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

Document Type

Article

Publication Date

7-1-2025

Identifier

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).

Journal Title

Journal of pediatric psychology

Volume

50

Issue

7

First Page

620

Last Page

632

MeSH Keywords

Humans; Cognitive Behavioral Therapy; Child; Chronic Disease; Exercise Therapy; Adolescent; Combined Modality Therapy; Randomized Controlled Trials as Topic; Exercise; Outcome Assessment, Health Care

PubMed ID

39514679

Keywords

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

Comments

Grants and funding

Link to Full Text
Library Record

Share

COinS