Improved Insulin Resistance, Adiponectin and Liver Enzymes without Change in Plasma Vaspin Level after 12 Weeks of Exercise Training among Obese Male Adolescents

Effects of exercise on glycolipid metabolism in adolescents with overweight and obesity: a systematic review and meta-analysis of 26 randomized controlled trials

Objective

The aim of this meta-analysis was to investigate the effect of exercise intervention on glycolipid metabolism in overweight and obese adolescents.

Methods

A systematic review and meta-analysis of randomized trials were conducted. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered (ID: CRD42024623686). Electronic searches were performed using the following databases: Web of Science, PubMed, Scopus, Cochrane and Embase. Randomized controlled trials of exercise interventions were included. Data on fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) before and after exercise interventions were extracted for overweight and obese adolescents. Risk of bias was assessed using the Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality of the evidence. Standardized mean differences (SMDs) were calculated to compare differences between exercise and conventional control groups. Subgroup analyses were performed to assess whether effects differed by exercise type, intervention duration, supervision, and intervention frequency.

Results

A total of 984 participants (576 in experimental groups and 408 in control groups) were included across 26 studies. The analysis revealed that exercise interventions significantly improved key metabolic parameters: FBG (SMD: -0.42 95% CI [-0.73 to -0.12]), FINS (SMD: -0.81 95% CI [-1.13 to -0.49]), TC (SMD: -0.18 95% CI [-0.34 to -0.01]), TG (SMD: -0.46 95% CI [-0.56 to -0.25]), LDL-C (SMD: -0.28 95% CI [-0.44 to -0.12]), and HDL-C (SMD: 0.26 95% CI [0.11-0.40]). Subgroup analysis indicated that exercise type, supervision and intervention frequency influenced the effectiveness.

Conclusion

The analysis suggests that exercise interventions improve glycolipid metabolism in adolescents with overweight and obesity. Continuous endurance training demonstrated greater efficacy in improving blood glucose parameters, whereas hybrid-type exercise showed advantages in improving lipid metabolism. Engaging in three supervised training sessions weekly may be the optimal approach to enhance glycolipid metabolism in obese adolescents. These findings provide evidence for clinicians and healthcare professionals (e.g., exercise physiologists, physical therapists) to guide exercise prescriptions for obese adolescents, thereby preventing worsening metabolic imbalances.

Effects of different supervised and structured physical exercise on the physical fitness trainability of children and adolescents: a meta-analysis and meta-regression : Physical fitness trainability in children and adolescents' health

BACKGROUND

Physical fitness has been considered an important health indicator. Several factors can impact the increase in physical fitness in children and adolescents, including chronological age, sex and BMI, in addition to training variables such as weekly frequency, session and intervention duration, and types of exercises performed. To know the importance of variables that can impact physical fitness, it is important for health professionals to identify the most efficient way of prescribing physical exercises for children and adolescents. The aim is review and meta-analyses of the effects of supervised and structured physical exercise on the physical fitness trainability of children and adolescents.

METHODS

Relevant articles were searched in the PubMed, Cochrane Library, Embase and Scopus platform databases and selected based on the following criteria: children and adolescents aged between 7 and 17 years who performed any type of structured physical exercise compared to a control group without exercise and evaluating physical fitness (strength or muscular power, cardiorespiratory fitness (CRF) or speed. The results are reported in accordance with PRISMA 2020.

RESULTS

Eighty studies were included with a total of 5769 participants. Strength exercises (ES: 1.073; 95% CI, 0.612-1.533; P < 0.001; I2: 74%), concurrent (ES: 1.054; 95% CI, 0.255-1.853; P < 0.010; I2: 72%) and sports (ES: 0.573; 95% CI, 0.015 to 1.132; P < 0.044; I2: 34%) seem to be the most effective in increasing muscular strength. Aerobic activities (ES: 0.400; 95% CI, 0.258-0.542; P < 0.001; I2: 74%), sports (ES: 0.271; 95% IC, 0.148-0.394; P < 0.001; I2: 15), or HIIT (ES: 0.668; 95% IC, 0.333-1.003; P < 0.001; I2: 29%) resulted in increased CRF (ES: 0.514; 95% IC, 0.220-1.808; P < 0.001; I2: 66%). The practice of physical exercise increased muscular power (ES: 0.241; 95% CI, 0.053-0.429; P = 0.012; I2: 0%). The practice of HIIT impacts MAS gains (ES: 0.048; 95% CI, 0.050 - 0.026; P = 0.029; I2: 44%).

CONCLUSION

Supervised and structured physical exercise can improve muscular strength (15-35%), CRF (5.4-8.5%), muscular power (5.6-11.8%), and MAS (5.4%) trainability in children and adolescents. Sex, BMI of the subjects and type of exercise performed (aerobic activities, exclusive to strength, HIIT or sports) should be considered when prescribing the exercise.

