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Bicki AC, Seth D, McCulloch CE, Lin F, Ku E. Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial. Pediatr Nephrol 2024; 39:2467-2474. [PMID: 38503990 DOI: 10.1007/s00467-024-06340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care. METHODS Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months. RESULTS Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12). CONCLUSIONS Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).
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Affiliation(s)
- Alexandra C Bicki
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - Divya Seth
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Elaine Ku
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, CA, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Kao TSA, Ling J, Vu C, Hawn R, Christodoulos H. Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes. Ann Behav Med 2023:7169372. [PMID: 37195909 PMCID: PMC10354860 DOI: 10.1093/abm/kaad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure. PURPOSE This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time). METHODS Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators. RESULTS The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4). CONCLUSIONS Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.
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Affiliation(s)
| | - Jiying Ling
- College of Nursing, Michigan State University, USA
| | - Christina Vu
- College of Nursing, Michigan State University, USA
| | - Rachel Hawn
- College of Nursing, Michigan State University, USA
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Physical activity promotion in rural health care settings: A rapid realist review. Prev Med Rep 2022; 29:101905. [PMID: 35879935 PMCID: PMC9307466 DOI: 10.1016/j.pmedr.2022.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Rural communities have a unique health care and physical activity context. We conducted a rapid realist review in partnership with knowledge users. Check-ins from health care providers may lead to intervention success and are valued by participants. A method for tracking progress is an important component of interventions delivered in rural health care settings.
Physical activity promotion in health care settings is poorly understood and has limited uptake among health care providers. The environmental and health care context of rural communities is unique from urban areas and may interact to influence intervention delivery and success. The aim of this rapid realist review was to synthesize knowledge related to the promotion of physical activity in rural health and social care settings. We searched Medline EBSCO, CINAHL, PsychINFO, and SPORTDiscus for relevant publications. We included qualitative or quantitative studies reporting on an intervention to promote physical activity in rural health (e.g., primary or community care) or social (e.g., elder support services) care settings. Studies without a rural focus or well-defined physical activity/exercise component were excluded. Populations of interest included adults and children in the general population or clinical sub-population. Intervention mechanisms from included studies were mapped to the Behaviour Change Wheel (capability, opportunity, motivation (COM-B)). Twenty studies were included in our review. Most interventions focused on older adults or people with chronic disease risk factors. The most successful intervention strategies leading to increased physical activity behaviour included wearable activity trackers, and check-ins or reminders from trusted sources. Interventions with mechanisms categorized as physical opportunity, automatic motivation, and psychological capability were more likely to be successful than other factors of the COM-B model. Successful intervention activities included a method for tracking progress, providing counselling, and follow-up reminders to prompt behaviour change. Cultivation of necessary community partnerships and adaptations for implementation of interventions in rural communities were not clearly described and may support successful outcomes in future studies.
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Michalopoulou M, Ferrey AE, Harmer G, Goddard L, Kebbe M, Theodoulou A, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:838-850. [PMID: 35344379 DOI: 10.7326/m21-3128] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Maryam Kebbe
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
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Qiu LT, Sun GX, Li L, Zhang JD, Wang D, Fan BY. Effectiveness of multiple eHealth-delivered lifestyle strategies for preventing or intervening overweight/obesity among children and adolescents: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:999702. [PMID: 36157474 PMCID: PMC9491112 DOI: 10.3389/fendo.2022.999702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effect of multiple eHealth-delivered lifestyle interventions on obesity-related anthropometric outcomes in children and adolescents. METHODS The Medline (via PubMed), Embase, Cochrane Library, Web of Science, CBM, VIP, CNKI, and Wanfang electronic databases were systematically searched from their inception to March 18, 2022, for randomized controlled trials (RCTs). Meta-analyses were performed to investigate the effect of multiple eHealth-delivered lifestyle interventions on obesity-related anthropometric outcomes (body mass index [BMI], BMI Z-score, waist circumference, body weight, and body fat%). Two independent investigators reviewed the studies for accuracy and completeness. All included studies were evaluated using the Cochrane Risk-of-Bias (ROB) Tool. RESULTS Forty trials comprising 6,403 patients were selected for the meta-analysis. The eligible trials were published from 2006 to 2022. Compared with the control group, the eHealth-intervention group was more effective in reducing BMI (weighted mean difference [WMD] = -0.32, 95% confidence interval [CI]: -0.50 to -0.13, I2 = 85.9%), BMI Z-score (WMD = -0.08, 95% CI: -0.14 to -0.03, I2 = 89.1%), waist circumference (WMD = -0.87, 95% CI: -1.70 to -0.04, I2 = 43.3%), body weight (WMD = -0.96, 95% CI: -1.55 to -0.37, I2 = 0.0%), and body fat% (WMD = -0.59, 95% CI: -1.08 to -0.10, I2 = 0.0%). The subgroup analysis showed that parental or school involvement (WMD = -0.66, 95% CI: -0.98 to -0.34), eHealth-intervention duration of >12 weeks (WMD = -0.67, 95% CI: -0.96 to -0.38), and mobile-based interventions (WMD = -0.78, 95% CI: -1.13 to -0.43) had a significantly greater intervention effect size on BMI. CONCLUSIONS This review recommends that multiple eHealth-delivered lifestyle strategies may be useful for preventing or treating overweight and obesity among children and adolescents. However, our results should be cautiously interpreted due to certain limitations in our study.
