Exercise and Type 2 Diabetes in Youth

  • Kristen Nadeau
  • Jane E.B. Reusch
  • Judith Regensteiner
Part of the Contemporary Diabetes book series (CDI)


The antecedents of adult cardiovascular disease begin in childhood. Accompanying the dramatic increase in childhood obesity and decline in physical activity, the prevalence of type 2 diabetes mellitus (T2DM) in pediatrics is also rising, forecasting earlier macrovascular and microvascular complications. Poor physical fitness is associated with increased cardiovascular morbidity and mortality. The presence of T2DM appears to confer a specific exercise defect, as adults with T2DM have reduced VO2max, slower VO2kinetics, and slower heart rate kinetics when compared with age, pubertal stage, weight, and activity-matched controls. As little exercise data exists in youth with T2DM, our group assessed VO2max in adolescents with T2DM, compared with nondiabetic, obese, and lean controls. We found significant impairments in maximal and submaximal exercise, not explainable by weight or activity level alone. VO2max/kg was strongly related to insulin resistance, as well as inflammation, impaired endothelial function, and ectopic lipid deposition. Notably, these defects are already happening in very young patients, with no other comorbidities or reasons for exercise dysfunction. Therefore, since exercise capacity predicts cardiovascular and all cause mortality, it is critical to further assess the mechanisms of exercise dysfunction in T2DM youth, as well as the impact of diabetes treatments in adolescents. On the basis of studies in adults and in adolescents with obesity and insulin resistance, exercise interventions appear helpful, but further study in pediatric T2DM is required.


Exercise Type 2 diabetes Pediatrics Insulin resistance 


  1. 1.
    Berenson, G.S., et al., Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med, 1998. 338: p. 1650–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Raitakari, O.T., et al., Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA, 2003. 290: p. 2277–83.PubMedCrossRefGoogle Scholar
  3. 3.
    Pinhas-Hamiel, O. and P. Zeitler, Advances in the epidemiology and treatment of type 2 diabetes in children. Adv Pediatr, 2005. 52: p. 223–59.PubMedCrossRefGoogle Scholar
  4. 4.
    Dietz, W.H., A.L. Franks, and J.S. Marks, The obesity problem [comment]. N Engl J Med, 1998. 338(16): p. 1157; author reply 1158.PubMedGoogle Scholar
  5. 5.
    Kaufman, F.R., Type 2 diabetes mellitus in children and youth: a new epidemic. J Pediatr Endocrinol Metab, 2002. 15 (Suppl. 2): p. 737–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Narayan, K.M., et al., Lifetime risk for diabetes mellitus in the United States. JAMA, 2003. 290(14): p. 1884–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Hillier, T. and K. Pedula, Complications in young adults with early-onset type 2 diabetes. Diab Care, 2003. 26: p. 2999–3005.CrossRefGoogle Scholar
  8. 8.
    Pavkov, M.E., et al., Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA, 2006. 296: p. 421–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Hillier, T.A. and K.L. Pedula, Characteristics of an adult population with newly diagnosed type 2 diabetes: the relation of obesity and age of onset. Diabetes Care, 2001. 24(9): p. 1522–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Hu, F.B., et al., The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women. Arch Intern Med, 2001. 161: p. 1717–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Fagot-Campagna, A., et al., Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr, 2000. 136(5): p. 664–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaufman, F.R., Type 2 diabetes mellitus in children and youth: a new epidemic. J Pediatr Endocrinol Metab, 2002. 15 (Suppl. 2): p. 737–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Wei, M., et al., Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA, 1999. 282(16): p. 1547–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Blair, S.N. and M. Wei, Sedentary habits, health, and function in older women and men. Am J Health Promot, 2000. 15(1): p. 1–8.PubMedGoogle Scholar
  15. 15.
    Seyoum, B., et al., Exercise capacity is a predictor of cardiovascular events in patients with type 2 diabetes mellitus. Diab Vasc Dis Res, 2006. 3(3): p. 197–201.PubMedCrossRefGoogle Scholar
  16. 16.
    Wei, M., et al., Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med, 2000. 132(8): p. 605–11.PubMedGoogle Scholar
  17. 17.
    Ribeiro, J., et al., Overweight and obesity in children and adolescents: relationship with blood pressure, and physical activity. Ann Hum Biol, 2003. 30(2): p. 203–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Koga, T., A. Kawaguchi, and H. Aizawa, Physical activity and cardiovascular risk in children. Lancet, 2006. 368(9544): p. 1326; author reply 1326–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Klasson-Heggebo, L., et al., Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med, 2006. 40(1): p. 25–9; discussion 25–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Andersen, L.B., et al., Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet, 2006. 368(9532): p. 299–304.PubMedCrossRefGoogle Scholar
  21. 21.
