Abstract
Longitudinal paediatric population studies have provided evidence that the risk factor theory may be extended to children and adolescents. These studies could assist in identifying individuals at increased coronary risk. Numerous studies have focused on the effects of regular exercise on the paediatric lipoprotein profile, a recognised primary risk factor, with equivocal results. Cross-sectional comparisons of dichotomised groups provide the strongest evidence of an exercise effect. ‘Trained’ or ‘active’ children and adolescents demonstrate ‘favourable’ levels of high density lipoprotein-cholesterol (HDL-C), triacylglycerol, total cholesterol (TC)/HDL-C and low density lipoprotein-cholesterol (LDL-C)/HDL-C, whilst TC is generally unaffected. The evidence regarding LDL-C in these studies is equivocal. A possible self-selection bias means that a cause-effect relationship between exercise and the lipoprotein profile cannot be readily established from this design. Correlational studies are difficult to interpret because of differences in participant characteristics, methods employed to assess peak oxygen uptake and habitual physical activity (HPA), and the statistical techniques used to analyse multivariate data. Directly measured cardiorespiratory fitness does not appear to be related to lipoprotein profiles in the children and adolescents studied to date, although there are data to the contrary. The relationship with HPA is more difficult to decipher. The evidence suggests that a ‘favourable’ lipoprotein profile may be related to higher levels of HPA, although differences in assessment methods preclude a definitive answer. While few prospective studies exist, the majority of these longitudinal investigations suggest that imposed regular exercise has little, if any, influence on the lipoprotein levels of children and adolescents. However, most prospective studies have several serious methodological design weaknesses, including low sample size, inadequate exercise training volume and a lack of control individuals. Recent studies have suggested that increases in HDL-C and reductions in LDL-C may be possible with regular exercise. The identification of a dose-response relationship between exercise training and the lipoprotein profile during the paediatric years remains elusive.
Similar content being viewed by others
Notes
Where possible, the distinction between childhood (usually < 10 years of age) and adolescence (the period of rapid growth, maturation and development following childhood) has been made in this manuscript. At times, the generic term ‘children’ has been used to include all individuals who have yet to attain full physical maturity (i.e. adulthood).
References
Smith BW, Metheny WP, Sparrow AW. Serum lipid and lipoprotein profiles of elite age-group runners. In: Weiss MR, Gould D, editors. Sport for children and youths. Champaign (IL): Human Kinetics, 1986: 269–73
Tolfrey K, Campbell IG, Jones AM. Predictor variables and the lipid-lipoprotein profile in prepubertal girls and boys. Med Sci Sports Exerc 1999; 31 (11): 1550–7
Kwee A, Wilmore JH. Cardiorespiratory fitness and risk factors for coronary artery disease in 8- to 15-year-old boys. Pediatr Exerc Sci 1990; 2: 372–83
Al-Hazzaa HM, Sulaiman MA, Al-Matar AJ, et al. Cardiorespiratory fitness, physical activity patterns and coronary risk factors in preadolescent boys. Int J Sports Med 1994; 15 (5): 267–72
Thorland WG, Gilliam TB. Comparison of serum lipids between habitually high and low active pre-adolescent males. Med Sci Sports Exerc 1981; 13 (5): 316–21
Nizankowska-Blaz T, Abramowicz T. Effects of intensive physical training on serum lipids and lipoproteins. Acta Paediatr Scand 1983; 72: 357–9
