Effect of an interdisciplinary intervention with motivational approach on exercise capacity in obese adolescents: a randomized controlled clinical trial

Abstract

Objective To evaluate the effect of an interdisciplinary intervention with a motivational approach on exercise capacity and usual physical activity levels in overweight and obese adolescents. Methods This is a randomized, controlled clinical trial with single blinding of subjects. Adolescents aged 15 to 18 years with overweight and obesity (body mass index ≥ 85 percentile) were included. The adolescents were randomized into two groups: interdisciplinary intervention or control - traditional approach aiming at lifestyle modifications. The initial evaluations were carried out, including the cardiopulmonary exercise test and the physical activity level measurement by using the International Physical Activity Questionnaire and a pedometer. The evaluations were performed in two moments: time zero (time of inclusion in the study) and after 3 months (end of intervention). There were 12 sessions with weekly meetings. Results A total of 37 participants were included, 19 in the Intervention Group. There were no significant differences in the baseline demographic, anthropometric and physical activity characteristics between groups, with mean age of 17.3±1.0 years in the Control Group, and 16.8±0.9 years in the Intervention Group (p=0.14). The motivational intervention did not cause significant differences (p>0.05) in the comparison of the variables of exercise capacity and usual physical activity (questionnaire and pedometer) between groups. Conclusion The intervention with a motivational approach did not alter exercise capacity and levels of usual physical activity in overweight and obese adolescents. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1. CG: Control Group; IG: Intervention Group.

. Flowchart of study participants

Figura 1. Fluxograma dos participantes do estudo

GC: Grupo Controle; GI: Grupo Intervenção.

