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Systematic review and meta-analysis of combined cognitive-behavioral therapy and physical activity and exercise

William R Black1,2, Lauren von Klinggraeff3, David A White4,5

  • 1Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.

Journal of Pediatric Psychology
|November 8, 2024
PubMed

Insights

Cognitive-behavioral therapy (CBT) combined with physical activity (PA) or exercise (Ex) showed a small, nonsignificant effect in pediatric chronic disease. More research is needed to confirm the efficacy of these integrated interventions.

Area of Science:

  • Pediatric Health
  • Behavioral Medicine
  • Chronic Disease Management

Background:

  • Cognitive-behavioral therapy (CBT) is increasingly combined with physical activity (PA) or exercise (Ex) for pediatric populations.
  • The independent benefits of PA and exercise on health and psychological outcomes are known.
  • It remains unclear if combining CBT with PA or Ex offers superior efficacy compared to CBT alone in pediatric chronic disease.

Purpose of the Study:

  • To systematically review and meta-analyze randomized clinical trials (RCTs).
  • To assess the efficacy of CBT combined with PA (CBT+PA) or Ex (CBT+Ex) interventions in children with chronic diseases.
  • To compare the efficacy of combined interventions against CBT alone.

Main Methods:

  • Included RCTs involving children (≤18 years) with chronic conditions.
  • Studies required CBT+Ex or CBT+PA interventions and objective measures of PA and Ex.
  • Searched seven databases, with data extracted and analyzed using random-effect meta-analyses.

Main Results:

  • Five eligible studies reported on 446 children.
  • A small, nonsignificant overall effect (d=0.10) was observed, suggesting combined interventions slightly increased PA & Ex engagement compared to CBT alone.
  • Further analyses were inconclusive due to the limited number of studies.

Conclusions:

  • Additional RCTs are necessary to investigate integrated PA & Ex interventions for pediatric chronic disease.
  • Future trials should provide more detailed data on PA & Ex.
  • The study protocol was prospectively registered on Open Science Framework (osf.io/m4wtc).
Abstract

Keywords:
chronic and recurrent painevidence-based practicehealth behaviormeta-analysisrandomized clinical trialrandomized controlled trialsystematic review

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