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Affiliations

¹ Department of Anatomy, University of Otago, Dunedin, New Zealand.

² Academic Urology Unit, University of Aberdeen, Aberdeen, UK.

³ c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

⁴ Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

⁵ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

⁶ Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.

Free PMC article

Free PMC article

Affiliations

¹ Department of Anatomy, University of Otago, Dunedin, New Zealand.

² Academic Urology Unit, University of Aberdeen, Aberdeen, UK.

³ c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

⁴ Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

⁵ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

⁶ Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.

Abstract

Background: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017.

Objectives: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations.

Search methods: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies.

Selection criteria: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment).

Data collection and analysis: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE.

Main results: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it.

Authors' conclusions: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.

Trial registration: ClinicalTrials.gov NCT00740428 NCT00617149 NCT02865954 NCT00551551 NCT01069484 NCT01155804 NCT01672697 NCT01578369 NCT00476567 NCT01243554 NCT01696201 NCT03041246 NCT00763984 NCT02270008 NCT02334397 NCT02420288 NCT02682212 NCT03247660 NCT02513420.

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Conflict of interest statement

In accordance with Cochrane's Commercial Sponsorship Policy, the following declarations are applicable for the three years prior to the publication date of this review.

SW: none known. PL: none known. RB: none known. JC: none known. SM: was an investigator on three of the included trials in the review and had no role in screening, risk of bias assessment or data extraction for these trials. AK: none known JHS: none known.

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References

References to studies awaiting assessment

References to other published versions of this review

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fecal incontinence / prevention & control

# data[].attributes.attachment_link.keywords[]
pregnancy complications / prevention & control

# data[].attributes.attachment_link.keywords[]
puerperal disorders / prevention & control

# data[].attributes.attachment_link.keywords[]
urinary incontinence / prevention & control

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national center for biotechnology information

# data[].attributes.attachment_link.title
Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women - PubMed

# data[].attributes.attachment_link.description
This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for ...

# data[].attributes.body
Women's health and pelvic health are new fields, so there isn't as much research as other areas of physiotherapy. However, pelvic floor muscular training may show limited effects on treating urinary incontinence using a mixed prevention and treatment approach, but using targeted prevention and treatments shows greater reductions in urinary incontinence. This is the cornerstone of physiotherapy, creating targeted prevention and treatments. Assessing to understand the specific problem list for the patient and target the treatment to their problems. Regardless of what the research is showing, stress incontinence is mainly due to weakening, stretching and a lack of endurance within the muscles of the pelvic floor. This systematic review acknowledged that the studies had high risks of bias. If stress incontinence is due to weakening and stretching, then strengthening both in maximal strength and endurance should help the issue. However, the effects of this treatment seem minimal within this paper. More research will need to be done to make more conclusive statements on the effectiveness of this treatment. Regarding faecal incontinence, there is a lack of research and minimal to no effectiveness of pelvic floor muscular training. More research should be done in this area.

# data[].attributes.attachment_link.title
Physiotherapy for Urinary Incontinence - Griffith Physiotherapy Clinic

# data[].attributes.body
This video is a good and comprehensive resource to help people understand what urinary incontinence is and how to treat it. Risk factors such as obesity, diabetes, stroke, and medications can be brought up to your GP and can help reduce or prevent urinary incontinence in the future.Reduced mobility can affect urge incontinence, which means you can't get to the toilet fast enough, or you are tripping or falling on your way to the toilet. Targeted treatment from physiotherapists to improve mobility can reduce this type of incontinence. This video provides exercise for PFMT to help reduce UI. These exercises may help, but a comprehensive assessment is needed to determine what muscles are weak or have reduced endurance to target treatment for those issues. Even though there is minimal effectiveness shown within the literature regarding pelvic floor muscular training, treating the patient and not the problem is the best way to go. If the patient presents with muscle weakening and lack of endurance, strengthening those muscles will help improve this patient’s presentation.

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The typically developing paediatric foot: how flat should it be? A systematic review - Journal of Foot and Ankle Research

# data[].attributes.attachment_link.description
Background All typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. Whilst the child’s foot is expected to be flat, there is currently no consensus as to how flat this foot should be. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. The objective of this systematic review is to define the postural characteristics of the ‘typically’ developing paediatric foot. Methods The PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies. Results Thirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome. Conclusion Firstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.

