Effects of exercise on BMI z-score in overweight and obese children and adolescents: a systematic review with meta-analysis

BMC Pediatrics

Russell R Pate²  Kristi S Kelley¹  George A Kelley¹ 

[1] Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506-9190, USA;Children’s Physical Activity Research Group, Department of Exercise Science, University of South Carolina, Columbia, SC, USA

关键词: Systematic review;    Meta-analysis;    Adolescents;    Children;    Body mass index;    Body composition;    Adiposity;    Obesity;    Overweight;    Physical activity;    Exercise;   

Others  :  1143829
DOI  :  10.1186/1471-2431-14-225

 received in 2014-05-08, accepted in 2014-09-02,  发布年份 2014

【 摘 要 】

Background

Overweight 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.

Methods

Studies 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.

Results

Of 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 View MathML">. 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 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.

Conclusions

Exercise 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.

【 授权许可】

   
2014 Kelley et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Watts K, Jones TW, Davis EA, Green D: Exercise training in obese children and adolescents: current concepts. Sports Med 2005, 35:375-392.
• [2]Singh AS, Mulder C, Twisk JW, Van MW, Chinapaw MJ: Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008, 9:474-488.
• [3]McGee DL: Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 2005, 15:87-97.
• [4]Atlantis E, Barnes EH, Singh MA: Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes (Lond) 2006, 30:1027-1040.
• [5]August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, Silverstein JH, Speiser PW, Styne DM, Montori VM: Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008, 93:4576-4599.
• [6]Campbell K, Waters E, O’Meara S, Kelly S, Summerbell C: Interventions for preventing obesity in children. Cochrane Database Syst Rev 2002, CD001871.
• [7]Collins CE, Warren J, Neve M, McCoy P, Stokes BJ: Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med 2006, 160:906-922.
• [8]Epstein LH, Goldfield GS: Physical activity in the treatment of childhood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999, 31:S553-S559.
• [9]Flodmark CE, Marcus C, Britton M: Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes (Lond) 2006, 30:579-589.
• [10]Gilles A, Cassano M, Shepherd EJ, Higgins D, Hecker JE, Nangle DW: Comparing active pediatric obesity treatments using meta-analysis. J Clin Child Adolesc Psychol 2008, 37:886-892.
• [11]Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V: School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med 2009, 37:418-427.
• [12]Harris KC, Kuramoto LK, Schulzer M, Retallack JE: Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. Can Med Assoc J 2009, 180:719-726.
• [13]Hesketh KD, Campbell KJ: Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity 2010, 18:S27-S35.
• [14]Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, Paulo R, Hettinger A, Erwin PJ, Montori VM: Behavioral interventions to prevent childhood obesity: a systematic review and meta-analyses of randomized trials. J Clin Endocrinol Metab 2008, 93:4606-4615.
• [15]Kanekar A, Sharma M: Meta-analysis of school-based childhood obesity interventions in the U.K. and U.S. Int Q Commun Health Educ 2008, 29:241-256.
• [16]Katz DL, O’Connell M, Njike VY, Yeh MC, Nawaz H: Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond) 2008, 32:1780-1789.
• [17]Kelly KP, Kirschenbaum DS: Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention. Obes Rev 2011, 12:37-49.
• [18]Kitzmann KM, Dalton WT III, Stanley CM, Beech BM, Reeves TP, Buscemi J, Egli CJ, Gamble HL, Midgett EL: Lifestyle interventions for youth who are overweight: a meta-analytic review. Health Psych 2010, 29:91-101.
• [19]McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C, Erwin PJ, Montori VM: Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 2008, 93:4600-4605.
• [20]Oude LH, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, Summerbell CD: Interventions for treating obesity in children. Cochrane Database Syst Rev 2009, CD001872.
• [21]Reilly JJ, McDowell ZC: Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal. Proc Nutr Soc 2003, 62:611-619.
• [22]Seo DC, Sa J: A meta-analysis of obesity interventions among U.S. Minority children. J Adolesc Health 2010, 46:309-323.
• [23]Snethen JA, Broome ME, Cashin SE: Effective weight loss for overweight children: a meta-analysis of intervention studies. J Pediatr Nurs 2006, 21:45-56.
