Exercise, health outcomes, and pædiatric obesity: A systematic review of meta-analyses

Feasibility and efficacy of adding high-intensity interval training to a multidisciplinary lifestyle intervention in children with obesity-a randomized controlled trial

BACKGROUND

Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL).

METHODS

This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate.

RESULTS

Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): -0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: -0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure.

CONCLUSION

Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

Effects of Small-Sided Soccer Games on Physical Fitness and Cardiometabolic Health Biomarkers in Untrained Children and Adolescents: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis aimed to determine the benefits of an exercise intervention based on small-sided soccer games (SSSGs) on health-related physical fitness and cardiometabolic health in previously untrained children and adolescents. Methods: A systematic search on PubMed/MEDLINE, Web of Science, Scopus, Cochrane, and EBSCO databases was performed. Randomized or non-randomized controlled trials conducted in previously untrained children or adolescents (age < 18 years) that assessed the effect of SSSG-based intervention on health-related physical fitness and cardiometabolic risk biomarkers were included. Primary outcomes were cardiorespiratory fitness and waist circumference. Evidence was synthesized as the mean difference or standardized mean difference using a random-effects meta-analysis. The quality of evidence was assessed using ROB2 and ROBINS-I tools. Results: Sixteen studies (n = 2872 participants) were included in this meta-analysis. SSSGs significantly improved cardiorespiratory fitness (SMD, 0.12 [0.01; 0.23]) and showed a non-significant trend in decreased waist circumference (-7.49 cm [-15.03; 0.06]). Additionally, SSSGs significantly decreased systolic (MD, -3.85 mmHg [-5.75; -1.94]) and diastolic blood pressure (MD, -1.26 mmHg [-2.44; -0.08]) and triglycerides (-30.34 mg·dL-1 [-45.99; -14.69]). No effects on body composition or other cardiometabolic risk biomarkers were observed. After a sensitivity analysis, waist circumference and muscle strength were also shown to improve significantly following SSSGs. Comparisons between SSSG and other types of exercise interventions showed no differences in improved physical fitness or cardiometabolic risk. Conclusions: SSSG-based interventions effectively improve cardiorespiratory fitness, blood pressure, triglycerides, muscle strength, and waist circumference. There is less evidence of the effects of SSSGs on other health markers. Particular attention should be given to improving SSSG protocol reporting in future studies.

Relationship between youth cardiometabolic health and physical activity in medical records

BACKGROUND

Thers is limited research examining modifiable cardiometabolic risk factors with a single-item health behavior question obtained during a clinic visit. Such information could support clinicians in identifying patients at risk for adverse cardiometabolic health. We investigated if children meeting physical activity or screen time recommendations, collected during clinic visits, have better cardiometabolic health than children not meeting recommendations. We hypothesized that children meeting either recommendation would have fewer cardiometabolic risk factors.

METHODS AND FINDINGS

This cross-sectional study used data from electronic medical records (EMRs) between January 1, 2013 through December 30, 2017 from children (2-18 years) with a well child visits and data for ≥1 cardiometabolic risk factor (i.e., systolic and diastolic blood pressure, glycated hemoglobin, alanine transaminase, high-density and low-density lipoprotein, total cholesterol, and/or triglycerides). Physical activity and screen time were patient/caregiver-reported. Analyses included EMRs from 63,676 well child visits by 30,698 unique patients (49.3% female; 41.7% Black, 31.5% Hispanic). Models that included data from all visits indicated children meeting physical activity recommendations had reduced risk for abnormal blood pressure (odds ratio [OR] = 0.91, 95%CI 0.86, 0.97; p = 0.002), glycated hemoglobin (OR = 0.83, 95%CI 0.75, 0.91; p = 0.00006), alanine transaminase (OR = 0.85, 95%CI 0.79, 0.92; p = 0.00001), high-density lipoprotein (OR = 0.88, 95%CI 0.82, 0.95; p = 0.0009), and triglyceride values (OR = 0.89, 95%CI 0.83, 0.96; p = 0.002). Meeting screen time recommendations was not associated with abnormal cardiometabolic risk factors.

CONCLUSION

Collecting information on reported adherence to meeting physical activity recommendations can provide clinicians with additional information to identify patients with a higher risk of adverse cardiometabolic health.

WEB OF TRANSFORMATIONS: impact of multicomponent intervention on the relationship between sociodemographic indicators, changes in body composition, cardiorespiratory fitness and biochemical markers in adolescents with overweight and obesity

The study aims to analyze the relationships between changes after multicomponent intervention in sociodemographic indicators, body composition, cardiorespiratory fitness and biochemical markers in overweight/obese adolescents. Quasi-experimental study with 33 overweight/obese adolescents (17 in the intervention group (IG) and 16 in the control group (16)), in which the GI participated in the multicomponent intervention for 24 weeks. Sociodemographic indicators, body composition, cardiorespiratory fitness and biochemical markers were evaluated. Network analysis was performed using JASP software. In GI, the reduction in %BF proved to be the variable with greater connectivity and strength in the network compared to the control network. Changes in %BF were related to changes in ACR, BMI and leptin. It is concluded that the reduction in %BF is the most important variable in network relationships after the intervention, suggesting that the greater the reduction in %BF, the greater the effect on variables such as BMI, ACR and leptina.

Effects of a physical education intervention on children's physical activity and fitness: the PROFIT pilot study

BACKGROUND

Physical education classes are widely accepted as one of the most effective settings for promoting physical activity and health and have often been used to implement physical activity interventions. The aim of this pilot study was to test a physical education intervention program on physical activity levels and physical fitness in a sample of school-age children.

METHODS

Participants were a convenience sample of 50 children (34 experimental group and 16 in the comparative group) aged between 6 and 11 years old (Mean = 8.28 years). A 21-week intervention was implemented, consisting of high-intensity and physical fitness-focused exercises, in addition to a once-a-month extra class nutritional education. The following variables were evaluated before and post-intervention: physical fitness, sedentary behavior (SB), light physical activity (LPA), moderate physical activity (MVA), and vigorous physical activity (VPA). Propensity score analyses calculated the average treatment effect on the treated (ATET) within a quasi-experimental framework.

RESULTS

Physical fitness variables showed improvements after the intervention, specifically for agility (ATET = -0.67 s; p < 0.001), cardiorespiratory fitness (ATET = 89.27 m; p = 0.045), lower limbs power (ATET = 4.47 centimeters; p = 0.025), and speed (ATET = -1.06 s; p < 0.001). For physical activity and SB levels, there were no improvements after intervention implementation.

CONCLUSION

The intervention program showed preliminary effectiveness to improve physical fitness of children, but not SB nor physical activity.

Importance of training volume through the use of step trackers apps promoted from the subject of physical education to change body composition, physical fitness and physical activity in adolescents and the influence of gender✰,✰✰

The aim of the present study was to determine the changes in physical activity level (PA), kinanthropometric and derived variables, and physical fitness in adolescents, as a result of an out-of-school intervention with mobile step tracker apps promoted from the field of physical education, according to the volume of training completed and gender. A randomized controlled trial was carried out with 400 adolescents (210 males and 190 females) aged 12 to 16 years old (mean age: 13.96 ± 1.21 years-old). Adolescents were divided into experimental group (EG) (n = 240) and control group (CG) (n = 160). Two measurements were carried out, separated by a 10-week intervention, and PA, kinanthropometric variables and physical condition were measured. During the intervention, EG must use Strava (n = 74); Pokémon Go (n = 59); Pacer (n = 60); and MapMyWalk (n = 47) a minimum of 3 times per week, covering an incremental distance from 7,000 steps per day (week 1) to 12,500 steps per day (week 10). After that, EG were divided in quartile according to the volume of training completed. The results obtained showed a significant increase between pre-and post in PA (p = 0.009-0.044) and curl-up (p < 0.001-0.040) in EG regardless the quartile of compliance, and a reduction in fat variables (p < 0.001) and an increase in CMJ in 75-100 % compliance group (p = 0.005). The introduction of the covariate gender did not introduce changes in the intra-group evolution. On inter-group differences, differences were only found for the post-test values between 0-25 % Vs 25-50 % and between 50-75 % Vs 75-100 % with the group that completed a longer distance being the one that showed the lowest values in the post-test in both cases. When including the covariate gender, no significant differences were found for either the pre-test or the post-test on either variable. To conclude, a higher training volume with mobile apps seems to be relevant in the increase PA and strength and decrease of fat mass. The gender factor is not influential in the intra-group changes, but it is influential in the inter-group differences.

