Association of body composition, blood pressure, physical activity and fitness with cardiovascular and metabolic health in children

Background: Cardiovascular disease (CVD) has its origin early in life and is the number one cause of death worldwide. Obesity is a main predictor of the pathophysiological development of hypertension and cardiometabolic disease. Insufficient physical activity and fitness lead to overweight and obesity from childhood until adulthood. Advanced glycation end products (AGEs) accumulate in adults with micro- and macrovascular complications. Therefore, the association of cardiovascular risk factors such as childhood obesity, high blood pressure and physical inactivity with cardiometabolic health need to be investigated in a systems physiology approach. Aims:We aimed to investigate the association of obesity, high blood pressure, physical activity and fitness with micro- and macrovascular health in young children. Furthermore, we aimed to examine whether AGEs are related to cardiovascular risk factors early in life. Methods: First, we conducted a systematical review and meta-analysis in over 5000 children to investigate the association of body mass index (BMI), blood pressure and physical fitness with retinal vessel diameters. An electronic literature search was performed throughout the databases of PubMed, EMBASE, Ovid, Web of Science and the Cochrane Register of Controlled Trials. In a cross-sectional approach, over 1000 children (aged 7.2±0.4 years) were screened for BMI, blood pressure, retinal arteriolar (CRAE) and venular diameters (CRVE), pulse wave velocity (PWV) and subcutaneous AGEs. A shuttle run and a 20-m sprint test were performed to assess physical fitness parameters in children. Physical activity was reported by questionnaires. Based on data from the population-based German KiGGS Study and according to the American Academy of Pediatrics guidelines, blood pressure was categorised in children with normal, high-normal blood pressure and hypertension. Results: Our results showed that CRAE and PWV were associated with obesity and high blood pressure. Low physical fitness and physical inactivity (screen time) in childhood were determinants for unfavourable micro- and macrovascular health, but not independent of BMI and blood pressure. Moreover, physical fitness and screen time were independently associated with a higher accumulation of subcutaneous AGEs. Conclusions: Our study showed that obesity and high blood pressure are associated with vascular alterations already in young children. We found a beneficial association of physical fitness with vascular health and AGEs. Future primary prevention programs will have to address the improvement of physical activity and fitness to promote cardiometabolic health in children. Cardiovascular risk stratification using different vascular screening tools may be important to help recognize subclinical changes in children at risk. Long-term follow-up studies are needed to clarify whether early cardiovascular changes are predictive for the development of cardiometabolic disease later in life

Exercise and Arterial Modulation in Children: The EXAMIN YOUTH Study

Background: Cardiovascular disease (CVD) remains to be one of the most frequent causes of death worldwide. Cardiovascular (CV) risk factors such as hypertension and obesity often manifest in childhood. The study examines the associations of blood pressure, body mass index and physical activity with cardiopulmonary, metabolic, and psychosocial health of children in a systems physiology approach.Methods/Design: This cross-sectional study will be performed in a cohort of 6 to 8 year old school children (n = 1000). As a measure of vascular health, retinal microvascular diameters and large artery pulse wave velocity will be examined. Anthropometric parameters, such as weight, height, body mass index, and blood pressure will be assessed according to standardized protocols for children. Physical fitness and activity will be measured by a 20 m shuttle run, a 20 m sprint and a proxy-reported questionnaire on lifestyle behavior. Spirometry, assessment of heart rate variability and skin advanced glycation end products as well as a flanker test will be performed to determine systemic end organ alterations.Discussion: The study offers a unique integrative primary prevention concept that aims to set the grounds for a healthy and active lifestyle approach during childhood. It will help optimize CV risk stratification to identify children at risk of disease progression later in life. The study will demonstrate the importance of specific CV screening programs in children to reduce the growing burden of CV disease in adulthood. Prospective follow-up studies will have to prove the efficacy of primary prevention programs in children to achieve healthier aging as a long-term goal

Cardiorespiratory fitness and development of childhood cardiovascular risk: The EXAMIN YOUTH follow-up study

