The effects of a 12-week jump rope exercise program on body composition, insulin sensitivity, and academic self-efficacy in obese adolescent girls

Effect of self-regulating fatigue on health-related quality of life of middle-aged and elderly patients with recurrent stroke: a moderated sequential mediation model

Although the association between self-regulation of fatigue and health-related quality of life (HRQoL) has been confirmed, the potential mechanism remains unclear. This study aimed to explore the role of health literacy, health behavior, and exercise frequency in the relationship among middle-aged and elderly patients with recurrent stroke. A cross-sectional survey was conducted. A total of 176 patients completed the survey, in which self-regulation of fatigue, HRQoL, health literacy and health behavior were measured by questionnaires. Based on Bootstrap analyses, a moderating sequential mediation model using PROCESS software was constructed with health literacy and health behavior as mediators and exercise frequency as the moderator. Of the participants, the mean age was 65.44 ± 12.43 years. Self-regulation of fatigue was found to affect HRQoL indirectly through two significant mediation pathways: (1) health literacy (β=-0.11, 95%CI = -0.20, -0.03), which accounted for 28.79% of the total effect, and (2) health literacy and health behavior (β=-0.02, 95%CI = -0.05, -0.00), which accounted for 4.80% of the total effect. Exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Specifically, the interaction term between self-regulating fatigue and exercise frequency significantly predicted HRQoL (β = 0. 25, t = 2.55, p < 0.05). These findings highlight the role of health literacy and health behavior as sequential mediators of the relationship between self-regulating fatigue and HRQoL. Moreover, exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Encouraging patients with recurrent stroke to increase exercise frequency appropriately might improve HRQoL for patients with poor health literacy and health behavior.

Exercise and Insulin Resistance Markers in Children and Adolescents With Excess Weight: A Systematic Review and Network Meta-Analysis

Importance

Although benefits have been reported for most exercise modalities, the most effective exercise approaches for reducing insulin resistance in children and adolescents with excess weight and the optimal exercise dose remain unknown.

Objective

To compare exercise training modalities and their association with changes in insulin resistance markers among children and adolescents with excess weight and to establish the optimal exercise dose.

Data Sources

For this systematic review and network meta-analysis, 6 electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and CINAHL) were searched for studies from inception to April 1, 2023.

Study Selection

Randomized clinical trials (ie, randomized controlled trials and randomized trials without a control group) were included if they reported outcomes associated with aerobic training, resistance training, high-intensity interval training (HIIT), or a combination of these interventions.

Data Extraction and Synthesis

Data extraction for this systematic review was conducted following a network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Effect sizes were calculated as the mean difference (MD) with 95% CI using random-effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman method. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. The Cochrane Risk-of-Bias tool, version 2 (RoB2), was used to independently assess the risk of bias of the included studies. The certainty of evidence in consistent networks was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. The study protocol was prospectively registered with PROSPERO. Data analyses were conducted between May and June 2023.

Main Outcomes and Measures

The primary outcomes were fasting glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR).

Results

This analysis included 55 studies with a total of 3051 children and adolescents (mean [SD] age, 13.5 [2.3] years; 1537 girls [50.4%] and 1514 boys [49.6%]). Exercise was associated with reductions in fasting insulin (MD, -4.38 μU/mL [95% CI, -5.94 to -2.82 μU/mL]) and HOMA-IR (MD, -0.87 [95% CI, -1.20 to -0.53]). A nonlinear association in both markers was observed, with a required minimal exercise dosage of approximately 900 to 1200 metabolic equivalent of task minutes per week, especially in children and adolescents with insulin resistance at baseline. Combination HIIT and resistance training and concurrent training were the most effective approaches for reducing insulin resistance markers. On average, the certainty of evidence varied from low to moderate.

Conclusions and Relevance

These findings underscore the role of exercise interventions in enhancing insulin resistance markers among children and adolescents with overweight and obesity. It is advisable to include resistance exercises alongside aerobic and HIIT programs for a minimum of two to three 60-minute sessions per week.

Effects of rope skipping exercise on physical, cardiovascular fitness and exercise tolerance in adolescent students with moderate intellectual disability

BACKGROUND

Adolescents with intellectual disabilities (ID) who live a sedentary lifestyle may lead to an increased risk of chronic cardiovascular disease in adulthood. The aim of this study is to investigate the effects of 8-week progressive rope skipping training on physical, cardiovascular fitness and exercise tolerance of high school students with moderate ID.

METHODS

Thirty-four senior high school with ID (aged 15-18 years old) were randomised into experimental group received progressive skipping rope exercise (RS, n = 17) and control group no rope skipping exercise intervention group (CON, n = 17). The RS group were received progressive rope skipping exercise for 50 min each time, three times a week, for 8 weeks. The control group was not allowed to participate in intervention activities during the study period. The physical fitness, body composition, arterial stiffness index (ASI) and blood pressure were measured before and after the 8-week intervention.

