@misc{10481/77089,
year = {2022},
month = {8},
url = {https://hdl.handle.net/10481/77089},
abstract = {IMPORTANCE 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.
OBJECTIVES 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.
INTERVENTIONS 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.
MAIN OUTCOMES AND MEASURES Intelligence, executive function (cognitive flexibility,
inhibition, andworking memory), and academic performancewere assessed with standardized tests,
and hippocampal volume was measured with magnetic resonance imaging.
RESULTS 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.
CONCLUSIONS AND RELEVANCE 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 improvementswere not
identified.},
organization = {Spanish Government	DEP2013-47540	
DEP2016-79512-R	
DEP2017-91544-EXP},
organization = {European Commission		
European Commission
European Commission Joint Research Centre	667302},
organization = {Alicia Koplowitz Foundation},
organization = {ERDF (FEDER in Spanish)	B-CTS-355-UGR18},
organization = {University of Granada, Plan Propio de Investigacion, Visiting Scholar grants},
organization = {Junta de Andalucia},
organization = {Unit of Excellence on Exercise, Nutrition and Health (UCEENS)},
organization = {European Commission	SOMM17/6107/UGR},
organization = {EXERNET Research Network on Exercise and Health	DEP2005-00046/ACTI},
organization = {High Council of Sports	09/UPB/19},
organization = {Spanish Government	FPU 14/06837	
FPI-BES-2014-068829	
FJC2018-037925-I	
FJCI-2014-19563	
IJCI-2017-33642	
RYC2019-027287-I	
FPU15/02645	
FJCI-2017-33396	
IJC2019-041916-I},
organization = {Junta de Andalucia},
organization = {National Agency for Research and Development (ANID)/BECAS Chile	72180543},
organization = {Ramon Areces Foundation},
publisher = {American Medical Association},
title = {Effects of an Exercise Program on Brain Health Outcomes for Children With Overweight or Obesity. The ActiveBrains Randomized Clinical Trial},
doi = {10.1001/jamanetworkopen.2022.27893},
author = {Ortega Porcel, Francisco Bartolomé and Mora González, José Rafael and Cadenas Sánchez, Cristina and Esteban Cornejo, Irene and Hidalgo Migueles, Jairo and Solís Urra, Patricio and Verdejo Román, Juan and Rodríguez Ayllón, María and Molina García, Pablo and Ruiz Ruiz, Jonatan and Erickson, Kirk I. and Catena Martínez, Andrés},
}