Don’t skip exercise in lifestyle interventions for children with obesity

Exercise is a key component of a family-based lifestyle intervention program aimed at helping children lose fat, according to a secondary analysis of a nonrandomized controlled trial.

Over the course of the 22-week program, overweight or obese children whose families participated in a lifestyle intervention program with supervised exercise training saw an 18.1% reduction in visceral adipose tissue (VAT) compared to a 8.5% discount for those in the Basic Lifestyle Program (p=0.004), reported Cristina Cadenas-Sanchez, PhD, of the University of Granada in Spain, and colleagues.

Children in the exercise program also saw significantly greater reductions in abdominal subcutaneous adipose tissue (-9.9% vs. -3.0%, p=0.001) and fat fractions from intermuscular adipose tissue (-6.0% vs -2.6%, p=0.02) compared to controls, they scored in Open JAMA Network.

In addition, the number of respondents regarding VAT area (73.5% vs 36.5%) and fat fraction reduction (81.6% vs 38.5%) was 40% higher in the exercise group compared to the control group (p<0.001).

VAT reductions are likely the driving force responsible for 87.6% of the observed improvement in insulin resistance (β -0.102, 95% CI -0.230 to -0.002), highlighting “the importance of targeting childhood obesity therapies to this fat depot”, Padlock. -Sanchez and team wrote.

“Insulin resistance is a problem that could be reversed by substantial loss of VAT, and the present work highlights that exercise-induced VAT reduction could mediate a reduction in insulin resistance,” they explained. “This result should help protect against the development of type 2 diabetes.”

The only outcome that did not differ significantly between the two groups was the fraction of fat in pancreatic adipose tissue.

Cadenas-Sanchez and colleagues said current pediatric clinical practice guidelines from the Endocrine Society recommend these types of weight management interventions, but also emphasize the need for the whole family to participate, noting that exercise should be incorporated as a key component of a comprehensive program involving diet, nutrition and behavioral interventions.

For this secondary analysis, 116 overweight or obese children aged 8–12 years (mean age 10.6) from Vitoria-Gasteiz, Spain, were assigned to a 22-week family-based lifestyle program ( n=57) or the same program plus an exercise intervention (n=59).

The program consisted of two 45-minute sessions per month that promoted a healthy diet, physical activity, and proper sleep hygiene. It also incorporated a psychoeducational component that consisted of two 45-minute sessions per month in which children were taught skills for emotional coping and well-being. The exercise program consisted of 90 minutes of supervised and monitored exercise training 3 times per week. Parents attended classes with their children.

Changes in fat mass and other metabolic parameters were collected by MRI, anthropometric and fitness assessments, and fasting blood samples.

At baseline, 57.8% of children were obese. Over the course of the 22-week program, the mean participation rate in the family psychoeducation and lifestyle program was 85% for children and 83% for parents, while mean adherence to supervised training in the exercise group was 72%

Two exercise-related adverse events occurred and included knee and ankle pain.