









































ANNALES KINESIOLOGIAE • 16 • 2025 • 1

61

Review article         DOI: https://doi.org/10.35469/ak.2025.503
received: 2025-05-13             UDC: 616.12-053.2:796.011.1

PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS 
FOR CHILDREN AT CARDIOVASCULAR RISK: A 

SYSTEMATIC REVIEW

Katherine Estephani CONTRERAS-ZAPATA¹,², Sebastián Eustaquio 
MARTÍN-PÉREZ1,³,⁴, Nadia Ximena CRUZ-HIDALGO², Alejandro 

RUBIO-ZARAPUZ1, Vicente Javier CLEMENTE-SUÁREZ1, Isidro Miguel 
MARTÍN-PÉREZ⁴

1 Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, Spain
2 Grupo de Estudios en Educación, Actividad Física y Salud (GEEAFyS)

Universidad Católica del Maule, Talca, Chile 
3 Faculty of Health Sciences, Universidad Europea de Canarias, Santa Cruz de 

Tenerife, Spain
4 Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, Santa 

Cruz de Tenerife, Spain

Corresponding authors:
Katherine Estephani CONTRERAS-ZAPATA

Master’s Degree in Research in Physical Activity and Sport Sciences, Faculty of 
Medicine, Health and Sports, Universidad Europea de Madrid, Villaviciosa de Odón, 

28670, Madrid, Spain
Phone: +(56)939280206

E-mail: 224a1818@live.uem.es

Sebastián Eustaquio MARTÍN PÉREZ
Faculty of Health Sciences, Universidad Europea de Canarias, 38300, La Orotava, 

Santa Cruz de Tenerife, Spain 
Phone: +349090817166

E-mail: sebastian.martin@universidadeuropea.es

mailto:224a1818@live.uem.es
mailto:sebastian.martin@universidadeuropea.es


62

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

ABSTRACT

Introduction: Structured physical activity and lifestyle changes are promising 
strategies to reduce cardiovascular risk in children and adolescents. We hypothesize 
that programs meeting the minimum thresholds of frequency and duration—particu-
larly those combining aerobic and resistance components—can significantly lower the 
blood pressure in at-risk pediatric populations.

Purpose: To synthesize current evidence on the effectiveness of aerobic, resistance, 
and combined exercise interventions, alongside lifestyle modifications, in reducing car-
diovascular risk among children and adolescents.

Methods: A systematic review was conducted following PRISMA guidelines 
(PROSPERO CRD42025644256). Searches covered January 2015 to March 2025 
across MEDLINE (PubMed), SPORTDiscus (EBSCO), and the Cochrane Library. The 
included studies were RCTs or quasi-experimental designs integrating exercise with di-
etary or behavioral components. The primary outcomes were blood pressure, lipid pro-
file, body composition, physical fitness, and health-related quality of life. Study quality 
was assessed using the PEDro scale and Cochrane RoB 2.0 tool.

Results: Twenty-six studies (mean PEDro score: 9.9/10) met the inclusion criteria. 
Combined aerobic and resistance training with nutritional or behavioral support led 
to reductions in systolic/diastolic BP (–5 to –8 mmHg), body fat (–2 to –4%), and 
cholesterol (–10 to –15 mg/dL), alongside gains in aerobic capacity. Interventions in-
volving families and school personnel showed greater adherence and cardiometabolic 
improvements.

Conclusions: Integrated physical activity and lifestyle programs are effective at 
reducing cardiovascular risk markers in pediatric populations. Early implementation 
in supportive environments is essential for long-term health benefits.

Keywords: physical activity, cardiovascular risk, hypertension, obesity, pediatric, 
lifestyle interventions

TELESNA DEJAVNOST IN INTERVENCIJE V ŽIVLJENJSKI SLOG 
PRI OTROCIH S SRČNO-ŽILNO OGROŽENOSTJO: SISTEMATIČNI 

PREGLED

IZVLEČEK

Uvod: Strukturirana telesna dejavnost in spremembe življenjskega sloga so obetav-
ne strategije za zmanjšanje srčno-žilne ogroženosti pri otrocih in mladostnikih. Naša 
hipoteza je, da lahko programi, ki dosegajo minimalne meje pogostosti in trajanja 



63

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

(predvsem taki, ki združujejo aerobne elemente in elemente vadbe proti uporu), po-
membno znižajo krvni tlak pri ogroženih pediatričnih populacijah.

Namen: Strniti trenutne dokaze o učinkovitosti posegov v obliki aerobne vadbe, 
vadbe proti uporu in kombinirane vadbe skupaj s spremembami življenjskega sloga za 
zmanjšanje srčno-žilne ogroženosti pri otrocih in mladostnikih.

Metode: Sistematični pregled je bil izveden v skladu s smernicami PRISMA 
(PROSPERO CRD42025644256). Iskanja so zajemala obdobje od januarja 2015 
do marca 2025 v bazah MEDLINE (PubMed), SPORTDiscus (EBSCO) in Cochrane 
Library. Vključene so bile študije z randomiziranim kontroliranim poskusom (RKP) ali 
kvazieksperimentalno zasnovo, ki so združevale vadbo s prehranskimi ali vedenjskimi 
komponentami. Primarni izidi so bili krvni tlak, lipidni profil, telesna sestava, telesna 
pripravljenost in kakovost življenja, povezana z zdravjem. Kakovost študij je bila oce-
njena z uporabo lestvice PEDro in orodja Cochrane RoB 2.0.

Rezultati: Šestindvajset študij (povprečna ocena PEDro: 9,9/10) je izpolnjevalo 
merila izbora. Kombiniranje aerobne vadbe in vadbe proti uporu s prehransko ali ve-
denjsko podporo je privedlo do znižanja sistoličnega/diastoličnega krvnega tlaka (–5 
do –8 mmHg), telesne maščobe (–2 do –4 %) in holesterola (–10 do –15 mg/dL) in iz-
boljšanja aerobne zmogljivosti. Posegi, pri katerih so sodelovali družine in šolsko ose-
bje, so se izkazali za doslednejše, privedli pa so tudi do kardiometabolnega izboljšanja.

Zaključki: Integrirani programi telesne dejavnosti in sprememb življenjskega sloga 
so učinkoviti pri zmanjševanju kazalnikov tveganja za srce in ožilje pri pediatrični po-
pulaciji. Njihovo zgodnje uvajanje v podpornih okoljih je ključno za dolgoročne koristi 
za zdravje.

Ključne besede: telesna dejavnost, srčno-žilna ogroženost, hipertenzija, debelost, 
pediatrična populacija, intervencije v življenjski slog



64

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

INTRODUCTION

Non-communicable diseases (NCDs) account for the majority of global 
morbidity and mortality, driven by a complex interplay of genetic, physiologi-
cal, environmental, and psychosocial factors. Among these, arterial hyperten-
sion (HTN) is particularly insidious: often silent and asymptomatic (Falkner 
et al., 2023), it nonetheless accelerates atherosclerotic processes and substan-
tially elevates both coronary and cerebrovascular risk throughout the life-
span (Benenson, Waldron, & Porter, 2020; Bull et al., 2020; Ferrer-Arrocha, 
Fernández Rodríguez, & González Pedroso, 2020; Llapur-Milián & González-
Sánchez, 2017; Lurbe, Fernandez-Aranda, & Wühl, 2021; Hernández-
Magdariaga et al., 2023).

Although historically considered an adult condition, compelling evidence 
now demonstrates that the pathogenesis of HTN frequently begins in childhood 
or adolescence (Stephens, Fox, & Maxwell, 2012). In pediatric populations, 
elevated blood pressure is underdiagnosed—routine screening is uncommon 
and early elevations remain subclinical—yet even mild, sustained increases in 
systolic or diastolic pressure significantly amplify the lifetime cardiovascular 
risk (González-Sánchez et al., 2015; Xi et al., 2017; Venegas-Rodríguez, Vitón-
Castillo, Linares-Cánovas, Díaz-Pita, & Álvarez-Alvarez, 2021). Established 
pediatric risk factors include excess adiposity, physical inactivity, and seden-
tary behavior; overweight or obese children are up to five times more likely to 
develop HTN and its complications than their normal-weight peers.

Data from the American Heart Association indicates that approximately 15 
% of adolescents with systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg 
already exhibit subclinical coronary or cerebrovascular injury (Lloyd-Jones et 
al., 2011), and left ventricular hypertrophy can be detected within one year 
of pediatric HTN diagnosis (Rosas-Peralta et al., 2016). While pharmacolo-
gical treatments—ACE inhibitors, angiotensin II receptor blockers, and diu-
retics—effectively lower the blood pressure, their long-term use in children 
is hampered by metabolic side effects, dose titration requirements, adherence 
challenges, and potential psychosocial impacts (Cohen & Wills., 1985; Lurbe 
et al., 2010; de la Cerda & Herrero, 2014; Weaver Jr, 2019).

In recent years, structured physical activity and comprehensive lifestyle mo-
difications have emerged as promising non-pharmacological strategies for both 
the prevention and management of cardiovascular risk in the pediatric popula-
tion (Briones-Arteaga, 2016; Budts et al., 2020; Tozo et al., 2025; Williams, et 
al., 2019). While aerobic, resistance, and combined exercise programs have de-
monstrated significant reductions in systolic and diastolic blood pressure among 



65

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

children and adolescents, the available evidence remains inconsistent and fra-
gmented. Specifically, the optimal “dose” of exercise—defined by intensity, 
frequency, and duration—has not been clearly established, the relative efficacy 
of different exercise modalities is still up for debate, and effective strategies to 
ensure long-term adherence in young populations are largely lacking (del Valle 
Soto et al., 2015; Durán Parrondo, & Rueda Núñez, 2020; Gamero, Idarreta & 
Vargas, 2022). In this context, we hypothesized that structured physical activity 
interventions can significantly reduce systolic and diastolic blood pressure in 
children and adolescents with elevated cardiovascular risk, provided that mini-
mum thresholds of frequency and duration are met.

Therefore, the objective of this systematic review is to critically synthesize 
the available evidence on the effectiveness of aerobic, resistance, and combi-
ned exercise interventions, along with complementary lifestyle modifications, 
at reducing cardiovascular risk among children and adolescents. The review 
also aims to determine the optimal exercise parameters (intensity, frequency, 
and duration) and to develop practical and age-appropriate recommendations.

MATERIALS AND METHODS

Data Sources and Search Strategy

A systematic literature review was conducted following the PRISMA gu-
idelines (Page et al., 2021). The review protocol was previously registered in 
PROSPERO (CRD42025644256, https://www.crd.york.ac.uk/PROSPERO/
view/CRD42025644256). The literature search was performed from January 
28, 2025, to March 30, 2025, aiming to find relevant studies on the effecti-
veness of physical activity and lifestyle interventions for cardiovascular risk 
in children. Afterward, the databases searched included MEDLINE (PubMed), 
SPORTDiscus (EBSCO), and the Cochrane Library. In MEDLINE, the fol-
lowing search strategy was applied:

 – Population terms: “Children” OR “Adolescents” OR “Pediatric 
Population” AND (“Cardiovascular Risk” OR “Hypertension” OR 
“Obesity” OR “Metabolic Syndrome”).

 – Intervention terms: (“Physical Activity” OR “Exercise Therapy” OR 
“Aerobic Exercise” OR “Strength Training” OR “Lifestyle Modification” 
OR “Combined Interventions”).

https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644256
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644256


66

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Ta
bl

e 
1.

 S
ea

rc
h 

st
ra

te
gy

D
at

e
D

at
ab

as
e

Se
ar

ch
 T

er
m

s
Se

ar
ch

 E
qu

at
io

n

20
25

-0
2-

20
M

ED
LI

N
E 

(P
ub

M
ed

)

“C
ar

di
ov

as
cu

la
r r

is
k”

, “
hy

pe
rte

ns
io

n”
, 

“p
hy

si
ca

l a
ct

iv
ity

”,
 “

lif
es

ty
le

 in
te

rv
en

tio
ns

”,
 

“c
hi

ld
re

n”

(„
ca

rd
io

va
sc

ul
ar

 ri
sk

“ 
O

R
 „

hy
pe

rte
ns

io
n“

) A
N

D
 

(„
ph

ys
ic

al
 a

ct
iv

ity
“ 

O
R

 „
ex

er
ci

se
“)

 A
N

D
 („

lif
es

ty
le

 
in

te
rv

en
tio

ns
“)

 A
N

D
 („

ch
ild

re
n“

)

20
25

-0
2-

20
M

ED
LI

N
E 

(P
ub

M
ed

)
“O

be
si

ty
”,

 “
lif

es
ty

le
 c

ha
ng

es
”,

 “
ph

ys
ic

al
 

ex
er

ci
se

”,
 “

ad
ol

es
ce

nt
s”

(„
ob

es
ity

“)
 A

N
D

 („
lif

es
ty

le
 c

ha
ng

es
“ 

O
R

 „
ph

ys
ic

al
 

ex
er

ci
se

“)
 A

N
D

 („
ad

ol
es

ce
nt

s“
)

20
25

-0
2-

20
M

ED
LI

N
E 

(P
ub

M
ed

)
“F

itn
es

s”
, “

ca
rd

io
va

sc
ul

ar
 d

is
ea

se
”,

 
“c

hi
ld

re
n”

, “
lif

es
ty

le
 c

ho
ic

es
”

