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Exercise effects on arterial stiffness and heart health in children with excess weight: the SMART RCT
Davis CL, Litwin SE, Pollock NK, Waller JL, Zhu H, Dong Y, Kapuku G, Bhagatwala J, Harris RA, Looney J, Williams CF, Armento A, Schmidt MD, Bassali R
International Journal of Obesity 2020 May;44(5):1152-1163
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

INTRODUCTION: Childhood obesity and inactivity are associated with cardiovascular risk. Evidence is limited for exercise effects on arterial health in children. METHODS: One hundred and seventy-five inactive children with overweight or obesity (8 to 11 years, >= 85th percentile BMI, 61% female, 87% black, 73% with obesity) were randomized to an 8-month daily after-school aerobic exercise program (40 min/day, n = 90) or a sedentary control condition (n = 85). Carotid-femoral pulse wave velocity (PWV, primary outcome, arterial stiffness), fitness, adiposity, blood pressure (BP), glucose, insulin resistance, lipids, and c-reactive protein were measured at baseline and posttest (8 months). Adiposity, fitness, and BP were measured again at follow-up, 8 to 12 months later. Intent-to-treat analyses were conducted using mixed models. RESULTS: The study had 89% retention, with attendance of 59% in exercise and 64% in the control condition, and vigorous exercise participation (average heart rate 161 +/- 7 beats/min). Compared with controls, the exercise group had twice the improvement in fitness (VO2peak, 2.7 (95% CI 1.8 to 3.6) versus 1.3 (0.4 to 2.3) mL/kg/min) and adiposity (-1.8% (-2.4 to -1.1) versus -0.8% (-1.5 to -0.1)), each p = 0.04, and a large improvement in HDL-cholesterol (0.13 (0.075 to 0.186) versus -0.028 (-0.083 to 0.023) mmol/L, p < 0.0001). There was no group x time effect on other outcomes at 8 months, or on any outcomes at follow-up. The change in PWV at 8 months correlated with changes in insulin and insulin resistance (both r = 0.32), diastolic BP (r = 0.24), BMI (r = 0.22), and adiposity (r = 0.18). CONCLUSIONS: Eight months of aerobic exercise training improved fitness, adiposity, and HDL-cholesterol levels, but did not reduce arterial stiffness in children with excess weight. PWV improved as a function of insulin resistance, BP, BMI, and adiposity. Weight loss may be required to improve arterial stiffness. Exercise benefits waned after discontinuing the program.

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