Impact of physical exercise/activity on vascular structure and inflammation in pediatric populations: A literature review

Sleep and Inflammation during COVID-19 Virtual Learning in Adolescents with Overweight or Obesity

(1) Background: Adolescents present as a high-risk group for a range of adverse physical health outcomes during the pandemic, including sleep and C-reactive protein (CRP) levels. As adolescents with overweight or obesity (OWOB) present as an even higher risk group, the present study assessed relationships between sleep and CRP levels before and during COVID-19 in adolescents with OWOB. (2) Methods: Fourteen adolescents with OWOB participated in a pre-COVID1, pre-COVID2, and during-COVID-19 lab visit, measuring sleep and CRP levels. The sample size was limited by the number of participants who provided data before COVID-19 and who were enrolled in virtual school during the recruitment phase. However, our power analyses indicated needing a minimum of 10 participants to achieve adequate power. Pre-COVID1, pre-COVID2, and during-COVID-19 normative expected CRP levels were calculated based on age, sex, race, and body mass index percentile-matched data. Analyses compared pre-COVID1 and pre-COVID2 sleep with during-COVID-19 sleep, during-COVID-19 sleep and during-COVID-19 CRP levels, during-COVID-19 CRP levels with normative expected during-COVID-19 CRP levels, change in CRP levels from pre-COVID1 and pre-COVID2 to during-COVID-19 with normative expected CRP levels during those time periods, and change in CRP levels before COVID-19 with change in CRP levels during COVID-19. (3) Results. During COVID-19, participants experienced decreased sleep efficiency (p = 0.001), later wake time (p < 0.001), longer time in bed (p = 0.021), and onset latency (p = 0.004), compared to pre-COVID1, and decreased sleep efficiency (p = 0.002), longer onset latency (p = 0.006), and later wake time (p < 0.001) and bedtime (p = 0.016) compared with pre-COVID2. During-COVID-19 CRP levels were positively correlated with during-COVID-19 wake times (p = 0.01) and times in bed (p = 0.008). During-COVID-19 CRP levels were greater than normative expected CRP levels (p < 0.001). CRP levels increased more from pre-COVID1 and pre-COVID2 to during-COVID-19 than normative expected changes in CRP levels (p < 0.003). Changes in CRP levels before and during COVID-19 were not significantly different. (4) Conclusions. These findings highlight the consequential effects of COVID-19, including impairments in sleep, on adolescents with OWOB. CRP levels increased more (~5 mg/L) during COVID-19 than normative expected change.

Training the Vessels: Molecular and Clinical Effects of Exercise on Vascular Health-A Narrative Review

Accelerated biological vascular ageing is still a major driver of the increasing burden of cardiovascular disease and mortality. Exercise training delays this process, known as early vascular ageing, but often lacks effectiveness due to a lack of understanding of molecular and clinical adaptations to specific stimuli. This narrative review summarizes the current knowledge about the molecular and clinical vascular adaptations to acute and chronic exercise. It further addresses how training characteristics (frequency, intensity, volume, and type) may influence these processes. Finally, practical recommendations are given for exercise training to maintain and improve vascular health. Exercise increases shear stress on the vascular wall and stimulates the endothelial release of circulating growth factors and of exerkines from the skeletal muscle and other organs. As a result, remodeling within the vascular walls leads to a better vasodilator and -constrictor responsiveness, reduced arterial stiffness, arterio- and angiogenesis, higher antioxidative capacities, and reduced oxidative stress. Although current evidence about specific aspects of exercise training, such as F-I-T-T, is limited, and exact training recommendations cannot be given, some practical implications can be extracted. As such, repeated stimuli 5-7 days per week might be necessary to use the full potential of these favorable physiological alterations, and the cumulative volume of mechanical shear stress seems more important than peak shear stress. Because of distinct short- and long-term effects of resistance and aerobic exercise, including higher and moderate intensities, both types of exercise should be implemented in a comprehensive training regimen. As vascular adaptability towards exercise remains high at any age in both healthy individuals and patients with cardiovascular diseases, individualized exercise-based vascular health prevention should be implemented in any age group from children to centenarians.