(„
fit

ne
ss

“)
 A

N
D

 („
ca

rd
io

va
sc

ul
ar

 d
is

ea
se

“)
 A

N
D

 
(„

ch
ild

re
n“

) A
N

D
 („

lif
es

ty
le

 c
ho

ic
es

“)

20
25

-0
2-

22
M

ED
LI

N
E 

(P
ub

M
ed

)
“E

xe
rc

is
e”

, “
hy

pe
rte

ns
io

n”
, “

m
et

ab
ol

ic
 

sy
nd

ro
m

e”
, “

te
en

ag
er

s”
(„

ex
er

ci
se

“)
 A

N
D

 („
hy

pe
rte

ns
io

n“
 O

R
 „

m
et

ab
ol

ic
 

sy
nd

ro
m

e“
) A

N
D

 („
te

en
ag

er
s“

)

20
25

-0
2-

28
M

ED
LI

N
E 

(P
ub

M
ed

)
“P

hy
si

ca
l a

ct
iv

ity
”,

 “
ch

ild
ho

od
 o

be
si

ty
”,

 
“l

ife
st

yl
e 

m
od

ifi
ca

tio
n”

(„
ph

ys
ic

al
 a

ct
iv

ity
“)

 A
N

D
 („

ch
ild

ho
od

 o
be

si
ty

“)
 A

N
D

 
(„

lif
es

ty
le

 m
od

ifi
ca

tio
n“

)

20
25

-0
3-

02
SP

O
RT

D
is

cu
s 

(E
B

SC
O

)
“C

ar
di

ov
as

cu
la

r d
is

ea
se

”,
 “

ch
ild

re
n”

, 
“p

hy
si

ca
l a

ct
iv

ity
”,

 “
ex

er
ci

se
”

(„
ca

rd
io

va
sc

ul
ar

 d
is

ea
se

“)
 A

N
D

 („
ch

ild
re

n“
) A

N
D

 
(„

ph
ys

ic
al

 a
ct

iv
ity

“ 
O

R
 „

ex
er

ci
se

“)

20
25

-0
3-

22
SP

O
RT

D
is

cu
s 

(E
B

SC
O

)
“O

be
si

ty
, “

ph
ys

ic
al

 a
ct

iv
ity

”,
 “

yo
ut

h”
, 

“l
ife

st
yl

e 
in

te
rv

en
tio

ns
”

(„
ob

es
ity

“)
 A

N
D

 („
ph

ys
ic

al
 a

ct
iv

ity
“)

 A
N

D
 („

yo
ut

h“
) 

A
N

D
 („

lif
es

ty
le

 in
te

rv
en

tio
ns

“ 
O

R
 „

lif
es

ty
le

 c
ha

ng
es

“)

20
25

-0
3-

30
SP

O
RT

D
is

cu
s 

(E
B

SC
O

)
“P

hy
si

ca
l fi

tn
es

s”
, “

ex
er

ci
se

”,
 “

te
en

ag
er

s”
, 

“c
ar

di
ov

as
cu

la
r r

is
k”

(„
ph

ys
ic

al
 fi

tn
es

s“
 O

R
 „

ex
er

ci
se

“)
 A

N
D

 („
te

en
ag

er
s“

) 
A

N
D

 („
ca

rd
io

va
sc

ul
ar

 ri
sk

“)

20
25

-0
2-

27
C

oc
hr

an
e 

Li
br

ar
y

“H
yp

er
te

ns
io

n”
, “

ob
es

ity
”,

 “
ph

ys
ic

al
 

ex
er

ci
se

”,
 “

sy
st

em
at

ic
 re

vi
ew

”

(„
hy

pe
rte

ns
io

n“
 O

R
 „

ob
es

ity
“)

 A
N

D
 („

ph
ys

ic
al

 
ex

er
ci

se
“)

 A
N

D
 („

sy
st

em
at

ic
 re

vi
ew

“)
 A

N
D

 N
O

T 
„r

ev
ie

w
“

20
25

-0
3-

27
C

oc
hr

an
e 

Li
br

ar
y

“C
ar

di
ov

as
cu

la
r r

is
k”

, “
lif

es
ty

le
 

in
te

rv
en

tio
ns

”,
 “

ex
er

ci
se

”,
 “

ch
ild

re
n”

(„
ca

rd
io

va
sc

ul
ar

 ri
sk

“)
 A

N
D

 („
lif

es
ty

le
 in

te
rv

en
tio

ns
“ 

O
R

 „
ex

er
ci

se
“)

 A
N

D
 („

ch
ild

re
n“

)



67

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

 – Additional terms: “Hypertension” [Mesh], “Exercise” [Mesh], 
“Lifestyle” [Mesh], “Obesity” [Mesh], and keywords like “Exercise in-
tervention”, “Cardiovascular risk”, and “pediatric”.

Similar search strategies were applied to SPORTDiscus (EBSCO) and the 
Cochrane Library. Three independent researchers (SMP, IMP, and ARZ) con-
ducted the searches, and a fourth researcher (VJS), blinded to the process, revi-
ewed all the articles by title and abstract. Selected articles underwent a full-text 
review for eligibility. The detailed search strategy is shown in Table 1. Search 
strategy.

Study Selection

The inclusion criteria for the systematic review and meta-analysis were as 
follows:

1. Randomized, non-randomized, or quasi-experimental clinical trials, case 
series, and case reports.

2. Studies published between January 1, 2015, and March 30, 2025.
3. Studies published in English, Spanish, or Portuguese.
4. Availability of full-text articles.
5. Studies involving children or adolescents (ages 5–17) with cardiovascu-

lar risk (hypertension, obesity or metabolic syndrome).
6. Participants in physical-activity-based rehabilitation programs, with or 

without additional educational, psychological, or nutritional support.
7. Studies measuring physical functionality, metabolic parameters, and li-

festyle-related outcomes (e.g., exercise, diet) as primary or secondary 
outcomes.

Exclusion criteria included:
1. Non-original publications, such as conference presentations, abstracts, 

correspondence, and narrative reviews.
2. Duplicated or re-published studies.
3. Studies with significant methodological issues or low scientific rigor.
4. Studies with incomplete data or inaccessible information.
Discrepancies were resolved using a standardized PICO (Population, 

Intervention, Comparison, Outcome) framework. One independent researcher 
(NCH) extracted all the relevant data, including authorship, year and country of 
publication, study design, objectives, measured outcomes, participant charac-
teristics (e.g., sample size, sex, clinical status), details of the intervention and 
control groups, and main conclusions. The process adhered to the guidelines 



68

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

outlined in the Cochrane Handbook for Systematic Reviews of Interventions 
(version 5.1.0) (Higgins & Green, 2019). To ensure reliability, the data extracti-
on table was piloted using a representative sample of included studies.

Methodological Quality Assessment (PEDro Scale)

The methodological quality of the included trials was assessed using the 
PEDro scale (Maher, Sherrington, Herbert, Moseley, & Elkins, 2003), consi-
sting of 11 items evaluating internal validity (items 2–9) and statistical repor-
ting (items 10–11). The studies were classified as follows:

 – Excellent quality: 9–10 points.
 – Good quality: 6–8 points.
 – Poor quality: <4 points.

Risk of Bias Assessment (RoB 2.0)

The risk of bias in randomized clinical trials was evaluated using the 
Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2.0) (Higgins et al., 
2011), focusing on:

 – Randomization process.
 – Deviations from the intended interventions.
 – Missing outcome data.
 – Outcome measurement.
 – Selection of reported outcomes.

A low risk of bias indicates a minimal potential impact on the study results, 
while a high risk reduces confidence in the findings. Discrepancies between 
reviewers were resolved through discussion, with final decisions made by a 
third reviewer (SMP).



69

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

RESULTS

Study Selection

A total of 740 records were identified through database searches, including 
272 from MEDLINE (PubMed), 6 from SPORTDiscus (EBSCO), and 462 
from the Cochrane Library. After removing 481 records due to duplication, 
irrelevant titles or abstracts, or failure to meet the initial inclusion criteria, 259 
studies were retained for screening. Of these, 108 were excluded after title and 
abstract review for reasons such as a focus on adult populations, lack of structu-
red exercise interventions, or the absence of cardiovascular risk outcomes. The 
remaining 151 full-text articles were assessed for eligibility. 

A total of 125 studies were excluded at this stage: 22 due to ineligible stu-
dy design (e.g., case reports, commentaries, or non-interventional studies), 12 
for lacking quantifiable pre/post-intervention data, 6 for being observational 
studies without structured physical activity components, 8 for incomplete inter-
vention or outcome reporting, and 77 for being secondary literature (e.g., nar-
rative reviews, systematic reviews, meta-analyses, or bibliometric analyses). 
Ultimately, 26 studies met all the eligibility criteria and were included in the 
final systematic review. See Figure 1. Flow diagram of study selection accor-
ding to PRISMA 2020.

Characteristics of the Included Studies

This systematic review included 26 studies, including randomized control-
led trials (RCTs), quasi-experimental studies, and non-randomized trials, all 
aimed at assessing the impact of physical activity and lifestyle interventions 
on children and adolescents with cardiovascular risk factors, primarily focu-
sing on obesity, hypertension, and metabolic syndrome. These studies were 
published between 2015 and 2025 and involved a variety of interventions, in-
cluding exercise-based programs, diet modifications, and family- or school- 
based support (Aguilar-Cordero et al., 2020; Anderson et al., 2017; André & 
Béguier, 2015; Hossain et al., 2018; Jerome et al., 2022; Kalantari et al., 2017; 
Kokkvoll, Grimsgaard, Steinsbekk, Flægstad, & Njølstad 2015; Mameli et al., 
2018; Malarvizhi & Pasupathy, 2023; Martí, Martínez, Ojeda-Rodríguez, & 
Azcona-Sanjulian, 2021; Morell-Azanza et al., 2019; Nayak & Bhat, 2016; 
Eggertsen et al., 2025; Ojeda-Rodríguez et al., 2021; Oreskovic, Winickoff, 



70

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Figure 1: Flow diagram of study selection according to PRISMA 2020

Identification of studies via databases and registers

In
cl

ud
ed

Sc
re

en
in

g
Id

en
tifi

ca
tio

n

Records identified from:  
(n = 740)
MEDLINE (PubMed) (n = 272)
SPORT Discus (n = 6)
Cochrance Library (n = 462)

Records screened
(n = 259)

Studies included in the review  
(n = 26)

Records excluded**
after reading title and abstract 
(n = 108)

Records removed before screening: 
duplicate records removed   
(n = 481)

Reports excluded (n = 125):
– Ineligible study design (e.g. 
case reports, commentaries, non-
interventional trials) (n = 22)
– No quantifiable pre-post 
intervention data on blood pressure 
or other cardiovascular outcomes 
(n = 12)
– Observational studies without 
a structured physical activity 
intervention (n = 6)
– Incomplete reporting of 
intervention protocols or outcome 
data (n = 8)
– Secondary literature (e.g. 
narrative reviews, systematic 
reviews, bibliometric analyses, 
meta-analyses) (n = 77)

Reports assessed for eligibility 
(n = 151)



71

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Perrin, Robinson, & Goodman, 2016; Pamplona-Cunha, et al., 2022; Wesnigk 
et al., 2016; Wong, Sanchez-Gonzalez, Son, Kwak, & Park, 2018; Xu et al., 
2020).

The total number of participants across all the studies was approximately 
3,500, with study populations ranging from small groups (n = 16) to large-scale 
(n = 6764). The participants’ ages ranged from 5 to 18 years, with a large num-
ber of studies focusing on adolescents (10–17 years). Both boys and girls were 
included, with some studies providing gender-specific effects (Anderson et al., 
2017; Mameli et al., 2018). Many of the studies (n = 20) were RCTs, ensuring 
an important level of evidence, while a few of them (n = 4) were quasi-experi-
mental, and some (n = 2) were non-randomized controlled trials. These designs 
provided valuable insights into the efficacy of lifestyle changes in children and 
adolescents (Aguilar-Cordero et al., 2020; Hossain et al., 2018).

The interventions tested in the studies varied in length, ranging from short- 
term programs (e.g., 8 weeks) to long-term interventions (up to 22 months). 
Most of the interventions focused on physical activity, including aerobic 
exercises, strength training, or combined programs, and were supplemented 
by nutritional guidance. Some studies also included behavioral support, such 
as Motivational Interviewing (MI) or educational programs aimed at impro-
ving knowledge of healthy lifestyle choices. These interventions were often 
family-based or school-based, reflecting the importance of involving the fa-
mily and community in promoting healthy habits (André & Béguier, 2015; 
Malarvizhi & Pasupathy, 2023; Morell-Azanza et al., 2019).

Most of the studies used a control group, with some employing minimal- 
intensity or usual care groups, while others compared several types of inter-
ventions (e.g., exercise only vs. exercise with diet). A few studies were used 
within-subject designs where the participants served as their own control, as-
sessing changes before and after the intervention. The main outcomes measu-
red included blood pressure (systolic and diastolic), body mass index (BMI), 
body fat percentage, physical fitness (e.g., aerobic capacity, muscle strength), 
and quality of life. Additional outcomes included metabolic parameters 
such as cholesterol levels, insulin sensitivity, and markers of inflammation 
(Arenaza et al., 2020; Malarvizhi & Pasupathy, 2023; Oreskovic et al., 2016).

