Background
Methods
Study eligibility criteria
Data sources
Study selection
Data abstraction
Risk of bias
Statistical analysis
Calculation of effect sizes for primary and secondary outcomes from each study
Pooled estimates for primary and secondary outcomes
Stability and validity of changes in primary and secondary outcomes
Moderator analysis for BMI z-score
Meta-regression for changes in BMI z-score and potential covariates
Results
Study characteristics
Study | Country | Participants | Exercise intervention |
---|---|---|---|
Daley et al., 2006 [67] | United Kingdom | 47 Asian, Black and White male and female adolescents 11 to 16 yrs of age assigned to an exercise therapy group (n = 28) or an exercise placebo group (n = 23) | 3 days/wk of aerobic exercise, 40-49% HRR, 30 min/session for 8 wks (24 sessions) followed by an at home program for 6 wks |
Davis et al., 2012 [68] | United States | 222 overweight Black, White and Hispanic male and female children ages 7–11 yrs assigned to a low dose , or high dose aerobic or control group | 5 days/wk, running games, jump rope, modified basketball and soccer, average HR >150 bpm, 2–20 min sessions/day (high dose) or 1 – 20 min session/day (low dose) for 10–15 wks (school semester) |
Farpour-Lambert et al., 2009 [62] | Switzerland | 44 pre-pubertal obese male and female children assigned to an exercise or control group | 3 days/wk, 30 min of aerobic exercise at 55-65% VO2max, 20 min strength training, 10 min stretching/cool down in addition to physical education for 3 months |
Hagstromer et al., 2009 [69] | Sweden | 31 obese male and female adolescents assigned to an exercise or control group | 1 hr/wk of group activities (brisk walking, spinning, strength training (50-70% 1RM), swimming) for 13 wks |
Kelly et al., 2004 [63] | United States | 20 overweight male and female children and adolescents assigned to an exercise or control group | 4 days/wk, stationary cycling, 30–50 min/session, 50-80% VO2max, for 8 wks |
Maddison et al., 2011 [70] | New Zealand | 322 Maori, Pacific, ZN Euro/other overweight and obese male and female children assigned to an active video game intervention or to a sedentary video game control group | 60 min moderate to vigorous PA on most days of the wk by 1) supplementing periods of inactivity w/active video game play and 2) substituting periods of nonactive video games with active ones, for 12 wks |
Meyer et al., 2006 [71] | Germany | 67 obese male and female children assigned to an exercise or control group | 3 days/wk, 60–90 min/session, supervised swimming, aerobic training, sports games, and walking, for 6 months |
