Dataset Information

Exercise and BMI z-score in Overweight and Obese Children and Adolescents: A Systematic Review and Network Meta-Analysis of Randomized Trials.

ABSTRACT:

Aim

Examine the effects of selected types of exercise (aerobic, strength training, both) on BMI z-score in overweight and obese children and adolescents.

Methods

Randomized exercise intervention trials ≥ 4 weeks were included. Studies were retrieved by searching six electronic databases, cross-referencing and expert review. Dual selection and abstraction occurred. Risk of bias and confidence in cumulative evidence were assessed. Network meta-analysis was performed using multivariate random-effects meta-regression models while surface under the cumulative ranking curves were used to calculate a hierarchy of exercise treatments. The number needed to treat (NNT) and percentile improvement (U₃ ) were also calculated.

Results

Thirty-four studies representing 2,239 participants were included. Median exercise occurred 3 times per week, 50 minutes per session over a 12-week period. Statistically significant reductions in BMI z-score were found for aerobic exercise and combined aerobic and strength exercise, but not strength training alone (M±SD, 95% CI: aerobic, -0.10, -0.15 to -0.05; aerobic and strength, -0.11, -0.19 to -0.03; strength, 0.04, -0.07 to 0.15). Combined aerobic and strength training was ranked best, followed by aerobic exercise and strength training. The NNT was 2 for both aerobic exercise and combined aerobic exercise and strength training. Percentile improvements were 28.8% for aerobic exercise and 31.5% for combined aerobic exercise and strength training. Confidence in effect estimates was ranked as low for aerobic exercise and very low for combined aerobic and strength training as well as strength training.

Conclusions

Aerobic exercise and combined aerobic exercise and strength training are associated with reductions in BMI z-score.

SUBMITTER: Kelley GA

PROVIDER: S-EPMC5553313 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Exercise and BMI z-score in Overweight and Obese Children and Adolescents: A Systematic Review and Network Meta-Analysis of Randomized Trials.

Kelley George A GA Kelley Kristi S KS Pate Russell R RR

Journal of evidence-based medicine 20170501 2

<h4>Aim</h4>Examine the effects of selected types of exercise (aerobic, strength training, both) on BMI z-score in overweight and obese children and adolescents.<h4>Methods</h4>Randomized exercise intervention trials ≥ 4 weeks were included. Studies were retrieved by searching six electronic databases, cross-referencing and expert review. Dual selection and abstraction occurred. Risk of bias and confidence in cumulative evidence were assessed. Network meta-analysis was performed using multivaria ...[more]

PMID: 27792271

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Project description:BackgroundOverweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.MethodsStudies were included if they were randomized controlled exercise intervention trials ≥ 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990-2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, cross-referencing and expert review. Two authors (GAK, KSK) selected and abstracted data. Bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Exercise minus control group changes were calculated from each study and weighted by the inverse of the variance. All results were pooled using a random-effects model with non-overlapping 95% confidence intervals (CI) considered statistically significant. Heterogeneity was assessed using Q and I2 while funnel plots and Egger's regression test were used to assess for small-study effects. Influence and cumulative meta-analysis were performed as well as moderator and meta-regression analyses.ResultsOf the 4,999 citations reviewed, 835 children and adolescents (456 exercise, 379 control) from 10 studies representing 21 groups (11 exercise, 10 control) were included. On average, exercise took place 4 x week for 43 minutes per session over 16 weeks. Overall, a statistically significant reduction equivalent to 3% was found for BMI z-score (Χ¯, -0.06, 95% CI, -0.09 to -0.03; Q = 24.9, p = 0.01; I(2)=59.8%). No small-study effects were observed and results remained statistically significant when each study was deleted from the model once. Based on cumulative meta-analysis, results have been statistically significant since 2009. None of the moderator or meta-regression analyses were statistically significant. The number-needed-to treat was 107 with an estimated 116,822 million obese US children and adolescents and approximately 1 million overweight and obese children and adolescents worldwide potentially improving their BMI z-score by participating in exercise.ConclusionsExercise improves BMI z-score in overweight and obese children and adolescents and should be recommended in this population group. However, a need exists for additional studies on this topic.

