Effect of an individualised training programme during weight reduction on body composition: a randomised trial

Standardized vs. Relative Intensity in CrossFit

CrossFit is characterized by being a standardized training program that improves physical performance through the provision of several stimuli regardless of the participant's strength level. This study aimed to compare the acute response in total repetitions as a measurement of performance, jump ability, physiological demand (heart rate and blood lactate), and perceived effort considering the participants' strength level with individualized intensity in CrossFit. Thirty-five participants were assessed and asked to participate on two separate days in a standardized and relative 'As Many Repetitions As Possible' (AMRAP) CrossFit circuit. Both AMRAPs comprised strength, gymnastic and aerobic exercises, although only strength was individualized according to the participant's level. Before the statistical analysis, participants were allocated to higher- or lower-strength groups following the one-repetition maximum-bodyweight ratio in the push press exercise. Results support the existence of a strong relationship between strength level and total repetitions in both AMRAPs. In addition, differences in total repetitions and rate of perceived exertion between strength groups are discarded when AMRAP intensity is individualized while physiological demand and jump ability are maintained. Thus, the higher-strength participants may benefit from similar responses with a lower number of repetitions. Therefore, CrossFit trainers should be encouraged to prescribe strength tasks based on the percentage of 1RM for every training.

International fitness scale (IFIS): association with motor performance in children with obesity

Background

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health; and compared with their normal-weight peers, these individuals tend to have a lower level of self-confidence, and consequently lower physical activity adherence. Due to these self-perceived barriers, the aim of our study was to evaluate the efficacy of an online training program on self-reported physical fitness (SRPF) in children with obesity (OB).

Methods

A total of 32 children with OB carried out physical fitness (PF) tests and were asked to complete the International Fitness Enjoyment Scale (IFIS) questionnaire. The physical fitness tests were the Standing Broad Jump (SBJ), the 6-Min Walking Test (6MWT) and the 4 × 10 m sprint test. Children participated in a 3-weekly 60-min training session through Zoom platform. Before the beginning of the training protocol, OB children were compared with normal weight (NW) ones for PF batteries and the IFIS questionnaire. Changes in performances after the training were assessed by paired Student t and Wilcoxon tests.

Results

After the online training program children increased their performance in 6MWT (mean difference (MD) = 54.93; p < 0.0001) in SBJ (MD = 10.00; p = 0.0001) and in 4 × 10 m sprint test (MD = -0.78; p < 0.0001). No differences were found in children's physical fitness perception.

Discussion

Our study highlighted how a structured online training program can lead to improvements in PF of children with OB. Instead, the lack of differences in SRPF after the training suggests interesting questions to be explored on the aspects linked to self-perception. Therefore, even if our training protocol could not directly improve SRPF in children with obesity, the enhancement of their PF could be a starting point for achieving this result with a longer training period and consequently improve PA participation for children with OB.

Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre−post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro−Wilks test). Pre−post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.

Effects of an Online Supervised Exercise Training in Children with Obesity during the COVID-19 Pandemic

COVID-19 restrictions have dramatically reduced the active lifestyle and physical activity (PA) levels in the whole population, a situation that can contribute to weight gain and to develop obesity. To improve physical fitness (PF) in children with obesity during COVID-19 restrictions, sport specialists started to deliver physical training through tele-exercise. For these reasons, the aim of this study was to evaluate the effects of a 12-week online supervised training program in children with obesity on different PF components and PA levels. We enrolled a total of 40 Caucasian children (9 F/31 M; aged 11 ± 1.9 years) with obesity. The data collection consisted of a series of anthropometric measures, the PAQ-C questionnaire, and PF tests, valid and reliable tools to assess PF in children. We used a Wilcoxon’s t-test and a Student’s t-test, as appropriate, to assess the differences before and after the training protocol. A total of 37 patients completed the training protocol and were considered in the analysis. Our results show an improvement in all the PF tests, a reduction in the BMI z-score, the waist circumference, and in the waist-to-height ratio, and an increased PA level. In conclusion, the results of our study show that an online supervised training program is effective to promote PA, improving PF and reducing the BMI z-score in children with obesity.

Layperson-Led vs Professional-Led Behavioral Interventions for Weight Loss in Pediatric Obesity: A Systematic Review and Meta-analysis

IMPORTANCE

The appropriate approach for weight loss among children and adolescents with overweight and obesity remains unclear.

OBJECTIVE

To evaluate the difference in the treatment outcomes associated with behavioral weight loss interventions led by laypersons and professionals in comparison with unsupervised control arms among children and adolescents with overweight and obesity.

DATA SOURCES

For this systematic review and meta-analysis, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, the Cochrane Library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 1996, to June 1, 2019.

STUDY SELECTION

Included in this study were randomized clinical trials (RCTs) of behavioral interventions lasting at least 12 weeks for children and adolescents (aged 5-18 years) with overweight and obesity. Exclusion criteria included non-RCT studies, interventions lasting less than 12 weeks, adult enrollment, participants with other medical diagnoses, pharmacological treatment use, and articles not written in English. Two of 6 reviewers independently screened all citations. Of 25 586 citations, after duplicate removal, 78 RCTs (5780 participants) met eligibility criteria.

DATA EXTRACTION AND SYNTHESIS

A bayesian framework and Markov chain Monte Carlo simulation methods were used to combine direct and indirect associations. Random-effects and fixed-effect network meta-analysis models were used with the preferred model chosen by comparing the deviance information criteria. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

MAIN OUTCOMES AND MEASURES

The immediate and sustained changes in weight and body mass index (BMI) standardized mean difference (SMD) were primary outcomes planned before data collection began, whereas waist circumference and percent body fat were secondary outcomes. The hypothesis being tested was formulated before the data collection.

