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Exercise and BMI z-score in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials.

ABSTRACT: While overweight and obesity in children and adolescents is a major global health problem, the effects of exercise on overweight and obesity in children and adolescents are not well established despite numerous studies on this topic. The purpose of this study is to use the network meta-analytic approach to determine the effects of exercise (aerobic, strength training or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.Randomised exercise intervention trials >4 weeks, published in any language between 1 January 1990 and 31 September 2015, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching 6 electronic databases, cross-referencing and expert review. Dual abstraction of data will occur. The primary outcome will be changes in BMI z-score while the secondary outcome will be changes in body weight in kilograms (kg). Risk of bias will be assessed using the Cochrane risk of bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength training or both).The results of this study will be presented at a professional conference and published in a peer-reviewed journal.CRD42015026377.

SUBMITTER: Kelley GA

PROVIDER: S-EPMC4838707 | biostudies-other | 2016 Apr

REPOSITORIES: biostudies-other

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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.

Project description:BackgroundOverweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.MethodsStudies were included if they were randomized controlled exercise intervention trials ? 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990-2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, cross-referencing and expert review. Two authors (GAK, KSK) selected and abstracted data. Bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Exercise minus control group changes were calculated from each study and weighted by the inverse of the variance. All results were pooled using a random-effects model with non-overlapping 95% confidence intervals (CI) considered statistically significant. Heterogeneity was assessed using Q and I2 while funnel plots and Egger's regression test were used to assess for small-study effects. Influence and cumulative meta-analysis were performed as well as moderator and meta-regression analyses.ResultsOf the 4,999 citations reviewed, 835 children and adolescents (456 exercise, 379 control) from 10 studies representing 21 groups (11 exercise, 10 control) were included. On average, exercise took place 4 x week for 43 minutes per session over 16 weeks. Overall, a statistically significant reduction equivalent to 3% was found for BMI z-score (?¯, -0.06, 95% CI, -0.09 to -0.03; Q = 24.9, p = 0.01; I(2)=59.8%). No small-study effects were observed and results remained statistically significant when each study was deleted from the model once. Based on cumulative meta-analysis, results have been statistically significant since 2009. None of the moderator or meta-regression analyses were statistically significant. The number-needed-to treat was 107 with an estimated 116,822 million obese US children and adolescents and approximately 1 million overweight and obese children and adolescents worldwide potentially improving their BMI z-score by participating in exercise.ConclusionsExercise improves BMI z-score in overweight and obese children and adolescents and should be recommended in this population group. However, a need exists for additional studies on this topic.

Project description:BackgroundThere is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit group program -- a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both.Methods and designThe study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13-16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit group weight management program (G). Study arm two receives the same Loozit group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being.DiscussionThe Loozit study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings.Trial registrationThe protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572).

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Exercise and BMI z-score in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials.

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