有氧运动对超重肥胖儿童执行功能影响的Meta分析

doi:10.12114/j.issn.1007-9572.2023.0810

摘要/Abstract

摘要： 背景研究证实，超重肥胖儿童执行功能与肥胖密切相关，并可能存在双向关联。有氧运动作为一种有效的干预手段，可有效促进其大脑发展和认知功能，尤其是执行功能，但改善效果的量化关系仍需要进一步探讨。目的系统评价有氧运动对超重肥胖儿童执行功能相关指标干预效果。方法检索中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、中国生物医学文献数据库（CBM）、Cochrane Library、PubMed、Embase、Web of Science数据库中有氧运动干预超重肥胖儿童执行功能的随机对照试验，检索时限从各数据库建库至2023年7月。依据Cochrane风险偏倚评估工具对纳入的文献进行质量评估，采用RevMan 5.4和Stata 15.0软件对结局指标进行Meta分析。结果最终纳入9项随机对照试验，其中包括940例超重肥胖儿童。Meta分析结果显示，单次有氧运动干预能够有效提高超重肥胖儿童的执行功能（WMD=-6.98，95%CI=-11.89~-2.07，P=0.005）；亚组分析结果显示，单次干预时长<30 min的有氧运动对超重肥胖儿童执行功能子成分的改善均无显著性差异（WMD=-0.84，95%CI=-9.37~7.68，P=0.85）；单次干预时长>30 min的有氧运动可改善超重肥胖儿童的抑制功能（WMD=-10.50，95%CI=-19.15~-1.85，P=0.02）。进行长期运动干预（干预周期为8周）时，与对照组相比，有氧运动可改善超重肥胖儿童干扰控制（WMD=-0.16，95%CI=-0.18~-0.14，P<0.000 01），对计划（WMD=4.20，95%CI=-8.34~16.73，P=0.51）、注意（WMD=0.41，95%CI=-12.08~12.91，P=0.95）、同步（WMD=3.93，95%CI=-8.22~16.08，P=0.53）、连续（WMD=2.48，95%CI=-9.18~14.14，P=0.68）的改善效果不明显。结论单次长时间的有氧运动对超重肥胖儿童执行功能子成分有选择性积极影响，长周期固定频次、时间的有氧运动可以改善超重肥胖儿童干扰控制能力，但计划、注意、同步、连续方面未产生改善效果。

关键词: 超重, 肥胖症, 儿童, 有氧运动, 执行功能, Meta分析

Abstract:

Background

Studies have confirmed that executive function in overweight and obese children is closely related to obesity and may have a bidirectional association. Aerobic exercise, as an effective intervention, can effectively promote their brain development and cognitive function, especially executive function, but the quantitative relationship of the improvement effect still needs to be further explored.

Objective

To systematically evaluate the intervention effect of aerobic exercise on executive function-related indexes in overweight and obese children.

Methods

Randomized controlled trials of aerobic exercise interventions for executive function in overweight and obese children were searched in CNKI, Wanfang Data, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases, and the timeframe for searching was from the establishment of each database to July 2023. The quality of the included literature was assessed according to the Cochrane Risk of Bias Assessment Tool, and Meta-analysis of outcome indicators was performed using RevMan 5.3 and Stata 15.0 software.

Results

Nine randomized controlled trials, including 940 overweight and obese children, were finally included. The results of Meta-analysis showed that a single session of aerobic exercise intervention was effective in improving the executive function of overweight and obese children (WMD=-6.98, 95%CI=-11.89 to -2.07, P=0.005). Subgroup analyses showed no significant differences in the improvement of any of the executive function subcomponents in overweight and obese children with a single intervention duration of less than 30 minutes of aerobic exercise (WMD=-0.84, 95%CI=-9.37 to 7.68, P=0.85) ; aerobic exercise with a single intervention duration longer than 30 minutes improved inhibitory function in overweight and obese children (WMD=-10.50, 95%CI=-19.15 to -1.85, P=0.02). When a long-term exercise intervention was carried out (the intervention period was 8 weeks), in contrast to the control group, the aerobic exercise improved interference control in overweight and obese children (WMD=-0.16, 95%CI=-0.18 to -0.14, P<0.000 01), on planning (WMD=4.20, 95%CI=-8.34 to 16.73, P=0.51), attention (WMD=0.41, 95%CI=-12.08 to 12.91, P=0.95), synchronization (WMD=3.93, 95%CI=-8.22 to 16.08, P=0.53), and continuity (WMD=2.48, 95%CI=-9.18 to 14.14, P=0.68) were not significantly improved.

Conclusion

Aerobic exercise for a single long period of time had a selective positive effect on executive function subcomponents in overweight and obese children, and aerobic exercise for a long period of time with a fixed frequency and duration improved interference control in overweight and obese children, but did not produce an improvement in planning, attention, synchronization, or continuity.