RESULTS

After the 8-week progressive skipping rope exercise intervention, the participants from the RS group increased in the 3-min step test, sit-up test, grip strength and sit and reach test, when compared to the baseline (P < 0.05). The RS group exhibited lower the area under curve of heart rate (HR) during post-exercise recovery (P < 0.05). The participants in the RS group showed significant decreases in systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP) and HR when compared to the baseline (P < 0.05). Change SBP has moderate positive correlation with change ASI.

CONCLUSIONS

The results of this experiment suggest that progressive rope skipping exercise might improve physical fitness and promote cardiovascular health, as well as enhance exercise tolerance for adolescent students with moderate ID.

The effects of exercise training on insulin resistance in children and adolescents with overweight or obesity: a systematic review and meta-analysis

Aim

The aim of present meta-analysis was to determine the effects of exercise training (Exe) on insulin resistance (IR) and body weight in children and adolescents with overweight or obesity.

Methods

PubMed, Web of Science, and Scopus were searched for original articles, published through October 2022 that included exercise versus control interventions on fasting glucose, insulin, HOMA-IR, and body weight outcomes in children and adolescents with overweight or obesity. Standardized mean differences (SMD) for fasting insulin, and weighted mean differences (WMD) for fasting glucose, HOMA-IR, body weight (BW), and 95% confidence intervals were determined using random effects models.

Results

Thirty-five studies comprising 1,550 children and adolescents with overweight and obesity were included in the present meta-analysis. Exercise training reduced fasting glucose (WMD=-2.52 mg/dL, p=0.001), fasting insulin (SMD=-0.77, p=0.001), HOMA-IR (WMD=-0.82, p=0.001), and BW (WMD=-1.51 kg, p=0.001), as compared to a control. Subgroup analyses showed that biological sex, intervention duration, type of exercise training, BMI percentile, and health status (with or without diagnosed condition), were sources of heterogeneity.

Conclusion

Exercise training is effective for lowering fasting glucose, fasting insulin, HOMA-IR, and BW in children and adolescents with overweight or obesity and could provide an important strategy for controlling IR and related factors. With clear evidence for the effectiveness of exercise interventions in this vulnerable population, it is important to determine effective approaches for increasing exercise training in children and adolescents with overweight or obesity.

Effects of different exercise modalities and intensities on body composition in overweight and obese children and adolescents: a systematic review and network meta-analysis

Introduction: Childhood and adolescent overweight and obesity are global public health issues. Previous studies on exercise and overweight and obese children have produced inconsistent findings and lacked comparisons between different exercise modalities and intensities. Therefore, a network meta-analysis is necessary to provide evidence-based intervention programs. This study aims to identify the effects of different exercise modalities and intensities on changes in body composition in overweight and obese children and adolescents. Methods: A search for randomized controlled trials was conducted on Web of Science, PubMed, Scopus, and Embase involving exercise interventions aimed at improving body composition (body fat percentage, BMI, fat mass, fat-free mass, body weight) in overweight and obese children and adolescents. A random effects network meta-analysis was performed using STATA 14.0 software within a frequentist framework. The literature quality was assessed using the Cochrane Risk of Bias Tool 2.0. Results: Thirty-two papers involving 1,452 participants were included. There were six types of intervention involved in the study, including moderate intensity aerobic exercise, high-intensity aerobic exercise, moderate intensity resistance exercise, high-intensity resistance exercise, moderate intensity combined exercise, and high-intensity combined exercise. The network meta-analysis results revealed that high-intensity combined exercise was the best exercise mode for improving BMI [mean difference in kg/m² = -1.65, 95% CI (-3.27, -0.02)] and reducing fat mass [mean difference in kg = -2.87, 95% CI (-4.84, -0.91)]. Moderate intensity combined exercise was the best mode for weight loss [mean difference in kg = -4.58, 95% CI (-5.94, -3.22)] and improvement in body fat percentage [mean difference in% = -2.52, 95% CI (-3.83, -1.20)]. High-intensity resistance exercise had the optimal effect in increasing fat-free mass [mean difference in kg = 1.10, 95% CI (0.22, 1.99)]. Conclusion: In conclusion, the study found that combined exercise, whether moderate or high intensity, was more effective than any other exercise modality in improving body fat percentage and BMI, reducing fat mass and weight. Resistance exercise was the most effective in increasing fat-free mass.

Jumping Rope Improves the Physical Fitness of Preadolescents Aged 10-12 Years: A Meta-Analysis