Effects of a multicomponent intervention on cardiovascular risk factors in overweight children: a randomized clinical trial in light of complex systems

Analyzing the effects of interventions from a theoretical and statistical perspective that allows understanding these dynamic relationships of obesity etiology can be a more efficient and innovative way of understanding the phenomenon's complexity. Thus, we aimed to analyze the pattern of cardiovascular risk factors between-participants, and the effects within-participants of a multidisciplinary intervention on cardiovascular risk factors in overweight children. This is a randomized clinical trial, and 41 participated in this study. A multicomponent intervention (physical activities, nutritional and psychological counseling) was performed for 10 weeks. Anthropometric and hemodynamics measurements, lipid and glucose profile, cardiorespiratory fitness, and left ventricular mass were evaluated. A network analysis was done. Considering patterns in the network at baseline, WC, WHR, BMI, and Fat were the main variables for cardiovascular risks. Group was the most critical variable in the within-participant network. Participating in a multicomponent intervention and decreasing body fat promoted beneficial cardiovascular factors.

Exercise and Insulin Resistance Markers in Children and Adolescents With Excess Weight: A Systematic Review and Network Meta-Analysis

Importance

Although benefits have been reported for most exercise modalities, the most effective exercise approaches for reducing insulin resistance in children and adolescents with excess weight and the optimal exercise dose remain unknown.

Objective

To compare exercise training modalities and their association with changes in insulin resistance markers among children and adolescents with excess weight and to establish the optimal exercise dose.

Data Sources

For this systematic review and network meta-analysis, 6 electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and CINAHL) were searched for studies from inception to April 1, 2023.

Study Selection

Randomized clinical trials (ie, randomized controlled trials and randomized trials without a control group) were included if they reported outcomes associated with aerobic training, resistance training, high-intensity interval training (HIIT), or a combination of these interventions.

Data Extraction and Synthesis

Data extraction for this systematic review was conducted following a network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Effect sizes were calculated as the mean difference (MD) with 95% CI using random-effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman method. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. The Cochrane Risk-of-Bias tool, version 2 (RoB2), was used to independently assess the risk of bias of the included studies. The certainty of evidence in consistent networks was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. The study protocol was prospectively registered with PROSPERO. Data analyses were conducted between May and June 2023.

Main Outcomes and Measures

The primary outcomes were fasting glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR).

Results

This analysis included 55 studies with a total of 3051 children and adolescents (mean [SD] age, 13.5 [2.3] years; 1537 girls [50.4%] and 1514 boys [49.6%]). Exercise was associated with reductions in fasting insulin (MD, -4.38 μU/mL [95% CI, -5.94 to -2.82 μU/mL]) and HOMA-IR (MD, -0.87 [95% CI, -1.20 to -0.53]). A nonlinear association in both markers was observed, with a required minimal exercise dosage of approximately 900 to 1200 metabolic equivalent of task minutes per week, especially in children and adolescents with insulin resistance at baseline. Combination HIIT and resistance training and concurrent training were the most effective approaches for reducing insulin resistance markers. On average, the certainty of evidence varied from low to moderate.

Conclusions and Relevance

These findings underscore the role of exercise interventions in enhancing insulin resistance markers among children and adolescents with overweight and obesity. It is advisable to include resistance exercises alongside aerobic and HIIT programs for a minimum of two to three 60-minute sessions per week.

Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort

BACKGROUND

Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior.

METHOD

Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of 'No Exercise for Weight Loss', 'Exercise for Weight Loss', and 'Maladaptive Exercise' over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors.

RESULTS

Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the 'Exercise for Weight Loss' category were more likely than those in the 'No Exercise for Weight Loss Category' to transition to 'Maladaptive Exercise' over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex.

CONCLUSIONS

Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.

Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.

The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery

This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.

The stability of cardiometabolic risk factors clustering in children and adolescents: a 2-year longitudinal study

Objective

The present study aims to verify the odds of remaining with the clustering of 3 or more, 4 or more, and 5 or more risk factors across a 2-year time span.

Methods

Observational longitudinal study that included 358 children and adolescents (10.96 ± 2.28 years of age at baseline). Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Odds ratios of presenting n risk factors clustered at follow-up according to the number of risk factors observed at baseline were calculated.

Results

More participants than expected were found presenting clustering of 4 or more and 5 or more risk factors at both baseline (11.7% and 5.6%, respectively) and follow-up (9.5% and 5.6%, respectively). The odds ratios calculated demonstrated that the odds of presenting the same number of risk factors clustered or more at follow-up increased according to the number of risk factors clustered at baseline.

Conclusion

The higher the number of risk factors a child had at baseline, the higher the odds of presenting the same number of risk factors or more after two years of follow-up.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01174-1.

Effects and individual response of continuous and interval training on adiponectin concentration, cardiometabolic risk factors, and physical fitness in overweight adolescents

This study aimed to evaluate the effect and individual responsiveness after 12 weeks of high-intensity interval training (HIIT) and moderate-intensity of continuous training (MICT) on adiponectin, cardiometabolic risk factors and physical fitness in overweight adolescents. This study was participated by 52 adolescents, both sexes, 11 and 16 years old, separated into HIIT (n = 13), MICT (n = 15), and control group (CG, n = 24). Body mass, height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), blood pressure, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides, glucose, insulin, adiponectin, and C-reactive protein (CRP) were evaluated. Body mass index z-score (BMI-z), waist-to-height ratio (WHtR), insulin resistance, and insulin sensitivity were calculated. Resting heart rate (HR_rest), peak oxygen consumption (VO_2peak), right handgrip strength (HGS-right), left handgrip strength (HGS-left), and abdominal resistance (ABD) was evaluated. HIIT session lasted around 35 min and MICT of 60 min of exercises on stationary bicycle, three times a weekday for 12 weeks. ANOVA, effect size, and prevalence of responders were used for statistical analysis. HIIT reduced BMI-z, WHtR, LDL-c, and CRP, while increased of physical fitness. MICT reduced HDL-c, while increased of physical fitness. CG reduced FM, HDL-c, and CRP, while increased FFM and HR_rest. Frequencies of respondents in HIIT were observed for CRP, VO_2peak, HGS-right, and HGS-left. Frequencies of respondents in MICT were observed for CRP and HGS-right. Frequencies of no-respondents in CG were observed for WC, WHtR, CRP, HR_rest, and ABD.  Conclusion: Interventions with exercises were effective to adiposity, metabolic health, and physical fitness improvements. Individual responses were observed in inflammatory process and physical fitness, important changes in overweight adolescent's therapy.  Trial registration number and date of registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC), the number RBR-6343y7, date of registration May 3, 2017. What is Known: • Effect of regular physical exercise positively affects overweight, comorbidities, and metabolic diseases, recommended mainly for children and adolescents. What is New: • Due to the great inter-individual variability, the same stimulus can provide different responses; adolescents who benefit from the stimulus are considered responsive. • Intervention of HIIT and MICT did not alter the concentrations of adiponectin; however, the adolescents presented responsiveness to the inflammatory process and physical fitness.

Effects of physical activity on body mass and composition of school-age children and adolescents with overweight or obesity: Systematic review focusing on intervention characteristics

OBJECTIVE

The characteristics of physical activity (PA) interventions to improve body mass and composition in pediatric populations are unclear. This systematic review summarized the effects of PA on those outcomes in school-age children and adolescents with overweight or obesity, focusing on training components (frequency, intensity, duration, and type - FITT).