RESULTS

Of 25 586 citations retrieved, we included 78 RCTs (5780 participants), with a follow-up of 12 to 104 weeks. Compared with the control condition, random-effects models revealed that professional-led weight loss interventions were associated with reductions in weight (mean difference [MD], -1.60 kg [95% CI, -2.30 to -0.99 kg]; 68 trials; P < .001) and BMI (SMD, -0.30 [95% CI, -0.39 to -0.20]; 59 trials; P < .001) that were not sustained long term (weight MD, -1.02 kg [95% CI, -2.20 to 0.34 kg]; 21 trials; P = .06; BMI SMD, -0.12 [95% CI, -0.46 to 0.21]; 20 trials; P < .001). There was no association between layperson-led interventions and weight loss in the short-term (MD, -1.40 kg [95% CI, -3.00 to 0.26 kg]; 5 trials; P = .05) or long-term (MD, -0.98 kg [95% CI, -3.60 to 1.80 kg]; 1 trial; P = .23) compared with standard care. No difference was found in head-to-head trials (professional vs layperson MD, -0.25 kg [95% CI -1.90 to 1.30 kg]; 5 trials; P = .38).

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis found that professional-led weight loss interventions were associated with short-term but not sustained weight reduction among children and adolescents with overweight or obesity, and the evidence for layperson-led approaches was insufficient to draw firm conclusions.

Prevalence of responders for hepatic fat, adiposity and liver enzyme levels in response to a lifestyle intervention in children with overweight/obesity: EFIGRO randomized controlled trial

BACKGROUND/OBJECTIVE

Exercise and lifestyle interventions have been shown to reduce hepatic fat (HF) and adiposity in youth. However, the interindividual response in HF after a lifestyle intervention with or without exercise in children is unknown. The aim of the present study was to compare interindividual variability for HF, adiposity, gamma-glutamyl transferase (GGT), and the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) in children with overweight/obesity participating in a 22-week lifestyle intervention with (intensive intervention) or without exercise (control intervention).

METHODS

Data from 102 children (9-12 years, 55% girls) with overweight/obesity participating in the EFIGRO randomized controlled trial were analyzed. Percentage HF (magnetic resonance imaging), weight, body and fat mass index (BMI and FMI), GGT, AST/ALT, cardiorespiratory fitness (CRF, 20 meters shuttle run test) were assessed before and after the intervention by the same trained researchers. The control intervention consisted in 11 sessions of a family-based lifestyle and psycho-educational program. The intensive intervention included the control intervention plus supervised exercise (3 sessions/week).

RESULTS

The prevalence of responders for HF (54% vs. 34%), weight (27% vs. 11%), BMI (71% vs. 47%), FMI (90% vs. 60%), and GGT (69% vs. 39%) was higher in the intensive than in the control group (Ps < 0.05). Responders for weight (16 ± 3 vs. 6 ± 2 laps) and BMI (11 ± 2 vs. 3 ± 4 laps) improved more CRF levels than non-responders (Ps < 0.05).

CONCLUSIONS

The addition of exercise to a lifestyle intervention may increase the responder rates for HF, adiposity, and GGT in children with overweight/obesity. Improvements in CRF may explain differences between weight and BMI responders and non-responders.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02258126.

WITHDRAWN: Interventions for treating obesity in children

BACKGROUND

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences.

OBJECTIVES

To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.

SEARCH METHODS

We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). 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 were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.

MAIN RESULTS

We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.

AUTHORS' CONCLUSIONS

While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

The effect of resistance training interventions on weight status in youth: a meta-analysis

BACKGROUND

There has been a rise in research into obesity prevention and treatment programmes in youth, including the effectiveness of resistance-based exercise. The purpose of this meta-analysis was to examine the effect of resistance training interventions on weight status in youth.

METHODS

Meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO (registration number CRD42016038365). Eligible studies were from English language peer-reviewed published articles. Searches were conducted in seven databases between May 2016 and June 2017. Studies were included that examined the effect of resistance training on weight status in youth, with participants of school age (5-18 years).

RESULTS

There were 24 complete sets of data from 18 controlled trials (CTs) which explored 8 outcomes related to weight status. Significant, small effect sizes were identified for body fat% (Hedges' g = 0.215, 95% CI 0.059 to 0.371, P = 0.007) and skinfolds (Hedges' g = 0.274, 95% CI 0.066 to 0.483, P = 0.01). Effect sizes were not significant for: body mass (Hedges' g = 0.043, 95% CI - 0.103 to 0.189, P = 0.564), body mass index (Hedges' g = 0.024, 95% CI - 0.205 to 0.253, P = 0.838), fat-free mass (Hedges' g = 0.073, 95% CI - 0.169 to 0.316, P = 0.554), fat mass (Hedges' g = 0.180, 95% CI - 0.090 to 0.451, P = 0.192), lean mass (Hedges' g = 0.089, 95% CI - 0.122 to 0.301, P = 0.408) or waist circumference (Hedges' g = 0.209, 95% CI - 0.075 to 0.494, P = 0.149).

CONCLUSIONS

The results of this meta-analysis suggest that an isolated resistance training intervention may have an effect on weight status in youth. Overall, more quality research should be undertaken to investigate the impact of resistance training in youth as it could have a role to play in the treatment and prevention of obesity.

Adaptations Associated With an After-School Strength and Conditioning Program in Middle-School-Aged Boys: A Quasi-Experimental Design

High-intensity strength and conditioning programs aimed at improving youth performance are becoming increasingly prevalent. The purpose of this study was to investigate the effects of a 16-week after-school strength and conditioning program on performance and body composition in middle-school-aged boys. Subjects in the training group (n = 16, mean age = 11.8 years) performed 90 minutes of supervised plyometric and resistance training twice weekly for 16 weeks. A group of control subjects (n = 9, age = 12.1 years) maintained their current activity levels. Sprint speed, 5-10-5 proagility, jump height, isometric peak torque of the leg extensors and flexors, and dual energy x-ray absorptiometry-derived body composition were examined during pretesting and posttesting. Data were analyzed by performing independent samples t-tests on the absolute change scores between groups. The primary findings were that the training intervention elicited significant improvements in 20-m sprint times (p = 0.03; mean change for training group = -0.17 seconds) and body-fat percentage (p = 0.03; 2.5% absolute improvement), the latter of which was a function of reduced fat mass (p = 0.06; -0.84 kg). Between-group differences were not noted for agility, jump height, lean mass, or strength measures; however, effect sizes generally showed greater improvements for the training group. In contrast to findings in longitudinal studies performed in collegiate athletes, sprint speed may be particularly adaptable during adolescence. In addition to potentially improving sport performance, high-intensity plyometric and resistance training programs offer the added benefit of improved body composition. These programs appear less effective for agility and jump performance and do not elicit substantial improvements in muscle mass above maturation.

