Exercise Improves Risk Factors for Cardiovascular Disease in Children, Adolescents

A systematic review and meta-analysis published by investigators in BMC Sports Science, Medicine and Rehabilitation has reaffirmed the protective role of exercise in reducing the risk of cardiovascular disease (CVD) while improving overweight and obesity in children and adolescents. The results provide critical insights for pharmacists and other health care providers, who can feel confident in counseling younger patients on the wide-ranging benefits of exercise in their daily routines.¹

Instilling exercise habits in children is critical for the formation of long-term health routines. | Image Credit: © Drazen - stock.adobe.com

The Relationship Between Exercise, Overweight, and CVD

It is common knowledge that a healthy diet and exercising are strongly associated with reduced cardiovascular risk and a lower risk of developing overweight or obesity. Importantly, a high body mass index (BMI) caused by overweight and obesity is closely linked to a heightened risk of CVD and mortality, with risk factors that can be traced back to childhood and adolescence, according to past investigators. Determining whether such risks can be resolved before they become too serious to overcome is of top priority to researchers and public health authorities who seek to lower the burden of CVD.^2,3

The benefits of early intervention are clear. But determining exactly which risk parameters to target in younger patients—and how—remains hotly debated. Clinical guidelines outline various recommendations, including lifestyle interventions, medications, and surgery. But long-term medication use can induce adverse reactions, such as hypertension and gastrointestinal complications. Surgical approaches can reduce weight but have unproven effects on cardiometabolic factors. And altering dietary and lifestyle habits often is accompanied by reduced compliance and adherence.^1,4,5

Exercise offers numerous advantages compared with these alternatives, requiring little to no cost with high safety and effectiveness. Although exercise is recommended by institutions to reduce CVD risk, evidence is lacking on the proliferation of exercise among the youth, especially in low- and middle-income countries, which harbor a higher prevalence of adolescents with overweight or obesity. Furthermore, most studies have not quantified the gradient relationship that exists between the intensity, frequency, and duration of exercise and metabolic improvement.¹

Exercise Significantly Improves Overweight and Obesity, CVD Disease Risk

Therefore, the authors aimed to fill the present gaps in research through a systematic review of randomized controlled trials (RCTs) investigating core risk indicators of CVD and the effects of exercise on overweight and obese adolescents and children. In total, 83 RCTs, including 5172 children and adolescents with overweight or obesity, were featured in the review.¹

BMI was analyzed to begin the study. Physical activity was associated with reduced BMI in children and adolescents with overweight or obesity (standardized mean difference [SMD] = –0.48 [95% CI, –0.66 to –0.30]; P < .00001) compared with the control group.¹

Regarding lipid levels—a key indicator of CVD risk—exercise was associated with reductions in total cholesterol (SMD = –0.70 [95% CI, –0.91 to –0.49]; P < .00001), triglycerides (SMD = –0.60 [95% CI, –0.79 to –0.41]; P < .00001), and low-density lipoprotein (SMD = –0.61 [95% CI, –0.79 to –0.43]; P < .00001) in children and adolescents with overweight and obesity.¹

Lastly, in an analysis of fasting blood glucose, the investigators found that physical activity was associated with a reduction in fasting plasma glucose (SMD = –0.40 [95% CI, –0.57 to 0.23]; P < .00001) and fasting insulin (SMD = –0.80 [95% CI, –1.08 to –0.51]; P < .00001) in the experimental population compared with the control group.¹

Implications for Health Care Providers

A subgroup analysis revealed that, specifically, moderate-to-vigorous intensity endurance training for 12 weeks, with at least 3 sessions per week lasting at least 50 minutes each, had a significant effect on improving CVD risk factors in adolescents and children with overweight and obesity. Interestingly, exercise was found to have a major effect on boys in Asia, which could offer insights for providers regarding specific demographics that are at highest risk.¹

The findings garnered by these investigators could offer support to health care providers in the implementation of exercise interventions. The information that training for 12 weeks with 3 sessions per week is an ideal benchmark for significant risk reduction is especially helpful for pharmacists, who can counsel patients on effective exercise regimens based on their presentation.¹

“Considering that an elevated BMI in children and adolescents increases the risk of CVD in adulthood and the feasibility of exercise intervention, more rigorous, high-quality longitudinal follow-up studies should be conducted in the future to optimize exercise intervention strategies,” the authors wrote in their conclusion. “Simultaneously, globally targeted and strict policies should be implemented.”¹

REFERENCES

1. Men J, Zhu G, Li Y, et al. Impact of exercise on cardiovascular disease risk in overweight or obese children and adolescents: a systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation. 2025:225. doi:10.1186/s13102-025-01228-w

2. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. 2021;143(21). doi:10.1161/CIR.0000000000000973

3. Martens MD, Abuetabh Y, Schmidt MA, et al. Semaglutide Reduces Cardiomyocyte Size and Cardiac Mass in Lean and Obese Mice. JACC Basic Transl Sci. 2024;9(12):1429-1431. doi:10.1016/j.jacbts.2024.07.006

4. Khera R, Pandey A, Chandar AK, et al. Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis. Gastroenterology. 2018;154(5):1309-1319:e7. doi:10.1053/j.gastro.2017.12.024

5. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640