METHODS

Databases were searched for controlled trials applying exclusive PA and including children (5-12 y) or adolescents (13-17 y) with overweight/obesity.

RESULTS

Twenty-seven trials yielding 34 interventions were included. PA was recreational (children: k = 9, n = 478), systematized (children: k = 18, n = 565); or combined (children: k = 7, n = 205). Successful interventions were performed for 6- to 35 weeks (mostly 12-14 weeks), 2- to 5 d/wk (mostly 3 d/wk), during 8- to 60 min (mainly 60 min) with moderate to high intensity (60-90% maximal heart rate or 40-70% heart rate reserve). Half of the interventions applying recreational (4 out of 8), 59% of systematized (10 out of 17), and 57% of combined (4 out of 7) interventions reported improvements in body mass or composition, especially body fat. Benefits were more often reported for body composition (18 out of 34 interventions) than body mass (8 out of 34 interventions), irrespective of the age group.

CONCLUSION

Recreational and systematized PA may improve body mass, and particularly body composition in school-age children and adolescents with overweight or obesity. Successful programs were performed for at least six weeks and applied a PA amount consistent with the minimum recommended for pediatric populations (≥60 min of moderate-to-vigorous PA at least 3 d/wk).

The Role of Molecular and Hormonal Factors in Obesity and the Effects of Physical Activity in Children

Obesity and overweight are defined as abnormal fat accumulations. Adipose tissue consists of more than merely adipocytes; each adipocyte is closely coupled with the extracellular matrix. Adipose tissue stores excess energy through expansion. Obesity is caused by the abnormal expansion of adipose tissue as a result of adipocyte hypertrophy and hyperplasia. The process of obesity is controlled by several molecules, such as integrins, kindlins, or matrix metalloproteinases. In children with obesity, metabolomics studies have provided insight into the existence of unique metabolic profiles. As a result of low-grade inflammation in the system, abnormalities were observed in several metabolites associated with lipid, carbohydrate, and amino acid pathways. In addition, obesity and related hormones, such as leptin, play an instrumental role in regulating food intake and contributing to childhood obesity. The World Health Organization states that physical activity benefits the heart, the body, and the mind. Several noncommunicable diseases, such as cardiovascular disease, cancer, and diabetes, can be prevented and managed through physical activity. In this work, we reviewed pediatric studies that examined the molecular and hormonal control of obesity and the influence of physical activity on children with obesity or overweight. The purpose of this review was to examine some orchestrators involved in this disease and how they are related to pediatric populations. A larger number of randomized clinical trials with larger sample sizes and long-term studies could lead to the discovery of new key molecules as well as the detection of significant factors in the coming years. In order to improve the health of the pediatric population, omics analyses and machine learning techniques can be combined in order to improve treatment decisions.

Recreational Physical Activity Improves Adherence and Dropout in a Non-Intensive Behavioral Intervention for Adolescents With Obesity

Purpose: The aim of this study was to compare adherence and dropout rates in adolescents with obesity participating in a behavioral-counseling intervention with or without recreational physical activity (PA). Material and methods: Seventy-four adolescents (13 to 18y, 40 girls and 34 boys) with obesity (body mass index [BMI] z-score ≥ 2.0) were randomized into a counseling group (CG; n = 37) and a counseling + recreational physical activity group (CPAG; n = 37). Adolescents from both groups received behavioral counseling once a week for 12 weeks and monthly for an additional 12 weeks. CPAG adolescents participated in supervised recreational physical activity sessions twice a week for 12 weeks. Body composition, body image dissatisfaction, symptoms of depression, binge eating, bulimia, anorexia and quality of life were assessed at baseline and after 24-weeks. Result: The dropout rate was 2.73 times higher in adolescents from CG compared to CPAG (χ² = 4.48; p = .034; R²_McF = 0.044). Girls were 2.56 times more likely to withdraw when compared to boys (χ² = 3.86; p = .049; R²_McF = 0.038). Binomial logistic regression which incorporated sex, intervention group, BMI z-score and BSQ score at baseline (R²_McF = 0.177) explained 75% of the dropout rate. Both interventions were effective in reducing waist circumference (p < .01) and improving quality of life, symptoms of depression, bulimia and binge eating (p < .01). Conclusion: Incorporating a recreational physical activity component to a non-intensive behavioral intervention may be a feasible strategy to reduce dropout rates in adolescents with obesity seeking treatment.

Physical activity modifies the relation between gestational perfluorooctanoic acid exposure and adolescent cardiometabolic risk

OBJECTIVE

Exposure to per- and polyfluoroalkyl substances (PFAS) - endocrine disrupting chemicals - may increase cardiometabolic risk. We evaluated whether adolescent lifestyle factors modified associations between gestational PFAS exposure and cardiometabolic risk using a prospective cohort study.

METHODS

In 166 mother-child pairs (HOME Study), we measured concentrations of four PFAS in maternal serum collected during pregnancy. When children were age 12 years, we calculated cardiometabolic risk scores from visceral adiposity area, blood pressure, and fasting serum biomarkers. We assessed adolescent physical activity and Healthy Eating Index scores using the Physical Activity Questionnaire for Older Children (PAQ-C), actigraphy, and 24-h diet recalls. Using multivariable linear regression and weighted quantile sum regression, we examined whether physical activity or diet modified covariate-adjusted associations of PFAS and their mixture with cardiometabolic risk scores.

RESULTS

Physical activity modified associations between perfluorooctanoic acid (PFOA) and cardiometabolic risk scores. Each doubling of PFOA was associated with worse cardiometabolic risk scores among children with PAQ-C scores < median (β:1.4; 95% CI:0.5, 2.2, n = 82), but not among those with PAQ-C scores ≥ median (β: 0.2; 95% CI: 1.2, 0.7, n = 84) (interaction p-value = 0.01). Associations were most prominent for insulin resistance, leptin-adiponectin ratio, and visceral fat area. We observed results suggesting that physical activity modified the association of PFAS mixture with cardiometabolic risk scores, insulin resistance, and visceral fat area (interaction p-values = 0.17, 0.07, and 0.10, respectively); however, the 95% CIs of the interaction terms included the null value. We observed similar, but attenuated patterns for PFOA and actigraphy-based measures of physical activity. Diet did not modify any associations. Physical activity or diet did not modify associations for other PFAS.

CONCLUSIONS

Childhood physical activity modified associations of prenatal serum PFOA concentrations with children's cardiometabolic risk in this cohort, indicating that lifestyle interventions may ameliorate the adverse effects of PFOA exposure.

Relationship between Cardiorespiratory Fitness and Executive Function in Young Adults: Mediating Effects of Gray Matter Volume

We evaluated the association between cardiorespiratory fitness (CRF) and executive function (EF) in young adults and the mediating effects of GMV on this relationship. This study involved 217 college students. An incremental load exercise program was used to evaluate VO₂max. EF was estimated by the Flanker task, the 2-back task, and the more-odd shifting task, while structural magnetic resonance and region-based morphometry (RBM) were used to analyze GMV. The high CRF group had a shorter updating reaction time (RT) (p ≤ 0.05). CRF was positively correlated with the right orbital part of the middle frontal gyrus (ORBmid.R) GMV (p ≤ 0.05). ORBmid.R GMV was negatively correlated with updating RT (p ≤ 0.05). Model 4 in SPSS was used to assess the mediating effects of ORBmid.R GMV between CRF and updating RT. ORBmid.R GMV was established to have a partially mediating role between CRF and updating RT, which accounted for 19.6% of the total effect value. These findings indicate that the negative correlation between CRF and EF was significant, and ORBmid.R GMV played a mediating role in the relationship between CRF and EF, providing new evidence toward comprehensively revealing that CRF promotes EF performance.