To systematically review the effects of jumping rope on physical fitness among 10 to 12-year-old preadolescents, and to provide evidence-based support for its use in school physical education curriculum work. The PubMed, Web of Science, SPORTDiscus, ScienceDirect, and CNKI databases were searched for randomized controlled trials that assessed jumping rope and physical fitness among preadolescents aged 10-12 years. Meta-analyses were used to calculate the standardized mean difference (SMD) values and 95% confidence intervals (CI), and subgroup analyses were conducted on intervention duration, frequency and period. A total of 1048 subjects from 15 studies were included. Compared to regular physical education courses, jumping rope did not show a significant advantage in terms of body morphology. In terms of physical function, boys showed greater improvements in vital capacity, and girls showed greater improvements in resting HR. In terms of physical performance, boys showed greater improvements in speed, upper-body strength, lower-body strength, muscular endurance and agility, while girls showed greater improvements in coordination and balance. Boys experienced a minimal improvement in flexibility, while girls did not show a significant difference. Combining the results of the subgroup analyses, the optimal session time, frequency and intervention length of jumping rope for significantly improving the physical fitness of preadolescents were >40 min, 2 times/week and 8-12 weeks, respectively. In conclusion, jumping rope provides small to large benefits over regular physical education for both boys and girls aged 10-12 years in terms of physical function and physical performance indicators other than flexibility, while showing no significant advantage in terms of body morphology. Based on the available research, it is recommended that children aged 10-12 years participate in jump rope sessions for at least 40 minutes once or twice a week for 8-12 weeks to better develop physical fitness.

Relationships between athletic ability and academic performance in primary school students: A 3-year follow-up study

Background

The aim of this study was to examine whether academic performance is associated with students' athletic ability in primary school.

Methods

A 3-year follow-up study was conducted among 1,136 Chinese students. Sit-up and jump rope testers were used to measure 1-min sit-ups and 1-min jump ropes, respectively. Meanwhile, the Pittsburgh Sleep Quality Scale and the Beck Depression Inventory were used to estimate sleep quality and depression levels. The end-of-semester examinations were used to evaluate students' academic performance during the follow-up period.

Results

After adjusting for confounders, the mean change in Chinese language performance for participants stratified by 1-min sit-ups at baseline was 0.35 (95% CI: -0.37 to 0.76) for level 1 (slowest), 0.52 (95% CI: -0.54 to 1.08) for level 2, and 1.72 (95% CI: 1.14 to 2.30) for level 3 (fastest) (P for trend = 0.003); the mean change in math scores was 0.28 (95% CI: -0.50 to 0.95) for level 1 (slowest), 0.95 (95% CI: 0.38 to 1.52) for level 2, and 1.41 (95% CI: 0.82 to 1.99) for level 3 (fastest) (P for trend = 0.048). The mean change in foreign language scores was -0.45 (95% CI: -0.99 to -0.93) for level 1 (slowest), -0.14 (95% CI: -0.44 to 0.41) for level 2, and 0.69 (95% CI: 0.25 to 1.13) for level 3 (fastest) (P for trend = 0.004). The mean change in Chinese language performance for participants stratified by 1-min jump ropes at the baseline was 0.30 (95% CI: -0.16 to 0.76) for level 1 (slowest), 1.09 (95% CI: 0.42 to 1.76) for level 2, and 1.74 (95% CI: 1.14 to 2.35) for level 3 (fastest) (P for trend = 0.001). The mean change in math scores was 0.41 (95% CI: -0.11 to 0.92) for level 1 (slowest), 1.44 (95% CI: 0.69 to 2.19) for level 2, and 1.43 (95% CI: 0.76 to 2.10) for level 3 (fastest) (P for trend = 0.019). The mean change in foreign language performance was -0.71 (95% CI: -1.08 to -0.33) for level 1 (slowest), 0.95 (95% CI: -0.40 to 1.50) for level 2, and 0.91 (95% CI: 0.41 to 1.41) for level 3 (fastest) (P for trend < 0.001).

Conclusion

This study suggests that participation in jump rope and sit-up exercises may positively affect students' academic performance.

Effects of physical activity on body mass and composition of school-age children and adolescents with overweight or obesity: Systematic review focusing on intervention characteristics

OBJECTIVE

The characteristics of physical activity (PA) interventions to improve body mass and composition in pediatric populations are unclear. This systematic review summarized the effects of PA on those outcomes in school-age children and adolescents with overweight or obesity, focusing on training components (frequency, intensity, duration, and type - FITT).

METHODS

Databases were searched for controlled trials applying exclusive PA and including children (5-12 y) or adolescents (13-17 y) with overweight/obesity.

RESULTS

Twenty-seven trials yielding 34 interventions were included. PA was recreational (children: k = 9, n = 478), systematized (children: k = 18, n = 565); or combined (children: k = 7, n = 205). Successful interventions were performed for 6- to 35 weeks (mostly 12-14 weeks), 2- to 5 d/wk (mostly 3 d/wk), during 8- to 60 min (mainly 60 min) with moderate to high intensity (60-90% maximal heart rate or 40-70% heart rate reserve). Half of the interventions applying recreational (4 out of 8), 59% of systematized (10 out of 17), and 57% of combined (4 out of 7) interventions reported improvements in body mass or composition, especially body fat. Benefits were more often reported for body composition (18 out of 34 interventions) than body mass (8 out of 34 interventions), irrespective of the age group.

CONCLUSION

Recreational and systematized PA may improve body mass, and particularly body composition in school-age children and adolescents with overweight or obesity. Successful programs were performed for at least six weeks and applied a PA amount consistent with the minimum recommended for pediatric populations (≥60 min of moderate-to-vigorous PA at least 3 d/wk).