    Vuori, I.M., Health benefits of physical activity with special reference to interaction with diet. Public Health Nutr, 2001. 4(2B): p. 517–28.PubMedCrossRefGoogle Scholar
  22. 22.
    Erlichman, J., A.L. Kerbey, and W.P. James, Physical activity and its impact on health outcomes. Paper 1: The impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective. Obes Rev, 2002. 3(4): p. 257–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Smith, T.C., et al., Walking decreased risk of cardiovascular disease mortality in older adults with diabetes. J Clin Epidemiol, 2007. 60(3): p. 309–17.PubMedCrossRefGoogle Scholar
  24. 24.
    Fulton-Kehoe, D., et al., A case-control study of physical activity and non-insulin dependent diabetes mellitus (NIDDM). The San Luis Valley Diabetes Study. Ann Epidemiol, 2001. 11(5): p. 320–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Li, S., B. Culver, and J. Ren, Benefit and risk of exercise on myocardial function in diabetes. Pharmacol Res, 2003. 48(2): p. 127–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Knowler, W.C., et al., Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002. 346(6): p. 393–403.PubMedCrossRefGoogle Scholar
  27. 27.
    Krook, A., et al., Reduction of risk factors following lifestyle modification programme in subjects with type 2 (non-insulin dependent) diabetes mellitus. Clin Physiol Funct Imaging, 2003. 23(1): p. 21–30.PubMedCrossRefGoogle Scholar
  28. 28.
    Anonymous, American Diabetes Association: clinical practice recommendations 2002. Diabetes Care, 2002. 25 (Suppl. 1): p. S1–S147.Google Scholar
  29. 29.
    Krug, L.M., D. Haire-Joshu, and S.A. Heady, Exercise habits and exercise relapse in persons with non-insulin-dependent diabetes mellitus. Diabetes Educ, 1991. 17(3): p. 185–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Regensteiner, J.G., et al., Effects of non-insulin-dependent diabetes on oxygen consumption during treadmill exercise. Med Sci Sports Exerc, 1995. 27(6): p. 875–81.PubMedGoogle Scholar
  31. 31.
    Regensteiner, J.G., et al., Relationship between habitual physical activity and insulin area among individuals with impaired glucose tolerance. The San Luis Valley Diabetes Study. Diabetes Care, 1995. 18(4): p. 490–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Campaigne, B.N., et al., Effects of a physical activity program on metabolic control and cardiovascular fitness in children with insulin-dependent diabetes mellitus. Diabetes Care, 1984. 7(1): p. 57–62.PubMedCrossRefGoogle Scholar
  33. 33.
    Sigal, R.J., et al., Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care, 2006. 29(6): p. 1433–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Brage, S., et al., Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care, 2004. 27(9): p. 2141–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Ferreira, I., et al., Development of fatness, fitness, and lifestyle from adolescence to the age of 36 years: determinants of the metabolic syndrome in young adults: the Amsterdam growth and health longitudinal study. Arch Intern Med, 2005. 165(1): p. 42–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Platat, C., et al., Relationships of physical activity with metabolic syndrome features and low-grade inflammation in adolescents. Diabetologia, 2006. 49(9): p. 2078–85.PubMedCrossRefGoogle Scholar
  37. 37.
    DuBose, K.D., J.C. Eisenmann, and J.E. Donnelly, Aerobic fitness attenuates the metabolic syndrome score in normal-weight, at-risk-for-overweight, and overweight children. Pediatrics, 2007. 120(5): p. e1262–e1268.PubMedCrossRefGoogle Scholar
  38. 38.
    Kelishadi, R., et al., Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study. Horm Res, 2007. 67(1): p. 46–52.PubMedCrossRefGoogle Scholar
  39. 39.
    Eisenmann, J.C., et al., Fatness, fitness, and cardiovascular disease risk factors in children and adolescents. Med Sci Sports Exerc, 2007. 39(8): p. 1251–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Eisenmann, J.C., et al., Aerobic fitness, body mass index, and CVD risk factors among adolescents: the Quebec family study. Int J Obes, 2005. 29(9): p. 1077–83.CrossRefGoogle Scholar
  41. 41.
    Eisenmann, J.C., et al., Relationship between adolescent fitness and fatness and cardiovascular disease risk factors in adulthood: the Aerobics Center Longitudinal Study (ACLS). Am Heart J, 2005. 149(1): p. 46–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Morrato, E.H., et al., Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care, 2007. 30(2): p. 203–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Kimm, S.Y., et al., Longitudinal changes in physical activity in a biracial cohort during adolescence. Med Sci Sports Exerc, 2000. 32(8): p. 1445–54.PubMedCrossRefGoogle Scholar
  44. 44.
