1. Translating Pediatric Fitness from Lab to Schools Aaron L. Carrel, MD University of Wisconsin & Doug White, MS Department of Public Instruction

2. Objectives - Translating Fitness Describe exemplary community- academic partnershipDescribe exemplary community- academic 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

3. Why a school-based program? >90% of children enrolled Both active and passive decisions of activity, food, attendance can be altered Schools provide social and educational platform for obesity prevention CDC supports this, but does it work?

4. Is research influencing policy? BMI does not predict IR BMI does not predict IR Other parameters to assess outcomes of obesity? Other parameters to assess outcomes of obesity? Should fitness be assessed? Should fitness be assessed?

5. Correlation: 0.32 (P = 0.002) 0 20 40 60 80 100 120 140 2025303540455055 % Body fat Insulin concentration (n=222, ages 6-14) Fitness has greater correlation with insulin than body fat Correlation: -0.49 (P < 0.001) 0 20 40 60 80 100 120 140 20253035404550 VO 2 max (mL/kg per min) Insulin concentration Allen DB, Nemeth B, Clark R, Peterson S, Eickhoff J, Carrel AL. J Pediatr 2007, 150; 383-8.

6. 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

7. Wisconsin Partnership for Childhood Fitness (WPCF) Doug White, Dept of Public Instruction (DPI) Aaron Carrel, Dept of Pediatrics, UW David Allen, Dept of Pediatrics, UW Paul Moberg, PhD, Population Health Institute, UW Jon Hisgen, Health and Physical Education, DPI Brian Weaver, Coordinated School Health Program, DPI John Bowser, Population Health Institute Funded by the Wisconsin Partnership Program

8. WPCF Goal and Objectives Long Term Goal: Increase number of physically fit youth; reduce number of overweight/inactive youth Objectives (2008-2011): Determine PACER validity & reliabilityDetermine PACER validity & reliability Provide website for data collectionProvide website for data collection Collect/analyze data from across the state to create reference ranges for fitness levelsCollect/analyze data from across the state to create reference ranges for fitness levels

9. Translating assessment to the school PACERcorrelates with VO 2 max and with IR.PACER correlates with VO 2 max and with IR. PACER provides a valid ‘field-based measure of fitness and is predictive of IR greater than BMI alonePACER provides a valid ‘field-based measure of fitness and is predictive of IR greater than BMI alone Varness, Carrel, Allen. Int J Ped Endo 2009 Varness, Carrel, Allen. Int J Ped Endo 2009

10. WPCF Implementation Statewide Utilization of Fitnessgram®Statewide Utilization of Fitnessgram® –680 schools currently use FitnessGram® –448 due to participation in WPCF –71% of WI adolescents now tested annually Data Submission to UWData Submission to UW –126 schools submitted fitness data during the 2009- 10 school year –26,779 total student test submissions –Used to develop statewide “norms” of aerobic fitness

11. Website: facilitating connections Direct connection with schools for fitness assessment Ongoing statewide effort for children’s fitness and BMI through CDC funding

14. WPCF Evaluation Results WPCF provided large and continuing Fitness data set for normative & comparative purposesWPCF provided large and continuing Fitness data set for normative & comparative purposes WPCF revealed disparities in aerobic fitnessWPCF revealed disparities in aerobic fitness –Students in schools with > 50% minority students more likely to have low fitness (Odds Ratio = 3.0) –Disparity even stronger among minority girls (OR = 4.6)

15. Conclusions Demonstrates feasibility of performing, reporting and recording school-based fitnessDemonstrates feasibility of performing, reporting and recording school-based fitness Developed age and sex based reference ranges for childrenDeveloped age and sex based reference ranges for children Provides a “tool” to assess fitness, an important health indicator to supplement BMIProvides a “tool” to assess fitness, an important health indicator to supplement BMI Such partnerships and data can be useful for population based studiesSuch partnerships and data can be useful for population based studies

17. Integrated model for school health School environments are complex

18. CDC supports school-based programs. Logical ideas: Do they work? Current recommendations for 60 minutes per day of PA (IOM 2005)Current recommendations for 60 minutes per day of PA (IOM 2005) Recommended that >30 of those minutes come during school (Cochrane 2009, IOM 2005)Recommended that >30 of those minutes come during school (Cochrane 2009, IOM 2005) However, decreasing requirement of PE (50% in K-5, 25% by 8 th grade, to 5% in 12 th grade (Burgeson 2009)However, decreasing requirement of PE (50% in K-5, 25% by 8 th grade, to 5% in 12 th grade (Burgeson 2009)