Improving Body Mass Index of School-Aged Children Using a Nine-Week Rope Skipping Training Intervention: A One-Group Pre-Test Post-Test Design

Studies examining the effectiveness of rope skipping training to improve the body mass index (BMI) of school children are scarce. Hence, this study examined the effectiveness of nine-week skipping training on the BMI of primary six school-aged children (n = 77). The participants underwent 30 min of skipping training three days per week over a nine-week period. The participants’ BMI was measured at the baseline and during weeks 3, 6 and 9. The results from a one-way ANOVA with repeated measures indicated a statistically significant difference in the BMI for both males [F(3,111) = 9.42, p < 0.001, ηp2 = 0.203] and females [F(3,114) = 7.35, p < 0.001, ηp2 = 0.162], suggesting an improvement in BMI. Post hoc comparisons with a Bonferroni adjustment revealed significant differences in BMI after nine weeks of intervention for males between the pre-test (M = 21.47, SD = 4.94) and the 9-week post-test (M = 20.15, SD = 4.36), and for females between the pre-test (M = 21.56, SD = 5.80) and the 9-week post-test (M = 20.68, SD = 5.32). This study demonstrated that regular participation in vigorous physical activity such as skipping training could promote child health by preventing the likelihood of young children being overweight. This result has implications for the inclusion of skipping training into the school life of school-aged children to help manage their BMI levels.

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

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

Effects of different exercise types on visceral fat in young individuals with obesity aged 6-24 years old: A systematic review and meta-analysis

Introduction: The prevalence of pediatric obesity remains high all over the world. Various exercise interventions have been applied to decrease the visceral fat in young individuals with obesity. But the evidence remains controversial on the effect of the exercise on visceral fat. Moreover, it is unclear which type of the exercise is the most effective for young individuals with overweight or obesity to reduce visceral fat. Objective: The objective of this review and meta-analysis is to evaluate and compare the effectiveness of different exercise interventions on visceral fat in young individuals with overweight or obesity. Methods: Four databases consisting of PubMed, Web of Science, EBSCO, and Cochrane Library were searched prior to May 2022. Fifteen studies with a total of 30 data points involving 1,134 participants were included in this meta-analysis. And the interventions were limited to 4 exercise types [i.e., aerobic exercise (AE), resistance exercise (RE), aerobic exercise combined with resistance exercise (CE), and high-intensity interval training (HIIT)]. Data Synthesis: The results showed that AE (Standardized Mean Difference = -0.32; 95% CI = -0.50 to -0.13; p = 0.0007; I² = 37%) and HIIT (SMD = -0.59; 95% CI = -0.87 to -0.31; p < 0.0001; I² = 0%) had a significant reduction effect on visceral fat. And the effect of HIIT seemed better than AE. However, RE (SMD = -0.58; 95% CI = -1.34 to 0.17; p = 0.13; I² = 76%) and CE (SMD = -0.21; 95% CI = -0.81 to 0.38; p = 0.48; I² = 63%) had a non-significant effect on visceral fat decline. Additionally, compared with the control group, exercise interventions had a significant effect on reducing visceral fat in adolescents (SMD = -0.54; 95% CI = -0.82 to -0.26; p = 0.0001; I² = 64%) and young adults (SMD = -0.42; 95% CI = -0.69 to -0.15; p = 0.003; I² = 0%) rather than children (SMD = -0.15; 95% CI = -0.32 to 0.02; p = 0.08; I² = 0%). And the gender-based subgroup analysis indicated that the effectiveness of the exercise on the reduction of visceral fat was more significant in males (SMD = -1.27; 95% CI = -1.67 to -0.87; p < 0.00001; I² = 0%) than that in females (SMD = -0.31; 95% CI = -0.48 to -0.14; p = 0.0004; I² = 0%). Conclusion: This review and meta-analysis demonstrates that exercise interventions are efficient to decrease visceral fat in adolescents (12-18 years old) and young adults (18-24 years old). Among different exercise types, AE and HIIT are helpful for young individuals with overweight or obesity to reduce visceral fat and HIIT appears to be the most effective exercise intervention. In addition, the effect of exercise interventions on the consumption of visceral fat is more significant in males than that in females. Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022310878].

Jump rope training effects on health- and sport-related physical fitness in young participants: A systematic review with meta-analysis

The aim of this systematic review with meta-analysis was to assess the available body of published peer-reviewed articles related on the effects of jump rope training (JRT) compared with active/passive controls on health- and sport-related physical fitness outcomes. Searches were conducted in three databases, including studies that satisfied the following criteria: i) healthy participants; ii) a JRT programprogramme; iii) active or traditional control group; iv) at least one measure related to health- and sport-related physical fitness; v) multi-arm trials. The random-effects model was used for the meta-analyses. Twenty-one moderate-high quality (i.e., PEDro scale) studies were meta-analysed, involving 1,021 participants (male, 50.4%). Eighteen studies included participants with a mean age <18 years old. The duration of the JRT interventions ranged from 6 to 40 weeks. Meta-analyses revealed improvements (i.e., p = 0.048 to <0.001; ES = 0.23-1.19; I² = 0.0-76.9%) in resting heart rate, body mass index, fat mass, cardiorespiratory endurance, lower- and upper-body maximal strength, jumping, range of motion, and sprinting. No significant JRT effects were noted for systolic-diastolic blood pressure, waist-hip circumference, bone or lean mass, or muscle endurance. In conclusion, JRT, when compared to active and passive controls, provides a range of small-moderate benefits that span health- and sport-related physical fitness outcomes.