Association of physical fitness with cognitive function in the community-dwelling older adults

Background

Cognitive function generally declines with the aging process. Although the association of physical fitness with cognitive function has been proved, how many and how well the physical fitness components are linked to cognitive function is not clear. This study aimed to examine the association of physical fitness with cognitive function, and find out which aspects of physical fitness components are the most closely related to cognitive function in community-dwelling older adults.

Methods

This cross-sectional study was conducted from March to July 2019. The sample consisted of 107 older people in the community with a mean age of 71.7 ± 5.0 years. The cognitive function of the participants was measured by a Chinese version of the Mini-Mental State Examination (MMSE). Several physical fitness items including grip strength, 5-repetition sit-to-stand, timed up and go, sit and reach, one-leg balance with the eye open, and 6-min walk were measured to reflect muscle strength, muscle endurance, agility, flexibility, balance, and cardiopulmonary endurance, respectively.

Results

The correlation analysis showed that the grip strength and the 6-min walk were positively related to cognitive function (r = 0.42 and 0.35, P < 0.05), while the 5-repetition sit-to-stand was negatively associated with cognitive function (r = -0.43, P < 0.01) adjusting for sex, age and years of education. It was also found that the mean values of physical fitness items including grip strength and 6-min walk were significantly lower, and 5-repetition sit-to-stand and timed up and go were significantly greater in the older adults with cognitive impairment (MMSE score < 27) than those in the normal older adults (MMSE score ≥ 27) (P < 0.05). Stepwise regression analysis revealed that age, together with physical fitness items including grip strength and 6-min walk can explain the cognitive function in older adults.

Conclusion

The findings suggest that there is an association between physical fitness and cognitive function, and the grip strength and 6-min walk can help explain the cognitive function in community-dwelling older adults. More attention needs to be paid to the increase in physical fitness for preventing or improving the cognitive dysfunction of older persons in the community, and further longitudinal study is warranted.

Ideal cardiovascular health, inflammation, and arterial stiffness in the transition to adulthood

BACKGROUND

Ideal cardiovascular health (ICH) promotes primordial prevention of cardiovascular diseases. However, whether ICH is associated with arterial stiffness in the transition to adulthood and the mechanisms associated has yet to be shown. The aim of this investigation was to: 1) investigate whether there is a prospective association between ICH and pulse wave velocity (PWV) in the transition to adulthood; and 2) to stablish whether the association between ICH and PWV is mediated by inflammatory markers.

METHODS

Participants were part of the 1993 Pelotas Birth Cohort and follow-ups at 18- and 22-years were used in this study. At the age of 18 years, ICH was computed as the presence of ideal for the following metrics: physical activity, diet, smoking, blood cholesterol and glucose, blood pressure, and body mass index. At the age of 22 years, aortic PWV was obtained as well as interleukin-6 (IL-6) and C-reactive protein (CRP).

RESULTS

A total of 3528 (1851 females) were included in the analysis. A significant linear effect was observed for ICH on PWV. After adjusting for socioeconomical status, skin colour, birth weight, and mother schooling male and female participants with better ICH profile had PWV of 0.70 m·s^-1 and 0.60 m·s^-1 slower than participants with poor ICH. No evidence for a mediating role of inflammatory markers was observed for male (<1%) and female (<5%) mediated by IL-6 and CRP.

CONCLUSIONS

ICH is inversely associated with PWV among male and female in the transition to adulthood with no mediating role of inflammation.

Associations between physical activity, sedentary time and cardiovascular risk factors among Dutch children

Introduction

Physical activity (PA) plays an important role in the prevention of cardiovascular diseases, especially in children. Previous studies which investigated the role of PA and sedentary time (ST) in cardiovascular disease used different measurements and found inconsistent results. The current study used recommended standardized measures and provides an overview of PA and ST among Dutch primary school children and their associations with cardiovascular risk factors.

