{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:29:03Z","timestamp":1786422543087,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Obesity-associated alterations in pulmonary function have been inconsistently identified by spirometry in pediatric populations. Impulse oscillometry (IOS) offers sensitive detection of peripheral airway resistance, yet data remain limited. Moreover, the relationship between obesity indices and pulmonary function has not been comprehensively evaluated. This study aimed to compare pulmonary function and physical fitness between obese and normal-weight children and adolescents using spirometry, IOS, and the 6-min walk test (6-MWT), and assessed obesity indices as predictors of pulmonary outcomes. We enrolled 120 participants aged 8 to 15\u00a0years (obese:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200982; normal weight:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200938). Anthropometry included body mass index (BMI), waist circumference-to-height ratio (WHR), and chest circumference-to-height ratio (CCHR). Pulmonary function was assessed by IOS and spirometry, and physical fitness by the 6-MWT. Obese participants exhibited higher forced vital capacity (FVC) percent predicted (114\u2009\u00b1\u200917 vs 106\u2009\u00b1\u200912;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.02) and FVC\n                    <jats:italic>z<\/jats:italic>\n                    -score (1.09\u2009\u00b1\u20091.35 vs 0.52\u2009\u00b1\u20091.00;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.02). The ratio of volume expired in 1\u00a0s to FVC was reduced (85.0\u2009\u00b1\u20095.3 vs 88.1\u2009\u00b1\u20095.8;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.005), with no significant change in volume expired in 1\u00a0s. The 6-MWT distances were shorter in the obese group (542\u2009\u00b1\u200945\u00a0m vs 583\u2009\u00b1\u200959\u00a0m;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001), and\n                    <jats:italic>z<\/jats:italic>\n                    -score-adjusted distances were lower (0.29\u2009\u00b1\u20090.75 vs 1.24\u2009\u00b1\u20090.75;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). Height- and sex-adjusted IOS parameters (R\n                    <jats:sub>5<\/jats:sub>\n                    , R\n                    <jats:sub>20<\/jats:sub>\n                    , R\n                    <jats:sub>5\u221220<\/jats:sub>\n                    , Fres, AX) were elevated in obesity. Regression analysis identified BMI, WHR, and CCHR as independent predictors of reduced 6-MWT distance and increased R\n                    <jats:sub>5\u221220<\/jats:sub>\n                    .\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Pediatric obesity is associated with increased total, central, and peripheral airway resistance, and impaired physical fitness. BMI, WHR, and CCHR predict exercise limitation, while WHR and CCHR predict peripheral airway resistance.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Pediatric obesity is associated with reduced FRC, lower FEV1\/FVC ratios, and impaired physical fitness measured by the 6-min walk test.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Impulse oscillometry (IOS) reveals increased total and peripheral airway resistance in obese children and adolescents, not evident on spirometry.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Central adiposity markers, specifically waist circumference-to-height ratio (WHR) and chest circumference-to-height ratio (CCHR), are robust independent predictors of elevated airway resistance and functional limitations.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07240-7","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:01:08Z","timestamp":1783591268000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary function and physical fitness in obese children and adolescents: a comparison of impulse oscillometry, spirometry, and 6-min walk test"],"prefix":"10.1007","volume":"185","author":[{"given":"Koravich","family":"Na Nakorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanokporn","family":"Udomittipong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puthita","family":"Saengpanit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakarn","family":"Tovichien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawinee","family":"Charoensittisup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khunphon","family":"Mahoran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"7240_CR1","doi-asserted-by":"publisher","unstructured":"Hampl SE, Hassink SG, Skinner AC et al (2023) Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151. https:\/\/doi.org\/10.1542\/peds.2022-060640","DOI":"10.1542\/peds.2022-060640"},{"key":"7240_CR2","doi-asserted-by":"publisher","first-page":"187","DOI":"10.4103\/2249-4863.154628","volume":"4","author":"K Sahoo","year":"2015","unstructured":"Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS (2015) Childhood obesity: causes and consequences. J Family Med Prim Care 4:187\u2013192. https:\/\/doi.org\/10.4103\/2249-4863.154628","journal-title":"J Family Med Prim Care"},{"key":"7240_CR3","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1056\/NEJMoa1502821","volume":"373","author":"AC Skinner","year":"2015","unstructured":"Skinner AC, Perrin EM, Moss LA, Skelton JA (2015) Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 373:1307\u20131317. https:\/\/doi.org\/10.1056\/NEJMoa1502821","journal-title":"N Engl J Med"},{"key":"7240_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-020-01306-4","volume":"20","author":"MS Ferreira","year":"2020","unstructured":"Ferreira MS, Marson FAL, Wolf VLW, Ribeiro JD, Mendes RT (2020) Lung function in obese children and adolescents without respiratory disease: a systematic review. BMC Pulm Med 20:281. https:\/\/doi.org\/10.1186\/s12890-020-01306-4","journal-title":"BMC Pulm Med"},{"key":"7240_CR5","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1007\/s12098-015-1777-4","volume":"82","author":"L Kongkiattikul","year":"2015","unstructured":"Kongkiattikul L, Sritippayawan S, Chomtho S, Deerojanawong J, Prapphal N (2015) Relationship between obesity indices and pulmonary function parameters in obese Thai children and adolescents. Indian J Pediatr 82:1112\u20131116. https:\/\/doi.org\/10.1007\/s12098-015-1777-4","journal-title":"Indian J Pediatr"},{"key":"7240_CR6","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1016\/j.jaip.2017.07.010","volume":"6","author":"E Forno","year":"2018","unstructured":"Forno E, Han YY, Mullen J, Celed\u00f3n JC (2018) Overweight, obesity, and lung function in children and adults-a meta-analysis. J Allergy Clin Immunol Pract 6:570-581.e510. https:\/\/doi.org\/10.1016\/j.jaip.2017.07.010","journal-title":"J Allergy Clin Immunol Pract"},{"key":"7240_CR7","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.789290","volume":"9","author":"K Udomittipong","year":"2021","unstructured":"Udomittipong K, Thabungkan T, Nimmannit A, Tovichien P, Charoensitisup P, Mahoran K (2021) Obesity indices for predicting functional fitness in children and adolescents with obesity. Front Pediatr 9:789290. https:\/\/doi.org\/10.3389\/fped.2021.789290","journal-title":"Front Pediatr"},{"key":"7240_CR8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.jped.2017.06.007","volume":"94","author":"MS Assump\u00e7\u00e3o","year":"2018","unstructured":"Assump\u00e7\u00e3o MS, Ribeiro JD, Wamosy RMG, Figueiredo F, Parazzi PLF, Schivinski CIS (2018) Impulse oscillometry and obesity in children. J Pediatr (Rio J) 94:419\u2013424. https:\/\/doi.org\/10.1016\/j.jped.2017.06.007","journal-title":"J Pediatr (Rio J)"},{"key":"7240_CR9","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/j.orcp.2015.10.005","volume":"10","author":"KD van de Kant","year":"2016","unstructured":"van de Kant KD, Paredi P, Meah S, Kalsi HS, Barnes PJ, Usmani OS (2016) The effect of body weight on distal airway function and airway inflammation. Obes Res Clin Pract 10:564\u2013573. https:\/\/doi.org\/10.1016\/j.orcp.2015.10.005","journal-title":"Obes Res Clin Pract"},{"key":"7240_CR10","doi-asserted-by":"publisher","unstructured":"Kaminsky DA, Simpson SJ, Berger KI et al (2022) Clinical significance and applications of oscillometry. Eur Respir Rev 31.https:\/\/doi.org\/10.1183\/16000617.0208-2021","DOI":"10.1183\/16000617.0208-2021"},{"key":"7240_CR11","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.aller.2018.03.003","volume":"47","author":"PP de Oliveira