Zonderland ML, Erich WBM, Peltenburg AL, et al. Apolipoprotein and lipid profile in young female athletes. Int J Sports Med 1984; 5: 78–82
Atomi Y, Kuroda Y, Asami T, et al. HDL2-cholesterol of children (10 to 12 years of age) related to V̇O2max, body fat, and sex. In: Rutenfranz J, Mocellin R, Klimt F, editors. Children and exercise XII. Champaign (IL): Human Kinetics, 1986: 167–72
Tell GS, Vellar OD. Physical fitness, physical activity, and cardiovascular disease risk factors in adolescents: the Oslo Youth Study. Prev Med 1988; 17: 12–24
Mácek M, Bell D, Rutenfranz J, et al. A comparison of coronary risk factors in groups of trained and untrained adolescents. Eur J Appl Physiol 1989; 58: 577–82
Durant RH, Linder CW, Harkess JW, et al. The relationship between physical activity and serum lipids and lipoproteins in black children and adolescents. J Adolesc Health Care 1983; 4: 55–60
Wilmore JH, Constable SH, Stanforth PR, et al. Prevalence of coronary heart disease risk factors in 13- to 15-year-old boys. J Cardiac Rehab 1982; 2 (3): 223–33
Bell R, Mácek M, Rutenfranz J. Blood lipoprotein profiles in trained and untrained adolescents. In: Rutenfranz J, Mocellin R, Klimt F, editors. Children and exercise XII. Champaign (IL): Human Kinetics, 1986: 277–83
Rogers DM, Turley KR, Kujawa KI, et al. Allometric scaling factors for oxygen uptake during exercise in children. Pediatr Exerc Sci 1995; 7: 12–25
Tell GS. Cardiovascular disease risk factors related to sexual maturation: the Oslo Youth Study. J Chronic Dis 1985; 38: 633–42
Välimäki I, Hursti ML, Pihlakoski L, et al. Exercise performance and serum lipids in relation to physical activity in schoolchildren. Int J Sports Med 1980; 1: 132–6
Verschuur R, Kemper HCG, Besseling CWM. Habitual physical activity and health in 13- and 14-year old teenagers. In: Ilmarinen J, Välimäki I, editors. Children and sport. New York (NY): Springer, 1984: 255–61
Wanne O, Viikari J, Välimäki I. Physical performance and serum lipids in 14–16 year old trained, normally active and inactive children. In: Ilmarinen J, Välimäki I, editors. Children and sport. New York (NY): Springer, 1984: 241–6
Cresanta JL, Srinivasan SR, Webber LS, et al. Serum lipid and lipoprotein cholesterol grids for cardiovascular risk screening of children. Am J Dis Child 1984; 138: 379–87
Prewitt TE, Haynes SG, Graves K, et al. Nutrient intake, lipids, and lipoprotein cholesterol in black and white children: the Lipid Research Clinics Prevalence Study. Prev Med 1988; 17 (3): 247–62
Belcher JD, Ellison RC, Shepard WE, et al. Lipid and lipoprotein distributions in children by ethnic group, sex, and geographic location: preliminary findings of the Child and Adolescent Trial for Cardiovascular Health (CATCH). Prev Med 1993; 22 (2): 143–53
LaPorte RE, Montoye HJ, Casperson CJ. Assessment of physical activity in epidemiologic research: problems and prospects. Public Health Rep 1985; 100: 131–46
Morrow JR, Freedson PS. Relationship between habitual physical activity and aerobic fitness in adolescents. Pediatr Exerc Sci 1994; 6: 315–29
Montoye HJ, Kemper HCG, Saris WHM, et al. Measuring physical activity and energy expenditure. Champaign (IL): Human Kinetics, 1996
Rowland TW. Exercise and children’s health. Champaign (IL): Human Kinetics, 1990
Rowland TW. Developmental exercise physiology. Champaign (IL): Human Kinetics, 1996
Freedson PS, Rowland TW. Youth activity versus youth fitness: let’s redirect our efforts. Res Q Sports Exerc 1992; 63: 133–6
Haskell WL. Dose-response issues from a biological perspective. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health. Champaign (IL): Human Kinetics, 1994: 1030–9
Riddoch CJ, Boreham CAG. The health-related physical activity of children. Sports Med 1995; 19: 86–102
Rowland TW. The horse is dead: let’s dismount [editorial]. Pediatr Exerc Sci 1995; 7: 117–20