Background: Obesity- and hypertension-related cardiovascular (CV) risk has been shown to originate in childhood. Higher body mass index (BMI) and blood pressure (BP) have been associated with increased large artery stiffness and a lower microvascular arteriolar-to-venular diameter ratio (AVR) in children. This study aimed to investigate the association of cardiorespiratory fitness (CRF) with development of BMI, BP and vascular health during childhood.Methods: In our prospective cohort study, 1,171 children aged 6–8 years were screened for CRF, BMI, BP, retinal vessel diameters and pulse wave velocity using standardized protocols. Endurance capacity was assessed by 20 m shuttle run test. After 4 years, all parameters were assessed in 664 children using the same protocols.Results: Children with a higher CRF at baseline developed a significantly lower BMI (β [95% CI] −0.09 [−0.11 to −0.06] kg/m2, p < 0.001), a lower systolic BP (β [95% CI] −0.09 [−0.15 to −0.03] mmHg, p = 0.004) and a higher AVR (β [95% CI] 0.0004 [0.00004 to 0.0007] units, p = 0.027) after 4 years. The indirect association of CRF with development of retinal arteriolar diameters was mediated by changes in BMI.Conclusion: Our results identify CRF as a key modulator for the risk trajectories of BMI, BP and microvascular health in children. Obesity-related CV risk has been shown to track into adulthood, and achieving higher CRF levels in children may help counteract the development of CV risk and disease not only in pediatric populations, but may also help reduce the burden of CVD in adulthood.Registration:http://www.clinicaltrials.gov/ (NCT02853747)

Music, movement and mood in Parkinson’s: A transdisciplinary study to develop a new protocol to measure functional mobility in people with Parkinson’s by integrating motion capture with a pressure sensitive gait mat

Background Parkinson’s disease (PD) is a neurodegenerative brain disorder associated with early-onset functional motor impairments (Rana et al., 2012). There are several assessment scales for the evaluation of PD, but many motor measurement protocols lack reference to the qualitative assessment of functional mobility in everyday life (Opara et al., 2017). Moreover, previous studies have shown that pharmaceutical treatments in combination with physical therapy play an important role in improving motor symptoms, but the benefits do not seem to extend to mental well-being (Fox et al., 2018). Growing evidence suggest that an interdisciplinary approach by integrating musical activity with exercises may have the potential to improve both functional mobility and psychological wellbeing (Barnish & Barran, 2020). Methods The first phase of this mixed methods study includes a Patient and Public Involvement (PPI) consultation process (workshops and interviews; Rose et al., 2022) to develop a context-appropriate new group-based intervention program for and with PwP and health professionals. The focus will lie on music activity and the use music imagery to develop individual jukeboxes of musical cues to combat motor symptoms such as rigidity and freeze of gait. To evaluate the efficacy and the generalisability of the program, a 12-week within-subject repeated measures controlled trial will be conducted in Switzerland and the UK. An accurate and reliable quantitative measurement protocol will be developed to enable assessment of disease progression, and evaluation of interventions alongside qualitative observations of mobility in PwP. Moreover, we aim to provide fine-grained assessment of clinical measures (such as the Timed Up and Go) using an integrated motion capture (MoCap) and gait mat analysis system. Expected Outcomes and Perspectives This project lays the foundation for the development of non-pharmaceutical and low-cost intervention programs. Our PPI approach will provide better individualised and targeted prevention strategies to counteract the increasing financial and personal burden of PD worldwide. A unique aspect of the study is to develop a new quantitative functional mobility measurement protocol to assess PwP over time. This research approach will contribute to our understanding of functional mobility symptoms and the use of music in PD to reduce symptom severity and improve quality of life. References Barnish, M. S., & Barran, S. M. (2020). A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson’s disease. BMC Neurology, 20(1), Article 371. https://doi.org/10.1186/s12883-020-01938-3 Fox, S. H., Katzenschlager, R., Lim, S. Y., Barton, B., de Bie, R. M. A., Seppi, K., Coelho, M., & Sampaio, C. (2018). International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Movement Disorders, 33(8),1248-1266. https://doi.org/10.1002/mds.27372 Opara, J., Małecki, A., Małecka, E., & Socha, T. (2017). Motor assessment in Parkinson’s disease. Annals of Agricultural and Environment Medicine, 24(3), 411-415. https://doi.org/10.5604/12321966.1232774 Rana, A. Q., Siddiqui, I., & Yousuf, M. S. (2012). Challenges in diagnosis of young onset Parkinson’s disease. Journal of the Neurological Sciences, 323(1-2), 113-116. https://doi.org/10.1016/j.jns.2012.08.029 Rose, D. C., Poliakoff, E., Hadley, R., Guérin, S. M. R., Phillips, M., & Young, W. R. (2022) Levelling the playing field: The role of workshops to explore how people with Parkinson’s use music for mood and movement management as part of a patient and public involvement strategy. Frontiers in Rehabilitation Sciences, 3, Article 873216. https://doi.org/10.3389/fresc.2022.87321

Effects of a school-based physical activity program on retinal microcirculation and cognitive function in adolescents