Murphy et al., 2009 [72] | United States | 35 overweight male and female children 7 to 12 yrs of age assigned to either an exercise (n = 23) or delayed treatment control (n = 12) group | 5 days/wk of home-based Dance, Dance Revolution (DDR),10-30 min/session while wearing a pedometer to count steps for 12 wks |
Shaibi et al., 2006 [73] | United States | 22 overweight, adolescent Latino males assigned to either a resistance training or control group | 2 days/wk, resistance training,10 exercises, 1–3 sets, 8–15 reps, 62-97% 1RM, 1–2 min rest between sets, for 16 wks |
Weintraub et al., 2008 [74] | United States | 21 overweight Hispanic/Latino, Black or African American, Native Hawaiian or Pacific Islander male and female children, assigned to either a coed soccer or active placebo nutrition and health education group | 3-4 days/wk, 75 min activity/session for soccer group; 25-session, weekly state-of-the-art information-based nutrition and health education intervention for active placebo group, for 6 months |
Exercise | Control | |||||||
---|---|---|---|---|---|---|---|---|
Variable | Groups/Participants(#) | Mdn | Range | Groups/Participants(#) | Mdn | Range | ||
Age (years) | 11/456 | 11.4 ± 2.1 | 11 | 9 - 15 | 10/379 | 11.8 ± 2.2 | 11 | 9 – 16 |
Height (cm) | 6/242 | 155.2 ± 9.7 | 156 | 140 - 166 | 6/232 | 154.6 ± 12.0 | 156 | 136 – 168 |
Body weight (kg) | 6/242 | 71.3 ± 15.2 | 69 | 51 - 90 | 6/232 | 73.8 ± 18.7 | 72 | 47 – 98 |
BMI (z-score) | 11/456 | 2.3 ± 0.5 | 2 | 1 – 3 | 10/379 | 2.4 ± 0.6 | 2 | 1 – 3 |
BMI (kg/m2) | 10/428 | 28.4 ± 2.9 | 27 | 25 - 33 | 9/356 | 29.7 ± 3.4 | 31 | 25 – 35 |
BMI (percentile) | 6/201 | 97.8 ± 1.0 | 97 | 97 - 100 | 5/125 | 98.4 ± 1.1 | 98 | 98 – 100 |
Fat mass (kg) | 5/217 | 28.4 ± 6.2 | 31 | 21 - 34 | 5/209 | 29.5 ± 6.0 | 30 | 21 – 37 |
Body fat (%) | 9/416 | 38.2 ± 4.2 | 38 | 32 – 45 | 8/343 | 38.7 ± 4.7 | 40 | 31 – 45 |
Fat-free mass (kg) | 5/79 | 43.5 ± 10.7 | 43 | 28 – 54 | 5/69 | 45.0 ± 13.7 | 43 | 26 - 62 |
Waist circumference (cm) | 3/193 | 91.3 ± 6.0 | 88 | 87 - 98 | 3/184 | 95.5 ± 7.8 | 95 | 88 – 104 |
Waist-to-hip ratio | 2/54 | 0.94 ± 0.01 | 0.94 | 0.93 – 0.94 | 2/46 | 0.95 ± 0.01 | 0.95 | 0.94 – 0.95 |
Systolic BP (mmHg) | 6/112 | 117.6 ± 8.6 | 119 | 107 – 128 | 6/103 | 120.8 ± 10.7 | 123 | 101 – 133 |
Diastolic BP (mmHg) | 5/79 | 65.8 ± 6.5 | 67 | 56 – 74 | 5/69 | 66.2 ± 9.0 | 68 | 52 - 77 |
TC (mg/dl) | 4/65 | 156.6 ± 13.3 | 157 | 143 – 170 | 4/55 | 158.0 ± 3.9 | 157 | 143 – 170 |
HDL-C (mg/dl) | 5/98 | 39.8 ± 4.8 | 39 | 34 – 46 | 5/89 | 39.1 ± 5.2 | 39 | 33 – 46 |
TC:HDL-C | 3/43 | 4.2 ± 0.6 | 4 | 4 – 5 | 3/33 | 4.3 ± 0.5 | 4 | 4 – 5 |
LDL-C (mg/dl) | 5/98 | 100.8 ± 12.1 | 105 | 86 – 112 | 5/89 | 104.5 ± 9.0 | 109 | 94 – 112 |
TG (mg/dl) | 5/96 | 96.5 ± 27.5 | 98 | 53 – 125 | 5/89 | 97.3 ± 28.4 | 95 | 62 – 141 |
