Sport-based physical activity intervention on body weight in children and adolescents: a meta-analysis

Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study

BACKGROUND

Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status.

METHODS

Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES.

RESULTS

A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES.

CONCLUSIONS

When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.

Association between sports participation and overall health in children and adolescents

Emerging evidence revealed that participating in sports may have benefits for health, but the association between sports participation and self-rated overall health has not been clearly established in children and adolescents. The present study aimed to examine the cross-sectional relationships between sports participation and self-rated overall health. A national sample of 42,777 (mean age = 9.4 ± 5.2, 48.3% girls) United States children and adolescents completed self-administered questionnaires and were included in the final analysis. The crude and adjusted odds ratio (ORs) and 95% CI were used to analyze the association between sports participation and self-rated overall health. Results indicated that children and adolescents participated in sports were more likely to report better overall health (OR = 1.92, 95%CI: 1.83, 2.02) compared to those not participating in sports. This study found that sport participation was positively associated with self-rated overall health in children and adolescents. This study offers evidence concerning adolescents' health literacy promotion.

Relationship between Type and Intensity of Sports Activities and the Prevalence of Overweight in Serbian School Children

This study aimed to explore the relationship between different forms and intensities of sports activities and the prevalence of overweight in primary school children. Using International Obesity Task Force BMI criteria, we have identified body weight status in a group of 2893 children aged 9–15 years participating in 27 different sports and within a group of 4987 non-active children of the same age. We have compared the prevalence of overweight and obesity between these groups, as well as between genders and different forms and intensities of sports, within the group of active children. We have found lower prevalence of overweight (Χ2 = 41.689, DF = 1, p < 0.001), as well as prevalence of obesity (Χ2 = 175.184, DF = 1, p < 0.001) in physically active children compared with their non-active counterparts, as expected. Overweight (including obesity) had the highest prevalence in mixed sports of the Classification of Sports of the European Association of Preventive Cardiology, in boys (p = 0.003), as well as in girls (p = 0.043). A lower prevalence of overweight was noted in boys (p = 0.001), as well as in girls (p = 0.025) with more than 7 years of training. Regarding the number of hours of training per week, a lower prevalence of overweight was noted only in girls with 4 and more hours of training per week (p = 0.025). Concerning intensity, we have found a significant drop in the prevalence of overweight in children with sports activities whose intensity is more than 60 MET-hours per week. We conclude that a significant relationship between sports and the prevalence of overweight is found in children with more than 60 MET-hours of sports activities per week, as well as among children involved in mixed sports, and after more than 7 years spent in regular sports training.

Does organized sports participation in childhood and adolescence positively influence health? A review of reviews

•

Eight systematic reviews on organized sports participation related to health exist.

•

Organized sports participation has a moderate effect on crude body weight loss.

•

Dose relates to anxiety, depression, physical activity, and bone health responses.

•

Associations with psychological and social health were inconclusive.

•

Experimental and longitudinal population-based observational studies are needed.

Sports participations have the potential for both positive and negative health outcomes. We hence aimed (i) to assess systematically reviewed associations between organized sports participation in children and adolescents and their health, and (ii) to assess qualitative syntheses of experiences among children and adolescents concerning organized sports participation and health. A search was undertaken in April 2020 across the databases MEDLINE, EMBASE, APA PsycInfo (Ovid), Scopus, SPORTDiscus (EBSCOhost), and specialized databases for reviews. The recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction, and data synthesis was used. Systematic reviews were included that covered children and/or adolescents aged ≤ 18 years, and adult participants with retrospective exposure to—or experiences of—organized sports participation before the age of 19 and examining health outcomes and experiences (Prospero protocol CRD 42020206677). Five reviews based mainly on cross-sectional data, two mainly on longitudinal data, and one on experimental studies were included. A causal relationship of moderate-to-high level of evidence between organized sports participation and moderate crude weight reduction accentuated by diet control and team sports was identified. Evidence of causal relationships between sports participation and reduced anxiety, and depression and increased physical activity was at a moderate level. Evidence of causal relationships between sports participation and health was of low-to-moderate level concerning obesity status (inconclusive), bone health (positive), and psychological and social health (positive and negative). Causal relationships between organized child and adolescent sports participation and health remain uncertain. Experimental and well-conducted longitudinal primary studies are highly warranted.

Effects of Gamification on Behavioral Change in Education: A Meta-Analysis

BACKGROUND

Gamified reward systems, such as providing digital badges earned for specific accomplishments, are related to student engagement in educational settings. The purpose of this study was to conduct a meta-analytic review to quantify the effects of gamified interventions on student behavioral change.

