Effects of high-intensity intermittent running exercise in overweight children

Effect of high-intensity interval training on cardiorespiratory in children and adolescents with overweight or obesity: a meta-analysis of randomized controlled trials

Objective

This meta-analysis aimed to examine the effect of high-intensity interval training on cardiorespiratory fitness in children and adolescents with overweight or obesity, and to explore the optimal dose of high-intensity interval training to improve cardiorespiratory fitness in children and adolescents with overweight or obesity.

Methods

Randomized controlled trials on the effects of HIIT on cardiorespiratory fitness in children and adolescents with overweight or obesity were retrieved from six electronic databases, including PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. The quality assessment of the included studies was conducted following the revised quality evaluation method based on the PRISMA principles. Keywords for literature search mainly include high-intensity interval, cardiorespiratory fitness, overweight, obese, children, and adolescent, etc.

Results

(1) A total of 18 studies, comprising 581 participants (288 in the intervention group and 293 in the control group), were included and all of them were of moderate to high quality. (2) HIIT had a positive effect on the cardiorespiratory fitness levels of in children and adolescents with overweight or obesity (SMD = 0.91; 95% CI: 0.66, 1.15; p < 0.00001). (3) The improvement in cardiorespiratory fitness was more significant when the HIIT intervention lasted for more than 10 weeks (SMD = 1.04; 95% CI: 0.74, 1.34; p < 0.00001), was conducted 3 times per week, with 2 to 8 sets per session (SMD = 1.13; 95% CI: 0.71, 1.55; p < 0.00001), and maintained a ratio of approximately 1:1 between exercise and rest intervals (SMD = 1.11; 95% CI: 0.73, 1.50; p < 0.00001).

Conclusion and recommendations

(1) Long-term HIIT can improve cardiorespiratory fitness in children and adolescents with overweight or obesity. (2) To achieve significant improvements in cardiorespiratory fitness in a short period, children and adolescents with overweight or obesity can engage in HIIT programs lasting for more than 10 weeks, conducted 3 times per week, with 2 to 8 sets per session, and a ratio of approximately 1:1 between exercise and rest intervals.

Systematic Review Registration

Identifier: INPLASY202350033.

School-based high-intensity interval exercise program in children with overweight induce a greater improvements in body composition and physical fitness than moderate-intensity continuous exercise

BACKGROUND

High-intensity interval running exercise (HIIE) is emerging as a time-efficient exercise modality for improving body composition and fitness in comparison with moderate-intensity continuous aerobic exercise (MICE); however, existing evidence is still unclear in children with overweight and thus we compared the effects of HIIE and MICE on body composition, muscular, and cardiorespiratory fitness in children with overweight.

METHODS

In this randomized study, 40 male children with overweight aged 7-10 years were divided into an 8-week exercise regime: (1) HIIE group [n = 20; 2 sets of 15 × 20s at 85-95% maximal aerobic speed (MAS) separated by 15 × 20s recovery at 50% MAS, 3 days per week] and (2) MICE group [n = 20; 30 min at 60-70% MAS, 3 days per week]. Body composition, muscular and cardiorespiratory fitness were assessed before and after the 8-week intervention at similar times and conditions of the day.

RESULTS

Following the 8-week HIIE protocol, weight, BMI, and fat mass decreased significantly (weight: - 1.4% vs. 0.2%, p < 0.05; BMI: - 3.1% vs. - 0.7%, p < 0.05; fat mass: - 7.7% vs. - 1.6%, p < 0.01) as compared with MICE; while the VO2peak and MAS increased significantly in both groups, the increase in HIIE group was significantly greater than that of MICE group (VO2peak: 10.3% vs. 3.5%, p < 0.01; MAS:7.7% vs. 4.5%, p < 0.05). Although significant improvements in muscular fitness were observed in HIIE and MICE groups [counter movement jump (CMJ): 7.8% vs. 5.4%; sprinting ability: - 3.7% vs. - 1.7%], no significant differences were seen between them (p > 0.05).

CONCLUSION

Our findings suggested that school-based HIIE intervention was highly in improving body composition and cardiorespiratory fitness of children with overweight than the MICE regime; however, MICE still provided improvements over time that were just not to the same magnitude of HIIE.

The effect of 4 weeks of high-intensity interval training and 2 weeks of detraining on cardiovascular disease risk factors in male adolescents

NEW FINDINGS

What is the central question of this study? What is the effect of 4 weeks of high-intensity interval training (HIIT) and 2 weeks of detraining on vascular function and traditional cardiovascular disease (CVD) risk factors in male adolescents? What is the main finding and its importance? Four weeks of HIIT improved macrovascular function in adolescents. However, this training period did not measurably change microvascular function, body composition or blood biomarkers. Following 2 weeks of detraining, the improvement in flow-mediated dilatation (FMD) was lost. This highlights the importance of the continuation of regular exercise for the primary prevention of CVD.

