Exercise tolerance in obese vs. lean adolescents: a systematic review and meta‐analysis

Abstract

To prescribe feasible and medically safe exercise interventions for obese adolescents, it remains to be determined whether exercise tolerance is altered and whether anomalous cardiopulmonary responses during maximal exercise testing are present. Studies that examined cardiopulmonary responses to maximal exercise testing in obese adolescents were searched: cardiopulmonary exercise tests with respiratory gas exchange measurements of peak oxygen uptake (VO2peak) were performed and comparisons between obese and lean adolescents were made. Study quality was assessed using a standardized item list. By meta-analyses VO2peak, peak cycling power output (Wpeak) and peak heart rate (HRpeak) were compared between groups. Nine articles were selected (333 obese vs. 145 lean adolescents). VO2peak (L min(-1)), HRpeak and Wpeak were not different between groups (P ≥ 0.10), while a trend was found for a reduced VO2peak (mL min(-1) kg(-1) lean tissue mass) (P=0.07) in obese vs. lean adolescents. It remained uncertain whether anomalous cardiopulmonary responses occur during maximal exercise testing in obese adolescents. In conclusion, a trend was found for lowered VO2peak (mL min(-1)kg(-1) lean tissue mass) in obese vs. lean adolescents. Whether cardiopulmonary anomalies during maximal exercise testing would occur in obese adolescents remains uncertain. Studies are therefore warranted to examine the cardiopulmonary response during maximal exercise testing in obese adolescents.

Three weeks of respiratory muscle endurance training improve the O2 cost of walking and exercise tolerance in obese adolescents

“…For most variables, no differences were observed after versus before both interventions, with the notable exception of the time to exhaustion and walking slope, which were significantly higher after versus before RMET, whereas no significant differences were observed after versus before CTRL. _ VO 2 peak values, in absolute values and divided per unit of BM, are similar to those usually obtained in obese adolescents (Salvadego D et al 2010;Hansen et al 2014;Salvadego et al 2015Salvadego et al , 2017. GET, expressed as L/min of _ VO 2 , was not affected by either intervention (2.31 AE 0.47 and 2.39 AE 0.48 in before and after RMET; 2.14 AE 0.38 and 2.04 AE 0.14 in before and after CTRL).…”

Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

“…As recently noted by Hansen and coworkers (21), consensus regarding CPET in obese adolescents has yet to be reached. There may be differences in the effect of obesity on CPET as children age.…”

“…Despite this, evidence-based guidelines do not yet exist on how best to assess and track physical fitness in this population. Recently, Hansen and coworkers (21) reviewed a number of studies focused on assessing fitness from cardiopulmonary exercise testing (CPET) in obese adolescents. They were unable to find consensus among these studies, and reached the following conclusion: “Whether cardiopulmonary anomalies during maximal exercise testing would occur in obese adolescents remains uncertain.…”

“…A number of studies have shown that when lean body mass is appropriately considered, CPET measures in children and adolescents with obesity disorders are largely within normal ranges (12,18). In contrast, other studies of exercise gas exchange responses in obese children suggest that obesity impairs fitness, even when the data are normalized to some estimate of muscle mass (34) and, as Hansen and coworkers noted (21), much additional work is needed to develop useful approaches to assessing cardiorespiratory fitness in the child or adolescent with obesity. We reasoned that using all of the data obtained during CPET (i.e., peak, maximal, and submaximal), along with DXA estimates of muscle mass, would help more accurately assess fitness in the obese child or adolescent.…”

Obesity, Asthma, and Exercise in Child and Adolescent Health

“…Despite this, evidence-based guidelines do not yet exist on how best to assess and track aerobic fitness in this population. Recently, Hansen and coworkers (58) reviewed a number of studies focused on assessing aerobic fitness from cardiopulmonary exercise tests (CPET) in obese adolescents. They were unable to find consensus among these studies, and reached the following conclusion, “whether cardiopulmonary anomalies during maximal exercise testing would occur in obese adolescents remains uncertain.…”