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.

Changes in physical fitness of a home-based physical exercise program in childhood obesity: A quasi-experimental uncontrolled study

Few studies have evaluated the changes in physical fitness (PF) of obese children and adolescents of a physical activity program for the treatment of obesity, and even fewer have explored the modality of home-based physical exercise. The objective of this study is to evaluate the changes in PF and body composition (BC) of a home-based physical exercise for treating childhood obesity. Thirty-three overweight/obese children and adolescents participated for six months in a home-based intervention that combined aerobics and muscular strength exercises. The results were compared, before and after the intervention, for the different PF components (VO2_max, abdominal muscle resistance strength, and lower body explosive strength) and BC (body mass index Z-score (BMI-Z), percentage of body fat, and fat-free mass) variables. A significant reduction was observed in the percentage of body fat (4.7%) and the BMI- Z score (.23), and there was an increase in the fat-free mass of 2.9 kg ( p < .001). In addition, the VO2_max showed a significant increase ( p < .05). The results of the different strength tests also showed significant improvements ( p < .05). Our findings support the effectiveness of this program improving not only BC but also PF. However, our results should be interpreted with caution due to lack of control group.

Feasibility and Parental Acceptability of an 8-Week, Slow-Speed, High-Intensity, Community-Based Resistance Training Program for Preadolescent Children

High-intensity resistance training (RT) shows promise for improved cardiometabolic health in children. Achieving high-intensity RT safely is a challenge for community-based programs because of parental concerns and group engagement. Twenty preadolescent children completed an 8-week, twice per week program using slow speed to achieve high-intensity RT. Parent and child surveys were conducted to measure acceptability and effectiveness. Child fitness levels were assessed, and fasting blood draws and dual-energy x-ray absorptiometry were performed on a subset population. Perceived RT safety, self-efficacy, body composition, waist circumference, and fitness tests exhibited significant improvements. Using slow speed to achieve high-intensity RT may provide a safe and effective community-based alternative for preadolescents.

A Multi-Component Day-Camp Weight-Loss Program Is Effective in Reducing BMI in Children after One Year: A Randomized Controlled Trial

The objective of the present study was to evaluate the effectiveness of a one-year multi-component immersive day-camp weight-loss intervention for children with overweight and obesity. The study design was a parallel-group randomized controlled trial. One hundred fifteen 11-13-year-old children with overweight and obesity were randomized into either: A six-week day-camp intervention arm focusing on increased physical activity, and healthy diet followed by a subsequent one-year family-based intervention, or a standard intervention arm consisting of one weekly exercise session for six weeks. Body mass index (BMI) was the primary outcome. BMI z-score, clustered cardiovascular risk z-score, and body composition were secondary outcomes. All outcomes were measured at baseline, six week-, and 52 week follow-up. After six weeks, children from the day-camp intervention arm had improved their BMI (-2.2 kg/m² (95% CI -2.6 to -1.7, P<0.001)) and all secondary outcomes when compared to the children from the standard intervention arm. After 52 weeks, the day-camp intervention arm had a lower BMI (-1.2 kg/m² (95% CI -1.8 to -0.5, P = 0.001)), and BMI z-score (-0.20 (95% CI -0.35 to -0.05, P = 0.008)), and clustered cardiovascular risk z-score (-0.23 (95% CI -0.37 to -0.08, P = 0.002)) compared to the standard intervention arm. No group differences were detected in body composition after 52 weeks. This study shows that the day-camp intervention arm is effective in reducing BMI and improving the metabolic health of children with overweight and obesity. However, the effects seem to be diminishing over time.

The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical fitness during childhood and adolescence has been identified as an important determinant of current and future health status. While research has traditionally focused on the association between cardio-respiratory fitness and health outcomes, the association between muscular fitness (MF) and health status has recently received increased attention.

OBJECTIVE

The aim of this systematic review and meta-analysis was to evaluate the potential physiological and psychological benefits associated with MF among children and adolescents.

METHODS

A systematic search of six electronic databases (PubMed, SPORTDiscus, Scopus, EMBASE, PsycINFO and OVID MEDLINE) was performed on the 20th May, 2013. Cross-sectional, longitudinal and experimental studies that quantitatively examined the association between MF and potential health benefits among children and adolescents were included. The search yielded 110 eligible studies, encompassing six health outcomes (i.e., adiposity, bone health, cardiovascular disease [CVD] and metabolic risk factors, musculoskeletal pain, psychological health and cognitive ability). The percentage of studies reporting statistically significant associations between MF and the outcome of interest was used to determine the strength of the evidence for an association and additional coding was conducted to account for risk of bias. Meta-analyses were also performed to determine the pooled effect size if there were at least three studies providing standardised coefficients.

RESULTS

Strong evidence was found for an inverse association between MF and total and central adiposity, and CVD and metabolic risk factors. The pooled effect size for the relationship between MF and adiposity was r = -0.25 (95% CI -0.41 to -0.08). Strong evidence was also found for a positive association between MF and bone health and self-esteem. The pooled effect size for the relationship between MF and perceived sports competence was r = 0.39 (95% CI 0.34-0.45). The evidence for an association between MF and musculoskeletal pain and cognitive ability was inconsistent/uncertain. Where evidence of an association was found, the associations were generally low to moderate.

CONCLUSION

The findings of this review highlight the importance of developing MF in youth for a number of health-related benefits.

Effective interventions in overweight or obese young children: systematic review and meta-analysis

BACKGROUND

Treatment programs for overweight and obese young children are of variable effectiveness, and the characteristics of effective programs are unknown. In this systematic review with meta-analysis, the effectiveness of treatment programs for these children is summarized.