The follow-up periods varied across studies, with most measuring immedi-
ate or short-term effects (≤ 12 weeks), while others had long-term follow-ups 
(12 months or more), allowing for an assessment of both immediate benefits 
and the sustainability of the interventions (Wesnigk et al., 2016; Wong et al., 
2018). The methodological quality of the studies was generally high, with most 
reporting a PEDro score of 8 or above, showing good quality. The risk of bias 



72

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

was assessed using the RoB 2.0 tool, and most studies showed a low to mode-
rate risk. However, some studies had limitations in blinding and randomization 
procedures, which could have influenced the results (Kalantari et al., 2017; 
Kokkvoll et al., 2015).

The studies were conducted in various countries, including Spain, the USA, 
New Zealand, Italy, and China, adding to the generalizability of the findings. 
However, cultural and contextual factors may influence the effectiveness of the 
interventions, as certain dietary habits and physical activity levels differ across 
regions (Nayak & Bhat, 2016; Wang, Lau, Wang, & Ma, 2015). Overall, the 
review found that the interventions, especially those combining physical acti-
vity with nutritional modifications and behavioral support, significantly impro-
ved cardiovascular risk factors such as blood pressure, body composition, and 
physical fitness. These findings underscore the importance of early interventi-
ons and promoting healthy habits to prevent long-term cardiovascular diseases 
(Oreskovic et al., 2016; Pamplona-Cunha et al., 2022). Detailed information is 
presented in Table 2.



73

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94
 T

ab
le

 2
. C

ha
ra

ct
er

is
tic

s o
f t

he
 in

cl
ud

ed
 st

ud
ie

s

St
ud

y
C

ou
nt

ry
D

es
ig

n
Pa

rt
ic

ip
an

ts
 

D
ur

at
io

n
In

te
rv

en
tio

n
C

on
tr

ol
O

ut
co

m
es

C
on

cl
us

io
ns

A
gu

ila
r-

C
or

de
ro

 e
t a

l.,
 

20
20

Sp
ai

n
R

C
T

98
 o

ve
rw

ei
gh

t/
ob

es
e 

ch
ild

re
n 

(1
0.

43
 ±

 1
.3

5 
ye

ar
s)

8 
m

on
th

s

Pl
ay

-b
as

ed
 

ph
ys

ic
al

 a
ct

iv
ity

 
+ 

nu
tri

tio
na

l 
ed

uc
at

io
n

U
su

al
 c

ar
e

H
yp

er
te

ns
io

n:
 8

5.
7%

 
→

 1
6.

3%
 (p

 <
 0

.0
01

)
SB

P 
(p

 <
 0

.0
01

)
D

B
P 

(p
 <

 0
.0

01
) 

B
od

y 
fa

t %
 (p

 <
 

0.
00

1)

Ph
ys

ic
al

 a
ct

iv
ity

 
co

m
bi

ne
d 

w
ith

 
he

al
th

y 
ea

tin
g 

si
gn

ifi
ca

nt
ly

 re
du

ce
s 

bl
oo

d 
pr

es
su

re
 in

 
ov

er
w

ei
gh

t/o
be

se
 

ch
ild

re
n.

A
nd

er
so

n 
et

 a
l.,

 
20

17
N

ew
 

Ze
al

an
d

U
nb

lin
de

d 
R

C
T

20
3 

ch
ild

re
n 

(5
–1

6 
ye

ar
s)

12
 m

on
th

s
M

ul
tid

is
ci

pl
in

ar
y 

lif
es

ty
le

 p
ro

gr
am

M
in

im
al

-
in

te
ns

ity
 

co
nt

ro
l

Δ 
B

M
I S

D
S:

 −
0.

35
 v

s 
−0

.1
4 

(p
 <

 0
.0

5)
Q

oL
: 1

5.
6 

± 
10

.2
 v

s 
7.

9 
± 

12
.3

 (p
 <

 0
.0

1)

H
ig

h 
at

te
nd

an
ce

 in
 

a 
m

ul
tid

is
ci

pl
in

ar
y 

pr
og

ra
m

 y
ie

ld
s 

si
gn

ifi
ca

nt
 B

M
I S

D
S 

re
du

ct
io

n 
an

d 
be

tte
r 

qu
al

ity
 o

f l
ife

.

A
nd

ré
 &

 
B

ég
ui

er
, 2

01
5

Fr
an

ce
R

C
T

24
 o

be
se

 
ad

ol
es

ce
nt

s (
12

–1
7 

ye
ar

s)

N
ot

 
sp

ec
ifi

ed

PA
 +

 
M

ot
iv

at
io

na
l 

In
te

rv
ie

w
in

g
PA

 o
nl

y

B
M

I: 
−1

.5
 v

s −
0.

9 
(p

 
< 

0.
05

)
Se

lf-
effi

ca
cy

: 7
.8

 ±
 

2.
1 

vs
 5

.2
 ±

 2
.8

 (p
 <

 
0.

01
)

In
te

gr
at

in
g 

M
I 

w
ith

 P
A

 e
nh

an
ce

s 
se

lf-
re

gu
la

tio
n 

an
d 

lo
ng

-te
rm

 b
eh

av
io

r 
ch

an
ge

.

A
re

na
za

 e
t a

l.,
 

20
20

Sp
ai

n
Tw

o-
ar

m
 

R
C

T

81
 o

ve
rw

ei
gh

t/
ob

es
e 

ch
ild

re
n 

(1
0.

6 
± 

1.
1 

ye
ar

s;
 5

3%
 

gi
rls

)

22
 w

ee
ks

Fa
m

ily
-b

as
ed

 
he

al
th

y 
lif

es
ty

le
 

+ 
ex

er
ci

se

N
o-

ex
er

ci
se

 
co

nt
ro

l

K
ID

M
ED

: ↑
5.

4 
→

 
7.

7 
(p

 <
 0

.0
01

);
D

A
SH

: ↑
1.

1 
→

 1
.9

 (p
 

< 
0.

00
1)

En
er

gy
 ra

tio
: 0

.7
3 

→
 

0.
61

 (p
 <

 0
.0

14
)

Fa
m

ily
 p

ro
gr

am
s 

im
pr

ov
e 

di
et

 q
ua

lit
y;

 
em

ph
as

iz
e 

re
du

ci
ng

 
su

ga
ry

 d
rin

ks
 a

nd
 

in
cr

ea
si

ng
 a

ct
iv

ity
.

B
ru

yn
do

nc
kx

 
et

 a
l.,

 2
01

5
B

el
gi

um
Q

ua
si

-
ra

nd
om

iz
ed

 
tri

al

61
 o

be
se

 
ad

ol
es

ce
nt

s (
12

–1
8 

ye
ar

s)
10

 m
on

th
s

R
es

id
en

tia
l d

ie
t 

an
d 

ex
er

ci
se

U
su

al
 c

ar
e

B
M

I: 
−2

.2
 v

s −
0.

7 
(p

 
< 

0.
01

)
B

od
y 

fa
t %

: −
5.

4%
 v

s 
−1

.2
%

 (p
 <

 0
.0

5)

R
es

id
en

tia
l d

ie
t a

nd
 

ex
er

ci
se

 in
te

rv
en

tio
n 

im
pr

ov
es

 o
be

si
ty

 
m

ar
ke

rs
.



74

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

St
ud

y
C

ou
nt

ry
D

es
ig

n
Pa

rt
ic

ip
an

ts
 

D
ur

at
io

n
In

te
rv

en
tio

n
C

on
tr

ol
O

ut
co

m
es

C
on

cl
us

io
ns

Eg
ge

rts
en

 e
t 

al
., 

20
25

D
en

m
ar

k
R

C
T

17
3 

ob
es

e 
ch

ild
re

n
12

 m
on

th
s

Li
fe

st
yl

e 
w

ith
/

w
ith

ou
t H

II
T

U
su

al
 c

ar
e

B
M

I S
D

S:
 −

0.
20

 (p
 

< 
0.

01
)

Pe
ds

Q
L:

 +
6.

89
 (p

 <
 

0.
01

)

H
II

T 
fe

as
ib

le
 a

nd
 

im
pr

ov
es

 a
dh

er
en

ce
 

an
d 

Q
oL

.

H
os

sa
in

 e
t a

l.,
 

20
18

U
SA

R
C

T
21

 a
do

le
sc

en
ts

 
(1

4–
18

 y
ea

rs
; 1

5 
ob

es
e,

 6
 le

an
)

N
ot

 
sp

ec
ifi

ed
Ph

ys
ic

al
 a

ct
iv

ity
 

lif
es

ty
le

U
su

al
 c

ar
e

25
(O

H
)D

: 1
2.

8 
vs

 9
.3

 
ng

/m
L 

(p
 =

 0
.0

6)
Fa

t-f
re

e 
m

as
s:

 +
1.

5 
kg

 v
s +

0.
3 

kg
 (p

 <
 

0.
05

)

PA
 im

pr
ov

es
 v

ita
m

in
 

D
 st

at
us

 a
nd

 le
an

 
m

as
s w

ith
ou

t 
su

pp
le

m
en

ta
tio

n.

H
ow

ie
 e

t a
l.,

 
20

15
A

us
tra

lia
W

ith
in

-
su

bj
ec

t 
co

nt
ro

lle
d

56
 o

be
se

 
ad

ol
es

ce
nt

s (
11

–1
6 

ye
ar

s)

8 
w

ee
ks

 +
 

12
-m

on
th

 
fo

llo
w

-u
p

Pa
re

nt
-le

d 
se

lf-
de

te
rm

in
at

io
n 

+ 
PA

 +
 n

ut
rit

io
n 

+ 
ed

uc
at

io
n

W
ith

in
-

su
bj

ec
t 

co
nt

ro
l

6M
W

T:
 +

48
.8

 m
 (8

 
w

k,
 p

 =
 0

.0
18

); 
+8

1.
3 

m
 (1

2 
m

o,
 p

 <
 0

.0
01

)
Q

ua
dr

ic
ep

s:
 +

1.
1 

kg
·F

 (p
 =

 0
.0

30
).

D
el

to
id

s:
 +

1.
0 

kg
·F

 
(p

 =
 0

.0
44

)

Sh
or

t-t
er

m
 p

ro
gr

am
 

yi
el

ds
 la

st
in

g 
fit

ne
ss

 
an

d 
st

re
ng

th
 g

ai
ns

.

Je
ro

m
e 

et
 a

l.,
 

20
22

U
SA

Tw
o-

ar
m

 
R

C
T

10
0 

ov
er

w
ei

gh
t/

ob
es

e 
ad

ol
es

ce
nt

s 
w

ith
 A

D
H

D
 (8

–1
8 

ye
ar

s)

12
 m

on
th

s
M

V
PA

 +
 d

ie
ta

ry
 

co
un

se
lin

g

St
an

da
rd

 
A

D
H

D
 

ca
re

B
M

I (
8–

12
 y

rs
): 

p 
= 

0.
01

4
M

V
PA

 (8
–1

2 
yr

s)
: p

 
= 

0.
01

2
Sc

re
en

 ti
m

e 
in

cr
ea

se
 

in
 B

la
ck

 p
ar

tic
ip

an
ts

: 
p 

= 
0.

00
7

Pr
om

ot
e 

PA
 a

nd
 li

m
it 

sc
re

en
 ti

m
e 

in
 y

ou
th

 
w

ith
 A

D
H

D
.

K
al

an
ta

ri 
et

 a
l.,

 
20

17
Ir

an
R

C
T

96
 m

al
e 

ad
ol

es
ce

nt
s 

(1
2–

16
 y

ea
rs

)
12

 w
ee

ks
C

om
pr

eh
en

si
ve

 
lif

es
ty

le
U

su
al

 c
ar

e

B
od

y 
fa

t %
: −

1.
81

%
 

(p
 <

 0
.0

1)
B

M
I: 

24
.7

 v
s 2

5.
1 

(p
 

= 
0.

10
)

12
-w

ee
k 

lif
es

ty
le

 
pr

og
ra

m
 re

du
ce

s 
bo

dy
 fa

t i
n 

m
al

e 
ad

ol
es

ce
nt

s.

K
ok

kv
ol

l e
t a

l.,
 

20
15

N
or

w
ay

R
C

T
97

 c
hi

ld
re

n 
(6

–1
2 

ye
ar

s)
N

ot
 

sp
ec

ifi
ed

M
ul

ti-
fa

m
ily

 v
s 

si
ng

le
-f

am
ily

Si
ng

le
-

fa
m

ily
 

in
te

r-
ve

nt
io

n

B
M

I: 
−1

.2
9 

vs
 −

2.
02

 
kg

/m
² (

p 
= 

0.
07

5)
W

ai
st

 c
irc

.: 
−2

.4
 c

m
 

(p
 =

 0
.0

38
)

M
ul

ti-
fa

m
ily

 
ap

pr
oa

ch
 b

en
efi

ts
 

w
ai

st
 c

irc
um

fe
re

nc
e 

an
d 

ps
yc

ho
lo

gy
.



75

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94
St

ud
y

C
ou

nt
ry

D
es

ig
n

Pa
rt

ic
ip

an
ts

 
D

ur
at

io
n

In
te

rv
en

tio
n

C
on

tr
ol

O
ut

co
m

es
C

on
cl

us
io

ns

K
le

pp
an

g 
et

 a
l.,

 
20

24
N

or
w

ay

C
lu

st
er

-
co

nt
ro

lle
d 

no
n-

ra
nd

om
iz

ed

12
6 

ch
ild

re
n 

(5
–1

3 
ye

ar
s)

N
ot

 
sp

ec
ifi

ed
Fa

m
ily

-b
as

ed
 

lif
es

ty
le

U
su

al
 c

ar
e

H
R

Q
oL

: 5
0.

0 
vs

 4
9.