ABSTRACT

High-intensity interval training (HIIT) represents an effective method to improve cardiometabolic health in adolescents. This study aimed to investigate the effect of 4 weeks of HIIT followed by 2 weeks of detraining on vascular function and traditional cardiovascular disease (CVD) risk factors in adolescent boys. Nineteen male adolescents (13.3 ± 0.5 years) were randomly allocated to either a training (TRAIN, n = 10) or control (CON, n = 9) group. Participants in TRAIN completed 4 weeks of HIIT running with three sessions per week. Macro- (flow-mediated dilatation, FMD) and microvascular (peak reactive hyperaemia, PRH) function, body composition (fat mass, fat free mass, body fat percentage) and blood biomarkers (glucose, insulin, total cholesterol, high- and low-density lipoprotein, triacylglycerol) were assessed pre-, 48 h post- and 2 weeks post-training for TRAIN and at equivalent time points for CON. Following training, FMD was significantly greater in TRAIN compared to CON (9.88 ± 2.40% and 8.64 ± 2.70%, respectively; P = 0.036) but this difference was lost 2 weeks after training cessation (8.22 ± 2.47% and 8.61 ± 1.99%, respectively; P = 0.062). No differences were detected between groups for PRH (P = 0.821), body composition (all P > 0.14) or blood biomarkers (all P > 0.18). In conclusion, 4 weeks of HIIT improved macrovascular function; however, this training period did not measurably change microvascular function, body composition or blood biomarkers. The reversal of the FMD improvement 2 weeks post-training highlights the importance of the continuation of regular exercise for the primary prevention of CVD.

Effects of a High Intensity Interval Training (HIIT) Program on Anthropomorphic and Cardiometabolic Variables in School Children with Overweight and Obesity

The aim of this study was to assess the effects of a high intensity interval training (HIIT) program on anthropomorphic and cardiometabolic variables in schoolchildren with overweight and obesity. A total of 443 schoolchildren (age: 6.37 ± 0.65 years) took part in this study. The experimental group (EG; n = 295; age = 6.40 ± 0.64 years) was compound with children with overweight and obesity, whereas children with normoweight were included in the control group (CG; n = 148; 6.31 ± 0.67 years). The EG performed a training program based on HIIT two times per week for 28 weeks (56 sessions), whilst the CG performed their habitual physical education classes based on the national curriculum. Body mass index (BMI), waist circumference, body fat, ∑ 4 skinfold fat, waist to height ratio, waist circumference, and cardiometabolic risk were measured. The dependent variables were analysed by two-way analysis of covariance (ANCOVA 2 × 2). To analyse the percentage differences between groups, the chi-square test was used. P-value was set at p < 0.05. Significant differences were found in the EG in BMI, waist circumference, body fat, ∑ 4 skinfold fat, and waist to height ratio. In conclusion, an HIIT training program can be an effective tool for improving anthropomorphic variables and reducing cardiometabolic risk in schoolchildren with overweight and obesity.

Efficacy of traditional Chinese exercise for obesity: A systematic review and meta-analysis

BACKGROUND

Obesity is considered one of the biggest public health problems, especially in the background of the coronavirus disease 2019 (COVID-19) lockdown. It is urgent to find interventions to control and improve it. We performed this systematic review and meta-analysis to summarize the effect of traditional Chinese exercise on obesity.

METHODS

We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang database for updated articles published from the inception of each database to June 2022. Randomized controlled trials (RCTs) on traditional Chinese exercise in weight reduction were included, and related data were extracted. The random-effects model was used to adjust for the heterogeneity of the included studies, and funnel plots were used to examine publication bias.

RESULTS

A total of 701 participants were included in the 10 studies. Compared with the control group, the outcome of body weight [mean difference (MD) = -6.10; 95% CI = -8.79, -3.42], body mass index (MD = -2.03; 95% CI = -2.66, -1.41), body fat mass (MD = -3.12; 95% CI = -4.49, -1.75), waist circumference (MD = -3.46; 95% CI = -4.67, -2.24), hip circumference (MD = -2.94; 95% CI = -4.75, -1.30), and waist-to-hip ratio (MD = -0.04; 95% CI = -0.06, -0.03) in the intervention group had significant differences. Egger's test and funnel plots showed that the potential publication bias of the included studies was slight (p = 0.249).

CONCLUSION

Traditional Chinese exercise is an effective treatment for obesity; people under the COVID-19 lockdown could do these exercises to control weight. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles.

SYSTEMATIC REVIEW REGISTRATION

www.crd.york.ac.uk/PROSPERO/, identifier CRD42021270015.

Effects of high-intensity interval training on physical morphology, cardiorespiratory fitness and metabolic risk factors of cardiovascular disease in children and adolescents: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the safety and efficacy of high-intensity interval training in children and adolescents.

METHODS

Eight databases were searched. Descriptive analysis of the efficacy and safety of high-intensity interval training on body shape, cardiorespiratory fitness, and metabolic risk markers of cardiovascular disease in children and adolescents. Subgroup analysis was performed using age, participants, intervention time, and exercise frequency as covariates.

RESULTS

47 studies included 2995 children and adolescents. The results of the meta-analysis showed that high-intensity interval training significantly improved cardiorespiratory fitness indicators (VO2max, SBP, DBP and HRmax) and cardiovascular disease biomarkers (TC and HDL-C). HIIT had no significant effect on body shape indicators (BMI, BF% and WC) or cardiovascular disease biomarkers (TG and LDL-C).

CONCLUSION

Currently, there is insufficient evidence that HIIT with interval running as the predominant form improves physical indicators in children and adolescents. However, HIIT can be promoted in children and adolescents to improve cardiorespiratory fitness and reduce some metabolic risk of cardiovascular disease.

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).

Meta-analysis and systematic review of physical activity on neurodevelopment disorders, depression, and obesity among children and adolescents

Background

No consensus on whether physical activity (PA) is related to physical and mental health among pediatric population remains has been reached to date. To further explore their association, our study assessed the effect of PA on physical and mental health of children and adolescents through a systematic review and meta-analysis of randomized controlled studies (RCTs).

Methods

Several databases(Web of science, PubMed, Embase, Cochrane Central register of controlled trials, CINAHL) were searched from inception to 1st, December 2020 without language restrictions.

