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The Prospective Association of Organized Sports Participation With Cardiovascular Disease Risk in Children (the CHAMPS Study-DK)

  • Jeffrey J. Hebert
    Correspondence: Address to Jeffrey J. Hebert, PhD, School of Psychology and Exercise Science, Murdoch University, 90 S St, ECL 4.008, Murdoch, Western Australia 6150, Australia.
    School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia

    Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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  • Heidi Klakk
    Centre of Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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  • Niels Christian Møller
    Centre of Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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  • Anders Grøntved
    Centre of Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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  • Lars Bo Andersen
    Centre of Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway, and the Faculty of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway
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  • Niels Wedderkopp
    School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia

    Centre of Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Sports Medicine Clinic, the Orthopedic Department, Hospital of Middelfart, Institute of Regional Health Services Research, University of Southern Denmark, Middelfart, Denmark
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Published:November 16, 2016DOI:



      To investigate the prospective association of organized leisure-time sports participation with cardiovascular risk in children.


      Students were recruited from 10 public primary schools. From July 2009 to October 2010, parents reported children's weekly organized leisure-time sports participation via text messaging. Clustered cardiovascular risk was estimated with a composite score comprising fasting serum triglyceride levels, homeostasis assessment model-estimated insulin resistance, total to high-density lipoprotein cholesterol ratio, and systolic blood pressure. Additional outcomes were body mass index categories and fasting serum insulin and glucose concentrations. Associations were explored with generalized estimating equations and reported with beta coefficients (β) and percent difference per weekly sports session or incidence rate ratios. All models were adjusted for baseline values and other potential confounders.


      In total, 1197 children (53% female) with a mean age of 8.4±1.4 years were included. Participating in sports for 53 weeks was associated with lower clustered cardiovascular risk (β, −0.25; 95% CI, −0.41 to −0.10; percent difference, 3.2%; 95% CI, 5.2%-1.3%). Similar outcomes were observed for log homeostasis assessment model-estimated insulin resistance (β, −0.08; 95% CI, −0.12 to −0.04; percent difference, 3.4%; 5.1%-1.7%) and log insulin (β, −0.07; 95% CI, −0.11 to −0.04; percent difference, 2.6%; 95% CI, 4.0%-1.5%). Sports participation was associated with a 20% decreased risk of overweight/obesity (incidence rate ratio, 0.78; 95% CI, 0.64-0.96).


      Participating in organized leisure-time sports for approximately 1 year is associated with decreased clustered cardiovascular risk in children. These findings show that participating in youth sports may be an effective strategy to reduce cardiovascular risk in children.

      Abbreviations and Acronyms:

      HDL-C (high-density lipoprotein cholesterol), HOMA-IR (homeostasis assessment model-estimated insulin resistance), IRR (incident rate ratio)
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        • GBD 2013 Mortality and Causes of Death Collaborators
        Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 385: 117-171
        • Strong J.P.
        • Malcom G.T.
        • Newman III, W.P.
        • Oalmann M.C.
        Early lesions of atherosclerosis in childhood and youth: natural history and risk factors.
        J Am Coll Nutr. 1992; 11: 51S-54S
        • Berenson G.S.
        • Foster T.A.
        • Frank G.C.
        • et al.
        Cardiovascular disease risk factor variables at the preschool age. The Bogalusa heart study.
        Circulation. 1978; 57: 603-612
        • Bugge A.
        • El-Naaman B.
        • McMurray R.G.
        • Froberg K.
        • Andersen L.B.
        Tracking of clustered cardiovascular disease risk factors from childhood to adolescence.
        Pediatr Res. 2013; 73: 245-249
        • Andersen L.B.
        • Hasselstrom H.
        • Gronfeldt V.
        • Hansen S.E.
        • Karsten F.
        The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sports Study.
        Int J Behav Nutr Phys Act. 2004; 1: 6
        • Ekelund U.
        • Luan J.
        • Sherar L.B.
        • Esliger D.W.
        • Griew P.
        • Cooper A.
        • International Children's Accelerometry Database (ICAD) Collaborators
        Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents.
        JAMA. 2012; 307: 704-712
        • Metcalf B.
        • Henley W.
        • Wilkin T.
        Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54).
        BMJ. 2012; 345: e5888
        • Caspersen C.J.
        • Powell K.E.
        • Christenson G.M.
        Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
        Public Health Rep. 1985; 100: 126-131
        • Khan K.M.
        • Thompson A.M.
        • Blair S.N.
        • et al.
        Sports and exercise as contributors to the health of nations.
        Lancet. 2012; 380: 59-64
        • Hebert J.J.
        • Moller N.C.
        • Andersen L.B.
        • Wedderkopp N.
        Organized sports participation is associated with higher levels of overall health-related physical activity in children (CHAMPS Study-DK).
        PLoS One. 2015; 10: e0134621
        • Marques A.
        • Ekelund U.
        • Sardinha L.B.
        Associations between organized sports participation and objectively measured physical activity, sedentary time and weight status in youth.
        J Sci Med Sports. 2016; 19: 154-157
        • Bangsbo J.
        • Hansen P.R.
        • Dvorak J.
        • Krustrup P.
        Recreational football for disease prevention and treatment in untrained men: a narrative review examining cardiovascular health, lipid profile, body composition, muscle strength and functional capacity.
        Br J Sports Med. 2015; 49: 568-576
        • Idris N.S.
        • Evelein A.M.
        • Geerts C.C.
        • Sastroasmoro S.
        • Grobbee D.E.
        • Uiterwaal C.S.
        Effect of physical activity on vascular characteristics in young children.
        Eur J Prev Cardiol. 2015; 22: 656-664
        • Wedderkopp N.
        • Jespersen E.
        • Franz C.
        • et al.
        Study protocol. The Childhood Health, Activity, and Motor Performance School Study Denmark (The CHAMPS-study DK).
        BMC Pediatr. 2012; 12: 128
        • Møller N.C.
        • Tarp J.
        • Kamelarczyk E.F.
        • Brønd J.C.
        • Klakk H.
        • Wedderkopp N.
        Do extra compulsory physical education lessons mean more physically active children—findings from the Childhood Health, Activity, and Motor Performance School study Denmark (The CHAMPS-study DK).
        Int J Behav Nutr Phys Act. 2014; 11: 121
        • Cole T.J.
        • Bellizzi M.C.
        • Flegal K.M.
        • Dietz W.H.
        Establishing a standard definition for child overweight and obesity worldwide: international survey.
        BMJ. 2000; 320: 1240-1243
        • Tanner J.M.
        Growth at Adolescence, With a General Consideration of the Effects of Hereditary and Environmental Factors Upon Growth and Maturation from Birth to Maturity.
        2nd ed. Blackwell Scientific Publications, Oxford1962
        • Duke P.M.
        • Litt I.F.
        • Gross R.T.
        Adolescents' self-assessment of sexual maturation.
        Pediatrics. 1980; 66: 918-920
        • Baranowski T.
        • Smith M.
        • Baranowski J.
        • et al.
        Low validity of a seven-item fruit and vegetable food frequency questionnaire among third-grade students.
        J Am Diet Assoc. 1997; 97: 66-68
        • Johansen B.
        • Wedderkopp N.
        Comparison between data obtained through real-time data capture by SMS and a retrospective telephone interview.
        Chiropr Osteopat. 2010; 18: 10
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Andersen L.B.