Methods

503 children (55% girls, mean age (± SD) 10 ± 1y) were included. PA (total PA, lightPA and moderate to vigorous PA (MVPA)) and ST were measured with the Actigraph GT3X accelerometer. PA in different domains was measured with the BAECKE questionnaire. Cardiovascular risk factors included BMI z-score, waist circumference, blood pressure (z-score) and estimated cardiorespiratory fitness (CRF) as measured with the 20 meter shuttle run test.

Results

Children spent 57 ± 20 min/day (8%) on MVPA and 42% of the children reached the MVPA guideline of 60 min/day. Total PA and MVPA (h/day) were negatively associated with BMI z-score (B = -0.452, p = 0.011) and waist circumference (B = -3.553, p = 0.011) and positively associated with CRF (B = 2.527, p = <0.001). ST was positively associated with BMI z-score (B = 0.108, p = 0.048) and waist circumference (B = 0.920, p = 0.033). No significant associations were found between total PA or PA intensities and blood pressure.

Conclusion

This study used standardized measures of PA and therefore created an accurate overview of PA, ST and their associations with cardiovascular risk factors. PA and ST were associated with BMI z-score, waist circumference and CRF. The findings emphasize the importance of promoting MVPA in children, but also highlight the potential benefits of reducing ST to improve cardiovascular risk factors.

Trial registration

ClinicalTrials.gov NCT03440580.

Vascular Structure and Function in Children and Adolescents: What Impact Do Physical Activity, Health-Related Physical Fitness, and Exercise Have?

A physically active lifestyle can prevent cardiovascular disease. Exercise intervention studies in children and adolescents that aim to increase physical activity have resulted in reduced vascular wall thickening and improve cardiovascular function. Here we review the literature that explores the correlations between physical activity, health-related physical fitness, and exercise interventions with various measures of vascular structure and function in children and adolescents. While several of these studies identified improvements in vascular structure in response to physical activity, these associations were limited to studies that relied on questionnaires. Of concern, these findings were not replicated in studies featuring quantitative assessment of physical activity with accelerometers. Half of the studies reviewed reported improved vascular function with increased physical activity, with the type of vascular measurement and the way physical activity was assessed having an influence on the reported relationships. Similary, most of the studies identified in the literature report a beneficial association of health-related physical fitness with vascular structure and function. Overall, it was difficult to compare the results of these studies to one another as different methodologies were used to measure both, health-related physical fitness and vascular function. Likewise, exercise interventions may reduce both arterial wall thickness and increased vascular stiffness in pediatric populations at risk, but the impact clearly depends on the duration of the intervention and varies depending on the target groups. We identified only one study that examined vascular structure and function in young athletes, a group of particular interest with respect to understanding of cardiovascular adaptation to exercise. In conclusion, future studies will be needed that address the use of wall:diameter or wall:lumen-ratio as part of the evaluation of arterial wall thickness. Furthermore, it will be critical to introduce specific and quantitative measurements of physical activity, as intensity and duration of participation likely influence the effectiveness of exercise interventions.

Childhood obesity: an overview of laboratory medicine, exercise and microbiome

In the last few years, a significant increase of childhood obesity incidence unequally distributed within countries and population groups has been observed, thus representing an important public health problem associated with several health and social consequences. Obese children have more than a 50% probability of becoming obese adults, and to develop pathologies typical of obese adults, that include type 2-diabetes, dyslipidemia and hypertension. Also environmental factors, such as reduced physical activity and increased sedentary activities, may also result in increased caloric intake and/or decreased caloric expenditure. In the present review, we aimed to identify and describe a specific panel of parameters in order to evaluate and characterize the childhood obesity status useful in setting up a preventive diagnostic approach directed at improving health-related behaviors and identifying predisposing risk factors. An early identification of risk factors for childhood obesity could definitely help in setting up adequate and specific clinical treatments.

