Wirksamkeit von Trainingsinterventionen zur Reduktion kardiometabolischer Risikofaktoren bei Kindern und Jugendlichen mit Übergewicht und Adipositas

Zusammenfassung

Hintergrund und Fragestellung: Übergewicht und Adipositas gehen bereits bei Kindern und Jugendlichen mit kardiovaskulären Risikofaktoren wie Hypertonie, Fettstoffwechselstörungen und metabolischem Syndrom einher. Da die kardiometabolischen Risiken über die Adoleszenz hinaus fortbestehen, kommt ihnen eine tragende Rolle bei der Entstehung von kardiovaskulären Erkrankungen und Diabetes mellitus Typ 2 im Erwachsenenalter zu.

Methode: Es wurde eine systematische Literaturrecherche in 4 Onlinedatenbanken durchgeführt: Pubmed, PEDro, Cochrane Library und SPORTDiscus. Analysiert wurden Studien zur Wirksamkeit von Trainingsprogrammen im Hinblick auf die Verbesserung kardiometabolischer Parameter bei Kindern und Jugendlichen mit Übergewicht und Adipositas.

Ergebnisse: 12 randomisierte kontrollierte Studien erfüllten die Einschlusskriterien. In 9 Studien wurden Verbesserungen von mindestens einem klinischen und kardiometabolischen Parameter bei übergewichtigen und adipösen Kindern und Jugendlichen nach Beendigung der Trainingsintervention ermittelt.

Folgerung: Aerobe Trainingsprogramme haben das Potenzial, den verschiedenen kardiovaskulären Risikofaktoren bei übergewichtigen und adipösen Kindern und Jugendlichen wirksam zu begegnen. Die Evidenz bisheriger Studien ist als moderat zu betrachten. Zukünftig sind Studien von hoher methodischer Qualität notwendig.

Abstract

Background and objective: Excess weight in the younger population is associated with the various cardiovascular risk factors including hypertension, dyslipidemia and even metabolic syndrome early in life. Since these cardiometabolic profiles in children and adolescents track into adulthood they can give rise to the development of cardiovascular diseases and non-insulin-dependent diabetes.

Method: A systematic literature search was performed in 4 electronic databases, Pubmed, PEDro, Cochrane Library und SPORTDiscus, looking for data on the efficacy of training programmes to improve cardiometabolic outcome parameters in overweight and obese children and adolescents.

Results: 12 randomized controlled trials were assessed eligible for inclusion. 9 of 12 trials documented improvements of at least one clinical or cardiometabolic marker in overweight children or adolescents upon completion of the training programme.

Conclusion: Aerobic training programmes have the potential to effectively improve cardiovascular risk factors in overweight or obese children and juveniles. The evidence from previous studies is moderate. Further studies of high methodological quality are needed.

Schlüsselwörter

Kinder - Übergewicht - Training - kardiometabolische Risikofaktoren - systematische Literaturübersicht

