Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

Abstract

ObjectivesDetermine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents.DesignNetwork meta-analysis of randomised exercise intervention trials.SettingAny setting where a randomised trial could be conducted.ParticipantsOverweight and obese male and/or female children and adolescents 2–18 years of age.InterventionsRandomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.Primary outcomesChanges in BMI in kg/m2, fat mass and per cent body fat.ResultsFifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training (trueX- ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to −0.6; fat mass -2.1, –3.3 to −1.0 kg; per cent fat -1.5, –2.2 to −0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, –1.4 to −0.1; fat mass -2.5, –4.1 to −1.0 kg; per cent fat, -2.2, –3.2 to −1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,–2.5 to −0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.ConclusionsAerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.PROSPERO registration numberCRD42017073103.

Association between Exercise-Induced Changes in Cardiorespiratory Fitness and Adiposity among Overweight and Obese Youth: A Meta-Analysis and Meta-Regression Analysis

“…It is well established that body fat is a strong risk factor for obesity-related comorbidities in youth [36]. Several studies have reported the beneficial effects of exercise alone for clinically relevant improvements in body composition and metabolic parameters in youth with obesity [4,5], because fat is a key factor in metabolic complications [36]. The present meta-regression analysis also indicates a negative relationship between CRF and change in percent body fat.…”

Adipose Tissue Development and Expansion from the Womb to Adolescence: An Overview

“…Children with obesity generally report lower moderate-to-vigorous physical activity (MVPA) [ 120 ] and greater time spent in sedentary behaviors [ 121 ], which have been associated with greater adiposity measures [ 122 ]. As several randomized controlled trials (RCTs) investigating the effects of exercise on %BF, FM, or AT in healthy children across weight status have been published to date, pooled analyses of their findings were made possible through meta-analyses [ 123 , 124 , 125 ]. For example, García-Hermoso et al reported an effect of a supervised exercise intervention on reducing body fat in children with either healthy weight or overweight/obese, independent of mode and intensity [ 123 ].…”

“…It is noteworthy, however, that most of the included studies have combined exercise with additional interventions (i.e., dietary counseling and environmental changes), concealing the direct effect of exercise on adiposity measures. Another recent meta-analysis including RCTs of exercise-only interventions with a duration ≥4 weeks in children with overweight or obesity compared the effects of exercise mode on FM and %BF [ 124 ]. Pooled data analysis revealed that combining aerobic and strength exercises resulted in the greatest reductions of adiposity measures, although aerobic exercise alone also reduced adiposity compared to control arms.…”

Multicomponent Exercise Training Combined with Nutritional Counselling Improves Physical Function, Biochemical and Anthropometric Profiles in Obese Children: A Pilot Study

“…Regarding these physical exercise or psychomotor interventions, and according to the recent review of Kelley, et al [ 8 ], they should be the most important type of intervention for the overall physiological health of this group of age, given their clinically relevant improvements in adiposity outcomes, lack of adverse events and significant enhancements in a wide number of secondary outcomes. Regular exercise, especially aerobic training, is associated with the reduction of fasting insulin and HOMA-IR (homeostatic model assessment—insulin resistance) in children and adolescents with obesity and overweight [ 9 ].…”