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Impact of physical exercise in advanced-stage cancer patients: Systematic review and meta-analysis - PubMed

# data[].attributes.attachment_link.description
Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide comprehensive care to these patients and prescribe physical exercise programs as adjuvant therapy. The objective of this systematic r …

# data[].attributes.attachment_link.title
Effects of massage therapy on pain and anxiety intensity in patients with burns: A systematic review and meta-analysis - PubMed

# data[].attributes.attachment_link.description
This systematic review and meta-analysis aimed to examine the effects of massage therapy on pain and anxiety intensity in patients with burns. A comprehensive, systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electroni …

# data[].attributes.body
Flat feet are a common concern among parents of young children. A common question is "My child has flat feet, what should we do?". This study looked to understand how flat is too flat for a child's foot. It is commonly accepted that children are born with flexible, flat feet, which means the feet are flat, but when on the toes or moving an arch forms. This is not a cause for concern and should be resolved as the child ages. This study concluded that flat feet are normal in children. There is no consensus as to how flat a foot is required to be to raise concern. Children can have flat feet and no pain, and have good arches and have pain. Having flat feet does not equate to dysfunction or pain.

In practice, flat feet should really only be a concern in the presence of pain and limited function and range of motion.

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Exercise has been shown to have positive effects on advanced-stage cancer patients. Muscle mass, fatigue, dyspnea, and quality of life all improve because of exercise. It can't be said whether aerobic or resistance exercise is better for these patients, but each type is beneficial and has its unique benefits.

In practice, a combined exercise approach would likely be best, having both resistance and aerobic to gain the cardiovascular benefits and the strength, muscle mass, bone density, and mobility-increasing benefits that exercise can provide.

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Burns, both superficial and partial thickness, can result in lots of pain to the patient. While the burn heals, scar tissue and reduced mobility can occur. Massage has been investigated to understand its role in the pain and anxiety of burn patients.

Massage of approximately 20-30 minutes in duration has been shown to reduce both pain intensity and anxiety in burn patients.

Since massage is a simple and cost-effective way to reduce pain intensity and anxiety, massage should be a part of a patients' management plan.

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The role of exercise in the rehabilitation of patients with severe burns - PubMed

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Severe burn trauma results in persistent skeletal muscle catabolism and prolonged immobilization. We hypothesize that structured rehabilitative exercise is a safe and efficacious strategy to restore lean body mass and physical function in burn victims. Here, we review the evidence for the utility of …

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A burn can cause a great deal of immobilization in a patient. This can easily result in adverse complications, such as pain, reduced aerobic fitness, muscle wasting, and decreased strength and mobility.

Rehabilitative exercise training is a great way to reduce these complications and maintain function during recovery. In practice, getting the patient moving in both an aerobic and resistance capacity will improve recovery, and decrease time spent in hospital.

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

# data[].attributes.attachment_link.title
Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review - PubMed

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doi: 10.1186/s12969-016-0090-8.

Affiliations

¹ Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281, Israel.

² Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

³ Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281, Israel. uziely@zahav.net.il.

⁴ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. uziely@zahav.net.il.

doi: 10.1186/s12969-016-0090-8.

Affiliations

¹ Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281, Israel.

² Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

³ Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281, Israel. uziely@zahav.net.il.

⁴ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. uziely@zahav.net.il.

Abstract

Complex regional pain syndrome (CRPS) is a chronic, intensified localized pain condition that can affect children and adolescents as well as adults, but is more common among adolescent girls. Symptoms include limb pain; allodynia; hyperalgesia; swelling and/or changes in skin color of the affected limb; dry, mottled skin; hyperhidrosis and trophic changes of the nails and hair. The exact mechanism of CRPS is unknown, although several different mechanisms have been suggested. The diagnosis is clinical, with the aid of the adult criteria for CRPS. Standard care consists of a multidisciplinary approach with the implementation of intensive physical therapy in conjunction with psychological counseling. Pharmacological treatments may aid in reducing pain in order to allow the patient to participate fully in intensive physiotherapy. The prognosis in pediatric CRPS is favorable.

Keywords: CRPS; Chronic pain; Complex regional pain syndrome; Pain amplification syndrome; Pediatric.

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Matles AI. Reflex sympathetic dystrophy in a child. A case report. Bull Hosp Joint Dis. 1971;32(2):193-7. - PubMed

Merskey H, Bogduk N. Classification of chronic pain : descriptions of chronic pain syndromes and definitions of pain terms. 2. Seattle: IASP Press; 1994.