    Chatrath, R., et al., Physical fitness of urban American children. Pediatr Cardiol, 2002. 23(6): p. 608–12.PubMedCrossRefGoogle Scholar
  45. 45.
    Kim, Y., T.P. Ciaraldi, A. Kong, D. Kim, N. Chu, P. Mohideen, S. Mudaliar, R.R. Henry and , B.B. Kahn, Troglitazone but not metformin restores insulin-stimulated phosphoinositide 3-kinase activity and increased p110B protein levels in skeletal muscle of type 2 diabetic subjects. Diabetes, 2002. 51: p. 443–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Carnethon, M.R., M. Gulati, and P. Greenland, Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. JAMA, 2005. 294(23): p. 2981–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Klasson-Heggebo, L. and S.A. Anderssen, Gender and age differences in relation to the recommendations of physical activity among Norwegian children and youth. Scand J Med Sci Sports, 2003. 13(5): p. 293–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Riddoch, C.J., et al., Physical activity levels and patterns of 9- and 15-yr-old European children. Med Sci Sports Exerc, 2004. 36(1): p. 86–92.PubMedCrossRefGoogle Scholar
  49. 49.
    Luepker, R.V., How physically active are American children and what can we do about it? Int J Obes Relat Metab Disord, 1999. 23 (Suppl. 2): p. S12–S17.PubMedCrossRefGoogle Scholar
  50. 50.
    Flynn, M.A., et al., Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev, 2006. 7 (Suppl. 1): p. 7–66.PubMedCrossRefGoogle Scholar
  51. 51.
    Steffen, L.M., et al., Population trends in leisure-time physical activity: Minnesota Heart Survey, 1980–2000. Med Sci Sports Exerc, 2006. 38(10): p. 1716–23.PubMedCrossRefGoogle Scholar
  52. 52.
    Regensteiner, J.G., et al., Abnormal oxygen uptake kinetic responses in women with type II diabetes mellitus. J Appl Physiol, 1998. 85(1): p. 310–17.PubMedGoogle Scholar
  53. 53.
    Thamer, C., et al., Reduced skeletal muscle oxygen uptake and reduced beta-cell function: two early abnormalities in normal glucose-tolerant offspring of patients with type 2 diabetes. Diabetes Care, 2003. 26(7): p. 2126–32.PubMedCrossRefGoogle Scholar
  54. 54.
    Maffeis, C., Maximal aerobic power during running and cycling in obese and non-obese children. Acta Paediatr, 1994. 83(1): p. 113–16.PubMedCrossRefGoogle Scholar
  55. 55.
    Watanabe, K., Relationship between body composition and cardiorespiratory fitnmess in Japanese junior high school boys and girls. Ann Physiol Anthropol, 1994. 13(4): p. 167–74.PubMedGoogle Scholar
  56. 56.
    Marinov, B., S. Kostianev, and T. Turnovska, Ventilatory efficiency and rate of perceived exertion in obese and non-obese children performing standard exercise. Clin Physiol Funct Imaging, 2002. 22(4): p. 254–60.PubMedCrossRefGoogle Scholar
  57. 57.
    Norman, A.C., et al., Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents. Pediatrics, 2005. 115(6): p. e690–e696.PubMedCrossRefGoogle Scholar
  58. 58.
    Molnar, D. and J. Porszasz, The effect of fasting hyperinsulinaemia on physical fitness in obese children. Eur J Pediatr, 1990. 149: p. 570–3.PubMedCrossRefGoogle Scholar
  59. 59.
    Torok, K., Z. Szelenyi, J. Porszasz, and D. Molnar, Low physical performance in obese adolescent boys with metabolic syndrome. Int J Obes, 2001. 25: p. 966–70.CrossRefGoogle Scholar
  60. 60.
    McMurray, R.G., et al., Effects of improvement in aerobic power on resting insulin and glucose concentrations in children. Eur J Appl Physiol, 2000. 81(1–2): p. 132–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Shaibi, G.Q., et al., Cardiovascular fitness and the metabolic syndrome in overweight latino youths. Med Sci Sports Exerc, 2005. 37(6): p. 922–8.PubMedGoogle Scholar
  62. 62.
    Shaibi, G.Q., et al., Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Med Sci Sports Exerc, 2006. 38(7): p. 1208–15.PubMedCrossRefGoogle Scholar
  63. 63.