METHODS

A meta-analysis was performed using the following databases: The Academic Search Complete, Communication & Mass Media Complete, Education Source, ERIC, Library Information Science & Technology Abstracts, and PsycINFO. Inclusion in the review required: (a) peer-reviewed conducted between 2010 and 2019, (b) experimental controlled design, (c) gamification elements, and (d) educational setting.

RESULTS

Using a random-effects model, a statistically significant (Cohen's d (ES) = 0.48, 95% CI = 0.33, 0.62) gamification effect was evidenced by moderate and positive grand effects sizes (ES). Gamification effects were higher with adults in higher education (ES = 0.95) than K-12 students (ES = 0.92). Brief interventions delivered in days or less than 1 week were significantly more effective (ES = 1.57) than interventions lasting up to 20 weeks (ES = 0.30). Interventions incorporating gamification elements across years (ES = -0.20) was adversely associated with behavioral change.

CONCLUSIONS

Findings suggest that short-term over longer-term gamified interventions might be a promising way to initiate changes in learner's behaviors and improve learning outcome.

Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis

OBJECTIVE

This study aimed to examine (1) the independent effects of hypoxia on cognitive function and (2) the effects of exercise on cognition while under hypoxia.

METHODS

Design: Systematic review with meta-analysis.

DATA SOURCES

PubMed, Scopus, Web of Science, PsychInfo, and SPORTDiscus were searched. Eligibility criteria for selecting studies: randomized controlled trials and nonrandomized controlled studies that investigated the effects of chronic or acute exercise on cognition under hypoxia were considered (Aim 2), as were studies investigating the effects of hypoxia on cognition (Aim 1).

RESULTS

In total, 18 studies met our inclusionary criteria for the systematic review, and 12 studies were meta-analyzed. Exposure to hypoxia impaired attentional ability (standardized mean difference (SMD) = -0.4), executive function (SMD = -0.18), and memory function (SMD = -0.26), but not information processing (SMD = 0.27). Aggregated results indicated that performing exercise under a hypoxia setting had a significant effect on cognitive improvement (SMD = 0.3, 95% confidence interval: 0.14 - 0.45, I2 = 54%, p < 0.001). Various characteristics (e.g., age, cognitive task type, exercise type, exercise intensity, training type, and hypoxia level) moderated the effects of hypoxia and exercise on cognitive function.

CONCLUSION

Exercise during exposure to hypoxia improves cognitive function. This association appears to be moderated by individual and exercise/hypoxia-related characteristics.

Effects of Accumulated Short Bouts of Exercise on Weight and Obesity Indices in Adults: A Meta-Analysis

OBJECTIVE

To compile and quantify the effectiveness of accumulated short-bout exercise interventions on reducing the obesity indices in adults using meta-analysis.

DATA SOURCE

PubMed, PsycINFO, CINAHL, Cochrane Library, and SportDiscus.

STUDY INCLUSION AND EXCLUSION CRITERIA

(1) Description of a short-bout exercise trial (<30 minutes); (2) obesity indices must be measured pre- and postintervention; and (3) only adults and published in English.

DATA EXTRACTION

Two independent reviewers extracted data and assessed the quality of the studies included. Of 3257 articles retrieved, 18 studies met the inclusion criteria. Based on the Downs and Black checklist, the methodological quality of the included studies was fairly robust.

DATA SYNTHESIS

Pooled effect sizes (ESs) were calculated using a random effects model.

RESULTS

Average intervention length was approximately 16 weeks (ranged from 4 to 72 weeks). All weighted mean ES values for each obesity index measure were non-negative, ranging from small to large (ES = 0.33-0.96) in magnitude. Weighted mean ES for body mass (BM; n = 18; ES = 0.51, 95% confidence interval [CI] = 0.22-0.80), body mass index (BMI; n = 13; ES = 0.61, 95% CI = 0.24-0.97), waist circumference (n = 9; ES = 0.44, 95% CI = 0.15-0.73), body fat percentage (BF%; n = 8; ES = 0.33, 95% CI = 0.09-0.58), skinfold (n = 7; ES = 0.96, 95% CI = 0.39 -1.53), and fat mass (FM; n = 6; ES = 0.55, 95% CI = 0.21-0.90) were statistically significant. Moderator effects of intervention length (weeks) were observed for BM (Q_between [Cochran's Q: a measure of heterogeneity between studies] = 6.83, P < .05); BMI (Q_between = 13.93, P < .05); and FM (Q_between = 10.41, P < .05). Intervention length >10 weeks was more effective than shorter (≤10) intervention period for reducing BM, BMI, and FM.

CONCLUSION

Accumulated short bouts of exercise have a beneficial effect on reducing the obesity indices among adults. The current study can help health researchers and practitioners in designing their intervention programs, which can be applied within schools, clinics, and communities.