Investigaciones realizadas en Colombia relacionadas con actividad física y obesidad 2010-2020

Introducción: La obesidad es un problema de salud pública mundial. La actividad física es una herramienta importante de promoción y prevención de este problema. Se desconoce las investigaciones realizadas en Colombia al respecto, lo cual es necesario para implementar políticas públicas eficientes. Objetivo: analizar las investigaciones colombianas encontradas en bases de datos científicas sobre la actividad física y obesidad. Metodología: revisión sistemática de artículos de investigación realizados en Colombia del año 2010 al 2020, en las bases de datos PubMed y SciELO.  Resultados: de 87 artículos encontrados, 23 cumplieron los criterios de inclusión. El 91,3 % publicados en revistas indexadas internacionalmente. 69,5% estudios observacionales, 17,4% ensayos clínicos y 8,7% revisiones sistemáticas. Conclusiones: poca producción en Colombia. La mayoría en revistas indexadas, tuvieron diseño observacional y encontraron asociación entre poca actividad física con sobrepeso/obesidad. Alta prevalencia de sobrepeso/obesidad. Pocos autores fueron profesionales en el área del deporte y el entrenamiento. Introduction: Obesity is a global public health problem. Physical activity and exercise are important tools for promoting and preventing. The research carried out in Colombia in this regard is unknown, which is necessary to implement efficient public policies. Objective: to analyze Colombian research found in scientific databases on physical activity or exercise in overweight and obesity. Methodology: literary review of research articles carried out in Colombia from 2010 to 2020, in the PubMed and SciELO databases. Results: Of 87 articles found, 23 met the inclusion criteria. 91.3% published in internationally indexed journals. 69.5% observational studies, 17.4% clinical trials and 8.7% systematic reviews. Conclusions: little production in Colombia. Most of the indexed journals had an observational design and found an association between little physical activity and overweight/obesity. High prevalence of overweight/obesity. Few authors were professionals in the area of training.

Higher Running Speed and Cardiovascular Endurance Are Associated with Greater Level of Academic Achievement in Urban Catalan Primary School Children

The purpose of the present study was to determine the relationship between physical fitness and academic achievement in a sample of primary-school children. Data of 116 sixth-grade primary-school students (68 girls, 48 boys) from Barcelona (Catalonia, Spain) with a mean (SD) age of 11.4 years (0.4) was analyzed. To determine academic achievement, proficiency scores in the subjects Catalan language, Spanish language, English language, and Maths were derived from the Test de Compètencies Bàsiques. Physical fitness was assessed using the Cooper test (aerobic capacity), 20-m sprint test (linear velocity), and 4 × 10-m test (agility). The results showed that participants with a higher performance in the Cooper and 20-m sprint tests had significantly better academic achievement in the assessed subjects (p < 0.05; d range = 0.93 to −2.98). The findings of this investigation are interesting from a curricular perspective since a positive association between academic achievement and physical fitness indicates a strong reason to raise the physical education status in educational systems, a subject that has traditionally been considered less important by the educational community.

Associations of cardiorespiratory fitness and obesity parameters with blood pressure: fitness and fatness in youth Latin-American ethnic minority

Background: In spite of wide international evidence about cardiorespiratory fitness (CRF) and adiposity in association with cardiovascular disease, there is poor evidence about this relationship in schoolchildren of ethnic minorities.Aim: To examine the relationship between CRF and body composition on blood pressure (BP) in a sample of ethnic minority schoolchildren from three Latin-American countries.Material and methods: A descriptive cross sectional study of total n = 3866, mean age 12.5 (2.7) y [girls n = 1997, mean age 12.8 (2.8) y; boys n = 1869, mean age 12.2 (2.7) y] schoolchildren from three Latin-American countries (Colombia, Brazil, Chile). Main outcomes were CRF, body mass index (BMI), waist circumference, body fat percentage (%BF), and BP (systolic SB, diastolic BP, and mean arterial pressure (MAP).Results: In both sex, and after adjusting for covariates (age and ethnicity group), negative CRF by V˙O₂peak levels were associated with a higher body fatness parameters (BMI, WC, WHtR and %BF p<0.001), and blood pressure measures (systolic BP, diastolic BP, and MAP; p<0.001). A lower CRF (by V˙O₂peak) was associated with a higher BP in girls (systolic SB -0.15; -5.10 (0.30), diastolic BP -0.14; -4.43 (0.23), and MAP -0.15; -4.93 (0.26) at p<0.001), and boys (systolic SB -0.02; -0.85 (0.32), DB -0.07; -2.23 (0.23), and MAP-0.06; -1.89 (0.25 at p<0.001). There was a significant association between a 'high-CRF + low-%BF' with a lower systolic SB diff = - 9.6 [0.7], diastolic BP diff= - 11.0 [0.6]; and MAP level diff = - 10.6 [0.6] all p<0.001). There was a significant association between a 'high-CRF + low-BMI' with a lower systolic diff = - 10.3 [1.1], diastolic diff = - 11.2 [1.1], and MAP diff = - 10.9 [1.0] all p<0.001.Conclusion: A lower CRF is associated with a higher body fatness parameters, and higher BP levels in Latin-American ethnic schoolchildren.Abbreviators: %BF: Percentage of Body fat; BIA: Bioelectric impedance analysis; BMI: Body mass index; BP: Blood pressure; CRF: Cardiorespiratory fitness; CVD: Cardiovascular disease; LDL-cholesterol: SD: Standard deviation; WC: Waist circumference; WHtR: Waist-height to ratio; V˙O₂max: Maximal oxygen consumption; V˙O₂peak: Peak of oxygen consumption.

Drawing on Cultural Traditions to Improve Cardiorespiratory Fitness with South Asian Children: A Feasibility Study

Background: South Asian children have a higher prevalence of cardiovascular disease risk factors compared with children of other ethnic backgrounds. Our objective was to explore the feasibility, acceptability, and potential fitness-related impact of a 7-month afterschool Bhangra dance intervention for South Asian children. Methods: We recruited 172 children grades 3 through 6 across 4 elementary schools for an intervention involving twice weekly Bhangra sessions in the school setting. Feasibility and acceptability were defined by recruitment, attendance, and retention metrics. The primary fitness outcome was cardiorespiratory fitness (CRF), measured via shuttle run laps and VO₂ max. Secondary fitness outcomes included musculoskeletal (vertical jump height) and morphological fitness (waist circumference and BMI). Results: Sample size ranged from 28 to 54 participants per school (n = 172); mean attendance rate was 74%; and retention rate was 87%. VO₂ max and shuttle laps increased by 1.4 mL·kg/min [95% confidence interval (CI): 0.93 to 1.84] and by 7.6 (95% CI: 6.11 to 9.08), respectively. Both these improvements remained significant after controlling for sex and age (VO₂ max) and sex and baseline weight (shuttle laps). Musculoskeletal and morphological fitness indices also improved. Conclusions: Findings suggest that an afterschool Bhangra dance intervention is feasible, acceptable, and associated with CRF improvements as well as other indices of physical fitness.

Effects of Different Doses of Exercise on Inflammation Markers Among Adolescents With Overweight/Obesity: HEPAFIT Study

PROPOSE

Obesity-related metabolic risk factors in adolescents who are overweight/obese may be associated with systemic low-grade inflammation; therefore, we investigated whether 6 months of exercise training altered markers of inflammation.

METHODS

Secondary analyses of a randomized controlled exercise-based intervention trial (September 2017-December 2018). Adolescents aged 11 to 17 years (Tanner stage II-V), 70% girls, with a body mass index z-score at or above the 85th percentile, and/or with excess of adiposity (body fat ≥ 30%). The participants were randomly assigned to the following 4 groups for 6 months: (1) standard physical education lessons, as a control (CTRL); (2) high-intensity physical education class (HIPE); (3) low-to-moderate intensity physical education class (LIPE); (4) a combined group (PLUS). Inflammatory markers and immune molecules including chemokines, cytokines, and growth factors (n = 65 biomarkers) were determined by cytokine antibody array.