Key words: Overweight, Obesity, Child, Executive function, Aerobic exercise, Meta-analysis

赵瑞,陈乐琴,吴依妮,等. 有氧运动对超重肥胖儿童执行功能影响的Meta分析[J]. 中国全科医学, 2024, 27(30): 3817-3824. DOI: 10.12114/j.issn.1007-9572.2023.0810.
ZHAO Rui,CHEN Leqin,WU Yini, et al. Meta-analysis of the Effects of Aerobic Exercise on Executive Function in Overweight and Obese Children[J]. Chinese General Practice, 2024, 27(30): 3817-3824. DOI: 10.12114/j.issn.1007-9572.2023.0810.

图/表 11

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检索步骤	检索式
#1	aerobic exercise[Mesh]
#2	aerobic training[Title/Abstract] OR Physical Activity[Title/Abstract] OR Physical Exercise[Title/Abstract] OR Acute Exercise[Title/Abstract] OR Exercise，Isometric[Title/Abstract] OR endurance exercise[Title/Abstract] OR Treadmill[Title/Abstract] OR walking[Title/Abstract] OR Jogging[Title/Abstract] OR Swimming[Title/Abstract] OR Dancing[Title/Abstract] OR Cycling[Title/Abstract] OR Taijiquan[Title/Abstract]
#3	#1 OR #2
#4	Obesity[Mesh]
#5	Overweight[Mesh]
#6	Obese[Title/Abstract] OR Body mass index[Title/Abstract] OR body fat[Title/Abstract] OR excess weight[Title/Abstract]
#7	#4 OR #5 OR #6
#8	Child[Title/Abstract]
#9	Executive Function[Mesh]
#10	Executive Control[Title/Abstract] OR Cognitive Function[Title/Abstract] OR cognitive performance[Title/Abstract] OR inhibitory control[Title/Abstract] OR Shifting[Title/Abstract] OR working memory[Title/Abstract] OR Planning[Title/Abstract] OR cognitive function[Title/Abstract] OR Refresh function[Title/Abstract] OR cognitive flexibility[Title/Abstract] OR Reasoning[Title/Abstract] OR problem solving[Title/Abstract]
#11	#9 OR #10
#12	randomized controlled trial[Publication Type] OR randomized[Title/Abstract] OR placebo[Title/Abstract]
#13	#3 AND #7 AND #8 AND #11 AND #12

检索步骤	检索式
#1	aerobic exercise[Mesh]
#2	aerobic training[Title/Abstract] OR Physical Activity[Title/Abstract] OR Physical Exercise[Title/Abstract] OR Acute Exercise[Title/Abstract] OR Exercise，Isometric[Title/Abstract] OR endurance exercise[Title/Abstract] OR Treadmill[Title/Abstract] OR walking[Title/Abstract] OR Jogging[Title/Abstract] OR Swimming[Title/Abstract] OR Dancing[Title/Abstract] OR Cycling[Title/Abstract] OR Taijiquan[Title/Abstract]
#3	#1 OR #2
#4	Obesity[Mesh]
#5	Overweight[Mesh]
#6	Obese[Title/Abstract] OR Body mass index[Title/Abstract] OR body fat[Title/Abstract] OR excess weight[Title/Abstract]
#7	#4 OR #5 OR #6
#8	Child[Title/Abstract]
#9	Executive Function[Mesh]
#10	Executive Control[Title/Abstract] OR Cognitive Function[Title/Abstract] OR cognitive performance[Title/Abstract] OR inhibitory control[Title/Abstract] OR Shifting[Title/Abstract] OR working memory[Title/Abstract] OR Planning[Title/Abstract] OR cognitive function[Title/Abstract] OR Refresh function[Title/Abstract] OR cognitive flexibility[Title/Abstract] OR Reasoning[Title/Abstract] OR problem solving[Title/Abstract]
#11	#9 OR #10
#12	randomized controlled trial[Publication Type] OR randomized[Title/Abstract] OR placebo[Title/Abstract]
#13	#3 AND #7 AND #8 AND #11 AND #12

