Advertisement

Sports Medicine

, Volume 49, Issue 1, pp 83–94 | Cite as

Exercise Dose and Weight Loss in Adolescents with Overweight–Obesity: A Meta-Regression

  • Lee StonerEmail author
  • Michael W. Beets
  • Keith Brazendale
  • Justin B. Moore
  • R. Glenn Weaver
Systematic Review

Abstract

Background

A recent meta-analysis reported that exercise interventions are effective for promoting weight loss in adolescents with overweight–obesity. However, the meta-analysis did not investigate whether there is an optimal exercise dose for promoting weight loss in overweight and obese adolescents. A common method of expressing exercise dose is the calculation of metabolic equivalents (METs), expressed as MET-h/week.

Objectives

The objective of this study was to determine the association between exercise dose (MET-h/week) and weight loss [body weight, body mass index (BMI)] in adolescents with overweight–obesity.

Data Sources

Trials included in the original meta-analysis were extracted, and a subsequent search to identify studies published between May 2015 and May 2018 was conducted. The search included electronic databases (PubMed, Web of Science SPORTDiscus, Google Scholar) and the reference lists of eligible articles and relevant reviews.

Study Selection

The inclusion criteria were as follows: (i) randomized controlled trial; (ii) structured exercise intervention, alone or combined with other intervention components; (iii) control group received no structured exercise or behavioral modification designed to increase physical activity; (iv) participants overweight or obese (BMI ≥ 85th percentile); and (v) participants aged between 10 and 19 years.

Appraisal and Synthesis Methods

Fifteen trials were extracted from the original meta-analysis. The current search identified an additional five trials (three articles). Data from 20 trials (16 articles) involving 1091 participants (54% female, 17% not reported) were included in the analysis. Effect sizes were reported as mean difference, and random effects meta-regression quantified the association between exercise dose and weight loss. Study quality was assessed using a modified Jadad’s scale.

Results

Total body weight change (decrease) ranged from − 2.7 to 19.3 (median 2.5) kg, and BMI change (decrease) ranged from − 1.6 to 6.3 (median 0.9) kg/m2. MET-h/week ranged from 5.4 to 36.0 (median 6.0). Each MET-h/week was associated with a 0.13 kg/m2 (95% confidence interval [CI] 0.08–0.19) and 0.33 kg (95% CI 0.08–0.59) decrease in BMI and body weight, respectively.

Limitations

The prescribed exercise dose for the majority of trials was low. As such, we were unable to discern whether there was an optimal exercise dose for weight loss (i.e., if the association between dose and weight loss was non-linear). Additionally, most trials had small sample sizes (median n = 34) and 17 trials had methodological limitations.

Conclusions

Each MET-h/week was associated with a 0.13 kg/m2 and 0.33 kg decrease in BMI and body weight, respectively. While this relationship appears to be linear, i.e., no optimal exercise dose, it should be emphasized that the exercise prescription dose for the majority of trials was low. Subsequent trials, with greater exercise dosage, are required to determine whether there is an ‘optimal’ dose for promoting weight loss in adolescents with overweight–obesity. However, the current findings lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in this population.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Lee Stoner, Michael Beets, Keith Brazendale, Justin Moore, and R. Glenn Weaver declare that they have no conflicts of interest relevant to the content of this review.

