Systematic review and meta-analysis of combined cognitive-behavioral therapy and physical activity and exercise interventions for pediatric chronic disease

William R Black; Lauren von Klinggraeff; David A White; ACSM-CEP; Bethany Forseth; Jamie L Jackson; Carolyn R Bates; Christopher D Pfledderer; Sidney Dobbins; Kristen R Hoskinson; Alison Gehred; Ann M Davis

doi:10.1093/jpepsy/jsae087

Systematic review and meta-analysis of combined cognitive-behavioral therapy and physical activity and exercise interventions for pediatric chronic disease

J Pediatr Psychol. 2024 Nov 8:jsae087. doi: 10.1093/jpepsy/jsae087. Online ahead of print.

Authors

William R Black^{1

2}, Lauren von Klinggraeff³, David A White^{4

5}; ACSM-CEP; Bethany Forseth^{5

6}, Jamie L Jackson^{1

2}, Carolyn R Bates^{5

7}, Christopher D Pfledderer^{8

9}, Sidney Dobbins¹, Kristen R Hoskinson^{1

2}, Alison Gehred¹, Ann M Davis^{5

7}

Affiliations

¹ Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.
² Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
³ Department of Community and Behavioral Health Sciences, Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States.
⁴ Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, United States.
⁵ Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States.
⁶ Department of Physical Therapy, Rehabilitation Sciences, & Athletic Training, University of Kansas Medical Center, Kansas City, KA, United States.
⁷ Department of Pediatrics, University of Kansas Medical Center, Kansas City, KA, United States.
⁸ Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center Houston, School of Public Health in Austin, Austin, TX, United States.
⁹ Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center Houston, School of Public Health in Austin, Austin, TX, United States.

PMID: 39514679
DOI: 10.1093/jpepsy/jsae087

Abstract

Objective: Cognitive-behavioral (CBT) interventions combined with either a physical activity (CBT+PA) or exercise intervention (CBT+Ex) are becoming more common in pediatric populations. Considering the independent effects of PA and exercise on health and psychological outcomes, it is unclear whether CBT alone differs from CBT+PA or CBT+Ex in efficacy. The main objective of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to assess the efficacy of CBT+PA and CBT+Ex interventions in pediatric chronic disease.

Method: This review included RCTs in children (≤18 years) with a chronic condition, a CBT+Ex or CBT+PA intervention, and an objective measure of PA&Ex. Seven databases were searched using MeSH terms and key terms and included studies published before July 1, 2023. Abstracts were reviewed for inclusion by two independent reviewers, data was extracted by three independent reviewers. Risk of bias (RoB 2) and study quality were coded. Random effect meta-analyses of differences in between-group change in PA&Ex were conducted.

Results: Eligible studies (k = 5) reported outcomes for a combined 446 children. A small, nonsignificant overall effect was found (d = 0.10, 95% CI -0.16, 0.35) indicating intervention groups (CBT+PA or CBT+Ex) increased engagement in PA&Ex more than comparator groups (CBT). Additional analyses were inconclusive due to the small number of eligible studies.

Discussion: Additional RCTs are needed with integrated PA&Ex interventions targeting pediatric chronic disease. Future trials should report more detailed PA&Ex data. The full protocol for this analysis was prospectively registered in Open Science Framework (project ID: osf.io/m4wtc).

Keywords: chronic and recurrent pain; evidence-based practice; health behavior; meta-analysis; randomized clinical trial; randomized controlled trial; systematic review.