Jorge","year":"2019","unstructured":"de Oliveira Jorge PP, de Lima JHP, Chong ESDC, Medeiros D, Sol\u00e9 D, Wandalsen GF (2019) Impulse oscillometry in the assessment of children\u2019s lung function. Allergol Immunopathol (Madr) 47:295\u2013302. https:\/\/doi.org\/10.1016\/j.aller.2018.03.003","journal-title":"Allergol Immunopathol (Madr)"},{"key":"7240_CR12","doi-asserted-by":"publisher","unstructured":"(2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111\u2013117. https:\/\/doi.org\/10.1164\/ajrccm.166.1.at1102","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"7240_CR13","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1002\/pri.428","volume":"14","author":"G Morinder","year":"2009","unstructured":"Morinder G, Mattsson E, Sollander C, Marcus C, Larsson UE (2009) Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiother Res Int 14:91\u2013104. https:\/\/doi.org\/10.1002\/pri.428","journal-title":"Physiother Res Int"},{"key":"7240_CR14","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1111\/j.1440-1843.2010.01906.x","volume":"16","author":"H Kalhoff","year":"2011","unstructured":"Kalhoff H, Breidenbach R, Smith HJ, Marek W (2011) Impulse oscillometry in preschool children and association with body mass index. Respirology 16:174\u2013179. https:\/\/doi.org\/10.1111\/j.1440-1843.2010.01906.x","journal-title":"Respirology"},{"key":"7240_CR15","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1002\/ppul.23085","volume":"50","author":"E Lauhkonen","year":"2015","unstructured":"Lauhkonen E, Koponen P, Nuolivirta K et al (2015) Obesity and bronchial obstruction in impulse oscillometry at age 5\u20137 years in a prospective post-bronchiolitis cohort. Pediatr Pulmonol 50:908\u2013914. https:\/\/doi.org\/10.1002\/ppul.23085","journal-title":"Pediatr Pulmonol"},{"key":"7240_CR16","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1136\/thoraxjnl-2017-210716","volume":"73","author":"S Ekstr\u00f6m","year":"2018","unstructured":"Ekstr\u00f6m S, Hallberg J, Kull I et al (2018) Body mass index status and peripheral airway obstruction in school-age children: a population-based cohort study. Thorax 73:538\u2013545. https:\/\/doi.org\/10.1136\/thoraxjnl-2017-210716","journal-title":"Thorax"},{"key":"7240_CR17","doi-asserted-by":"publisher","first-page":"2937","DOI":"10.1002\/ppul.26111","volume":"57","author":"DP Wilhite","year":"2022","unstructured":"Wilhite DP, Bhammar DM, Martinez-Fernandez T, Babb TG (2022) Mechanical effects of obesity on central and peripheral airway resistance in nonasthmatic early pubescent children. Pediatr Pulmonol 57:2937\u20132945. https:\/\/doi.org\/10.1002\/ppul.26111","journal-title":"Pediatr Pulmonol"},{"key":"7240_CR18","doi-asserted-by":"publisher","first-page":"319","DOI":"10.3345\/cep.2024.01053","volume":"68","author":"A Klubdaeng","year":"2025","unstructured":"Klubdaeng A, Udomittipong K, Palamit A, Charoensittisup P, Mahoran K (2025) Impact of obesity on pulmonary function of preschool children: an impulse oscillometry study. Clin Exp Pediatr 68:319\u2013325. https:\/\/doi.org\/10.3345\/cep.2024.01053","journal-title":"Clin Exp Pediatr"},{"key":"7240_CR19","unstructured":"De Onis M World Health Organization Reference Curves. The ECOG\u2019s eBook on Child and Adolescent Obesity. Available from: https:\/\/www.ebook.ecog-obesity.eu. Accessed 5 May 2024"},{"key":"7240_CR20","unstructured":"Bl\u00f6ssner M, Siyam A, Borghi E, Onyango A, Onis Md WHO AnthroPlus for personal computers Manual: software for assessing growth of the world's children and adolescents. World Health Organization. Available from: https:\/\/www.who.int\/tools\/growth-reference-data-for-5to19-years. Accessed 5 May 2024"},{"key":"7240_CR21","doi-asserted-by":"publisher","unstructured":"King GG, Bates J, Berger KI et al (2020) Technical standards for respiratory oscillometry. Eur Respir J 55. https:\/\/doi.org\/10.1183\/13993003.00753-2019","DOI":"10.1183\/13993003.00753-2019"},{"key":"7240_CR22","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","volume":"200","author":"BL Graham","year":"2019","unstructured":"Graham BL, Steenbruggen I, Miller MR et al (2019) Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 200:e70\u2013e88. https:\/\/doi.org\/10.1164\/rccm.201908-1590ST","journal-title":"Am