METHODS

PubMed, Embase, Web of Science, and PsycINFO databases were searched up to April 2012. Articles reporting the effect of treatment on the body weight of overweight or obese children with a mean age in the range of 3-<8 years are included. Studies reporting the change in BMI z-score with standard error were included in a meta-analysis. For this purpose, a random-effects model was used.

RESULTS

The search identified 11,250 articles, of which 27 were included in this review. Eleven studies, including 20 treatment programs with 1015 participants, were eligible for the meta-analysis. The pooled intervention effect showed high heterogeneity; therefore, subgroup analysis was performed. Subgroup analysis showed that program intensity and used components partly explained the heterogeneity. The subgroup with two studies using multicomponent treatment programs (combining dietary and physical activity education and behavioral therapy) of moderate or high intensity showed the largest pooled change in BMI z-score (-0.46; I2, 0%).

CONCLUSION

Although the subgroup multicomponent treatment programs of moderate to high intensity contained only two studies, these treatment programs appeared to be most effective in treating overweight young children.

The effects of resistance exercise training on body composition and strength in obese prepubertal children

OBJECTIVE

To assess the effects of resistance exercise training on body composition and muscular strength in obese prepubertal children.

DESIGN

Study participants, who were between the ages of 8 and 12 years, met Tanner I (stage) criteria, had a body mass index ≥ 95th percentile for age and sex, were randomized to either high-repetition, moderate-intensity resistance training (n = 12) or to the non-intervention control group (n = 7) for 12 weeks. Exercise training was performed twice a week for 75 minutes per session. Body composition was assessed using dual energy x-ray absorptiometry and muscular strength was evaluated using a 1-repetition-maximum test.

RESULTS

Exercise-group participants attended 98% of the 24 total sessions and showed a significant increase in body weight (57.6± 13.5 vs 59.6± 14.1 kg), height (144.9± 9 vs 146.6± 10.4 cm), lean body mass (32.6± 6.8 vs 34.0± 7.0 kg), lean body mass index (lean body mass in kg/height2; 15.3± 1.6 vs 15.6± 1.5 kg/m2), arm strength (28.4± 5.8 vs 31.2± 6.0 kg), and leg strength (89.4± 31.7 vs 113.4± 34 2 kg) from baseline measures (P < 0.05). Control group participants also showed significant increases in weight, height, and lean body mass from baseline measures (P < 0.05) but not in arm or leg strength. When the changes in participant body composition and muscular strength were compared between the exercise and control groups, significant differences were found in leg lean mass and leg strength (P < 0.05). There were no changes in percent body fat and fat mass index [FM/height2(kg/m2)] in either group.

CONCLUSION

Resistance training increases leg lean mass and leg strength in obese prepubertal youth and may have a positive effect on overall physical activity and health.

Exercise intervention in childhood obesity: a randomized controlled trial comparing hospital-versus home-based groups

OBJECTIVE

The aim of this study was to compare the effect of a hospital clinic group- versus home-based combined exercise-diet program for the treatment of childhood obesity.

METHODS

One hundred ten overweight/obese Spanish children and adolescents (6-16 years) in 2 intervention groups (hospital clinic group-based [n = 45] and home-based [n = 41]) and a sex-age-matched control group (n = 24) were randomly assigned to participate in a 6-month combined exercise (aerobic and resistance training) and Mediterranean diet program. Anthropometric values (including body weight, height, body mass index, BMI-Z score, and waist circumference) were measured pre- and postintervention for all the participants. Percentage body fat was also determined with a body fat analyzer (TANITA TBF-410 M).

RESULTS

Our study showed a significant reduction in percentage body fat and body mass index Z-score among both intervention-group participants (4%, 0.16, hospital clinic group-based; 4.4%, 0.23, home-based; P < .0001). There was also a significant reduction in waist circumference in the home-based group (4.4 cm; P = .019). Attendance rates at intervention sessions were equivalent for both intervention groups (P = .805).

CONCLUSIONS

The study findings indicate that a simple home-based combined exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents, because it improves body composition, is feasible and can be adopted on a large scale without substantial expenses.

A conative educational model for an intervention program in obese youth

BACKGROUND

Obesity in children has increased in recent years throughout the world and is associated with adverse health consequences. Early interventions, including appropriate pedagogy strategies, are important for a successful intervention program. The aim of this study was to assess changes in body mass index, the ability to perform sport activities, behavior in the classroom and academic performance following one year of a health-wellness intervention program in obese youth.

METHODS

The CEMHaVi program included 37 obese children (19 girls and 18 boys). Participants received an intervention program consisting of physical activity and health education. Assessment included body mass index, academic performance, classroom performance and ability to perform sport activities. Paired t tests were used to assess the effects of intervention, and chi square was used to assess inter-action between measures.

RESULTS

Findings of the study suggest significant decrease in Z scores of Body Mass Index and an improvement of academic performance, classroom behavior and the ability to perform sport activities (p < 0.05). Chi square testing showed significant positive inter-actions between body mass index, classroom behavior and academic performance.

CONCLUSIONS

Results following year one of CEMHaVi showed that a program of physical activity and health education had positive effects on obesity, behavior in the classroom and the ability to perform sport activities in obese adolescents. Significant inter-action in changes between variables was observed. Findings are important for designing intervention models to improve health in obese youth.

External validity reporting in behavioral treatment of childhood obesity: a systematic review

CONTEXT

To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity.

EVIDENCE ACQUISITION

Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors.

EVIDENCE SYNTHESIS

1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability.

CONCLUSIONS

Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

The effect of combined exercise training in adolescents who are overweight or obese with intellectual disability: the role of training frequency

Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

Health-related fitness in children and adolescents

PURPOSE

The American Physical Therapy Association Section on Pediatrics developed a task force to summarize fitness guidelines for children and adolescents. The purposes of this article were to review components, measurement methods, and consequences of physical fitness, and to summarize evidence-based activity recommendations for youth.