Low AK, Ward K, Wines AP. Pediatric complex regional pain syndrome. J Pediatr Orthop. 2007;27(5):567-72. doi: 10.1097/BPO.0b013e318070cc4d. - DOI - PubMed

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complex regional pain syndromes* / diagnosis

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complex regional pain syndromes* / physiopathology

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complex regional pain syndromes* / therapy

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Pediatric complex regional pain syndrome: a review - PubMed

# data[].attributes.attachment_link.description
Complex regional pain syndrome (CRPS) is a chronic, intensified localized pain condition that can affect children and adolescents as well as adults, but is more common among adolescent girls. Symptoms include limb pain; allodynia; hyperalgesia; swelling and/or changes in skin color of the affected l ...

# data[].attributes.body
When assessing children with flat feet, it is necessary to gain an understanding of their developmental milestones, ability to perform functional tasks, presence of disease or comorbidities, presence of hypermobility, and a family history of flat feet.

When in the presence of pain or dysfunction, foot orthoses can help correct gait mechanics and relieve pressure on the foot. This can help reduce pain and dysfunction

Physiotherapy has also been shown to play a big role in flat feet. Strengthening the calves and muscles of the feet and correcting gait mechanics have all been shown to have positive effects on flat feet.

Flat feet is common in children so treatment should only be an option in the presence of pain or dysfunction.

# data[].attributes.body
Paediatric complex regional pain syndrome is a rare but debilitating condition. According to this review adolescent girls are more likely to have CRPS. This is also in line with adult women being more likely to develop chronic pain conditions.

Assessing the treatment of these patients, the review advocates for a multidisciplinary approach with physiotherapy and psychological therapy being the bulk of treatment.

With what we know about chronic pain conditions, physical therapy seems to be beneficial in maintaining function and modulating both descending and ascending pain pathways. Addressing fear avoidance, the analgesic effects of exercise, and applying the pain gate theory can all be beneficial for these patients.

Psychological therapy can be helpful due to improved coping mechanisms and modulating perceptions of pain that affect the descending pain pathways.

Pharmacological treatments may be beneficial only if other treatments seem to not be as effective. Medications should be used as an adjunct, not the main treatment.

# data[].attributes.attachment_link.title
A developmental perspective of influences on the onset and early trajectory of chronic pain in children attending physiotherapy in primary health care settings: An integrative review | New Zealand Journal of Physiotherapy

# data[].attributes.attachment_link.description
Chronic pain in childhood leads to long-term social, emotional, physical, and financial impacts, with lifelong heightened pain sensitivities. The prevalence of chronic pain in children has increased over the past 20 years. Physiotherapy is often the place of initial intervention for a child in pain, and initial treatment is predictive of chronic pain and can predict outcomes. Children’s pain experiences and responses are thought to be more modifiable than those of adults; therefore, quality physiotherapy interventions have the potential to positively influence the onset and early trajectory of chronic pain. Using a childhood developmental lens, this integrative review aimed to draw together research literature about biopsychosocial factors influencing chronic pain onset and early trajectory in primary-school-aged children. The results of the review contribute novel understandings for physiotherapists in primary healthcare. A range of biopsychosocial concerns including age at onset and pain duration, neuro-biological aspects, psychological influences, parental impacts, sleep quality, trauma history, and stress interact with children’s learning and development. Taken together, these factors have potential to influence chronic pain onset and early trajectory in children. Adopting a holistic understanding of childhood development in the early management of childhood chronic pain would promote positive physiotherapy interventions and may avoid pathologising what is developmentally normal.

# data[].attributes.body
There has been a lot of research conducted on breast cancer patients, specifically, exercise and its effects on health outcomes.

Aerobic exercise is better at improving cardiorespiratory fitness, while resistance training is better at improving strength, and fatigue. Both aerobic and resistance show similar improvements in health-related quality of life.

Factoring the evidence of this systematic review and noting that the studies had low risks of biases, a combined exercise treatment approach for these patients will likely result in the best outcomes.

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Affiliations

¹ Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.

² UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia.

Free PMC article

Free PMC article

Affiliations

¹ Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.

² UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia.

Abstract

Introduction: Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

Method: A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

Results: From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

Conclusion: When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Osborne SR, et al. Med J Aust. 2020 Dec;213 Suppl 11:S3-S32.e1. doi: 10.5694/mja2.50881. Med J Aust. 2020. PMID: 33314144

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Grants and funding

The authors received no specific funding for this work.