J Respir Crit Care Med"},{"key":"7240_CR23","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1183\/09031936.00080312","volume":"40","author":"PH Quanjer","year":"2012","unstructured":"Quanjer PH, Stanojevic S, Cole TJ et al (2012) Multi-ethnic reference values for spirometry for the 3\u201395-yr age range: the global lung function 2012 equations. Eur Respir J 40:1324\u20131343. https:\/\/doi.org\/10.1183\/09031936.00080312","journal-title":"Eur Respir J"},{"key":"7240_CR24","doi-asserted-by":"publisher","first-page":"193","DOI":"10.6515\/acs20140721d","volume":"31","author":"CA Chen","year":"2015","unstructured":"Chen CA, Chang CH, Lin MT et al (2015) Six-minute walking test: normal reference values for Taiwanese children and adolescents. Acta Cardiol Sin 31:193\u2013201. https:\/\/doi.org\/10.6515\/acs20140721d","journal-title":"Acta Cardiol Sin"},{"key":"7240_CR25","doi-asserted-by":"publisher","unstructured":"Calcaterra V, Verduci E, Ghezzi M et al (2021) Pediatric obesity-related asthma: the role of nutrition and nutrients in prevention and treatment. Nutrients 13. https:\/\/doi.org\/10.3390\/nu13113708","DOI":"10.3390\/nu13113708"},{"key":"7240_CR26","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1164\/rccm.201605-1039OC","volume":"195","author":"E Forno","year":"2017","unstructured":"Forno E, Weiner DJ, Mullen J et al (2017) Obesity and airway dysanapsis in children with and without asthma. Am J Respir Crit Care Med 195:314\u2013323. https:\/\/doi.org\/10.1164\/rccm.201605-1039OC","journal-title":"Am J Respir Crit Care Med"},{"key":"7240_CR27","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1590\/s1806-37132015000004517","volume":"41","author":"CG Albuquerque","year":"2015","unstructured":"Albuquerque CG, Andrade FM, Rocha MA et al (2015) Determining respiratory system resistance and reactance by impulse oscillometry in obese individuals. J Bras Pneumol 41:422\u2013426. https:\/\/doi.org\/10.1590\/s1806-37132015000004517","journal-title":"J Bras Pneumol"},{"key":"7240_CR28","doi-asserted-by":"publisher","first-page":"231","DOI":"10.4187\/respcare.02094","volume":"59","author":"H Handa","year":"2014","unstructured":"Handa H, Huang J, Murgu SD et al (2014) Assessment of central airway obstruction using impulse oscillometry before and after interventional bronchoscopy. Respir Care 59:231\u2013240. https:\/\/doi.org\/10.4187\/respcare.02094","journal-title":"Respir Care"},{"key":"7240_CR29","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/tropej\/fmm070","volume":"54","author":"DJ VanderJagt","year":"2008","unstructured":"VanderJagt DJ, Trujillo MR, Jalo I, Bode-Thomas F, Glew RH, Agaba P (2008) Pulmonary function correlates with body composition in Nigerian children and young adults with sickle cell disease. J Trop Pediatr 54:87\u201393. https:\/\/doi.org\/10.1093\/tropej\/fmm070","journal-title":"J Trop Pediatr"},{"key":"7240_CR30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0088015","volume":"9","author":"BW Oppenheimer","year":"2014","unstructured":"Oppenheimer BW, Berger KI, Segal LN et al (2014) Airway dysfunction in obesity: response to voluntary restoration of end expiratory lung volume. PLoS ONE 9:e88015. https:\/\/doi.org\/10.1371\/journal.pone.0088015","journal-title":"PLoS ONE"},{"key":"7240_CR31","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1378\/chest.103.5.1470","volume":"103","author":"F Zerah","year":"1993","unstructured":"Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G (1993) Effects of obesity on respiratory resistance. Chest 103:1470\u20131476. https:\/\/doi.org\/10.1378\/chest.103.5.1470","journal-title":"Chest"},{"key":"7240_CR32","doi-asserted-by":"publisher","unstructured":"Becerril S, Rodr\u00edguez A, Catal\u00e1n V et al (2019) Functional relationship between leptin and nitric oxide in metabolism. Nutrients 11. https:\/\/doi.org\/10.3390\/nu11092129","DOI":"10.3390\/nu11092129"},{"key":"7240_CR33","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.1080\/02770903.2021.1959925","volume":"59","author":"P Uysal","year":"2022","unstructured":"Uysal P, Anik A, Anik A (2022) School-age obese asthmatic children have distinct lung function measures from lean asthmatics and obese children. J Asthma 