Oxidative stress in exercise training: the involvement of inflammation and peripheral signals

The evidence about the health benefits of regular physical activity is well established. Exercise intensity is a significant variable and structured high-intensity interval training (HIIT) has been demonstrated to improve both whole-body and skeletal muscle metabolic health in different populations. Conversely, fatigue accumulation, if not resolved, leads to overwork, chronic fatigue syndrome (CFS), overtraining syndrome up to alterations of endocrine function, immune, systemic inflammation, and organic diseases with health threat. In response to temporary increases in stress during training, some athletes are unable to maintain sufficient caloric intake, thus suffering a negative energy balance that causes further stress. The regulation of the energy balance is controlled by the central nervous system through an elaborate interaction of the signalling that involves different tissues such as leptin, adiponectin and ghrelin whose provide important feedback to the hypothalamus to regulate the energy balance. Although exercise-induced reactive oxygen species are required for normal force production in muscle, high levels of ROS appear to promote contractile dysfunction. However, a high level of oxidative stress in may induce a rise in inflammatory markers and a disregulation in expression of adiponectin, leptin and grelin.

Preschool children's physical activity and cardiovascular disease risk: A systematic review

OBJECTIVES

Higher physical activity (PA) levels in adults are associated with lower cardiovascular disease risk, however it is unclear whether this association is evident in children younger than five years. Given that cardiovascular disease has early life origins, this study systematically reviews evidence of associations between PA and cardiovascular disease risk factors among children aged 3-5.5years.

DESIGN

Systematic review.

METHOD

A systematic search of multiple data bases was conducted to identify published papers reporting associations between any measure of PA and cardiovascular disease risk factors.

INCLUSION CRITERIA

English language; peer-reviewed; original quantitative research; mean age or majority of sample to be between 3.0-5.5years. Studies where the sample was characterised by a health condition (e.g. obese, hypertensive) were not eligible for inclusion.

RESULTS

Twelve papers met the inclusion criteria. At least one study for each cardiovascular disease risk factor except inflammation was included. PA was not associated with insulin resistance, and inconsistently associated with the remaining cardiovascular disease risk factors. Studies were mostly cross-sectional and methodologically heterogeneous. Longitudinal and experimental study designs and objective measurement of PA may help provide a clearer indication of the interplay between PA and cardiovascular disease risk in the preschool population.

Association between Sports Participation in Early Life and Arterial Intima-Media Thickness among Adults

Background: Early sports practice is associated with several health benefits during childhood and adolescence, moreover, recent evidence also suggests that sports during childhood and adolescence can produce some benefits during adulthood. However, the association between early sports practice and arterial thickness is not clear. Thus, our aim was analyze the association between sports participation in childhood and adolescence, carotid/femoral intima–media thickness, and blood flow index in adulthood. Material and Methods: Sample was composed of 107 adults (64 males) between 30 years and 50 years, which were recruited from different gyms and university staff from São Paulo State University. Participants were divided according to sports participation in early life (engaged in sports during childhood and adolescence (n = 52) and no engagement in sports during childhood and adolescence (n = 55)). Carotid and femoral intima–media thickness were measured through Doppler ultrasonography method. Carotid and femoral index were estimated from ultrasonography measures. As covariates, the following were adopted: chronological age, sex, body fat (through dual-energy x-ray absorptiometry), c-reactive protein, HOMA, alcohol consumption, tobacco smoking, mean arterial pressure and current physical activity (pedometer). General estimating equations were used, adopting p < 0.05. Results: In the adjusted analyses, early sports participation was associated with lower carotid intima–media index (early sports participation: 0.64 mm ± 0.14 mm vs. no early sports participation: 0.71 mm ± 0.21 mm; p = 0.011), but not associated with femoral intima–media thickness, carotid resistive index and femoral resistive index after the adjustment by potential confounders. Conclusions: Sports participation in childhood and adolescence was associated with a reduced carotid intima–media thickness, independently of relevant confounders.

