Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents.

Ruotsalainen H1, Kyngäs H2,3, Tammelin T4, Kääriäinen M2.

 J Adv Nurs. 2015 May 29. doi: 10.1111/jan.12696. (Review) PMID: 26031309

Abstract

AIMS:

To examine the effects of physical activity and exercise interventions on body mass index, subsequent physical activity and psychological symptoms for overweight and obese adolescents (12-18 years).

BACKGROUND:

Overweight and obesity have increased among adolescents globally and physical activity has decreased. Healthcare systems face challenges promoting physical activity and in treating obesity. Promotion of physical activity must be effective and school nurses should be equipped with the information and resources required to implement counselling for overweight and obese adolescents.

DESIGN:

A systematic review of randomized controlled trials was conducted according to procedures by the Centre for Reviews and Dissemination and the Joanna Briggs Institute.

DATA SOURCES:

Research studies published between 1950-2013 were identified from the following databases. CINAHL, MEDLINE (Ovid) and PsycINFO.

REVIEW METHODS:

Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. A narrative synthesis was used to report results, while a fixed-effect meta-analysis was used to analyse the interventions effects on physical activity and body mass index.

RESULTS:

Fourteen published studies were included to this review. Supervised exercise interventions most affected adolescents' body mass index. The interventions effect on adolescents' physical activity was small and heterogeneous. Two interventions positively affected psychological symptoms.

CONCLUSION:

Interventions were complex, with more than one component and the aspect that effectively promotes physical activity in obese adolescents was not clear. However, it seems that exercise interventions affect the body mass index of overweight or obese adolescents. Interventions that include a component for promoting physical activity with or without supervised exercise can affect subsequent physical activity and body mass index.

Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial.

Kipping RR, Howe LD, Jago R, et al.  BMJ. 2014 May 27;348:g3256. doi: 10.1136/bmj.g3256. (Original) PMID: 24865166

OBJECTIVE: To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children.

DESIGN: Cluster randomised controlled trial.

SETTING: 60 primary schools in the south west of England.

PARTICIPANTS: Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment.

INTERVENTIONS: The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching.

MAIN OUTCOME MEASURES: The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables.

RESULTS: 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was -1.35 (95% confidence interval -5.29 to 2.59) minutes per day for moderate to vigorous physical activity, -0.11 (-9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (-0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (-21 (-37 to -4) minutes per day), self reported servings of snacks per day (-0.22 (-0.38 to -0.05)), and servings of high energy drinks per day (-0.26 (-0.43 to -0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results.

CONCLUSION: The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity, decreasing sedentary behaviour, and increasing fruit and vegetable consumption in primary school children. Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level, as well as at the school environment level. These findings have relevance for researchers, policy makers, public health practitioners, and doctors who are involved in health promotion, policy making, and commissioning services.Trial registration Current Controlled Trials ISRCTN50133740.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18.

Dobbins M, Husson H, Decorby K, Larocca RL.
Cochrane Database Syst Rev. 2013 Feb 28;2:CD007651. doi: 10.1002/14651858.CD007651.pub2.

BACKGROUND: The World Health Organization (WHO) estimates that 1.9 million deaths
worldwide are attributable to physical inactivity and at least 2.6 million deaths
are a result of being overweight or obese. In addition, WHO estimates that
physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and 
rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and 
the burden of these and other chronic diseases has rapidly increased in recent
decades.
OBJECTIVES: The purpose of this systematic review was to summarize the evidence
of the effectiveness of school-based interventions in promoting physical activity
and fitness in children and adolescents.
SEARCH METHODS: The search strategy included searching several databases to
October 2011. In addition, reference lists of included articles and background
papers were reviewed for potentially relevant studies, as well as references from
relevant Cochrane reviews. Primary authors of included studies were contacted as 
needed for additional information.
SELECTION CRITERIA: To be included, the intervention had to be relevant to public
health practice (focused on health promotion activities), not conducted by
physicians, implemented, facilitated, or promoted by staff in local public health
units, implemented in a school setting and aimed at increasing physical activity,
included all school-attending children, and be implemented for a minimum of 12
weeks. In addition, the review was limited to randomized controlled trials and
those that reported on outcomes for children and adolescents (aged 6 to 18
years). Primary outcomes included: rates of moderate to vigorous physical
activity during the school day, time engaged in moderate to vigorous physical
activity during the school day, and time spent watching television. Secondary
outcomes related to physical health status measures including: systolic and
diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal
oxygen uptake (VOmax), and pulse rate.
DATA COLLECTION AND ANALYSIS: Standardized tools were used by two independent
reviewers to assess each study for relevance and for data extraction. In
addition, each study was assessed for risk of bias as specified in the Cochrane
Handbook for Systematic Reviews of Interventions. Where discrepancies existed,
discussion occurred until consensus was reached. The results were summarized
narratively due to wide variations in the populations, interventions evaluated,
and outcomes measured.
MAIN RESULTS: In the original review, 13,841 records were identified and
screened, 302 studies were assessed for eligibility, and 26 studies were included
in the review. There was some evidence that school-based physical activity
interventions had a positive impact on four of the nine outcome measures.
Specifically positive effects were observed for duration of physical activity,
television viewing, VO max, and blood cholesterol. Generally, school-based
interventions had little effect on physical activity rates, systolic and
diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of
printed educational materials and changes to the school curriculum that promote
physical activity resulted in positive effects.In this update, given the addition
of three new inclusion criteria (randomized design, all school-attending children
invited to participate, minimum 12-week intervention) 12 of the original 26
studies were excluded. In addition, studies published between July 2007 and
October 2011 evaluating the effectiveness of school-based physical interventions 
were identified and if relevant included. In total an additional 2378 titles were
screened of which 285 unique studies were deemed potentially relevant. Of those
30 met all relevance criteria and have been included in this update. This update 
includes 44 studies and represents complete data for 36,593 study participants.
Duration of interventions ranged from 12 weeks to six years.Generally, the
majority of studies included in this update, despite being randomized controlled 
trials, are, at a minimum, at moderate risk of bias. The results therefore must
be interpreted with caution. Few changes in outcomes were observed in this update
with the exception of blood cholesterol and physical activity rates. For example 
blood cholesterol was no longer positively impacted upon by school-based physical
activity interventions. However, there was some evidence to suggest that
school-based physical activity interventions led to an improvement in the
proportion of children who engaged in moderate to vigorous physical activity
during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 
3.75). Improvements in physical activity rates were not observed in the original 
review. Children and adolescents exposed to the intervention also spent more time
engaged in moderate to vigorous physical activity (with results across studies
ranging from five to 45 min more), spent less time watching television (results
range from five to 60 min less per day), and had improved VOmax (results across
studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions
of this update do not differ significantly from those reported in the original
review.
AUTHORS' CONCLUSIONS: The evidence suggests the ongoing implementation of
school-based physical activity interventions at this time, given the positive
effects on behavior and one physical health status measure. However, given these 
studies are at a minimum of moderate risk of bias, and the magnitude of effect is
generally small, these results should be interpreted cautiously. Additional
research on the long-term impact of these interventions is needed.

Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

Committee on Nutrition and the Council on Sports Medicine and Fitness
PEDIATRICS Vol. 127 No. 6 June 2011, pp. 1182-1189 (doi:10.1542/peds.2011-0965)
ACCESO A TEXTO COMPLETO
Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population.
Savoye M, Nowicka P, Shaw M, Yu S, Dziura J, Chavent G, O'Malley G, Serrecchia JB, Tamborlane WV, Caprio S.
Pediatrics. 2011 Mar;127(3):402-10
Abstract
OBJECTIVE: To determine if beneficial effects of a weight-management program could be sustained for up to 24 months in a randomized trial in an ethnically diverse obese population.

PATIENTS AND METHODS: There were 209 obese children (BMI > 95th percentile), ages 8 to 16 of mixed ethnic backgrounds randomly assigned to the intensive lifestyle intervention or clinic control group. The control group received counseling every 6 months, and the intervention group received a family-based program, which included exercise, nutrition, and behavior modification. Lifestyle intervention sessions occurred twice weekly for the first 6 months, then twice monthly for the second 6 months; for the last 12 months there was no active intervention. There were 174 children who completed the 12 months of the randomized trial. Follow-up data were available for 76 of these children at 24 months. There were no statistical differences in dropout rates among ethnic groups or in any other aspects.

RESULTS: Treatment effect was sustained at 24 months in the intervention versus control group for BMI z score (-0.16 [95% confidence interval: -0.23 to -0.09]), BMI (-2.8 kg/m(2) [95% confidence interval: -4.0-1.6 kg/m(2)]), percent body fat (-4.2% [95% confidence interval: -6.4% to -2.0%]), total body fat mass (-5.8 kg [95% confidence interval: -9.1 kg to -2.6 kg]), total cholesterol (-13.0 mg/dL [95% confidence interval: -21.7 mg/dL to -4.2 mg/dL]), low-density lipoprotein cholesterol (-10.4 mg/dL [95% confidence interval: -18.3 mg/dL to -2.4 mg/dL]), and homeostasis model assessment of insulin resistance (-2.05 [95% confidence interval: -2.48 to -1.75]).

CONCLUSIONS: This study, unprecedented because of the high degree of obesity and ethnically diverse backgrounds of children, reveals that benefits of an intensive lifestyle program can be sustained 12 months after completing the active intervention phase.

AMERICAN ACADEMY OF PEDIATRICS:Medical Conditions Affecting Sports Participation

Committee on Sports Medicine and Fitness.PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1205-1209 ( ACCESO A TEXTO COMPLETO)

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete and parents on the risks of injury as they relate to the child's condition. This statement updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.

Effect of school-based physical activity interventions on body mass index in children: a meta-analysis.

Harris KC, Kuramoto LK, Schulzer M, et al. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009 Mar 31;180(7):719-26

BACKGROUND: The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children.
METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months.
RESULTS: Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition.
INTERPRETATION: School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.

Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials.

BMJ. 2007 Oct 6;335(7622):703. Epub 2007 Sep 20.
van Sluijs EM, McMinn AM, Griffin SJ.

Comment in: BMJ. 2007 Oct 6;335(7622):677-8.

Se trata de una nueva revisión sistemática sobre la eficacia de las intervenciones para promover la actividad física en niños y adolescentes.

Los autores encontraron pocas pruebas del efecto de las intervenciones en población infantil,.

Sin embargo, si se encontraron pruebas de la efectividad (Strong) de las intervenciones basadas en la escuela con participación de la familia o la comunidad (intervenciones múltiples) para el incremento la actividad física en adolescentes.