The effect of exercise for underweight people

Introduction/Methods: This systematic review with meta-analysis aims to assess the magnitude of the effects ofphysical exercise programs on body mass index (BMI) and waist circumference (WC) of individuals withIntellectual and Developmental Disabilities (IDD), metabolic and cardiovascular health markers.۱ IntroductionObesity is a major public health problem due to its growing prevalence, as it increases the risk of developingvarious diseases such as cardiovascular or metabolic diseases (de Winter et al., ۲۱۲۱; Vancampfort et al., ۲۰۲۰),increasing mortality in earlier ages when compared to the general population (Hosking et al., ۲۰۱۶). Excessiveadiposity results from an imbalance between energy intake and expenditure.Body mass index (BMI) and abdominal adiposity assessed using waist circumference (WC), body compositionand anthropometric variables, are essential markers to assess overweight and obesity and are associated tometabolic disease and QoL (Klein et al., ۲۱۲۱; Kobo et al., ۲۰۱۹). This measure are non-evasive methods widelyused in individual with Intellectual and Developmental Disabilities (IDD) to measure nutritional status (Templeet al., ۲۱۲۱; Waninge et al., ۲۱۲۲) and individuals with IDD are more likely to be overweight or obese comparedto the general population (Zwierzchowska et al., ۲۰۲۱).A systematic review with meta-analysis carried out by Maïano and collaborators (Maïano et al., ۲۰۱۶) showedthat children and adolescents with IDD were ۱.۵۴ and ۱.۸۹ times more likely to be overweight and obese, whencompared to the population without disability. These results are transversal to all age groups, from children (Wanget al., ۲۰۱۸), to adolescents (Krause et al., ۲۰۱۶) and adults (de Winter et al., ۲۱۲۱). Several factors may influencethis prevalence, such as: ۱) being female (de Winter et al., ۲۱۲۱); ۲) advancing in age (Ranjan et al., ۲۰۱۸); ۳)having DS (Krause et al., ۲۰۱۶); ۴) having a degree of mild or moderate disability (Ranjan et al., ۲۰۱۸); ۵) geneticfactors (Wang et al., ۲۰۱۸). Other additional factors such as socioeconomic level, perceptions and attitudestowards physical activity, health problems and other characteristics of the disability itself (McGillivray et al.,۲۱۲۱), may also play a determinant role in this prevalence.Considering the BMI variable, Temple and collaborators (Temple et al., ۲۱۱۷), when evaluating ۱۱,۶۴۳individuals with IDD, verified that ۵.۵% of the sample was underweight, ۳۶.۱% in the normal range, ۲۴.۷%overweight, and ۳۲.۱% obese. Concluded that levels of overweight and obesity were high. Likewise, Foley andcollaborators (Foley et al., ۲۰۱۷), evaluating ۴,۱۷۴ individuals with IDD, he also found that ۳۲% were overweightand ۱۱% were obese. At the same time, ۲۱% of the participants were above the cut-off for abdominal obesity.High values of BMI and WC, show a high prevalence of overweight and obesity in individuals with IDD. Thesevalues are associated with high risk metabolic and cardiovascular disease, excessive health costs (Vohra et al.,۲۰۱۷; Wyszyńska et al., ۲۰۱۷) and increased risk of incidence and mortality (Parra-Soto et al., ۲۰۲۱). On the otherhand, BMI and WC are recommended by ACSM (American College of Sports Medicine, ۲۰۲۱) as two possiblemeasures of anthropometric and body composition for individuals with IDD.The global impact of physical activity and physical exercise on BMI and WC in people with IDD is not known,nor is the most effective type of exercise training for promoting these variables. International guidelinesrecommend by WHO (World Health Organization, ۲۰۲۰) and ACSM (American College of Sports Medicine,۲۰۲۱) identify physical activity and exercise as important tools to improve daily life and wellbeing with a positiveimpact in different age groups (Kim et al., ۲۰۱۹). For these people, the variable mentioned, when practicedregularly, seem to be associated with improvements not only in physical fitness but also in reducing the risk ofthe appearance of metabolic and cardiovascular disease, reducing health costs and promoting their QoL (Pestanaet al., ۲۰۱۸; Jacinto et al., ۲۰۲۱).