Effects of an Exercise Program on Cardiometabolic and Mental Health in Children With Overweight or Obesity

Abstract

ImportanceChildhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health.ObjectiveTo investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity.Design, Setting, and ParticipantsThis secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context.InterventionThe exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines.Main Outcomes and MeasuresCardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators.ResultsThe 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, −0.74 to −0.02) SDs; decreased low-density lipoprotein cholesterol level by −7.00 (95% CI, −14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by −0.59 (95% CI, −1.06 to −0.12), fat mass index by −0.67 (95% CI, −1.01 to −0.33), and visceral adipose tissue by −31.44 (95% CI, −58.99 to −3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health.Trial RegistrationClinicalTrials.gov Identifier: NCT02295072

The effects of physical activity on white matter microstructure in children with overweight or obesity: The ActiveBrains randomized clinical trial

“…Consistent with the literature, a network meta-analysis found that high-intensity and frequent resistance exercises may be the most effective, followed by exergames, aerobic exercises, and mind–body exercises ( Wang et al., 2019 ) to improve cognition in adults. Our physical activity intervention, which consisted of 60 min of aerobic exercise and 20 min muscular training, improved cardiorespiratory fitness but not muscular fitness ( Migueles et al., 2023 ), and it could be one of the reasons we did not find any significant effect on white matter microstructure. Therefore, muscular training interventions to improve muscular fitness are needed to test if muscular fitness influences white matter in young people.…”

“…This study includes data from the ActiveBrains project, an RCT, whose primary aim was to explore the effects of a 20-week physical activity program on behavioral outcomes, including intelligence, executive function, and academic performance as well as on hippocampal volume as a primary region of interest in children with overweight or obesity ( Cadenas-Sánchez et al., 2016 ; Ortega et al., 2022 ). As secondary outcomes, it also included physical and mental health as well as other specific brain structural and functional indicators ( Migueles et al., 2023 ; Ortega et al., 2022 ), as white matter microstructure, which is the main outcome of this study. The ActiveBrains project was approved by the Human Research Ethics Committee of the University of Granada and was registered in ClinicalTrials.gov (identifier: NCT02295072).…”

Evaluating the impact of exercise on intermediate disease markers in overweight and obese individuals through a network meta-analysis of randomized controlled trials

“…In total, we included studies from 56 randomized controlled trials, which included 3193 people diagnosed with overweight and obesity. Interventions in the experimental group included: aerobic exercises (32 studies) 18 – 34 , resistance training (9 studies) 35 – 43 , concurrent training (23 studies) 23 , 29 , 34 , 44 – 54 .…”

Accelerometry-assessed daily physical activity and compliance with recommendations in Spanish children: importance of physical education classes and vigorous intensity

“…On the other hand, there is a high prevalence of overweight and obesity in children and adolescents ( NCD Risk Factor Collaboration, 2017 ; ALADINO, 2020 ; Bibiloni et al, 2022 ; Serra Majem et al, 2003 ), which increases their risk of developing diseases in adulthood ( Umer et al, 2017 ; Migueles et al, 2023 ). Therefore, having physical activity recommendations that are as tailored as possible to the biological circumstances of children and adolescents, as well as promoting programs that aid in meeting these recommendations, can play an essential role in preventing excess body weight in this population ( Gralla et al, 2016 ; Poitras et al, 2016 ; Owens, Galloway & Gutin, 2016 ; World Health Organization (WHO), 2020 ; Chaput et al, 2020 ; García-Hermoso et al, 2021 ; Migueles et al, 2023 ).…”