    Ball, G.D., et al., Insulin sensitivity, cardiorespiratory fitness, and physical activity in overweight Hispanic youth. Obes Res, 2004. 12(1): p. 77–85.PubMedCrossRefGoogle Scholar
  64. 64.
    Ribeiro, M.M., et al., Diet and exercise training restore blood pressure and vasodilatory responses during physiological maneuvers in obese children. Circulation, 2005. 111(15): p. 1915–23.PubMedCrossRefGoogle Scholar
  65. 65.
    Nassis, G.P., et al., Aerobic exercise training improves insulin sensitivity without changes in body weight, body fat, adiponectin, and inflammatory markers in overweight and obese girls. Metabolism, 2005. 54(11): p. 1472–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Carrel, A.L., et al., Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Arch Pediatr Adolesc Med, 2005. 159(10): p. 963–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Nwobu, C.O. and C.C. Johnson, Targeting obesity to reduce the risk for type 2 diabetes and other co-morbidities in African American youth: a review of the literature and recommendations for prevention. Diab Vasc Dis Res, 2007. 4(4): p. 311–19.PubMedCrossRefGoogle Scholar
  68. 68.
    Sallis, J.F., et al., The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, play and active recreation for kids. Am J Public Health, 1997. 87(8): p. 1328–34.PubMedCrossRefGoogle Scholar
  69. 69.
    Pangrazi, R.P., et al., Impact of Promoting Lifestyle Activity for Youth (PLAY) on children's physical activity. J Sch Health, 2003. 73(8): p. 317–21.PubMedCrossRefGoogle Scholar
  70. 70.
    McGavock, J., E. Sellers, and H. Dean, Physical activity for the prevention and management of youth-onset type 2 diabetes mellitus: focus on cardiovascular complications. Diab Vasc Dis Res, 2007. 4(4): p. 305–10.PubMedCrossRefGoogle Scholar
  71. 71.
    Crespo, C.J., et al., Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med, 2001. 155(3): p. 360–5.PubMedGoogle Scholar
  72. 72.
    Berkey, C.S., et al., One-year changes in activity and in inactivity among 10- to 15-year-old boys and girls: relationship to change in body mass index. Pediatrics, 2003. 111(4, Part 1): p. 836–43.PubMedCrossRefGoogle Scholar
  73. 73.
    Zeitler, P., et al., Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes, 2007. 8(2): p. 74–87.PubMedCrossRefGoogle Scholar
  74. 74.
    Faulkner, M.S., et al., Cardiovascular endurance and heart rate variability in adolescents with type 1 or type 2 diabetes. Biol Res Nurs, 2005. 7(1): p. 16–29.PubMedCrossRefGoogle Scholar
  75. 75.
    Rowell, L., Human circulation regulation during physical stress. New York: Oxford University Press, 1986.Google Scholar
  76. 76.
    Regensteiner, J.G., et al., Recently diagnosed type 2 diabetes mellitus adversely affects cardiac function during exercise. Diabetes, 2002. 51 (Suppl. 2): p. A59.Google Scholar
  77. 77.
    Baldi, J.C., et al., The effect of type 2 diabetes on diastolic function. Med Sci Sports Exerc, 2006. 38(8): p. 1384–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Regensteiner, J.G., et al., Oral L-arginine and vitamins E and C improve endothelial function in women with type 2 diabetes. Vasc Med, 2003. 8(3): p. 169–75.PubMedCrossRefGoogle Scholar
  79. 79.
    Williams, S., J.A. Cusco, M.A. Roddy, M.T. Johnstone, and M.A. Creager, Impaired nitric oxide-mediated vasodilation in patients with non-insulin-dependent diabetes mellitus. J Am Coll Cardiol, 1996. 27: p. 567–74.PubMedCrossRefGoogle Scholar
  80. 80.
    Kingwell, B., M. Formosa, M. Muhlmann, S.J. Bradley, and G.K. McConell, Type 2 diabetic individuals have impaired leg blood flow responses to exercise: role of endothelium-dependent vasodilation. Diabetes Care, 2003. 26(3): p. 899–904.PubMedCrossRefGoogle Scholar
  81. 81.
    Estacio, R., J.G. Regensteiner, E.E. Wolfel, B. Jeffers, M. Dickenson and, R.W. Schrier, The association between diabetic complications and exercise capacity in NIDDM patients. Diabetes Care, 1998. 21: p. 291–5.PubMedCrossRefGoogle Scholar
  82. 82.
    Steinberg, H.O. and A.D. Baron, Vascular function, insulin resistance and fatty acids. Diabetologia, 2002. 45: p. 623–34.PubMedCrossRefGoogle Scholar
  83. 83.
