ReviewImprovement of the lipid profile with exercise in obese children: A systematic review
Highlights
► Aerobic exercise programs have a large effect on TG concentration. ► Combined exercise programs have a moderate effect on HDL-C concrentration. ► Few randomized clinical trials have been conducted.
Introduction
The lipid profile is defined as the relationship between the blood concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) (Grundy et al., 2005). Dyslipidemia is an alteration of the profile corresponding to abnormal blood levels of TG and/or cholesterol-carrying lipoproteins affecting one or all of the subfractions of blood lipids. Characteristically, these levels are abnormally high, although some forms of dyslipidemia may include low values (typically of HDL-C) (American College of Sport Medicine, 2010). Dyslipidemia is associated with cardiovascular disease (Rohatgi, 2010). Prospective studies show that the serum lipid and lipoprotein levels can track from childhood into young adulthood and are predictive of adult levels (Lobstein et al., 2004). Much of the information on atherosclerosis in children comes from studies on autopsies after accidents. The Bogalusa Heart Study concluded that 50% of children of 2–15 years had evidence of fatty streaks in the arterial intimae (Berenson et al., 1998). The American Heart Association therefore stresses the need to develop strategies for primary prevention of atherosclerotic cardiovascular disease in childhood (Kavey et al., 2003).
In this sense, obesity in childhood causes a wide range of co-morbidities including dyslipidemia among others (Burke, 2006). Worldwide, the prevalence of childhood obesity has increased greatly during the past three decades (Han et al., 2010). In the young, obesity accelerates the advance of atherosclerosis even before clinical symptoms appear (McGill et al., 2002). For instance, according to the latest report of the American Academy of Paediatrics, it increases the risk of future coronary artery disease, although the actual risk is unknown (Daniels and Greer, 2008). Children who are obese or overweight with co-morbidities (dyslipidemia, atheroma, or hypertension) should receive treatment (Han et al., 2010). Frequently, an exercise program is used to treat obese children because it improves aerobic fitness (Saavedra et al., 2011), although this improvement is less clear than for normal-weight children (Watts et al., 2005). It also has to be borne in mind that the maturing process in children causes their physiological response to exercise to be different from that of adults (American College of Sport Medicine, 2010). For children, the treatment of obesity and its associated pathologies ultimately involves the child eating less and being more physically active. Increased physical activity has been associated with increased life expectancy and decreased risk of cardiovascular disease (Williams et al., 2002). One study in normal-weight children have reported little or no alteration of the lipid profile following programs of physical exercise (Stoedefalke, 2007). The overall findings of a recent meta-analysis of aerobic exercise and lipid profiles in children and adolescents which considered only studies carried out in the United States suggest that short-term aerobic exercise does not improve HDL-C, LDL-C, or TC, but does reduce TG (Kelley and Kelley, 2007). It has to be noted, however, that this meta-analysis included only two studies which clearly reported that all the subjects studied were overweight or obese. There is little information available on how obese children who are prone to lipid profile alterations respond to exercise. One review on overweight and obese children suggests that diet is more relevant than exercise in improving the lipid profile, although more information is required since physical exercise does indeed lead to improvements in blood pressure and body composition (Watts et al., 2005). Given this context, the purpose of this systematic review was to examine the evidence for the effectiveness of diverse exercise interventions on the lipid profile (HDL-C, LDL-C, TC, and TG) of obese children.
Section snippets
Literature search
A computerized search was made in seven databases: CINAHL (1937 to 31th January 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (2002 to 31th January 2012), EMBASE (1980 to 15th December 2011), ERIC (1966 to 31th January 2012), MEDLINE (1965 to 31th January 2012), PsycINFO (1987 to 31th January 2012), and Science Citation Index (1900 to 31th January 2012). No manual searches were made. The search strategy included the topic's specialist journals. The search was conducted between
Study selection
Using the search protocol (Fig. 1), we identified 671 potentially relevant articles. Of these, 601 were discarded because it was clear from the abstracts that they did not meet the criteria. The full text of the remaining 70 candidates was then examined. This led to 63 being rejected—11 for failing the subjects' profile criterion (overweight children), 15 the study design criterion (no experimental studies), 33 the type of intervention criterion (interventions with diet, education, nutrition,
Discussion
To the best of our knowledge, the present paper is the first systematic review to study the evidence for the effectiveness of diverse exercise programs on the lipid profile in obese children. In the following, the discussion will be presented separately for the two types of intervention (aerobic and combined programs) and for the methodological aspects of the studies that were analyzed.
Conclusions
The conclusions that can be drawn from this review are valid and based on the evidence concerning the effects of physical exercise on the lipid profile of obese children. The severely restrictive nature of the inclusion criteria, however, led to only a small number (n = 7) of the studies being analyzed, so that prudence is called for in applying these conclusions. The analysis has shown that: (i) the programs based on aerobic exercise presented a moderate (ES = − 0.49, I² = 87) and a large (ES = − 0.55, I
Conflict of interest
The authors declare that there are no conflicts of interest.
Acknowledgments
This study was funded by European Regional Development Fund (Una manera de hacer Europa) and the Autonomous Government of Extremadura (Gobierno de Extremadura) (PRI07B092). During the finishing of this paper, YE and JMS were visiting researchers at the Cardiff Metropolitan University (UK), supported by a grant awarded by the European Regional Development Fund (Una manera de hacer Europa) and the Autonomous Government of Extremadura (Gobierno de Extremadura) (PO10012 and GR10171, respectively).
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