OBJECTIVE: To determine the effect of exercise training (ET) on components of the insulin resistance syndrome (IRS) in obese children. DESIGN: Randomized, modi®ed cross-over study, with subjects assigned to one of two conditions: (1) 4 months of ET followed by 4 months of no-ET; or (2) 4 months of no-ET followed by 4 months of ET. Measurements were made at three time points: 0, 4 and 8 months. SUBJECTS: 79 obese, but otherwise healthy children (age: 7 ± 11 y, percent fat (%fat) 27 ± 61%). MEASUREMENTS: Plasma lipid and lipoprotein concentrations, plasma insulin and glucose concentrations; %fat; submaximal heart rate (HR) as an index of ®tness. EXERCISE TRAINING: ET was offered 5 daweek 40 minad. For the 73 children who completed 4 months of ET, the mean attendance was 80% (that is, 4 daweek) and the average HR during ET was 157 bpm. RESULTS: Signi®cant (P`0.05) group x time interactions were found for plasma triglyceride (TG) and insulin concentrations and %fat. The average change for both groups, from just before ET to just after the 4 month ET was À0.24 mmol Á l À1 for TG, À25.4 pmol Á l À1 for insulin and À1.6 units for %fat. When Group 1 ceased ET, over the following 4 month period the average change for insulin was 26.6 pmol Á l À1 and for %fat 1.3 units. CONCLUSION: Some components (plasma TG, insulin, %fat) of the IRS are improved as a result of 4 months of ET in obese children. However, the bene®ts of ET are lost when obese children become less active.

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In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

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