Mobile health interventions and cardiorespiratory fitness in pediatric obesity

Sammanfattning: Pediatric obesity treatment, preferably at an early age, is important since obesity severely impairs present and future health. Current approaches for lifestyle changes do not provide results of clinical relevance, and effective treatment approaches are needed. Further, children with obesity have lower cardiorespiratory fitness (CRF) than their normal-weight peers. Therefore, it is important to assess CRF in clinical practice and to understand its potential relation to other cardiometabolic risk factors in this group of children. Study I investigated the feasibility, in terms of acceptability, compliance, usage of the intervention, and trial procedures, of a novel mobile Health (mHealth) intervention combined with standard behavioral treatment. The control group received standard behavioral treatment. After using the mHealth intervention for six months, parents and staff found it acceptable and reported that the intervention helped them to reach the treatment goal. Further, the intervention group had higher attendance at appointments than the control group. In Study II, a randomized controlled multi-center trial was conducted to evaluate the effectiveness of the same mHealth intervention as in Study I. However, the RCT was hampered by low recruitment, high attrition, and severe technical issues resulting in that a process analysis was conducted to understand what went wrong, in specific relation to the intervention group. Barriers were found for both the mHealth intervention and the study design. Study enrollment before or during the summer negatively affected recruitment. Attrition among participants, mHealth usage and engagement among participants and staff were highly impaired by technical issues with the mHealth intervention. After extensive adjustments regarding layout and technical functionality, Study III investigated the effect of the mHealth intervention and clinical appointments in a cohort of children at one obesity clinic. This group of children was compared with a randomly selected obesity cohort from a quality registry. At one-year follow-up the mHealth approach resulted in significantly better treatment results, of clinical relevance, compared with the control group. In Study IV reference values for CRF in children with obesity were conducted aimed at enabling improved grading, in a clinical setting, of children’s CRF health. The reference values were based on cross-sectional data from children with obesity performing a sub-maximal cycle ergometer test between 1999–2013. Analysis of CRF data showed a negative time trend whit a small but significant decrease of CRF over the studied years. In Study V, potential associations between CRF and cardiometabolic risk factors were explored in children with obesity. Cross-sectional data showed a significant inverse relationship between CRF and inflammatory markers, and the association remained when adjusted for degree of obesity. Children with the lowest CRF levels according to the reference values, had higher levels of low-grade inflammation compared with children who had the highest CRF levels.