Rowlands AV, Eston RG, Ingledew DK. Measurement of physical activity in children with particular reference to the use of heart rate and pedometry. Sports Med 1997; 24 (4): 258–72
Blair SN, Kohl III HW, Paffenbarger Jr RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262 (17): 2395–401
Blair SN. McCloy Research Lecture: physical activity, physical fitness and health. Res Q Exerc Sport 1993; 64 (4): 365–76
Armstrong N, Williams J, Balding J, et al. Cardiopulmonary fitness, physical activity patterns, and selected coronary risk factor variables in 11- to 16-year-olds. Pediatr Exerc Sci 1991; 3: 219–28
Dishman RK. Determinants of participation in physical activity. In: Bouchard C, Shephard RJ, Stephens T, et al. editors. Exercise, fitness and health. Champaign (IL): Human Kinetics, 1990: 75–101
Bouchard C, Lesage R, Lortie G, et al. Aerobic performance in brothers, dizygotic and monozygotic twins. Med Sci Sports Exerc 1986; 18 (6): 639–46
Klissouras V. Heritability of adaptive variation. J Appl Physiol 1971; 31 (3): 338–44
Howald H. Ultrastructure and biochemical function of skeletal muscle in twins. Ann Hum Biol 1976; 3: 455–62
Lesage R, Simoneau JA, Jobin J, et al. Familial resemblance in maximal heart rate, blood lactate and aerobic power. Hum Hered 1985; 35 (3): 182–9
Bouchard C. Genetics of aerobic power and capacity. In: Malina RN, Bouchard C, editors. Sport and human genetics. Champaign (IL): Human Kinetics, 1986: 59–88
Beunen GP, Rogers DM, Woynarowska B, et al. Longitudinal study of ontogentic allometry of oxygen uptake in boys and girls grouped by maturity status. Ann Hum Biol 1997; 24 (1): 33–43
Batterham AM, Tolfrey K, George KP. Nevill’s explanation of Kleiber’s 0.75 mass exponent: an artifact of collinearity problems in least squaresmodels? J Appl Physiol 1997; 82 (2): 693–7
Gilliam TB, Katch VL, Thorland W, et al. Prevalence of coronary heart disease risk factors in active children, 7 to 12 years of age. Med Sci Sports 1977; 9: 21–5
Montoye HJ, Block WD, Gayle R. Maximal oxygen uptake and blood lipids. J Chronic Dis 1978; 31: 111–8
Sady SP, Berg K, Beal D, et al. Aerobic fitness and serum high-density lipoprotein cholesterol in young children. Hum Biol 1984; 56 (4): 771–81
Fripp RR, Hodgson JL, Kwiterovich PO, et al. Aerobic capacity, obesity and atherosclerotic risk factors in male adolescents. Pediatrics 1985; 75: 813–8
Mácek M, Rutenfranz J, Lange Anderson K, et al. Favourable levels of cardio-vascular health and risk indicators during childhood and adolescence. Eur J Appl Physiol 1985; 144: 360–7
Gilliam TB, Freedson PS, MacConnie SE, et al. Comparison of blood lipids, lipoproteins, anthropometric measures, and resting and exercise cardiovascular responses in children, 6–7 years old. Prev Med 1981; 10: 754–64
Sallis JF, Patterson TL, Buono MJ, et al. Relation of cardiovascular fitness and physical activity to cardiovascular disease risk factors in children and adults. Am J Epidemiol 1988; 127 (5): 933–41
Taimela S, Lehtimäki T, Porkka PVK, et al. The effect of physical activity on serum total and low-density lipoprotein cholesterol concentrations varies with apolipoprotein E phenotype in male children and young adults: the Cardiovascular Risk in Young Finns Study. Metabolism 1996; 45 (7): 797–803
Tolfrey K, Campbell IG, Batterham AM. Exercise training induced alterations in prepubertal children’s lipid-lipoprotein profile. Med Sci Sports Exerc 1998; 30 (12): 1684–92
Hager RL, Tucker LA, Seljaas GT. Aerobic fitness, blood lipids, and body fat in children. Am J Public Health 1995; 85 (12): 1702–6
Lauer RM, Connor WE, Leaverton PE, et al. Coronary heart disease risk factors in school children: the Muscatine Study. J Pediatr 1975; 86 (5): 697–706
