Childhood Inactivity, a Public Health Priority


  • Sanja Kovacic Department of Neurology, General Hospital Zabok and Hospital of Croatian Veterans, Zabok, Faculty of Medicine, University of Osijek, Josip Juraj Strosmayer, 31000 Osijek, Croatia
  • Marko Sukreski Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia



atherosclerosis, cardiovascular diseases, risk factors, childhood inactivity


The continuing epidemic of cardiovascular diseases calls for a renewed and intensified preventive public health action. The widespread occurrence and silent progression of atherosclerosis has created a cardiovascular diseases burden that is massive in terms of its attendant death and disability, as well as social and economic costs.

Atherosclerosis begins to develop in childhood and progresses into the adult years, significantly affected by the associated risk factors. Recent studies of children, adolescents, and young adults have demonstrated the close link of blood cholesterol level, blood pressure level, smoking, physical inactivity, and obesity with the extent and severity of atherosclerosis in the underage population. These findings underscore the opportunities for preventing cardiovascular diseases during childhood and adolescence, as well as the lifelong importance of prevention. In most children, atherosclerotic vascular changes are minor and can be minimized or even prevented with adherence to a healthy lifestyle. Accordingly, participation of children in sports and active play has never been more crucial than it is today. Furthermore, beside the beneficial role of physical activity in delaying or preventing metabolic complications, it has also been shown to improve bone mineral density, increase school performance, and have a positive effect on mental health.


World Health Organisation. Global Status Report on Noncummunicable Disease. WHO Press: Geneva 2014.

World Health Organisation. Global Action Plan for the Prevention and Control of Noncommunicable Diseases. 2013-2020. WHO Press: Geneva 2013.

Thubrikar MJ. Vascular Mechanics and Pathology. Berlin: Springer Science; 2007.

McGill HC Jr., McMahan CA. Determinants of atherosclerosis in the young. Pathobiological determinants of atherosclerosis in youth (PDAY) research group. Am J Cardiol 1998; 82: 30-36.

Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001; 103: 2705–2710.

Steinberg D. In celebration of the 100th anniversary of the lipid hypothesis of atherosclerosis. J Lipid Res 2013; 54: 2946-2949.

Konstantinov IE, Mejevoi N, Anichkov NM, Nikolai N. Anichkov and his theory of atherosclerosis. Tex Heart Inst J 2006; 33: 417-423.

Hamze M, Desmetz C, Berthe ML, Roger P, Boulle N, Brancherau P et al. Characterization of resident B cells of vascular walls in human atherosclerotic patients. J Immunol 2013; 191: 3006-3016.

McGill HC, McMahan CA, Gidding SS. Preventing heart disease in the 21st century: implications of the pathobiological determinants of atherosclerosis in youth (PDAY) study.†Circulation 2008; 117: 1216-1227.

Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382: 1329–1340.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino R, Sr, Gibbsons R et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2014; 129: S49-S73.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015; 131: e29–e322.

Bessesen DH. Update on obesity. J Clin Endocrinol Metab 2008; 93: 2027–2034.

Shively CA, Register TC, Clarkson TB. Social stress, visceral obesity, and coronary artery atherosclerosis: product of a primate adaptation. Am J Primatol 2009; 71: 742-751.

Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature 2006; 444: 881–887.

Neel JV. Diabetes Mellitus: A „thrifty‟ genotype rendered detrimental by “progressâ€. Am J Hum Genet 1962; 14: 353-62.

Chakravarthy MV, Booth FW. Eating, exercise, and “thrifty†genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. J Appl Psychol 2004; 96: 3-10.

Bellisari A. Evolutionary origins of obesity. Obes Rev 2008; 9:165-180.

NIH consensus development panel on physical activity and cardiovascular health. Physical activity and cardiovascular health. J Amer Med Assoc 1996; 276: 241-246.

Kadoglou NPE. Exercise and carotid atherosclerosis. Eur J Vasc Endovasc Surg 2008; 35: 264–272.

Tanaka H, Seals DR, Monahan KD, Clevenger CM, DeSouza CA, Dinenno FA. Regular aerobic exercise and the age-related increase in carotid artery intima-media thickness in healthy men.†J Appl Physiol 2002; 92: 1458-1464.