RESULTS

Of the 120 randomly assigned participants, 95 were included in the analysis. Considering these 22 proteins, the LIPE group shows statistical significance in 9 proteins with log-fold change (logFC) and P < 0.05 (in BLC, eotaxin, fibroblast growth factor-6 [FGF-6], GCP-2, I-309, IGFBP-4, MCP-4, NAP-2, and PARC), followed by the PLUS group in 9 proteins (BLC, pro-epidermal growth factor, eotaxin, FGF-6, MCP-4, NAP-2, osteopontin, PARC, and RANTES), the HIPE group in 7 proteins (FGF-4, FGF-7, GCP-2, IGF-1, IGFBP-1, IGFBP-4, and MIP-1 delta), and the CTRL group in 6 proteins (FGF-4, IP-10, Leptin, MCP-1, MIG, and MIP-1 delta). However, subanalysis performed to detect differentially expressed proteins at baseline and after intervention, with significance at an adjusted P value ≤ 0.05 and absolute log fold-change (logFC) ≥ 1.0, showed 3 downregulated proteins in the LIPE group (BLC(logFC) = 1.27, eotaxin(logFC) = 1.18, and MCP-4(logFC) = 1.14), and 4 proteins in the HIPE group (BLC(logFC) = 1.45, FGF-6(logFC) = 1.20, MCP-4(logFC) = 1.50, and PARC(logFC) = 1.33), supporting that the changes we observed in the exercise groups were not time-related changes but occurred in response to exercise.

CONCLUSIONS

Implementing a 6-month physical exercise program in overweight/obese adolescents, based on LIPE and PLUS groups, significantly change several circulating inflammatory levels. Interventions involving supervised physical exercise may reduce the associated effects of systemic low-grade inflammation, thus preventing the development of obesity-related metabolic diseases in adolescents with overweight/obesity.

Exercise dose on hepatic fat and cardiovascular health in adolescents with excess of adiposity

OBJECTIVE

The HEPAFIT study was aimed at examining the impact of a 6-month physical education intervention, considering various levels of exercise intensity, on hepatic fat and cardiometabolic health outcomes in adolescents with excess adiposity.

METHODS

Adolescents (n = 120), 11-17 years with excess adiposity by body fat >30%, were randomly assigned to one of the following 4 groups for 6 months: (1) standard physical education lessons, control (CTRL); (2) high-intensity physical education (HIPE); (3) low-to-moderate intensity physical education (LIPE) and (4) combined HIPE and LIPE (PLUS). The primary outcome was hepatic fat content measured by vibration-controlled transient elastography (controlled attenuation parameter [CAP]). Secondary outcomes were traditional cardiovascular health markers (body composition, serum lipids, aminotransferases and health-related physical fitness components).

RESULTS

Adjusted mixed effects linear models revealed a significant decrease in CAP levels in HIPE (-20.02 dB/m, p < 0.0001) (p = 0.001 vs. CTRL group) and PLUS (-16.25 dB/m, p = 0.005) groups. Body fat decreased in the HIPE (-2.88%, p < 0.001) (p = 0.001 vs. CTRL group) and LIPE (-1.26%, p = 0.022) groups. The physical fitness components were increased in the HIPE and PLUS group relative to the baseline (p < 0.05), and the HIPE group showed a reduction in the total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (p < 0.05).

CONCLUSIONS

Implementation of a 6-month physical education exercise program, particularly high-intensity or combined high and low-intensity, improves hepatic fat storage and significantly reduces cardiometabolic markers in adolescents with excess of adiposity. Interventions involving supervised physical exercise may help to improve metabolism and fat deposition at the hepatic level, thus preventing the development of non-alcoholic fatty liver disease in adolescents.

Gross Motor Coordination: We Have a Problem! A Study With the Körperkoordinations Test für Kinder in Youth (6-13 Years)

The main goal of our cross-sectional research was to determine the current values of gross motor coordination (GMC) of Italian boys and girls between 6 and 13 years of age. Secondary goals were to study gender differences, and the four subtests trend with ages. Results were compared with the references proposed by KTK authors and with similar searches. Anthropometric measurements and KTK data from 2,206 schoolchildren (girls: n = 1,050; boys: n = 1,156) were collected. The KTK raw score (RS) increased with the age of the subjects (r = 0.678; p < 0.001). In 11-13-year-old subjects, the increase in results is less than in younger subjects. RS showed differences by gender (F = 5.899; p = 0.015) and age (F = 269.193; p < 0.001) without interaction gender × age. Motor quotient (MQ) tended to decrease with age (r = -0.148; p < 0.001); it showed differences by gender (F = 79.228; p < 0.001), age (F = 14.217; p < 0.001), and an interaction gender × age (F = 2.249; p < 0.05). Boys showed better performance than did girls in the raw scores of three of four subtests (JS: F = 24.529; MS: F = 9.052; HH: F = 11.105). Girls show better performances than did boys in the WB (F = 14.52). Differences between genders make us believe it appropriate to maintain a differentiated standardization. RS increased with age, and it seems reasonable, therefore, to maintain a GMC age-based normalization. On the contrary, MQ tended to decrease. All this makes us speculate that today's young people accumulate less significant motor experiences over the years compared to those achieved by their peers in the 1970s. Italian data were lower than German references and Belgian results but slightly higher than the Brazilian ones. The comparison among these four searches confirmed a worrying downward trend in GMC and its characterization by geographical and sociocultural areas. Updated parameters of the KTK can provide helpful references to improve policies to support physical activity, sport, and physical education in youth.

High-Intensity Interval Training and Cardiometabolic Risk Factors in Children: A Meta-analysis

CONTEXT

High-intensity interval training (HIIT) has been widely used to prevent and treat cardiovascular risk factors in adolescents and adults; nevertheless, the available evidence in children is scarce.

OBJECTIVE

To synthesize evidence regarding the effectiveness of HIIT interventions on improving cardiovascular risk factors and cardiorespiratory fitness (CRF) in children from 5 to 12 years old.

DATA SOURCES

We searched 5 databases, Medline, Embase, SPORTDiscus, the Cochrane Library, and Web of Science.

STUDY SELECTION

Randomized controlled trials (RCTs) evaluating the effectiveness of HIIT interventions on cardiometabolic risk factors and CRF in children were included.

DATA EXTRACTION

Meta-analyses were conducted to determine the effect of HIIT on body composition, cardiometabolic and CRF variables in comparison with nontraining control groups.

RESULTS

A total of 11 RCTs and 512 participants were included. The results of the meta-analysis revealed a significant improvement in peak oxygen uptake (standardized mean difference [SMD] = 0.70, 95% confidence interval [CI] = 0.28 to 1.12; P = 0.001], in total cholesterol [SMD = -1.09, 95% CI = -1.88 to -0.30; P = 0.007], in low-density lipoprotein cholesterol [SMD = -1.28, 95% CI = -2.34 to -0.23; P = 0.017] and triglycerides [SMD = -0.71, 95% CI = -1.15 to -0.28; P = 0.001) levels.

LIMITATIONS

Because of the small number of available RCTs, it was not possible to conduct a subgroup analysis or a linear meta-regression analysis.

CONCLUSIONS

HIIT is a feasible and time-efficient approach for improving CRF, total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in children.

The effect of a Mediterranean diet vs. a low-fat diet on non-alcoholic fatty liver disease in children: a randomized trial

Non-alcoholic fatty liver disease (NAFLD) is becoming ever more common in children, due to the increasing global prevalence of obesity. The first-line treatment consists of weight loss through a combination of a healthy diet and exercise. The objective of this study was to determine the effects of a Mediterranean Diet or a low-fat diet on reducing hepatic steatosis and insulin resistance in children with NAFLD. This 12-week randomised clinical trial was conducted with children aged 9-17 years diagnosed with NAFLD and randomised into either a Mediterranean Diet or a low-fat diet group. By the end of the study, hepatic steatosis had decreased significantly in both groups (p < 0.001). Liver enzymes also improved significantly, while significant decreases were observed in insulin resistance in both groups, although this decrease was greater in the Mediterranean Diet group (p = 0.010). This study demonstrated that a decrease in hepatic steatosis and an improvement in insulin sensitivity can be achieved with both a Mediterranean Diet and a low-fat diet over 12 weeks, with no significant decrease in the energy required for growth, in children with NAFLD.

