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Abstract(s)
O excesso de peso (incluindo pré-obesidade e obesidade) na adolescência é uma preocupação de saúde pública, uma vez que está associado a condições de saúde adversas, a curto e longo prazos. Comportamentos de saúde inapropriados, como um aporte energético excessivo e níveis insuficientes de atividade física (AF), podem conduzir ao excesso de peso. Existe uma necessidade urgente em encontrar estratégias que possam influenciar positivamente os comportamentos alimentares e de AF. O projeto PAC-MAnO (The effect of a Physical Activity Consultation in the management of adolescent overweight) foi desenhado com o objetivo de investigar o impacto de uma Consulta de Atividade Física, com recurso a técnicas de entrevista motivacional, no comportamento de AF e z-score do índice de massa corporal (IMC) em adolescentes com excesso de peso seguidos em consulta de Obesidade Pediátrica. De acordo com o nosso conhecimento, este é o primeiro estudo realizado em Portugal a analisar, de forma vasta, o impacto de uma Consulta de Atividade Física na gestão do peso em adolescentes com excesso de peso.
Entre setembro de 2016 e dezembro 2018, os adolescentes com excesso de peso (IMC ≥ p85), em consulta de primeira vez (n=165), que consentiram em participar no projeto PAC-MAnO, foram alocados por amostragem consecutiva em três grupos: Grupo de controlo (GC), Grupo experimental I (GEI), e Grupo experimental II (GEII). O GC seguiu o plano assistêncial base (consultas de Pediatria e Nutrição) durante 12 meses. Os GEs foram expostos à Consulta de AF adicionalmente ao plano assistêncial base durante os mesmos 12 meses. Os participantes incluídos no GEII foram adicionalmente convidados/encorajados a participar em duas sessões semanais de exercício físico, durante os primeiros 6 meses do projeto (fase I). No momento inicial, aos 6 (final da fase I) e aos 12 meses (final da fase II), foi realizado um conjunto de avaliações antropométricas, clínicas, nutricionais e de AF.
Dos participantes recrutados, 132 completaram a fase I (GC n=41, GI n=45, GEII n=46) e 102, a fase II (GC n=28, GEI n=36, GEII n=38). Apenas 43,5% (n=20) dos participantes do GEII cumpriram pelo menos 80% das sessões de exercício agendadas (fase I). Aos 6 meses, quer o GEI, quer o GEII mostraram melhorias significativas no z-score do IMC (d=0.75, p=.002; d=0.60, p=.045), composição corporal, aptidão cardiorespiratória (ApCR) (d=1.48, p=.012; d=1.32, p=.022), e AF moderada (d=0.81, p=.005; d=1.39, p<.001), vigorosa (d=0.83, p=.001; d=1.04, p<.001) e moderada-vigorosa (d=0.90, p=.001; d=1.43, p<.001). O GEI mostrou ainda melhorias no espessamento do complexo íntima-média da artéria carótida primitiva (d=1.09, p=.044), bem como no tempo em comportamento sedentário (d=0.70, p=.019) aos 6 meses, comparativamente ao GC. Aos 12 meses foram observadas melhorias adicionais no z-score do IMC (d=0.95, p<.001; d=0.86, p=.015), composição corporal e ApCR (ml/kg/min) (d=1.58, p=.033; d=1.17, p=.043) em ambos os GEs, comparativamente ao GC. O custo líquido atribuído ao GEI foi de 12,41 e 7,78 € por participante (representando um acréscimo de 19.5 e 24.1% comparativamente ao GC) para a fase I e II, respetivamente. Estimou-se uma redução de 0,002 e 0,009 no z-score do IMC aos 6 e 12 meses, para cada Euro (1€) gasto no GEI. O custo líquido do GEII foi de 252,37 e 7,78 € por participante, para a fase I e II, respetivamente.
De acordo com os resultados observados, a inclusão de uma Consulta de AF num programa clínico multidisciplinar de gestão do peso em adolescentes (com recurso a técnicas de entrevista motivacional) pode melhorar de forma eficaz os níveis de AF, z-score do IMC, composição corporal e ApCR dos adolescentes, comparativamente àqueles expostos ao plano assistêncial base (consultas de Pediatria e Nutrição), com um bom custoeficácia. Estes resultados são observáveis a 6 meses, com melhorias adicionais a 12 meses. A inclusão de sessões de exercício físico poderá representar uma mais-valia, desde que se assegure a presença dos participantes nas referidas sessões.
