An increasing number of children are now obese and fail to meet minimum recommendations for physical activity (PA). Schools play a critical role in impacting children's activity behaviors, including PA. Our objective was to assess whether CDC-based school-centered strategies to promote PA increase long-term cardiovascular fitness (CVF) levels in students in schools. A prospective observational trial was conducted in 26 middle schools to implement CDC school-based strategies to increase PA for 3 years. Students had CVF assessed by Fitnessgram (PACER), a 20-meter shuttle run, at the start and end of each school year. A post-study questionnaire was administered to assess each school's strategy adherence. At baseline, 2402 students with a mean age 12.2 ± 1.1 years showed a mean CVF measured by PACER of 33.2 ± 19.0 laps (estimated VO2max 44.3 ± 5.3 ml/kg/min). During the first year, there was a significant increase in the mean PACER score (Δ = 3, 95% CI: 2–4.1 laps, p < 0.001) and PACER z-score (Δ = 0.09, 95% CI: 0.04–0.14, p = 0.001). Subsequently, however, a significant negative trend in PACER z-scores occurred (β = −0.02, p < 0.0001) so that over the 3-year study period, the intervention did not increase overall CVF. This effort to implement CDC school-based PA strategies in middle schools did not result in sustained increase in CVF over 3 years. It remains to be clarified whether this limited efficacy indicates that CDC physical activity strategies are not sufficiently robust to meaningfully impact health outcomes and/or additional support is needed in schools to improve fidelity of implementation.

BACKGROUND The US Centers for Disease Control and Prevention (CDC) promotes school‐based strategies to increase physical activity (PA). Implementation feasibility and effect of these interventions on cardiovascular fitness (CVF) is unknown. METHODS Forty‐nine low‐SES schools were randomly assigned to either (1) continue routine PA programs (N = 24 schools, 2399 students) or (2) implement 4 CDC‐based PA strategies (N = 25 schools, 2495 students). CVF assessed by PACER (Progressive Aerobic Cardiovascular Endurance Run) was obtained at the beginning and end of the school year. A post‐study questionnaire was administered at each school to assess adherence. RESULTS Overall, PACER z‐scores were not augmented by CDC‐based PA strategies. In boys, PACER z‐scores increased similarly in both intervention and control schools. In girls, increased mean PACER z‐score was greater in control schools (p < .01). Fifty‐two percent of intervention school's staff reported inability to implement or sustain 4 CDC‐based PA strategies. CONCLUSIONS Planned implementation of school‐based CDC PA strategies did not increase CVF compared to routine PA programming. Lack of efficacy in girls suggests need for sex‐specific targeted strategies. These findings highlight limited efficacy of CDC‐based PA recommendations alone in low‐SES schools. Schools may require additional support to successfully implement recommendations and meaningfully affect health outcomes.

Stimulant medications for the treatment of attention deficit hyperactivity disorder (ADHD) and inhaled corticosteroids (ICS) for the treatment of asthma are two classes of medications that are commonly prescribed in pediatrics. Among other adverse effects of these medications, growth attenuation has long been a focus of investigation. With stimulants, growth deficits of 1-1.4 cm/year have been observed in the short term, mainly in the first 2 years of treatment, in a dose-dependent manner. Long-term studies on stimulants have reported divergent effects on growth, with many studies showing no clinically significant height deficits by adulthood. The study that followed the largest cohort of children on stimulants, however, reported an overall adult height deficit of 1.29 cm in subjects who had received stimulant medications, with mean adult height deficit of 4.7 cm among those taking the medication consistently. With ICS use, mild growth suppression is seen in the short term (particularly in the first year of therapy) with growth rates reduced by 0.4-1.5 cm/year. Available current evidence indicates that the impact of ICS use on adult height is not clinically significant, with effects limited to 1.2 cm or less. There is significant individual variability in growth suppression with ICS use, with the specific pharmacologic agent, formulation, dose exposure, age, puberty, medication adherence, and timing of administration being important modifying factors. Based on currently available evidence, the therapeutic benefits of ICS for management of asthma and stimulant medications for management of ADHD outweigh the potential risk for growth suppression. Strategies to minimize growth attenuation and other potential adverse effects of these medications include using the lowest efficacious dose, frequent assessments and dose titration. Particular vigilance is essential with concomitant use of multiple medications that can attenuate growth and to evaluate for potential adrenal insufficiency from ICS use.

Thyroid dysfunction in adolescents treated with minocycline for acne has been previously described as transient effect and/or associated with autoimmune thyroiditis. We report non-immune-mediated thyroid dysfunction associated with minocycline/doxycycline in three adolescents whose clinical courses suggest an adverse effect that may be more common, serious, and persistent than realized previously.