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Affiliation(s)
- Li-Ting Qiu
- The College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Gui-Xiang Sun
- The College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- Provincial Key Laboratory of Traditional Chinese Medicine (TCM) Diagnostics, Hunan University of Chinese Medicine, Changsha, China
- Institute of Chinese Medicine Diagnosis, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Gui-Xiang Sun, ; Ling Li,
| | - Ling Li
- The College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Gui-Xiang Sun, ; Ling Li,
| | - Ji-Dong Zhang
- The College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Dan Wang
- School of Physical Education and Health, Hunan University of Technology and Business, Changsha, China
| | - Bo-Yan Fan
- The College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
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Tripette J, Gando Y, Murakami H, Kawakami R, Tanisawa K, Ohno H, Konishi K, Tanimoto M, Tanaka N, Kawano H, Yamamoto K, Morishita A, Iemitsu M, Sanada K, Miyatake N, Miyachi M. Effect of a 1-year intervention comprising brief counselling sessions and low-dose physical activity recommendations in Japanese adults, and retention of the effect at 2 years: a randomized trial. BMC Sports Sci Med Rehabil 2021; 13:133. [PMID: 34696811 PMCID: PMC8543897 DOI: 10.1186/s13102-021-00360-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
Background In an effort to increase people’s adherence to active lifestyles, contemporary physical activity (PA) guidelines now include low-dose PA. Methods PA was evaluated in 583 participants of the Nutritional and Physical Activity Intervention Study (NEXIS) cohort (30–65 years old); 349 inactive participants (MVPA, 2.7 ± 1.0 MET-h/day) were randomly assigned to the intervention or control groups, and 235 active participants participated in follow-up visits. The intervention aimed to increase MVPA and comprised five brief counseling sessions over 1 year. The 1-year target for the participant was increasing their step-count to 10,000 steps/d or +3000 steps/d, relative to the baseline score. The counseling sessions were designed to stimulate progressive changes in physical behaviors by recommendations promoting small and/or light-intensity bouts of PA. PA was measured at baseline, the end of the intervention, and 1 year after the intervention ended. Additionally, several nutrition, health, and fitness parameters were measured. Results Participants in the intervention group significantly increased their step-count from 8415 ± 1924 at baseline to 9493 ± 2575 at the end of the 1-year period. During the same period, MVPA significantly increased by 0.9 MET-h. The daily time spent in ≥ 3, ≥ 4 and ≥ 5 MET activities increased by 11, 6, and 3 min, respectively. This increase in PA remained observable 1 year after intervention concluded. The active group maintained higher physical activity levels throughout the two years. The intervention group showed smaller energy intakes at the end of the 2-year period. Significant correlations were noted between the 1-year change in MVPA and the change in resting heart rate (r = − 0.22), and between the 2-year change in MVPA and the change in waist circumference (r = − 0.08) and peak oxygen consumption capacity (r = 0.23) in the intervention group only. Conclusions A prolonged and progressive PA intervention promoting small bouts of light-to-moderate PA may be used in healthy, not-optimally-active people to increase PA beyond the strict period of the intervention. Further studies are necessary to understand whether low-dose PA messages can be effective in initiating a progressive increase toward larger amounts of PA. Trial registration: Clinical Trials.gov, NCT00926744, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00360-7.