SUMMARY OF KEY POINTS

Health-related fitness is comprised of body composition, flexibility, cardiorespiratory endurance, and muscular strength and endurance. Each of these components is reviewed in terms of definition, assessment, normative values, and recommendations.

CONCLUSIONS

The task force supports the guidelines of the US Department of Health and Human Services, which state that to promote overall health and wellness, youth should participate in 60 minutes or more of physical activity every day.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Physical therapists should apply research relevant to health-related fitness when treating youth. Promoting fitness, health, and wellness in our communities is a responsibility all therapists should assume.

Sever's injury: treatment with insoles provides effective pain relief

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. The traditional advice is to reduce and modify the level of physical activity. Recommended treatment in general is the same as for adults with Achilles tendon pain. The purpose of the study was to find out if insoles, of two different types, were effective in relieving heel pain in a group of boys (n=38) attending a Sports Medicine Clinic for heel pain diagnosed as Sever's injury. The type of insole was randomized, and self-assessed pain during physical activity in the treatment phase with insoles was compared with pain in the corresponding pre- and post-treatment phases without insoles. There were no other treatments added and the recommendations were to stay on the same activity level. All patients maintained their high level of physical activity throughout the study period. Significant pain reduction during physical activity when using insoles was found. Application of two different types of insoles without any immobilization, other treatment, or modification of sport activities results in significant pain relief in boys with Sever's injury.

Youth resistance training: updated position statement paper from the national strength and conditioning association

Faigenbaum, AD, Kraemer, WJ, Blimkie, CJR, Jeffreys, I, Micheli, LJ, Nitka, M, and Rowland, TW. Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. J Strength Cond Res 23(5): S60-S79, 2009-Current recommendations suggest that school-aged youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities (). Not only is regular physical activity essential for normal growth and development, but also a physically active lifestyle during the pediatric years may help to reduce the risk of developing some chronic diseases later in life (). In addition to aerobic activities such as swimming and bicycling, research increasingly indicates that resistance training can offer unique benefits for children and adolescents when appropriately prescribed and supervised (). The qualified acceptance of youth resistance training by medical, fitness, and sport organizations is becoming universal ().Nowadays, comprehensive school-based programs are specifically designed to enhance health-related components of physical fitness, which include muscular strength (). In addition, the health club and sport conditioning industry is getting more involved in the youth fitness market. In the U.S.A., the number of health club members between the ages of 6 and 17 years continues to increase () and a growing number of private sport conditioning centers now cater to young athletes. Thus, as more children and adolescents resistance train in schools, health clubs, and sport training centers, it is imperative to determine safe, effective, and enjoyable practices by which resistance training can improve the health, fitness, and sports performance of younger populations.The National Strength and Conditioning Association (NSCA) recognizes and supports the premise that many of the benefits associated with adult resistance training programs are attainable by children and adolescents who follow age-specific resistance training guidelines. The NSCA published the first position statement paper on youth resistance training in 1985 () and revised this statement in 1996 (). The purpose of the present report is to update and clarify the 1996 recommendations on 4 major areas of importance. These topics include (a) the potential risks and concerns associated with youth resistance training, (b) the potential health and fitness benefits of youth resistance training, (c) the types and amount of resistance training needed by healthy children and adolescents, and (d) program design considerations for optimizing long-term training adaptations. The NSCA based this position statement paper on a comprehensive analysis of the pertinent scientific evidence regarding the anatomical, physiological, and psychosocial effects of youth resistance training. An expert panel of exercise scientists, physicians, and health/physical education teachers with clinical, practical, and research expertise regarding issues related to pediatric exercise science, sports medicine, and resistance training contributed to this statement. The NSCA Research Committee reviewed this report before the formal endorsement by the NSCA.For the purpose of this article, the term children refers to boys and girls who have not yet developed secondary sex characteristics (approximately up to the age of 11 years in girls and 13 years in boys; Tanner stages 1 and 2 of sexual maturation). This period of development is referred to as preadolescence. The term adolescence refers to a period between childhood and adulthood and includes girls aged 12-18 years and boys aged 14-18 years (Tanner stages 3 and 4 of sexual maturation). The terms youth and young athletes are broadly defined in this report to include both children and adolescents.By definition, the term resistance training refers to a specialized method of conditioning, which involves the progressive use of a wide range of resistive loads and a variety of training modalities designed to enhance health, fitness, and sports performance. Although the term resistance training, strength training, and weight training are sometimes used synonymously, the term resistance training encompasses a broader range of training modalities and a wider variety of training goals. The term weightlifting refers to a competitive sport that involves the performance of the snatch and clean and jerk lifts.This article builds on previous recommendations from the NSCA and should serve as the prevailing statement regarding youth resistance training. It is the current position of the NSCA that:

Interventions for treating obesity in children

BACKGROUND

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences.

OBJECTIVES

To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.

SEARCH STRATEGY

We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). 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 were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.

MAIN RESULTS

We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.

AUTHORS' CONCLUSIONS

While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials

CONTEXT

Evaluating the efficacy of pediatric weight loss treatments is critical.

OBJECTIVE

This is the first meta-analysis of the efficacy of RCTs comparing pediatric lifestyle interventions to no-treatment or information/education-only controls.

DATA SOURCES

Medline, PsycINFO, and Cochrane Controlled Trials Register.

STUDY SELECTION

Fourteen RCTs targetting change in weight status were eligible, yielding 19 effect sizes.

DATA EXTRACTION

Standardized coding was used to extract information on design, participant characteristics, interventions, and results.

DATA SYNTHESIS

For trials with no-treatment controls, the mean effect size was 0.75 (k = 9, 95% confidence interval [CI] = 0.52-0.98) at end of treatment and 0.60 (k = 4, CI = 0.27-0.94) at follow-up. For trials with information/education-only controls, the mean ES was 0.48 (k = 4, CI = 0.13-0.82) at end of treatment and 0.91 (k = 2, CI = 0.32-1.50) at follow-up. No moderator effects were identified.

CONCLUSIONS

Lifestyle interventions for pediatric overweight are efficacious in the short term with some evidence for extended persistence. Future research is required to identify moderators and mediators and to determine the optimal length and intensity of treatment required to produce enduring changes in weight status.

