Effects of a Twelve-Week Randomized Intervention of Exercise and/or Diet on Weight Loss and Weight Maintenance, and Other Metabolic Parameters in Obese Preadolescent Children

Shalitin, Shlomit; Ashkenazi‐Hoffnung, Liat; Yackobovitch‐Gavan, Michal; Nagelberg, Nessia; Karni, Y; Hershkovitz, Eli; Loewenthal, Neta; Shtaif, Biana; Gat-Yablonski, Galia; Phillip, Moshe

doi:10.1159/000245931

Cited by 72 publications

(112 citation statements)

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“…The cumulative evidence from this meta-analysis supports recommendations on international exercise (32,33) and highlights the notion that greater participation in aerobic exercise programs can result in greater reductions in CRF. The results of several studies reporting the impact of aerobic exercise on insulin resistance in obese youths are controversial or inconsistent (8,9,34,35). However, some controlled clinical trials (6, 7) or a meta-analysis in an other less-specific population (10) have reported a decrease in both fasting glucose and/or insulin levels.…”

Section: Discussionmentioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Aerobic exercise reduces insulin resistance markers in obese youth: a meta-analysis of randomized controlled trials

García-Hermoso

Saavedra

Escalante

et al. 2014

European Journal of Endocrinology

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Objective: The purpose of this meta-analysis was to examine the evidence for the effectiveness of aerobic exercise interventions on reducing insulin resistance markers in obese children and/or adolescents. A secondary outcome was change in percentage of body fat. Methods: A computerized search was made from seven databases: CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, PsycINFO, and Science Citation Index. The analysis was restricted to randomized controlled trials that examined the effect of aerobic exercise on insulin resistance markers in obese youth. Two independent reviewers screened studies and extracted data. Effect sizes (ES) and 95% confidence interval (CI) were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic. Results: Nine studies were selected for meta-analysis as they fulfilled the inclusion criteria (nZ367). Aerobic exercise interventions resulted in decreases in fasting glucose (ESZK0.39; low heterogeneity) and insulin (ESZK0.40; low heterogeneity) and in percentage of body fat (ESZK0.35; low heterogeneity). These improvements were specifically accentuated in adolescents (only in fasting insulin), or through programs lasting more than 12 weeks, three sessions per week, and over 60 min of aerobic exercise per session. Conclusions: This meta-analysis provides insights into the effectiveness of aerobic exercise interventions on insulin resistance markers in the obese youth population.

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Section: Discussionmentioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Aerobic exercise reduces insulin resistance markers in obese youth: a meta-analysis of randomized controlled trials

García-Hermoso

Saavedra

Escalante

et al. 2014

European Journal of Endocrinology

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“…A flowchart of study selection is provided in Fig 1. Manual searches revealed 5 additional publications. [22][23][24][25][26][27] Six articles reported fasting insulin measurements as median and interquartile range (25th-75th percentile), reported data in change scores from baseline, or did not report either premeasurement or postmeasurement data. A request for missing data was sent to each of the corresponding authors.…”

Section: Study Selectionmentioning

confidence: 99%

“…23,25,28,40,51,53,57,58 Sensitivity analysis removing these 9 effects decreased the mean effect of exercise on fasting insulin in children and adolescents from .001) for the remaining 24 effects. When examining IR, 3 effects from 2 studies outside of the 95% CI were identified by using the forest plot to identify potential outliers.…”

Section: Effect Of Potential Outliersmentioning

confidence: 99%

“…29 IR was calculated by using fasting levels of insulin and glucose by using the homeostasis model assessment (HOMA) technique in each study included in this analysis. 22,25,31,32,[34][35][36][37][38][39][40][41] A decrease in fasting insulin levels or IR among participants in exercise interventions resulted in a positive ES. Two authors (M.V.F.…”

Section: Es Calculationmentioning

confidence: 99%

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Exercise and Insulin Resistance in Youth: A Meta-Analysis

