Effect of Increased Exercise in School Children on Physical Fitness and Endothelial Progenitor Cells: A Prospective Randomized Trial

C Walther, L Gaede, V Adams, G Gelbrich, A Leichtle, S Erbs, M Sonnabend, K Fikenzer, A Korner, W Kiess, M Bruegel, J Thiery and G. Schuler

Circulation, 2009, 120(22), 2251-2259. DOI: 10.1161/CIRCULATIONAHA.109.865808


Background— The aim of this prospective, randomized study was to examine whether additional school exercise lessons would result in improved peak oxygen uptake (primary end point) and body mass index–standard deviation score, motor and coordinative abilities, circulating progenitor cells, and high-density lipoprotein cholesterol (major secondary end points).

Methods and Results— Seven sixth-grade classes (182 children, aged 11.1±0.7 years) were randomized to an intervention group (4 classes with 109 students) with daily school exercise lessons for 1 year and a control group (3 classes with 73 students) with regular school sports twice weekly. The significant effects of intervention estimated from ANCOVA adjusted for intraclass correlation were the following: increase of peak Vo2 (3.7 mL/kg per minute; 95% confidence interval, 0.3 to 7.2) and increase of circulating progenitor cells evaluated by flow cytometry (97 cells per 1x106 leukocytes; 95% confidence interval, 13 to 181). No significant difference was seen for body mass index–standard deviation score (–0.08; 95% confidence interval, –0.28 to 0.13); however, there was a trend to reduction of the prevalence of overweight and obese children in the intervention group (from 12.8% to 7.3%). No treatment effect was seen for motor and coordinative abilities (4; 95% confidence interval, –1 to 8) and high-density lipoprotein cholesterol (0.03 mmol/L; 95% confidence interval, –0.08 to 0.14).

Conclusions— Regular physical activity by means of daily school exercise lessons has a significant positive effect on physical fitness (Vo2max). Furthermore, the number of circulating progenitor cells can be increased, and there is a positive trend in body mass index–standard deviation score reduction and motor ability improvement. Therefore, we conclude that primary prevention by means of increasing physical activity should start in childhood.

Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Identifier: NCT00176371.

ASCI-ID: 1433-231