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Recommendations Summary

Pediatric Weight Management (PWM) Physical Activity in the Treatment of Childhood and Adolescent Obesity

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  PWM: Physical Activity

  Physical activity should be included as part of a multi-component pediatric weight-management program. Research indicates that increasing physical activity as part of a multi-component program results in significant improvements in weight status and body composition in children and adolescents.

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

    Physical Activity Risks

    • Consultation with a physician prior to beginning an exercise program is needed. Consultation with an exercise specialist is recommended if an exercise prescription is given
    • Intense physical activity in some overweight and obese individuals may contribute to disability or death. 

  • Conditions of Application

    None.

  • Potential Costs Associated with Application

    • If the physical activity component of the pediatric weight-management program includes organized exercise sessions, program resources and personnel will need to be available
    • If physical activity is required, program resources may be necessary to facilitate this
    • Absence of health insurance coverage for weight management could limit program access.

  • Recommendation Narrative

    Physical Activity is an Integral Part of Pediatric Weight Management

    28 randomized and controlled trials, 16 studies of other design and one review article reported on treatment programs for childhood obesity.

    The evidence indicates that including a physical activity component as part of a multi-disciplinary weight-management program for children and adolescents is both standard practice and makes important contributions to the overall goal of weight loss.

    Six RCTs compared the same diet and behavioral interventions with and without an exercise component.

    • Three studies reported at least short-term improvements in at least one adiposity measure when exercise was added to the program (Epstein LH, Wing RR, Penner BC, Kress, 1985; Gutin B, Barbeau P et al, 2002; Becque MD, Katch V et al, 1988). Only the Epstein study examined the differences between groups at 12 months. By this time, the between-group differences had disappeared.
    • Three studies (Epstein LH, Wing RR, Koeske R, Valoski, 1984; Rocchini AP, Katch V et al, 1988; Schwingshandl J, Sudi K et al, 1999) did not find any significant differences in adiposity measures when a physical activity component was added to a diet and behavior intervention.

    Only one study (Owens S, Gutin B et al, 1999) examined the ability to bring about weight loss with physical activity alone. The authors report that participation in a four-month, high-intensity, five-days-a-week program, brought about greater reduction in total fat mass and increased fat-free mass than controls. It is worth noting that subjects were paid ($1 per session) to participate in the exercise sessions. There was no report of longer-term outcomes.

    As the above studies indicate, the link between physical activity and weight loss appears to be dependent upon other factors such as the type of physical activity intervention (e.g., see Epstein LH, Wing RR, Koeske R, Valoski A. 1985 below), intensity, duration and frequency of exercise (Grade I).

    What Type of Physical Activity Intervention Is Best?

    Three RCTs (Epstein LH, Wing RR, Koeske R, Valoski A. 1985; Epstein LH, Paluch RA, Gordy CC, Dorn, 2000; Gutin B, Barbeau P et al, 2002) and one non-randomized trial (Sothern M, Loftin M et al, 2000) compared physical activity interventions either in terms of the type of activity (Sothern M, Loftin M et al, 2000; Epstein LH, Wing RR, Koeske R, Valoski A, 1985) or in terms of intensity (Gutin B, Barbeau P et al, 2002; Epstein LH, Paluch RA, Gordy CC, Dorn, 2000). Epstein LH, Valoski A, Wing RR, McCurley J, 1994, reports on the ten-year outcomes of Epstein LH, Wing RR, Koeske R, Valoski A, 1985.

    Only Epstein LH, Wing RR, Koeske R, Valoski A, 1985, report statistically significant differences among different physical activity interventions: Subjects in a lifestyle physical activity group maintained greater weight loss at two years, compared to aerobics and calisthenics groups. Epstein LH, Valoski A, Wing RR, McCurley J, 1994, report that differences among exercise interventions (aerobics vs. calisthenics and lifestyle activity vs. calisthenics) persisted over 10 years.

    Thus, while lifestyle physical activity interventions may provide longer-lasting benefits, the research is still too limited to draw any strong conclusions (Grade III).

  • Recommendation Strength Rationale

    Both intervention and observational research are consistent in demonstrating a significant contribution to adiposity improvement from the inclusion of a physical activity intervention as part of a multi-component pediatric weight-management program.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the effectiveness of using a program to increase physical activity as a part of an intervention program to treat childhood obesity?
  
  How do different physical activity interventions compare as part of a multicomponent childhood obesity treatment program?

  • References

    Becque MD, Katch V, Rocchini A, Marks C, and Moorehead C. Coronanry Risk Incidence of Obese Adolescents: Reduction by Exercise Plus Diet Intervention/ Pediatrics 1988;81;605-12.
    
    Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000; 154 (3):220-6.
    
    Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994, 13:373-383.
    
    Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology 1984; 52:429-437.
    
    Epstein LH, Wing RR, Penner BC, Kress MJ. Effect of diet and controlled exercise on weight loss in obese children.  J Pediatr 1985;107:358-61.
    
    Gutin B, Barbeau P, Owens S, Lemmon C, Bauman M, Allison J, Kang H, Litaker M. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents Am J Clin Nutr 2002;75:818-26.
    
    Owens S, Gutin B, Allison J, Riggs S, Ferguson M, Litaker M, Thompson W. Effect of physical training on total and visceral fat in obese children. Medicine & Science in Sports & Exercise 1999;31:143-148
    
    Rocchini AP, Katch V, Anderson J, Hinderliter J, Becque D, Martin M, Marks C. Blood Pressure in Obese Adolescents: Effect of Weight Loss. Pediatrics 1988;82:16-23.
    
    Schwingshandl J, Sudi K, et al. Effect of an individualized training programme during weight reduction on body composition: a randomized trial. Arch Dis Child 1999; 81:426-8.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    None.