et al. 2014

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BACKGROUND AND OBJECTIVES: The prevalence of obesity and diabetes is increasing among children, adolescents, and adults. Although estimates of the efficacy of exercise training on fasting insulin and insulin resistance have been provided, for adults similar estimates have not been provided for youth. This systematic review and meta-analysis provides a quantitative estimate of the effectiveness of exercise training on fasting insulin and insulin resistance in children and adolescents.METHODS: Potential sources were limited to peer-reviewed articles published before June 25, 2013, and gathered from the PubMed, SPORTDiscus, Physical Education Index, and Web of Science online databases. Analysis was limited to randomized controlled trials by using combinations of the terms adolescent, child, pediatric, youth, exercise training, physical activity, diabetes, insulin, randomized trial, and randomized controlled trial. The authors assessed 546 sources, of which 4.4% (24 studies) were eligible for inclusion. Thirty-two effects were used to estimate the effect of exercise training on fasting insulin, with 15 effects measuring the effect on insulin resistance. Estimated effects were independently calculated by multiple authors, and conflicts were resolved before calculating the overall effect. RESULTS:Based on the cumulative results from these studies, a small to moderate effect was found for exercise training on fasting insulin and improving insulin resistance in youth (Hedges' d effect size = 0.48 [95% confidence interval: 0.22-0.74], P , .001 and 0.31 [95% confidence interval: 0.06-0.56], P , .05, respectively). CONCLUSIONS:These results support the use of exercise training in the prevention and treatment of type 2 diabetes. Pediatrics 2014;133:e163-e174 Mr Fedewa conceptualized and designed the study, conducted the initial analysis, and drafted the initial manuscript; Dr Gist coded and analyzed effects and reviewed and revised the initial manuscript; Dr Evans assisted with conceptualizing and designing the study and reviewed and revised the initial manuscript; Dr Dishman assisted with conceptualizing and designing the study, performed additional statistical analysis, and critically reviewed and revised the initial manuscript; and all authors approved the final manuscript as submitted. The global prevalence of pediatric type 2 diabetes mellitus (T2DM) has paralleled the rise in obesity, increasing steadily since the late 1970s. 1 This endocrine disorder is caused by a combination of peripheral insulin resistance (IR) in muscle and adipose tissue and inadequate insulin secretion from the pancreas, eventually resulting in a relative insulin deficiency. 2 Early dysfunction in b-cell activity and cellular IR appear long before manifestation of the signs and symptoms of T2DM. 3 Deterioration of peripheral insulin sensitivity and b-cell dysfunction can be observed as the disease progresses in youth at risk for developing metabolic syndrome and T2DM. 4 Puberty is marked by a decrease in physical activity 5 and an incr...

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“…Although these multi-faceted and resource intensive weight loss programs, involving weekly nutrition education sessions, homework assignments, group physical activity sessions, and frequent follow-up phone calls, are effective for some [8][9][10], they are unaffordable and impractical for many others. In many cases, resources are lacking to support multidisciplinary teams consisting of physicians, nurses, dieticians, physical therapists and/or psychologists, as have been utilized in several successful childhood obesity interventions [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents

Sylvetsky¹,

Welsh²,

Walsh³

et al. 2012

OJPed

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Introduction: Pediatricians are encouraged to promote behavior modification to reduce childhood obesity and its co-morbidities, yet the effectiveness of office counseling is unclear. We aimed to evaluate if a low-intensity intervention (action-oriented counseling) in a clinic setting results in weight stabilization, and if the effect is modified by a diagnosis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that patients with NAFLD would be more motivated to adhere to the lifestyle goals set in clinic, due to the diagnosis of an obesity-related condition; and, would therefore achieve greater weight reduction compared to similarly overweight and obese patients without a diagnosis of NAFLD. Methods: A retrospective chart review was conducted on 73 (35 male, 38 female) overweight and obese patients (BMI ≥ 85th percentile) attending a pediatric GI clinic between January 2006 and October 2011. Analysis was conducted to determine if lifestyle goals discussed with the patient at each clinic visit were associated with improved BMI, BMI z-score, and liver enzymes. Treatment outcomes among NAFLD patients and similarly obese patients without NAFLD were compared using t-tests and chi-square tests. Results: Of the children evaluated, 74.0% achieved a reduction or stabilization in BMI z-score after 3 months of follow-up. Among NAFLD patients, liver enzymes improved in 72% of those who were able to stabilize or reduce their BMI and among 43% of those who gained weight. Treatment outcome did not significantly differ based on having a diagnosis of NAFLD, although there was a trend towards greater improvements. Conclusion: Our study suggests that action oriented counseling including goalsetting in a low intensity, clinic based approach is effective in improving patient BMI, in the presence or absence of an obesity-related co-morbidity, such as NAFLD. Further, we demonstrated that lifestyle modification led to improvement of liver enzymes in NAFLD patients and may result in other clinically relevant improvements. Longer studies will be needed to determine if the improvements are sustained.

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Effects of a Twelve-Week Randomized Intervention of Exercise and/or Diet on Weight Loss and Weight Maintenance, and Other Metabolic Parameters in Obese Preadolescent Children

Cited by 72 publications

References 85 publications

ENDOCRINOLOGY AND ADOLESCENCE: Aerobic exercise reduces insulin resistance markers in obese youth: a meta-analysis of randomized controlled trials

ENDOCRINOLOGY AND ADOLESCENCE: Aerobic exercise reduces insulin resistance markers in obese youth: a meta-analysis of randomized controlled trials

Exercise and Insulin Resistance in Youth: A Meta-Analysis

Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents

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