The Effect of an Intervention with Active Video Games Combined with Multicomponent Exercise on Cardiorespiratory fitness in Children with Overweight and Obesity: A Randomized Controlled Trial. (Preprint)

Background

Childhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure.

Objective

The main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity.

Methods

We recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants.

Results

The AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO_2peak) was found.

Conclusions

A 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO_2peak). Greater benefits were found in children with the highest fat percentage.

Trial Registration

ClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713

Biological and socioeconomic factors as moderator in relationship between leisure-time physical activity and cardiometabolic risk in adolescents from southern Brazil

BACKGROUND

Given the important repercussions that sociodemographic factors can have on physical activity, especially in the field of leisure, and cardiometabolic risk, it seems relevant to analyze the implications of these variables on the relationship between physical activity in leisure time (LTPA) and cardiometabolic risk. In this sense, the present study aims to verify the moderating role of biologic and socioeconomic factors in the relationship between LTPA and cardiometabolic risk in adolescents in southern Brazil.

METHODS

Cross-sectional study that included 1596 adolescents selected at random (58.2% girls), aged between 10 and 17 years. LTPA, biological and socioeconomic factors were assessed using a self-reported questionnaire and the cardiometabolic risk score (total cholesterol/HDL-c ratio, triglycerides, fasting glucose, systolic blood pressure, and waist circumference, considering the participant's age and sex) was included as an outcome. Associations and moderations were tested by multiple linear regression models.

RESULTS

It was observed a positive interaction of LTPA and sex (p = 0.048) and LTPA and school system (p = 0.037), and negative interaction of LTPA and skin color (p = 0.040), indicating that these factors were moderators in the relationship between LTPA and clustered cardiometabolic risk score (cMetS) in adolescents. A reduction in cardiometabolic risk was observed according to the increase in weekly minutes of LTPA among boys, non-white adolescents, and students from municipal schools.

CONCLUSIONS

The association between LTPA and cardiometabolic risk was moderated by sex, skin color, and school system in adolescents from southern Brazil.

Overweight/Obese Schoolchildren with Low Muscle Strength Have a Lower Cardiorespiratory Capacity and Greater Cardiovascular Risk: Results of the School Health Survey of the Extreme South of Chile 2019

Objective: To compare cardiovascular risk and cardiorespiratory capacity in schoolchildren from a region in the extreme south of Chile according to nutritional status and muscular strength. Methods: An analytical cross-sectional study was performed on a sample of 594 schoolchildren from 5th to 8th grade in the extreme south of Chile. Based on body mass index and lower limb muscle strength, participants were divided into four groups: high strength-normal weight, high strength-overweight/obese, low strength-normal weight, and low strength-overweight/obese. Then, waist-to-height ratio and cardiorespiratory capacity, measured with the 20 m shuttle run test, were assessed to determine their cardiovascular risk, comparing the four groups. Results: The overweight/obese group with high muscular strength presented better indicators in anthropometric variables (waist circumference and waist-to-height ratio) than their peers with low muscular strength. Additionally, the overweight/obese group with low muscular strength presented a lower cardiorespiratory capacity than their peers with high muscular strength. Both results were observed in boys and girls. Conclusion: The results of this study suggest that overweight/obese schoolchildren with high muscle strength present healthier anthropometric indicators and greater cardiorespiratory capacity than their peers with low muscle strength. These results confirm the relevance of measuring muscle strength in schoolchildren and its usefulness to assess functionality. These results encourage the scientific community to continue studying the role that muscle strength plays in modulating the effects of overweight and obesity on respiratory and cardiovascular conditions in childhood.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

The 3 Minute Step Test is a validated field test to evaluate the functional exercise capacity in children aged 6 to 12

BACKGROUND

Field tests are useful to assess the functional exercise capacity. The 6minute walking test (6MWT) is the most common field test even if alternatives are needed. The main aim of the study was to verify if the 3minute step test (3MST) is a valid tool to measure the functional exercise capacity and can surrogate the 6MWT in healthy children from 6- to 12-years-old.

METHODS

This randomized cross-over trial recruited 30 healthy children from 6 to 12 years. One 6MWT and two 3MST (3MST₁ and 3MST₂) were performed randomly on 3 consecutive days. The variables were the distance (6MWT), the number of steps (3MST) and the cardiorespiratory parameters.

RESULTS

The distance walked during 6MWT was very strongly correlated to the number of steps during the 3MST (3MST₁: rho=0.833; P<0.001 and 3MST₂: rho=0.868; P<0.001). Heart rate (HR) was lower than the theoretical maximal HR at the end of both tests. The change in HR and perceived fatigue were significantly higher after the 3MST. A learning effect was observed in the 3MST (+8 steps; P<0.001).

CONCLUSIONS

The 3MST is validated and can be a surrogate for the 6MWT in healthy children population between 6 and 12 years old. A training test is required in these children.

Impact of self-determination theory in a physiotherapeutic training : A pilot-study on motivation for movement of obese adolescents

Background

This study determined to what extent the underpinning of physiotherapeutic interventions with the evidence-based motivational psychological concept of the self-determination theory (SDT) by Ryan and Deci can increase motivation and enjoyment of movement in obese adolescents.

Methods

In this study 12 obese adolescents aged 14–18 years were offered a targeted group-specific sports program including a home exercise program of 8 weeks. The group leaders were trained in the SDT and supported to integrate motivational aspects. A SDT-based questionnaire by Kohake and Lehnert was used to evaluate motivational interventions.

Results

In total, seven (58%) patients finished the study. In the before-after comparison there were little changes in motivation. Results showed that contrary to expectations the motivation of the obese adolescents to move and to participate in the study was generally high. In the study, more internalized forms of motivation dominated, the highest quality form of motivation.

Conclusion

Digital technologies could be a successful way to further increase motivation and compliance of our target group. This MotiMove study is a basis for future research programs and empower physiotherapists and movement experts to develop and implement training programs for obese adolescents and children.

Supplementary Information

The online version of this article (10.1007/s00508-021-01849-4) contains supplementary material, which is available to authorized users.

Effects of circuit training or a nutritional intervention on body mass index and other cardiometabolic outcomes in children and adolescents with overweight or obesity

Objective

We aimed to assess the effectiveness of the first 6 months of a 24 month multidisciplinary intervention program including circuit training and a balanced diet in children and adolescents with obesity.

Methods

A quasi-experimental intervention trial included 242 participants (age [mean±standard deviation]: 11.3±2.06 years, 97 girls) of at least 85th percentile of age- and sex-specific body mass index (BMI). Participants were grouped into three to receive usual care (usual care group), exercise intervention with circuit training (exercise group), or intensive nutritional and feedback intervention with a balanced diet (nutritional group). Primary outcome was BMI z-score, while secondary outcomes included body composition, cardiometabolic risk markers, nutrition, and physical fitness.

Results

Among the participants, 80.6% had a BMI ≥ the 97th percentile for age and sex. The BMI z-score of the overall completers decreased by about 0.080 after 6 months of intervention (p < 0.001). After the intervention, both exercise and nutritional groups had significantly lower BMI z-scores than the baseline data by about 0.14 and 0.075, respectively (p < 0.05). Significant group by time interaction effects were observed between exercise versus usual care group in BMI z-score (β, -0.11; 95% confidence interval (CI), -0.20 to -0.023) and adiponectin (β, 1.31; 95% CI, 1.08 to 1.58); and between nutritional versus usual care group in waist circumference (β, -3.47; 95% CI, -6.06 to -0.89). No statistically significant differences were observed in any of the other secondary outcomes assessed.

Conclusion

Multidisciplinary intervention including circuit training and a balanced diet for children and adolescents with obesity reduced the BMI z-score and improved cardiometabolic risk markers such as adiponectin and waist circumference.