To investigate the effect of combined aerobic and coordinative exercise on retinal microcirculation and its association with changes in cognitive performance in healthy adolescents.; Using cluster-randomization (on class-level), 36 participants were allocated to an exercise group (EX) performing a 20-min aerobic and coordinative exercise session on each school day over a period of 8 weeks or a control group, which was encouraged to have social interactions (CON).; Prior to and following the intervention period, central retinal arteriolar (CRAE) and venular diameters (CRVE) were assessed by use of a static vessel analyzer. Additionally, a computer-based version of the Stroop Color-Word task was administered to assess inhibitory control.; The statistical analysis revealed that EX compared to CON showed higher CRAE at post-test, when pre-test values were accounted for, F(1,32)=4.92, p=0.036, η; 2; =0.130. In contrast, no such effect was reported for CRVE. With regard to cognitive performance, a greater reduction of reaction time on the Stroop task was observed in EX relative to CON, F(1,30)=8.58, p=0.006, η; 2; =0.222. The increase in CRAE was significantly correlated with a decrease of reaction time on trials demanding inhibitory control, even after adjusting for covariates, r(31)=-0.438, p=0.011.; A structured exercise program leads to a widening of retinal arteriolar diameters, which is associated with improvements in inhibitory control. Consequently, daily exercise sessions performed during the school break-time can be recommended for promoting both cardiovascular and cognitive health in adolescents

Cardiovascular risk markers and cognitive performance in children

Markers of cardiovascular risk and cognitive performance were assessed in 347 children. In contrast with body mass index and blood pressure, only retinal microcirculation explained a unique proportion of variance in inhibitory control and information processing, when dependencies between markers of cardiovascular risk were accounted for

Functional mobility assessment in Parkinson’s: A pilot feasibility study and a new methodological approach

Background Parkinson’s disease (PD) is associated with motor impairments that negatively impact functional mobility (Armstrong & Okun, 2020). Functional mobility is “a person’s ability to move to accomplish activities of daily living” (Bouça-Machado et al., 2020). Whilst several assessment scales exist to evaluate PD, many focus on symptom severity or use speed as a proxy for quality of movement (e.g. Timed Up and Go; Buckley et al., 2019; Mirelman et al., 2019). Here we share the development of an integrated motion capture and pressure-sensitive gait mat sequence to assess functional mobility. Design/Methods To capture aspects of functional mobility accurately, we developed a new assessment protocol (FMA-P) to measure which aspects of movement differed between people with (n = 12) and without (n = 12) PD. The sequence involved rising from a chair, locomotion, turning, bending, picking up and placing an object (keys), and returning to sit down on the chair (mean of three trials). Results The mean age of our participants was 65.25 ± 7.8 years, 46% females. We found significant differences in locomotion such as a lower step ratio (p = 0.023), stride length (p < 0.001), and stride velocity (p = 0.019), as well as a higher double support time (p = 0.004), and stride length variability (p = 0.004) in people with PD (PwP) compared to aged-matched healthy participants. PwP showed a lower toe-off set angle (p = 0.042), lower foot height (p = 0.007), and a lower heel strike angle (p = 0.006) during locomotion. Further, a lower shoulder-elbow arm swing angular velocity (p=0.042), and a higher elbow-wrist arm swing angular velocity (p = 0.054) were observed in PwP compared to controls. Getting up from a chair was associated with a lower inclination amplitude in PwP compared to healthy controls (p = 0.047). In the turning section, we found a later onset of pelvis rotation in PwP (p = 0.034). More time was required for PwP to pick the keys up from the floor compared to controls (p = 0.002). Discussion The new measurement protocol could contribute to early diagnosis of PD, offering a quantitative evaluation of functional mobility. For example, reduced toe and heel offset angles may be early determinants of developing shuffling in later disease stages. Moreover, our findings provide objective and precise information about a variety of qualitative aspects of functional mobility. This approach can therefore be used to evaluate change over time thereby improving the evidence base of outcome variables for intervention studies. The FMA-P is of high clinical relevance to aid in the quantitative evaluation of clinical measures of motor impairment. References Armstrong, M. J., & Okun, M. S. (2019). Diagnosis and treatment of Parkinson disease. A review. JAMA, 232(6), 548-560. https://doi.org/10.1001/jama.2019.22360 Bouça-Machado, R., Duarte, G. S., Patriarca, M., Castro Caldas, A., Alarcão, J., Fernandes, R. M., Mestre, T. A.,, Matias, R., & Ferreira, J. J. (2020). Measurement instruments to assess functional mobility in Parkinson’s disease: A systematic review. Movement Disorders Clinical Practice, 7(2), 129-139. https://doi.org/10.1002/mdc3.12874 Buckely, C., Alcock, L., McArdle, R., Rana Zia Ur Rehman, R. Z. U., Del Din, S., Mazzà, C., Yarnall, A.J., & Rochester, L. (2019). The role of movement analysis in diagnosing and monitoring neurodegenerative conditions: Insights from gait and postural control. Brain Sciences, 9(2), Article 34. https://doi.org/10.3390/brainsci9020034 Mirelman, A., Bonato, P., Cmicioli, R., Ellis, T. D., Giladi, N., Hamilton, J. L., Hass, C. J., Hausdorff, J. M., Pelosin, E., & Almeida Q. J. (2019). Gait impairments in Parkinson’s disease. The Lancet Neurology, 18(7), 697-708. https://doi.org/10.1016/s1474-4422(19)30044-

