Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training

Abstract

ABSTRACT. Objective. Little is known about the relations of fitness and fatness to left ventricular structure and function in obese adolescents. This project had 2 purposes: 1) to determine the correlations of cardiovascular fitness and adiposity to left ventricular parameters in obese adolescents; and 2) to see the effect of 8 months of physical training (PT) at low and high intensities.Design. Obese 13-to 16-year-olds (N ‫؍‬ 81) were tested at baseline and then randomly assigned to lifestyle education (LSE) alone, LSE plus moderate-intensity PT, or LSE plus high-intensity PT. Follow-up testing was conducted 8 months later. Because no significant differences were found between moderate-intensity and high-intensity PT, the groups were combined to form a LSE ؉ PT group.Intervention. Eight months of PT, offered 5 days per week with the target energy expenditure for all PT participants being 250 kcal/session, and LSE every 2 weeks.Outcome Measures. Left ventricular mass divided by height to the 2.7th power (LVM/Ht 2.7 ), midwall fractional shortening (MFS), and relative wall thickness (RWT) were measured using M-mode echocardiography. Cardiovascular fitness was measured by a maximal multistage treadmill test; percent body fat (%BF) with dualenergy radiograph absorptiometry; and visceral adipose tissue (VAT) with magnetic resonance imaging.Results. At baseline, high levels of VAT were associated with higher RWT (r ‫؍‬ 0.30) and lesser MFS (r ‫؍‬ ؊0.29). Compared with the LSE-alone group, the LSE ؉ PT group significantly improved in cardiovascular fitness and decreased in %BF and VAT. However, there were no significant differences between groups on changes in LVM/Ht 2.7 , MFS, or RWT. Individual changes in cardiovascular fitness, %BF, and VAT did not correlate significantly with interindividual changes in left ventricular structure and function.Conclusions. High levels of VAT were associated with unfavorable left ventricular structure and function. However, no evidence was provided that an 8-month PT program, which improved cardiovascular fitness and reduced general and visceral adiposity, improved left ventricular structure and function. Future studies consisting of longer training programs and/or greater weight reductions are needed to see whether the adverse left ventricular effects of obesity can be ameliorated by exercise training. O besity and physical inactivity are modifiable lifestyle factors associated with cardiovascular disease, one of the major killers in the United States. 1 The prevalence of obesity in American children is on the rise and presents a major public health concern. 2 Unfavorable cardiovascular risk profiles are already present in children with low levels of cardiovascular fitness (CVF) and high levels of percent body fat (%BF) and visceral adipose tissue (VAT). [3][4][5][6][7] In addition, adolescent obesity is strongly associated with adult obesity and may lead to type 2 diabetes, hypertension, or stroke. 2 Left ventricular mass (LVM) and relative wall thickness (RWT), measures of left ve...

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