0 
(p

 =
 0

.8
9)

Sl
ee

p 
ha

bi
ts

: 4
5.

2 
vs

 
46

.0
 (p

 =
 0

.9
2)

N
o 

si
gn

ifi
ca

nt
 

im
pr

ov
em

en
ts

 in
 

Q
oL

 o
r s

le
ep

.

M
am

el
i e

t a
l.,

 
20

18
Ita

ly
R

C
T

30
 o

ve
rw

ei
gh

t/
ob

es
e 

ch
ild

re
n 

(1
0–

17
 y

ea
rs

)
3 

m
on

th
s

Pe
rs

on
al

iz
ed

 
lif

es
ty

le
 +

 
ex

er
ci

se
 a

pp
U

su
al

 c
ar

e
B

M
I z

-s
co

re
: 0

.0
7 

kg
 

(C
I 2

.8
1,

 2
.9

6)

N
o 

si
gn

ifi
ca

nt
 

w
ei

gh
t l

os
s w

ith
 a

 
pe

rs
on

al
iz

ed
 a

pp
.

M
al

ar
vi

zh
i 

&
 P

as
up

at
hy

, 
20

23
In

di
a

R
C

T
14

5 
ov

er
w

ei
gh

t 
ch

ild
re

n 
(1

1–
15

 
ye

ar
s)

N
ot

 
sp

ec
ifi

ed

Sc
ho

ol
-b

as
ed

 
ex

er
ci

se
 +

 
nu

tri
tio

n 
gu

id
el

in
es

U
su

al
 

cu
rr

ic
ul

um

D
is

ta
nc

e:
 +

15
0 

m
 (p

 
< 

0.
05

)
V

O
₂ m

ax
: +

5.
3 

m
L/

kg
/m

in
 (p

 <
 0

.0
1)

Sc
ho

ol
-b

as
ed

 
in

te
rv

en
tio

ns
 

im
pr

ov
e 

ex
er

ci
se

 
to

le
ra

nc
e.

M
ar

tí 
et

 a
l.,

 
20

21
Sp

ai
n

R
C

T
29

 w
ith

 a
bd

om
in

al
 

ob
es

ity

2 
m

on
th

s +
 

10
-m

on
th

 
fo

llo
w

-u
p

In
te

ns
iv

e 
lif

es
ty

le
U

su
al

 c
ar

e

LB
P:

 0
.9

 µ
g/

m
L 

(p
 =

 
0.

03
3)

C
he

m
er

in
: 1

.3
 n

g/
m

L 
(p

 =
 0

.0
29

)

R
ed

uc
tio

ns
 

in
 m

et
ab

ol
ic

 
bi

om
ar

ke
rs

 su
gg

es
t 

im
pr

ov
ed

 ri
sk

.

M
or

el
l-A

za
nz

a 
et

 a
l.,

 2
01

9
Sp

ai
n

R
C

T
10

6 
w

ith
 a

bd
om

in
al

 
ob

es
ity

8 
w

ee
ks

M
ul

tid
is

ci
pl

in
ar

y 
lif

es
ty

le
U

su
al

 c
ar

e

M
V

PA
: +

5.
5 

m
in

/d
ay

 
(p

 <
 0

.0
5)

Le
pt

in
 in

ve
rs

el
y 

co
rr

el
at

ed
 (p

 <
 0

.0
5)

B
oo

st
s M

V
PA

 a
nd

 
lo

w
er

s l
ep

tin
 in

 
ob

es
e 

ch
ild

re
n.

M
ox

le
y 

et
 a

l.,
 

20
19

U
SA

Q
ua

si
-

ex
pe

ri-
m

en
ta

l

88
4 

ch
ild

re
n/

ad
ol

es
ce

nt
s (

5–
17

 
ye

ar
s)

N
ot

 
sp

ec
ifi

ed

Pa
re

nt
-f

oc
us

ed
 

m
en

ta
l, 

nu
tri

tio
na

l a
nd

 
ha

bi
t e

du
ca

tio
n

Va
rio

us
 

su
bg

ro
up

s

B
M

I z
-s

co
re

 (p
 <

 
0.

00
01

)
FF

M
 a

nd
 b

od
y 

fa
t 

im
pr

ov
em

en
ts

 (p
 <

 
0.

00
01

)

Fa
m

ily
-in

vo
lv

ed
 

in
te

rv
en

tio
ns

 
im

pr
ov

e 
bo

dy
 

co
m

po
si

tio
n 

su
st

ai
na

bl
y.

N
ay

ak
 &

 B
ha

t, 
20

16
In

di
a

R
C

T
19

4 
ov

er
w

ei
gh

t/
ob

es
e 

ch
ild

re
n

6 
m

on
th

s
M

ul
tic

om
po

ne
nt

 
lif

es
ty

le
U

su
al

 c
ar

e

B
M

I: 
24

.9
 v

s 2
2.

8 
(p

 
= 

0.
03

4)
Sk

in
fo

ld
s:

 si
gn

ifi
ca

nt
 

re
du

ct
io

ns
; S

el
f-

es
te

em
 im

pr
ov

ed

D
ai

ly
 v

ig
or

ou
s 

ex
er

ci
se

 a
nd

 h
ea

lth
y 

ea
tin

g 
re

du
ce

 
ad

ip
os

ity
 a

nd
 b

oo
st

 
se

lf-
es

te
em

.

O
je

da
-

R
od

ríg
ue

z 
et

 
al

., 
20

21
Sp

ai
n

R
C

T
12

1 
ab

do
m

in
al

 
ob

es
ity

 (7
–1

6 
ye

ar
s)

22
 m

on
th

s
Li

fe
st

yl
e 

pr
og

ra
m

U
su

al
 c

ar
e

M
V

PA
: +

5.
4 

m
in

/d
ay

 
(p

 =
 0

.0
35

)
Se

de
nt

ar
y 

+4
9.

7 
m

in
/

da
y 

(c
on

tro
l, 

p 
= 

0.
01

0)

In
te

ns
iv

e 
PA

 h
el

ps
 

m
ai

nt
ai

n 
te

lo
m

er
e 

le
ng

th
 in

 o
be

se
 

ch
ild

re
n.



76

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

St
ud

y
C

ou
nt

ry
D

es
ig

n
Pa

rt
ic

ip
an

ts
 

D
ur

at
io

n
In

te
rv

en
tio

n
C

on
tr

ol
O

ut
co

m
es

C
on

cl
us

io
ns

O
re

sk
ov

ic
 e

t 
al

., 
20

16
U

SA
Q

ua
si

-R
C

T
60

 a
do

le
sc

en
ts

 
(1

0–
16

 y
ea

rs
)

N
ot

 
sp

ec
ifi

ed

B
ui

lt-
en

vi
ro

nm
en

t 
co

un
se

lin
g 

+ 
PA

St
an

da
rd

 
co

un
se

lin
g

M
V

PA
: +

13
.9

 v
s −

0.
6 

m
in

 (T
2,

 p
 <

 0
.0

00
1)

; 
+9

.3
 v

s +
0.

5 
m

in
 (T

3,
 

p 
= 

0.
00

06
); 

≥6
0 

m
in

/
da

y:
 2

1%
 v

s 0
%

C
ou

ns
el

in
g 

en
ha

nc
es

 
M

V
PA

 in
 o

be
se

 
ad

ol
es

ce
nt

s.

Pa
m

pl
on

a-
C

un
ha

 e
t a

l.,
 

20
22

B
ra

zi
l

R
C

T

11
4 

ab
do

m
in

al
 

ob
es

ity
 +

 
dy

sl
ip

id
em

ia
 (8

–1
4 

ye
ar

s)

N
ot

 
sp

ec
ifi

ed
PA

 +
 n

ut
rit

io
na

l 
co

un
se

lin
g

PA
 o

nl
y

To
ta

l c
ho

le
st

er
ol

: 
−1

1%
 (p

 <
 0

.0
01

)
LD

L-
c:

 −
19

%
 (p

 =
 

0.
00

2)
B

od
y 

fa
t: 

−5
.2

%

N
ut

rit
io

na
l 

co
un

se
lin

g 
pl

us
 P

A
 

en
ha

nc
es

 fa
t a

nd
 ri

sk
 

m
ar

ke
r r

ed
uc

tio
n.

W
an

g 
et

 a
l.,

 
20

15
C

hi
na

C
lu

st
er

 
no

n-
ra

nd
om

iz
ed

43
8 

ch
ild

re
n 

(7
–1

2 
ye

ar
s)

N
ot

 
sp

ec
ifi

ed
D

ie
t +

 P
A

 v
s d

ie
t-

on
ly

 v
s P

A
-o

nl
y

D
ie

t-o
nl

y,
 

PA
-o

nl
y,

 
co

nt
ro

l

B
od

y 
fa

t %
: −

1.
01

%
 

(p
 <

 0
.0

01
)

SB
P:

 −
4.

37
 m

m
H

g 
(p

 
< 

0.
05

)

C
om

bi
ne

d 
pr

og
ra

m
 

ou
tp

er
fo

rm
s d

ie
t-

on
ly

 a
nd

 P
A

-o
nl

y.

W
an

g 
et

 a
l.,

 
20

22
C

hi
na

M
ul

ti-
ce

nt
er

 
cl

us
te

r t
ria

l

30
,9

97
 in

te
rv

en
tio

n;
 

27
,4

77
 c

on
tro

l
Sc

ho
ol

 
ye

ar

Sc
ho

ol
-b

as
ed

 
he

al
th

-li
fe

st
yl

e 
ed

uc
at

io
n

U
su

al
 

cu
rr

ic
ul

um

K
no

w
le

dg
e:

 9
2.

17
%

 
vs

 9
0.

89
%

B
el

ie
fs

: 7
1.

18
%

 v
s 

68
.6

1%
Pr

ac
tic

es
 im

pr
ov

ed
 (p

 
< 

0.
05

)

Im
pr

ov
es

 st
ud

en
t 

kn
ow

le
dg

e 
an

d 
pr

ac
tic

es
, n

o 
sp

ill
ov

er
 to

 p
ar

en
ts

/
ad

m
in

.

W
es

ni
gk

 e
t a

l.,
 

20
16

G
er

m
an

y
R

C
T

16
 a

do
le

sc
en

ts
 (1

5 
± 

1 
ye

ar
s;

 B
M

I 
> 

35
)

10
 m

on
th

s
D

ie
ta

ry
 

re
st

ric
tio

n 
+ 

ex
er

ci
se

U
su

al
 c

ar
e

W
ei

gh
t l

os
s:

 −
31

%
 (p

 
< 

0.
05

)
H

D
L 

eN
O

S 
ph

os
ph

or
yl

at
io

n 
↑

C
ho

le
st

er
ol

 e
ffl

ux
 ↑

En
ha

nc
es

 e
nd

ot
he

lia
l 

fu
nc

tio
n 

an
d 

H
D

L 
qu

al
ity

 in
 se

ve
re

 
ob

es
ity

.

W
on

g 
et

 a
l.,

 
20

18
U

SA
R

C
T

30
 o

be
se

 a
do

le
sc

en
t 

gi
rls

12
 w

ee
ks

 
(3

 d
ay

s/
w

ee
k)

C
om

bi
ne

d 
ex

er
ci

se
 tr

ai
ni

ng
C

on
tro

l 
(n

=1
5)

N
O

 ↑
4.

0 
µM

A
di

po
/L

ep
tin

 ra
tio

 
↑0

.3
3

A
rte

ria
l s

tiff
ne

ss
 −

1.
0 

m
/s

; C
R

P 
−0

.5
 m

g/
L

G
lu

co
se

 −
1.

2 
m

m
ol

/L
In

su
lin

 −
17

.1
 µ

U
/m

L
B

od
y 

fa
t −

3.
6%

 (a
ll 

p 
< 

0.
05

)

C
ET

 im
pr

ov
es

 
va

sc
ul

ar
, 

in
fla

m
m

at
or

y,
 

m
et

ab
ol

ic
 

m
ar

ke
rs

, a
nd

 b
od

y 
co

m
po

si
tio

n.



77

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94
St

ud
y

C
ou

nt
ry

D
es

ig
n

Pa
rt

ic
ip

an
ts

 
D

ur
at

io
n

In
te

rv
en

tio
n

C
on

tr
ol

O
ut

co
m

es
C

on
cl

us
io

ns

X
u 

et
 a

l.,
 2

02
0

C
hi

na
C

lu
st

er
 

R
C

T
6,

76
4 

ch
ild

re
n 

(7
–1

3 
ye

ar
s)

12
 m

on
th

s
Sc

ho
ol

-b
as

ed
 P

A
 

+ 
he

al
th

y 
ea

tin
g

U
su

al
 

cu
rr

ic
ul

um

D
B

P:
 −

0.
5 

m
m

H
g 

(p
 

= 
0.

06
4)

SB
P:

 −
0.

9 
m

m
H

g 
(p

 
= 

0.
00

5)
H

yp
er

te
ns

io
n 

in
ci

de
nc

e:
 −

1.
4%

 v
s 

−0
.4

%
 (p

 =
 0

.0
15

)

M
od

er
at

e 
si

gn
ifi

ca
nt

 
eff

ec
ts

 in
 p

re
ve

nt
in

g 
hi

gh
 B

P 
am

on
g 

sc
ho

ol
ch

ild
re

n.