References

1. 1. 1. Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatric Endocrinol. 2014;6(3):129-43. Review.
   2. Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatric Endocrinol. 2014;6(3):129–143. Review.
2. 1. 2. Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’recommendations. Obes Rev. 2006;7(Suppl 1): 7-66. Review.
   2. Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’recommendations. Obes Rev. 2006;7(Suppl 1):7–66. Review.
3. 1. 3. Komal W, Jaipanesh K, Seemal M. Association of leisure time physical activity, watching television, obesity & lipid profile among sedentary low-income south Indian population. East Afr J Public Health. 2010;7(3):225-8.
   2. Komal W, Jaipanesh K, Seemal M. Association of leisure time physical activity, watching television, obesity & lipid profile among sedentary low-income south Indian population. East Afr J Public Health. 2010;7(3):225–228.
4. 1. 4. Dumith SC, Hallal PC, Menezes AM, Araújo CL. Sedentary behavior in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. Cad Saude Publica. 2010;26(10):1928-36.
   2. Dumith SC, Hallal PC, Menezes AM, Araújo CL. Sedentary behavior in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. Cad Saude Publica. 2010;26(10):1928–1936.
5. 1. 5. Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017;92(2):251-65. Review.
   2. Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017;92(2):251–265. Review.
6. 1. 6. Sociedade Brasileira de Cardiologia; Sociedade Brasileira de Hipertensão; Sociedade Brasileira de Nefrologia. [VI Brazilian guidelines on hypertension]. Arq Bras Cardiol. 2010;95(1 Suppl):1-51. Portuguese. Erratum in: Arq Bras Cardiol. 2010;95(4):553.
   2. Sociedade Brasileira de Cardiologia. Sociedade Brasileira de Hipertensão. Sociedade Brasileira de Nefrologia VI Brazilian guidelines on hypertension. Arq Bras Cardiol. 2010;95(1) Suppl:1–51. Portuguese. Erratum in: Arq Bras Cardiol. 2010;95(4):553.
7. 1. 7. Sola K, Brekke N, Brekke M. An activity-based intervention for obese and physically inactive children organized in primary care: feasibility and impact on fitness and BMI: A one-year follow-up study. Scand J Prim Health Care. 2010;28(4):199-204.
   2. Sola K, Brekke N, Brekke M. An activity-based intervention for obese and physically inactive children organized in primary care: feasibility and impact on fitness and BMI: A one-year follow-up study. Scand J Prim Health Care. 2010;28(4):199–204.
8. 1. 8. Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130(6):e1647-71. Review.
   2. Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130(6):e1647–e1671. Review.
9. 1. 9. Prochaska JO, Wright JA, Velicer WF. Evaluating theories of health behavior change: A hierarchy of criteria applied to the transtheoretical model. Appl Psychol. 2008;57(4):561-88.
   2. Prochaska JO, Wright JA, Velicer WF. Evaluating theories of health behavior change: A hierarchy of criteria applied to the transtheoretical model. Appl Psychol. 2008;57(4):561–588.
10. 1. 10. Velasquez MM, Crouch C, Stephens NS, DiClemente CC. Group treatment for substance abuse: a stages-of-change therapy manual. 2th ed. Guilford Publications; 2015.
    2. Velasquez MM, Crouch C, Stephens NS, DiClemente CC. Group treatment for substance abuse: a stages-of-change therapy manual. 2th. Guilford Publications; 2015.
11. 1. 11. Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics. 2015;135(4):649-57.
    2. Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics. 2015;135(4):649–657.
12. 1. 12. Mostafavi F, Ghofranipour F, Feizi A, Pirzadeh A. Improving physical activity and metabolic syndrome indicators in women: a transtheoretical model-based intervention. Int J Prev Med. 2015;6:28.
    2. Mostafavi F, Ghofranipour F, Feizi A, Pirzadeh A. Improving physical activity and metabolic syndrome indicators in women: a transtheoretical model-based intervention. 28Int J Prev Med. 2015;6
13. 1. 13. Gourlan M, Sarrazin P, Trouilloud D. Motivational interviewing as a way to promote physical activity in obese adolescents: a randomised-controlled trial using self-determination theory as an explanatory framework. Psychol Health. 2013;28(11):1265-86.
    2. Gourlan M, Sarrazin P, Trouilloud D. Motivational interviewing as a way to promote physical activity in obese adolescents: a randomised-controlled trial using self-determination theory as an explanatory framework. Psychol Health. 2013;28(11):1265–1286.
14. 1. 14. Miller WR, Rollnick S. Entrevista motivacional: preparando as pessoas para a mudança de comportamentos adictivos. Porto Alegre: Artmed; 2001.
    2. Miller WR, Rollnick S. Entrevista motivacional: preparando as pessoas para a mudança de comportamentos adictivos. Porto Alegre: Artmed; 2001.
15. 1. 15. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.
    2. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. 18BMC Med. 2010;8
16. 1. 16. Ribeiro FA, Boff RM, Feoli AM, Gustavo AS, Donadio MV, Oliveira MS. Randomized clinical trial of a motivational interdisciplinary intervention based on the transtheoretical model of change for lifestyle modification in overweight/obese adolescents: MERC study protocol. Internat J Clin Trials. 2016;3(4):225-32.
    2. Ribeiro FA, Boff RM, Feoli AM, Gustavo AS, Donadio MV, Oliveira MS. Randomized clinical trial of a motivational interdisciplinary intervention based on the transtheoretical model of change for lifestyle modification in overweight/obese adolescents: MERC study protocol. Internat J Clin Trials. 2016;3(4):225–232.
17. 1. 17. American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211-77. Review. Erratum in: Am J Respir Crit Care Med. 2003;15:1451-2.
    2. American Thoracic Society. American College of Chest Physicians ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–277. Review. Erratum in: Am J Respir Crit Care Med. 2003;15:1451-2.
18. 1. 18. Borel B, Fabre C, Saison S, Bart F, Grosbois JM. An original field evaluation test for chronic obstructive pulmonary disease population: the six-minute stepper test. Clin Rehabil. 2010;24(1):82-93.