The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome

BACKGROUND

The objective of this study was to examine the associations between adiposity, metabolic syndrome (MetS), cytokines and moderate-to-vigorous physical activity (MVPA) in youth with Prader-Willi syndrome (PWS) and non-syndromic obesity (OB).

METHODS

Twenty-one youth with PWS and 34 with OB aged 8-15 years participated. Measurements included body composition, blood pressure, fasting blood markers for glucose control, lipids and inflammation and MVPA. Group differences for adiposity, MetS, blood parameters and MVPA were determined using independent t-tests and chi-square (χ2) analyses. Bivariate correlations and analysis of variance (ANOVA) examined the associations between adiposity, MetS severity, cytokines and MVPA.

RESULTS

PWS presented similar percentage of body fat (%), lower body mass index (BMI) z-scores, insulin resistance, triglycerides, MetS severity, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and MVPA and higher high-density lipoprotein (HDL) and adiponectin (ADP) than OB. Fewer PWS presented MetS based on BMI z-score (61.9% vs. 91.2%) and glucose (14.3% vs. 44.1%) compared to OB. In all youth, MetS severity was significantly associated with body fat %, ADP, interleukin-6 (IL-6) and TNF-α and also with CRP in PWS, but associations became non-significant for CRP and IL-6 when controlling for body fat %. In PWS, those with low MVPA had significantly higher TNF-α than those with high MVPA (1.80±0.45 vs. 1.39±0.26 pg/mL).

CONCLUSIONS

Although PWS presented better cardiometabolic profiles than OB and lower MetS risk, associations between body fat, MetS and cytokines were somewhat similar for both groups, with the exception of CRP. Results suggest a potential role for MVPA related to MetS and inflammation and extend associations shown in OB to PWS.

Exercise, health outcomes, and pædiatric obesity: A systematic review of meta-analyses

OBJECTIVES

This study is a systematic review of meta-analyses that have addressed the effects of exercise-based interventions alone and the health outcomes (anthropometric, body composition, cardiometabolic, hepatic, vascular, and cardiorespiratory fitness parameters) in overweight and obese children and adolescents.

DESIGN

Systematic review of meta-analysis.

METHODS

Six electronic sources were searched. The inclusion criteria were: children and/or adolescents classified as overweight or obese, and previous systematic reviews and meta-analyses that included exercise interventions compared to a control group. Standardized mean differences, risk of bias, heterogeneity, and small-study effects were calculated. Subgroup analyses (intervention characteristics) were done.

RESULTS

Eighteen meta-analyses met the inclusion criteria. The results showed improvements in some anthropometric and body composition (body mass, BMI, BMI z-score, central obesity, fat mass) and cardiometabolic (TG, fasting glucose, fasting insulin) parameters, and in cardiorespiratory fitness. For the cardiometabolic and vascular parameters, aerobic programs and interventions showed themselves to be effective if they were of four to 12 weeks, or involved a total exercise time of at least 1500min, or involved sessions of at least 60min.

CONCLUSIONS

The study provides indications of the appropriate dose of exercise with which to reduce health problems in the obese young population.

Sport-based physical activity recommendations and modifications in C-reactive protein and arterial thickness

We analyzed the effects of 1 year of engagement in ≥ 300 min/week of organized sports on inflammatory levels and vascular structure in adolescents. The sample was composed of 89 adolescents (11.6 ± 0.7 years old [43 boys and 46 girls]), stratified according to engagement in ≥ 300 min/week of sport practice during at least 12 months of follow-up (n = 15, sport practice; n = 74, non-sport practice). Arterial thickness (carotid and femoral) was assessed by ultrasound scan, while high sensitive C-reactive protein levels were used to assess inflammatory status. Trunk fatness (densitometry scanner), biological maturation (age at peak height velocity), blood pressure, and skipping breakfast were treated as covariates. Independently of body fatness and biological maturation, the group engaged in sports presented a higher reduction in C-reactive protein (mean difference -1.559 mg/L [95%CI -2.539 to -0.579]) than the non-sport group (mean difference -0.414 mg/L [95%CI -0.846 to 0.017]) (p = 0.040). There was a significant relationship between changes in C-reactive protein and changes in femoral intima-media thickness in the non-sport group (r = 0.311 [95%CI 0.026 to 0.549]).