        • Wedderkopp N.
        • Hansen H.S.
        • Cooper A.R.
        • Froberg K.
        Biological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study.
        Prev Med. 2003; 37: 363-367
        • Andersen L.B.
        • Lauersen J.B.
        • Brønd J.C.
        • et al.
        A new approach to define and diagnose cardiometabolic disorder in children.
        J Diabetes Res. 2015; 2015: 539835
        • Klakk H.
        • Grontved A.
        • Moller N.C.
        • Heidemann M.
        • Andersen L.B.
        • Wedderkopp N.
        Prospective association of adiposity and cardiorespiratory fitness with cardiovascular risk factors in healthy children.
        Scand J Med Sci Sports. 2014; 24: e275-e282
        • Mykkanen L.
        • Kuusisto J.
        • Haffner S.M.
        • Pyorala K.
        • Laakso M.
        Hyperinsulinemia predicts multiple atherogenic changes in lipoproteins in elderly subjects.
        Arterioscler Thromb. 1994; 14: 518-526
        • Haffner S.M.
        • Valdez R.A.
        • Hazuda H.P.
        • Mitchell B.D.
        • Morales P.A.
        • Stern M.P.
        Prospective analysis of the insulin-resistance syndrome (syndrome X).
        Diabetes. 1992; 41: 715-722
        • Lee I.M.
        • Shiroma E.J.
        • Lobelo F.
        • Puska P.
        • Blair S.N.
        • Katzmarzyk P.T.
        Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.
        Lancet. 2012; 380: 219-229
        • Strong W.B.
        • Malina R.M.
        • Blimkie C.J.
        • et al.
        Evidence based physical activity for school-age youth.
        J Pediatr. 2005; 146: 732-737
        • World Health Organization
        Global Recommendations on Physical Activity for Health.
        World Health Organization, Geneva, Switzerland2010: 17-21
        • Griffiths L.J.
        • Cortina-Borja M.
        • Sera F.
        • et al.
        How active are our children? Findings from the Millennium Cohort Study.
        BMJ Open. 2013; 3: e002893
        • Ramos J.S.
        • Dalleck L.C.
        • Tjonna A.E.
        • Beetham K.S.
        • Coombes J.S.
        The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis.
        Sports Med. 2015; 45: 679-692
        • Jelleyman C.
        • Yates T.
        • O'Donovan G.
        • et al.
        The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis.
        Obes Rev. 2015; 16: 942-961
        • Guagliano J.M.
        • Rosenkranz R.R.
        • Kolt G.S.
        Girls' physical activity levels during organized sports in Australia.
        Med Sci Sports Exerc. 2013; 45: 116-122
        • Leek D.
        • Carlson J.A.
        • Cain K.L.
        • et al.
        Physical activity during youth sports practices.
        Arch Pediatr Adolesc Med. 2011; 165: 294-299
        • Gutin B.
        • Barbeau P.
        • Owens S.
        • et al.
        Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents.
        Am J Clin Nutr. 2002; 75: 818-826
        • Kang H.S.
        • Gutin B.
        • Barbeau P.
        • et al.
        Physical training improves insulin resistance syndrome markers in obese adolescents.
        Med Sci Sports Exerc. 2002; 34: 1920-1927
        • Hay J.
        • Wittmeier K.
        • MacIntosh A.
        • et al.
        Physical activity intensity and type 2 diabetes risk in overweight youth: a randomized trial.
        Int J Obes (Lond). 2016; 40: 607-614
        • Nielsen G.
        • Wikman J.M.
        • Jensen C.J.
        • Schmidt J.F.
        • Gliemann L.
        • Andersen T.R.
        Health promotion: the impact of beliefs of health benefits, social relations and enjoyment on exercise continuation.
        Scand J Med Sci Sports. 2014; 24: 66-75
        • Sallis R.
        Developing healthcare systems to support exercise: exercise as the fifth vital sign.
        Br J Sports Med. 2011; 45: 473-474
        • Lobelo F.
        • Stoutenberg M.
        • Hutber A.
        The Exercise is Medicine Global Health Initiative: a 2014 update.
        Br J Sports Med. 2014; 48: 1627-1633
        • Levine J.A.
        Non-exercise activity thermogenesis (NEAT).
        Best Pract Res Clin Endocrinol Metab. 2002; 16: 679-702
        • Rasmussen A.R.
        • Wohlfahrt-Veje C.
        • Tefre de Renzy-Martin K.
        • et al.
        Validity of self-assessment of pubertal maturation.
        Pediatrics. 2015; 135: 86-93
        • Balagopal P.B.
        • de Ferranti S.D.
        • Cook S.
        • et al.
        • American Heart Association Committee on Atherosclerosis, Hypertension and Obesity in Youth of the Council on Cardiovascular Disease in the Young; Council on Nutrition, Physical Activity and Metabolism; Council on Epidemiology and Prevention
        Nontraditional risk factors and biomarkers for cardiovascular disease: mechanistic, research, and clinical considerations for youth: a scientific statement from the American Heart Association.
        Circulation. 2011; 123: 2749-2769