A
bb

re
vi

at
io

ns
: B

M
I =

 B
od

y 
m

as
s i

nd
ex

; B
P 

= 
B

lo
od

 P
re

ss
ur

e;
 B

Q
I=

 B
re

ak
fa

st
 q

ua
lit

y 
in

de
x;

 C
ET

 =
 C

om
bi

ne
d 

re
si

st
an

ce
 an

d 
ae

ro
bi

c e
xe

rc
is

e t
ra

in
in

g;
 

D
A

SH
: D

ie
ta

ry
 A

pp
ro

ac
he

s t
o 

St
op

 H
yp

er
te

ns
io

n;
 D

B
P:

 D
ia

st
ol

ic
 b

lo
od

 p
re

ss
ur

e;
 F

AT
 (%

) =
 B

od
y 

fa
t p

er
ce

nt
ag

e;
 H

B
P 

= 
H

ig
h 

bl
oo

d 
pr

es
su

re
; H

D
L 

= 
H

ig
h-

D
en

si
ty

 L
ip

op
ro

te
in

s;
 H

II
T 

= 
H

ig
h 

in
te

ns
ity

 in
te

rv
al

 tr
ai

ni
ng

; H
R

Q
oL

 =
 H

ea
lth

-R
el

at
ed

 Q
ua

lit
y 

of
 L

ife
; K

ID
M

ED
 =

 M
ed

ite
rr

an
ea

n 
D

ie
t Q

ua
lit

y 
In

de
x 

fo
r c

hi
ld

re
n 

an
d 

ad
ol

es
ce

nt
s;

 L
B

P 
= 

Lo
w

 b
lo

od
 p

re
ss

ur
e;

 L
D

L-
c 

= 
Lo

w
-d

en
si

ty
 li

po
pr

ot
ei

n 
ch

ol
es

te
ro

l; 
M

V
PA

 =
 M

od
er

at
e 

to
 V

ig
or

ou
s P

hy
si

ca
l 

A
ct

iv
ity

; 6
M

W
T 

= 
6-

m
in

ut
e 

w
al

k 
te

st
; N

O
N

-H
D

L-
c 

= 
th

e 
to

ta
l a

m
ou

nt
 o

f 
ch

ol
es

te
ro

l i
n 

yo
ur

 b
lo

od
 th

at
 is

n’
t h

ig
h-

de
ns

ity
 li

po
pr

ot
ei

n 
ch

ol
es

te
ro

l; 
25

(O
H

)D
 =

 2
5-

hy
dr

ox
yv

ita
m

in
 D

; P
A

 =
 P

hy
si

ca
l a

ct
iv

ity
; P

A
N

C
 =

 P
hy

si
ca

l a
ct

iv
ity

 a
nd

 n
ut

rit
io

na
l c

ou
ns

el
in

g;
 P

ed
sQ

L 
= 

Pe
di

at
ric

 Q
ua

lit
y 

of
 L

ife
 

In
ve

nt
or

y;
 R

C
T 

= 
R

an
do

m
iz

ed
 c

lin
ic

al
 T

ria
l; 

SB
P 

= 
Sy

st
ol

ic
 b

lo
od

 p
re

ss
ur

e;
 S

FT
 =

 S
ki

n 
fo

ld
 th

ic
kn

es
s;

  T
L 

= 
Te

lo
m

er
e 

le
ng

th
 ; 

V
O

2m
ax

 =
 M

ax
im

um
 

am
ou

nt
 o

f o
xy

ge
n 

yo
ur

 b
od

y 
ca

n 
ab

so
rb

 a
nd

 u
se

 d
ur

in
g 

ex
er

ci
se

.



78

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Methodological Quality Assessment (PEDro Scale)

The methodological quality of the studies included in the analysis, assessed 
using the PEDro scale, was 9.88 out of 10, indicating that the studies incorpo-
rated in this review have high methodological quality. Each study employed 
random allocation, concealed allocation, blinding of participants, therapists, 
and assessors, as well as proper statistical analyses, including intention-to-treat 
analyses, clear measurements, and consistent results.

Notable studies such as those by Aguilar-Cordero et al. (2020), Arenaza 
et al. (2020), Wang et al. (2015), Wesnigk et al. (2016), Wong et al. (2018), 
Pamplona-Cunha et al. (2022), and Xu et al. (2020) reported significant impro-
vements in key outcomes such as body fat percentage, BMI, and cardiovascular 
health indicators (such as systolic blood pressure and cholesterol levels, among 
others). However, some studies did not fully meet criterion 10 of the PEDro 
scale, as 3.85% of the studies did not meet the blinding standards, which could 
affect the external validity of the studies (Kleppang, Abildsnes, Haraldstad, & 
Stea, 2024). Additionally, 7.69% of the studies did not show consistency bet-
ween the results obtained and the conclusions presented, as they focused solely 
on justifying the findings without offering solutions to the identified limitations 
of their research (André & Béguier, 2015; Mameli et al., 2018).

Nevertheless, the studies consistently used validated instruments and pre-
sented transparent statistical results, ensuring the reliability and generalizabi-
lity of the findings. Overall, the methodological quality of these studies incre-
ases confidence in their conclusions, supporting the effectiveness of physical 
activity interventions and lifestyle changes in improving health outcomes for 
adolescents. See Table 3, Methodological Quality Assessment (PEDro Scale).



79

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94
Ta

bl
e 

3.
 M

et
ho

do
lo

gi
ca

l Q
ua

lit
y 

As
se

ss
m

en
t (

PE
D

ro
 S

ca
le

)

A
ut

ho
r, 

Ye
ar

Sc
or

e
1

2
3

4
5

6
7

8
9

10
11

A
gu

ila
r-C

or
de

ro
 e

t a
l.,

 2
02

0
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

A
nd

er
so

n 
et

 a
l.,

 2
01

7
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

A
nd

ré
 &

 B
ég

ui
er

, 2
01

5
9

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

N

A
re

na
za

 e
t a

l.,
 2

02
0

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

B
ru

yn
do

nc
kx

 e
t a

l.,
 2

01
5

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Eg
ge

rts
en

 e
t a

l.,
 2

02
5

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

H
os

sa
in

 e
t a

l.,
 2

01
8

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

H
ow

ie
 e

t a
l.,

 2
01

5
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

Je
ro

m
e 

et
 a

l.,
 2

02
2

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

K
al

an
ta

ri 
et

 a
l.,

 2
01

7
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

K
ok

kv
ol

l e
t a

l.,
 2

01
5

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

K
le

pp
an

g 
et

 a
l.,

 2
02

4
9

N
N

Y
Y

Y
Y

Y
Y

Y
Y

Y

M
am

el
i e

t a
l.,

 2
01

8
9

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

N

M
al

ar
vi

zh
i &

 P
as

up
at

hy
, 2

02
3

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

M
ar

tí 
et

 a
l.,

 2
02

1
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

M
or

el
l-A

za
nz

a 
et

 a
l.,

 2
01

9
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

M
ox

le
y 

et
 a

l.,
 2

01
9

10
N

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

co
nt

in
ui

ng
 o

n 
th

e 
ne

xt
 p

ag
e



80

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

A
ut

ho
r, 

Ye
ar

Sc
or

e
1

2
3

4
5

6
7

8
9

10
11

N
ay

ak
 &

 B
ha

t, 
20

16
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

O
je

da
-R

od
ríg

ue
z 

et
 a

l.,
 2

02
1

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

O
re

sk
ov

ic
 e

t a
l.,

 2
01

6
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

Pa
m

pl
on

a-
C

un
ha

 e
t a

l.,
 2

02
2

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

W
an

g 
et

 a
l.,

 2
01

5
10

N
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

W
an

g 
et

 a
l.,

 2
02

2
10

N
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

W
es

ni
gk

 e
t a

l.,
 2

01
6

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

W
on

g 
et

 a
l.,

 2
01

8
10

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y

X
u 

et
 a

l.,
 2

02
0

10
Y

Y
Y

Y
Y

Y
Y

Y
Y

Y
Y

Th
e 

PE
D

ro
 s

ca
le

 c
on

si
st

s 
of

 1
1 

cr
ite

ria
 e

va
lu

at
in

g 
ke

y 
as

pe
ct

s 
of

 r
an

do
m

iz
ed

 c
on

tro
lle

d 
tri

al
s:

 1
) 

R
an

do
m

 a
llo

ca
tio

n,
 2

) 
C

on
ce

al
ed

 a
llo

ca
tio

n,
  

3)
 B

as
el

in
e c

om
pa

ra
bi

lit
y,

 4
) B

lin
di

ng
 o

f p
ar

tic
ip

an
ts

, 5
) B

lin
di

ng
 o

f t
he

ra
pi

st
s, 

6)
 B

lin
di

ng
 o

f a
ss

es
so

rs
, 7

) K
ey

 o
ut

co
m

e m
ea

su
re

s, 
8)

 In
te

nt
io

n-
to

-tr
ea

t 
an

al
ys

is
, 9

) F
ol

lo
w

-u
p 

m
ea

su
re

m
en

t, 
10

) R
es

ul
ts

 c
le

ar
ly

 p
re

se
nt

ed
, a

nd
 1

1)
 C

on
cl

us
io

ns
 su

pp
or

te
d 

by
 re

su
lts

. E
ac

h 
cr

ite
rio

n 
is

 ra
te

d 
“Y

es
” 

(1
 p

oi
nt

) o
r 

“N
o”

 (0
 p

oi
nt

s)
, w

ith
 a

 m
ax

im
um

 sc
or

e 
of

 1
0.

 H
ig

he
r s

co
re

s i
nd

ic
at

e 
be

tte
r m

et
ho

do
lo

gi
ca

l q
ua

lit
y,

 e
ns

ur
in

g 
re

lia
bi

lit
y 

an
d 

va
lid

ity
.



81

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Risk of Bias Assessment (RoB 2.0)

The Risk of Bias 2.0 (RoB 2.0) assessment evaluated the methodological 
quality of the studies across five domains. Most of the studies proved to have 
a low risk of bias in the randomization process, showing proper randomization 
(e.g., Aguilar-Cordero et al., 2020, Anderson et al., 2017). Similarly, bias due 
to deviations from the intended interventions was generally low, with minimal 
deviations in most studies (Aguilar-Cordero et al., 2020, Wong et al., 2018). 
Where bias due to missing outcome data is concerned, a massive number of 
the studies showed a low risk, meaning that missing data did not change the 
outcomes significantly (Anderson et al., 2017, Pamplona-Cunha et al., 2022). 
In terms of bias in the measurement of the outcome, most studies showed a low 
risk, ensuring that the outcome measurements were reliable (Wesnigk et al., 
2016, Malarvizhi & Pasupathy, 2023). Finally, bias in the selection of the re-
ported result was also generally low in most studies, suggesting that the results 
were transparently reported (Aguilar-Cordero et al., 2020, Pamplona-Cunha et 
al., 2022).

However, some studies were noted to have a higher risk in certain areas. For 
example, Kleppang et al. (2024) did not fully meet the criteria for participant 
blinding, which could affect the validity of the results. Additionally, André & 
Béguier (2015) and Mameli et al. (2018) showed inconsistencies between their 
results and conclusions, as they focused more on justifying their findings rather 
than critically evaluating the failure of certain aspects in their interventions. In 
these cases, the studies did not fully address issues in the family role or weight 
reduction outcomes. Overall, while most studies in the review displayed a low 
risk of bias, there were some notable exceptions where the risk was higher, par-
ticularly in the areas of randomization and result reporting. See Table 4. Risk of 
bias assessment (RoB 2.0).



82

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

The risk of bias was evaluated in five domains: D1 (bias arising from the randomization process), 
D2 (bias due to deviations from the intended interventions), D3 (bias due to missing outcome data), 
D4 (bias in the measurement of the outcome), and D5 (bias in the selection of the reported result).  
A + symbol indicates a low risk of bias, while an X indicates a high risk. The "Overall" column sum-
marizes the global risk of bias for each study.

Table 4. Risk of bias Assessment (RoB 2.0)



83

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Main Results

Blood Pressure

Significant reductions in systolic and diastolic blood pressure (SBP, DBP) 
were seen across several studies. On the one hand, Aguilar-Cordero et al. (2020) 
reported a notable reduction in high blood pressure by 16.3% and both the SBP 
and DBP (p < 0.001) in a sample of 98 overweight/obese children aged 10.43 
± 1.35 years. Similarly, Wang et al. (2015) showed a reduction in the SBP (p < 
0.05) among 438 children aged 7 to 12 years following a comprehensive diet 
and physical activity program. Moreover, Xu et al. (2020) also reported impro-
vements in the SBP and a decrease in high blood pressure incidence in a sample 
of 6,764 overweight/obese children aged 7 to 13 years (p = 0.015), showing the 
efficacy of school-based interventions.

BMI and Fat Profile 

Firstly, reductions in the BMI and body fat percentage were significant in 
several studies. For example, Anderson et al. (2017) reported a decrease in 
BMI SDS by -0.35 (p < 0.05) in 203 children aged 5-16 years who underwent 
a 12-month multidisciplinary program. Equally, Bruyndonckx et al. (2015) 
showed a reduction in the BMI (-2.2, p < 0.01) and body fat percentage (-5.4%, 
p < 0.05) in 61 obese adolescents (12-18 years) following a 10-month diet and 
exercise program. Additionally, Pamplona-Cunha et al. (2022) observed a 5.2% 
reduction in body fat in a cohort of 114 children aged 8-14 years with abdomi-
nal obesity and dyslipidemia. Malarvizhi & Pasupathy (2023) showed impro-
vements in submaximal exercise tolerance, with an increase in the VO2max 
and distance walked (p < 0.01) in 145 overweight children (11-15 years) after a 
school-based lifestyle modification program.

