studies on the efficacy and/or influence of exercise in the treatment and/or prevention
of childhood obesity. Physical activity, obesity and cardiovascular risk
factors in children were studied in the Belgian Luxembourg Child Study II [46].
A randomly selected population of 1,028 children was studied from a rural
area with a high prevalence of obesity and cardiovascular risk factors, demonstrating
that physical activity, mainly in boys, contributes significantly to reduction
of body fat mass. In another study [47] sports activity (three times per week),
nutritional changes and behavior changes was the basis of an outpatient program
run for 9- to 12-years-old adipose children since 1987. The control examinations
show weight loss and improvement in blood lipid parameters. Children who
maintain the correct nutritional habits and remain active in sports, show longlasting
constant weight. This study show the importance of modifying behavior
in physical activity and eating habits: it can be very important, probably more
important that a transient caloric restriction. These considerations are also supported
by other studies on the effects of decreasing sedentary behavior and
increasing activity, also by promoting family-based interventions [48–50]. A two
years study on Japanese children reported reduced body weight and body fat after
daily, structured aerobic exercise [51]. A 15-week combined aerobic and strength
training program resulted in a 3.7% decrease in body fat [52]. A 5–20% decrease
in body weight and body fat has been demonstrated, respectively, after combined
caloric restriction and physical activity [53].
There is a lot of experimental evidence that physical activity could have
positive effects on children obesity by enhancing aerobic capacity, reducing
percent of body fat, improving body composition, reducing risk factors associated
with obesity and insulin resistance.
Thus, there is evidence to consider physical activity as one of the most
important factors for therapy and prevention of obesity in children; to achieve
this objective is very important to promote physical activity through behavioral
change. To achieve this result, the public/health intervention seems to be most
useful and cost-effective for obesity, because the high prevalence of obesity and
the school-based interventions seems to be the more appropriate approach.
Vandongen et al. [54] enrolled 30 schools randomly assigned to intervention or
control condition. Exercise activities were structured and teachers were offered
resource package to help with fitness instruction. Increases in endurance fitness
were observed in the fitness condition in boys and girls: both exhibited greater
reductions in triceps skinfold measures compared to controls. No effects were
observed for BMI. In another study concerning a multi-risk factor intervention
for cardiovascular risk factor among high school students, physical activity
knowledge gains were greater for children in the intervention condition, and
differences were also found in resting heart rate, BMI, triceps skinfold thickness
and subscapular skinfold thickness [55].
The primary school physical education seems to be important also for the
effects on physical activity and obesity prevention during adult life: it has been
demonstrated [56] that daily physical education at the primary school level had
a significant long-term positive effect on the exercise habits and prevention of
obesity during adult life.
Type of Exercise in Obese Children
In children, exercise (defined as behavior that is planned and undertaken
with the purpose of improving or maintaining physical fitness) is only a part of
daily physical activity.
A 1996 report from the Surgeon General on ‘Physical Activity and Health’
recommends that ‘All people over the age of 2 years should accumulate at least
30min of endurance-type physical activity of a least moderate intensity, on
most preferably all days of the week’ [57].
The choice of the type of exercise must be done carefully because it is crucial
for the real resolution of the obesity. Of course the different age, sex, gender
and degree and duration of obesity explain why it is impossible to suggest
a precise type of exercise: it is essential that the type of exercise is chosen for
the peculiar situation of that obese child and that it is slowly progressive.
However, it is well demonstrated by many authors [58, 59] that the
decrease of obesity is best obtained by a dynamic, aerobic exercise with the use
of different muscle groups in different parts of the body.
It is important to begin with exercises in the standing position, followed
by cycle ergometer for 10–15 min at a time, dancing and stretching; moreover,
walking is another very useful type of physical activity.
Another relevant aspect to remember is that physical activity must include
not only morning but also afternoon and (if possible) evening exercises. It is
also important that the obese child participates in team games, gymnastics and
sports in order to find amusement in his activity; for this purpose, dancing is
another good motivator of physical activity especially in adolescents with a
consequent improvement of compliance. The exercises should develop the skill,
speed, endurance and strength; therefore, if the child improves his general physical
fitness, he will enhance his mood and he can become happy to do exercise.
Among the different types of exercises, swimming is the most recommended
because this sport involves almost all muscle groups of the human body
and gives a significant improve to the physiological body growth. On the contrary,
other sports like cycling can be useful but is clearly not complete as swimming
for the development of chest muscles and other sports like skating can
cause harm to the obese child because genu valgu, which is a common problem
for these children, may worsen by skating.
Of course, special exercises for the corrections of orthopedic complications
of obesity (e.g. scoliosis) must be suggested.
As a general rule, it is important to underline that all exercise must be performed
correctly because incorrect techniques not only reduce their beneficial
effects but can also cause serious healthy problems.
Finally, obese children must be encouraged to recognize that there are positive
results from their efforts even if not demonstrated in loss of weight; in fact,
good results will encourage spontaneous physical activity also during leisure
time; in this respect the role of the family and of the friends is essential because
they can give obese children their emotional and psychological support that it
is essential to increase the possibility of success of exercise training. It has been
demonstrated that the parent activity level is a strong predictor of child activity
[60, 61]. In conclusion, exercise and physical activity are important means for
prevention and treatment of childhood obesity. The final goal of the exercise for
the obese child is the development of a real, continuous, active lifestyle which
can assure lifelong health benefits.
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