Efeito do exercício físico sobre peso corporal em crianças com excesso de peso: ensaio clínico comunitário randomizado em uma favela no Brasil

Abstract

Associação da obesidade com doenças crônicas tem se mostrado mais intensa nas áreas carentes. Examinamos o efeito de um programa de exercício físico para crianças com excesso de peso, em uma favela do Recife, Pernambuco, Brasil, por meio de um ensaio comunitário, randomizado, com 78 crianças. Um grupo (n = 39) recebeu três aulas semanais de exercícios físicos durante seis meses. Não foi realizada nenhuma intervenção em relação à alimentação. A análise por intenção de tratamento demonstrou que todas as crianças apresentaram aumento significativo de peso. Entretanto, esse aumento foi menor no grupo que sofreu a intervenção (diferença média entre os grupos; -1.37; IC95%: -2,00; -0,74). Em relação ao índice de massa corporal (IMC), também foi verificada uma diferença significativa (p = 0,049) entre os dois grupos (diferença média entre os grupos; -0,53; IC95%: -1,06; -0,002). Na análise restrita às crianças que completaram o estudo (intervenção = 30 e controle = 38), os resultados foram similares. Concluímos que um programa regular de exercícios físicos para crianças com excesso de peso em áreas carentes seja eficaz, sem a necessidade de intervenções dietéticas, na redução do ganho ponderal e do IMC.

A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children

“…Home TV usage monitor. Parental education materials Universal: no differences in results by parental educationBMI↓0Triceps skin fold thickness↓Waist circumference↓Waist-hip ratio↓Kalavainen et al 2007 [48]RCT; 12 month follow-up; Final sample = 69; Quality = Strong1 Health care centre, Finland; 7-9 years; 60% girls; ObeseTreatment of obesityNutrition and physical activity intervention; Treatment: Family-based group treatment programme – diet and physical activity education and behavioural therapy Universal: No association between social class and obesity-related outcomesWeight for height↓0BMI↓BMI SDS↔Alves et al 2008 [49]RCT; 6 month follow-up; Final sample = 68; Quality = StrongCommunity setting (exact setting unclear), Brazil; 5-10 years; 49% girls; OverweightIncrease physical activity in overweight children to reduce BMIPhysical activity intervention; Treatment: Physical activity sessions 3 times per week Targeted: Children from a disadvantaged areaBMI↓+Robinson et al 2003 [50]RCT (pilot); 12 week follow-up; Final sample = 60; Quality = StrongCommunity centres and homes, USA; 8-10 years; 100% girls; At risk of obesityPrevent further weight gain in low SES African American girlsPhysical activity intervention; Treatment: Dance classes and TV viewing reduction intervention (GEMS) targeting African American girls at risk of obesity Targeted : Recruited from low income neighbourhoodsBMI↔0Waist circumference↔Willet 1995 [51]Non-randomised controlled trial; 1 year follow-up; Final sample = 40; Quality = Strong1 community setting (exact setting unclear), USA; 7-12 years; 100% girlsPrevention of obesity in low income African American girlsNutrition and physical activity intervention; Prevention: Mother and daughter culturally specific obesity prevention programme (based on the Know Your Body health education curriculum) Targeted: low SES, African American girlsBMI↔0% overweight↔Hamad et al 2011 [52]RCT; 1 year follow-up; Final sample = 1501; Quality = StrongMicrocredit institution, Republic of Peru; <5 yearsTo improve the general health of disadvantaged childrenNutrition and physical activity intervention; Prevention: Mic...…”

“…A RCT [49] investigated the effects of a similar six month exercise session targeted intervention in 68 overweight children aged 5 to 10 years from a disadvantaged area in Brazil. After six months weight gain was less in the intervention group compared with controls (difference in change (IG-CG) = -1.37 kg; p < 0.001) and there was significant decrease in BMI in the intervention group compared with controls (difference in change (IG-CG) = -0.53 kg.m 2 ; p = 0.049).…”

Fatores associados à autoavaliação do peso corporal em mulheres praticantes de academia.

“…In parallel, it can be observed that physically active people exhibit improvements in the various different components of physical fitness, which, in turn, confers countless health benefits, primarily when muscle mass is increased and body fat is reduced 10 . As a result, the long term effects of exercise on body weight appear to be more effective than merely adopting dietary restrictions 11 , particularly since adherence to such diets is very often motivated by consumption of non-scientific literature 12 . Many unhealthy attitudes are the result of dissatisfaction with self image, predominantly dissatisfaction with aspects related to body weight, and this phenomenon is predominantly observed among women 13 .…”

Effects of Intervention Programs on Child and Adolescent BMI: A Meta-Analysis Study

“…Melnyk et al 51 obtained exactly the same results (r = .59) with sessions of 20-30 minutes of PA, but with a frequency of 1-2 times week. In the study carried out by Alves et al 52 involving recreational activities of moderate energy expenditure (playing ball, running, jumping, dancing) and aerobic sessions, the effect size of reduction in the BMI of 78 children was much more modest (r = .05).…”