Temporal trend of cardiorespiratory endurance in urban Catalan high school students over a 20 year period

Background

Physical fitness is considered an important indicator of health in adolescents. However, in recent years several studies in the scientific literature have shown a considerable lower trend and an alarming worsening of the current adolescents’ physical condition when comparing with previous decades, especially in urban populations. The aim of the current study was to analyse the temporal trend in cardiorespiratory endurance (CRE) in urban Catalan adolescents over a 20-year period (1999–2019).

Methods

A cross-sectional analysis study considering the 20-m Shuttle Run test (SRT) results obtained in the last 20 years was carried out. 1,701 adolescents between 15 and 16 years old (914 boys and 787 girls) were divided into four groups, corresponding to consecutive periods of five years (Group 1: 1999–2004; Group 2: 2005–2009; Group 3: 2010–2014 and Group 4: 2015–2019). ANOVA was used to test the period effect on CRE and post hoc Bonferroni analysis was performed to test pairwise differences between groups (p < 0.05).

Results

Results showed a significantly lower performance in CRE in both sexes. The percentual negative difference was 0.67%, 9.6% and 7% for boys and 5.06%, 14.97% and 9.41% for girls, when comparing the performance in 20-m Shuttle Run test for the first period, respectively.

Conclusions

Results suggest that the physical fitness of Catalan urban adolescents is lower in both sexes when comparing the different analysed periods of time. Therefore, CRE adolescents should be improved in order to help to protect against cardiovascular disease and other health risks in adulthood.

Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation's youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China's more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Effects of Exercise on Plantar Pressure during Walking in Children with Overweight/Obesity

PURPOSE

To investigate the effect of a 13-wk exercise program, based on "movement quality" and "multigames" work, on plantar pressure during walking in children with overweight/obesity (OW/OB).

METHOD

Seventy children (10.8 ± 1.2 yr, 58.5% girls) with OW/OB, as defined by the World Obesity Federation, were assigned to either a 13-wk exercise program (intervention group [EG]; n = 39), or to a usual lifestyle control group (CG) (n = 31). Children underwent assessments of basic anthropometry (weight and height) and plantar pressure during walking before and after the intervention period, recording plantar surface area (cm), maximum force (N), and force-time integrals (N·s).

RESULTS

After the 13-wk intervention period, the EG participants showed no significant change in total plantar surface area, while the CG participants experienced an increase in this variable (small effect size, -2.5 SD; P = 0.015). Compared with the GC participants, the EG participants showed a greater increase in the maximum force supported beneath the forefoot during walking at the end of the intervention period (small effect size, 0.33 SD; P = 0.012), specifically under the lateral and medial forefoot (both P < 0.05). Force-time changed similarly in both groups by the end of the intervention period (all regions P > 0.05).

CONCLUSIONS

These results suggest the exercise program led to positive structural and functional changes in plantar pressure during walking. The increase in maximum force supported by the forefoot in the EG children might indicate a change toward a more normal foot rollover pattern and a more adult gait.

Multicomponent Exercise Training Combined with Nutritional Counselling Improves Physical Function, Biochemical and Anthropometric Profiles in Obese Children: A Pilot Study

Aerobics or strength exercise plus diet interventions have been shown to counteract childhood obesity. However, little is known with regard to periodized multicomponent exercise interventions combined with nutritional counselling, which might be less demanding but more enjoyable and respectful of children and adolescents’ nature. In order to analyze the impact of such a multimodal approach, 18 obese children (10.8 ± 1.6 years; 63% females; z Body Mass Index 3 ± 0.4) trained for 60 min, twice weekly and were measured for body composition, biochemical parameters and physical function. We found that 16 weeks of multimodal intervention (14 of training), based on fun-type skill-learning physical activities and physical conditioning with challenging circuits and games, together with nutritional counselling, led to an attendance > 80%, with significant overall health improvement. Body composition was enhanced (p < 0.01 for z BMI, mid-upper-arm-circumference, waist-to-height ratio, tricipital and subscapular skinfolds, body-fat % by Slaughter equation and Dual energy X-ray absorptiometry body fat% and trunk fat%), as well as metabolic profile (LDL cholesterol, gamma-glutamyl transferase , alanine aminotransferase ; p < 0.05), homeostatic model assessment of insulin resistance (HOMA-IR; p < 0.05) and inflammatory response (C-Reactive Protein; p < 0.05). Physical fitness was also improved (p < 0.01) through better cardiovascular test scores and fundamental movement patterns (Functional Movement Screen-7, FMS-4). Tailoring multimodal supervised strategies ensured attendance, active participation and enjoyment, compensating for the lack of strict caloric restrictions and the low volume and training frequency compared to the exercise prescription guidelines for obesity. Nutritional counselling reinforced exercise benefits and turned the intervention into a powerful educational strategy. Teamwork and professionals’ specificity may also be key factors.

Influence of Adiposity on Physical Activity in Schoolchildren: The Moderator Role of Adherence to the Mediterranean Diet

Background: Studies were performed in order to determine the existing relationship between body composition and both physical activity (PA) levels and food habits. Nevertheless, no study has yet examined if the association between adiposity and PA in children is moderated by adherence to the Mediterranean diet (MD). Methods: the cross-sectional and associative analysis involved a total of 370 children (55.1% boys) aged 6–13, from six different schools from the Murcia region of Spain. Results: The different values of moderator [adherence to the MD expressed as a Mediterranean Diet Quality Index (KIDMED) score] are shown by the slope and the different areas of significance. The first area was shown below ≤3.8, indicating that the unfavorable influence of excess of adiposity on PA could be intensified for children in this area. The second area was a significant positive area was shown above ≥9.3, expressing that the unfavorable influence of adiposity could be reduced for those who were above this estimation point. Conclusion: Our findings reveal that the adverse effects of excess adiposity on PA can be moderated by adherence to the MD among schoolchildren.

Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children

Importance

Childhood obesity is one of the biggest public health threats facing the UK, and video game use is considered a risk behavior for obesity among children. However, few studies have explored the prospective association between video game use and body mass index (BMI) or the potential mediators of this association.

Objectives

To investigate whether a longer-term association exists between video game use at a young age and BMI SD score in later years, independent of television use, and to ascertain whether this association is mediated by other energy-balance behaviors.

Design, Setting, and Participants

This cohort study is a secondary analysis of data from the Millennium Cohort Study, a nationally representative sample of children who were born in the UK between September 1, 2000, and January 31, 2002, that focused on data collected when the children were aged 5, 7, 11, and 14 years. Data for all variables, except BMI, were provided by parental or caregiver reporting if the children were younger than 14 years of age. At age 14 years, the children self-reported their own behavior. Initial data analysis was conducted between September 18, 2018, and September 28, 2018, with supplementary analyses conducted from October 7, 2019, to November 22, 2019.

Main Outcomes and Measures

The main outcome variable was BMI SD scores, with video game use as the exposure variable of interest. Physical activity, bedtime regularity, sugar-sweetened beverage consumption, and high-calorie food consumption were included as potential mediating behaviors.

Results

The full sample comprised 16 376 children and had a nearly equal number of boys (8393 [51.3%]) and girls (7983 [48.7%]). Every 1 SD increase in the number of hours of video game use at age 5 years was associated with a β = 0.018 higher BMI SD score at age 14 years (95% CI, 0.004-0.032). A small partial mediation of this association was found (direct association: β = 0.017 [95% CI, 0.003-0.031]; indirect association: β = 0.0011 [95% CI, 0.0003-0.0019]), suggesting that irregular bedtimes and higher consumption of sugar-sweetened beverages were mediators. The mediation model accounted for 36.7% (95% CI, 35.5-37.8) of the variance of the BMI SD score at age 14 years.

Conclusions and Relevance

Results of this study suggest a small (and not clinically meaningful) association between video game use in early childhood and higher BMI in later years, which may be mediated by irregular bedtimes and higher consumption of sugar-sweetened beverages. Future interventions to prevent childhood obesity should incorporate health promotion in mainstream video games to target children most at risk because of their high level of video game use.