    2. Borel B, Fabre C, Saison S, Bart F, Grosbois JM. An original field evaluation test for chronic obstructive pulmonary disease population: the six-minute stepper test. Clin Rehabil. 2010;24(1):82–93.
19. 1. 19. Rodrigues AN, Perez AJ, Carletti L, Bissoli NS, Abreu GR. Maximum oxygen uptake in adolescents as measured by cardiopulmonary exercise testing: a classification proposal. J Pediatr (Rio J.). 2006;82(6):426-30.
    2. Rodrigues AN, Perez AJ, Carletti L, Bissoli NS, Abreu GR. J Pediatr. 6. Vol. 82. Rio J: 2006. Maximum oxygen uptake in adolescents as measured by cardiopulmonary exercise testing: a classification proposal; pp. 426–430.
20. 1. 20. Karila C, de Blic J, Waernessyckle S, Benoist MR, Scheinmann P. Cardiopulmonary exercise testing in children: an individualized protocol for workload increase. Chest. 2001;120(1):81-7.
    2. Karila C, Blic J, Waernessyckle S, Benoist MR, Scheinmann P. Cardiopulmonary exercise testing in children: an individualized protocol for workload increase. Chest. 2001;120(1):81–87.
21. 1. 21. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
    2. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381.
22. 1. 22. Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997;29(10):1344-9.
    2. Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997;29(10):1344–1349.
23. 1. 23. Han H, Gabriel KP, Kohl HW. Evaluations of Validity and Reliability of a Transtheoretical Model for Sedentary Behavior among College Students. Am J Health Behav. 2015;39(5):601-9.
    2. Han H, Gabriel KP, Kohl HW. Evaluations of Validity and Reliability of a Transtheoretical Model for Sedentary Behavior among College Students. Am J Health Behav. 2015;39(5):601–609.
24. 1. 24. Mameli C, Krakauer JC, Krakauer NY, Bosetti A, Ferrari CM, Schneider L, et al. Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience. PloS One. 2017;12(7):e0181095.
    2. Mameli C, Krakauer JC, Krakauer NY, Bosetti A, Ferrari CM, Schneider L, et al. Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience. PloS One. 2017;12(7):e0181095.
25. 1. 25. van Vliet M, Heymans MW, von Rosenstiel IA, Brandjes DP, Beijnen JH, Diamant M. Cardiometabolic risk variables in overweight and obese children: a worldwide comparison. Cardiovasc Diabetol. 2011; 10:106. Review.
    2. van Vliet M, Heymans MW, von Rosenstiel IA, Brandjes DP, Beijnen JH, Diamant M. Cardiometabolic risk variables in overweight and obese children: a worldwide comparison. 106Cardiovasc Diabetol. 2011;10 Review.
26. 1. 26. Magge SN, Goodman E, Armstrong SC; COMMITTEE ON NUTRITION; SECTION ON ENDOCRINOLOGY; SECTION ON OBESITY. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics. 2017;140(2).pii:e20171603.
    2. Magge SN, Goodman E, Armstrong SC, COMMITTEE ON NUTRITION. SECTION ON ENDOCRINOLOGY. SECTION ON OBESITY The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics. 2017;140(2) pii:e20171603.
27. 1. 27. Wilfley DE, Tibbs TL, Van Buren D, Reach KP, Walker MS, Epstein LH. Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol. 2007;26(5):521-32.
    2. Wilfley DE, Tibbs TL, Van Buren D, Reach KP, Walker MS, Epstein LH. Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol. 2007;26(5):521–532.
28. 1. 28. Ham OK, Sung KM, Lee BG, Choi HW, Im EO. Transtheoretical model based exercise counseling combined with music skipping rope exercise on childhood obesity. Asian Nurs Res (Korean Soc Nurs Sci). 2016;10(2):116-22.
    2. Ham OK, Sung KM, Lee BG, Choi HW, Im EO. Transtheoretical model based exercise counseling combined with music skipping rope exercise on childhood obesity. Asian Nurs Res (Korean Soc Nurs Sci) 2016;10(2):116–122.
29. 1. 29. Woods C, Mutrie N, Scott M. Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active. Health Educ Res. 2002;17(4):451-60. Review.
    2. Woods C, Mutrie N, Scott M. Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active. Health Educ Res. 2002;17(4):451–460. Review.
30. 1. 30. Hayes G, Dowd KP, MacDonncha C, Donnelly AE. Tracking of Physical Activity and Sedentary Behavior From Adolescence to Young Adulthood: A Systematic Literature Review. J Adolesc Health. 2019;65(4):446-54.
    2. Hayes G, Dowd KP, MacDonncha C, Donnelly AE. Tracking of Physical Activity and Sedentary Behavior From Adolescence to Young Adulthood: A Systematic Literature Review. J Adolesc Health. 2019;65(4):446–454.
31. 1. 31. Greca JP, Silva DA, Loch MR. Physical activity and screen time in children and adolescents in a medium size town in the South of Brazil. Rev Paul Pediatr. 2016;34(3):316-22.
    2. Greca JP, Silva DA, Loch MR. Physical activity and screen time in children and adolescents in a medium size town in the South of Brazil. Rev Paul Pediatr. 2016;34(3):316–322.
32. 1. 32. Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, et al. Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics. 2017;140(Suppl 2):S97-S101. Review.
    2. Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, et al. Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics. 2017;140(Suppl 2):S97–S101. Review.
33. 1. 33. Enes CC, Slater B. Obesidade na adolescência e seus principais fatores determinantes. Rev Bras Epidemiol. 2010;13(1):163-71.
    2. Enes CC, Slater B. Obesidade na adolescência e seus principais fatores determinantes. Rev Bras Epidemiol. 2010;13(1):163–171.
34. 1. 34. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;5(2):CD008066. Review.
    2. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;5(2):CD008066. Review.
35. 1. 35. Karintrakul S, Angkatavanich J. A randomized controlled trial of an individualized nutrition counseling program matched with a transtheoretical model for overweight and obese females in Thailand. Nutr Res Pract. 2017; 11(4):319-26.
    2. Karintrakul S, Angkatavanich J. A randomized controlled trial of an individualized nutrition counseling program matched with a transtheoretical model for overweight and obese females in Thailand. Nutr Res Pract. 2017;11(4):319–326.
36. 1. 36. Stice E, Shaw H, Marti CN. A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull. 2006;132(5):667-91.
    2. Stice E, Shaw H, Marti CN. A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull. 2006;132(5):667–691.