Body Composition and Physical Fitness Affect Central Hemodynamics in Young Children

Objective:; Central hemodynamics are related to cardiovascular (CV) outcomes in adults, but associations with childhood CV risk remain unclear. The study aimed to investigate the association of obesity, physical activity, and fitness with parameters of central pulse wave reflection in young prepubertal children.; Methods:; In this cross-sectional study, 1,324 primary school children (aged 7.2 ± 0.4 years) were screened for parameters of pulse wave reflection such as augmentation index (AIx), central pulse pressure (CPP), body mass index (BMI), and cardiorespiratory fitness (CRF) by standardized procedures for children.; Results:; The mean AIx and AIx@75 were 22.2 ± 7.7 and 29.2 ± 9.2%, respectively. With each unit increase in BMI, AIx [-0.226 (-0.328; -0.125)%] and AIx@75 [-0.444(-0.660; -0.229)%] decreased, whereas peak forward pulse wave increased (; p; < 0.001). Increasing BMI was associated with higher CPP, but did not remain significant after adjustment for CRF and heart rate. One unit increase in CRF was associated with lower AIx@75 [-0.509(-0.844; -0.173)%,; p; = 0.003] and lower reflection magnitude [RM: -0.559 (-0.890; -0.227),; p; = 0.001], independent of body weight and height. Girls had significantly higher AIx, AIx@75, peak backward pulse wave, and RM compared with boys.; Conclusion:; Childhood obesity was associated with higher CPP but lower augmentation of the reflected pulse wave in children. Assessment of central blood pressures appears to be a valuable asset to childhood CV risk screening. The validity of augmentation indices during childhood development and the association with early vascular aging in children need to be verified in long-term follow-up studies. Physical activity and fitness have the potential to improve vascular hemodynamics in susceptible children and, thus, counteract vascular aging.; Trial registry: ClinicalTrials.gov:; Exercise and Arterial Modulation in Youth.; Identifier:; NCT02853747; URL: https://clinicaltrials.gov/ct2/show/NCT02853747

Exercise and Arterial Stiffness in the Elderly: A Combined Cross-Sectional and Randomized Controlled Trial (EXAMIN AGE)

Arterial stiffness (AST) is a main determinant of cardiovascular (CV) mortality. Long-term physical activity (PA) is considered to decrease age-related progression of AST but effects of short-term exercise interventions on AST remain unclear.; In a combined cross-sectional and interventional study approach, we investigated the effects of long-term PA and short-term high-intensity interval training (HIIT) on AST in an older population. 147 older individuals (mean age 59 ± 7 years) were assigned to three groups according to their PA and CV risk profile and compared: healthy active (HA,; n; = 35), healthy sedentary (HS,; n; = 33) and sedentary at risk (SR,; n; = 79). In addition, SR were randomized to either 12 weeks of HIIT or standard recommendations. Pulse wave velocity (PWV) was measured by applanation tonometry. Cardiorespiratory fitness (CRF) was performed by symptom-limited spiroergometry to determine maximal oxygen uptake (VO2max).; Higher CRF was associated with lower PWV (; p; &lt; 0.001) and VO2max explained 18% of PWV variance. PWV was higher in SR (8.2 ± 1.4 m/s) compared to HS (7.5 ± 1.6 m/s) and HA (7.0 ± 1.1 m/s;; p; &lt; 0.001). 12 weeks of HIIT did not change PWV in SR. HIIT-induced reduction in systolic BP was associated with a reduction in PWV (; p; &lt; 0.05).; SR show higher PWV compared to HS and long-term PA is associated with lower PWV. Reduction of AST following short-term HIIT seems to depend on a concomitant decrease in blood pressure. Our study puts into perspective the effects of long- and short-term exercise on arterial wall integrity as treatment options for CV prevention in an older population.; ClinicalTrials.gov: NCT02796976 (https://clinicaltrials.gov/ct2/show/NCT02796976)