How Can Promoting Skeletal Muscle Health and Exercise in Children and Adolescents Prevent Insulin Resistance and Type 2 Diabetes?

Skeletal muscle secretome, through its paracrine and endocrine functions, contributes to the maintenance and regulation of overall physiological health. We conducted a narrative review on the role of skeletal muscle and exercise in maintaining glucose homeostasis, driving insulin resistance (IR), and preventing type 2 diabetes in pediatric populations, especially in the context of overweight and obesity. Myokines such as interleukin (IL)-6, IL-8, and IL-15, as well as irisin, myonectin, and myostatin, appear to play a crucial role in IR. Skeletal muscle can also become a target of obesity-induced and IR-induced inflammation. In the correlation between muscle, IR, and inflammation, the role of infiltration of the immune cells and the microvasculature may also be considered. It remains unclear which exercise approach is the best; however, combining aerobic exercise with resistance training seems to be the most effective strategy for managing IR, with high-intensity activities offering superior metabolic benefits and long-term adherence. Encouraging daily participation in enjoyable and engaging exercise is key for long-term commitment and effective glucose metabolism management. Promoting physical activity in children and adolescents must be a top priority for public health, not only in terms of individual quality of life and well-being but also for community health.

Effects of Aerobic Exercise on Serum Adiponectin Concentrations in Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

Serum adiponectin plays a vital role in various physiological processes, such as anti-inflammatory, anti-atherosclerotic, anti-apoptotic and pro-angiogenic activities. Any abnormalities in its concentration can lead to adverse health outcomes, particularly in children and adolescents. Therefore, it is crucial to investigate factors influencing serum adiponectin concentrations in this population. The primary objective of this study was to systematically evaluate the impact of aerobic exercise on serum adiponectin concentrations in children and adolescents with obesity. To achieve this, a comprehensive literature search was conducted up to January 2023, utilising five databases: PubMed, Web of Science, Embase, Cochrane Library and Clinicaltrial.gov. The inclusion criteria involved studies that focused solely on aerobic exercise as an intervention for children and adolescents with obesity. Only studies that reported outcome indicators related to serum adiponectin were considered for analysis. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) assessment tool, and statistical analysis was performed using RevMan 5.4.1 analysis software. This meta-analysis incorporated data from eight trials, involving a total of 272 subjects. The results demonstrated that aerobic training significantly increased serum adiponectin concentrations [standardized mean difference (SMD) = 0.85; 95% confidence interval (CI) = 0.33 to 1.37; I2 = 0%; p = 0.001] in children and adolescents with obesity when compared to non-exercise controls. Furthermore, the magnitude of this effect appears to be influenced by the intensity of aerobic exercise, with higher-intensity aerobic exercise resulting in greater increases in serum adiponectin concentrations.

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 Physical Exercise on Cardiometabolic Biomarkers and Inflammatory Markers in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The prevalence of obesity among children as well as the beneficial effects of physical exercise (PE) on weight loss has been determined by modulating the secretory factors of adipose tissue. PE has also been shown to have beneficial effects on obesity.

OBJECTIVE

The objective of this systematic review and meta-analysis was to investigate the effects of physical exercise (PE) on adiponectin and other important health markers in children.

DATA SOURCES

We searched 6 electronic databases (PubMed/Medline, Embase, Cochrane Library, Cinahl, Scopus, and Web of Science) and Google Scholar for randomized controlled trials from inception to December 15, 2021. We used random-effects models to estimate weighted mean difference (WMD) with 95% confidence intervals (CI).

STUDY SELECTION

Fourteen studies were included (N = 468 participants; mean age: 14 years).

RESULTS

In general, PE increased adiponectin (WMD: 0.91 µg/mL; 95% CI, 0.27 to 1.55, p = 0.005), high-density lipoprotein cholesterol (HDL-C) (WMD: 1.01 mg/dL; 95% CI, 0.33 to 1.69, p = 0.004), and VO₂max (WMD: 2.52 mL.kg.min; 95% CI, 1.41 to 3.62, p = 0.00,001). The levels of c-reactive protein (WMD: -0.37 mg/L; 95% CI, -0.57 to -0.17, p = 0.0003), insulin (WMD: -4.61 μIU/ml; 95% CI, -5.46 to -3.76, p = 0.00,001), fasting glucose (WMD: -5.11 mg/dL; 95% CI, -7.88 to -2.34, p = 0.0003), and insulin resistance index (WMD: -1.44; 95% CI, -1.92 to -0.96, p = 0.00,001), decreased significantly.

CONCLUSION

Our study showed that PE may increase the level of adiponectin, HDL-C, and VO₂max in children.