Non-HDL-C (mg/dl) | 3/43 | 116.7 ± 14.0 | 109 | 108 – 133 | 3/33 | 121.0 ± 7.3 | 122 | 113 – 128 |
Fasting glucose (mg/dl) | 6/207 | 89.6 ± 3.8 | 91 | 84 – 91 | 6/211 | 89.8 ± 3.5 | 90 | 85 – 93 |
VO2max (ml.kg-1.min-1) | 8/385 | 28.5 ± 4.3 | 26 | 23 – 37 | 7/310 | 28.1 ± 4.8 | 27 | 23 – 37 |
Energy intake (kcals) | 2/18 | 2407 ± 840 | 2407 | 1813 - 3001 | 2/19 | 2326 ± 1007 | 2326 | 1614 – 3038 |
Risk of bias assessment
Primary outcome
BMI Z-score
Variable | Studies (#) | ES (#) | Participants (#) |
Z( p) | Q( p) |
I
2
(%)
| 95% PI | |
---|---|---|---|---|---|---|---|---|
Primary | ||||||||
- BMI (z-score) | 10 | 11 | 835 |
-0.06 (-0.09, -0.03)*
| -4.32(<0.001) |
24.9(0.01)*
| 59.8 | -0.15, 0.02 |
Secondary | ||||||||
- Body weight (kg) | 6 | 6 | 474 |
-0.74 (-1.18, -0.30)*
| -3.29(<0.001) | 4.8(0.44) | 0 |
-1.36, -0.12*
|
- BMI (kg.m2) | 8 | 8 | 562 |
-0.47 (-0.86, -0.08)*
| -2.38(0.02) |
24.5(<0.001)*
| 71.4 | -1.67, 0.73 |
- BMI (percentile) | 4 | 4 | 104 |
-0.10 (-0.18, -0.02)*
| -2.53(0.01) | 1.1(0.78) | 0 | -0.27, 0.07 |
- Fat mass (kg) | 5 | 5 | 426 |
-0.65 (-1.15, -0.16)*
| -2.58(<0.01) | 4.7(0.32) | 14.9 | -1.72, 0.42 |
- Body Fat (%) | 9 | 9 | 759 |
-0.96 (-1.43, -0.50)*
| -4.04(<0.001) |
16.6(0.03)*
| 51.8 | -2.27, 0.35 |
- Fat-free mass (kg) | 5 | 5 | 148 | -0.07 (-0.62, 0.48) | -0.26(0.79) |
10.6(
0.03)*
| 62.3 | -- |
- Waist circumference (cm) | 3 | 3 | 377 | 0.27 (-2.08, 2.62) | 0.23(0.82) |
4.7(
0.09)*
| 57.5 | -- |
- Waist-to-hip ratio | 2 | 2 | 100 | -0.03 (-0.09, 0.04) | -0.71(0.48) |
24.5
(<0.001)*
| 95.9 | -- |
- Systolic BP (mmHg) | 6 | 6 | 215 | -2.66 (-7.73, 2.41) | -1.03(0.30) |
16.7(
0.01)*
| 70.0 | -- |
- Diastolic BP (mmHg) | 5 | 5 | 148 | -1.46 (-4.73, 1.80) | -0.88(0.38) | 6.2(0.19) | 35.0 | -- |
- TC (mg/dl) | 4 | 4 | 120 | 0.06 (-7.00, 7.12) | 0.02(0.99) | 2.4(0.50) | 0 | -- |
- HDL-C (mg/dl) | 5 | 5 | 187 | 1.70 (-1.08, 4.49) | 1.20(0.23) |
10.5(
0.03)*
| 61.8 | -- |
- TC:HDL-C | 3 | 3 | 76 | -0.22 (-0.47, 0.02) | -1.78(0.07) | 0.5(0.79) | 0 | -- |
- LDL-C (mg/dl) | 5 | 5 | 187 | -1.53 (-8.78, 5.71) | -0.42(0.68) |
7.9(
0.09)*
| 49.6 | -- |
- TG (mg/dl) | 5 | 5 | 185 |
-12.46
(-24.7, -
0.22)*
| -1.99(0.05) | 1.7(0.78) | 0 | -32.3, 7.4 |
- Non-HDL-C (mg/dl) | 3 | 3 | 76 | 0.40 (-7.67, 8.46) | 0.10(0.92) | 0.83(0.66) | 0 | -- |
- Fasting glucose (mg/dl) | 6 | 6 | 418 | -0.60 (-2.13, 0.93) | -0.77(0.44) | 7.23(0.20) | 30.8 | -- |
- Fasting insulin (smd) | 6 | 7 | 405 |
-0.39
(-0.57, -
0.21)*
| -4.25(<0.001) | 5.93(0.43) | 0 |
-0.6, -
0.15*
|
- VO2max (ml.kg-1.min-1) | 7 | 8 | 695 |
1.92
(0.67,
3.17)*
| 3.02(<0.001) |
16.9(
0.02)*
| 58.6 | -1.60, 5.45 |
- Energy intake (kcals) | 2 | 2 | 37 |
-346 (-
506, -
188)*
| -4.24(<0.001) | 0.02(0.88) | 0 | -- |