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Affiliation(s)
- Julien Tripette
- Center for Interdisciplinary AI and Data Science, Ochanomizu University, Bunkyo, Tokyo, Japan.,Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo, Japan
| | - Yuko Gando
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo, Japan.,Faculty of Sports Science, Surugadai University, Hanno, Saitama, Japan
| | - Haruka Murakami
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Harumi Ohno
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo, Japan.,Faculty of Health Care, Kiryu University, Midori, Gunma, Japan
| | - Kana Konishi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo, Japan.,Faculty of Food and Nutritional Sciences, Toyo University, Itakura, Gunma, Japan
| | - Michiya Tanimoto
- Faculty of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Wakayama, Japan
| | - Noriko Tanaka
- Research Center of Health, Physical Fitness and Sports, University of Nagoya, Nagoya, Aichi, Japan
| | - Hiroshi Kawano
- Faculty of Letters, Kokushikan University, Setagaya, Tokyo, Japan
| | - Kenta Yamamoto
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Nakano, Tokyo, Japan
| | - Akie Morishita
- Okayama Southern Institute of Health, Okayama Health Foundation, Okayama, Okayama, Japan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kiyoshi Sanada
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | | | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo, Japan. .,Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
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Kao TSA, Ling J, Hawn R, Vu C. The effects of motivational interviewing on children's body mass index and fat distributions: A systematic review and meta-analysis. Obes Rev 2021; 22:e13308. [PMID: 34170612 DOI: 10.1111/obr.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).
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Affiliation(s)
- Tsui-Sui Annie Kao
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rachel Hawn
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Christina Vu
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Does Motivational Interviewing Improve the Weight Management Process in Adolescents? A Systematic Review and Meta-analysis. Int J Behav Med 2021; 29:78-103. [PMID: 34268708 DOI: 10.1007/s12529-021-09994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Due to the complex nature and high heterogeneity of motivational interviewing (MI) trials, available data on the effectiveness of these interventions on weight management in the early years of life is not yet conclusive. This study aimed to (1) evaluate the effectiveness of MI-based interventions on modifying obesity-related behaviors and consequently controlling weight in adolescents, and (2) determine characteristics of participants and interventions through sub-group analysis. METHODS Electronic databases, i.e., Medline, Elsevier, ISI, Cochrane Central Register of Controlled Trials (Clinical Trials), PsycINFO, and subject-related key journals were searched for randomized controlled trials that investigated the effect of MI-based interventions on weight management in overweight/obese adolescents. Primary outcomes were BMI, BMI Z-score, waist circumference, and fat percentage. Secondary outcomes were related behaviors (dietary intake and physical activity) and cognitive abilities (self-efficacy, self-regulation, self-control). Of the 3673 studies initially screened for eligibility, nineteen studies met the inclusion criteria and eighteen studies were entered in the meta-analysis. Meta-regression and sub-group analyses were conducted to control the high heterogeneity of studies. Sensitivity analysis has been conducted based on the Cochrane guidelines using the leave-one-out methods. RESULTS MI-based interventions did not affect on all primary outcomes, including BMI, BMI Z-score, waist circumference, and fat percentage; however, in terms of secondary outcomes, only sugary beverage intake was reduced in adolescents (SMD = - 0.47, K = 3, I2 = 26.2%). Physical activity and cognitive variables were not considered in the current analysis due to limited data and high heterogeneity in measurements and reports. In addition, findings of sensitivity results showed that MI could significantly reduce waist circumference among adolescents (SMD = - 0.51, 95% CI - 0.91 to - 0.11). In terms of subgroup analysis, our results showed that various characteristics of participants (age, sex, weight status) and interventions (parental involvement, study duration, fidelity assessment, type of the control groups) could affect related primary and secondary outcomes among adolescents. CONCLUSION MI-based behavioral interventions had minor effects on reducing sugary beverage intake in all adolescents while a reduction in central obesity was noted predominantly among girls and those with complete participation. The current results indicate that the main characteristics influencing goal achievement in MI interventions are the age of participants, MI fidelity assessment, parental involvement, duration of interventions, and type of the control groups.
