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What should be the preferred exercise modality for overweight and obese individuals? Protocol for a systematic review and network meta-analysis.

ABSTRACT: BACKGROUND:Obesity is a global epidemic with profound consequences for individuals and societies. Physical exercise is important to weight reduction and weight loss maintenance. However, results on what the most effective type of exercise are unclear. The aim of this systematic review is to evaluate the effects of various exercise modalities with and without caloric restriction on body composition and metabolic health outcomes in overweight and obese adults. METHODS:We will perform a comprehensive literature search in PubMed, Embase (via Ovid) and CENTRAL (through the Cochrane Library). Relevant papers will be screened in two stages: first, by title and abstract and then the full text of the remaining papers. Two reviewers will screen all the studies, and any disagreements will be discussed with and resolved by a third reviewer. Data extraction and risk of bias assessment will be performed using a pre-piloted form. A network meta-analysis combining direct and indirect treatment effect estimates will be conducted if adequate data are available. The quality of the evidence will be judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION:The results of this proposed systematic review and meta-analysis will identify whether any exercise modality should be preferred for overweight and obese adults, as well as assess the quality of the evidence. This knowledge has potential importance for clinicians and patients. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019103371.

SUBMITTER: Aasdahl L

PROVIDER: S-EPMC6360785 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAuricular acupressure has been used for treating obesity, but inconsistent outcomes have been reported. Moreover, systematic reviews and meta-analyses have seldom addressed the effects of auricular acupressure and duration of treatment in overweight/obese individuals. This study reviewed research articles on auricular acupressure for weight reduction, analyzed the related effects on obesity, and explored the relationships between weight reduction and treatment duration, as well as outcome variables.MethodsWe searched PubMed, Cochrane Library, CINAHL, MEDLINE with Full Text, National Digital Library of Theses and Dissertation in Taiwan, and Airiti Library for articles up to July 4, 2018. Eight eligible trials were identified for qualitative synthesis, and one of them was excluded from quantitative synthesis. Inclusion criteria were as follows: intervention contained auricular acupressure, study subjects were overweight and/or obese, as defined by published authors, and the study design had 2 or more arms for comparison.ResultsPooled analysis of the 7 remaining studies revealed that auricular acupressure alone, or with diet and/or exercise, was effective for weight reduction, particularly for decreasing body weight (BW), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), body fat mass (BFM), and body fat percentage (BFP), compared with no treatment, sham treatment, or use of surgical tape with diet and/or exercise. However, there was no effect on hip circumference. A 12-week acupressure intervention was associated with a larger effect on lowering BW and BMI compared with 4-, 6-, and 8-week interventions. The methodologic quality of trials included in the quantitative synthesis ranged from scores 2 to 6 based on the modified Jadad scale. Additionally, this meta-analysis combined studies that used different acupoints and outcomes evaluated at different timepoints, which may have been potential sources of bias.ConclusionThe study results indicate that auricular acupressure is effective for weight reduction. However, further vigorous studies that use double-blind randomized controlled design are needed to verify these findings. WC, WHR, BFP, or BFM should be used as obesity-related parameters in weight reduction studies to detect changes in fat, muscle, and skeletal weight.

Project description:OBJECTIVES:Determine 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. DESIGN:Network meta-analysis of randomised exercise intervention trials. SETTING:Any setting where a randomised trial could be conducted. PARTICIPANTS:Overweight and obese male and/or female children and adolescents 2-18 years of age. INTERVENTIONS:Randomised 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 OUTCOMES:Changes in BMI in kg/m2, fat mass and per cent body fat. RESULTS:Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± 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. CONCLUSIONS:Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents. PROSPERO REGISTRATION NUMBER:CRD42017073103.

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What should be the preferred exercise modality for overweight and obese individuals? Protocol for a systematic review and network meta-analysis.

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