• [24]Stice E, Shaw H, Marti CN: A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull 2006, 132:667-691.
• [25]Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ: Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005, CD001871.
• [26]Wilfley DE, Tibbs TL, Van Buren DJ, Reach KP, Walker MS, Epstein LH: Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psych 2007, 26:521-532.
• [27]Young KM, Northern JJ, Lister KM, Drummond JA, O’Brien WH: A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev 2007, 27:240-249.
• [28]Guerra PH, Nobre MRC, da Silveira JAC, Taddei JADC: The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials. Clinics 2013, 68:1263-1273.
• [29]Lavelle HV, Mackay DF, Pell JP: Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Pub Health 2012, 34:360-369.
• [30]Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M: AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 2009, 62:1013-1020.
• [31]Inokuchi M, Matsuo N, Takayama JI, Hasegawa T: BMI z-score is the optimal measure of annual adiposity change in elementary school children. Ann Hum Biol 2011, 38:747-751.
• [32]Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Report. Washington, DC; 2008.
• [33]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Int Med 2009, 151:W65-W94.
• [34]Sacks HS, Chalmers TC, Smith H: Randomized versus historical controls for clinical trials. Am J Med 1982, 72:233-240.
• [35]Schulz KF, Chalmers I, Hayes R, Altman DG: Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995, 273:408-412.
• [36]Jago R, Jonker ML, Missaghian M, Baranowski T: Effect of 4 weeks of pilates on the body composition of young girls. Prev Med 2006, 42:177-180.
• [37]Dietz WH: Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998, 101:518-525.
• [38]Lee E, Dobbins M, DeCorby K, Mcrae L, Tirilis D, Husson H: An optimal search filter for retrieving systematic reviews and meta-analyses. BMC Med Res Methodol 2012, 12:51. BioMed Central Full Text
• [39]Reference Manager. 12.0.3. Philadelphia, PA: Thompson ResearchSoft; 2009.
• [40]Microsoft Excel. Redmond, WA: Microsoft Corporation; 2007.
• [41]Sun C, Pezic A, Tikellis G, Ponsonby AL, Wake M, Carlin JB, Cleland V, Dwyer T: Effects of school-based interventions for direct delivery of physical activity on fitness and cardiometabolic markers in children and adolescents: a systematic review of randomized controlled trials. Obes Rev 2013, 14:818-838.
• [42]Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS: 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 2011, 43:1575-1581.
• [43]Cohen J: Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968, 70:213-220.
• [44]Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J 2011, 343:d5928.
• [45]Ahn S, Becker BJ: Incorporating quality scores in meta-analysis. J Educ Behav Stat 2011, 36:555-585.
• [46]Riley RD, Lambert PC, Staessen JA, Wang J, Gueyffier F, Thijs L, Boutitie F: Meta-analysis of continuous outcomes combining individual patient data and aggregate data. Stat Med 2008, 27:1870-1893.
• [47]Follmann D, Elliot P, Suh I, Cutler J: Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992, 45:769-773.
• [48]Hedges LV, Olkin I: Statistical Methods for Meta-Analysis. San Diego, CA: Academic Press; 1985.
• [49]Dersimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials 1986, 7:177-188.
• [50]Bergstrom I, Landgren B, Brinck J, Freyschuss B: Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density. Osteoporos Int 2008, 19:177-183.
• [51]Kraemer HC, Kupfer DJ: Size of treatment effects and their importance to clinical research and practice. Biol Psychiatry 2006, 59:990-996.
• [52]Higgins JPT, Green S: Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated march 2011]. Cochrane Collaboration 2011.
• [53]Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014, 311:806-814.
• [54]Cali AMG, Caprio S: Obesity in children and adolescents. J Clin Endocrinol Metab 2008, 93:s31-s36.
• [55]Haslam DW, James WP: Obesity. Lancet 2005, 366:1197-1209.
• [56]Higgins JPT, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. Br Med J 2003, 327:557-560.
• [57]Higgins JP, Thompson SG, Spiegelhalter DJ: A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A 2009, 172:137-159.
• [58]Kelley GA, Kelley KS: Impact of progressive resistance training on lipids and lipoproteins in adults: another look at a meta-analysis using prediction intervals. Prev Med 2009, 49:473-475.
• [59]Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple graphical test. Br Med J 1997, 315:629-634.
• [60]Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rucker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP: Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Br Med J 2011, 343:d4002.
