C.N. Ezenwugo1, J. Potterton1, A. Stewart1, A.T. Ajidahun1
1University of the Witswatersrand, Health Sciences, Johannesburg, South Africa
Background: Childhood overweight and obesity constitute a current global pandemic because our world has become highly industrialised and children engage in less active play but consume more energy-dense foods. The pandemic persists despite general knowledge that physical activity is beneficial for weight control. Evidence-based studies on the effective implementation of activity interventions in childhood overweight/obesity are lacking.
Purpose: To determine how physical activity interventions can be effectively implemented in the management of overweight and obesity in children.
Methods: A quantitative systematic review was conducted using the Johanna Briggs Institute (JBI) guidelines. Randomised control trials conducted on healthy overweight/obese children aged 6-12 years were assessed for inclusion. The Centres for Disease Control and Prevention (CDC) definition of overweight and obesity was used. English language studies that administered only physical activity interventions for a length of ≥12 weeks in the intervention group were considered. The control group could receive any other form of intervention or “no intervention”. The BMI z-score was used to assess study outcomes. A comprehensive 15-year database and reference list search was conducted by two independent reviewers. Comparable data were extracted and the changes in BMI z-score at various points was calculated. Values were summarised as mean differences (MD) with 95% confidence intervals (CI). Across-study statistical heterogeneity was assessed to determine the relevance of a forest plot.
Results: Four research papers (n=302) were included in the systematic review. The studies scored a moderate to good methodological quality rating. Mean BMI z-score changes varied significantly within study intervention and control groups. One study showed a marked improvement in BMI z-scores in both sole diet and diet+exercise intervention groups with no significant difference between the two groups but significantly greater success than in sole exercise interventions. Overall, there was a significant difference in BMI z-score changes between all intervention and control groups. After direct supervision of exercise was removed from the intervention groups, the reduction in BMI z-score values significantly declined. Meta-analysis results indicated considerable study heterogeneity (I2=99%, p=0).
Conclusion(s): Sole physical activity interventions are efficacious in improving BMI z-score status in children but require direct supervision for sustained weight loss. Activity interventions should be conducted thrice weekly for about an hour and should include both aerobic and resistance exercises. The use of sole dietary restriction is more efficacious than sole exercise intervention at the initial stage of weight management in children. Sole dietary intervention or a combined regimen of diet plus exercise are of comparable benefit but offer superior benefit to sole exercise intervention in improving BMI z-score status.
Implications: Physical activity may not be the first line of action for overweight and obesity management in children. A gradual introduction of supervised exercise activity serves as a buffer for dietary control and intervention programs must include lengthy monitoring beyond 12 months. Policy makers should emphasize multi-component interventions anchored primarily on dietary control. Recreational play, physical education at school and after-school sports involving parental and community participation should subsequently be phased in to ensure long-term sustainability.
Funding, acknowledgements: South African Society of Physiotherapists (SASP)
University of the Witwatersrand Faculty Research Committee (FRC)
University of the Witwatersrand Faculty Research Committee (FRC)
Keywords: Childhood, Obesity, Physical activity
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: The study was a systematic review and did not involve human subjects
All authors, affiliations and abstracts have been published as submitted.