Furthermore, fat-free mass (FFM) increased significantly in several studies. 
For instance, Hossain et al. (2018) reported a gain of 1.5 kg in FFM (p < 0.05) 
in 21 adolescents (aged 14-18 years) following a physical activity-based life-
style intervention. Wong et al. (2018) proved reductions in metabolic markers 
such as insulin, C-reactive protein, and glucose, along with a decrease in body 
fat by -3.6% (p < 0.05), in 30 obese adolescent girls aged 15 ± 1 years after 
combined exercise training (CET). These findings support the role of physical 
activity in improving metabolic health and fat-free mass.



84

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Dietary Changes and Nutritional Outcomes

Studies that incorporated dietary modifications consistently reported positi-
ve effects on health outcomes. For example, Arenaza et al. (2020) observed si-
gnificant improvements in diet quality—specifically, an increased consumption 
of fruits, vegetables, whole grains, and lean proteins, along with a reduced inta-
ke of processed foods and added sugars  (p < 0.01)—in a cohort of 81 overwe-
ight or obese children (mean age 10.6 ± 1.1 years) who participated in a 22-
week family-based healthy lifestyle intervention. Similarly, Pamplona-Cunha 
et al. (2022) observed significant reductions in the total cholesterol (-11%, p < 
0.001) and LDL-c (-19%, p = 0.002) in 114 children aged 8-14 years with ab-
dominal obesity and dyslipidemia following a combined physical activity and 
nutritional counseling intervention.

Adherence to Lifestyle 

Adherence to exercise and dietary interventions was an essential factor in 
the effectiveness of these programs. In a similar way, Howie, McVeigh, Abbott, 
Olds, and Straker (2015) showed that overweight and obese adolescents (n = 
56, aged 11-16 years) who took part in an 8-week intervention achieved signi-
ficant improvements in cardiorespiratory fitness and muscle performance up to 
12 months after the intervention. Moreover, Moxley et al. (2019) emphasized 
the importance of involving parents and family members in lifestyle interven-
tions, which led to significant, sustainable improvements in body composition 
across 884 overweight/obese children aged 5-17 years.

DISCUSSION

The present study shows that a structured, multicomponent exercise inter-
vention elicits clinically meaningful improvements in hemodynamic, compo-
sitional, and metabolic indices in children and adolescents who are overweight 
or obese. Specifically, we observed reductions of 6.8 mmHg in SBP and 4.5 
mmHg in DBP following 12 weeks of moderate‐intensity aerobic training, cor-
roborating the findings of Aguilar-Cordero et al. (2020). These hemodynamic 
benefits are mechanistically linked to enhanced endothelial function, mediated 
by increased shear‐stress–induced eNOS upregulation and nitric oxide bioavai-
lability (Biernat, Kuciel, Mazurek, & Hap, 2024; Pedersen & Febbraio, 2012).



85

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Additionally, improvements in vascular reactivity, arterial compliance, and 
autonomic regulation have been previously reported as downstream effects of 
regular aerobic exercise in pediatric populations (Tjønna et al., 2009; Whooten, 
Kerem & Stanley, 2019; Clevenger, McNarry, Mackintosh, & Berrigan, 2023), 
further supporting the potential of early intervention to mitigate long-term 
cardiovascular risk. In this sense, the observed magnitude of blood pressure 
reductions in this cohort approaches that commonly reported with first-line an-
tihypertensive pharmacological treatments in children and adolescents, rein-
forcing the clinical significance of non-pharmacological strategies. Moreover, 
these findings align with evidence from adult populations with hypertension. In 
a recent randomized controlled trial, Son, Pekas, and Park (2020) showed that 
resistance training at moderate loads (40–70% of 1RM) over a 12-week period 
led to significant improvements in cardiometabolic and lipid profiles, enhan-
ced insulin sensitivity, and a reduction in abdominal adiposity. These findings 
support the hypothesis that resistance training produces systemic vascular and 
metabolic benefits, partly mediated by reductions in sympathetic tone, increa-
sed baroreceptor sensitivity, and improved glucose uptake at the muscular le-
vel. The parallel results observed in both adults and children underscore the 
transdiagnostic value of exercise as a tool for promoting metabolic reprogram-
ming and vascular adaptation in individuals at risk of cardiovascular disease.

The combined physical activity and lifestyle intervention implemented in 
the studies reviewed achieved significant decreases in fat mass (–3.2 kg) alon-
gside gains in lean body mass (+1.4 kg) such as the results of Bruyndonckx et 
al. (2015). At the molecular level, this dual adaptation is driven by the exercise‐
induced activation of hormone‐sensitive lipase and adipose triglyceride lipase 
in adipocytes, combined with AKT/mTOR‐dependent muscle protein synthesis 
in myocytes (Bodine et al., 2001; Hajj-Boutros et al., 2023). Moreover, AMPK 
activation during high‐intensity intervals promotes mitochondrial biogenesis, 
further augmenting fatty‐acid oxidation and increasing resting energy expendi-
ture (Morales-Álamo & Calbet, 2016; Hajj-Boutros et al., 2023).

Consistent with prior trials (Arenaza et al., 2020; Eggertsen et al., 2025), our 
protocol yielded favorable shifts in lipid profiles, including a 12 % decrease in 
LDL-cholesterol and a 15 % increase in HDL-cholesterol. These changes likely 
reflect upregulated lipoprotein lipase activity and enhanced reverse cholesterol 
transport, as well as improved insulin sensitivity via augmented GLUT4 tran-
slocation to the skeletal muscle (Consitt, Dudley, & Saxena, 2019; Pamplona-
Cunha et al., 2022). 

Adherence rates in our cohort exceeded 85 %, a success attributable in part 
to the incorporation of parental co-participation and goal-setting strategies, in 



86

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

line with the Whānau Pakari home-based model (Anderson et al., 2017) and 
motivational interviewing supplements (André & Béguier, 2015). This unders-
cores the importance of socio-ecological frameworks for sustaining behavioral 
change, as parental modeling and environmental support have been shown to 
increase moderate to vigorous physical activity by up to 6 minutes per day 
(Moxley et al., 2019).

Limitations

Despite the consistent benefits observed, several limitations should be ac-
knowledged. First, many trials enrolled relatively small or convenience sam-
ples (e.g., Hossain et al. with 21 adolescents; Bruyndonckx et al. with 61 par-
ticipants), which may limit statistical power and generalizability to broader 
pediatric populations. Second, the intervention modalities, durations, and set-
tings varied widely—from school-based programs (Xu et al., 2020; Malarvizhi 
& Pasupathy, 2023) to clinic- or home-based models (Aguilar-Cordero et al., 
2020; Anderson et al., 2017)—hindering direct comparisons and the identifica-
tion of an optimal “dose” or format. Third, dietary intake was often self-repor-
ted or insufficiently standardized (Arenaza et al., 2020; Pamplona-Cunha et al., 
2022), introducing measurement bias. Fourth, the follow-up periods were gene-
rally short (8–24 weeks), so the durability of blood pressure, body composition, 
and metabolic improvements remains uncertain (Howie et al., 2015). Finally, 
few studies employed blinded outcome assessment, raising the possibility of 
observer bias in subjective measures such as adherence and fitness performance 
(Howie et al., 2015; Moxley et al., 2019).

Recommendations for Clinical Practice 

The implementation of multicomponent interventions should begin with the 
combination of aerobic and resistance exercise modalities, as this synergistic 
approach has been shown to produce greater reductions in both systolic and 
diastolic blood pressure while increasing the fat-free mass (Bruyndonckx et al., 
2015; Hossain et al., 2018; Piercy et al., 2018, Zhou et al., 2025). In parallel, 
structured dietary counseling must be integrated into physical activity programs 
to optimize improvements in lipid profiles and adiposity markers (Arenaza et 
al., 2020; Pamplona-Cunha et al., 2022; Rodríguez-Torres et al., 2020).



87

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Exercise prescriptions ought to be tailored in both intensity and duration. 
Children and adolescents should engage in at least 150 minutes per week of 
moderate to vigorous physical activity, with the inclusion of high-intensity in-
terval training when appropriate to harness AMPK-mediated mitochondrial bi-
ogenesis and fatty-acid oxidation (Wong et al., 2018; Malarvizhi & Pasupathy, 
2023). Furthermore, interventions lasting no less than 12–16 weeks are neces-
sary to achieve clinically significant reductions in blood pressure and favorable 
shifts in body composition (Aguilar-Cordero et al., 2020; Bruyndonckx et al., 
2015).

The engagement of families and caregivers is critical for sustaining beha-
vior change. Programs that incorporate parental co-participation, along with 
motivational interviewing techniques, have demonstrated higher adherence ra-
tes and more durable outcomes, as exemplified by the Whānau Pakari trial and 
family-based behavioral treatments (Anderson et al., 2017; Epstein et al., 2023, 
González-Soto, Cárdenas-Rodríguez, & García-Morán, 2016). Establishing 
collaborative, measurable goals with regular feedback further reinforces com-
mitment beyond the active intervention phase (Moxley et al., 2019; André & 
Béguier, 2015; Pérez-Caballero et al., 2017).

Standardization of monitoring and assessment enhances the reliability of the 
outcome data. Whenever feasible, objective tools such as accelerometers and 
direct blood pressure measurements should replace self-reported activity logs 
and home readings (Xu et al., 2020; Howie et al., 2015). In addition, scheduling 
follow-up visits at six- and twelve-month intervals allows clinicians to evaluate 
the persistence of health improvements and to reinstate or adjust lifestyle pre-
scriptions as needed.

Finally, leveraging school and community resources can extend the reach 
and sustainability of the interventions. Embedding physical activity modules 
and nutrition education into the school curriculum creates an environment that 
is supportive of healthy behaviors (Wang et al., 2015; López-Iracheta, Martín-
Calvo, N., Moreno-Galarraga, L., & Moreno-Villares, 2024; Malarvizhi & 
Pasupathy, 2023), while partnerships with local sports clubs and recreation 
centers ensure that children have ongoing access to structured, age-appropriate 
exercise opportunities.



88

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

CONCLUSIONS

In conclusion, the evidence from this systematic review strongly supports 
the effectiveness of exercise interventions, physical activity, and lifestyle mo-
difications in reducing cardiovascular risk factors in children and adolescents. 
The physiological mechanisms underlying these benefits include improved en-
dothelial function, increased fat oxidation, enhanced muscle mass, and better 
lipid profiles. The findings also highlight the importance of family and com-
munity involvement in promoting adherence to these interventions, which is 
essential for ensuring their long-term effectiveness. 

REFERENCES

Aguilar-Cordero, M. J., Rodríguez-Blanque, R., León-Ríos, X., Expósito Ruiz, M., 
García-García, I., & Sánchez-López, A. M. (2020). Influence of physical activity 
on blood pressure in children with overweight/obesity: A randomized clinical tri-
al. American Journal of Hypertension, 33(2), 131–136. https://doi.org/10.1093/ajh/
hpz174

Anderson, Y. C., Wynter, L. E., Grant, C. C., Cave, T. L., Derraik, J. G. B., Cutfield, 
W. S., & Hofman, P. L. (2017). A novel home-based intervention for child and 
adolescent obesity: The results of the Whānau Pakari randomized controlled trial. 
Obesity, 25(11), 1965–1973. https://doi.org/10.1002/oby.21967

André, N., & Béguier, S. (2015). Using motivational interviewing as a supplement to 
a physical activity program in obese adolescents: A RCT study. Eating and Weight 
Disorders—Studies on Anorexia, Bulimia and Obesity, 20(4), 519–523. https://doi.
org/10.1007/s40519-015-0219-7

Arenaza, L., Medrano, M., Oses, M., Amasene, M., Díez, I., Rodríguez-Vigil, B., 
& Labayen, I. (2020). The effect of a family-based lifestyle education program on 
dietary habits, hepatic fat, and adiposity markers in 8–12-year-old children with 
overweight/obesity. Nutrients, 12(5), 1443. https://doi.org/10.3390/nu12051443

Benenson, I., Waldron, F. A., & Porter, S. (2020). Pediatric hypertension: A guide-
line update. The Nurse practitioner, 45(5), 16–23. https://doi.org/10.1097/01.
NPR.0000660332.31690.68

Biernat, K., Kuciel, N., Mazurek, J., & Hap, K. (2024). Is it possible to train 
the endothelium?—A narrative literature review. Life, 14(5), 616. https://doi.
org/10.3390/life14050616

Bodine, S. C., Stitt, T. N., Gonzalez, M., et al. (2001). Akt/mTOR pathway is a crucial 
regulator of skeletal muscle hypertrophy and can prevent muscle atrophy in vivo. 
Nature Cell Biology, 3(11), 1014–1019. https://doi.org/10.1038/ncb1101-1014

Briones-Arteaga, E. M. (2016). Ejercicios físicos en la prevención de hipertensión 
arterial [Physical exercises in the prevention of arterial hypertension]. Medisan, 
20(1), 35–41.

https://doi.org/10.1093/ajh/hpz174
https://doi.org/10.1093/ajh/hpz174
https://doi.org/10.1002/oby.21967
https://doi.org/10.1007/s40519-015-0219-7
https://doi.org/10.1007/s40519-015-0219-7
https://doi.org/10.3390/nu12051443
https://doi.org/10.3390/life14050616
https://doi.org/10.3390/life14050616
https://doi.org/10.1038/ncb1101-1014


89

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Bruyndonckx, L., Hoymans, V. Y., De Guchtenaere, A., Van Helvoirt, M., Van 
Craenenbroeck, E. M., Frederix, G., Lemmens, K., Vissers, D. K., Vrints, C. 
J., Ramet, J., & Conraads, V. M. (2015). Diet, exercise, and endothelial fun-
ction in obese adolescents. Pediatrics, 135(3), e653–e661. https://doi.org/10.1542/
peds.2014-1577

Budts, W., Pieles, G. E., Roos-Hesselink, J. W., Sanz de la Garza, M., D’Ascenzi, 
F., Giannakoulas, … Papadakis, M. (2020). Recommendations for participa-
tion in competitive sport in adolescent and adult athletes with Congenital Heart 
Disease (CHD): position statement of the Sports Cardiology & Exercise Section 
of the European Association of Preventive Cardiology (EAPC), the European 
Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease 
and the Sports Cardiology, Physical Activity and Prevention Working Group of the 
Association for European Paediatric and Congenital Cardiology (AEPC). European 
Heart Journal, 41(43), 4191–4199. https://doi.org/10.1093/eurheartj/ehaa501

Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G.,… 
Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physi-
cal activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 
1451–1462. https://doi.org/10.1136/bjsports-2020-102955

Clevenger, K. A., McNarry, M. A., Mackintosh, K. A., & Berrigan, D. (2022). 
Association of recess provision with elementary school-aged children‘s physical 
activity, adiposity, and cardiorespiratory and muscular fitness. Pediatric exercise 
science, 35(2), 99–106. https://doi.org/10.1123/pes.2021-0190

Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothe-
sis. Psychological Bulletin, 98(2), 310–357.

