CLINICAL QUESTION: In school-aged overweight or obese children, are physical therapy strategies effective in decreasing BMI, increasing health and fitness or increasing physical activity? Are these strategies more effective than other approaches that may include education, dietary or counseling approaches?
OVERALL CLINICAL BOTTOM LINE: Based on the evidence from these five studies, the most effective intervention for reducing BMI includes personalized exercise instruction and nutritional counseling with significant amount of individual attention. The results did not point to any intervention that increased fitness level for the overweight or obese child. However, the four outcome measures used for measuring changes in fitness levels (VO2max, shuttle run, 6-minute walk test, resting heart rate) do not have good normative values and/or MCIDs in which to judge whether the observed changes were clinically significant. To improve body fat percentage, a school-based, lifestyle-focused, fitness-oriented with a small student:teacher would be indicated. For the school-based physical therapist, a significant amount of coordination of staff to achieve the small student:staff ratio would be required to implement these techniques. Cooperation from teachers and parents would be necessary in order to support the nutritional education and behavior modification. In a school-based treatment setting, the space required for motor skill instruction is easily available in a gymnasium or on the outdoor field. Support for activities could be gathered from parent-groups and/or physical education teachers.
The ideal study that would most directly answer my clinical question would include four components. Subjects would be of low socio-economic status in order to be most like my current clinical population. Interventions would be implemented for at least one school year (9 months) to assess the sustainability of effects over time. Parent involvement would be incorporated into the intervention to maximize adherence to intervention. Finally, the intervention would directly compare exercise with diet modification in order to specifically determine if physical therapy intervention (e.g., exercise) was most effective in decreasing BMI, increasing health habits, or increasing physical activity.
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