Exercise and Cardiovascular Disease Risk Factors in Children and Adolescents With Obesity: A Systematic Review With Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to examine the effects of exercise on cardiovascular disease (CVD) risk factors in children and adolescents with obesity. Randomized controlled trials (RCTs) of exercise ≥4 weeks in children and adolescents with obesity were included if one or more CVD risk factors were included as an outcome. Studies were retrieved by searching 7 electronic databases, cross-referencing, and expert review. Data were pooled using the inverse-variance heterogeneity (IVhet) model and strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Thirty-nine studies representing 1548 participants (847 exercise, 701 control) met the inclusion criteria. Aerobic exercise improved 10 of 12 (83.3%) outcomes (P < .05 for all) while combined aerobic and strength training improved 5 of 8 (62.5%) outcomes (P < .05 for all). The strength of evidence ranged from "very low" to "moderate." It was concluded that aerobic exercise, as well as combined aerobic and strength training, is associated with improvements in multiple CVD risk factors among children and adolescents with obesity. However, the generally low strength of evidence suggests a need for future well-designed and conducted RCTs on the effects of exercise, especially strength training, in children and adolescents with obesity.

Fitness Promotion in a Jump Rope-Based Homework Intervention for Middle School Students: A Randomized Controlled Trial

Physical activity (PA) homework offers a promising approach for students to be physically active after school. The current study aims to provide holistic insights into PA homework design and the effects of implementation in practice. In total, ninety-three middle school students were randomly assigned to a homework group (HG) or control group (CG). Participants in HG (n = 47) were requested to complete jump rope homework three times per week for 12 weeks, while their counterparts in CG attended one health education class every week. A homework sheet was used to provide instructions and record information for exercise behaviors during homework completion. Physical fitness tests were conducted to investigate the effects of the jump rope homework on the physical fitness of middle school students. After the intervention, participants in HG reported moderate to vigorous PA during jump rope exercise. The average duration for each practice was approximately 48 min. The returned homework sheets accounted for 86.88% of all homework assignments, indicating a good completion rate. Compared with their counterparts in CG, participants performing jump rope exercise indicated greater improvement in speed, endurance, power, and core muscular endurance. Jump rope homework strengthened physical fitness for middle school students, which provided a valuable addition to comprehensive school PA practice.

Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Lean / Fat Free Body Mass (LBM) is metabolically involved in active processes such as resting energy expenditure, glucose uptake, and myokine secretion. Nonetheless, its association with insulin sensitivity / resistance / glucose tolerance and metabolic syndrome remains unclear in childhood.

METHODS

The current investigation aimed to examine the differences in fat-free mass /lean body mass according to the presence of insulin sensitivity/insulin resistance/glucose tolerance/metabolic syndrome in children. A systematic search was carried out in Medline/PubMed, Embase, Scopus, Web of Science, and SciELO, covering the period from each database's respective start to 21 June 2021. Two researchers evaluated 7111 studies according to the inclusion criteria: original human studies, written in English or Spanish, evaluating fat-free mass/lean body mass in children and adolescents including both with and without insulin sensitivity/insulin resistance /glucose tolerance and metabolic syndrome and reported the differences between them in terms of fat free mass/lean body mass. The results of the studies were combined with insulin sensitivity, insulin, resistance, glucose tolerance and metabolic syndrome. The standardized mean difference (SMD) in each study was calculated and combined using the random-effects model. Heterogeneity between studies was tested using the index of heterogeneity (I2), leave-one-out sensitivity analyses were performed, and publication bias was assessed using the Egger and Begg tests.

RESULTS

Finally, 15 studies which compared groups defined according to different glucose homeostasis criteria or metabolic syndrome out of 103 eligible studies were included in this systematic review and 12 studies in the meta-analysis. Meta-analysis showed lower fat-free mass/lean body mass percentage in participants with insulin resistance/glucose tolerance/metabolic syndrome (SMD -0.47; 95% CI, - 0.62 to - 0.32) while in mass units (kg), higher values were found in the same group (SMD, 1.01; 95% CI, 0.43 to 1.60).

