Exercise dose and diabetes risk in overweight and obese children

A randomized controlled trial

Catherine Lucy Davis, Norman K. Pollock, Jennifer L Waller, Jerry David Allison, B. Adam Dennis, Reda W Bassali, Agustín Meléndez, Colleen A. Boyle, Barbara A. Gower

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Context: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. Objectives: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. Design, Setting, and Participants: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. Intervention: Children were randomly assigned to low-dose (20 min/d; n=71) or high-dose (40 min/d; n=73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n=78). Main Outcome Measures: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [V̇O 2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. Results: The study had 94% retention (n=209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] ×103 μU/mL; P=.01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] ×103 μU/mL; P=.03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P<.001 and -0.8% [95% CI, -1.6% to -0.07%]; P=.03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P<.001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P=.01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak V̇O2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P=.02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P=.03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. Conclusion: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. Trial Registration clinicaltrials.gov Identifier: NCT00108901.

Original languageEnglish (US)
Pages (from-to)1103-1112
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume308
Issue number11
DOIs
StatePublished - Sep 12 2012

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Randomized Controlled Trials
Exercise
Intra-Abdominal Fat
Control Groups
Area Under Curve
Insulin Resistance
Adipose Tissue
Insulin
Adiposity
Glucose Tolerance Test
Oxygen Consumption
Type 2 Diabetes Mellitus
Body Mass Index
Magnetic Resonance Spectroscopy
X-Rays
Outcome Assessment (Health Care)
Pediatrics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Exercise dose and diabetes risk in overweight and obese children : A randomized controlled trial. / Davis, Catherine Lucy; Pollock, Norman K.; Waller, Jennifer L; Allison, Jerry David; Dennis, B. Adam; Bassali, Reda W; Meléndez, Agustín; Boyle, Colleen A.; Gower, Barbara A.

In: JAMA - Journal of the American Medical Association, Vol. 308, No. 11, 12.09.2012, p. 1103-1112.

Research output: Contribution to journalArticle

@article{d585f5a55fdf44148ef9fc47f8dd65b8,
title = "Exercise dose and diabetes risk in overweight and obese children: A randomized controlled trial",
abstract = "Context: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. Objectives: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. Design, Setting, and Participants: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42{\%} male; 58{\%} black) were recruited from 15 public schools in the Augusta, Georgia, area. Intervention: Children were randomly assigned to low-dose (20 min/d; n=71) or high-dose (40 min/d; n=73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n=78). Main Outcome Measures: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [V̇O 2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. Results: The study had 94{\%} retention (n=209). Most children (85{\%}) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95{\%} CI, -6.26 to -0.85] ×103 μU/mL; P=.01) and the low-dose group (adjusted mean difference, -2.96 [95{\%} CI, -5.69 to -0.22] ×103 μU/mL; P=.03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4{\%} [95{\%} CI, -2.2{\%} to -0.7{\%}]; P<.001 and -0.8{\%} [95{\%} CI, -1.6{\%} to -0.07{\%}]; P=.03) and visceral fat (adjusted mean difference, -3.9 cm3 [95{\%} CI, -6.0 to -1.7 cm3]; P<.001 and -2.8 cm3 [95{\%} CI, -4.9 to -0.6 cm3]; P=.01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak V̇O2, 2.4 [95{\%} CI, 0.4-4.5] mL/kg/min; P=.02 and 2.4 [95{\%} CI, 0.3-4.5] mL/kg/min; P=.03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. Conclusion: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. Trial Registration clinicaltrials.gov Identifier: NCT00108901.",
author = "Davis, {Catherine Lucy} and Pollock, {Norman K.} and Waller, {Jennifer L} and Allison, {Jerry David} and Dennis, {B. Adam} and Bassali, {Reda W} and Agust{\'i}n Mel{\'e}ndez and Boyle, {Colleen A.} and Gower, {Barbara A.}",
year = "2012",
month = "9",
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TY - JOUR

T1 - Exercise dose and diabetes risk in overweight and obese children

T2 - A randomized controlled trial

AU - Davis, Catherine Lucy

AU - Pollock, Norman K.

AU - Waller, Jennifer L

AU - Allison, Jerry David

AU - Dennis, B. Adam

AU - Bassali, Reda W

AU - Meléndez, Agustín

AU - Boyle, Colleen A.

AU - Gower, Barbara A.

PY - 2012/9/12

Y1 - 2012/9/12

N2 - Context: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. Objectives: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. Design, Setting, and Participants: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. Intervention: Children were randomly assigned to low-dose (20 min/d; n=71) or high-dose (40 min/d; n=73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n=78). Main Outcome Measures: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [V̇O 2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. Results: The study had 94% retention (n=209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] ×103 μU/mL; P=.01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] ×103 μU/mL; P=.03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P<.001 and -0.8% [95% CI, -1.6% to -0.07%]; P=.03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P<.001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P=.01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak V̇O2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P=.02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P=.03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. Conclusion: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. Trial Registration clinicaltrials.gov Identifier: NCT00108901.

AB - Context: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. Objectives: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. Design, Setting, and Participants: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. Intervention: Children were randomly assigned to low-dose (20 min/d; n=71) or high-dose (40 min/d; n=73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n=78). Main Outcome Measures: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [V̇O 2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. Results: The study had 94% retention (n=209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] ×103 μU/mL; P=.01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] ×103 μU/mL; P=.03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P<.001 and -0.8% [95% CI, -1.6% to -0.07%]; P=.03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P<.001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P=.01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak V̇O2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P=.02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P=.03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. Conclusion: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. Trial Registration clinicaltrials.gov Identifier: NCT00108901.

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DO - 10.1001/2012.jama.10762

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JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

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