The Effectiveness of Physical Activity Interventions for Low-Income and Ethnic Minority Children and Youths: A Meta-Analysis

Background: Children and youths from low-income families and certain ethnic minority groups show high levels of risk and vulnerability to physical inactivity. The aim of this review was to examine the effectiveness of interventions to increase physical activity (PA) in children and youths from low-income and ethnic minority (LIEM) families. Methods: Eight databases were systematically searched for PA interventions for LIEM children and youths. Twenty-six studies were included in the analyses. Effect sizes (ESs) were calculated using a random-effects model. The ESs were computed using Hedges g with 95% confidence interval. Results: There were small to medium effects of interventions on PA in LIEM children and youth (Q = 1499.193, df = 30, P < .05; I2 = 97.999). Analyses on the moderator variables showed that ES for participants aged 9–12 years (ES = 0.542, P = .01); intervention length less than 13 weeks (ES = 0.561, P = .01); specialists as the intervention agent (ES = 0.680, P < .05); interventions without technology (ES = 0.363, P = .02); and interventions with a behavioral modification component (ES = 0.336, P = .03) were significantly different from zero. Conclusion: PA intervention can be an effective strategy to increase PA for LIEM children and youths.

Overview of meta-analysis on prevention and treatment of childhood obesity

OBJECTIVES

This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents.

DATA SOURCE

A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed.

SUMMARY OF DATA

A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term.

CONCLUSION

The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Trends and Prevalence of Overweight and Obesity among Children Aged 2-7 Years from 2011 to 2017 in Xiamen, China

BACKGROUND

Childhood overweight and obesity have become some of the most serious public health problems in the 21st century and have a significant impact on affected children as they grow into adulthood.

OBJECTIVE

The purpose of this study was to evaluate the overweight and obesity status and their main influencing factors in preschool children aged 2-7 years in urban areas of China between 2011 and 2017.

METHODS

A stratified cluster random sampling method was used to conduct a sample survey of children aged 2-7 years in Xiamen, one of China's five special economic zones. The 56,738 participants (29,444 boys, 27,294 girls) were examined at three time points (15,757 in 2011, 19,098 in 2014, and 21,883 in 2017), and were analyzed for factors influencing obesity.

RESULTS

Between 2011 and 2017, the prevalence of overweight and obesity in preschool children between 2 and 7 years old was 10.91 and 5.66%, respectively. The overweight and obesity rates were higher in boys (11.85 and 7.11%) than in girls (9.90 and 4.09%), and the difference was statistically significant (p < 0.01). In the past 7 years, the overweight and obesity rates showed a downward trend in both boys and girls (p < 0.01). The peak ages for overweight were 6 years in boys and 2 years in girls, while the obesity rate peaked at 6 years. In those children with obesity, the proportion of those with moderate to severe obesity decreased from 40.70% in 2011 to 32.80% in 2017. Multiple stepwise regression analysis showed that children who were averse to sports activities preferred greasy foods and had earlier introduction of solid foods as infants, as well as those who were born at a high birth weight, ate fast, and those with parents with obesity were more likely to have obesity themselves (p < 0.05).

CONCLUSIONS

Although preventative and control measures for childhood obesity have achieved initial results, Chinese preschool children remain to have high levels of overweight and obesity. It is therefore necessary to strengthen monitoring of overweight and obesity in preschool-aged children and implement appropriate interventions when necessary.

Effects of exercise intervention on visceral fat in obese children and adolescents

INTRODUCTION

This meta-analysis study was aimed to assess the effects of exercise intervention on visceral fat in obese children and adolescents.

EVIDENCE ACQUISITION

Electronic database searches were performed in Academic Search Complete, CINAHL, Healthsource, MEDLINE, and SportDiscus, and from the earliest record to November 2017. Keywords included "exercise or training," "visceral fat," and "child or adolescent or youth." The inclusion criteria for eligible studies were as follows: 1) subjects were obese at baseline; 2) aged 6-19 years; 3) visceral fat was reported at baseline and after an intervention; and 4) studies were published in peer-reviewed journals written in English.

EVIDENCE SYNTHESIS

A total of 207 studies were observed at the initial search and 73 effect sizes (ESs) were derived from the 34 selected studies. The overall exercise intervention effect was large (Cohen's d [ES]=-1.003, 95% CI=-1.114, -0.892). Moderator analyses results showed that gender (Qb=8.23, df=2, P=0.016), exercise type (Qb=10.68, df=2, P=0.005), and intervention length (Qb=24.71, df=2, P<0.001) influenced the overall ES.

CONCLUSIONS

The group of both boys and girls (ES=-0.95) who participated combined exercise program (Aerobic + Resistance training; ES=-1.17) for 12 months (ES=-1.24) appeared to be the most effective exercise strategy for reducing visceral fat in obese youth.