Becque MD, Katch VL, Rocchini AP, et al. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics 1988; 81: 605–12
Vaccaro P, Mahon AD. The effects of exercise on coronary heart disease risk factors in children. Sports Med 1989; 8: 139–53
Armstrong N, Balding J, Gentle P, et al. Serum lipids and blood pressure in relation to age and sexual maturity. Ann Hum Biol 1992; 19 (5): 477–87
Gutin B, Manos TM. Physical activity in the prevention of childhood obesity. Ann N Y Acad Sci 1993; 699: 115–26
Armstrong N, Welsman J. Young people and physical activity. Oxford: Oxford University Press, 1997
Tran ZV, Weltman A. Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight: a meta-analysis. JAMA 1985; 254 (7): 919–24
Suter E, Hawes MR. Relationship of physical activity, body fat, diet, and blood lipid profile in youths 10–15 yr. Med Sci Sports Exerc 1993; 25 (6): 748–54
Hofman A, Walter HJ. The association between physical fitness and cardiovascular disease risk in children in a five-year follow-up study. Int J Epidemiol 1989; 18 (4): 830–5
Durant RH, Baranowski T, Rhodes T, et al. Association among serum lipid and lipoprotein concentrations and physical activity, physical fitness, and body composition in young children. J Pediatr 1993; 123: 185–92
Craig SB, Bandini LG, Lichtenstein AH, et al. The impact of physical activity on lipids, lipoproteins, and blood pressure in preadolescent girls. Pediatr 1996; 98 (3): 389–95
Belsley DA, Kuh E, Welsh RE. Regression diagnostics: identifying influential data and sources of collinearity. New York (NY): Wiley, 1980
Berlin JA, Antman EM. Advantages and limitations of meta-analytic regressions of clinical trials data. Online J Curr Clin Trials 1994 Jun 4; Doc. no. 134
Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. 2nd rev. ed. New York (NY): Erlbaum, 1983
Tabachnick BG, Fidell LS. Using multivariate statistics. 3rd rev. ed. New York (NY): Harper Collins College Publishers, 1996
Williams PT. Weight set-point theory and the high-density lipoprotein concentrations of long-distance runners. Metabolism 1990; 39 (5): 460–7
Keesey RE. The physiological regulation of body weight and the issue of obesity. Med Clin North Am 1989; 73: 15–27
American College of Sports Medicine. Guidelines for exercise testing and prescription. 5th rev. ed. Philadelphia (PA): Lea & Febiger, 1995
Léger L. Aerobic performance. In: Docherty D, editor. Measurement in pediatric exercise science. Champaign (IL): Human Kinetics, 1996: 183–223
Stewart KJ, Brown CS, Hickey CM, et al. Physical fitness, physical activity, and fatness in relation to blood pressure and lipids in preadolescent children. J Cardiopulmonary Rehabil 1995; 15: 122–9
Durant RH, Linder CW, Mahoney OM. Relationship between habitual physical activity and serum lipoprotein levels in white male adolescents. J Adolesc Health Care 1983; 4 (4): 235–40
Sallis JF, Buono MJ, Roby JJ, et al. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc 1993; 25: 99–108
Cale L. Self-report measures of children’s physical activity: recommendations for future development and a new alternative measure. Health Educ J 1994; 53: 439–53
Durant RH, Baranowski T, Davis H, et al. Reliability and variability of indicators of heart rate monitoring in children. Med Sci Sports Exerc 1993; 25: 389–95
Stratton G. Children’s heart rates during physical education lessons: a review. Pediatr Exerc Sci 1996; 8 (3): 215–33
Sallo M, Silla R. Physical activity with moderate to vigorous intensity in preschool and first-grade schoolchildren. Pediatr Exerc Sci 1997; 9: 44–54
Treiber FA, Musante L, Hartdagan S, et al. Validation of a heart rate monitor for children in laboratory and field settings. Med Sci Sports Exerc 1989; 21: 338–42