    Simoneau, J.-A. and D.E. Kelley, Altered glycolytic and oxidative capacitites of skeletal muscle contribute to insulin resistance in NIDDM. J Appl Physiol, 1997. 83: p. 166–71.PubMedGoogle Scholar
  84. 84.
    Marin, P., M. Krotkiewski, B. Anderson, and P. Bjorntorp, Muscle fiber composition and capillary density in women and men with NIDDM. Diabetes Care, 1994. 17: p. 382–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Regensteiner, J.G., T.A. Bauer, and J.E. Reusch, Rosiglitazone improves exercise capacity in individuals with type 2 diabetes. Diabetes Care, 2005. 28(12): p. 2877–83.PubMedCrossRefGoogle Scholar
  86. 86.
    Mikines, K.J., et al., Effect of training on the dose-response relationship for insulin action in men. J Appl Physiol, 1989. 66(2): p. 695–703.PubMedGoogle Scholar
  87. 87.
    Ferrara, C.M., et al., Effects of aerobic and resistive exercise training on glucose disposal and skeletal muscle metabolism in older men. J Gerontol A Biol Sci Med Sci, 2006. 61(5): p. 480–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Brandenburg, S., J. Reusch, T.A. Bauer, B.W. Jeffers, W.R. Hiatt, and J.G. Regensteiner, Effects of exercise training on oxygen uptake kinetic responses in women with type 2 diabetes. Diabetes Care, 1999. 22(10): p. 1640–6.PubMedCrossRefGoogle Scholar
  89. 89.
    Albertini, J.P., et al., Effect of rosiglitazone on factors related to endothelial dysfunction in patients with type 2 diabetes mellitus. Atherosclerosis, 2007. 195: p. e159–e166.PubMedCrossRefGoogle Scholar
  90. 90.
    Travers, S.H., et al., Gender and Tanner stage differences in body composition and insulin sensitivity in early pubertal children. J Clin Endocrinol Metab, 1995. 80(1): p. 172–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Moran, A., et al., Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes, 1999. 48(10): p. 2039–44.PubMedCrossRefGoogle Scholar
  92. 92.
    Kelly, A.S., et al., Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. J Pediatr, 2004. 145(6): p. 731–6.PubMedCrossRefGoogle Scholar
  93. 93.
    Carrell, A., R.R. Clark, S.E. Peterson, B.A. Nemeth, J. Sullivan, and D.B. Allen, Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program. Arch Pediatr Adolesc Med, 2005. 159: p. 963–8.CrossRefGoogle Scholar
  94. 94.
    Ritenbaugh, C., et al., A lifestyle intervention improves plasma insulin levels among Native American high school youth. Prev Med, 2003. 36(3): p. 309–19.PubMedCrossRefGoogle Scholar
  95. 95.
    Monzavi, R., et al., Improvement in risk factors for metabolic syndrome and insulin resistance in overweight youth who are treated with lifestyle intervention. Pediatrics, 2006. 117(6): p. e1111–e1118.PubMedCrossRefGoogle Scholar
  96. 96.
    Gutin, B., et al., Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Am J Clin Nutr, 2002. 75(5): p. 818–26.PubMedGoogle Scholar
  97. 97.
    Kang, H.S., et al., Physical training improves insulin resistance syndrome markers in obese adolescents. Med Sci Sports Exerc, 2002. 34(12): p. 1920–7.PubMedCrossRefGoogle Scholar
  98. 98.
    Balagopal, P., et al., Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr, 2005. 146(3): p. 342–8.PubMedCrossRefGoogle Scholar
  99. 99.
    Balagopal, P., et al., Reversal of obesity-related hypoadiponectinemia by lifestyle intervention: a controlled, randomized study in obese adolescents. J Clin Endocrinol Metab, 2005. 90(11): p. 6192–7.PubMedCrossRefGoogle Scholar
  100. 100.
    Davis, C.L., et al., Aerobic exercise and snoring in overweight children: a randomized controlled trial. Obesity, 2006. 14(11): p. 1985–91.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kristen Nadeau
    • 1
  • Jane E.B. Reusch
    • 2
  • Judith Regensteiner
    • 3
  1. 1.Division of EndocrinologyDepartment of Pediatrics, University of Colorado DenverAuroraUSA
  2. 2.Division of EndocrinologyMetabolism and Diabetes, Department of Medicine, University of Colorado DenverAuroraUSA
  3. 3.Divisions of General Internal Medicine and CardiologyDepartment of Medicine, University of Colorado DenverAuroraUSA

Personalised recommendations