Systematic review of interventions in the management of overweight and obese children which include a dietary component

BACKGROUND

The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice.

OBJECTIVES

To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese.

SEARCH STRATEGY

Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles.

SELECTION CRITERIA

(i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded.

DATA COLLECTION AND ANALYSIS

An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate.

MAIN RESULTS

There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult.

REVIEWERS' CONCLUSIONS

There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice.

Weight training in youth-growth, maturation, and safety: an evidence-based review

OBJECTIVE

To review the effects of resistance training programs on pre- and early-pubertal youth in the context of response, potential influence on growth and maturation, and occurrence of injury.

DESIGN

Evidence-based review.

METHODS

Twenty-two reports dealing with experimental resistance training protocols, excluding isometric programs, in pre- and early-pubertal youth, were reviewed in the context of subject characteristics, training protocol, responses, and occurrence of injury.

RESULTS

Experimental programs most often used isotonic machines and free weights, 2- and 3-day protocols, and 8- and 12-week durations, with significant improvements in muscular strength during childhood and early adolescence. Strength gains were lost during detraining. Experimental resistance training programs did not influence growth in height and weight of pre- and early-adolescent youth, and changes in estimates of body composition were variable and quite small. Only 10 studies systematically monitored injuries, and only three injuries were reported. Estimated injury rates were 0.176, 0.053, and 0.055 per 100 participant-hours in the respective programs.

CONCLUSION

Experimental training protocols with weights and resistance machines and with supervision and low instructor/participant ratios are relatively safe and do not negatively impact growth and maturation of pre- and early-pubertal youth.

Active healthy living: prevention of childhood obesity through increased physical activity

The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

BACKGROUND

Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear.

OBJECTIVE

To determine the efficacy of exercise alone for treating overweight in children/adolescents.

DESIGN

A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N=481 overweight boys and girls, aged approximately 12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD).

RESULTS

Few studies were of robust design. The pooled SMD was -0.4 (-0.7, -0.1, P=0.006) for percent body fat, and -0.2 (-0.6, 0.1, P=0.07) for central obesity outcomes, whereas the pooled WMD was -2.7 kg (-6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/weeks).

CONCLUSIONS

Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.

Childhood obesity. Treatment options

The prevalence of child and adolescent overweight and obesity is rapidly increasing and is associated with morbidity, both medical and psychosocial. Obesity is unlikely to resolve spontaneously. It is important that health professionals can assess obesity and initiate an action plan. The evidence base for what works best in the management of child and adolescent overweight and obesity is limited. It is uncertain whether protocols from clinical research trials can be translated into primary care. Dietary change, with an emphasis on lower fat intake and smaller portion size, should be commenced. There should be an increase in physical activity and a decrease in sedentary behaviours, combined with behavioural change and parental involvement. These are the elements of a lifestyle intervention. In the severely obese adolescent with obesity-related co-morbidity, the use of very low-energy diets and anti-obesity agents could be considered. Bariatric surgery may be indicated in carefully selected, older, severely obese adolescents.

Validation of the Children???s OMNI-Resistance Exercise Scale of Perceived Exertion

PURPOSE

This investigation examined concurrent validity of the Children's OMNI-Resistance Exercise Scale (OMNI-RES) of perceived exertion for 10- to 14-yr-old females (N = 25) and males (N = 25) performing unilateral biceps curl (BC) and knee extension (KE) isotonic exercises.

METHODS

The criterion variable was total weight lifted (Wt(tot)), determined separately for females and males during BC and KE. Subjects performed three separate sets of 6, 10, and 14 repetitions for BC and KE at 50% 1-RM. Ratings of perceived exertion for the active muscles (RPE-AM) and overall body (RPE-Overall) were measured during the final repetition.

RESULTS

For both female and male groups across the three sets: (a) RPE-AM ranged from 2.9 to 8.3 for BC and 4.5 to 9.6 for KE, and (b) RPE-O ranged from 1.9 to 7.0 for BC and 3.6 to 7.7 for KE. Positive linear regression coefficients ranged from r = 0.72 to 0.88 (P < 0.01) between Wt(tot) and RPE-AM and RPE-Overall for BC and KE in both gender groupings. RPE did not differ between females and males at any measurement point within each set for BC and KE. RPE-AM was greater (P < 0.01) than RPE-Overall in the three sets of BC and KE.

CONCLUSION

Findings provided concurrent validation of the Children's OMNI-RES to measure RPE for the active muscle and overall body in 10- to 14-yr-old females and males performing upper and lower body resistance exercise.

Obesity-related cardiovascular risk factors: intervention recommendations to decrease adolescent obesity

The incidence of adolescent obesity is increasing dramatically in the United States with associated risks of hypertension, adverse lipid profiles, and Type II diabetes. Unless reversed, this trend predicts an epidemic of adult cardiovascular disease. Interventions at home, at school, and in the community are required to empower teens to increase physical activity and to modify eating habits. This article describes assessment for obesity-related health problems as well as scientific guidelines and research-based intervention strategies to decrease obesity in adolescents.

Exercise Training in Obese Children and Adolescents

Childhood obesity has reached epidemic proportions worldwide and is associated with increased cardiovascular mortality and morbidity in adult life. The increase in fat mass in children and adolescents has occurred concomitantly with a decline in reported time for exercise. Evidence suggests that non-physically active children are more likely to become non-physically active adults and that encouraging the development of physical activity habits in children helps establish patterns that continue into adulthood. Dietary treatment of obesity is relatively ineffective in adults and it has been suggested that prevention of obesity in childhood and adolescence should emphasise increased physical activity rather than diet because of fears relating to the adverse effects of inappropriate eating patterns. Despite this, there are very few randomised controlled studies investigating the efficacy of exercise training in obese children or adolescents and many of the extant studies have been poorly controlled and have not specifically stratified the independent effect of exercise versus dietary modification. This review focuses on the well designed controlled trials that have evaluated the effect of exercise training in obese children and adolescents on body composition, haemodynamic and metabolic variables, cardiovascular fitness, muscular strength and vascular function. These studies indicate that, although exercise training does not consistently decrease bodyweight or body mass index, it is associated with beneficial changes in fat and lean body mass, emphasising the importance of comprehensive assessment of body composition in future exercise-training studies. Exercise training improves cardiovascular fitness and muscular strength; however, it seems to have little effect on blood lipid profile or blood pressure in obese young people. Importantly, recent studies have demonstrated that exercise training improves vascular endothelial function, an important surrogate measure that may predict future atherosclerotic risk in obese children and adolescents. Given that improvement in vascular function in these training studies occurred in the absence of changes in lipid fractions, haemodynamic variables or glucose metabolism, exercise appears to have a direct beneficial effect on the vasculature, in addition to its putative benefits through risk-factor modification.