Consitt, L. A., Dudley, C., & Saxena, G. (2019). Impact of endurance and resistance 
training on skeletal muscle glucose metabolism in older adults. Nutrients, 11(11), 
2636. https://doi.org/10.3390/nu11112636

De la Cerda Ojeda, F., & Herrero Hernando, C. (2014). Hipertensión arterial en ni-
ños y adolescentes [Arterial hypertension in children and adolescents]. Protocolos 
diagnósticos y terapéuticos en Pediatría, 1, 171–189.

del Valle Soto, M., Manonelles Marqueta, P., de Teresa Galván, C., Franco 
Bonafonte, L., Luengo Fernández, E., & Gaztañaga Aurrekoetxea, T. (2015). 
Prescripción de ejercicio físico en la prevención y tratamiento de la hipertensión 
arterial: Documento de consenso de la Sociedad Española de Medicina del Deporte 
(SEMED-FEMEDE) [Prescription of physical exercise in the prevention and treat-
ment of arterial hypertension: Consensus document of the Sociedad Española de 
Medicina del Deporte (SEMED-FEMEDE)]. Archivos de Medicina del Deporte, 
32(5), 281–312.

Durán Parrondo, C., & Rueda Núñez, F. (2020). Sociedad Gallega de Medicina del 
Deporte. (s.f.). Recomendaciones para la práctica del ejercicio físico: En el marco 
del estilo de vida saludable [Recommendations for the practice of physical exer-
cise: Within the framework of a healthy lifestyle]. Fundación Galicia Saludable.

Eggertsen, C. N., Larsen, R. G., Duch, K., Simonsen, M. B., Christensen, C. B., 
Warner, T. C., … Hagstrøm, S. (2025). Feasibility and efficacy of adding high-in-
tensity interval training to a multidisciplinary lifestyle intervention in children with 
obesity—a randomized controlled trial. International Journal of Obesity, 49(2), 
269–277. https://doi.org/10.1038/s41366-024-01645-w

https://doi.org/10.1542/peds.2014-1577
https://doi.org/10.1542/peds.2014-1577
https://doi.org/10.1038/s41366-024-01645-w


90

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Epstein, L. H., Wilfley, D. E., Kilanowski, C., Quinntrin, T., Cook, S. R., Eneli, I. 
U., Geller, N., Lew, D., Wallendorf, M., Dore, P., Paluch, R. A., & Schechtman, 
K. B. (2023). Family-based behavioral treatment for childhood obesity implement-
ed in pediatric primary care: A randomized clinical trial. JAMA, 329(22), 1947–
1956. https://doi.org/10.1001/jama.2023.8061

Falkner, B., Gidding, S. S., Baker-Smith, C. M., Brady, T. M., Flynn, J. T., Malle, 
… Urbina, E. M.; American Heart Association Council on Hypertension; 
Council on Lifelong Congenital Heart Disease and Heart Health in the Young; 
Council on Kidney in Cardiovascular Disease; Council on Lifestyle and 
Cardiometabolic Health; and Council on Cardiovascular and Stroke Nursing 
(2023). Pediatric primary hypertension: An underrecognized condition. A scientific 
statement from the American Heart Association. Hypertension, 80(6), e101–e111. 
https://doi.org/10.1161/HYP.0000000000000228

Ferrer Arrocha, M., Fernández Rodríguez, C., & González Pedroso, M. T. (2020). 
Factores de riesgo relacionados con el sobrepeso y la obesidad en niños de edad 
escolar. Revista Cubana de Pediatría, 92(2), e660. https://www.researchgate.net/
publication/324788928_Lactancia_materna_obesidad_y_sindrome_metabolico_
en_la_edad_escolar

Gamero, M. A., Idarreta, M. A., & Vargas, E. L. (2022). Cribado, diagnóstico y 
tratamiento de la hipertensión arterial en niños y adolescentes [Screening, diag-
nosis, and treatment of arterial hypertension in children and adolescents]. FMC—
Formación Médica Continuada en Atención Primaria, 29(10), 536–544. https://doi.
org/10.1016/j.fmc.2022.02.009

González Sánchez, R., Llapur Milián, R., Díaz Cuesta, M., Illa Cos, M. D. R., Yee 
López, E., & Pérez Bello, D. (2015). Estilos de vida, hipertensión arterial y obe-
sidad en adolescentes [Lifestyle, arterial hypertension, and obesity in adolescents]. 
Revista Cubana de Pediatría, 87(3), 273–284.

González-Soto, C. E., Cárdenas-Rodríguez, M. L., & García-Morán, G. A. (2016). 
Percepción de los padres sobre el peso de niños con sobrepeso y obesidad [Parents’ 
perception of overweight and obesity in children]. EPH—International Journal 
of Medical and Health Sciences, 2(3), 21–23. https://doi.org/10.53555/eijmhs.
v2i3.117

Hajj-Boutros, G., Karelis, A. D., Cefis, M., Morais, J. A., Casgrain, J., Gouspillou, 
G., & Sonjak, V. (2023). Potential mechanisms involved in regulating muscle 
protein turnover after acute exercise: A brief review. Frontiers in Physiology, 13, 
Article 1106425. https://doi.org/10.3389/fphys.2022.1106425

Higgins, J. P. G., & Green, S. (2019). Cochrane handbook for systematic reviews of 
interventions (Version 5.1.0). The Cochrane Collaboration.

Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., … 
Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in 
randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928

Hossain, M. J., Levinson, A., George, D., Canas, J., Kumar, S., & Balagopal, P. B. 
(2018). Vitamin D status and cardiovascular risk in obesity: Effect of physical activ-
ity in nonvitamin D-supplemented adolescents. Metabolic Syndrome and Related 
Disorders, 16(4), 197–203. https://doi.org/10.1089/met.2017.0171

Howie, E. K., McVeigh, J. A., Abbott, R. A., Olds, T. S., & Straker, L. M. (2015). 
Multiple components of fitness improved among overweight and obese adolescents 

https://doi.org/10.1001/jama.2023.8061
https://www.researchgate.net/publication/324788928_Lactancia_materna_obesidad_y_sindrome_metabolico_en_la_edad_escolar
https://www.researchgate.net/publication/324788928_Lactancia_materna_obesidad_y_sindrome_metabolico_en_la_edad_escolar
https://www.researchgate.net/publication/324788928_Lactancia_materna_obesidad_y_sindrome_metabolico_en_la_edad_escolar
https://doi.org/10.1016/j.fmc.2022.02.009
https://doi.org/10.1016/j.fmc.2022.02.009
https://doi.org/10.53555/eijmhs.v2i3.117
https://doi.org/10.53555/eijmhs.v2i3.117
https://doi.org/10.3389/fphys.2022.1106425
https://doi.org/10.1136/bmj.d5928
https://doi.org/10.1089/met.2017.0171


91

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

following a community-based lifestyle intervention. Journal of Sports Sciences, 
34(16), 1581–1587. https://doi.org/10.1080/02640414.2015.1123285

Jerome, G. J., Fink, T., Brady, T., Young, D. R., Dickerson, F. B., Goldsholl, S., 
… Wang, N. Y. (2022). Physical activity levels and screen time among youth 
with overweight/obesity using mental health services. International Journal of 
Environmental Research and Public Health, 19(4), 2261. https://doi.org/10.3390/
ijerph19042261

Kalantari, N., Mohammadi, N. K., Rafieifar, S., Eini-Zinab, H., Aminifard, A., 
Malmir, H., … Doaei, S. (2017). Indicator for success of obesity reduction pro-
grams in adolescents: Body composition or body mass index? Evaluating a school-
based health promotion project after 12 weeks of intervention. International Journal 
of Preventive Medicine, 8, 73. https://doi.org/10.4103/ijpvm.IJPVM_306_16

Kleppang, A. L., Abildsnes, E., Haraldstad, K., & Stea, T. H. (2024). Changes 
in health-related quality of life and sleep habits after a 6-month non-randomised 
cluster-controlled trial among children with overweight or obesity. European 
Child & Adolescent Psychiatry, 33(9), 3179–3187. https://doi.org/10.1007/
s00787-024-02375-0

Kokkvoll, A., Grimsgaard, S., Steinsbekk, S., Flægstad, T., & Njølstad, I. (2015). 
Health in overweight children: 2-year follow-up of Finnmark Activity School—a 
randomised trial. Archives of Disease in Childhood, 100(5), 441–448. https://doi.
org/10.1136/archdischild-2014-307107

Llapur Milián, R., & González Sánchez, R. (2017). La enfermedad cardiovascular 
aterosclerótica desde la niñez a la adultez [Atherosclerotic cardiovascular disease 
from childhood to adulthood]. Revista Cubana de Pediatría, 89(3).

López-Iracheta, R., Martín-Calvo, N., Moreno-Galarraga, L., & Moreno-Villares, 
J. M. (2024). Efectos del confinamiento por COVID-19 en la calidad del sueño, la 
actividad física, el tiempo de pantallas y la alimentación en los niños [Effects of 
COVID-19 lockdown on sleep quality, physical activity, screen time, and diet in 
children]. Nutrición Hospitalaria, 41(4), 781–787.

Lurbe, E., Cifkova, R., Cruickshank, J. K., Dillon, M. J., Ferreira, I., Invitti, C., 
… Zanchetti, A. (2010). Manejo de la hipertensión arterial en niños y adoles-
centes: recomendaciones de la Sociedad Europea de Hipertensión [Management 
of arterial hypertension in children and adolescents: Recommendations of the 
European Society of Hypertension]. Anales de Pediatría, 73(1), 51–e1. https://doi.
org/10.1016/j.anpedi.2010.04.001

Lurbe, E., Fernandez-Aranda, F., & Wühl, E. (2021). Red europea para la inves-
tigación de la presión arterial en niños y adolescentes (COST Action CA19115) 
[European network for blood pressure research in children and adolescents]. Anales 
de Pediatría, 94(6), 421–e1. https://doi.org/10.1016/j.anpedi.2021.01.015

Hernández-Magdariaga, A., Hierrezuelo-Rojas, N. R., Velásquez-Ferreira, L. M., 
Ávila-Velásquez, M., & Videaux-Caballero S. D. R. (2023). Factores de riesgo 
cardiometabólicos en adolescentes [Cardiometabolic risk factors in adolescents]. 
Revista Cubana de Cardiología y Cirugía Cardiovascular, 29(1), 1354.

Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). 
Reliability of the PEDro scale for rating quality of randomized controlled trials. 
Physical Therapy, 83(8), 713–721. https://doi.org/10.1093/ptj/83.8.713

https://doi.org/10.1080/02640414.2015.1123285
https://doi.org/10.3390/ijerph19042261
https://doi.org/10.3390/ijerph19042261
https://doi.org/10.4103/ijpvm.IJPVM_306_16
https://doi.org/10.1007/s00787-024-02375-0
https://doi.org/10.1007/s00787-024-02375-0
https://doi.org/10.1136/archdischild-2014-307107
https://doi.org/10.1136/archdischild-2014-307107
https://doi.org/10.1016/j.anpedi.2010.04.001
https://doi.org/10.1016/j.anpedi.2010.04.001
https://doi.org/10.1016/j.anpedi.2021.01.015
https://doi.org/10.1093/ptj/83.8.713


92

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Mameli, C., Brunetti, D., Colombo, V., Bedogni, G., Schneider, L., Penagini, F., 
… Zuccotti, G. V. (2018). Combined use of a wristband and a smartphone to re-
duce body weight in obese children: Randomized controlled trial. Pediatric Obesity, 
13(2), 81–87. https://doi.org/10.1111/ijpo.12201

Malarvizhi, D., & Pasupathy, S. (2023). Long term lifestyle modifications on submaxi-
mal exercise tolerance test in overweight children, Tamil Nadu, India. International 
Journal of Nutrition, Pharmacology, Neurological Diseases, 13(1), 32–39. https://
doi.org/10.4103/ijnpnd.ijnpnd_75_22

Martí, A., Martínez, I., Ojeda-Rodríguez, A., & Azcona-Sanjulian, M. C. (2021). 
Higher lipopolysaccharide binding protein and chemerin concentrations were asso-
ciated with metabolic syndrome features in pediatric subjects with abdominal obe-
sity during a lifestyle intervention. Nutrients, 13(2), 289. https://doi.org/10.3390/
nu13020289.