Results

38,236 records were identified primitively and 31 included studies with 1,255 participants eventually met our inclusion criteria, all of which exhibited a relatively low-moderate risk of bias of overall quality. In regard to mental health, the administration of PA, compared with the control group, led to moderate improvements in Autism Spectrum Disorder(ASD)[Standard mean difference (SMD) = -0.50, Confidence interval(CI): -0.87, -0.14)] and depression(SMD = -0.68, CI: -0.98, -0.38) among children and adolescents. Similarly, significant result was observed in obesity (SMD = -0.58, CI: -0.80, -0.36). No significant differences were observed in Attention deficit hyperactivity disorder (ADHD) (SMD = -0.29, CI: -0.59, 0.01).

Conclusion

Altogether, PA may have a beneficial effect on children and adolescents with ASD, depression and obesity; nevertheless, there is insufficient evidence to confirm its efficacy in ADHD. More large-scale population based randomized controlled trials are needed to explore more reliable evidence between them.

Effects and dose-response relationships of exercise intervention on weight loss in overweight and obese children: a meta-regression and system review

The aim of this study was to determine the effect of different exercise doses on weight loss in obese/overweight children. PubMed, Embase, SPORTDiscus, and the Cochrane library were searched from inception to November 2020 for randomized controlled trials. Fourty six trials involving 2,599 obese/overweight children were finally included. Different exercise dose interventions had different impacts. Exercise intervention reduce body weight (BW) by 1.46 kg (95% CI, -2.35 to -0.56, p=0.001), body fat percentage (BF%) by 2.24 (95% CI, -2.63 to -1.84, p<0.001) and body mass index (BMI) by 1.09 kg/m² (95% CI, -1.45 to -0.73, p<0.001). Each MET-h/week was association with 0.147 kg (95% CI, -0.287 to -0.007, p=0.039) decrease in BW, 0.060 (95% CI, -0.118 to -0.002, p=0.042) decrease in BF%, and 0.069 kg/m² (95% CI, -0.125 to -0.014, p=0.015) decrease in BMI. The findings suggest that there is a positive liner between exercise dose and weight loss, each MET-h/week associated with 0.147 kg, 0.060 and 0.069 kg/m² decrease in body weight, BF%, BMI, respectively.

The Mediating Effect of Physical Fitness and Dietary Intake on the Relationship of Physical Activity with Body Composition in High School Students

We aimed to investigate the relationship between physical activity (PA) and health-related physical fitness (PF) in adolescents and analyze if the associations of PA with body composition (BC) in adolescents are mediated by physical fitness or energy intake (EI). The participants were 236 adolescents (140 girls 16.1 ± 0.92 years). Cardiorespiratory fitness (CRF) was assessed using the Yo-YoITL1, and the push-up test was used to evaluate strength. BCs were measured on an electrical weight scale. Triaxial accelerometers were used to determine PA levels and moderate-to-vigorous PA (MVPA) levels. EI was estimated with a validated questionnaire. Mediation effects were estimated using bootstrapped 95% confidence intervals and were deemed significant if zero was not included in the intervals. The mediation analysis revealed an indirect effect of MVPA only through PF on BC, specifically through CRF on body fat (B = −0.0146, 95% BootCI (−0.0219; −0.0076)) and on lean body mass (B = 0.0096, 95% BootCI (0.0049; 0.0152)), as well as through upper body strength on body fat (B = −0.012, 95% BootCI (−0.0171; −0.0072)) and on lean body mass (B = 0.0059, 95% BootCI (0.003; 0.0095)). These results suggest that PA of at least a moderate intensity is relevant to BC and health-related PF in adolescents, regardless of the EI.

Concurrent Training Promotes Greater Gains on Body Composition and Components of Physical Fitness Than Single-Mode Training (Endurance or Resistance) in Youth With Obesity

The prevalence of obesity in the pediatric population has become a major public health issue. Indeed, the dramatic increase of this epidemic causes multiple and harmful consequences, Physical activity, particularly physical exercise, remains to be the cornerstone of interventions against childhood obesity. Given the conflicting findings with reference to the relevant literature addressing the effects of exercise on adiposity and physical fitness outcomes in obese children and adolescents, the effect of duration-matched concurrent training (CT) [50% resistance (RT) and 50% high-intensity-interval-training (HIIT)] on body composition and physical fitness in obese youth remains to be elucidated. Thus, the purpose of this study was to examine the effects of 9-weeks of CT compared to RT or HIIT alone, on body composition and selected physical fitness components in healthy sedentary obese youth. Out of 73 participants, only 37; [14 males and 23 females; age 13.4 ± 0.9 years; body-mass-index (BMI): 31.2 ± 4.8 kg·m-2] were eligible and randomized into three groups: HIIT (n = 12): 3-4 sets×12 runs at 80–110% peak velocity, with 10-s passive recovery between bouts; RT (n = 12): 6 exercises; 3–4 sets × 10 repetition maximum (RM) and CT (n = 13): 50% serial completion of RT and HIIT. CT promoted significant greater gains compared to HIIT and RT on body composition (p &lt; 0.01, d = large), 6-min-walking test distance (6 MWT-distance) and on 6 MWT-VO2max (p &lt; 0.03, d = large). In addition, CT showed substantially greater improvements than HIIT in the medicine ball throw test (20.2 vs. 13.6%, p &lt; 0.04, d = large). On the other hand, RT exhibited significantly greater gains in relative hand grip strength (p &lt; 0.03, d = large) and CMJ (p &lt; 0.01, d = large) than HIIT and CT. CT promoted greater benefits for fat, body mass loss and cardiorespiratory fitness than HIIT or RT modalities. This study provides important information for practitioners and therapists on the application of effective exercise regimes with obese youth to induce significant and beneficial body composition changes. The applied CT program and the respective programming parameters in terms of exercise intensity and volume can be used by practitioners as an effective exercise treatment to fight the pandemic overweight and obesity in youth.