Efeito da atividade física associada à orientação alimentar em adolescentes obesos: comparação entre o exercício aeróbio e anaeróbio

A obesidade na adolescência é uma doença universal de prevalência mundial crescente, assumindo caráter epidemiológico como problema de saúde pública na sociedade moderna. Este trabalho teve como objetivo comparar o efeito do exercício físico aeróbio contínuo e anaeróbio intermitente associado à orientação alimentar sobre a composição corporal, as medidas bioquímicas e a capacidade física de adolescentes obesos. Foram investigados 28 adolescentes (média de idade = 13 anos), com índice de massa corporal (IMC) acima do percentil 95 para a idade e sexo, distribuídos em dois grupos de forma aleatória: exercício de caminhada contínua (GEC; n = 13) e exercício de corrida intermitente (GEI; n = 15) e submetidos a um programa de treinamento físico três vezes por semana durante 16 semanas por 20 a 40 minutos. A atividade de orientação nutricional ocorreu uma vez por semana, em grupo, por 60 minutos, durante todo o experimento. Foram realizadas, no período inicial e final, medidas de peso e altura, pregas subcutâneas, circunferências do braço (CB) e muscular do braço (CMB), composição corporal por bioimpedância elétrica, análises bioquímicas séricas (glicemia e lipídios) e determinação direta de consumo máximo de oxigênio (VO2max) e limiar anaeróbio (LAn). Como resultados antropométricos, observamos diminuição do IMC e das pregas cutâneas com diferença significativa nos dois grupos (GEC e GEI). Na avaliação bioquímica, houve diminuição significativa nos níveis séricos de HDL e LDL, colesterol total, e aumento do triglicérides e glicemia no GEC, embora mantendo-se dentro dos valores de normalidade. No GEI, o HDL e triglicérides tiveram diminuição significativa. O VO2max aumentou estatisticamente nos dois grupos. Concluímos que a atividade física proposta e a orientação alimentar, tanto para o GEC quanto para GEI, foi suficiente e satisfatória, promovendo diminuição ponderal, melhora da composição corporal, dos níveis lipídicos e aumento na capacidade aeróbia dos adolescentes.

Effect of a 3-week body mass reduction program on body composition, muscle function and motor performance in pubertal obese boys and girls

The aim of this study was to investigate the effects of a multidisciplinary body mass reduction (BMR) program on body composition, muscle function and motor performance in 50 obese [mean body mass index (BMI): 35.9+/-5.8 kg/m2] boys and girls aged 12-17 yr (Tanner stage III, IV and V). The hospital-based BMR program combined an energy-restricted diet (1400-1600 kcal), nutritional education, psychological counselling and moderate physical activity (45-60 min/ session; 5 sessions/week; 60-80% of the maximal heart rate) during a 3-week period. Fat mass, fat-free mass, maximal power during jumping and stair climbing as well as maximal strength of the upper and lower limb muscles were quantified before and after the treatment. Body mass and fat mass significantly decreased following the BMR program, respectively -5.1 and -7.8% (p<0.001), while percent fat-free mass increased 2.3% (p<0.001). The treatment significantly increased both stair climbing and jumping power, respectively 8.2 and 8.9% (p<0.05), and the same was true for maximal strength of the upper and lower limb muscles (p<0.001). For the first time, it was demonstrated that a BMR program entailing diet and physical exercise significantly improved body composition, muscle function and motor performance in obese boys and girls aged 12-17 yr, while gender and pubertal stages had no influence on BMR program-induced changes.

Elderly obese women display the greatest improvement in stair climbing performance after a 3-week body mass reduction program

OBJECTIVE

To investigate whether stair climbing performance and body composition are similarly affected by a body mass reduction (BMR) program in obese individuals of different gender, age and body mass index (BMI) level.

DESIGN

Longitudinal, clinical intervention study entailing energy-restricted diet (5023-7535 kJ/day), nutritional education, psychological counselling and moderate physical activity (indoor cycling, outdoor walking, gymnastics routines, five sessions/week) during a 3-week period.

SUBJECTS

A total of 466 male and 807 female subjects categorized as a function of gender, age (< vs >/=50 y) and BMI (< vs >/=40 kg/m(2)).

MEASUREMENTS

Body mass, stair climbing time and power before and after the BMR program. Fat-free mass and fat mass were also evaluated by bioimpedance analysis, in a representative subgroup of 160 patients, to evaluate the relation between fat-free mass and power output.

RESULTS

Body mass, fat-free mass and fat mass significantly decreased following the BMR program (P<0.001), with male subjects reducing body mass and fat-free mass more than and fat mass less than the female subjects. Stair climbing time decreased (P<0.001) and therefore anaerobic power significantly increased 9.7% after the treatment. The greatest improvement in stair climbing performance was observed in obese women aged >/=50 y. Significant inverse correlations were found between initial power or fat-free mass level and respective percent increases (R=-0.35/-0.37, P<0.001) and between BMR-induced percent changes in body mass and power (R=-0.13, P<0.001).

CONCLUSION

Subjects with the lowest baseline level in stair climbing performance (and probably with the lowest amount of fat-free mass), that is, obese women aged more than 50 y, obtained the largest enhancement after the 3-week BMR program, likely improving overall functional capacities and resulting in greater independence during daily-living activities in such a population.