Higher Cardiorespiratory Fitness Levels May Attenuate the Detrimental Association between Weight Status, Metabolic Phenotype and C-Reactive Protein in Adolescents-A Multi-Cohort Study

Results from several studies show that only obese, unfit subjects, but not obese, fit subjects, are at higher mortality risk than are normal-weight fit subjects. The aim of the study was two-fold: (1) to examine the differences in C-reactive protein levels across different metabolic phenotypes (healthy and unhealthy) of weight status and (2) ascertain whether high levels of cardiorespiratory fitness (CRF) attenuate the association of C-reactive protein and metabolic phenotypes of weight status. This was a pooled study, which included data from three cross-sectional projects (1706 youth (921 girls) aged 12-18 years). We used a Shuttle run test to assess CRF. Adolescents were classified into six metabolic phenotypes (healthy and unhealthy) of weight status (non-overweight, overweight and obese), based on age- and sex-specific cutoff points for triglycerides, systolic blood pressure, HDL-cholesterol, glucose and body mass index. High-sensitivity assays were used to obtain the C-reactive protein as inflammatory biomarker. After adjustment for potential confounders (age, sex, pubertal stage and country), the analysis of covariance (ANCOVA) shows that C-reactive protein is directly associated with metabolic phenotypes of weight status. Subjects with obesity, regardless of their metabolic profile, had higher levels of C-reactive protein Z-score. In addition, (after adjustments for potential confounders) a two-way ANCOVA showed that high levels of CRF attenuated the associations of C-reactive protein levels in metabolic healthy non-overweight and in adolescents with obesity. In conclusion, higher CRF levels may attenuate the detrimental association between obesity and C-reactive protein independently of metabolic phenotype. Findings from this study are important for prevention, clinical practice on issues associated with adiposity and metabolic disorders.

Study protocol and baseline characteristics of "SCHOOL IN ACTION" program on support to physical activity and healthy lifestyles in adolescents

Physical activity promotes positive effects on people's health, but most adolescents do not engage in sufficient physical activity to receive the benefits. Studies suggest that school-based interventions can be effective in increasing physical activity in adolescents. However, the literature is inconsistent on the effect size and the type of intervention. This paper presents the design of the SCHOOL IN ACTION program to increase physical activity engagement and healthy eating habits. The cluster randomized controlled trial was performed during a period of six months of intervention and 12 months of follow-up in adolescents from four Brazilian public schools. The theoretical model is based on health promoting schools and the social-ecological and self-determination theory. The action strategies were: improvement of exercises intensity during physical education classes and during lunch breaks; vegetable gardening experience; active breaks in non-physical education classes; counselling health to parents and adolescents and changes in the school environment to promote physical activity and healthy eating. Primary variables were physical activity and sedentary behavior (both assessed by accelerometers). Secondary variables were body composition (assessed by dual-energy x-ray absorptiometry) and eating habits (assessed by questionnaire and 3-day food recall). Questionnaires were used to assess other information related to life satisfaction, health behavior and socioeconomic information. Statistical analysis will follow the principles of intention-to-treat and will explore the composition data analysis and mediating factors of lifestyle-related behaviors. We propose that SCHOOL IN ACTION program will be effective to provide evidence to increase physical activity and food healthy habits in adolescents' students.

ClinicalTrials.gov registration: NCT03153176.

TRIAL STATUS: Follow-up and data analysis.

Exceptional Reported Effects and Data Anomalies Merit Explanation from "A randomized controlled trial of coordination exercise on cognitive function in obese adolescents" by

We read the recent article in Psychology of Sport and Exercise by Liu et al. ("A randomized controlled trial of coordination exercise on cognitive function in obese adolescents") with great interest. Our interest in the article stemmed from the extraordinary differences in obesity-related outcomes reported in response to a rope-jumping intervention. We requested the raw data from the authors to confirm the results and, after the journal editors reinforced our request, the authors graciously provided us with their data. We share our evaluation of the original data herein, which includes concerns that weight and BMI loss by the intervention appears extraordinary in both magnitude and aspects of the distributions. We request that the authors address our findings by providing explanations of the extraordinary data or correcting any errors that may have occurred in the original report, as appropriate.

Effects of high-intensity interval training and nutrition advice on cardiometabolic markers and aerobic fitness in adolescent girls with obesity

The aim of the study was to compare the effects of high-intensity interval training (HIIT) and nutrition advice on cardiometabolic biomarkers, hormonal parameters, and cardiorespiratory fitness in adolescent girls with obesity. Adolescent girls with obesity (n = 44, aged 13-19 years) were randomized into a 12-week intervention as follows: (i) dietary advice and HIIT (n = 22), and (ii) dietary advice only (n = 22). The concentration of biomarkers of inflammation, biochemical and hormonal testing, oral glucose tolerance test, cardiorespiratory fitness, physical activity levels, and nutrition were assessed. After a 3-month intervention, the diet+HIIT group significantly increased insulin sensitivity index (-0.34 ± 1.52 vs. 1.05 ± 3.21; p = 0.001) and work load (0.6 ± 11.3 W vs. 14.6 ± 20.2 W; p = 0.024) and decreased glucose area under the curve (-0.29 ± 4.69 vs. -0.98 ± 4.06; p = 0.040), insulin area under the curve (-9.65 ± 117.9 vs. -98.7 ± 201.8; p = 0.003), and high-sensitivity C-reactive protein (hs-CRP) (0.12 ± 1.92 mg/L vs. -1.47 ± 3.67 mg/L; p = 0.039) in comparison with the diet group. Regarding within-group changes, both groups had significant improvements in body mass index (BMI), BMI-standard deviation score, body fat percentage, and systolic blood pressure. Positive impact on waist circumference, waist circumference/height ratio, diastolic blood pressure, hs-CRP, work load, maximal heart rate, and resting heart rate was observed only after the diet+HIIT intervention. No significant change was noted in peak oxygen uptake, lipid profile, and hormonal parameters between groups after intervention. Novelty HIIT and nutrition advice increased insulin sensitivity and decreased BMI, body fat, systolic blood pressure, and diastolic blood pressure. Nutrition advice decreased BMI, body fat, and systolic blood pressure in adolescent girls with obesity.

Grip Strength Moderates the Association between Anthropometric and Body Composition Indicators and Liver Fat in Youth with an Excess of Adiposity

Paediatric non-alcoholic fatty liver disease (NAFLD) is considered the most common early driver of chronic liver disease. The aim of this study was to examine whether grip strength moderates the association between anthropometric and body composition parameters and controlled attenuation parameter (CAP), an indicator of fat deposits in the liver, in children and adolescents with excess of adiposity. A total of 127 adolescents (67% girls) aged between 11 and 17, attending two public schools in Bogotá (Colombia), who had an axiological evaluation of obesity were included in this study. A grip strength test was assessed as an indicator of muscular strength, and cardiorespiratory fitness by maximal oxygen uptake was assessed using the 20 m shuttle-run test. Waist circumference (WC), waist-to-height ratio (WHtR), fat mass, and visceral adipose tissue (VAT) (cm³) were included as anthropometric and body composition measures. CAP was determined with a FibroScan^® 502 Touch device (Echosens, Paris, France). The anthropometric and body composition parameters including WC, WHtR, fat mass, and VAT were positively associated with the CAP (range β = 0.423 to 0.580), slightly reduced after being adjusted for handgrip strength/weight. The Johnson-Neyman technique revealed a significant inverse relationship between WC, WHtR, VAT, and CAP when grip strength normalized by body mass was above but not equal to or below 0.475 (8.1% of the sample), 0.469 (8.9% of the sample), and 0.470 (8.5% of the sample), respectively. In conclusion, grip strength adjusted by body mass, has a moderating effect on the association between anthropometric and body composition parameters (including WC, WHtR, and VAT) and CAP in in children and adolescents with excess of adiposity, suggesting the importance of promoting muscular strength during paediatric population in order to prevent NAFLD.