The effects of exercises with a Pilates ball on balance, reaction time and dual-task performance of kindergarten children

Aim: This study investigated the effects of exercises conducted with a Pilates ball on the motor skills of preschool children. Methods: 62 preschool children were randomly divided into two groups: an intervention group (IG) (n = 30) and a control group (CG) (n = 32). Exercises with a Pilates ball were practiced in IG. The One Leg Standing test, Functional Reach test, Ruler Drop test and Timed-Up and Go test were the outcome measures. Results: Static balance performance and dual-task performance were found to be significantly improved in the intragroup and intergroup comparisons, favoring the IG (p < 0.05). Conclusion: The exercises carried out in this study were found to be effective on static balance and dual-task performance. The study can guide an exercise program for the preschool age group. Clinical Trial Registration: NCT04575441 (ClinicalTrials.gov).

High-intensity interval training in high-school physical education classes: Study protocol for a randomized controlled trial

Background

School and Physical Education classes (PEC) are privileged spaces, promoters of positive changes for the rest of life. High-Intensity Interval Training (HIIT) is presented as a time-efficient alternative to aerobic training, as it leverages the number of exercise participants, resulting in improvements in health outcomes. Despite the widespread interest in the advantages that the HIIT methodology reveals, there is a lack of randomized controlled studies investigating the impact on adolescents, mainly adressing adolescents’ environment, such as schools. This study aims to evaluate the utility of a HIIT program integrated into high-school PEC, as a strategy that allows students to improve their Physical Fitness, Physical Activity (PA) level, and Motivation for Exercise.

Methods

This study is a two-arm randomized controlled trial design with adolescents from the 10th to 12th grades (15–17 years). The trial will aim to recruit 300 students from 1 secondary school. The HIIT sessions will be applied in the first 10–15 min of each PEC, twice a week, for 16 weeks, ranged from 14 to 20 all-out bouts intervals, adopting a 2:1 work to rest ratio. A cut-point of ≥ 90% of maximal heart rate will be a criterion for satisfactory compliance to high-intensity exercise. A rated perceived exertion scale will be measured in each exercise session to estimate effort, fatigue, and training load. The control group will continue the usual programmed PEC. Study outcomes will be measured at baseline and after the HIIT program. Cardiorespiratory fitness is the primary outcome. Secondary outcomes include: muscular fitness, PA and motivation for exercise.

Discussion

HIIT protocols presents wide applicability in PEC and great adaptation to the facilities. The authors aim to provide novel HIIT protocols for schools.

Application of an Online Combination Exercise Intervention to Improve Physical and Mental Health in Obese Children: A Single Arm Longitudinal Study

Introduction: Childhood obesity has become a global public health concern in the past decade. The purpose of this study was to explore the effectiveness of an online combination exercise intervention in improving the physical and mental health of obese children.

Methods: This study adopted a one-group pre-test and post-test research design. A total of 28 obese children from 6 elementary schools in Heze City, Shandong Province, China, were recruited. All participants received an 8-week online combination exercise intervention and were tested at a three-month follow-up. Participants were tested and surveyed regarding their demographic, feasibility, and obesity indicators using mental health and quality of life questionnaires. The data were statistically analyzed using a one-way analysis of variance with repeated measures.

Results: A total of 26 obese children (Mean_age = 10.15 years) completed the study. The retention rate was 92.9% for the entire trial (two obese children withdrew due to their inability to exercise) and no adverse events were reported. In addition, the obese children completed 25/32 (78.1%) of the online courses. After 8 weeks of the intervention, the changes in the body fat percentage of the obese children [mean difference (MD) = –3.126, p < 0.001, Cohen’s d = –1.777], thinking dimension score (MD = 1.654, p < 0.001, Cohen’s d = 0.603), total quality of life score (MD = 6.385, p < 0.05, Cohen’s d = 0.610), and work attitude dimension score (MD = 1.346, p < 0.001, Cohen’s d = 0.744) showed significant differences compared to the baseline. However, no significant differences were identified between the post-intervention and three-month follow-up measurements (p > 0.05), and we assumed that the intervention effect was maintained three months after the intervention.

Conclusion: An online combination exercise intervention is a safe and feasible option to improve the mental health and quality of life of obese children and may have long-term health benefits.

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.

Effekte von hochintensivem Intervalltraining (HIIT) auf Body-Mass-Index (BMI) und Körperfettanteil von übergewichtigen und adipösen Kindern – eine systematische Übersichtsarbeit

Hintergrund Mehr als 340 Millionen Kinder gelten weltweit als übergewichtig oder adipös, ihre Anzahl nahm in den letzten Jahren – auch durch die Coronapandemie – erheblich zu. Eine alternative Behandlung zur Reduzierung des Übergewichts, die in den Empfehlungen bisher keine große Beachtung findet, stellt das sogenannte hochintensive Intervalltraining (HIIT) dar.

Ziel Darstellung der Wirksamkeit von hochintensivem Intervalltraining auf den BMI und Körperfettanteil übergewichtiger und adipöser Kinder im Alter von 6–13 Jahren.