Influência do treinamento aeróbio e anaeróbio na massa de gordura corporal de adolescentes obesos

O objetivo deste estudo foi verificar as influências do exercício aeróbio e anaeróbio na composição corporal de adolescentes obesos do sexo masculino. A amostra foi constituída de 28 adolescentes com idades entre 15 e 19 anos, que apresentavam obesidade grave. Os voluntários foram distribuídos aleatoriamente em três grupos: grupo I: exercício anaeróbio; grupo II: exercício aeróbio; e grupo III: controle. O grupo I realizou treinamento intervalado em cicloergômetro que consistiu de 12 "tiros" de 30" com máxima força e velocidade, pedalando com carga alta (0,8% do massa corporal x 25 watts) e recuperação ativa de 3'; o grupo II realizou treinamento aeróbio em cicloergômetro pedalando com carga relativa ao limiar ventilatório por 50 minutos. Já o terceiro grupo funcionou como controle, sem atividade física. Todos os grupos tiveram orientação nutricional e o período de intervenção foi de 12 semanas (três meses). Os voluntários realizaram densitometria óssea com análise da composição corporal (DEXA) e avaliações médicas e de aptidão física. Quando comparados os períodos inicial e final de intervenção foram observadas reduções nas variáveis massa corporal, IMC, na massa de gordura corporal total e de membros inferiores e na percentagem de gordura corporal de tronco nos grupos de exercício. Diferenças foram observadas entre os grupos I e III para os deltas percentuais de massa de gordura corporal total e de membros inferiores e na percentagem de gordura de membros inferiores. Os dados sugerem que o exercício físico, tanto aeróbio como anaeróbio, aliado à orientação nutricional, promove maior redução ponderal, quando comparado com a orientação nutricional somente, e que, neste estudo, o exercício anaeróbio foi mais eficiente para promover a diminuição da gordura corporal e da percentagem de gordura e o exercício aeróbio foi mais eficaz no sentido de preservar e/ou aumentar a massa magra e a massa livre de gordura.

Changes in fat mass, fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme

The purpose of this study was to describe changes in fat mass (FM), fat-free mass (FFM) and aerobic fitness in severely obese children and adolescents during residential treatment in the Medical Paediatric Centre Zeepreventorium. Treatment consisted of moderate dietary restriction, physical activity and psychological support. This study was a clinical observation of 20 severely obese children and adolescents (8 boys and 12 girls, aged 15.4+/-1.8 years) who completed the 10-month residential programme. Height, weight, FM, FFM and aerobic fitness was measured four times during the intervention: at baseline, 11 weeks, 24 weeks and at 33 weeks (at the end of the programme ). The mean decrease in level of overweight was 46% (P<0.001), with a mean loss of 8.9% FM (P<0.001). Submaximal performance (PWC150) improved from 123+/-35 Watt to 152+/-37 Watt (P<0.001). Maximal performance levels increased (performance time: from 14+/-2.9 min to 15.3+/-3.5 min, peak power: from 186+/-38 Watt to 205+/-45 Watt, P<0.01) without an improvement in absolute VO(2 peak).

CONCLUSION

A moderate dietary restriction in combination with physical activity and psychological support in severely obese children and adolescents is effective in decreasing body fat and improving physical performance. Further research is needed to evaluate the longer-term effects of such a programme.

Interventions for treating obesity in children

BACKGROUND

The prevalence of overweight and obesity is increasing in child populations throughout the world. Obesity in children has significant short and long term health consequences.

OBJECTIVES

To assess the effects of a range of lifestyle interventions designed to treat obesity in childhood.

SEARCH STRATEGY

We searched CCTR, MEDLINE, EMBASE, CINAHL, PsychLIT, Science Citation Index, Social Science Citation Index. Each database was searched from 1985 to July 2001. We also contacted experts in child obesity treatment.

SELECTION CRITERIA

We selected randomised controlled trials of lifestyle interventions for treating obesity in children with a minimum of six months duration. Examples of lifestyle interventions include dietary, physical activity and/or behavioural therapy interventions, with or without the support of associated family members. Interventions from any setting and delivered by any professional were considered. However, interventions that specifically dealt with the treatment of eating disorders were excluded.

DATA COLLECTION AND ANALYSIS

Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information where this was appropriate.

MAIN RESULTS

We included 18 randomised controlled trials with 975 participants. Many studies were run from a specialist obesity clinic within a hospital setting. Five studies (n=245 participants) investigated changes in physical activity and sedentary behaviour. Two studies (n=107 participants) compared problem-solving with usual care or behavioural therapy. Nine studies (n=399 participants) compared behavioural therapy at varying degrees of family involvement with no treatment or usual care or mastery criteria and contingent reinforcement. Two studies (n=224 participants) compared cognitive behavioural therapy with relaxation.Most of the studies included in this review were too small to have the power to detect the effects of the treatment. We did not conduct a meta-analysis since so few of the trials included the same comparisons and outcomes. Therefore, we synthesised the results in a narrative format.

REVIEWER'S CONCLUSIONS

Although 18 research studies were found, most of these were very small studies drawn from homogenous, motivated groups in hospital settings and so generalisable evidence from them is limited. In conclusion, there is a limited amount of quality data on the components of programs to treat childhood obesity that favour one program over another. Further research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required. We conclude that no direct conclusions can be drawn from this review with confidence.

Effects of dietary intervention and strength training on blood lipid level in obese children

AIMS

To evaluate effects of a low energy diet, with or without strength training, on blood lipid profile in obese children.

METHODS

Eighty two obese children were enrolled into a six week dietary programme, and were randomly allocated to a training group or a non-training group. The training group underwent regular exercise sessions with emphasis on strength training.

RESULTS

Height increased significantly, with a non-significant reduction in body mass index. Fat free mass increased significantly in the training group. Serum total cholesterol was significantly reduced in both groups. The LDL:HDL ratio significantly decreased in the training group.

CONCLUSION

Results support the potentially beneficial effects of both diet and physical training. Further and longer term evaluation of such programmes is required.