3.1 Search results
A total of 1572 literature related to the topic were retrieved by a preliminary search of the database by keywords (32 on Zhiwang, 484 on Web of Science, 585 on Pubmed, and 471 on EBSCOHost), and 1563 literature were excluded according to the exclusion and inclusion criteria as well as reading the title of the article, the abstract, and the full-text reading, and finally, 9 literature were included in the statistical analysis.
3.2 Basic characteristics of the included literature
Nine studies were included in this study[15][22][23][24][25][28][29][45][58] (see Table 1), five from China[23][24][25][28][45] and four from the United States[15][22][29][58]; sixwere published to enter five years[22][23][24][25][28][45]; eight were randomized controlled trials[15][22][23][24][25][28][45][58] and one was non-randomized controlled[29]; the sample size included in each study ranged from 35 to 206, for a total sample size of 764; subjects were between 8 and 16 years of age, with a BMI between 13 and 40.38, or a BMI ≧ 85%; all 9 papers reported the intervention modality, involving exercise modalities including: jump rope, basketball, soccer, running, dance, classroom-based academic physical education program (combiningexercise with math curriculum), and games; training intensity was moderate in 6 papers[15][24][25][28][29][58], moderate to high intensity in 2 papers[22][45], and high intensity in 1 paper[23]; duration ranged from 10 to 75 min, with 40 min beingthe majority; exercise duration, 5 articles for long-term intervention[15][22][24][25][45]and 4 articles for acute intervention[23][28][29][58];the test tasks included: Flanker task, stroop task, more-odd shifting task, 2-Back task and Switch task, and the test indexes were all expressed in response time performance.
Table 1 Basic characteristics of the included literature
Author / Year of Publication
|
Country
|
Study Design
|
Sample size
Age: M±SD or range
|
BMI
|
Campaign intervention
|
Testing tasks
|
Test Indicators
|
Movement
Mode
|
Single
Campaign
Time
|
Exercise intensity
|
Length of exercise
|
Frequency
|
Li Huanyu 2022
|
china
|
RCT
|
80
|
19.5-24.1
|
Basketball and jump rope
|
20minand
40min
|
Medium intensity
|
Acute
|
1 time
|
Flanker
- Back
more-odd shifting
|
20min
WM:↓
40min
IC:↓
WM:↓
CF:↓
|
Vazou et al.2014
|
United States
|
Non-RCT
|
35
10.55±0.75
Age
|
13-33
|
Classroom Sports Academic Program
|
10min
|
Medium intensity
|
Acute
|
1 time
|
Flanker
|
IC:↓
WM:↑
CF:↑
|
Zhang et al.2022
|
china
|
RCT
|
72
11.03±10.03Age
|
26.02±1.05
|
Running
Jumping rope
|
30min
|
High intensity
|
Acute
|
1 time
|
Stroop
|
IC:↓
|
Logan et al.2020
|
United States
|
RCT
|
206
8-10Age
|
40.38±4.78
|
Dance, games, soccer
|
20-25
min
|
Medium to high intensity
|
Long-term
|
9 months / 5 days / week
|
Flanker
|
IC:↓
|
Krafft et al.2014
|
United States
|
RCT
|
43
8-11Age
|
BMI≧85%
|
Jumping rope
|
40min
|
Medium intensity
|
Long-term
|
8 months / 5 days / week
|
Flanker
|
CC:↓
|
Tomporowski et al.2008
|
United States
|
RCT
|
69
9.2±1.2 Age
|
25.3±
5.0
|
Running
|
23min
|
Medium intensity
|
Acute
|
1
Time
|
Switch Task
|
CF:↑
|
Liu et al. 2018
|
Taiwan, China
|
RCT
|
70
12-16 Age
|
27.96±3.16
|
Jumping rope
|
75min
|
Medium intensity
|
Long-term
|
12 weeks / 2 times / week
|
Stroop
|
CC:↓
|
Chou et al.2019
|
Taiwan, China
|
RCT
|
84
12.19±0.68 Age
|
24.84±3.08
|
High cognitive movement games
|
40min
|
Medium intensity
|
Long-term
|
8 weeks / 3 times / week
|
Stroop
|
IC:↓
|
Xian et al.2019
|
China
|
RCT
|
36
9-16 Age
|
29.33±3.46
|
Treadmill, dance, jump rope and swimming), ball sports (including basketball, badminton and soccer), outdoor training, yoga and resistance training
|
5h
|
Medium to high intensity
|
Long-term
|
66 weeks / 6 times / week
|
Stroop
|
IC:↓
|
Abbreviations: RCT: randomized controlled trial; IC: inhibitory control; CC: cognitive control; WM: working memory; CF: cognitive flexibility; "↓" improved; "↑" not improved
3.3 Literature quality evaluation
Nine of the included publications were at moderate risk of bias. Due to the specificity of the experimental design, all literature subjects were aware of the purpose of the experiment or it was not explicitly stated in the article; none of the selective outcome reporting aspects were specified; and the overall quality was relatively good in terms of random sequence generation, completeness of outcome data and other sources of bias (see Figures 2 and 3).
