The physical activity and nutrition in children (PANIC) study
Timo Lakka, Professor of Medical Physiology Publications
The objective of The PANIC Study is to provide new scientific evidence on physical activity, sedentary behavior, diet, eating behavior, cardiorespiratory and neuromuscular fitness, excess body adiposity, overweight, metabolism, cardiovascular function, bone mineral density, cognition, reading and arithmetic skills, sleep, pain and other aspects of life quality, oral health and healthcare expenses and particularly on the effects of increased physical activity, improved diet and genetic factors on health and wellbeing among children and adolescents.
study design and study population
The PANIC Study is a large and long-term controlled physical activity and diet intervention study in a population sample of children from the city of Kuopio. We invited 732 children from the city of Kuopio who started the first grade in one of the 18 primary schools in 2007-2009 to participate in the study. Of them 512 (70%) children 6-8 years of age participated in the baseline study in 2007-2009. In the baseline study we assessed the lifestyle, health and wellbeing of the children comprehensively using carefully-selected measures. After all baseline assessments, the children were allocated into the intervention group or the control group. Children and their parents in the intervention group participated in an intensive physical activity and diet intervention for two years. Of those who participated in the baseline study, 440 (86%) children also participated in the 2-year follow-up study in 2009-2011. This indicates a good compliance of the participants to the study. In the 2-year follow-up study we repeated all assessments performed in the baseline study using the same measures. Children in the intervention group will participate in a less intensive intervention until adulthood. All children who are still willing to participate in the study will be invited to the 8-year follow-up study in 2015-2017 when they are 14-16 years old and to the 13 year-follow-up study in 2020-2022 at the age of 19-21 years.
physical activity intervention
The aims of the physical activity intervention are 1) to increase total physical activity to at least two hours per day by increasing different types of physical activity, such as unstructured physical activity, organized sports in sports clubs, structured exercise in exercise clubs, commuting to and from school and physical activity during recess , 2) to increase the versatility of physical activity to develop physical, psychic, emotional, cognitive and social skills and functions, 3) to provide a variety of positive physical activity experiences to help each child find a suitable type of physical activity and to be able to enjoy exercise on the long-term, 4) to decrease sedentary behaviors, such as watching television and playing on computer, to a maximum of two hours per day and 5) to increase energy consumption to maintain energy balance and to prevent overweight. The children and their parents in the intervention group met our physical activity specialist seven times during the two-year intensive intervention period. The physical activity counseling visits occurred at baseline and 1.5, 3, 6, 12, 18 and 24 months after the baseline visit. Our physical activity specialist gave the children and their parents detailed and individualized instructions on physical activity and sedentary behavior to promote health and wellbeing. The children were offered a possibility to participate in exercise clubs, supervised by our trained exercise instructors, in the afternoons after school once a week. We will continue a less intensive physical activity intervention until adulthood. The physical activity intervention has been planned to comply with the Finnish physical activity recommendations for children.
The aims of the diet intervention are 1) to decrease the intake of saturated fat and to increase the intake of unsaturated fat, 2) to increase the consumption of vegetables, fruit and berries, 3) to increase the consumption of foods containing lots of fibre, such as whole-grain products, 4) to decrease the intake of sugar and salt and 5) to avoid excess energy intake to prevent overweight among children and their parents. The children and their parents in the intervention group met our authorized nutritionist seven times during the two-year intensive intervention period. The diet counseling visits occurred at baseline and 1.5, 3, 6, 12, 18 and 24 months after the baseline visit. The nutritionist gave the children and their parents detailed and individualized instructions on diet to promote health and wellbeing. The children and their parents were also encouraged to participate in cooking clubs, supervised by nutritionists, where they were instructed to cook healthy meals and snacks. We will continue a less intensive diet intervention until adulthood. The diet intervention has been planned to comply with the Finnish nutrition recommendations.
We assessed the lifestyle, health and wellbeing of the children 6-8 years of age comprehensively in the baseline study in 2007-2009. The assessments covered for example the following areas: physical activity and sedentary behavior; diet and eating behavior; cardiorespiratory and neuromuscular fitness; body fat mass and fat-free mass; adipose tissue and skeletal muscle metabolism; glucose and lipid metabolism; systemic low-grade inflammation, oxidative stress and redox regulation; whole-body bone mineral mass and density; maximal workload and maximal oxygen consumption during a maximal exercise stress test on cycle ergometer; heart rate, blood pressure, heart rate variation and beat-to-beat blood pressure before during and after the maximal exercise test, artery wall compliance before and after the maximal exercise test; changes in vastus lateralis muscle circulation and oxygen consumption during the maximal exercise test; sleep, pain and other aspects of life quality; oral health; pregnancy, birth and early childhood events; health care expenses; genome-wide association study (GWAS), MetaboChip focusing on the genetics of cardiometabolic risk factors and diseases and ExomeChip focusing on less common gene variants. We also asked the parents about their lifestyle factors and chronic diseases. We repeated the same assessments of the lifestyle, health and wellbeing of the children and the parents in the 2-year follow-up study in 2009-2011. We will repeat these assessments also in the 8-year follow-up study in 2015-2017 and in the 13-year follow-up study in 2020-2022 if sufficient funding will be available.
The analyses and reporting of the results of the baseline study are ongoing (www.lastenliikuntajaravitsemus.fi). We will start analyzing and reporting the 2-year follow-up and intervention data in the end of 2013. We are planning the 8-year follow-up study that will be started in the end of 2015 when the subjects are in the ninth grade. We aim to repeat almost all assessments of the baseline study and the 2-year follow-up study and to perform some scientifically important examinations of the structures and functions of organs that are relevant for our research questions.
The Research Ethics Committee of Hospital District of Northern Savo approved the study in 2006. The children and their parents were informed about the study orally and in writing and were asked for their written consent to participate in the study. We follow internationally accepted research ethical principles in conducting the study and in analyzing and reporting the results.
national research collaboration
Clinical exercise testing (PhD Kai Savonen, Professor Rainer Rauramaa, Dose Responses to Exercise Training Study, Kuopio Research Institute of Exercise Medicine); Cognition and learning in children (Professor Anna-Maija Poikkeus, Docent Paavo Leppänen, First Steps Study, University of Jyväskylä); Childhood risk factors for chronic diseases (Professor Olli Raitakari, Professor Olli Simell, Professor Jorma Viikari, STRIP Study, University of Turku); Functional brain imaging (Docent Sara Määttä, Kuopio Univesity Hospital); Bioinformatics (MD Leo-Pekka Lyytikäinen, University of Tampere).
international research collaboration
Genetics of fetal and early childhood development (Professor Mark McCarthy, University of Cambridge, and Early Growth Genetics (EGG) Consortium), Genetics of metabolic and cardiovascular diseases (Professor Michael Boehnke, University of Michigan, Michigan, USA, Professor Mark McCarthy, University of Oxford, England, and MetaboChip Consortium); The objective assessment of physical activity and sleep (Professor Ulf Ekelund, University of Oslo, Norway, Professor Soren Brage, University of Cambridge, England); Lifestyle-gene interactions (Professor Tuomas Kilpeläinen, University of Copenhagen), Genetics of pain (Professor William Maixner, University of Chapel Hill, North Carolina, USA).
The homepages of the study www.lastenliikuntajaravitsemus.fi