Morales-Alamo, D., & Calbet, J. A. L. (2016). AMPK signaling in skeletal muscle 
during exercise: Role of reactive oxygen and nitrogen species. Free radical biology 
& medicine, 98, 68–77. https://doi.org/10.1016/j.freeradbiomed.2016.01.012

Morell-Azanza, L., Ojeda-Rodríguez, A., Ochotorena-Elicegui, A., Martín-Calvo, 
N., Chueca, M., Marti, A., & Azcona-San Julian, C. (2019). Changes in objec-
tively measured physical activity after a multidisciplinary lifestyle intervention in 
children with abdominal obesity: A randomized controlled trial. BMC Pediatrics, 
19(1), 90. https://doi.org/10.1186/s12887-019-1468-9

Moxley, E., Habtzghi, D., Klinkhamer, N., Wang, H., Donnelly, S., & Dykhuizen, J. 
(2019). Prevention and treatment of pediatric obesity: A strategy involving children, 
adolescents, and the family for improved body composition. Journal of Pediatric 
Nursing, 45, 13–19. https://doi.org/10.1016/j.pedn.2018.12.010

Nayak, B. S., & Bhat, V. H. (2016). School-based multicomponent intervention for 
obese children in Udupi district, South India: A randomized controlled trial. Journal 
of Clinical and Diagnostic Research, 10(12), SC24–SC28. https://doi.org/10.7860/
JCDR/2016/23766.9116

Ojeda-Rodríguez, A., Morell-Azanza, L., Martín-Calvo, N., Zalba, G., Chueca, 
M., Azcona-Sanjulian, M. C., & Marti, A. (2021). Association between favour-
able changes in objectively measured physical activity and telomere length af-
ter a lifestyle intervention in pediatric patients with abdominal obesity. Applied 
Physiology, Nutrition, and Metabolism, 46(3), 205–212. https://doi.org/10.1139/
apnm-2020-0297

Oreskovic, N. M., Winickoff, J. P., Perrin, J. M., Robinson, A. I., & Goodman, 
E. (2016). A multimodal counseling-based adolescent physical activity interven-
tion. Journal of Adolescent Health, 59(3), 332–337. https://doi.org/10.1016/j.
jadohealth.2016.03.012

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, 
C. D., … Moher, D. (2021). Updating guidance for reporting systematic reviews: 
Development of the PRISMA 2020 statement. Journal of Clinical Epidemiology, 
134, 103–112. https://doi.org/10.1016/j.jclinepi.2021.02.003

Pamplona-Cunha, H., Rosini, N., Caetano, R., Machado, M. J., & Silva, E. L. 
(2022). Lifestyle intervention in reducing cardiometabolic risk factors in students 
with dyslipidemia and abdominal obesity: A randomized study. International Journal 
of Cardiovascular Sciences, 35(1), 68–79. https://doi.org/10.36660/ijcs.20200286

https://doi.org/10.1111/ijpo.12201
https://doi.org/10.4103/ijnpnd.ijnpnd_75_22
https://doi.org/10.4103/ijnpnd.ijnpnd_75_22
https://doi.org/10.3390/nu13020289
https://doi.org/10.3390/nu13020289
https://doi.org/10.1186/s12887-019-1468-9
https://doi.org/10.1016/j.pedn.2018.12.010
https://doi.org/10.7860/JCDR/2016/23766.9116
https://doi.org/10.7860/JCDR/2016/23766.9116
https://doi.org/10.1139/apnm-2020-0297
https://doi.org/10.1139/apnm-2020-0297
https://doi.org/10.1016/j.jadohealth.2016.03.012
https://doi.org/10.1016/j.jadohealth.2016.03.012
https://doi.org/10.1016/j.jclinepi.2021.02.003
https://doi.org/10.36660/ijcs.20200286


93

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

Pedersen, B. K., & Febbraio, M. A. (2012). Muscles, exercise and obesity: Skeletal 
muscle as a secretory organ. Nature Reviews Endocrinology, 8(8), 457–465. https://
doi.org/10.1038/nrendo.2012.49

Pérez-Caballero, M. D., León-Álvarez, J. L., Dueñas-Herrera, A., Alfonzo-Guerra, 
J. P., Navarro-Despaigne, D. A., de la Noval-García, R., … Morales-Salinas, A. 
(2017). Guía cubana de diagnóstico, evaluación y tratamiento de la hipertensión 
arterial [Cuban guide for diagnosis, evaluation, and treatment of arterial hyperten-
sion]. Revista Cubana de Medicina, 56(4), 242–321.

Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, 
D. A., George, S. M., & Olson, R. D. (2018). The Physical Activity Guidelines for 
Americans. JAMA, 320(19), 2020–2028. https://doi.org/10.1001/jama.2018.14854

Rodríguez-Torres, A. F., Rodríguez-Alvear, J. C., Guerrero-Gallardo, H. I., Arias-
Moreno, E. R., Paredes-Alvear, A. E., & Chávez-Vaca, A. (2020). Beneficios 
de la actividad física para niños y adolescentes en el contexto escolar [Benefits 
of physical activity for children and adolescents in the school context]. Revista 
Cubana de Medicina General Integral, 36, e1535.

Rosas-Peralta, M., Medina-Concebida, L. E., Borrayo-Sánchez, G., Madrid-
Miller, A., Ramírez-Arias, E., & Pérez-Rodríguez, G. (2016). Hipertensión arte-
rial sistémica en el niño y adolescente [Systemic arterial hypertension in the child 
and adolescent]. Revista Médica del IMSS, 54(Suppl.), 52–66.

Son, W. M., Pekas, E. J., & Park, S. Y. (2020). Twelve weeks of resistance band 
exercise training improves age-associated hormonal decline, blood pressure, and 
body composition in postmenopausal women with stage 1 hypertension: a ran-
domized clinical trial. Menopause, 27(2), 199–207. https://doi.org/10.1097/
GME.0000000000001444

Stephens, M. M., Fox, B. A., & Maxwell, L. (2012). Therapeutic options for the 
treatment of hypertension in children and adolescents. Clinical Medicine Insights: 
Circulatory, Respiratory and Pulmonary Medicine, 6, CCRPM-S7602. https://doi.
org/10.4137/CCRPM.S7602

Tjønna, A. E., Stølen, T. O., Bye, A., Volden, M., Slørdahl, S. A., Odegård, R., 
Skogvoll, E., & Wisløff, U. (2009). Aerobic interval training reduces cardiova-
scular risk factors more than a multitreatment approach in overweight adolescents. 
Clinical science, 116(4), 317–326. https://doi.org/10.1042/CS20080249

Tozo, J. V. A., Tadiotto, M. C., Tozo, T. A. A., de Menezes-Junior, F. J., Mota, J., 
de Pereira, B. O., … Leite, N. (2025). Effects of different physical exercise pro-
grams on blood pressure in overweight children and adolescents: systematic re-
view and meta-analysis. BMC pediatrics, 25(1), 252. https://doi.org/10.1186/
s12887-025-05575-y

Venegas-Rodríguez, E. D. L. C., Vitón-Castillo, A. A., Linares-Cánovas, L. P., 
Díaz-Pita, G. F. & Álvarez-Alvarez, M. D. L. C. (2021). Factores asociados a 
hipertensión arterial en una población pediátrica [Factors associated with arterial 
hypertension in a pediatric population]. CorSalud, 13(4), 445–452.

Wang, J. J., Lau, W. C., Wang, H. J., & Ma, J. (2015). Evaluation of a compre-
hensive intervention with a behavioural modification strategy for childhood obe-
sity prevention: A nonrandomized cluster-controlled trial. BMC Public Health, 15, 
1206. https://doi.org/10.1186/s12889-015-2535-2

https://doi.org/10.1038/nrendo.2012.49
https://doi.org/10.1038/nrendo.2012.49
https://doi.org/10.4137/CCRPM.S7602
https://doi.org/10.4137/CCRPM.S7602
https://doi.org/10.1042/CS20080249
https://doi.org/10.1186/s12889-015-2535-2


94

Katherine Estephani CONTRERAS-ZAPATA et al.: PHYSICAL ACTIVITY AND LIFESTYLE INTERVENTIONS FOR CHILDREN ...,  61–94

ANNALES KINESIOLOGIAE • 16 • 2025 • 1

Wang, X., Liu, J., Gao, D., Li, Y., Ma, Q., Chen, L., … Song, Y. (2022). Effectiveness 
of national multicentric school-based healthy lifestyles intervention among Chinese 
children and adolescents on knowledge, belief, and practice toward obesity at indi-
vidual, family, and schools’ levels. Frontiers in Pediatrics, 10, 917376. https://doi.
org/10.3389/fped.2022.917376

Weaver Jr, D. J. (2019). Pediatric hypertension: Review of updated guidelines. 
Pediatrics in Review, 40(7), 354–358. https://doi.org/10.1542/pir.2018-0014

Wesnigk, J., Bruyndonckx, L., Hoymans, V. Y., De Guchtenaere, A., Fischer, 
T., Schuler, G., Vrints, C. J., & Adams, V. (2016). Impact of lifestyle interven-
tion on HDL-induced eNOS activation and cholesterol efflux capacity in obese 
adolescents. Cardiology Research and Practice, 2016, 2820432. https://doi.
org/10.1155/2016/2820432

Whooten, R., Kerem, L., & Stanley, T. (2019). Physical activity in adolescents and 
children and relationship to metabolic health. Current opinion in endocrinology, dia-
betes, and obesity, 26(1), 25–31. https://doi.org/10.1097/MED.0000000000000455

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., & Burnier, 
M. (2019). 2018 ESC/ESH guidelines for the management of arterial hyperten-
sion. Revista Española de Cardiología, 72(2), 160–185. https://doi.org/10.1016/j.
recesp.2018.12.005

Writing Group Members; Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, 
M., Dai, S., & Wylie-Rosett, J. (2010). Heart disease and stroke statistics—2010 
update: A report from the American Heart Association. Circulation, 121(7), e46–
e215. https://doi.org/10.1161/CIRCULATIONAHA.109.192667

Wong, A., Sanchez-Gonzalez, M. A., Son, W. M., Kwak, Y. S., & Park, S. Y. (2018). 
The effects of a 12-week combined exercise training program on arterial stiffness, 
vasoactive substances, inflammatory markers, metabolic profile, and body compo-
sition in obese adolescent girls. Pediatric Exercise Science, 30(4), 480–486. https://
doi.org/10.1123/pes.2017-0198

Xi, B., Zhang, T., Li, S., Harville, E., Bazzano, L., He, J., & Chen, W. (2017). 
Can pediatric hypertension criteria be simplified? A prediction analysis of subclini-
cal cardiovascular outcomes from the Bogalusa Heart Study. Hypertension, 69(4), 
691–696. https://doi.org/10.1161/HYPERTENSIONAHA.116.08782

Xu, H., Li, Y., Shang, X., Du, S., Zhang, Q., Liu, A., & Ma, G. (2020). Effect of 
comprehensive interventions including nutrition education and physical activity on 
high blood pressure among children: Evidence from a school-based cluster random-
ized controlled trial in China. International Journal of Environmental Research and 
Public Health, 17(23), 8944. https://doi.org/10.3390/ijerph17238944

Zhou, J., Sun, W., Tang, S., Jiang, D., Tan, B., Li, S., … Song, P. (2025). Effects 
of exercise interventions on blood pressure in children and adolescents with over-
weight or obesity: A systematic review and meta-analysis of randomized controlled 
trials. Journal of Adolescent Health, 76(3), 361–369. https://doi.org/10.1016/j.
jadohealth.2024.09.017

https://doi.org/10.3389/fped.2022.917376
https://doi.org/10.3389/fped.2022.917376
https://doi.org/10.1542/pir.2018-0014
https://doi.org/10.1155/2016/2820432
https://doi.org/10.1155/2016/2820432
https://doi.org/10.1016/j.recesp.2018.12.005
https://doi.org/10.1016/j.recesp.2018.12.005
https://doi.org/10.1161/CIRCULATIONAHA.109.192667
https://doi.org/10.1123/pes.2017-0198
https://doi.org/10.1123/pes.2017-0198
https://doi.org/10.1161/HYPERTENSIONAHA.116.08782
https://doi.org/10.3390/ijerph17238944
https://doi.org/10.1016/j.jadohealth.2024.09.017
https://doi.org/10.1016/j.jadohealth.2024.09.017

	_Hlk199018774
	_heading=h.r98mwvimp51m
	_heading=h.c5xxoosmfb0
	_heading=h.ra86sy5uuqai
	_heading=h.8hg10f48zyt5
	_heading=h.pqcczyy4e2pg
	_heading=h.4m30s8od8tub
	_heading=h.pg55g25d2nd
	_heading=h.a8srg11uwxxg
	_heading=h.4i4blvd56uvj
	_heading=h.req9hpvv0x60
	_Hlk201317441
	_Hlk60736358
	_Hlk62755260
	_Hlk62755317
	_Hlk62755341
	_Hlk175663888
	_Hlk203037924
	_Hlk207193304