Methode Die Erstellung der systematischen Übersichtsarbeit orientierte sich an den PRISMA-Guidelines. Für die Literaturrecherche wurden die Datenbanken MEDLINE, Cochrane Library, CINAHL, Embase, Sports Medicine & Education Index und Web of Science nach Studien mit hochintensivem Intervalltraining für übergewichtige und adipöse Kinder durchsucht. Die Bewertung der methodischen Studienqualität erfolgte mittels PEDro-Skala, MINORS und Risk of Bias. Die Berichtsqualität wurde anhand von CONSORT und TREND bewertet.

Ergebnisse Es wurden 6 randomisierte kontrollierte Studien und 2 kontrollierte klinische Studien mit 479 HIIT-Teilnehmenden betrachtet. Diese zeigten, dass hochintensives Intervalltraining positive Auswirkungen auf den BMI und Körperfettanteil übergewichtiger und adipöser Kinder hat.

Schlussfolgerung Hochintensives Intervalltraining ist eine kinderfreundliche und zugleich effektive Alternative zur Behandlung von übergewichtigen und adipösen Kindern. Weitere klinische Studien sind erforderlich, um die Ergebnisse zu bekräftigen.

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.

Effectiveness and process evaluation in obesity and type 2 diabetes prevention programs in children: a systematic review and meta-analysis

BACKGROUND

Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results.

METHODS

A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria.

RESULTS

Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS).

CONCLUSIONS

Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667.

Inter-individual differences in body mass index were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity

BACKGROUND

Exercise has been recommended as an important intervention for reducing adiposity in children and adolescents with overweight and obesity.

OBJECTIVE

Determine whether inter-individual differences exist in relation to exercise-induced changes in adiposity among children and adolescents with overweight and obesity.

METHODS

Meta-analysis of randomized controlled aerobic exercise trials and body mass index (BMI) in kg · m^-2 . Change outcome standard deviations were pooled using the inverse-variance heterogeneity model.

RESULTS

Twenty-eight studies (1185 participants) were included. Inter-individual differences in BMI were -0.1 (95% compatibility interval, -0.7 to 0.7). The 95% prediction interval for inter-individual responses in a future study was -2.9 to 2.9. The probability of a clinically meaningful difference in variability was 29% (possibly clinically important) in favour of controls vs exercisers.

CONCLUSIONS

Inter-individual differences for BMI in kg · m^-2 were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity.

Improvement of exercise capacity following neonatal respiratory failure: A randomized controlled trial

Exercise capacity deteriorates in school-aged children born with major anatomical foregut anomalies and/or treated with extracorporeal membrane oxygenation. The aim of the present study was to evaluate whether exercise capacity can be improved in the short term and long term in children born with anatomical foregut anomalies and/or treated with extracorporeal membrane oxygenation. Therefore, we evaluated two different interventions in this single-blinded randomized controlled trial. Forty participants were randomly assigned to group A: standardized anaerobic high-intensity interval training plus online lifestyle coaching program, B: online lifestyle coaching program only, or C: standard of care. Inclusion criteria were as follows: score ≤-1 standard deviation (SD) on the Bruce protocol. Exercise capacity was assessed at baseline (T0), after 3 months (T1), and after 12 months (T2). Exercise capacity improved over time: mean (SD) standard deviation score (SDS) endurance time: T0 -1.91 (0.73); T1 -1.35 (0.94); T2 -1.20 (1.03): both P < .001. No significant differences in maximal endurance time were found at T1 (group A-C: estimated mean difference (SDS): 0.06 P = .802; group B-C: -0.17 P = .733) or T2 (group A-C: -0.13 P = .635; group B-C: -0.18 P = .587). Exercise capacity improved significantly over time, irrespective of the study arm. Not only residual morbidities may be responsible for reduced exercise capacity. Parental awareness of reduced exercise capacity rather than specific interventions may have contributed. Monitoring of exercise tolerance and providing counseling on lifestyle factors that improve physical activity should be part of routine care, and aftercare should be offered on an individual basis.

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

OBJECTIVES

Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m², fat mass and per cent body fat) in overweight and obese children and adolescents.

DESIGN

Network meta-analysis of randomised exercise intervention trials.

SETTING

Any setting where a randomised trial could be conducted.

PARTICIPANTS

Overweight and obese male and/or female children and adolescents 2-18 years of age.

INTERVENTIONS

Randomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.

PRIMARY OUTCOMES

Changes in BMI in kg/m², fat mass and per cent body fat.

RESULTS

Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.

CONCLUSIONS

Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.

PROSPERO REGISTRATION NUMBER

CRD42017073103.

Response of obese schoolchildren to high-intensity interval training applied in the school context

BACKGROUND

High-intensity interval training (HIIT) has been widely used to fight cardiovascular risk factors in adolescents and adults, but no data are available on its applicability in children.

OBJECTIVES

To assess the effects of HIIT on different anthropometric and cardiovascular parameters of overweight and obese children aged 7-9 years.

MATERIAL AND METHODS

Four groups were formed: 1) an overweight control group (OWCG, n=30, BMI=21.60±3.72kg/m²); 2) an obesity control group (OCG, n=34, BMI=23.92±3.11kg/m²); 3) an overweight intervention group (OWIG, n=69, BMI=20.01±1.88kg/m²), and 4) an obesity intervention group (OIG, n=141, BMI=24.12±2.66kg/m²). BMI, body fat (BF), waist circumference, height-waist ratio, systolic and diastolic blood pressure and cardiorespiratory fitness (CRF) were assessed before and after intervention.

