham C. Physical activity, physical fitness and children’s health: current concepts. In: Armstrong N, van Mechelen W, editors. Pediatric exercise science and medicine. Oxford (NY): Oxford University Press, 2000: 243–52Google Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Non Eleri Thomas
    • 1
  • Julien S. Baker
    • 2
  • Bruce Davies
    • 2
  1. 1.School of Sport, Physical Education and RecreationUniversity of Wales Institute CardiffCyncoedWales
  2. 2.School of Applied SciencesUniversity of GlamorganPontypriddWales

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