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pediatric obesity / prevention & control

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Physiotherapy and related management for childhood obesity: A systematic scoping review - PubMed

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When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in ...

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Childhood obesity is a rising issue and can have a lot of negative impacts on a child's life. Just like in adults, health markers, fatigue, posture, and pain are all negatively affected.

Within this paper, using a multidisciplinary approach is in line with the current state of the literature. Children rely on family support more so than adults, so adding a parental component to treatment is a necessity. Children who's families that also make lifestyle changes are more likely to succeed.

The key areas of treatment are, increasing physical activity, improving motor skills and improving body composition. To achieve this, physios are going to have to make treatment fun and a lot of play. Find out what the child enjoys and tailor treatment towards their hobbies.

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Affiliations

¹ Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan.

² Department of Trauma & Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust Victoria Rd, Macclesfield SK10 3BL, UK.

³ Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia.

⁴ Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.

Free PMC article

Free PMC article

Affiliations

¹ Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan.

² Department of Trauma & Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust Victoria Rd, Macclesfield SK10 3BL, UK.

³ Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia.

⁴ Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.

Abstract

The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I ² 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m ² (MD: -0.41 kg/m ²; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I ² 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I ² 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I ² 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I ² 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I ² 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I ² 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I ² 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I ² 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I ² 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I ² 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I ² 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

Keywords: adolescents; children; interventions; obesity.

Conflict of interest statement

The authors declare no conflict of interest.

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non-randomized controlled trials as topic

# data[].attributes.attachment_link.keywords[]
pediatric obesity / prevention & control*

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national center for biotechnology information

# data[].attributes.attachment_link.title
Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis - PubMed

# data[].attributes.attachment_link.description
The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search ...

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Flat feet🦶 are a common condition. In infants👶 and toddlers, the longitudinal arch is not developed and flat feet🦶 are normal. The arch develops in childhood, and by adulthood, most people have…

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🌟 Exercise and Cancer: Boosting Health, One Step at a Time 🌟 Exercise is more than just movement—it’s a powerful tool for cancer care! 💪🏽 Engaging in regular exercise can improve strength, reduce…

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Rehabilitation is an essential component in the management of patients with burns and should be commenced on the day of injury is sustained. In other words, oedema control, respiratory care, positioning, functional movements which are pertinent in burn cases must begin without delay.

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Facebook and other social media platforms can be a great way to get quick and easily digestible material to improve your life and condition. It can also be an area for deceit and fear-mongering.

This specific post talks about the benefits of exercise with cancer. Reducing fatigue, improving strength, improving mental health, and improving treatment outcomes.

Mental health has been a huge topic within the health and wellness space recently and for very good reason. Our mental wellbeing can affect everything we do, and can make living a healthier and more robust lifestyle easier.

Cancer patients should be exercising both aerobic and resistance to improve their condition and their treatment outcomes.

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A burn can lead to a lot of adverse effects. Respiratory complications, reduced strength and mobility. In the early stages of rehab, tending to respiratory complications, maintaining range of motion and reducing oedema are the main treatment goals. Later stages of treatment are to prevent scar adhesions and maintain strength and mobility.

The main takeaway is that burn management is a multimodal approach that needs care in multiple domains. Massage, airway clearance, mobilization are all key treatment areas that need tending to.

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Paediatric chronic pain is influenced by a host of factors. One of which being family and social circles. With children living at home with their family, bringing the family into the treatment can significantly increase treatment outcomes. School, sports, and friends are a big component of a child's life, so getting them to participate as much as possible in the activities they enjoy can aid in outcomes.

Physiotherapists require a deep understanding of the biopsychosocial model to truly impact this child's life.

Taking into consideration the wide array of literature on pain and paediatric pain, the reason adults and children develop these conditions is widely unknown. There are risk factors that have been identified to increase the risk of developing chronic pain and for having adverse outcomes.

Children can be limited by their social surroundings so working to improve or with their social circles and complex psychological factors will result in the best outcomes.

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This post on Facebook talks about the immense effects of this treatment chair. Appraising this post, the first alarming thing is that it is scattered with half-truths. The literature is not conclusive on the effects of electrical therapy and even pelvic floor muscular therapy for the prevention and treatment of urinary incontinence. However, this post claims that 2 28-minute treatments a week for 3 weeks will strengthen your pelvic floor and build new muscle within that time frame.

Noticeable strength gains are not seen in strength studies until approximately six weeks, and noticeable muscle mass in muscle mass studies is not built until approximately eight weeks. This post can be enticing to women who are suffering from urinary incontinence, but this company has used only small amounts of research to back up their claims.