RESULTS

There were significant differences in BMI (P<.001), BF (P<.001), and CRF (P<.001) between the groups (control vs. intervention) before and after intervention (OWCG vs. OWIG and OCG vs. OIG). BMI decreased in the OWIG (BMI, 20.01±1.88 at baseline vs. 19.00±2.02 after HIIT, P<.001) and OIG (BMI, 24.12±2.66 at baseline vs. 23.23±3.23 after HIIT, P<.001) groups. Similarly, BF decreased in the OWIG (BF, 21.84±4.97 at baseline vs. 19.55±4.81% after HIIT, P<.001) and OIG (BF, 30.26±11.49 at baseline vs. 26.81±6.80% after HIIT, P<.001) groups. CRF improved in both intervention groups (P<.001). There was a significant decrease in the prevalence rate of schoolchildren with obesity (from 66.4% to 49.6%) (P<.001).

CONCLUSION

The intervention conducted in the school setting improved the anthropometric and cardiovascular parameters of schoolchildren, and also allowed for reducing the proportion of schoolchildren with obesity.

Physical activity for children with chronic disease; a narrative review and practical applications

BACKGROUND

Physical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer.

METHODS

For each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions.

RESULTS

Overall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program.

CONCLUSIONS

Future research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease.

Feasibility of incorporating high-intensity interval training into physical education programs to improve body composition and cardiorespiratory capacity of overweight and obese children: A systematic review

Background/objective

High-intensity interval training (HIIT) can produce similar or improved results compare with traditional training, but the question as to whether HIIT can be used in the setting of physical education (PE) remains unanswered. The aim of this systematic review was to critically analyze the feasibility of incorporating HIIT programs into PE classes to improve the body compositions and cardiorespiratory fitness of overweight students.

Methods

We conducted database searches for literature dating between January 2012 and January 2017. Of the final six studies selected, three were conducted in children under 12 years old and three involved adolescents between 12 and 18 years old.

Results

The HIIT protocols consisted of 2–3 sessions per week, with intervals of 15 s and passive or active rests of 15 s, totaling up to 6 min of work with 4 min of rest. The duration of HIIT programs was 6–24 weeks. Significant changes were reported in body composition, body mass index, body fat (%), waist circumference, and sum of skinfolds; and increases in muscle mass were observed. The inclusion of HIIT programmes improved maximal oxygen uptake (VO_2max), performance in the intermittent Yo-Yo test and maximal aerobic speed.

Conclusions

The HIIT programmes showed improvements in the variables studied, with interventions two or three times weekly. Therefore, they can be used in schools, as a strategy to combat the childhood obesity pandemic and HIIT can be use alongside with existing PE activities within the same lesson or in specific periods during day school.

Effects of 28 weeks of high-intensity interval training during physical education classes on cardiometabolic risk factors in Chilean schoolchildren: a pilot trial

The purpose of this investigation was to determine the effects of 28 weeks of high-intensity interval training (HIIT) during physical education classes on the weight status, cardiorespiratory capacity, and blood pressure of overweight and obese schoolchildren. The participants included 197 schoolchildren (108 girls and 89 boys) aged between 6 and 11 years (8.39 ± 1.15 years) in four groups: experimental group 1 (EG1) = 59 overweight schoolchildren; experimental group 2 (EG2) = 92 obese schoolchildren; control group 1 (CG1) = 17 overweight children; and control group 2 (CG2) = 29 obese schoolchildren. The participants in the EGs carried out HIIT twice per week for 28 weeks. After the 28-week intervention, the participants showed significant reductions in body mass index (p < 0.001). Waist circumference of boys in EG2 and waist-to-height ratio of girls in EG2 was significantly reduced (p < 0.05). Body fat percentage diminished, for girls in both groups and boys in EG2 (p < 0.05). Furthermore, the program significantly reduced the number of hypertensive schoolchildren (p = 0.001) and reduced the percentage of obese schoolchildren. The distance covered in the 6-min walk test improved significantly for girls in EG1 and EG2 (p < 0.05) and boys in EG2.

CONCLUSIONS

The 28-week HIIT program caused significant improvements in the cardiorespiratory capacity, anthropometric variables, and blood pressure levels of overweight and obese children. What is Known: • High-intensity interval training (HIIT) programs improve health, but investigations have used relatively short intervention periods. What is New: • The 28-week period (a large intervention period) of HIIT-based games during physical education classes caused significant improvements in cardiorespiratory capacity, anthropometric variables, and blood pressure levels of overweight and obese schoolchildren.

High-intensity interval training in overweight and obese children and adolescents: systematic review and meta-analysis

INTRODUCTION

While High Intensity Interval Training is praised in many populations for its beneficial effects on body composition and cardiometabolic health, its use among obese youth remain uncertain. This study aimed at determining whether HIIT is effective to improve aerobic fitness and reduce cardiometabolic risk factors in overweight and obese youth.

EVIDENCE ACQUISITION

A systematic search was conducted and articles reporting studies that investigated the effects of HIIT in 6 to 18-year-old youth were eligible. Meta-analyses were performed when appropriate.

EVIDENCE SYNTHESIS

Fifteen studies were included for the systematic review and meta-analyses. HIIT significantly improves maximal oxygen uptake (1.117 [95% CI: 0.528 to 1.706], P<0.001), and reduces body mass (-0.295 [95% CI: -0.525 to -0.066], P<0.05), body fat (-0.786 [95% CI: -1.452 to -0.120], P<0.05), systolic and diastolic blood pressure (-1.026 [95% CI: -1.370 to -0.683], P<0.001; -0.966 [95% CI: -1.628 to -0.304], P<0.01 respectively), and the HOMA-IR (-1.589 [95% CI: -2.528 to -0.650], P<0.01). However, there is significant heterogeneity, and low to high inconsistency for most cardiometabolic risk factors and aerobic fitness.