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Kepper M, Walsh-Bailey C, Staiano A, Fowler LA, Gacad A, Blackwood A, Fowler SA, Kelley M. Health Information Technology Use Among Healthcare Providers Treating Children and Adolescents With Obesity: a Systematic Review. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fowler LA, Grammer AC, Staiano AE, Fitzsimmons-Craft EE, Chen L, Yaeger LH, Wilfley DE. Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications. Int J Obes (Lond) 2021; 45:957-981. [PMID: 33627775 PMCID: PMC7904036 DOI: 10.1038/s41366-021-00765-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Technology holds promise for delivery of accessible, individualized, and destigmatized obesity prevention and treatment to youth. OBJECTIVES This review examined the efficacy of recent technology-based interventions on weight outcomes. METHODS Seven databases were searched in April 2020 following PRISMA guidelines. Inclusion criteria were: participants aged 1-18 y, use of technology in a prevention/treatment intervention for overweight/obesity; weight outcome; randomized controlled trial (RCT); and published after January 2014. Random effects models with inverse variance weighting estimated pooled mean effect sizes separately for treatment and prevention interventions. Meta-regressions examined the effect of technology type (telemedicine or technology-based), technology purpose (stand-alone or adjunct), comparator (active or no-contact control), delivery (to parent, child, or both), study type (pilot or not), child age, and intervention duration. FINDINGS In total, 3406 records were screened for inclusion; 55 studies representing 54 unique RCTs met inclusion criteria. Most (89%) included articles were of high or moderate quality. Thirty studies relied mostly or solely on technology for intervention delivery. Meta-analyses of the 20 prevention RCTs did not show a significant effect of prevention interventions on weight outcomes (d = 0.05, p = 0.52). The pooled mean effect size of n = 32 treatment RCTs showed a small, significant effect on weight outcomes (d = ‒0.13, p = 0.001), although 27 of 33 treatment studies (79%) did not find significant differences between treatment and comparators. There were significantly greater treatment effects on outcomes for pilot interventions, interventions delivered to the child compared to parent-delivered interventions, and as child age increased and intervention duration decreased. No other subgroup analyses were significant. CONCLUSIONS Recent technology-based interventions for the treatment of pediatric obesity show small effects on weight; however, evidence is inconclusive on the efficacy of technology based prevention interventions. Research is needed to determine the comparative effectiveness of technology-based interventions to gold-standard interventions and elucidate the potential for mHealth/eHealth to increase scalability and reduce costs while maximizing impact.
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Affiliation(s)
- Lauren A. Fowler
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Anne Claire Grammer
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Amanda E. Staiano
- grid.250514.70000 0001 2159 6024LSU’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Ellen E. Fitzsimmons-Craft
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Ling Chen
- grid.4367.60000 0001 2355 7002Division of Biostatistics, Washington University School of Medicine, St. Louis, MO USA
| | - Lauren H. Yaeger
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Denise E. Wilfley
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
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Zachurzok A, Springwald A, Gibała P, Matusik P. Current therapeutic strategies in treating obesity in children and adolescents - review of the literature. DEVELOPMENTAL PERIOD MEDICINE 2019; 21:286-292. [PMID: 29077568 PMCID: PMC8522947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 04/04/2024]
Abstract
The present paper is a review of current knowledge concerning the most appropriate strategy in the conservative therapy of obese children and adolescents. It presents an account of the combined mode of therapy consisting of behavioral and dietary counseling with appropriate physical activity (also using the support of modern media and devices). The rise in obesity is usually a long-lasting process involving genetic predispositions but also environmental factors which can be modified. The treatment of obesity should be focused on these modified factors and be a lifelong treatment, not merely a short period of exercise or a diet program. Successful therapy depends on the cooperation of the medical team with children and their parents or caregivers.
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Affiliation(s)
- Agnieszka Zachurzok
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Anna Springwald
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Piotr Gibała
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Paweł Matusik
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
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12
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Zachurzok A, Springwald A, Gibała P, Matusik P. Current therapeutic strategies in treating obesity in children and adolescents - review of the literature. DEVELOPMENTAL PERIOD MEDICINE 2017. [PMID: 29077568 PMCID: PMC8522947 DOI: 10.34763/devperiodmed.20172103.286292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present paper is a review of current knowledge concerning the most appropriate strategy in the conservative therapy of obese children and adolescents. It presents an account of the combined mode of therapy consisting of behavioral and dietary counseling with appropriate physical activity (also using the support of modern media and devices). The rise in obesity is usually a long-lasting process involving genetic predispositions but also environmental factors which can be modified. The treatment of obesity should be focused on these modified factors and be a lifelong treatment, not merely a short period of exercise or a diet program. Successful therapy depends on the cooperation of the medical team with children and their parents or caregivers.
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Affiliation(s)
- Agnieszka Zachurzok
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Anna Springwald
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Piotr Gibała
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland
| | - Paweł Matusik
- School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia in Katowice, KatowicePoland, Paweł Matusik Department of Pediatrics and Pediatric Endocrinology Medyków 16, 40-752 Katowice, Poland tel. (+48 32) 20-71-654
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