Tsanakas JN, Bannister OM, Boon AW, et al. The ‘Sport Tester’: a device for monitoring the free running test. Arch Dis Child 1986; 61: 912–4
Durant RH, Baranowski T, Davis H, et al. Reliability and variability of heart rate monitoring in 3-, 4-, or 5-yr-old children. Med Sci Sports Exerc 1992; 24 (2): 265–71
Hardman AE, Hudson A, Jones PRM, et al. Brisk walking and plasma high density lipoprotein cholesterol concentration in previously sedentary women. BMJ 1989; 299: 1204–5
Hardman AE, Hudson A. Brisk walking and serum lipid and lipoprotein variables in previously sedentary women: influence of 12 weeks of regular brisk walking followed by 12 weeks of detraining. Br J Sports Med 1994; 28: 261–6
Duncan JJ, Gordon NE, Scott CB. Women walking for health: how much is enough? JAMA 1991; 266 (23): 3295–9
Blair SN, Connelly JC. How much physical activity should we do? The case for moderate amounts and intensities of physical activity. Res Q Exerc Sport 1996; 67 (2): 193–205
Lee CJ. Nutritional status of selected teenagers in Kentucky. Am J Clin Nutr 1978; 31: 1453–64
Gilliam TB, Burke MB. Effect of exercise on serum lipids and lipoproteins in girls, ages 8 to 10 years. Artery 1978; 4: 203–13
Widhalm K, Maxa E, Zyman H. Effect of diet and exercise upon the cholesterol and triglyceride content of plasma lipoproteins in overweight children. Eur J Pediatr 1978; 127: 121–6
Gilliam TB, Freedson PS. Effects of a 12 week school physical fitness program on peak V̇O2, body composition and blood lipids in 7 to 9 year old children. Int J Sports Med 1980; 1 (2): 73–8
Dwyer T, Coonan WE, Worsley A, et al. An assessment of the effects of two physical activity programmes on coronary heart disease risk factors in primary school children. Community Health Studies 1979; III (3): 196–202
Linder CW, Durant RH, Mahoney OM. The effect of physical conditioning on serum lipids and lipoproteins in white male adolescents. Med Sci Sports Exerc 1983; 15: 232–6
Bryant JG, Garrett HL, Dean MS. Coronary heart disease: the beneficial effects of exercise to children. Louisiana State Med J 1984; 136: 15–7
Deveaux KF, Bell RD, Laxdal VA. The effect of a season of competitive soccer on the serum lipid and lipoprotein cholesterol profile of adolescent boys. In: Rutenfranz J, Mocellin R, Klimt F, editors. Children and exercise XII. Champaign (IL): Human Kinetics, 1986: 173–83
Savage MP, Petratis MM, Thomson WH, et al. Exercise training effects on serum lipids of prepubescent boys and adult men. Med Sci Sports Exerc 1986; 18: 197–204
Sasaki J, Shindo M, Tanaka H, et al. Along-term aerobic exercise program decreases the obesity index and increases the high density lipoprotein cholesterol concentration in obese children. Int J Obes 1987; 11 (4): 339–45
Ben-Ezra V, Gallagher K. Blood lipid profiles of 8–10 year old children: the effect of diet and exercise [abstract]. Med Sci Sports Exerc 1989; 21: 584
Blessing DL, Keith RE, Williford HN, et al. Blood lipid and physiological responses to endurance training in adolescents. Pediatr Exerc Sci 1995; 7 (2): 192–202
Rowland TW, Martel L, Vanderburgh P, et al. The influence of short-term aerobic training on blood lipids in healthy 10–12 year old children. Int J Sports Med 1996; 17 (7): 487–92
Williford HN, Blessing DL, Duey WJ, et al. Exercise training in black adolescents: changes in blood lipids and V̇O2max. Ethn Dis 1996; 6: 279–85
Linder CW, Durant RH, Gray RG, et al. The effects of exercise on serum lipid levels in children [abstract]. Med Sci Sports Exerc 1979; 27: 297
Fisher AG, Brown M. The effects of diet and exercise on selected coronary risk factors in children [abstract]. Med Sci Sports Exerc 1982; 14: 171
Hunt HF, White JR. Effects of ten weeks of vigorous daily exercise on serum lipids and lipoproteins in teenage males [abstract]. Med Sci Sports Exerc 1980; 12: 93
