Run2gether for health!

The prevalence of diabetes in children in the Netherlands is approximately 5000
individuals, with an increase of 250 patients every year. In addition, the
prevalence of childhood obesity is increasing enormously in the Netherlands.
Also these individuals are already early in lifetime prone to be at risk for
developing diabetes. Children in the western world are becoming less physical
active, while it is especially important for these two groups to be physical
active on a regular base. An active lifestyle has got important benefits for
good health. Main goals for these two groups are to increase sensitivity of
insulin and to reduce the risks for cardiovascular diseases on the mid-long
term. Because parental influence are of great importance during early lifespan,
this project aims on a intervention with a child supported by the active
participation by one of the parents. Because parents contribute to a large
extend to the education and development of a child and because physical
inactivity is often based on a family culture, parental support is very
important for a growing child. By providing a program that aims at both child
and elder, parents retain their roles as important determinants of risk and
protective behavior, but this time in a good healthy manner.

To evaluate if the program *Run2gether* can change physical behavior in
children with obesity and/or diabetes, and thereby increase physical fitness
level and insulin sensitivity en reduce body weight. An additional goal for
children with diabetes, is to improve their diabetes management. Besides a risk
profile for possible future cardiovascular problems is made, by assessing
characteristics of the blood vessels and the endothelial function.
Because this is a pilot-oriented study, main goals are to test how many
participants are able to finish the 6 months of training and to measure the
effectiveness of the intervention. In addition, the program is evaluated
afterwards and adjusted if necessary. We consider the program as a success, if
at least 70% of the participants are able to accomplish the 6 months of
training. We assume that long-term lifestyle changes are possible, if the
participant are able to conduct our 6 months of training. To be successful, our
intervention most be also proven effective on body characteristics and physical
fitness.

What is the effect of the exercise program on children with diabetes and/or
obesity with active parental support on:
* Percentage finishers after the 6 months of training;
* Physical fitness, activity level, BMI, waist circumference and insulin
sensitivity.
This pilot study will be conducted as a pre-post design with a convenient
cohort, with one baseline measurement at start and one measurement after
finishing the 6 months program.

The intervention consists of a workshop, a 6 months training period, online
feedback and a final event as a reward.
The program will kick off with a workshop in which the importance of good
nutrition will be explained, along with the role of insulin and the effect on
the blood sugar levels. Next, exercise capacity for the participating children
is tested. Based on these results, children will be divided in different
training groups. The training program will be conducted both under supervision
in groups and on an individual base (child and parent). Group lessons are
performed once a week, with a decreasing frequency in time and an increasing
occurrence of individual training sessions following a prescribed training
schedule. Children will report their results in a personal online web-dossier,
which is accessible for child, parents, investigator and the diabetes nurse.
The diabetes nurse will be available for children to ask questions about their
diabetes management in relationship to sport.

This program is aimed at healthy changes in behavior towards physical activity,
to provide participants with opportunities to create a better medical condition
and to provide important tools and information about secondary prevention of
different kind of diseases. The minimal risks regarding this program are less
significant than possible improvements of healthiness of the participants. With
this program, promising long-term changes of the physical condition are
possible.