The effects of physical activity on adipokines in individuals with overweight/obesity across the lifespan: A narrative review

This narrative review summarizes current knowledge on the effects of physical activity (PA) on adipokine levels in individuals with overweight and obesity. Approximately 90 investigations including randomized control, cross-sectional and longitudinal studies that reported on the effects of a single session of PA (acute) or long-term PA (chronic) on adipokine levels in individuals with overweight/obesity were reviewed. The findings support the notion that there is consensus on the benefits of chronic exercise training-regardless of the mode (resistance vs. aerobic), intensity and cohort (healthy vs. diabetes)-on adipokine levels (such as tumour necrosis factor-alpha, interleukin-6, adiponectin, visfatin, omentin-1 and leptin). However, several confounding factors (frequency, intensity, time and type of exercise) can alter the magnitude of the effects of an acute exercise session. Available evidence suggests that PA, as a part of routine lifestyle behaviour, improves obesity complications by modulating adipokine levels. However, additional research is needed to help identify the most effective interventions to elicit the most beneficial changes in adipokine levels in individuals with overweight/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.

The Effects of Exercise on Abdominal Fat and Liver Enzymes in Pediatric Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Despite the prevalence of obesity and the multiple position stands promoting exercise for the treatment of obesity and hepatic function, a meta-analytic approach has not previously been used to examine the effects in the pediatric population. The aim of the study was to determine the effectiveness of exercise interventions on abdominal fat, liver enzymes, and intrahepatic fat in overweight and obese youth.

MATERIALS AND METHODS

A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of supervised exercise interventions on abdominal fat (visceral and subcutaneous fat), liver enzymes (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase), and intrahepatic fat. Fourteen clinical trials (1231 youths) were eligible for inclusion in this systematic review and meta-analysis. Standardized mean difference [SMD] and 95% confidence intervals (CIs) were calculated.

RESULTS

Exercise was associated with a significant reduction in visceral (SMD = -0.661; 95% CI, -0.976 to -0.346; p < 0.001), subcutaneous (SMD = -0.352; 95% CI, -0.517 to -0.186; p < 0.001) and intrahepatic fat (SMD = -0.802; 95% CI, -1.124 to -0.480; p < 0.001), as well as gamma-glutamyl transferase (SMD = -0.726; 95% CI, -1.203 to -0.249; p < 0.001), but did not alter any other liver enzyme. Subgroup analysis recommends exercise programs that involve aerobic exercise longer than three sessions per week.

CONCLUSIONS

This meta-analysis supports current recommendation for physical exercise, mainly aerobic, as an effective intervention for nonalcoholic fatty liver disease progression by targeting hepatic lipid composition, visceral and subcutaneous adipose tissue. Systematic review registration: PROSPERO CRD42016042163.

Effects of Exercise on Carotid Arterial Wall Thickness in Obese Pediatric Populations: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

In pediatric populations, the use of carotid intima-media thickness (IMT) as a marker of cardiovascular risk has increased. However, previous studies examining the effects of exercise training on arterial structure and function in obese children and adolescents have shown inconsistent findings. The primary aim of this systematic review and meta-analysis is to expand on the current body of literature by providing a quantitative estimate of the change in carotid IMT following exercise training as well as to provide an exploratory analysis of potential moderators associated with the variation in response to an exercise training intervention in overweight and obese youth.

MATERIALS AND METHODS

A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on carotid IMT in pediatric obesity (6-18-year-olds). Hedges' g and 95% confidence intervals (CIs) were calculated.

RESULTS

Six randomized controlled trials (303 youths) were included. Exercise was associated with a small-to-moderate but significant reduction in carotid IMT (g = -0.306; 95% CI -0.540 to -0.072; p = 0.011). Likewise, exercise program duration per week significantly influenced the effect of exercise on carotid IMT (β = -0.060; p = 0.015).

CONCLUSIONS

Exercise seems to reduce carotid IMT in childhood obesity. Therefore, encouraging obese pediatric individuals to become physically active can lead to favorable changes in the arterial wall.

Exercise, adipokines and pediatric obesity: a meta-analysis of randomized controlled trials

BACKGROUND/OBJECTIVE

Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of this meta-analysis was to determine the effectiveness of exercise interventions on adipokines in pediatric obesity.

SUBJECTS/METHODS

A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on adipokines (adiponectin, leptin, resistin and visfatin) in pediatric obesity (6-18 years old). Fourteen randomized controlled trials (347 youths) were included. Weighted mean difference (WMD) and 95% confidence intervals were calculated.

RESULTS

Exercise was associated with a significant increase in adiponectin (WMD=0.882 μg ml-1, 95% CI, 0.271-1.493) but did not alter leptin and resistin level. Likewise, exercise intensity and change in body fat; as well as total exercise program duration, duration of the sessions, and change in body fat all significantly influenced the effect of exercise on adiponectin and leptin, respectively.

CONCLUSIONS

Exercise seems to increase adiponectin levels in childhood obesity. Our results also suggested that exercise on its own, without the concomitant presence of changes in body composition levels, does not affect leptin levels.