第一作者	发表年份（年）	样本量（T/C）	年龄（岁）（T/C）	试验组		结局指标
第一作者	发表年份（年）	样本量（T/C）	年龄（岁）（T/C）	干预方案	周期、频率、时长	结局指标
KRAFFT^[22]	2014	43（24/19）	T：9.7±0.8 C：9.9±0.9	有氧运动（捉人、跳绳）：HR>150次/min	8个月，5 d/周，40 min/次	①
谢丹丹^[23]	2020	80（60/20）	T#：9.65±0.67 T##：9.75±0.64 T###：9.75±0.64 C：9.90±0.72	篮球+"8"字跳绳：5 min热身与拉伸→10 min（HR 130~150次/min）→2 min休息→10 min（HR 130~150次/min）→2 min休息	一次性运动：20 min/次、30 min/次、40 min/次	①②③
张廷剑^[24]	2019	80（40/40）	T#：10.20±0.69 T##：10.40±0.50 C#：10.30±0.73 C###：10.50±0.51	篮球+"8"字跳绳：热身与拉伸→基本部分（HR 130~150次/min）→总结与放松	一次性运动：20 min/次、40 min/次	①②③
CHOU^[25]	2020	84（44/40）	T：12.30±0.66 C：12.08±0.69	运动游戏：10 min热身→30 min运动游戏（HR>150次/min）	8周，3 d/周，40 min/次	④
CHOU^[18]	2023	108（37、38/33）	T#：11.37±0.58 T###：11.00±0.64 C：11.32±0.54	竞争性团队游戏（跑步、跳绳、改良足球、棒球、篮球）：10 min热身→20 min/40 min（60%~69%）HR_max→10 min放松	8周，5 d/周，20 min/次或40 min/次	④
CHEN^[26]	2016	50（25/25）	T：12.64±0.70 C：12.84±0.75	5 min热身→30 min中等强度（60%~70%）HRmax→5 min放松	3个月，4 d/周，40 min/次	⑤
DAVIS^[21]	2007	94（33、32/29）	9.20±0.84	5 min热身→20 min/40 min（HR>150次/min）→5 min热身	15周，5 d/周，20 min/次或40 min/次	⑥
DAVIS^[19]	2011	171（55、56/60）	9.3±1.0	5 min热身→20 min/40 min（HR>150次/min）→5 min热身	13周，5 d/周，20 min/次或40 min/次	⑥
GALLOTTA^[27]	2015	230（78、83/69）	8~11	协调训练：15 min热身→30 min（5<RPE<8身体活动）→15 min热身	60 min/次，5个月	⑦

第一作者	发表年份（年）	样本量（T/C）	年龄（岁）（T/C）	试验组		结局指标
第一作者	发表年份（年）	样本量（T/C）	年龄（岁）（T/C）	干预方案	周期、频率、时长	结局指标
KRAFFT^[22]	2014	43（24/19）	T：9.7±0.8 C：9.9±0.9	有氧运动（捉人、跳绳）：HR>150次/min	8个月，5 d/周，40 min/次	①
谢丹丹^[23]	2020	80（60/20）	T#：9.65±0.67 T##：9.75±0.64 T###：9.75±0.64 C：9.90±0.72	篮球+"8"字跳绳：5 min热身与拉伸→10 min（HR 130~150次/min）→2 min休息→10 min（HR 130~150次/min）→2 min休息	一次性运动：20 min/次、30 min/次、40 min/次	①②③
张廷剑^[24]	2019	80（40/40）	T#：10.20±0.69 T##：10.40±0.50 C#：10.30±0.73 C###：10.50±0.51	篮球+"8"字跳绳：热身与拉伸→基本部分（HR 130~150次/min）→总结与放松	一次性运动：20 min/次、40 min/次	①②③
CHOU^[25]	2020	84（44/40）	T：12.30±0.66 C：12.08±0.69	运动游戏：10 min热身→30 min运动游戏（HR>150次/min）	8周，3 d/周，40 min/次	④
CHOU^[18]	2023	108（37、38/33）	T#：11.37±0.58 T###：11.00±0.64 C：11.32±0.54	竞争性团队游戏（跑步、跳绳、改良足球、棒球、篮球）：10 min热身→20 min/40 min（60%~69%）HR_max→10 min放松	8周，5 d/周，20 min/次或40 min/次	④
CHEN^[26]	2016	50（25/25）	T：12.64±0.70 C：12.84±0.75	5 min热身→30 min中等强度（60%~70%）HRmax→5 min放松	3个月，4 d/周，40 min/次	⑤
DAVIS^[21]	2007	94（33、32/29）	9.20±0.84	5 min热身→20 min/40 min（HR>150次/min）→5 min热身	15周，5 d/周，20 min/次或40 min/次	⑥
DAVIS^[19]	2011	171（55、56/60）	9.3±1.0	5 min热身→20 min/40 min（HR>150次/min）→5 min热身	13周，5 d/周，20 min/次或40 min/次	⑥
GALLOTTA^[27]	2015	230（78、83/69）	8~11	协调训练：15 min热身→30 min（5<RPE<8身体活动）→15 min热身	60 min/次，5个月	⑦

亚组分析		异质性检验结果		效应模型	Meta分析结果
亚组分析		I²值	P值	效应模型	WMD（95%CI）	P值
单次运动干预时长<30 min
执行功能	抑制	0	0.40	固定	-2.16（-11.01~6.69）	0.63
	转换	0	0.66	固定	25.00（-16.62~66.63）	0.24
	刷新	0	0.38	固定	133.69（85.60~181.78）	0.89
单次运动干预时长>30 min
执行功能	抑制	0	0.98	固定	-10.50（-19.15~-1.85）	0.02
	转换	0	0.52	固定	-35.58（-81.06~9.90）	0.13
	刷新	23%	0.26	固定	112.63（64.09~161.17）	0.41