Adolescent excess weight (including overweight and obesity) is a major public health concern, as it is associated with several short and long-run adverse health outcomes. Inappropriate health behaviors, such as increased energy intake and decreased levels of physical activity (PA), may be at the front of this epidemic. There is an urgent need for new strategies that may positively influence dietary and PA behaviors. The PAC-MAnO (The effect of a Physical Activity Consultation in the management of adolescent overweight) project was designed to investigate the impact of a Physical Activity Consultation (PAC) based on motivational interview on PA behavior and body mass index (BMI) z-score among adolescents with excess weight followed at a Pediatric Obesity Clinic. To the best of our knowledge, this is the first Portuguese study analyzing so broadly the impact of a PAC in management of adolescent excess weight. Between September 2016 and December 2018, adolescents with excess weight (BMI ≥85th percentile) attending the Clinic for the first time (n=165), who agreed to participate in the PAC-MAnO project, were allocated by consecutive sampling into three groups: Control group (CG), Experimental group I (EGI), and Experimental group II (EGII). CG followed standard care (Pediatric and Nutrition consultations) for 12 months. EG’s I and II were both exposed to PAC plus standard care for 12 months. EGII participants were additionally invited/encouraged to attend two exercise sessions/week in the first 6 months (phase I). Anthropometric, clinical, PA and nutritional assessments were performed at baseline, 6 (end of phase I) and 12 months (end of phase II). From the participants enrolled, 132 completed phase I (CG n=41, EGI n=45, EGII n=46) and 102, phase II (CG n=28, EGI n=36, EGII n=38). Only 43.5% (n=20) of EGII participants attended at least 80% of the scheduled exercise sessions (phase I). At 6 months, both EGI and EGII showed significant improvements in BMI z-score (d=0.75, p=.002; d=0.60, p=.045), body composition, cardiorespiratory fitness (CRF) (d=1.48, p=.012; d=1.32, p=.022), and moderate (d=0.81, p=.005; d=1.39, p<.001), vigorous (d=0.83, p=.001; d=1.04, p<.001), and moderate-vigorous PA (d=0.90, p=.001; d=1.43, p<.001). EGI showed additional improvements in carotid intima-media thickness (d=1.09, p=.044), and sedentary time (d=0.70, p=.019), compared to CG at 6 months. At 12 months, further improvements in BMI z-score (d=0.95, p<.001; d=0.86, p=.015), body composition and CRF (ml/kg/min) (d=1.58, p=.033; d=1.17, p=.043) were observed in both EG’s, compared to CG. Net cost of EGI was 12.41 and 7.78 € per participant (19.5 and 24.1% above CG cost) for phase I and II. It was estimated that for each 1€ spent in EGI, a decrease of 0.002 and 0.009 in BMI z-score was obtained at 6 and 12 months, respectively. For EGII, net cost was 252.37 and 7.78 € per participant, for phase I and II, respectively. According to the results reported, the inclusion of a PAC (based on motivational interview) in a multidisciplinary clinical weight management program is a cost-effective way of improving PA, BMI z-score, body composition and CRF in adolescents at 6 months, with further improvements at 12 months, compared to standard care (comprising Pediatric and Nutrition consultations only). Inclusion of exercise sessions may have an additional value, if attendance would be guarantee.
Adolescent excess weight (including overweight and obesity) is a major public health concern, as it is associated with several short and long-run adverse health outcomes. Inappropriate health behaviors, such as increased energy intake and decreased levels of physical activity (PA), may be at the front of this epidemic. There is an urgent need for new strategies that may positively influence dietary and PA behaviors. The PAC-MAnO (The effect of a Physical Activity Consultation in the management of adolescent overweight) project was designed to investigate the impact of a Physical Activity Consultation (PAC) based on motivational interview on PA behavior and body mass index (BMI) z-score among adolescents with excess weight followed at a Pediatric Obesity Clinic. To the best of our knowledge, this is the first Portuguese study analyzing so broadly the impact of a PAC in management of adolescent excess weight. Between September 2016 and December 2018, adolescents with excess weight (BMI ≥85th percentile) attending the Clinic for the first time (n=165), who agreed to participate in the PAC-MAnO project, were allocated by consecutive sampling into three groups: Control group (CG), Experimental group I (EGI), and Experimental group II (EGII). CG followed standard care (Pediatric and Nutrition consultations) for 12 months. EG’s I and II were both exposed to PAC plus standard care for 12 months. EGII participants were additionally invited/encouraged to attend two exercise sessions/week in the first 6 months (phase I). Anthropometric, clinical, PA and nutritional assessments were performed at baseline, 6 (end of phase I) and 12 months (end of phase II). From the participants enrolled, 132 completed phase I (CG n=41, EGI n=45, EGII n=46) and 102, phase II (CG n=28, EGI n=36, EGII n=38). Only 43.5% (n=20) of EGII participants attended at least 80% of the scheduled exercise sessions (phase I). At 6 months, both EGI and EGII showed significant improvements in BMI z-score (d=0.75, p=.002; d=0.60, p=.045), body composition, cardiorespiratory fitness (CRF) (d=1.48, p=.012; d=1.32, p=.022), and moderate (d=0.81, p=.005; d=1.39, p<.001), vigorous (d=0.83, p=.001; d=1.04, p<.001), and moderate-vigorous PA (d=0.90, p=.001; d=1.43, p<.001). EGI showed additional improvements in carotid intima-media thickness (d=1.09, p=.044), and sedentary time (d=0.70, p=.019), compared to CG at 6 months. At 12 months, further improvements in BMI z-score (d=0.95, p<.001; d=0.86, p=.015), body composition and CRF (ml/kg/min) (d=1.58, p=.033; d=1.17, p=.043) were observed in both EG’s, compared to CG. Net cost of EGI was 12.41 and 7.78 € per participant (19.5 and 24.1% above CG cost) for phase I and II. It was estimated that for each 1€ spent in EGI, a decrease of 0.002 and 0.009 in BMI z-score was obtained at 6 and 12 months, respectively. For EGII, net cost was 252.37 and 7.78 € per participant, for phase I and II, respectively. According to the results reported, the inclusion of a PAC (based on motivational interview) in a multidisciplinary clinical weight management program is a cost-effective way of improving PA, BMI z-score, body composition and CRF in adolescents at 6 months, with further improvements at 12 months, compared to standard care (comprising Pediatric and Nutrition consultations only). Inclusion of exercise sessions may have an additional value, if attendance would be guarantee.
Description
Keywords
Adolescentes Gestão do peso Atividade física Alteração comportamental Saúde endotelial Adolescents Weight management Physical activity Behavior change Endothelial health Teses de doutoramento - 2020