CONCLUSIONS

Although few studies have reported cardiometabolic risks, HIIT may also be as effective as traditional endurance continuous training to decrease blood pressure and insulin resistance. HIIT is effective to improve aerobic fitness, body composition, and cardiometabolic risk factors in obese youth, but data are insufficient to determine whether it is more effective than traditional continuous submaximal intensity exercise training.

Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial

Background

Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males.

Objective

The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation.

Methods

We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25.

Results

Retention to the intervention was 87.5% (21/24). Over the duration of the intervention, session attendance was 67.5% (170/252); repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4%), 89.9 (6.1%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO₂ max, 3.0; 90% confidence limits ±2.6%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear.

Conclusions

Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population.

Trial Registration

ClinicalTrials.gov NCT03477773; https://clinicaltrials.gov/ct2/show/NCT03477773 (Archived by WebCite at http://www.webcitation.org/6yDLgVs35)

Effects of moderate intensity endurance training vs. high intensity interval training on weight gain, cardiorespiratory capacity, and metabolic profile in postnatal overfed rats

BACKGROUND

Obesity is associated with several comorbidities, such as cardiovascular disease and type 2 diabetes mellitus, and may have its origin in early life stages, such as in the lactation period, through metabolic programming. Physical activity aids in decreasing the chances of developing cardiovascular and metabolic diseases, even with small weight losses and, in children, can play an essential role in preventing weight gain and other health problems. The present study aimed to evaluate the effects of moderate intensity endurance training and high intensity interval training (HIIT) protocols on obesity-related parameters and cardiorespiratory capacity in overfed Wistar rats throughout the breastfeeding period.

METHODS

Two days after birth, forty male and female Wistar rats were clustered into two groups: Control Litter Group (CL; ten animals/litter) and Reduced Litter Group (RL; four animals/litter). At weaning, RL animals were distributed randomly into three experimental groups: sedentary, moderate intensity endurance training and HIIT, while CL animals were clustered into a sedentary group.

RESULTS

RL male and female body weight, before weaning, was significantly higher when compared with CL animals. This difference was maintained between CLSed and RLSed groups after weaning during all assessed periods. Adiposity was significantly higher in RLSed males when compared to CLSed males, and alterations in glycaemic metabolism were also observed. Endurance and HIIT protocols were efficient in improving maximal cardiorespiratory capacity, as well as concerning the glycemic metabolism and central fat accumulation of males and females submitted to childhood overfeeding by the litter reduction method.

CONCLUSIONS

Both moderate endurance training and HIIT protocols included in early life were efficient in reverting or preventing certain metabolic alterations as a consequence of overfeeding during breastfeeding in male and female Wistar rats.

Exercise and adiposity in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials

INTRODUCTION

Overweight and obesity is a worldwide public health problem among children and adolescents. However, the magnitude of effect, as well as hierarchy of exercise interventions (aerobic, strength training or both), on selected measures of adiposity is not well established despite numerous trials on this issue. The primary purposes of this study are to use the network meta-analytical approach to determine the effects and hierarchy of exercise interventions on selected measures of adiposity in overweight and obese children and adolescents.

METHODS AND ANALYSIS

Randomised exercise intervention trials >4 weeks, available in any language up to 31 August 2017 and which include direct and/or indirect evidence, will be included. Studies will be located by searching seven electronic databases, cross-referencing and expert review. Dual selection and abstraction of data will occur. The primary outcomes will be changes in body mass index (in kg/m²), fat mass and percent body fat. Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength or both).

ETHICS AND DISSEMINATION

This study does not require ethics approval. Findings will be presented at a professional conference and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD 42017073103 .

Perspectives on high-intensity interval exercise for health promotion in children and adolescents

Physical activity lowers future cardiovascular disease (CVD) risk; however, few children and adolescents achieve the recommended minimum amount of daily activity. Accordingly, there is virtue in identifying the efficacy of small volumes of high-intensity exercise for health benefits in children and adolescents for the primary prevention of CVD risk. The purpose of this narrative review is to provide a novel overview of the available literature concerning high-intensity interval-exercise (HIIE) interventions in children and adolescents. Specifically, the following areas are addressed: 1) outlining the health benefits observed following a single bout of HIIE, 2) reviewing the role of HIIE training in the management of pediatric obesity, and 3) discussing the effectiveness of school-based HIIE training. In total, 39 HIIE intervention studies were included in this review. Based upon the available data, a single bout of high-intensity exercise provides a potent stimulus for favorable, acute changes across a range of cardiometabolic outcomes that are often superior to a comparative bout of moderate-intensity exercise (14 studies reviewed). HIIE also promotes improvements in cardiorespiratory fitness and cardiometabolic health status in overweight and obese children and adolescents (10 studies reviewed) and when delivered in the school setting (15 studies reviewed). We thus conclude that high-intensity exercise is a feasible and potent method of improving a range of cardiometabolic outcomes in children and adolescents. However, further work is needed to optimize the delivery of HIIE interventions in terms of participant enjoyment and acceptability, to include a wider range of health outcomes, and to control for important confounding variables (eg, changes in diet and habitual physical activity). Finally, research into the application of HIIE training interventions to children and adolescents of different ages, sexes, pubertal status, and sociocultural backgrounds is required.

