Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 2126-2134 (doi:10.1542/peds.2006-1285)
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ARTICLE

Exercise Therapy as a Treatment for Psychopathologic Conditions in Obese and Morbidly Obese Adolescents: A Randomized, Controlled Trial

Amanda J. Daley, PhDa, Robert J. Copeland, MMedScib, Neil P. Wright, MB, BChirc, Andrea Roalfe, MSca and Jerry K. H. Wales, DM, FRCPCHd

a Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham, United Kingdom
b Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
c Sheffield Children's National Health Service Trust, Sheffield, United Kingdom
d Academic Unit of Child Health, Children's Hospital, Sheffield, United Kingdom

OBJECTIVE. We conducted a proof-of-concept, randomized, controlled trial to investigate the effects of a supervised exercise therapy intervention on psychopathologic outcomes in obese adolescents.

METHODS. The participant sample consisted of 81 adolescents (age: 11–16 years) who had been referred to a children's hospital for evaluation of obesity or who responded to a community advertisement. Participants were assigned randomly to exercise therapy, an equal-contact exercise placebo intervention, or usual care. Intervention participants attended 3 one-on-one sessions per week for 8 weeks and then completed a home program for another 6 weeks. Outcomes included self-perceptions (self-esteem), depression, affect, physical activity, aerobic fitness, and BMI.

RESULTS. A total of 18 of 81 participants were categorized as morbidly obese (BMI SD score: >3.5; adult equivalent BMI: ≥40). At baseline, 30.3% of participants had a Children's Depression Inventory score of ≥13, and 27% reported recent suicidal ideation. Repeated-measures mixed analysis of covariance (controlling for baseline scores) revealed significant changes in physical self-worth, associated measures of self-esteem, and physical activity over time, consistently favoring exercise therapy. There were no significant changes in BMI.

CONCLUSIONS. Findings confirmed psychopathologic conditions as a serious health concern in obese and morbidly obese adolescents. Our study is the first randomized, controlled trial to demonstrate that a brief supervised exercise therapy intervention has the potential to improve psychopathologic outcomes significantly and to increase physical activity in obese adolescents, relative to usual care.

Key Words: obesity • exercise • children • psychopathologic conditions • weight • self-esteem

Abbreviations: HR—heart rate • PSW—physical self-worth • GSW—global self-worth • CDI—Children's Depression Inventory • RCT—randomized, controlled trial

Accepted Jun 15, 2006.


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