Dwyer T, Coonan WE, Leitch DR, et al. An investigation of the effects of daily physical activity on the health of primary school students in South Australia. Int J Epidemiol 1983; 12 (3): 308–13
Bryant JG, Garrett HL, Dean-Mostafa MS. The effects of an exercise program on selected risk factors to coronary heart disease in children [letter]. Soc Sci Med 1984; 19 (7): 765–6
Howell DC. Fundamental statistics for the behavioral sciences. 3rd rev. ed. Belmont (CA): Duxbury Press, 1995
Haskell WL. Health consequences of physical activity: understanding and challenges regarding dose-response. Med Sci Sports Exerc 1994; 26 (6): 649–60
Superko HR. Exercise training, serum lipids, and lipoprotein particles: is there a change threshold? Med Sci Sports Exerc 1991; 23 (6): 677–85
Kim H-K, Kalkhoff RK. Changes in lipoprotein composition during the menstrual cycle. Metabolism 1979; 23: 663–8
Jones DY, Judd JT, Taylor PR, et al. Menstrual cycle effect on plasma lipids. Metabolism 1988; 37 (1): 1–2
Krummel D, Etherton TD, Peterson S, et al. Effects of exercise on plasma lipids and lipoproteins of women. Proc Soc Exp Biol Med 1993; 204: 123–37
Pollock ML. The quantification of endurance training programs. Exerc Sport Sci Rev 1973; 1: 155–88
Haskell WL. The influence of exercise on the concentrations of triglyceride and cholesterol in human plasma. Exerc Sport Sci Rev 1984; 12: 205–44
Lokey EA, Tran ZV. Effects of exercise training on serum lipid and lipoprotein concentrations in women: a meta-analysis. Int J Sports Med 1989; 10 (6): 424–9
Tran ZV, Weltman A, Glass GV, et al. The effects of exercise on blood lipids and lipoproteins: a meta-analysis of studies. Med Sci Sports Exerc 1983; 15 (5): 393–402
Berg A, Frey I, Baumstark MW, et al. Physical activity and lipoprotein lipid disorders. Sports Med 1994; 17 (1): 6–21
Durstine JL, Haskell WL. Effect of exercise training on plasma lipids and lipoproteins. Exerc Sport Sci Rev 1994; 22: 477–521
Montoye HJ. Physical activity, physical fitness and heart disease risk factors in children. In: Stull GA, Eckert HM, editors. Effects of physical activity on children. Champaign (IL):Human Kinetics, 1986: 127–52
Armstrong N, Davies B. High density lipoprotein cholesterol and physical activity patterns in children. Aust J Sports Med 1982; 14: 53–9
Blair SN, Kohl HW, Gordon NF, et al. How much physical activity is good for health? Annu Rev Public Health 1992; 13: 99–126
Blair SN, Wells CL, Weathers RD, et al. Chronic disease: the physical activity dose-response controversy. In: Dishman RK, editor. Advances in exercise adherence. Champaign (IL): Human Kinetics, 1994: 31–54
Haskell WL. Dose-response relationship between physical activity and disease risk factors. In: Oja P, Telama R, editors. Proceedings of the World Congress on Sport for All. Tampere: Elsevier Science Publishers, 1991: 125–33
Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR Morb Mortal Wkly Rep 1997; 46: RR-6
Riddoch C, Mutrie N, Parfitt G, et al. Young and active? Policy framework for young people and health-enhancing physical activity. London: Health Education Authority, 1998
Williams PT, Wood PD, Krauss RM, et al. Does weight loss cause the exercise-induced increase in plasma high density lipoproteins? Atherosclerosis 1983; 47 (2): 173–85
Bailey RC, Olson J, Pepper SL, et al. The level and tempo of children’s physical activities: an observational study. Med Sci Sports Exerc 1995; 27 (7): 1033–41
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tolfrey, K., Jones, A.M. & Campbell, I.G. The Effect of Aerobic Exercise Training on the Lipid-Lipoprotein Profile of Children and Adolescents. Sports Med 29, 99–112 (2000). https://doi.org/10.2165/00007256-200029020-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200029020-00003