Effects of the ActiveBrains trial on cardiometabolic and mental health in children with overweight or obesity: A Randomized Clinical Trial

ImportanceChildhood obesity is a risk factor for type 2 diabetes (T2D), cardiovascular disease, and mental disorders later in life. To investigate the parallel effects on cardiometabolic and mental health in children with overweight or obesity will provide new insights on the benefits of exercise on overall health. ObjectiveThis study aimed to investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. DesignParallel-group randomized clinical trial (RCT) conducted in Granada (Spain) from November 2014 to June 2016. SettingClinical setting. ParticipantsEligibility criteria included children with overweight or obesity aged 8 to 11.9 years from Granada (Spain) and surrounding areas. InterventionThe exercise program included 3-5 sessions/week (90 min/session) of aerobic plus resistance training for 20-weeks. The wait-list control group continued with their usual routines. Main Outcomes and MeasuresCardiometabolic outcomes included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipids biomarkers, glucose, insulin, and blood pressure). Cardiometabolic risk score (z-score) was calculated based on age and sex reference values for triglycerides, inverted high-density lipoprotein cholesterol, glucose, the average of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. ResultsThe ActiveBrains exercise program reduced the cardiometabolic risk score by [~]0.4 (95% confidence interval [CI95%]: -0.75, -0.03) standard deviations (SD). The exercise program had a positive effect on low-density lipoprotein cholesterol (-7.40 [CI95%: -14.82, 0.016] mg/dL), body mass index (-0.60 [CI95%: -1.07, -0.13] kg/m2), fat mass index (-0.70 [CI95%: -1.03 to -0.36] kg/m2), visceral adipose tissue (-34.05 [CI95%: -61.38, -6.73] g), and cardiorespiratory fitness (+3.07 [CI95%: 0.68, 5.45] laps) in the exercise group compared to controls. No effects were observed on mental health outcomes. Conclusions and RelevanceThe ActiveBrains exercise program improved cardiometabolic health in children with overweight or obesity, yet it had no effect on mental health. These findings support public health initiatives promoting exercise programs in children with excess body weight to prevent future cardiovascular comorbidities. Trial RegistrationClinicalTrials.gov Identifier: NCT02295072. Key PointsO_ST_ABSQuestionC_ST_ABSWhat are the parallel effects of exercise on cardiometabolic and mental health in children with excess of adiposity? FindingsIn this parallel-group randomized clinical trial of 109 children with overweight or obesity, a 20-week exercise program including aerobic plus resistance training improved body composition, cardiorespiratory fitness, and cardiometabolic risk factors. No effects on mental health were observed. MeaningExercise programs should be promoted in children with excess adiposity to improve their cardiometabolic health.