CONCLUSIONS

Our results identified lower values of fat-free mass/lean body mass (%) in children and adolescents with insulin resistance/glucose tolerance/metabolic syndrome and higher values of fat-free mass/lean body mass when these are expressed in kg. The evidence of the impact of lean mass on children's glucose homeostasis or metabolic syndrome is limited, so future studies research should focus on explaining the effect of fat-free mass/lean body mass on different metabolic outcomes. Moreover, it may be interesting to evaluate the quality (muscle density) or functional (muscle strength) outcomes in addition to both absolute (kg) and relative (%) values in future studies. The systematic review was prospectively registered at PROSPERO (registration number CRD42019124734; available at: http://www.crd.york.ac.uk/prospero [accessed: 05 April 2019]).

Autoeficácia alimentar em crianças e adolescentes com sobrepeso ou obesidade: revisão integrativa de instrumentos

RESUMO Objetivo: Descrever as características dos instrumentos para avaliação da autoeficácia alimentar no sobrepeso e na obesidade em crianças e adolescentes. Métodos: Revisão integrativa da literatura, realizada em maio de 2020, em seis bases de dados (PubMed; Web of Science; Scopus; CINAHL, ADOLEC e PsycINFO) com a seguinte estratégia de busca: self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Resultados: Incluíram-se 35 artigos e 21 instrumentos aplicados às crianças de 6 a 9 anos (n=2), em adolescentes de 10 a 19 anos (n=9) e em crianças e adolescentes de 7 a 18 anos (n=10). Os instrumentos têm de 4 a 30 itens e variaram de duas a cinco dimensões, sendo as mais frequentes “alimentação saudável” e “atividade física”. Conclusão: Existem diferentes instrumentos confiáveis destinados à avaliação da autoeficácia alimentar do público adolescente e infantil, o que sinaliza a importância desse construto para prevenção e controle da obesidade e sobrepeso.

Effects of a physical activity intervention on schoolchildren fitness

The global prevalence of childhood obesity is high. Obesity main causes are linked to sedentary lifestyles. Increasing physical activity (PA) and reducing sedentary activities are recommended to prevent and treat obesity. This study aimed to evaluate the effectiveness of a 6-month school PA intervention on obesity prevention and healthy behaviors in school-aged children. Participating students (10-11 years of age) were randomly divided into an intervention group and a control group. Children in the intervention group (n = 80) participated in a multicomponent PA that included improvement in extracurricular physical activities (with an additional 40 min per day for 5/6 days per week). Children (n = 80) in the control group participated in usual practice. Participants had mean body mass index of 19.7 ± 2.9 kg/m2 , and 33.7% of them were overweight or with obesity at T0. The change in body mass index in intervention group (-2.4 ± 0.6 kg/m2 ) was significantly different from that in control group (3.01 ± 1.8 kg/m2 ). The effects on waist circumference, waist-to-height ratio, and physic fitness were also significant in intervention group compared with control group (all p < 0.05). Furthermore, there is a significant decrease in overweight or children with obesity in the experimental group (to 17.5%, p < 0.05). These findings suggest that a school-based intervention program represents an effective strategy for decreasing the number of overweight and children with obesity.

Eating self- efficacy in overweight and obese children and adolescents: integrative review of instruments

ABSTRACT Objective: To describe the characteristics of instruments to assess eating self-efficacy in overweight and obesity in children and adolescents. Methods: Integrative literature review, conducted in May 2020, in six databases (PubMed; Web of Science; Scopus; CINAHL, ADOLEC, and PsycINFO) with the following search strategy: Self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Results: The inclusion of thirty-five articles and twenty-one instruments was applied to children 6 to 9 years old (n=2), adolescents 10 to 19 years old (n=9), and children and adolescents 7 to 18 years old (n=10). The instruments have 4 to 30 items and vary from two to five dimensions, the most frequent being “healthy eating” and “physical activity.” Conclusion: There are different reliable instruments designed to assess eating self-efficacy in adolescents and children, indicating the importance of this construct for preventing and controlling obesity and overweight.

The Effects of Different Exercise Modalities in the Treatment of Cardiometabolic Risk Factors in Obese Adolescents with Sedentary Behavior-A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

Obesity has become increasingly prevalent in adolescents due to unhealthy diet habits, sedentary behavior and a lack of physical activities. This study aims to assess the effects of different exercise modalities in the treatment of cardiometabolic risk factors (CRF) in obese adolescents with sedentary behavior.

METHODS

A systematic search was conducted using databases (PubMed, Embase, Cochrane library, Web of Science, CNKI and VIP database) from the earliest available date to August 2021. Nineteen randomized controlled trials (RCTs) with 704 participants were included. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and a statistical analysis was performed by the Review Manage 5.3 and Stata 15.1 software.

RESULTS

The results of the meta-analysis showed that exercise could significantly improve obese adolescents' body mass index (BMI) (MD = -1.99, 95% CI: -2.81 to -1.17, p < 0.00001), low density liptein cholesterol (LDL-C) (SMD = -0.98, 95% CI: -1.58 to -0.37, p = 0.002), triglyceride (TG) (SMD = -0.93, 95% CI: -1.72 to -0.14, p = 0.02), total cholesterol (TC) (SMD = -1.00, 95% CI: -1.73 to -0.26, p = 0.008), peak oxygen uptake (VO₂peak) (MD = 3.27, 95% CI: 1.52 to 5.02, p = 0.0003) and homeostatic model assessment insulin resistance (HOMA-IR) (SMD = -2.07, 95% CI: -3.3 to -0.84, p = 0.001). However, there was no statistically significant difference in high-density liptein cholesterol (HDL-C) (SMD = 0.40, 95% CI: -0.28 to 1.08, p = 0.25).

