The effects of a low-dose physical activity intervention on physical activity and body mass index in severely obese adolescents

Abstract

Background While severe obesity in childhood poses the greatest long-term health risks, access to treatment is a common barrier. The present pilot study examined the effect of a 7-week low-dose physical activity (PA) intervention on PA and body mass index (BMI) in severe obese adolescents delivered via telephone and mail. Methods Adolescents (n = 64) receiving care from a pediatric obesity medical clinic were randomized to a control (n = 30) or intervention (n = 34) group. Height and weight were measured and BMI z-scores were calculated. PA was assessed by a pedometer. All measurements were completed pre- and post-intervention. The intervention group received weekly newsletters and telephone calls discussing various PA topics based on motivational interviewing for 7 weeks. The control group received no contact. A series of 2 × 2 (group by time) repeated measures analysis of covariances (ANCOVAs) adjusting for length of time between visits were performed to examine the effect of the intervention on PA and BMI z-scores. Results The majority of adolescents were severely obese (77%, BMI: > 99th percentile). Intention-to-treat analysis revealed intervention effects were not observed for either pedometer steps or BMI z-score (p > 0.05). Among those with complete data, adolescents who successfully changed their BMI z-score had larger BMI z-score changes than those who did not change their BMI z-score (p = 0.0001). This improvement was due to something other than PA as the change in BMI z-score was similar among those who did and did not successfully increase PA levels (p > 0.05). Conclusions More intensive, comprehensive, and longer-term treatment is needed in this high risk population.

Physical activity promotion in rural health care settings: A rapid realist review

“…Over half of the articles in our sample originated from the United States (n = 11) ( Batsis et al, 2020 , Batsis et al, 2021 , Currie et al, 2018 , Greaney et al, 2017 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2018 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ), followed by Australia (n = 3) ( Paul et al, 2019 , Eakin et al, 2012 , Sangster et al, 2016 ), Canada (n = 2) ( Miedema et al, 2015 , Davis et al, 2016 ), and the United Kingdom (n = 2; Table 3 ) ( Connelly et al, 2017 , Lee et al, 2007 ). Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ). Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , …”

“…Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ). Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) (…”

“…Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) ( Batsis et al, 2020 , Batsis et al, 2021 , Greaney et al, 2017 , Miedema et al, 2015 , Batsis et al, 2021 ), physicians (n = 4) ( Hsu et al, 2018 , Miedema et al, 2015 , Melton et al, 2016 , Currie et al, 2018 ), and exercise physiologists (n = 3) ( Paul et al, 2019 , Miedema et al, 2015 , Eakin et al, 2012 ). Two included studies reported on the same intervention delivered in a rural primary care setting, describing the effectiveness ( Reed et al, 2018 ) and feasibility/implementation ( Reed et al, 2020 …”

“…Ten articles ( Hsu et al, 2018 , Paul et al, 2019 , Connelly et al, 2017 , Greaney et al, 2017 , Miedema et al, 2015 , Melton et al, 2016 , Robles et al, 2014 , Sangster et al, 2016 , Batsis et al, 2021 , Currie et al, 2018 ) provided no definition or measure of rurality but were included as they self-identified their study as taking place in a rural setting. Seven articles defined the communities as rural by stating the location’s population (range: 5,495 – 20,613 people) ( Davis et al, 2016 , Lee et al, 2007 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), and three provided a specific definition of rurality based on national health policies ( Batsis et al, 2020 , Reed et al, 2018 , Eakin et al, 2012 ).…”

Effect of a 1-year intervention comprising brief counselling sessions and low-dose physical activity recommendations in Japanese adults, and retention of the effect at 2 years: a randomized trial

“…Interventions using the low-dose PA concept have been used in pre-clinical populations; however, reports present contrasting results. In one study, a low-dose PA program has been ineffective in changing PA habits and reducing BMI in a population of obese adolescents [ 35 ]. In another study, a 1-year intervention resembling that of the NEXIS was associated with a > 4 kg decrease in a population of overweight Japanese adults [ 36 ].…”