Translating Pediatric Fitness from Lab to Schools

Aaron L. Carrel, MD Aaron L. Carrel, MD

University of WisconsinUniversity of Wisconsin

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Doug White, MSDoug White, MS

Department of Public InstructionDepartment of Public Instruction

Objectives - Translating Fitness

• Describe exemplary community-Describe exemplary community-academic partnershipacademic partnership

• Fitness is important for child healthFitness is important for child health

• Roles schools play in promoting fitnessRoles schools play in promoting fitness

• Statewide partnership Childhood FitnessStatewide partnership Childhood Fitness

Why a school-based program?

• >90% of children enrolled >90% of children enrolled

• Both active and passive Both active and passive decisions of activity, food, decisions of activity, food, attendance can be alteredattendance can be altered

• Schools provide social and Schools provide social and educational platform for educational platform for obesity preventionobesity prevention

• CDC supports this, but CDC supports this, but does it work?does it work?

Is research influencing policy?

• BMI does not predict IRBMI does not predict IR

• Other parameters to assess Other parameters to assess outcomes of obesity? outcomes of obesity?

• Should fitness be assessed?Should fitness be assessed?

Correlation: 0.32 (P = 0.002)

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% Body fat

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(n=222, (n=222, ages 6-14)ages 6-14)

Fitness has greater correlation with insulin than body fatFitness has greater correlation with insulin than body fat

Correlation: -0.49 (P < 0.001)

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VO2max (mL/kg per min)

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Allen DB, Nemeth B, Clark R, Peterson S, Eickhoff J, Carrel AL. J Pediatr 2007, 150; 383-8.Allen DB, Nemeth B, Clark R, Peterson S, Eickhoff J, Carrel AL. J Pediatr 2007, 150; 383-8.

Can we translate research from the exercise lab to the school?

•

• Fitness is a better predictor of insulin resistance than BMI in children*

• Individual fitness testing impractical on large scale**

*DB Allen, AL Carrel. J Peds 2007; **TS Varness, AL Carrel, et al 2009

Wisconsin Partnership for Wisconsin Partnership for Childhood Fitness (WPCF)Childhood Fitness (WPCF)

Doug White, Dept of Public Instruction (DPI)Doug White, Dept of Public Instruction (DPI)

Aaron Carrel, Dept of Pediatrics, UWAaron Carrel, Dept of Pediatrics, UW

David Allen, Dept of Pediatrics, UWDavid Allen, Dept of Pediatrics, UW

Paul Moberg, PhD, Population Health Institute, UWPaul Moberg, PhD, Population Health Institute, UW

Jon Hisgen, Health and Physical Education, DPIJon Hisgen, Health and Physical Education, DPI

Brian Weaver, Coordinated School Health Program, DPIBrian Weaver, Coordinated School Health Program, DPI

John Bowser, Population Health InstituteJohn Bowser, Population Health Institute

Funded by the Wisconsin Partnership ProgramFunded by the Wisconsin Partnership Program

WPCF Goal and Objectives

Long Term Goal: Increase number of physically fit Long Term Goal: Increase number of physically fit youth; reduce number of overweight/inactive youthyouth; reduce number of overweight/inactive youth

Objectives (2008-2011):Objectives (2008-2011):

• Determine PACER validity & reliabilityDetermine PACER validity & reliability

• Provide website for data collection Provide website for data collection

• Collect/analyze data from across the state to Collect/analyze data from across the state to create reference ranges for fitness levelscreate reference ranges for fitness levels

Translating assessment to the school

• PACERPACER correlates with VOcorrelates with VO22 max and with IR. max and with IR.

• PACER provides a valid PACER provides a valid ‘‘field-based measure of fitness field-based measure of fitness and is predictive of IR greater than BMI alone and is predictive of IR greater than BMI alone

Varness, Carrel, Allen. Int J Ped Endo 2009Varness, Carrel, Allen. Int J Ped Endo 2009

WPCF Implementation WPCF Implementation

• Statewide Utilization of Fitnessgram®Statewide Utilization of Fitnessgram®

– 680 schools currently use FitnessGram®680 schools currently use FitnessGram®

– 448 due to participation in WPCF448 due to participation in WPCF

– 71% of WI adolescents now tested annually71% of WI adolescents now tested annually

• Data Submission to UWData Submission to UW

– 126 schools submitted fitness data during the 2009-126 schools submitted fitness data during the 2009-10 school year10 school year

– 26,779 total student test submissions26,779 total student test submissions

– Used to develop statewide Used to develop statewide ““normsnorms”” of aerobic fitness of aerobic fitness

Website: facilitating connections

• Direct connection with schools for fitness assessment

• Ongoing statewide effort for children’s fitness and BMI through CDC funding

WPCF Evaluation ResultsWPCF Evaluation Results

• WPCF provided large and continuing Fitness WPCF provided large and continuing Fitness data set for normative & comparative purposesdata set for normative & comparative purposes

• WPCF revealed disparities in aerobic fitnessWPCF revealed disparities in aerobic fitness

– Students in schools with > 50% minority Students in schools with > 50% minority students more likely to have low fitness students more likely to have low fitness (Odds Ratio = 3.0)(Odds Ratio = 3.0)

– Disparity even stronger among minority girls Disparity even stronger among minority girls (OR = 4.6)(OR = 4.6)

Conclusions• Demonstrates feasibility of performing, reporting Demonstrates feasibility of performing, reporting

and recording school-based fitnessand recording school-based fitness

• Developed age and sex based reference ranges Developed age and sex based reference ranges for childrenfor children

• Provides a “tool” to assess fitness, an important Provides a “tool” to assess fitness, an important health indicator to supplement BMIhealth indicator to supplement BMI

• Such partnerships and data can be useful for Such partnerships and data can be useful for population based studiespopulation based studies

Integrated model for school health

School environments are complex

CDC supports school-based programs.Logical ideas: Do they work?

• Current recommendations for 60 minutes per day of Current recommendations for 60 minutes per day of PA PA (IOM 2005)(IOM 2005)

• Recommended that >30 of those minutes come during Recommended that >30 of those minutes come during school school (Cochrane 2009, IOM 2005)(Cochrane 2009, IOM 2005)

• However, decreasing requirement of PE (50% in K-5, However, decreasing requirement of PE (50% in K-5, 25% by 825% by 8thth grade, to 5% in 12 grade, to 5% in 12thth grade grade (Burgeson 2009)(Burgeson 2009)