Long term impact of one daily unit of physical exercise at school on cardiovascular risk factors in school children.

BACKGROUND: Obesity and physical inactivity in children correlate with the presence of cardiovascular risk factors. The aim of this prospective, randomised, interventional study was to examine the long term impact of additional physical exercise lessons at school on fitness and cardiovascular risk factors. METHODS: We randomly assigned 366 5th and 6th grade students class-wise into an intervention group that participated in one-daily physical exercise unit at school and a control group, participating in conventional school sports twice a week. The intervention duration was 4 years. At baseline and yearly follow-up, anthropometric measurements, body coordination tests, spiroergometry, questionnaires and blood samples were performed. RESULTS: A total of 236 children qualified for analysis of the intervention effect after 4 years. At the beginning students of the intervention and control groups had similar values for fitness assessed by peak oxygen uptake. Peak oxygen uptake was significantly better in the intervention group at first and second follow-up. After 4 years we found no difference in fitness any longer. Students in the intervention group were more likely to have healthy body mass index percentiles in comparison to the control group (within 10th to 90th percentile: intervention 86.4%, control 78.2%, P = 0.13). CONCLUSION: Over a period of 1-2 years, additional physical exercise lessons at school resulted in an improvement of fitness. However, long-term follow-up failed to demonstrate ongoing improvement of performance in the intervention compared with the control group. Nevertheless, the intervention group had lower rates of body mass index above the 90th percentile throughout the entire follow-up. Therefore more physical exercise units at school seem justified.

Impact of minimising door-to-balloon times in ST-elevation myocardial infarction to less than 30 min on outcome: an analysis over an 8-year period in a tertiary care centre.

BACKGROUND: Guidelines recommend door-to-balloon times (DBTs) below 60 min for patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to determine if an optimised STEMI-protocol reduces DBT and increases the number of patients to receive PCI within 60 min of hospital presentation. We hypothesised that DBT of <30 min can be accomplished for the majority of patients. METHODS AND RESULTS: Between 2001 and 2008 data from 1,146 consecutive patients with acute STEMI admitted for primary PCI within 12 h after symptom-onset were analysed. Times to angioplasty from symptom-onset (pain-to-balloon time, PBT) and from hospital arrival (DBT) to PCI and clinical outcomes were analysed. In the end of 2003 numerous strategies were implemented to reduce revascularisation times. These strategies resulted in a stable reduction of median DBT to 29 min [interquartile range (IQR) 22-39]. Overall, 94% of patients had median DBT < 60 min and 56% <30 min. Consequently, PBT was significantly reduced from median 218 min (IQR 168-286) to 167 min (IQR 119-245) for non-transferred patients. Major cardiac adverse events (composite of congestive heart failure, reinfarction and cardiac death) were significantly associated with DBT > 30 min and age, systolic blood pressure, anterior infarction, PBT > 4 h, cardiogenic shock as well as multivessel disease. CONCLUSIONS: A dedicated STEMI-protocol including several hospital strategies is feasible during daily clinical practice to decrease revascularisation times, results in a greater proportion of patients achieving guideline recommendations, and is associated with an improved clinical outcome.