CONCLUSION

Exercise can effectively improve cardiometabolic risk factors in obese adolescents with sedentary behavior. For obese adolescents who want to lose weight and improve cardiorespiratory fitness, combined aerobic and resistance training and high-intensity interval training are optimal choices. For obese adolescents with high blood lipids, aerobic training can be regarded as a primary exercise modality to reduce the high risk of cardiovascular diseases; For obese adolescents with insulin resistance, combined aerobic and resistance training can be considered to reduce the high risk of diabetes. It is hoped that more high-quality studies will further expand the meta-analysis results and demonstrate the optimal exercise frequency and treatment intensity of cardiometabolic risk factors in obese adolescents with sedentary behavior in the future.

School-Based Exercise and Life Style Motivation Intervention (SEAL.MI) on Adolescent's Cardiovascular Risk Factors and Academic Performance: Catch Them Young

There are shreds of evidence of shared biological mechanisms between obesity and hypertension during childhood intoadulthood, and loads of research literature has proven that it will profoundly cost nations' economies and health if neglected. The prevention and early diagnosis of cardiovascular risk factors such as overweight and hypertension is an essential strategy for control, effective treatment and prevention of its' complications. The study aims to assess the effect of school-based Exercise and Lifestyle Motivation Intervention (SEAL-MI) on adolescents' cardiovascular risk factors and academic performance. An experimental study was conducted among 1005 adolescents-520 and 485 were randomly selected for the control and study groups, respectively.A structured interview questionnaire was used to collect demographic details and data related to dietary habits, physical activity, sleep qualityand academic performance. The study group adolescents were given the SEAL-MI for six months, including a school-based rope exercise for 45 min per day for 5 days a week and a motivation intervention related to dietary habits, physical activity, and sleep. Post tests-1 and 2 were done after 3 and 6 months of intervention.The prevalence of overweight among adolescents was 28.73%, and prehypertension was 9.26%. Among overweight adolescents, the prevalence of prehypertension was found to be very high (32.25%). There was a significant weight reduction in post-intervention B.P. (p = 0.000) and improvement in dietary habits, physical activity, sleep (p = 0.000), and academic performance. A significant positive correlation was found between BMI and SBP (p = 0.000) and BMI and academic performance (p = 0.003). The linear regression analyses revealed that the gender (ß: 0.47, 95% CI: 0.39, 0.81), age (ß: 0.39, 95% CI: 0.17, 0.46), family income (ß: 0.2, 95% CI: 0.41, 0.5), residence (ß: 0.19, 95% CI: 0.01, 0.27), and type of family (ß: 0.25, 95% CI: 0.39, 0.02) had the strongest correlation with the BMI of the adolescents. Additionally, Mother's education (ß: 0.35, 95% CI: 0.18, 0.59) had the strongest correlation with the SBP of the adolescents. In contrast, the DBP was negatively persuaded by age (ß: -0.36, 95% CI: 1.54, 0.29) and gender (ß: -0.26, 95% CI: 1.34, 0.12) of the adolescents. Regular practice of rope exercise and lifestyle modification such as diet, physical activity, and quality sleep among adolescents prevent and control childhood CVD risk factors such asoverweight and hypertension. The SEAL-MI may lead to age-appropriate development of adolescents as well as improve their academic performance and quality of life. Giving importance to adolescents from urban habitats, affluent, nuclear families, and catching them young will change the disease burden significantly.

Effects of Caloric Restriction and Rope-Skipping Exercise on Cardiometabolic Health: A Pilot Randomized Controlled Trial in Young Adults

The aim of this study is to investigate the effects of calorie restriction (CR), rope-skipping (RS) exercise, and their joint effects on cardiometabolic health in young adults. An 8-week randomized trial was conducted on 46 undergraduates aged 19–21 y from South China. The participants were randomized into the following three groups: Calorie restriction (CR) group (n = 14), Rope-skipping (RS) group (n = 14), and CR plus RS (CR–RS) group (n = 12). At both allocation and the end of the intervention, data on anthropometry, serum metabolic, and inflammatory markers were collected. A total of 40 participants completed the intervention and were included in the analysis. After the 8-week intervention, the participants from the CR group and the CR–RS group reduced in body weight (−1.1 ± 1.7 kg, −1.3 ± 2.0 kg), body mass index (−0.4 ± 0.6 kg/m², −0.5 ± 0.7 kg/m²), body fat percentage (−1.2 ± 1.6%, −1.7 ± 1.8%), and body fat mass (−1.1 kg (−2.2, −0.3), −1.1 kg (−2.5, −0.4)) compared to the baseline (p < 0.05 or p = 0.051). For metabolic and inflammatory factors, the participants in the CR–RS group showed significant decreases in low density lipoprotein cholesterol (−0.40 mmol/L) and interleukin-8 (−0.73 mmol/L). While all the above markers showed no significant difference among the groups after intervention, in the subgroup of overweight/obese participants (n = 23), the CR–RS group had significantly lower blood pressure, fasting insulin, homeostatic model assessment of insulin resistance, tumor necrosis factor-α, and interleukin-8 levels than the CR or RS groups (p < 0.05). In conclusion, both CR and CR–RS could reduce weight and improve body composition in young adults. More importantly, in those with overweight or obesity, CR–RS intervention might be superior to either CR or RS in improving cardiometabolic health.