Hagg U, Wandt B, Bergstrom G, Volkmann R, Gan LM. Physical exercise capacity is associated with coronary and peripheral vascular function in healthy young adults. J Appl Physiol 2005; 289: 1627-1634.

Moreau KL, Donato AJ, Seals DR, Dinenno FA, Blackett SD, Hoetzer GL et al. Arterial Intima-media thickness: site-specific associations with HRT and habitual exercise. Am J Physiol-Heart C 2002; 283: 1409-1417.

Kim Y, Lee S. Physical activity and abdominal obesity in youth. Appl Physiol Nutr Metab 2009; 34: 571–581.

Barbeau P, Johnson MH, Howe CA, Allison J, Davis CL, Gutin B et al. Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Obesity 2007; 15: 2077-2085.

Bell LM, Watts K, Siafarikas A, Thompson A, Ratnam N, Bulsara M et al. Exercise alone reduces insulin resistance in obese children independently of changes in body composition. J Clin Endocrinol Metab 2007; 92: 4230-4235.

Benson AC, Torode ME, Fiatarone Singh MA. The effect of high-intensity progressive resistance training on adiposity in children: a randomized controlled trial. Int J Obes 2008; 32: 1016-1027.

Carnethon MR. Physical activity and cardiovascular disease: how much is enough? Am J Lifestyle Med Suppl 2009; 3: 44S-49S.

Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. J Am Med Assoc 2002; 288: 1994–2000.

Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke 2003; 34: 2475–2481.

Krishnan P, Balamurugan A, Urbina E, Srinivasan SR, Bond G, Tang R et al. Cardiovascular risk profile of asymptomatic healthy young adults with increased carotid artery intima-media thickness: the Bogalusa Heart Study. J La State Med Soc 2003; 155: 165–169.

Duff GL, McMillan GC. Pathology of atherosclerosis. Am J Med 1951; 1: 92–108.

McGill HC Jr., Geer JC, Strong JP. Natural history of human atherosclerotic lesions. In: Sandler M, Bourne GH, editors. Atherosclerosis and its Origin. New York: Academic Press; 1963. p. 39–65.

Berenson GS, Wattigney WA, Tracy RE, Newman WP, Srinivasan SR, Webber LS et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy: the Bogalusa Heart Study. Am J Cardiol 1992; 70: 851–8.

Reddick RL, Zhang SH, Maeda N. Aortic atherosclerotic plaque injury in apolipoprotein E deficient mice. Atherosclerosis 1998; 140: 297-305.

Mahe G, Carsin M, Zeeny M, De Bosschere JP. Dietary pattern, a modifiable risk factor that can be easily assessed for atherosclerosis vascular disease prevention in clinical practice. Public Health Nutr 2011; 14: 319-26.

Myers J, McAuley J, Lavie CJ, Despress J-P, Arena R, Kokkinos P. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis 2015; 57: 306-314.

McGill HC Jr., McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr Suppl 2000; 72: 1307S–15S.

Koplan JP, Liverman CT, Kraak VA. Preventing Childhood Obesity: Health in the Balance. Washington DC: National Academies Press; 2005.

Wang YC, Gortmaker SL, Sobol AM, Kuntz KM. Estimating the energy gap among US children: a counterfactual approach. Pediatrics 2006; 118: e1721-1733.

Stanton RA. Nutrition problems in an obesogenic environment. Med J Aust 2006; 184: 76-79.

Carter MA, Swinburn B. Measuring the “obesogenic†food environment in New Zealand primary schools. Health Promot Int 2004; 19: 15-20.

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB et al. Heart disease and stroke statistics--2012 update: A report from the American Heart Association. Circulation 2012; 125: e2-e220.

Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J et al. Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance - United States. MMWR 2010; 59: 1-142.

Zimmermann-Sloutskis D, Wanner, M, Zimmermann E, Martin BW. Physical activity levels and determinants of change in young adults: a longitudinal panel study. Int J Behav Nutr Phys 2010; 7: 2.