3.4 Effectiveness of exercise on executive function in overweight and obese children and adolescents
Meta-analysis results showed a high degree of study heterogeneity (I2 =86.5%, p=0.00), so a random effects model was used to analyze the results as follows: SMD=-0.432, 95% CI=-0.764, -0.099, Z=2.55, p=0.011, indicating that exercise has a moderately positive effect on executive function in obese child adolescents and can improve executive function in obese child adolescents (see Figure 4).
The results of the examination of the facilitative effects of exercise on the subcomponents of executive function showed that exercise facilitated the improvement of working memory and inhibitory control, while it did not significantly improve cognitive flexibility. Among them, working memory was the most effective (SMD=-1.09, P=0.012<0.05) and inhibitory control was the second most effective (SMD=-0.41, P=0.022<0.05) (see Table 2).
Table 2 Promotional effect of physical exercise on each subfunction of executive function
Function
|
Number of Literature
|
SMD
|
95% CI
|
Z
|
P
|
Inhibit control
|
6
|
-0.41
|
-0.76,-0.06
|
2.29
|
0.022
|
Working Memory
|
2
|
-1.09
|
-1.94,-0.24
|
2.52
|
0.012
|
Cognitive flexibility
|
3
|
-0.09
|
-0.85,0.67
|
0.23
|
0.818
|
3.5 Sensitivity Analysis
Due to the high degree of heterogeneity in the literature, to explore the sources of heterogeneity, sensitivity analyses were performed on the included literature, which did not affect the study results after excluding any of the literature, indicating that the combined effect value results are more stable (see Figure 5).
3.6 Publication bias analysis
Since less than 10 articles were included, the publication bias of the articles was not analyzed by plotting funnel plots. Egger linear regression was used to test for the presence of bias and the results were as follows: t=-1.16, p=0.265>0.05, indicating that there was no publication bias in this study.
3.7 Subgroup analysis
(1) Duration of intervention. The nine included papers could be divided into acute and long-term interventions, and the results after combining effect sizes were as follows: acute exercise: SMD=-0.456, 95% CI: -0.893, -0.019, p=0.041<0.05; long-term exercise: SMD=-0.372, 95% CI: -0.88, 0.137, p=0.152>0.05. Acute exercise achieved a positive moderate degree of effect on executive function in overweight and obese children and adolescents (ES=0.456>0.2), while the effect of long-term exercise intervention was not significant.
3.7.1 Analysis of acute intervention subgroups
(1) Intervention modalities. A total of four of the nine included papers were acute interventions, and the interventions included: jump rope combined with basketball, classroom-based physical education academic program, running, and jump rope, with the following combined effect sizes: jump rope combined with basketball: SMD= -0.822, 95% CI: -1.012, -0.632, p=0.000<0.01; physical education academic program: SMD=- 0.222, 95% CI: -0.636, 0.192, p=0.29 > 0.05; running: SMD=0.545, 95% CI: 0.25, 0.839, p=0.000 < 0.01; skipping rope: SMD=-0.296, 95% CI: -0.865, 0.273, p=0.309 > 0.05. The exercise modality of jumping rope combined with basketball achieved a positive large effect level on executive function in overweight and obese children and adolescents (ES=0.822>0.8).
(2) Single duration. The duration of acute interventions in the nine included papers ranged from 10-40 min, and the results after combining effect sizes were as follows: 40 min: SMD=-1.172, 95% CI: -1.547, -0.706, p=0.000<0.01; 30 min: SMD=-0.097, 95% CI: -0.499, 0.304, p=0.635>0.05; 20min: SMD=-0.618, 95% CI: -1.475, 0.239, p=0.158>0.05; 23min: SMD=0.709, 95% CI: 0.365, 1.053, p=0.000<0.01; 12min: SMD=-0.1, 95% CI: -0.814, 0.614, P=0.784 > 0.05; 10min: SMD=-0.284, 95% CI: -0.814, 0.614, P=0.369 > 0.05. A single sustained 40min exercise session achieved a positive large effect level on executive function in overweight obese children and adolescents (ES=1.172>0.8).
(3) Intensity of intervention. Acute intervention intensities in the nine included papers included moderate and high intensity, and the results after combining effect sizes were as follows: moderate intensity: SMD=-0.53, 95% CI: -1.04, -0.02, P=0.043<0.05; high intensity: SMD=0.1, 95%: -0.5, 0.3, P=0.635>0.05. Moderate intensity exercise achieved a positive moderate degree of effect on executive function in overweight and obese children and adolescents (ES=0.53>0.2).