References

  1. 1.
    Stoner L, Rowlands D, Morrison A, et al. Efficacy of exercise intervention for weight loss in overweight and obese adolescents: meta-analysis and implications. Sports Med. 2016;46(11):1737–51.CrossRefGoogle Scholar
  2. 2.
    Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56(4):441–7.CrossRefGoogle Scholar
  3. 3.
    Swift DL, McGee JE, Earnest CP, et al. The effects of exercise and physical activity on weight loss and maintenance. Prog Cardiovasc Dis. 2018;61(2):206–13.CrossRefGoogle Scholar
  4. 4.
    Wasfy MM, Baggish AL. Exercise dose in clinical practice. Circulation. 2016;133(23):2297–313.CrossRefGoogle Scholar
  5. 5.
    American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  6. 6.
    NCCOR. Youth compendium of physical activities. 2018. https://www.nccor.org/tools-youthcompendium/. Accessed 20 May 2018.
  7. 7.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3(3):e123–30.Google Scholar
  8. 8.
    Stovold E, Beecher D, Foxlee R, et al. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Syst Rev. 2014;29(3):54.CrossRefGoogle Scholar
  9. 9.
    CDC. Basics about childhood obesity. 2015. http://www.cdc.gov/obesity/childhood/basics.html. Accessed 12 May 2015.
  10. 10.
    Higgins J, Green S, Cochrane Collaboration, editors. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley; 2008.Google Scholar
  11. 11.
    Crowther M, Lim W, Crowther MA. Systematic review and meta-analysis methodology. Blood. 2010;116(17):3140–6.CrossRefGoogle Scholar
  12. 12.
    Butte NF, Watson KB, Ridley K, et al. A youth compendium of physical activities: activity codes and metabolic intensities. Med Sci Sports Exerc. 2018;50(2):246–56.CrossRefGoogle Scholar
  13. 13.
    Borenstein M, Hedges LV, Higgins JP, et al. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.CrossRefGoogle Scholar
  14. 14.
    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefGoogle Scholar
  15. 15.
    Ryan R. Cochrane Consumers and Communication Review Group: meta-analysis. http://cccrg.cochrane.org. Accessed 17 May 2015.
  16. 16.
    Balagopal P, George D, Patton N, et al. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr. 2005;146(3):342–8.CrossRefGoogle Scholar
  17. 17.
    Ben Ounis O, Elloumi M, Zouhal H, et al. Effect of individualized exercise training combined with diet restriction on inflammatory markers and IGF-1/IGFBP-3 in obese children. Ann Nutr Metab. 2010;56(4):260–6.CrossRefGoogle Scholar
  18. 18.
    Davis JN, Kelly LA, Lane CJ, et al. Randomized control trial to improve adiposity and insulin resistance in overweight Latino adolescents. Obesity (Silver Spring). 2009;17(8):1542–8.CrossRefGoogle Scholar
  19. 19.
    Davis JN, Tung A, Chak SS, et al. Aerobic and strength training reduces adiposity in overweight Latina adolescents. Med Sci Sports Exerc. 2009;41(7):1494–503.CrossRefGoogle Scholar
  20. 20.
    Kim ES, Im JA, Kim KC, et al. Improved insulin sensitivity and adiponectin level after exercise training in obese Korean youth. Obesity (Silver Spring). 2007;15(12):3023–30.CrossRefGoogle Scholar
  21. 21.
    Lee KJ, Shin YA, Lee KY, et al. Aerobic exercise training-induced decrease in plasma visfatin and insulin resistance in obese female adolescents. Int J Sport Nutr Exerc Metab. 2010;20(4):275–81.CrossRefGoogle Scholar
  22. 22.
    Melnyk BM, Small L, Morrison-Beedy D, et al. The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents. J Pediatr Health Care. 2007;21(5):315–22.CrossRefGoogle Scholar
  23. 23.
    Meyer AA, Kundt G, Lenschow U, et al. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48(9):1865–70.CrossRefGoogle Scholar
  24. 24.
    Rocchini AP, Katch V, Schork A, et al. Insulin and blood pressure during weight loss in obese adolescents. Hypertension. 1987;10(3):267–73.CrossRefGoogle Scholar
  25. 25.
    Sun MX, Huang XQ, Yan Y, et al. One-hour after-school exercise ameliorates central adiposity and lipids in overweight Chinese adolescents: a randomized controlled trial. Chin Med J (Engl). 2011;124(3):323–9.Google Scholar
  26. 26.
    Toulabi T, Khosh Niyat Nikoo M, Amini F, et al. The influence of a behavior modification interventional program on body mass index in obese adolescents. J Formos Med Assoc. 2012;111(3):153–9.CrossRefGoogle Scholar
  27. 27.
    Tsang TW, Kohn M, Chow CM, et al. A randomised placebo-exercise controlled trial of Kung Fu training for improvements in body composition in overweight/obese adolescents: the “Martial Fitness” study. J Sports Sci Med. 2009;8(1):97–106.Google Scholar
  28. 28.
    Wong PC, Chia MY, Tsou IY, et al. Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Ann Acad Med Singap. 2008;37(4):286–93.Google Scholar
  29. 29.
    Son WM, Sung KD, Bharath LP, et al. Combined exercise training reduces blood pressure, arterial stiffness, and insulin resistance in obese prehypertensive adolescent girls. Clin Exp Hypertens. 2017;39(6):546–52.CrossRefGoogle Scholar
  30. 30.
    Alberga AS, Prud’homme D, Sigal RJ, et al. Effects of aerobic training, resistance training, or both on cardiorespiratory and musculoskeletal fitness in adolescents with obesity: the HEARTY trial. Appl Physiol Nutr Metab. 2016;41(3):255–65.CrossRefGoogle Scholar
  31. 31.
    Staiano AE, Marker AM, Beyl RA, et al. A randomized controlled trial of dance exergaming for exercise training in overweight and obese adolescent girls. Pediatr Obes. 2017;12(2):120–8.CrossRefGoogle Scholar
  32. 32.
    Pbert L, Druker S, Barton B, et al. A school-based program for overweight and obese adolescents: a randomized controlled trial. J Sch Health. 2016;86(10):699–708.CrossRefGoogle Scholar
  33. 33.
    Sutherland R, Reeves P, Campbell E, et al. Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the ‘Physical Activity 4 Everyone’ cluster randomized trial. Int J Behav Nutr Phys Act. 2016;22(13):94.CrossRefGoogle Scholar
  34. 34.
    Lubans DR, Smith JJ, Plotnikoff RC, et al. Assessing the sustained impact of a school-based obesity prevention program for adolescent boys: the ATLAS cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2016;20(13):92.CrossRefGoogle Scholar
  35. 35.
    Bland JM, Altman DG. Correlation in restricted ranges of data. BMJ. 2011;11(342):d556.CrossRefGoogle Scholar
  36. 36.
    Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 2009;28(5):w822–31.CrossRefGoogle Scholar
  37. 37.
    Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.CrossRefGoogle Scholar
  38. 38.
    Rhodes RE, Warburton DE, Murray H. Characteristics of physical activity guidelines and their effect on adherence: a review of randomized trials. Sports Med. 2009;39(5):355–75.CrossRefGoogle Scholar
  39. 39.
    Blair SN, Kohl HW 3rd, Barlow CE, et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273(14):1093–8.CrossRefGoogle Scholar
  40. 40.
    Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, et al. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262(17):2395–401.CrossRefGoogle Scholar
  41. 41.
    Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.CrossRefGoogle Scholar
  42. 42.
    Lavie CJ, Arena R, Swift DL, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015;117(2):207–19.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Exercise ScienceUniversity of South CarolinaColumbiaUSA
  3. 3.Department of Family and Community MedicineWake Forest School of MedicineWinston-SalemUSA

Personalised recommendations