This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI z-score of the overall completers decreased by about 0.05 after the 16-week intervention (p = 0.02). After the intervention, only the exercise group had a significantly lower BMI z-score than the baseline score by about 0.1 (p = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = −1.52, 95%CI = −2.58–−0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12–2.29), diastolic blood pressure (β = −5.24, 95%CI = −9.66–−0.83), high-sensitivity C-reactive protein (β = −1.67, 95%CI = −2.77–−1.01), and wall sit test score (β = 50.74, 95%CI = 32.30–69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.

The purpose of this study was to determine favorable physical activities, by intensity, type, and frequency that would serve to minimize the prevalence of metabolic syndrome. A total of 24,178 individuals participated in the Korean National Health and Nutrition Examination Survey that investigated the risk factors for metabolic syndrome and physical activity including the physical activity type (vigorous and moderate activity, walking, strength, and flexibility) and the frequency (numbers of days per weeks where physical activity lasted at least 10 min per session). Complex-samples analysis, descriptive statistics, Pearson’s Chi-square test, and multivariate logistic regression analyses were conducted to analyze the data. The results confirmed that physical activity had a favorable effect on reducing the occurrence of metabolic syndrome. The lowest prevalence of metabolic syndrome was observed when vigorous physical activity was conducted six times per week (OR 0.65, 95% CI 0.45–0.94). The associated beneficial effects included improvements in the risk factors of metabolic syndrome, depending on the specific physical activity type and frequency. Patients diagnosed, as having metabolic syndrome should be aware of the associated underling risk factors in order to determine a targeted physical activity intervention.

Despite considerable efforts to tackle childhood obesity, it is recognized as one of the biggest health problems globally. Childhood obesity is a leading cause of many comorbid conditions such as metabolic syndrome and insulin resistance as well as type 2 diabetes. A strong body of evidence suggests that regular exercise without calorie restriction or weight loss is associated with reduced insulin resistance as well as improved insulin sensitivity in overweight and obese adults. However, despite the well-known benefits associated with regular exercise alone, the independent role of exercise training without calorie restriction on insulin resistance is still uncertain in youth. Some studies observed that both the aerobic and resistance type of exercise training without calorie restriction resulted in meaningful changes in insulin sensitivity, suggesting that exercise alone is an effective therapeutic strategy for reducing insulin resistance in overweight and obese youth. However, only few studies are available on the optimal dose of exercise training without calorie restriction or preferred exercise modality for reducing insulin resistance, which warrants further investigations in the pediatric population.

Background: Childhood obesity is linked to adverse cardiovascular outcomes in adulthood. This study aimed to assess the impact of childhood obesity on the vasculature and to investigate whether vascular alteration precedes arterial wall thickening in childhood. Methods: A total of 295 overweight (body mass index [BMI] 85th to 95th percentile, n = 30) and obese (BMI ≥ 95th percentile, n = 234) children aged 7–17 years and 31 normal-weight controls with similar age and gender were prospectively recruited. We assessed anthropometric data and laboratory findings, and measured the carotid intima–media thickness (IMT), carotid artery (CA) diameter, M-mode-derived arterial stiffness indices, and velocity vector imaging parameters, including the CA area, fractional area change, circumferential strain, and circumferential strain rate (SR). Results: The mean ± standard deviation age of the participants was 10.8 ± 2.1 years; 172 (58%) children were male. Regarding structural properties, there was no difference in the IMT between the three groups. The CA diameter was significantly increased in obese children, whereas the CA area showed a significant increase beginning in the overweight stage. Regarding functional properties, contrary to β stiffness and Young’s elastic modulus, which were not different between the three groups, the circumferential SR showed a significant decrease beginning in the overweight stage and was independently associated with BMI z-scores after adjusting for covariates. Conclusion: We have demonstrated that arterial stiffening and arterial enlargement precede arterial wall thickening, and that these vascular alterations begin at the overweight stage in middle childhood or early adolescence.