Project description: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.

Project description:ContextPediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available.ObjectivesTo test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race.Design, setting, and participantsRandomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area.InterventionChildren were randomly assigned to low-dose (20 min/d; n = 71) or high-dose (40 min/d; n = 73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n = 78).Main outcome measuresThe prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [VO2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat.ResultsThe study had 94% retention (n = 209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] × 10(3) μU/mL; P = .01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] × 10(3) μU/mL; P = .03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P < .001 and -0.8% [95% CI, -1.6% to -0.07%]; P = .03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P < .001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P = .01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak VO2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P = .02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P = .03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race.ConclusionIn this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race.Trial registrationclinicaltrials.gov Identifier: NCT00108901.

Project description:BackgroundMedically treated injuries have been shown to increase with increasing body mass index (BMI). Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs.MethodsSedentary adults with BMIs between 25 and 40 kg/m(2 )(n = 397) enrolled in one of two randomized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program. Interventions differed by duration of the exercise goal (150, 200, or 300 minutes/week or control group). Walking was prescribed as the primary mode of exercise. At six month intervals, participants were asked, "During the past six months, did you have any injury or illness that affected your ability to exercise?" Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise.ResultsDuring the 18-month study, 46% reported at least one injury/illness, and 32% reported at least one injury that was attributed to exercise. Lower-body musculoskeletal injuries (21%) were the most commonly reported injury followed by cold/flu/respiratory infections (18%) and back pain/injury (10%). Knee injuries comprised one-third of the lower-body musculoskeletal injuries. Only 7% of the injuries were attributed to exercise alone, and 59% of the injuries did not involve exercise. BMI (p </= 0.01) but not exercise (p >/= 0.41) was significantly associated with time to first injury and injuries over time. Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness.ConclusionsOverweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults randomized not to participate in prescribed exercise. Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI, weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults.Trial registrationClinicaltrials.gov NCT00177502 and NCT00177476.

Project description:BackgroundExercise is widely used for obesity management, but the optimal doses of exercise for improving body mass index (BMI) in children and adolescents with overweight and obesity remain unclear. This study aimed to evaluate the dose‒response effects of various exercises on BMI in children and adolescents with overweight and obesity.MethodsA systematic search was conducted in Web of Science (Core Collection), PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library for randomized controlled trials on relevant studies, covering literature up to July 2024. Three independent reviewers assessed bias via the Cochrane risk of bias tool. The quality of evidence was assessed using Confidence in Network Meta-Analysis framework. A dose‒response network meta-analysis was used to evaluate the impact of various exercise interventions and explore dose‒response relationships. All outcomes were analyzed with the mean difference (MD) and 95% credible intervals (CrIs) calculated for combined statistics.ResultsThe study included 39 publications with 1,814 participants, 47.3% female and a median age of 14 years. The intervention involved six exercise modalities. High-intensity interval training demonstrated a significant reduction in BMI (MD = -1.33, 95% CrIs - 2.01 to -0.66), followed by combined exercise (MD = -1.25, 95% CrIs - 1.93 to -0.61), moderate-intensity continuous training (MD = -1.09, 95% CrIs - 1.73 to -0.45), and mixed aerobic exercise (MD = -1.05, 95% CrIs - 1.67 to -0.42). There was an 'L'-shaped nonlinear dose-response relationship between total exercise dose and BMI, with 200 METs-min/day identified as the minimum exercise dose required to achieve a clinically meaningful reduction in BMI.ConclusionLow-quality evidence indicates that HIIT, CE, MAE, and MICT improve BMI in children and adolescents with overweight and obesity, with clarified exercise doses for clinical benefit. These findings are relevant for exercise prescription and public health policy.Trial registrationCRD42024566450.

Dataset Information

Exercise and BMI z-score in Overweight and Obese Children and Adolescents: A Systematic Review and Network Meta-Analysis of Randomized Trials.

Aim

Methods

Results

Conclusions

Publications

Exercise and BMI z-score in Overweight and Obese Children and Adolescents: A Systematic Review and Network Meta-Analysis of Randomized Trials.

Similar Datasets

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