Effects of high-intensity interval training on body composition, aerobic and anaerobic performance and plasma lipids in overweight/obese and normal-weight young men

To examine the effects of short high-intensity interval training (HIIT) on body composition, physical performance and plasma lipids in overweight/obese compared to normal-weight young men. Nine overweight/obese and nine normal-weight men (control group) aged 17 to 20 years underwent a HIIT programme three times per week for eight weeks. Body composition, indices of aerobic [maximal aerobic velocity (MAV) and maximal oxygen uptake (VO_2max)] and anaerobic [squat jump (SJ), counter-movement jump (CMJ), five-jump test (FJT), 10-m and 30-m sprint] performances, as well as fasting plasma lipids, were assessed in the two groups at PRE and POST HIIT. The HIIT programme resulted in significant reductions in body mass (-1.62%, P=0.016, ES=0.11) and fat mass (-1.59%, P=0.021, ES=0.23) in obese, but not in normal-weight subjects. MAV (+5.55%, P=0.005, ES=0.60 and +2.96%, P=0.009, ES=0.82), VO_2max (+5.27%, P=0.006, ES=0.63 and +2.88%, P=0.009, ES=0.41), FJT (+3.63%, P=0.005, ES=0.28 and +2.94%, P=0.009, ES=0.52), SJ (+4.92%, P=0.009, ES=0.25 and +6.94%, P=0.009, ES=0.70) and CMJ (+6.84%, P=0.014, ES=0.30 and +6.69%, P=0.002, ES=0.64) significantly increased in overweight/obese and normal-weight groups, respectively. 30-m sprint time significantly decreased in both groups (-1.77%, P=0.038, ES=0.12 and -0.72%, P=0.030, ES=0.16). Plasma total cholesterol (-11.8%, P=0.026, ES=0.96), LDL cholesterol (-11.9%, P=0.050, ES=0.77) and triglycerides (-21.3%, P=0.023, ES=1.08) significantly decreased in the obese group, but not in the normal-weight group. The eight-week HIIT programme resulted in a slight improvement in physical fitness and a significant decrease in plasma lipids in the obese. Short duration HIIT may contribute to an improved cardiometabolic profile in the obese.

Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years

BACKGROUND

Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages.

OBJECTIVES

To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.

MAIN RESULTS

We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials.

AUTHORS' CONCLUSIONS

Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.

The Case for Vigorous Physical Activity in Youth

Although it is widely recognized that regular physical activity is associated with a variety of health-related benefits in youths, the extent to which vigorous physical activity, as opposed to moderate or light physical activity, may be especially beneficial for youths is not completely understood. This review will examine the evidence for the efficacy of vigorous physical activity for promoting the well-being of youths as indicated by body composition, physical fitness, cardiometabolic biomarkers, and cognitive function. Potential caveats associated with the promotion of vigorous physical activity among youths will also be discussed, as will the inclusion of vigorous physical activity in current recommendations by national organizations for physical activity among youths.

Is high-intensity interval training more effective on improving cardiometabolic risk and aerobic capacity than other forms of exercise in overweight and obese youth? A meta-analysis

BACKGROUND

The scientific interest in high-intensity interval training (HIIT) has greatly increased during recent years.

OBJECTIVE

The objective of this meta-analysis was to determine the effectiveness of HIIT interventions on cardio-metabolic risk factors and aerobic capacity in overweight and obese youth, in comparison with other forms of exercise.

DATA SOURCES

A computerized search was made using seven databases.

STUDY ELIGIBILITY CRITERIA

The analysis was restricted to studies that examined the effect of HIIT interventions on cardio-metabolic and/or aerobic capacity in pediatric obesity (6-17 years old).

PARTICIPANTS AND INTERVENTIONS

Nine studies using HIIT interventions were selected (n = 274).

STUDY APPRAISAL AND SYNTHESIS METHODS

Standarized mean difference (SMD) and 95% confidence intervals were calculated. The DerSimonian-Laird approach was used.

RESULTS

HIIT interventions (4-12 week duration) produced larger decreases in systolic blood pressure (SMD = 0.39; -3.63 mmHg) and greater increases in maximum oxygen uptake (SMD = 0.59; 1.92 ml/kg/min) than other forms of exercise. Also, type of comparison exercise group and duration of study were moderators.

CONCLUSIONS

HIIT could be considered a more effective and time-efficient intervention for improving blood pressure and aerobic capacity levels in obese youth in comparison to other types of exercise. © 2016 World Obesity.

The influence of a six-week, high-intensity games intervention on the pulmonary oxygen uptake kinetics in prepubertal obese and normal-weight children

The pulmonary oxygen uptake response is deleteriously influenced by obesity in prepubertal children, as evidenced by a slower phase II response. To date, no studies have investigated the ability of an exercise intervention to ameliorate this. The objective of the study was to investigate the influence of a 6-week, high-intensity, games-orientated intervention on the oxygen uptake kinetic response of prepubertal obese and normal-weight children during heavy-intensity exercise. Thirteen normal-weight and 15 obese children participated in a twice-weekly exercise intervention involving repeated bouts of 6-min high-intensity, games-orientated exercises followed by 2 min of recovery. Sixteen normal-weight and 11 obese children served as a control group. At baseline and post-intervention, each participant completed a graded-exercise test to volitional exhaustion and constant work-rate, heavy-intensity exercise. Post-intervention, obese children demonstrated a reduced phase II τ (pre-intervention: 30 ± 8 cf. post-intervention: 24 ± 7 s), mean response time (pre-intervention: 50 ± 10 cf. post-intervention: 38 ± 9 s) and phase II amplitude (pre-intervention: 1.51 ± 0.30 cf. post-intervention: 1.34 ± 0.27 L·min−1). No changes were evident in the normal-weight children. In conclusion, the present findings demonstrate that a 6-week, high-intensity intervention can have a significant positive impact on the dynamic oxygen uptake response of obese prepubertal children.