PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
JAMA Netw Open. 2022 Aug 1;5(8):e2227893. doi: 10.1001/jamanetworkopen.2022.27893.
Pediatric overweight and obesity are highly prevalent across the world, with implications for poorer cognitive and brain health. Exercise might potentially attenuate these adverse consequences.
To investigate the effects of an exercise program on brain health indicators, including intelligence, executive function, academic performance, and brain outcomes, among children with overweight or obesity and to explore potential mediators and moderators of the main effects of exercise.
DESIGN, SETTING, AND PARTICIPANTS: All preexercise and postexercise data for this 20-week randomized clinical trial of 109 children aged 8 to 11 years with overweight or obesity were collected from November 21, 2014, to June 30, 2016, with neuroimaging data processing and analyses conducted between June 1, 2017, and December 20, 2021. All 109 children were included in the intention-to-treat analyses; 90 children (82.6%) completed the postexercise evaluation and attended 70% or more of the recommended exercise sessions and were included in per-protocol analyses.
All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions per week in an out-of-school setting.
Intelligence, executive function (cognitive flexibility, inhibition, and working memory), and academic performance were assessed with standardized tests, and hippocampal volume was measured with magnetic resonance imaging.
The 109 participants included 45 girls (41.3%); participants had a mean (SD) body mass index of 26.8 (3.6) and a mean (SD) age of 10.0 (1.1) years at baseline. In per-protocol analyses, the exercise intervention improved crystallized intelligence, with the exercise group improving from before exercise to after exercise (mean z score, 0.62 [95% CI, 0.44-0.80]) compared with the control group (mean z score, -0.10 [95% CI, -0.28 to 0.09]; difference between groups, 0.72 SDs [95% CI, 0.46-0.97]; P < .001). Total intelligence also improved significantly more in the exercise group (mean z score, 0.69 [95% CI, 0.48-0.89]) than in the control group (mean z score, 0.07 [95% CI, -0.14 to 0.28]; difference between groups, 0.62 SDs [95% CI, 0.31-0.91]; P < .001). Exercise also positively affected a composite score of cognitive flexibility (mean z score: exercise group, 0.25 [95% CI, 0.05-0.44]; control group, -0.17 [95% CI, -0.39 to 0.04]; difference between groups, 0.42 SDs [95% CI, 0.13-0.71]; P = .005). These main effects were consistent in intention-to-treat analyses and after multiple-testing correction. There was a positive, small-magnitude effect of exercise on total academic performance (mean z score: exercise group, 0.31 [95% CI, 0.18-0.44]; control group, 0.10 [95% CI, -0.04 to 0.24]; difference between groups, 0.21 SDs [95% CI, 0.01-0.40]; P = .03), which was partially mediated by cognitive flexibility. Inhibition, working memory, hippocampal volume, and other brain magnetic resonance imaging outcomes studied were not affected by the exercise program. The intervention increased cardiorespiratory fitness performance as indicated by longer treadmill time to exhaustion (mean z score: exercise group, 0.54 [95% CI, 0.27-0.82]; control group, 0.13 [95% CI, -0.16 to 0.41]; difference between groups, 0.42 SDs [95% CI, 0.01-0.82]; P = .04), and these changes in fitness mediated some of the effects (small percentage of mediation [approximately 10%-20%]). The effects of exercise were overall consistent across the moderators tested, except for larger improvements in intelligence among boys compared with girls.
In this randomized clinical trial, exercise positively affected intelligence and cognitive flexibility during development among children with overweight or obesity. However, the structural and functional brain changes responsible for these improvements were not identified.
ClinicalTrials.gov Identifier: NCT02295072.
儿科超重和肥胖在全球范围内普遍存在，这对认知和大脑健康有不良影响。运动可能会减轻这些不利后果。
研究运动方案对脑健康指标的影响，包括超重或肥胖儿童的智力、执行功能、学业成绩和大脑结果，并探讨运动的主要影响的潜在中介和调节因素。
设计、地点和参与者：本 20 周随机临床试验共纳入 109 名 8 至 11 岁超重或肥胖儿童，所有儿童的基线期数据均于 2014 年 11 月 21 日至 2016 年 6 月 30 日收集，神经影像学数据处理和分析于 2017 年 6 月 1 日至 2021 年 12 月 20 日进行。所有 109 名儿童均纳入意向治疗分析；90 名儿童（82.6%）完成了运动后评估，参加了至少 70%推荐的运动课程，并纳入了方案分析。
所有参与者均接受生活方式建议。对照组继续其日常活动，而运动组每周至少参加 3 次由监督的 90 分钟的课外运动。
采用标准化测试评估智力、执行功能（认知灵活性、抑制和工作记忆）和学业成绩，并采用磁共振成像测量海马体体积。
109 名参与者包括 45 名女孩（41.3%）；参与者的平均（SD）体重指数为 26.8（3.6），平均（SD）年龄为 10.0（1.1）岁。在方案分析中，运动干预改善了晶体智力，与对照组相比（平均 z 分数，-0.10[95%CI，-0.28 至 0.09]），运动组的改善更为明显（平均 z 分数，0.62[95%CI，0.44 至 0.80]；组间差异，0.72 个标准差[95%CI，0.46 至 0.97]；P<0.001）。运动组的总智力也显著提高（平均 z 分数，0.69[95%CI，0.48 至 0.89]），而对照组仅略有提高（平均 z 分数，0.07[95%CI，-0.14 至 0.28]；组间差异，0.62 个标准差[95%CI，0.31 至 0.91]；P<0.001）。运动也对认知灵活性的综合评分产生了积极影响（平均 z 分数：运动组，0.25[95%CI，0.05 至 0.44]；对照组，-0.17[95%CI，-0.39 至 0.04]；组间差异，0.42 个标准差[95%CI，0.13 至 0.71]；P=0.005）。这些主要影响在意向治疗分析和经过多次测试校正后仍然一致。运动对总学业成绩有正向、小幅度的影响（平均 z 分数：运动组，0.31[95%CI，0.18 至 0.44]；对照组，0.10[95%CI，-0.04 至 0.24]；组间差异，0.21 个标准差[95%CI，0.01 至 0.40]；P=0.03），部分由认知灵活性介导。运动方案并未影响抑制、工作记忆、海马体体积和其他大脑磁共振成像结果。该干预措施提高了心肺功能表现，表现为跑步机至力竭的时间延长（平均 z 分数：运动组，0.54[95%CI，0.27 至 0.82]；对照组，0.13[95%CI，-0.16 至 0.41]；组间差异，0.42 个标准差[95%CI，0.01 至 0.82]；P=0.04），这些健身方面的变化部分介导了运动的影响（大约 10%-20%的影响归因于中介作用）。除了男孩在智力方面的改善明显大于女孩外，运动的效果在所有测试的调节因素中总体一致。
在这项随机临床试验中，运动对超重或肥胖儿童的智力和认知灵活性有积极影响。然而，尚不清楚这些改善的原因是大脑结构还是功能的变化。
ClinicalTrials.gov 标识符：NCT02295072。
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