Electrical stimulation has been shown to help UI, strength gains from electrical stimulation do occur, and muscle mass is maintained by electrical stimulation, with limited research showing its effects on the building of new muscle. All these claims have been shown, however, the timeframe and concrete claims of building muscle and strength in such a short time frame are misleading.

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This systematic review and meta analysis found that the studies included have a low risk of bias. Different interventions such as, exercise, diet, diet and exercise, behavioural therapy, behavioural therapy and diet, behavioural therapy and exercise, and a combined approach.

In reducing BMI in these children, diet and exercise seemed to result in the greatest reductions. A combined approach using behavioural therapy, diet, and exercise yielded the best results for overall obesity management. Involving the family in the treatment was shown to be a key contributing factor to the success of the treatment.

Taking this information into practice, using a combined approach and involving the family will likely yield the best results. Incorporating psychological services to improve the behavioural aspects, and physiotherapy for the exercise aspects. Dieticians also become very integral due to diet being a big factor in childhood obesity.

A multidisciplinary team will be needed to make lasting changes within these patients lives.

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Stop Stress Urinary Incontinence With 5 Easy Exercises

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Useful exercises for children with flat feet that require intervention

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Useful exercises for children with flat feet that require intervention

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Flat Feet in CHILDREN | What is it? | Exercises to Develop Arch in the foot & foot muscle

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Useful exercises for children with in toeing

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Useful exercises for children with in toeing

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Physiotherapy for Children's Intoeing | The Best Exercises to help with Children's Intoeing

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Useful exercises for patients with breast cancer

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Useful exercises for patients with breast cancer

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Gentle, Mobility Flow Exercises After Breast Cancer Surgery or Radiation: For Tightness and Pain

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Useful exercises for range of motion in patients with leg and foot burns

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Useful exercises for range of motion in patients with leg and foot burns

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Exercise after sustaining a burn to your leg or foot

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Useful resource for the diagnosis and treatment options for patients with CRPS

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Useful resource for the diagnosis and treatment options for patients with CRPS

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As a future physiotherapist, it is very important for me to understand these complex paediatric pain conditions and the management for my future practice. In general, paediatric pain has physical, emotional, and also developmental causes that should be approached in a balanced way, aiming for the biopsychosocial model of pain. A better understanding of these components will make me not only a more effective care provider but translate into improved outcomes for my patients and families.

Recognizing that perceptions of pain and how these are articulated vary significantly among children based on factors such as age, degree of cognitive development, cultural affordance, known together as sociocultural differences between cultures, and broader family dynamics underscores the importance of individualized care. An adept skill at reading these pain messages will allow me to communicate effectively and identify pain and the areas of their life it is affecting the most. Utilizing well-established assessment tools, such as the FLACC scale or self-report questionnaires, will also assist with ensuring valid evaluation.

Pharmacological approaches are only one aspect of holistic paediatric pain management. Non-pharmacological treatments have been proven effective, such as cognitive-behavioural therapy (CBT), distraction techniques, exercise therapy, manual therapy, advice and education, and family involvement. For example, helping parents use comforting techniques or giving appropriate explanations of what is going on and the ways we are going to achieve their goals. The importance of this understanding in my future practice motivates me to integrate these holistic practices.

One of the most important things we have to learn about is how uncontrolled pain in childhood impairs physical function and their ability to participate in the hobbies they enjoy. Recognizing the biopsychosocial model of pain means we also need to consider familial and environmental factors, as these could be the push that sends a child over their point of maximum tolerable pain threshold (i.e., perhaps parental anxiety, poor understanding, and lack of support). Engagement of multidisciplinary teams, incorporating psychology, physiotherapy, and social workers, can, therefore, work within this broader context to optimize care.

It is unclear at this time where I will practice, but either way, keeping up with pediatric pain and new guidelines will continue to be critical in my professional development and implementation of optimal treatment for the paediatric patients I am likely to see. In my journey to create a culture of compassion and quality, pushing for better pain management protocols and equipping my fellow practitioners are now part of it.

Knowing complex paediatric pain conditions and management helps structure my approach to patient care. I strive to compassionately and effectively support children and their families by incorporating evidence-based methods into my practice, engaging with family-centered care, and recognizing that pain is a multifactorial entity. This will ensure that my future practice will not only take away the pain but address the well-being of these children in a holistic way.