Kahn JA, Huang B, Gillman MW, Field AE, Austin SB, Colditz GA et al. Patterns and determinants of physical activity in U.S. adolescents. J Adolesc Health 2008; 42: 369-377.

Centers for Disease Control and Prevention. Physical activity levels among children aged 9-13 years - United States. MMWR 2002; 52: 785-788.

Whalen, LG, Grunbaum, JA, Kinchen, S, McManus, T, Shanklin, S, Kann, L (2006). Middle school youth risk behavior survey 2003: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. [WWW document]. URL

Strauss RS, Rodzilsky D, Burack G, Colin, M. Psychosocial correlates of physical activity in healthy children. Arch Pediatr Adolesc Med 2001; 155: 897-902.

Eaton DK, Kann L, Kinchen S, Ross J, Hawkins J, Lowry R et al. Youth risk behavior surveillance - United States. MMWR 2006; 55: 1-108.

Wang G, Dietz WH. Economic burden of obesity in youths aged 6 to 17 years: 1979-1999. Pediatrics 2002; 109: E81-81.

Environmental Protection Agency. Travel and Environmental Implications of School Sitting. Washington, D.C.: U.S. Environmental Protection Agency; 2003. EPA 231-R-03- 004.

Epstein LH, Paluch RA, Coleman KJ, Vito D, Anderson K. Determinants of physical activity in obese children assessed by accelerometer and self-report. Med Sci Sports Exerc 1996; 28: 1157-1164.

Centers for Disease Control and Prevention. Barriers to children walking and biking to school - United States. MMWR 2002; 51: 701-704.

Nationwide Personal Transportation Study. Transportation Characteristics of School Children, Report No. 4. 1972. Washington, DC: Federal Highway Administration.

Kohl HW 3rd, Hobbs KE. Development of physical activity behaviors among children and adolescents. Pediatrics 1998; 101: 49-554.

Kann L, Kinchen SA., Williams BI, Ross JG, Lowry R, Grunbaum JA et al. Youth risk behavior surveillance - United States, 1999. MMWR 2000; 49: 1-32.

Child Trends. Watching Television. [WWW document]. URL

Rideout VJ, Roberts DF, Foehr UG. Generation M: Media in the Lives of 8-18 Year Olds. Henry J. Kaiser Family Foundation: Menlo Park, CA 2005.

Roberts DF, Foehr UG, Rideout VJ, Brodie M. Kids & Media @ the New Millennium. Henry J. Kaiser Family Foundation: Menlo Park, CA 1999.

U.S. Department of Health and Human Services (DHHS). Physical Activity Fundamental to Preventing Disease. 2002.

Ginsburg KR. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 2007; 119: 182-191.

Burdette HL, Whitaker RC. Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect. Arch Pediatr Adolesc Med 2005; 159: 46-50.

Boreham C, Riddoch C. The physical activity, fitness and health of children. J Sports Sci 2001; 19: 915-929.

U.S. Department of Health and Human Services (DHHS). Physical Activity and Health: A Report of the Surgeon General. GA: CDC: Atlanta 1996.

Sothern MS, Loftin M, Suskind RM, Udall JN, Blecker U. The health benefits of physical activity in children and adolescents: implications for chronic disease prevention. Eur J Pediatr 1999; 158: 271-274.

Armstrong N, Simons-Morton B. Physical activity and blood lipids in adolescents. Pediatr Exer Sci 1994; 6: 381-405.

Secretary of Health and Human Services, Secretary of Education, (2000). Promoting Better Health for Young People Through Physical Activity and Sports. [WWW document]. URL 2000.

Alpert BS, Wilmore JH. Physical activity and blood pressure in adolescents. Pediatr Exer Sci 1994; 6: 361-380.

Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sandirha LB et al. TV viewing and physical activity are independently associated with metabolic risk in children: the European youth heart study. PLoS Med 2006; 3: e488.

Pate RR, Wang CY, Dowda M, Farrell SW, O'Neill JR. Cardiorespiratory fitness levels among US youth 12 to 19 years of age: findings from the 1999-2002 National health and nutrition examination survey. Arch Pediatr Adolesc Med 2006; 160: 1005-1012.

National Guidelines. National Association for Sport and Physical Education, (2011). [WWW document]. URL






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