Effects of Interval Jump Rope Exercise Combined with Dark Chocolate Supplementation on Inflammatory Adipokine, Cytokine Concentrations, and Body Composition in Obese Adolescent Boys

We examined the effects of six weeks of dark chocolate supplementation combined with interval jump rope exercise (JRE) on inflammatory cytokines, adipokines, and body composition in obese adolescent boys. Forty-eight obese adolescent boys (age  = 15.4  ±  1.1 years and body mass index  =  32.2  ±  2.4 kg/m²) were randomly assigned into one of four groups: JRE + white chocolate (JW; n = 13), JRE + dark chocolate supplementation (JD; n = 13), dark chocolate supplementation (DS; n = 12), or control (C; n = 12). Participants in JW and JD groups performed JRE for three times per week for six weeks. Participants in the DS and JD groups consumed 30 g of dark chocolate containing 83% of cocoa. Body composition, pro-inflammatory cytokines ((hs-CRP, TNF-α, IL-6), adipokines (leptin, resistin, RBP-4, chemerin, MCP-1), and anti-inflammatory adipokines (irisin, adiponectin)) were evaluated prior to and after the intervention trials. All three intervention trials significantly (p < 0.05) decreased body mass, waist-hip ratio, fat mass, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, and increased irisin and adiponectin concentrations. The improvements in these parameters were greater in the JD group, and additionally, chemerin concentrations decreased only in the JD group. JD enhanced adiponectin concentrations and decreased IL-6 concentrations compared to C. Moreover, JD significantly reduced chemerin concentrations, an effect not observed in any of the other interventions. We demonstrated that dark chocolate supplementation potentiated JRE-induced decreases in body mass, WHR, FM, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, chemerin as well as increases irisin and adiponectin concentrations in obese adolescent boys. Therefore, JRE combined with dark chocolate supplementation could be a beneficial in reducing obesity-induced inflammation in adolescent boys.

Exercise training modulates the gut microbiota profile and impairs inflammatory signaling pathways in obese children

Childhood obesity has reached epidemic levels and is a serious health concern associated with metabolic syndrome, nonalcoholic fatty liver disease, and gut microbiota alterations. Physical exercise is known to counteract obesity progression and modulate the gut microbiota composition. This study aims to determine the effect of a 12-week strength and endurance combined training program on gut microbiota and inflammation in obese pediatric patients. Thirty-nine obese children were assigned randomly to the control or training group. Anthropometric and biochemical parameters, muscular strength, and inflammatory signaling pathways in mononuclear cells were evaluated. Bacterial composition and functionality were determined by massive sequencing and metabolomic analysis. Exercise reduced plasma glucose levels and increased dynamic strength in the upper and lower extremities compared with the obese control group. Metagenomic analysis revealed a bacterial composition associated with obesity, showing changes at the phylum, class, and genus levels. Exercise counteracted this profile, significantly reducing the Proteobacteria phylum and Gammaproteobacteria class. Moreover, physical activity tended to increase some genera, such as Blautia, Dialister, and Roseburia, leading to a microbiota profile similar to that of healthy children. Metabolomic analysis revealed changes in short-chain fatty acids, branched-chain amino acids, and several sugars in response to exercise, in correlation with a specific microbiota profile. Finally, the training protocol significantly inhibited the activation of the obesity-associated NLRP3 signaling pathway. Our data suggest the existence of an obesity-related deleterious microbiota profile that is positively modified by physical activity intervention. Exercise training could be considered an efficient nonpharmacological therapy, reducing inflammatory signaling pathways induced by obesity in children via microbiota modulation.

Physical fitness regimens could stimulate shifts in gut microbiome composition and metabolism that counteract health risks associated with childhood obesity. This condition can increase the risk of metabolic and cardiovascular disease later in life. Several studies have indicated that disturbances in the microbial populations in the digestive tract may contribute to these diseases. Researchers led by Sonia Sánchez-Campos of the Institute of Biomedicine, León,Spain, recently assessed the impact of exercise and endurance training on microbiome composition in obese children. They determined that these regimens can produce measurable shifts in the gut microbe population, yielding bacterial communities that are more similar to those seen in non-obese children. These shifts were accompanied by alterations in metabolic activity that may help mitigate inflammatory signaling and other processes that fuel obesity-related disease.