59:1548\u20131559. https:\/\/doi.org\/10.1080\/02770903.2021.1959925","journal-title":"J Asthma"},{"key":"7240_CR34","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.orcp.2022.06.005","volume":"16","author":"E D'Auria","year":"2022","unstructured":"D\u2019Auria E, Calcaterra V, Gasparini C et al (2022) The impact of adiposity indices on lung function in children with respiratory allergic diseases. Obes Res Clin Pract 16:314\u2013318. https:\/\/doi.org\/10.1016\/j.orcp.2022.06.005","journal-title":"Obes Res Clin Pract"},{"key":"7240_CR35","doi-asserted-by":"publisher","first-page":"217","DOI":"10.4274\/jcrpe.1990","volume":"7","author":"\u0130T \u00d6zgen","year":"2015","unstructured":"\u00d6zgen \u0130T, \u00c7ak\u0131r E, Torun E, G\u00fcle\u015f A, Hepokur MN, Cesur Y (2015) Relationship between functional exercise capacity and lung functions in obese chidren. J Clin Res Pediatr Endocrinol 7:217\u2013221. https:\/\/doi.org\/10.4274\/jcrpe.1990","journal-title":"J Clin Res Pediatr Endocrinol"},{"key":"7240_CR36","doi-asserted-by":"publisher","unstructured":"Giontella A, Tagetti A, Bonafini S et al (2024) Comparison of performance in the six-minute walk test (6MWT) between overweight\/obese and normal-weight children and association with haemodynamic parameters: a cross-sectional study in four primary schools. Nutrients 16. https:\/\/doi.org\/10.3390\/nu16030356","DOI":"10.3390\/nu16030356"},{"key":"7240_CR37","doi-asserted-by":"publisher","unstructured":"Hirunpoom J, Nimpun D, Jittham W (2022) Obesity-related factors that affect 6-minute walk test performance in Thai obese children. J Child Obes 7. https:\/\/doi.org\/10.36648\/2572-5394.22.7.124","DOI":"10.36648\/2572-5394.22.7.124"},{"key":"7240_CR38","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1002\/ppul.22915","volume":"49","author":"WJ Davidson","year":"2014","unstructured":"Davidson WJ, Mackenzie-Rife KA, Witmans MB et al (2014) Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol 49:1003\u20131010. https:\/\/doi.org\/10.1002\/ppul.22915","journal-title":"Pediatr Pulmonol"},{"issue":"Suppl 2","key":"7240_CR39","doi-asserted-by":"publisher","first-page":"S72","DOI":"10.1080\/02701367.2013.849159","volume":"84","author":"L Huang","year":"2013","unstructured":"Huang L, Chen P, Zhuang J, Walt S (2013) Metabolic cost, mechanical work, and efficiency during normal walking in obese and normal-weight children. Res Q Exerc Sport 84(Suppl 2):S72-79. https:\/\/doi.org\/10.1080\/02701367.2013.849159","journal-title":"Res Q Exerc Sport"},{"key":"7240_CR40","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s00431-007-0553-5","volume":"167","author":"P Calders","year":"2008","unstructured":"Calders P, Deforche B, Verschelde S et al (2008) Predictors of 6-minute walk test and 12-minute walk\/run test in obese children and adolescents. Eur J Pediatr 167:563\u2013568. https:\/\/doi.org\/10.1007\/s00431-007-0553-5","journal-title":"Eur J Pediatr"},{"key":"7240_CR41","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1097\/pep.0000000000000284","volume":"28","author":"J Druce Axley","year":"2016","unstructured":"Druce Axley J, Werk LN (2016) Relationship between abdominal adiposity and exercise tolerance in children with obesity. Pediatr Phys Ther 28:386\u2013391. https:\/\/doi.org\/10.1097\/pep.0000000000000284","journal-title":"Pediatr Phys Ther"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07240-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07240-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07240-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:50:04Z","timestamp":1786420204000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07240-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["7240"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07240-7","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"28 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The research protocol was reviewed and approved by the Siriraj Institutional Review Board (reference: Si 335\/2024) and was conducted in accordance with the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Participants and guardians provided written informed consent after the research protocol and procedures were explained.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"563"}}