• [61]Lau J, Schmid CH, Chalmers TC: Cumulative meta-analysis of clinical trials builds evidence for exemplary medical care: the potsdam international consultation on meta-analysis. J Clin Epidemiol 1995, 48:45-57.
• [62]Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M: Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009, 54:2396-2406.
• [63]Kelly AS, Wetzsteon RJ, Kaiser DR, Steinberger J, Bank AJ, Dengel DR: Inflammation, insulin, and endothelial function in overweight children and adolescents: The role of exercise. J Pediatr 2004, 145:731-736.
• [64]Borenstein M, Hedges L, Higgins J, Rothstein H: Introduction to Meta-Analysis. West Sussex: John Wiley & Sons; 2009.
• [65]American College of Sports Medicine: ACSM’s Guidelines for Exercise Testing and Prescription. Baltimore: Lippincott, Williams & Wilkins; 2006.
• [66]Littell JH, Corcoran J, Pillai V: Systematic Reviews and Meta-Analysis. New York: Oxford University Press; 2008.
• [67]Daley AJ, Copeland RJ, Wright NP, Roalfe A, Wales JK: Exercise therapy as a treatment for psychopathologic conditions in obese and morbidly obese adolescents: a randomized, controlled trial. Pediatrics 2006, 118:2126-2134.
• [68]Davis CL, Pollock NK, Waller JL, Allison JD, Dennis BA, Bassali R, Melendez A, Boyle CA, Gower BA: Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial. JAMA 2012, 308:1103-1112.
• [69]Hagstromer M, Elmberg K, Marild S, Sjostrom M: Participation in organized weekly physical exercise in obese adolescents reduced daily physical activity. Acta Paediatr 2009, 98:352-354.
• [70]Maddison R, Foley L, Ni MC, Jiang Y, Jull A, Prapavessis H, Hohepa M, Rodgers A: Effects of active video games on body composition: a randomized controlled trial. Am J Clin Nutr 2011, 94:156-163.
• [71]Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W: Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006, 48:1865-1870.
• [72]Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R: Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes 2009, 4:205-214.
• [73]Shaibi GQ, Cruz ML, Ball GD, Weigensberg MJ, Salem GJ, Crespo NC, Goran MI: Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Med Sci Sports Exerc 2006, 38:1208-1215.
• [74]Weintraub DL, Tirumalai EC, Haydel KF, Fujimoto M, Fulton JE, Robinson TN: Team sports for overweight children: the stanford sports to prevent obesity randomized trial (SPORT). Arch Pediatr Adolesc Med 2008, 162:232-237.
• [75]Engels EA, Schmid CH, Terrin N, Olkin I, Lau J: Heterogeneity and statistical significance in meta-analysis: an empirical study of 125 meta-analyses. Stat Med 2000, 19:1707-1728.
• [76]Glass GV, McGaw B, Smith ML: Meta-Analysis in Social Research. Newbury Park, California: Sage; 1981.
• [77]Altman DG, Bland JM: Absence of evidence is not evidence of absence. Br Med J 1995, 311:485.
• [78]Katz MH: Multivariable analysis: a practical guide for clinicians. New York: Cambridge University Press; 2011.
• [79]Kovalchik SA: Aggregate-data estimation of an individual patient data linear random effects meta-analysis with a patient covariate-treatment interaction term. Biostatistics 2012, 14:273-283.
• [80]Cooper H, Patall EA: The relative benefits of meta-analysis conducted with individual participant data versus aggregated data. Psychol Methods 2009, 14:165-176.
• [81]Steinberg KK, Smith SJ, Stroup DF, Olkin I, Lee NC, Williamson GD, Thacker SB: Comparison of effect size estimates from a meta-analysis of summary data from published studies and from a meta-analysis using individual patient data for ovarian cancer studies. Am J Epidemiol 1997, 145:917-925.
• [82]Stewart LA, Parmar MKB: Meta-analysis of the literature or of individual patient data: is there a difference? Lancet 1993, 341:418-422.
• [83]Jeng GT, Scott JR, Burmeister LF: A comparison of meta-analytic results using literature vs individual patient data. Paternal cell immunization for recurrent miscarriage. JAMA 1995, 274:830-836.
• [84]Olkin I, Sampson A: Comparison of meta-analysis versus analysis of variance of individual patient data. Biometrics 1998, 54:317-322.
• [85]Mathew T, Nordstrom K: On the equivalence of meta-analysis using literature and using individual patient data. Biometrics 1999, 55:1221-1223.
• [86]Riley RD, Lambert PC, Abo-Zaid G: Meta-analysis of individual participant data: rationale, conduct, and reporting. Br Med J 2010, 340:c221.
• [87]Atlanta, Georgia, Centers for Disease Control and Prevention. Division of Nutrition,Physical Activity and Obesity: How Much Physical Activity do Children Need? 11-9-2011. 2014, 4-18.
• [88]Rothman KJ: No adjustments are needed for multiple comparisons. Epidemiol 1990, 1:43-46.