The effectiveness of exercise as an intervention in the treatment of childhood obesity

We appraised eight articles examining the effect of exercise as an intervention for pediatric obesity. We evaluated significant changes in adiposity and fitness, benefits versus costs of the interventions, and feasibility of the interventions in seven articles that had good methodology. Six articles used lifestyle exercise - everyday activities usually already part of a child‘s life - as an intervention. Lifestyle exercise with more formalized programmed aerobic exercise was used in four studies. Either alone or in combination with programmed aerobic exercise, lifestyle exercise significantly decreased BMI in five studies. Four articles used between group comparisons: two studies showed significant decreases in adiposity measures (BMI and body fat percentage) and two studies showed significant increases in fitness. Of the five articles that used within-group comparisons, all showed significant decreases in adiposity measures and four showed significant increases in fitness. Based on the evidence, we cannot determine which intervention produced the largest fitness gains because they all used different outcome measures to determine fitness level. The largest mean BMI decrease was achieved immediately after an eight-week camp-based intervention in which subjects exercised an average of 7.5 hours per day (total of 420 hours). However, no follow-up data were reported. Thus, we cannot make a judgment about the effectiveness of long-term maintenance of these improvements. This study would not be feasible in the clinical setting due to the time-consuming nature of the intervention. The two studies that reported long-term follow-ups (12-17 months after intervention) reported either maintenance of improved BMI and fitness levels or the subjects did not fall back as far as the comparison group. This evidence demonstrates successful long-term integration of a more active lifestyle. In studies that had control groups (no exercise intervention), BMI increased in the pediatric population over time. For overweight or obese children, we would recommend lifestyle exercise either alone or in combination with programmed aerobic exercise for long-term improvements in BMI and fitness. Future studies should include BMI-for-age percentile (the gold standard for assessment of body weight) and waist circumference (correlated with disease risk and mortality) as outcome measures of adiposity in the pediatric population as well as valid and feasible fitness tests such as the step test to allow comparisons between studies