Keywords

children - obesity - exercise - cardiometabolic risk factors - systematic review

• Literatur

• 1 Atlantis E, Barnes EH, Singh MA. Efficacy of exercise for treating overweight in children and adolescents. Int J Obes 2006; 7: 1027-1040
• 2 Camhi SM, Katzmarzyk PT. Tracking of cardiometabolic risk factor clustering from childhood to adulthood. Int J Pediatr Obes 2010; 2: 122-129
• 3 Daniels SR. Complications of obesity in children and adolescents. Int J Obes 2009; 1: 60-65
• 4 Farpour-Lambert NJ, Aggoun Y, Marchand LM et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009; 25: 2396-2406
• 5 Halpern A, Mancini MC, Magalhães ME et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Syndr 2010; 2: 55
• 6 Hansen D, Dendale P, van Loon LJC et al. The impact of training modalities on the clinical benefits of exercise intervention in patients with cardiovascular disease risk or type 2 diabetes mellitus. Sports Med 2010; 11: 921-940
• 7 Huang SH, Weng KP, Hsieh KS et al. Effects of a classroom-based weight-control intervention on cardiovascular disease in elementary-school obese children. Acta Paediatr Taiwan 2007; 4: 201-206
• 8 Johnston CA, Tyler C, Fullerton G et al. Results of an intensive school-based weight loss program with overweight Mexican American children. Int J Pediatr Obes 2007; 3: 144-52
• 9 Johnston CA, Tyler C, McFarlin BK et al. Weight loss in overweight Mexican American children. Pediatrics 2007; 6: 1450-1457
• 10 Kang HS, Gutin B, Barbeau P et al. Physical training improves insulin resistance syndrome markers in obese adolescents. Med Sci Sports Exerc 2002; 12: 1920-1927
• 11 Kelishadi R, Hashemipour M, Mohammadifard N et al. Short- and long-term relationships of serum ghrelin with changes in body composition and the metabolic syndrome in prepubescent obese children following two different weight loss programmes. Clin Endocrinol 2008; 5: 721-729
• 12 Kelly AS, Wetzsteon RJ, Kaiser DR et al. Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. J Pediatr 2004; 6: 731-736
• 13 Kleiser C, Schaffrath Rosario A, Mensink GB et al. Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS Study. BMC Public Health 2009; 9: 46
• 14 Kurth BM, Schaffrath Rosario A. Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland Ergebnisse des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS). Ernährung 2007; 5: 213-219
• 15 l’Allemand D, Wiegand S, Reinehr T et al. Cardiovascular risk in 26 008 European overweight children as established by a multicenter database. Obesity 2008; 16: 1672-1679
• 16 Lambert M, Delvin EE, Levy E et al. Prevalence of cardiometabolic risk factors by weight status in a population-based sample of Quebec children and adolescents. Can J Cardiol 2008; 7: 575-583
• 17 Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5: 4-85
• 18 Lobstein T, Jackson-Leach R. Burden of paediatric disease in Europe: 1. The increase in prevalence is itself increasing. Int J Pediatr Obes 2006; 1: 26-32
• 19 Maggio AB, Aggoun Y, Martin XE et al. Long-term follow-up of cardiovascular risk factors after exercise training in obese children. Int J Pediatr Obes 2011; 2: 603-610
• 20 Mahler D, Froelicher V, Miller N et al. Hrsg. ACSM’s Guideline for Exercise Testing and Prescription. Philadelpia: Lippincott Williams & Wilkins; 1995
• 21 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; 9: 1865-1870
• 22 Moran A, Jacobs Jr DR, Steinberger J et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes 1999; 10: 2039-2044
• 23 Moseley AM, Maher C, Herbert RD et al. Reliability of a scale for measuring the methodological quality of clinical trials. Rome: Proceedings of the VII th Cochrane Colloquium; 1999
• 24 Oude LuttikhuisH, Baur L, Jansen H et al. Interventions for treating obesity in children. . Cochrane Database Syst Rev 2009; 1 CD001872
• 25 Parsons TJ, Power C, Logan S et al. Childhood predictors of adult obesity. Int J Obes Relat Metab Disord 1999; 8: 1-107
• 26 Peters JC, Wyatt HR, Donahoo WT et al. From instinct to intellect: the challenge of maintaining healthy weight in the modern world. Obes Rev 2002; 2: 69-74
• 27 Savoye M, Shaw M, Dziura J et al. Effects of a weight management program on body composition and metabolic parameters in overweight children. JAMA 2007; 4: 2697-2704
• 28 Savoye M, Nowicka P, Shaw M et al. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics 2011; 3: 402-410
• 29 Singh GK, Kogan MD, Van Dyck PC et al. Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations. Ann Epidemiol 2008; 9: 682-695
• 30 Srinivasan SR, Bao W, Wattigney WA et al. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism 1996; 2: 235-2340
• 31 Summerbell CD, Waters E, Edmunds LD et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005; 3 CD00187159
• 32 Wabitsch M, Kunze D. Leitlinie zur Prävention und Therapie von Übergewicht und Adipositas im Kindes- und Jugendalter. www.a-g-a.de/Leitlinie.pdf (31.01.2011)
• 33 Watts K, Beye P, Siafarikas A et al. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. J Am Coll Cardiol 2004; 10: 1823-1827
• 34 Watts K, Beye P, Siafarikas A et al. Effects of exercise training on vascular function in obese children. J Pediatr 2004; 5: 620-62
• 35 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 Singapore 2008; 4: 286-293
• 36 Zimmet P, Alberti K, George MM et al. The metabolic syndrome in children and adolescents. Pediatric Diabetes 2007; 8: 299-306