CONCLUSION

Inflammation decreased in adolescents engaged in organized sports, independently of trunk fatness and biological maturation. Moreover, inflammation was related to arterial thickening only in adolescents not engaged in sports. What is Known: • Intima media thickness is a relevant marker of cardiovascular disease in pediatric groups, being affected by obesity and inflammation. • The importance of monitoring inflammatory markers from childhood is enhanced by the fact that alterations in these inflammatory markers in early life predict inflammation and alterations in carotid IMT in adulthood. What is New: • Anti-inflammatory properties related to physical exercise performed at moderate intensity, on inflammation and alterations in IMT are not clear in pediatric groups. • Due to the importance that sport participation has assumed as a promoter of improvements in health and quality of life, it is necessary to understand its potential benefits for cardiovascular health during human growth.

Associations of Objectively Measured Physical Activity and Sedentary Time With Arterial Stiffness in Pre-Pubertal Children

PURPOSE

To investigate the relationships of objectively measured physical activity (PA) and sedentary time (ST) to arterial stiffness in prepubertal children.

METHOD

Altogether 136 children (57 boys, 79 girls) aged 6-8-years participated in the study. Stiffness index (SI) was assessed by pulse contour analysis based on photoplethysmography. ST, light PA, moderate PA, and vigorous PA were assessed using combined acceleration and heart rate monitoring. We investigated the associations of ST (<1.5METs) and time spent in intensity level of PA above 2-7METs in min/d with SI using linear regression analysis. We studied the optimal duration and intensity of PA to identify children being in the highest quarter of SI using Receiver Operating Characteristics curves.

RESULTS

Moderate PA, vigorous PA, and cumulative time spent in PA above 3 (β=-0.279, p = .002), 4 (β =-0.341, P<0.001), 5 (β =-0.349, P<0.001), 6 (β =-0.312, P<0.001), and 7 (β =-0.254, p = .005) METs were inversely associated with SI after adjustment for age, sex, and monitor wear time. The cutoffs for identifying children being in the highest quarter of SI <68 min/d for PA exceeding 5 METs and <26 min/d for PA exceeding 6 METs.

CONCLUSION

Lower levels of PA exceeding 3-6 METs were related to higher arterial stiffness in children.

Effects of Exercise on Carotid Arterial Wall Thickness in Obese Pediatric Populations: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

In pediatric populations, the use of carotid intima-media thickness (IMT) as a marker of cardiovascular risk has increased. However, previous studies examining the effects of exercise training on arterial structure and function in obese children and adolescents have shown inconsistent findings. The primary aim of this systematic review and meta-analysis is to expand on the current body of literature by providing a quantitative estimate of the change in carotid IMT following exercise training as well as to provide an exploratory analysis of potential moderators associated with the variation in response to an exercise training intervention in overweight and obese youth.

MATERIALS AND METHODS

A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on carotid IMT in pediatric obesity (6-18-year-olds). Hedges' g and 95% confidence intervals (CIs) were calculated.

RESULTS

Six randomized controlled trials (303 youths) were included. Exercise was associated with a small-to-moderate but significant reduction in carotid IMT (g = -0.306; 95% CI -0.540 to -0.072; p = 0.011). Likewise, exercise program duration per week significantly influenced the effect of exercise on carotid IMT (β = -0.060; p = 0.015).

CONCLUSIONS

Exercise seems to reduce carotid IMT in childhood obesity. Therefore, encouraging obese pediatric individuals to become physically active can lead to favorable changes in the arterial wall.